The Benefit of Music as Medicine in Palliative Care

Lou Beckerman RN, RM, MNFSH Churchill Fellow 2006

A six week journey to the West Coast of the USA

with travelling companions – guitar and Tibetan singing bowl

This report is dedicated to all the patients who have been gracious enough to receive the sound I offer in the spirit of healing. Through receiving they have been inspirational and such very generous givers.

‘Nothing is lost, nothing is forgotten, You are in my song now; you are in my memory

I guess that makes you a part of me’

from ‘Lullabies and an Old Love Song’ Lou Beckerman

PRELUDE

Born into a family of musicians I have sung my way though life. Singing, for me, was like breathing. It wasn’t until I experienced vocal problems in adulthood that I realised how vulnerable people can feel about their voices (especially in a culture which emphasises the entertainment value rather than the art of expressing our deepest self in voice), and conversely how the voice can be such a healing tool. Having also had feedback from members of my concert audiences who reported feeling a release of emotions or being ‘transported’ I set out on a new path of discovery and training – into the hugely rewarding realms of healing sound and natural voice coaching. So, having worked for most of my professional life concurrently in music (singer-songwriter/ guitarist) and healthcare (RN, RM - nurse in general practice); as a trained healer (NFSH) and an artist (fine art / illustration – Royal Academy exhibitor), I began to combine my skills and experience as a Healing Arts Practitioner rather than agonising over which career to follow. ‘Renaissance Woman’ is how I have sometimes been referred to!! With a deep personal commitment to bringing sound and song into healthcare – as ‘sound medicine’, I was commissioned to facilitate several projects for NHS Trusts: ‘Sounding Out!’ with stroke sufferers (recently filmed and also featured on BBC South East Today); ‘Just A Song At Twilight’ with frail older patients: ‘Space Of Sound’ – relaxing concerts for patients, visitors and staff to name a few. Coming from a nursing as well as music background has enabled me to work closely with the medical and nursing teams - always a priority.

Over the years I have enjoyed working with all ages and abilities; with patients in varying states of health and in numerous settings. But it has perhaps been the most rewarding, and such an enormous privilege, to work in the field of end-of-life care with patients, their loved-ones and staff in hospice and hospital settings. It has felt a real blessing and honour to be with someone at this special time of their life.

To add to this, my personal experience of my dying ninety-year-old mother’s last whispered word, ‘Sing!’ to my sister and I as we arrived at her bedside. It seemed the most natural thing to do. My friend and colleague, Jeremy, also wished to be sung to. Towards the end of his cancer journey and nearing his

death, he would visibly relax and report feeling detached from his pain. When Irena, a beautiful young woman with breast cancer, was in a coma and dying at home, I sang to her and her family a song which I felt inspired to compose for her that same morning. It served to relax and release emotion for all of us who were accompanying her.

I am continuously moved and motivated by the courageous response of those I’ve known and worked with in end-of-life circumstances, and my own songs are often legacies arising out of these inspiring encounters. The lyrics of three: ‘Song Of A Winged Spirit’ (‘Song For Jeremy’), ‘You Are All You Need’ (‘Irena’s Song’) and ‘Lullabies and an Old Love Song’ are reproduced in this report. To then have the prospect, afforded by a Churchill Fellowship, to visit, experience, and observe how music is used in the care of the dying in the USA, was a most empowering and undreamed-of opportunity. How fortunate and honoured I felt. My PROPOSAL was twofold:

To explore how the use of live music meets the specific needs of the dying, their loved-ones and carers.

To offer my voice and music wherever a suitable situation arose, travelling

with guitar and Tibetan singing bowl*, welcoming the opportunity to develop and expand my own repertoire of appropriate healing music and to write more songs as ‘legacies of love’ – as something tangible and personal to bring comfort to the bereaved. I have found that the most marvellous learning for me often emerges through my own teaching and sharing with others.

Singing bowls* are a type of musical instrument classified as a standing bell. Made from seven metals, they are played by the friction of rubbing a wooden or leather wrapped ‘wand’ around the rim of the bowl to produce soft, warm, harmonic overtones (often multiple harmonic overtones simultaneously) and a continuous 'singing' sound. Tibetan singing bowls, with their unique and ancient sound, were traditionally an aid to Buddhist meditation practice. Today they are also used worldwide

for meditation, relaxation, performance and in healthcare.

4

My AIMS for my return were:

To initiate more music projects in hospices and hospitals – working with patients and end-of-life care teams. I felt sure that the experience gained from this opportunity would give me fresh inspiration and courage – allowing me to inspire and spread my own music further afield – with a deeper understanding of its most effective use.

To make more widely known the benefits so that others might also feel

they were able to participate in their own way. I enjoy teaching and encouraging the music in everybody – patients, loved-ones and staff - to find an opening for themselves - thereby bringing comfort and relief.

THE ROLE OF MUSIC IN HEALTHCARE AND ‘MUSIC THANATOLOGY’

Ancient healing had music and medicine as two flowers on the same stem. Sound, to influence health, can be dated back to Plato and Aristotle, and sixth century BC mathematician and philosopher Pythagoras developed a system of curative music. We are informed that in biblical times David played his harp to lighten King Saul’s depression. During medieval times, monks began a tradition of chanting for the sick. Many indigenous peoples have supported ill and dying members of their communities through elaborate musical observances. Mothers from every culture have instinctively sung lullabies – or cradle songs - to soothe and lull their children to sleep. As a complement to medical technology, ‘Music Thanatology’ (from the Greek ‘thanatos’ meaning death), draws on music, through non-intrusive peaceful support, to promote relaxation and comfort for the ill and dying. Practitioners sensitively, tenderly and lovingly use music to alleviate emotional pain for the patient and their loved ones as well as easing physiological symptoms such as restlessness, sleeplessness, pain and laboured breathing. Music can help the letting-go process, easing transition, and helping to nurture a peaceful passage. Silence and breath-work also play an important role.

5

Often in sophisticated clinical settings, for the patient, loved-ones and team of carers, the shared experience of live music can help foster an intimacy which aids communication and also the release of difficult emotions such as fear generally (often overwhelming) - fear of abandonment, fear of death - sadness, distress, grief, anger and spiritual loneliness. Sometimes it is love and gratitude that need to be released. Both music and imagination are stored in the right hemisphere of the brain and in using both simultaneously, the listener can be carried on an inner voyage, the music helping to take thoughts away from the preoccupation of illness and all that surrounds it. To do this, even for a short time, can bring relief. The therapeutic effect of sound frequencies offered with the intention of bringing about a state of harmony can have a profound effect on all present. For the singer, or music practitioner, the experience of bringing therapeutic music to the bedside is also emotionally meaningful on a personal level. We are all at various stages of recognizing our own mortality, and having the privilege of being so close to people as they near their death can help us to be more conscious of, and grateful for, what we have. Accepting our mortality is an important step towards embracing life.

6

CENTRES AND PROJECTS VISITED:

Queen of the Valley Hospital, Napa Zen Hospice Project, San Francisco

Brahma Kumaris World Spiritual University, San Francisco San Diego Hospice

International Harp Therapy Programme Congregation Beth Sholom, Napa

Veterans Home of California, Yountville Lama Foundation – Singing in Circle – New Mexico

Threshold Choir Healing Muses

Art for Recovery programme, UCSF Comprehensive Cancer Centre Napa Interfaith Council Hospice of Napa Valley

Healing Journeys Annual Conference, San Francisco

My dedicated preparation for the Travel Fellowship had begun in earnest many months before my leaving England for the USA. I had known about a number of innovative and worthwhile music projects in end-of–life care on the West Coast, which facilitate a positive and transformative transition. Some of these proved easier than others to communicate with from afar, and there were a number of contacts who generously helped me to make connections with others I had been unaware of. Eventually, on August 1st, 2006, I set off on my journey, feeling I had organised as best I could a number of exciting and significant meetings and visits, but also leaving some space for serendipity. With my two travelling companions – Tibetan singing bowl and guitar, I was mindful that travelling with my much-cherished guitar (in a soft case on my back) might prove challenging – as indeed it proved to be at times. However, as an integral part of my intended undertaking, I was determined not to leave it behind. As it happens, a week after entering the US a significant terrorist plot was foiled leading to rigid regulations regarding baggage. In effect, despite some not too seriously problematic internal flights, I was sometimes ushered first onto a plane because of it, and an unexpected asset was the fact that people like to talk about music and are curious so it provided an easy means to connect with people along the way.

7

My first base was to be in NAPA, north of, and in commuting distance of San Francisco. I had been invited to spend the morning of my second day in California visiting the QUEEN OF THE VALLEY HOSPITAL, NAPA for my first observation of how an American hospital functions and to facilitate a session of sound and song for patients (many with strokes) and staff on the Rehabilitation Unit.

This impressive hospital, founded by the Catholic ministry of the Sisters of St. Joseph of Orange, is a premiere medical facility in the Napa Valley. Caring for the patients is based on four core values: ‘dignity, service, excellence and justice’, inspiring a reaching out to those in need, and helping to heal the whole person - mind, body and spirit.

I arrive with guitar

This was an interesting visit for me, observing that the care of the patients was much as I had been used to. On my tour of the departments I sensed an enviable informality which I enjoyed. My session with stroke rehabilitation patients and staff, and ensuing discussion about the healing potential of sound, rhythm and song in healthcare, was a welcome and worthwhile start to my schedule.

For some of these patients with strokes, whose vocal communication had been silenced, an understandably low confidence prevailed. As many people who cannot use words in speech are often able to retrieve lyrics in a known song by singing, or by improvisation, we worked with this for building self-esteem and confidence, and attempting to counter the potential isolation of these silenced ones. As everybody can participate in music – passively or actively - by listening, experiencing, swaying, clapping time, humming, sounding or singing with words, it was an inclusive and unifying session, building on a sense of togetherness.

8

That same evening it had also been arranged that I would give a presentation at Napa Library entitled, ‘Healing through Music – Sound and Song for Healing, Relaxation and Well-being’. The evening had been publicised and was well-attended. For the eighty-plus audience ‘the evening was a healing experience for many who were grieving over the loss of a loved-one’ later reported the Friends of Napa Library Newsletter.

I was able to integrate into the programme a viewing of the BBC South East Today news item on my sound work with patients in the UK, and made a new link with some music therapists who I would visit later in my stay.

Poster advertising the Napa evening

9

SAN FRANCISCO turned out to be uncharacteristically warm - not anything resembling Mark Twain's, ‘The coldest winter I ever spent was summer in San Francisco!’ (A few weeks later I understood his sentiment!) I was to grow to really enjoy this city, full of charm with its vibrant mix of wackiness and culture and easy and open people. I found the wondrous diversity of life exciting - throbbing Chinatown, Italian, Russian ... and a host of other ethnic neighbourhoods. Creativity was widespread and I warmed to a billboard which read, ‘Practice happiness’.

In San Francisco I was to have my first introduction to the renowned ZEN HOSPICE PROJECT at Laguna Grove Care. Whilst in the UK planning my visit it had been suggested that I offer healing music for the once-a-month Friday afternoon ‘Celebration of Life’ where patients, visitors and staff gather together for some light relief at the end of the week. The afternoon was to be themed on an ‘English Tea’ as a special welcome for me!

The Zen Hospice Project (ZHP) is internationally recognized as having changed the way in which care for the dying can be achieved. It is really a concept of care based

on the 2,500 year-old Buddhist principles of cultivating mindfulness, wisdom, compassion and generosity through service. ZHP provides a spectrum of collaborative services in end-of-life care, including residential hospice care, volunteer programmes and public education events, which support mutually beneficial relationships among caregivers and individuals facing death. Creating an environment that is calm, receptive and honest, ZHP supports residents to actively explore their dying. Offering companionship, a willing ear, and a loving heart, this process can allow a time of immense growth and transformation. Practitioners honour the person’s experience, being open and present to whatever comes up – allowing the person to talk – or not to talk - about their dying. I had already worked in, and was to visit organisations that had formed through sacred philosophy. From my own experience, music can often transcend the need for words – or conversely might help release in words a stream of thought that suddenly takes shape. When music which comes from the heart is offered and touches another person on a very deep level there is sometimes no need to talk about beliefs – unless the patient wishes to. As a ‘contemplative musician’ it

10

is essential, and quite wonderful, to be in the moment and be flexible to whatever might present. Laguna Grove Care was the first of two venues where I was to experience, and contribute to, the ZHP style of working. It is a place of peace and comfort for the dying and their families and friends. On that ‘Celebration of Life’ afternoon, the loving attention to the residents was evident and impressive. Many gathered for the visitor from England and the special English tea, and I played music of an uplifting and spiritual nature. Amongst the patients were two who had been professional musicians – one a flautist and the other a guitarist – who responded deeply; it was a privilege to connect with them in this way at the end of their lives. Later in the month I was to begin a series of visits to another ZHP venue, Laguna Honda Hospice.

That evening I made my first of a number of visits to the BRAHMA KUMARIS centre in San Francisco. The Brahma Kumaris (BK) World Spiritual University offers through Raja Yoga meditation, a practical spirituality for everyday living. I have incorporated many of the BK teachings into my work and my own personal development – essentially enabling me to continue to engage at the deep level that is required without danger of ‘burn out’, and in general maintaining a healthy balance between inner and outer worlds; a spiritual sustenance to counteract worry and promote core values. The BK and its sister organisation, the Janki Foundation, do valuable work with health professionals in this context. So to have a BK meditation centre in the heart of San Francisco was for me most heartening. The Centre offers programmes in spiritual enrichment to the diverse communities of the San Francisco Bay area. I joined the community for a World Peace Hour meditation. Following the meditation there was a warm welcome and I was invited to return later in my Fellowship specifically to give an evening presentation there about my work with music in healthcare, and to also visit their beautiful retreat centre in Novatis – not far from San Francisco. When I did visit this retreat some time later I was able to offer a vocal ‘sound-bath’ to the people there.

11

On 6 August I took a flight from San Francisco to SAN DIEGO, where what was to be the best and most inspirational experience of my Fellowship took place. San Diego is a fine and friendly city where I felt comfortably at ease. I had been invited to join the director and interns on a harp therapy programme for eight days at the San Diego Hospice.

SAN DIEGO HOSPICE - ‘It’s about living’

San Diego Hospice and Palliative Care is a charitable, independent health care organization providing expert pain management and compassionate care to adults, children and infants living with serious or life-limiting illness. The centre has earned the community’s respect over the past 29 years by providing exceptional care to those in need, and has become a nationally recognized leader in hospice care, education and research. It aims to prevent and relieve suffering and promote quality of life, at every stage of life, through patient and family care, education, research and advocacy. Its beliefs are listed as:

No one should live in pain. No one should live in fear.

No one should die feeling alone. Everyone deserves to be a partner in her/his care, not just a patient.

Children deserve to have their grief honoured and their lives celebrated. We are changing the way people face living, dying and death for the better.

On my first visit simply to see the hospice environs I was delighted to find a grand piano in the foyer and moved by a most beautiful and colourful memorial placed upon it. According to Japanese legend, cranes live for 1,000 years so have become a symbol of longevity. Because most cranes mate for life, they also have become a symbol of love and devotion. And so it is believed that folding 1.000 origami paper cranes will bring happiness and good health. The inscription read, ‘These 1,000 cranes were a gift of love from L’s many friends and family during her illness. Our wish is to share the love within every fold of these paper cranes with all who are facing a

loss in their lives. We hope that this love will provide comfort and help our loved-ones through this change.’

12

I teamed up with the five harp therapy interns on the INTERNATIONAL HARP THERAPY PROGRAMME – under the direction of Christina Tourin, also an international recording and touring artist. This innovative virtuoso harpist and programme director envisages a harp player for every hospital and hospice for the year 2020! Our music blended so well, and to share with other musicians working with the same intent was a new and wonderful experience for me. I found them all incredibly generous spirited in their welcome to share the experience to be gained here.

We also played in the skilled nursing facility, Sharp Coronado Hospital

The hospice is a true centre of excellence. I have never experienced such warmth, inclusivity and loving regard for everyone in a health care setting. Lots of fun and laughter too - no separation of the dying from the living. The integrated therapy approach is what many of us aspire to. For instance the medical round for my first two days comprised the consultant, pharmacists, musicians, nurses, doctors, acupuncturist, social worker, interfaith chaplain, hypnotherapist, aromatherapist, dietician, medical students, healer, music therapist - and so on. There was a meaningful ritual remembering those who had passed the previous week and everyone was invited to speak if they wished. We all introduced ourselves and this set the tone for the round. Contribution and opinion from the musician-clinicians was always invited. The patients and families were sensitively given opportunities to voice anything on their minds and were introduced to each of us in turn. Here the dying process is transformed into a positive experience with patients leaving the world as (hopefully) they entered it, surrounded by love and expertise.

13

The International Harp Therapy Program endorses a balance between music, medicine and spirituality. Certified Practitioners offer both bedside music (repertoire from many genres) and interactive work with patients. At the core of the program is the principle that each individual has their own resonant tone, style of musical preference, and their own rhythm. Combining these elements, the practitioner offers the patient their own personal musical journey or ‘their own cradle of sound’ to help them in emotional, mental, physical and spiritual healing.

I fall in love with the harp

Perhaps one of the most valuable lessons I learned here was ‘less is more’ – where very short spans of music offered to the patients were often all that was needed. Having established with the care team, the patient and visitors what would be the most appropriate use of music, we worked in teams of two or three, positioning ourselves in the room appropriately for the comfort of the

14

patient. In considering the physiological, emotional and mental state, we would recognise whether we might assist, for example, with pain relief, in stabilizing breathing; whether to stimulate or calm physiological conditions as well as inner emotional or mental states. When John, with AIDS, had had an energetic medically focussed day we would offer calming music. We invited him to close his eyes and drift off to sleep while we played. On another day, when he had complained of feeling bored, he sang one or two of the song lyrics with us. It seemed as if he had been singing the whole song within himself and was happily transported to another place and time. For Jacqui, with breast cancer, we gently and unobtrusively improvised to synchronise with her breathing and the prevailing tone of the apparatus in her room. For Mary we created a gentle peaceful and calming space and picked tones to empathise with her breathing. For Jean we simply provided entertainment while she ate her lunch. Barbara, with leukaemia, who rarely spoke, was offered a harp to play which brought obvious enjoyment and distraction. Theresa, with cancer, had a haunted look of fear and preoccupation which eased enormously with the music. She reported a sense of being held in a loving space. Some poignant songs were actively welcomed as opportunities for sentimentality, and patients and relatives made requests; even photos were taken to send to absent loved ones. Every music encounter was documented on a data sheet so the programme could be evaluated. How gratifying it was also to see how the staff responded and we would sometimes simply play for them. The experience gained in the hospice was hugely valuable and insightful. It would be difficult to match such a centre of excellence. I noted one of many quotes from the memorial garden: 'It is one of the beautiful compensations of this life that no-one can sincerely try to help another without helping himself.' San Diego, for me, was perfect and it was with some regret that I couldn't stay for a longer period.

Whilst in the area I had also given a presentation about my work for an interested group in La Jolla (pronounced La Hoya - Mexican style) - a stunning smaller town by the ocean. I had also welcomed the opportunity to meet an old friend, Philip, a remarkable and enormously talented musician and gospel singer. We performed a session playing and singing jazz in a San Diego café which was a pleasing balance to the hospice work.

15

On my return to San Francisco I had arranged to re-visit the ZEN HOSPICE PROJECT, this time in a hospital setting. Laguna Honda Hospice exists within the institutional setting of Laguna Honda Hospital – the largest public long-term care facility in the United States (most are private now) with a traditional 25 bed open-ward design. This hospice ward is enhanced by a pleasant, friendly ‘social area’ leading outside to a pleasing and evocative memorial garden. The facility offers care to the medically underserved populations of the Bay Area – essentially those

without medical insurance. On first glimpse this old hospital appeared to me to be a forbidding place high on a hill in the city. Here there are many patients who don't have any other place to be and often nobody to care. However, once in the hospice area I found enormous warmth and dedication. The response to the music sung both at the bedside and in the communal area was so heartening and we made arrangements for me to return in a couple of weeks on my return to San Francisco. I planned to do several sessions there where it could make such a difference to patients.

This lovely and appreciative gentleman would close his eyes and describe how the music ‘transported’ him.

And the following song tells the story…

16

Nothing is lost, nothing is forgotten You are in my song now; you are in my memory

I guess that makes you a part of me

As we sing, ’Just a Song at Twilight’ Your own light is fading fast

Do you journey back through your early life? Do you find a meaning to your past?

Do the songs cut through your years like a very sharp knife? Where do you go – don’t you know? I can tell you - your eyes show me

Nothing is lost, nothing is forgotten: you are in my song now You are in my memory; I guess that makes you a part of me

And as we sing, ‘You Are My Sunshine’ The songs in your heart never die

Did someone make you happy though the skies were grey? Now you can’t even tell if it’s night or day

Do the songs cut through your years like a very sharp knife? Where do you go – don’t you know? I can tell you - your eyes show me

Time is a funny thing – they say it changes everything But lullabies and an old love song take you back where you belong

To memories that time never destroys

Nothing is lost, nothing is forgotten: you are in my song now You are in my memory; I guess that makes you a part of me

Lullabies and an Old Love Song by LB

17

Back to Napa where I had been invited to participate in the music for a Friday evening Shabbat service (the start of the Sabbath) at the Congregation Beth Sholom synagogue. Because of my visit, the focus for this evening was to be on healing. At the centre of Jewish life in Napa Valley, Congregation Beth Sholom is a vibrant community with a wide variety of spiritual, educational, and social programs for members of every age. It is a Reform Congregation serving a membership that reflects a wide variety of perspectives and religious and cultural backgrounds. Jewish people are welcomed from all circumstances, the community striving to serve the diverse needs of singles and families, Jews of all races, cultures and sexual orientations, as well as Jews-by-choice and interfaith families. I met with Rabbi Ken and Cantor Bella to prepare the content of the service. We chose appropriate songs from my repertoire (I frequently sing songs in Hebrew). Bella has a beautiful voice and we were to sing a delightful and heartfelt duet, Hashivenu. I loved being there and felt welcomed.

The Veterans Home of California at Yountville was founded in 1884 to serve the social and medical needs of veterans of the Civil War. Today, the mission of the Home is to provide long term residential care for veterans of all wars in an environment which maintains good health and vitality, reduces incidence and severity of disabilities, increases social interaction and promotes self-reliance and self-worth. Good-quality end-of-life care is fundamental to this establishment.

The Veterans Home is a town in itself with every facility - its own hospital, a 1,100 seat theatre, bowling alley, swimming pool, shops, etc, etc. As well as providing domiciliary and residential care there is a special restorative care programme helping veterans to resume a more independent way of living. And it was seemingly full of characters out of MASH!!

There are veterans here from WWI and II, Desert Storm, Iraq... Apparently the Vietnam veterans with their anti-establishment thinking commonly choose

18

not to come here and often find themselves getting older in hardship which seems rather sad.

I was to meet with the music therapists who play a significant role in the well-being of the community members. There are seven music therapists on the staff. End-of-life issues are common and the music therapy techniques used to address physical and mental health issues may include relaxation and imagery, song writing, instrument groups, passive listening, lyric analysis, bedside sessions, ‘sing-alongs’, music with art and drama, creative expression, drum circle, and discussion and support groups. The plan was to exchange ideas on good practice and for me to run a workshop on sound and song for wellbeing in the morning and stage a concert in the afternoon.

The voice workshop for the more disabled in the morning was enjoyable and successful and the afternoon concert was on a state-of-the-art stage in an impressive large auditorium with a superb sound system. Linking in with the music therapists I was to gain useful insights to how they work with this interesting and characterful community.

Two of the inspirational residents at the Veterans Home.

This classy lady – a country singer – is in her late seventies. Singing is surely age-defying…

19

SINGING IN CIRCLE at the LAMA FOUNDATION This women’s retreat, ‘Singing in Circle’, which was to be held during my USA visit seemed designed to enhance my Fellowship! Promoted as, ‘A weekend of singing in circle and learning songs, recognizing and immersing ourselves in the healing nature of circle singing. We will be singing songs of celebration, ceremony and community; songs celebrating the earth, our own spirit and creativity, songs of healing and passage, songs of playfulness and joy. Come raise your voice and heart in song!’ I felt impelled to attend. New Mexico is so different to California. Here there is a meeting - though not necessarily mixing - of Native American, white American, Mexican and Spanish cultures. The pueblos are where the Native Americans (they do actually still call them Indians) live. I enjoyed immensely the simple architecture of the adobe dwellings - their rich earth colour being such an integral part of the landscape. The skies here are dramatic, stormy, full of colour; with lightening flashes and forever changing, the light is so different. The people have such interesting, distinctive faces and together with the stunning landscape this is an artists' paradise. Driving up into the mountains it felt like the edge of the world. The community on Lama Mountain overlooks the Rio Grande Gorge at 9000 feet. The altitude was a little headache-provoking but nothing much worse than that. I had a homeopathic remedy which worked well for me and I drank copious amounts of water. I made my nest for three days in a yurt - a round structure of Turkish origin - constructed with wooden struts and canvas - no

electricity and susceptible to draughts. Eight beds were positioned with their bed ends towards the centre of the circle. All very challenging for this townie who doesn't ever go very far without her 'products'! The saving grace was a surprisingly beautiful bath house with a sunken bath looking out over the gorge and mountains as far as the eye could see. Lama is still recovering from a devastating forest fire about five years ago which destroyed acres of land, trees and homes, so rebuilding is in progress. They have a stunning brick dome with excellent acoustics where thirty-five of us gathered to make wonderful and

heartfelt music. The communal dining area - under shelter but outside - was also impressive and important as meal times have a huge significance with the whole community gathering together.

20

On the first night - directly overhead - there was the most dramatic thunder storm I had ever encountered - the rain on the yurt almost deafening. The Lama Foundation provides an opportunity to explore as a community what it means to live ‘sustainably’; to be ‘present’; to be in a ‘good relationship with all beings’; to live in a ‘heart-centred way’ and to put these understandings into practice. The community welcomes visitors each summer to a programme of retreats and activities which entail caring for the land and its sacred spaces. The music was highly professionally presented by three facilitators: Kate Munger, Becky Reardon and Terry Garthwaite – all extremely experienced and well respected. I found it was both inspiring and a welcome change to be a participant and observe others' facilitation techniques. There were some gorgeous voices to sing with and I also shared some of my own songs. One of the attractions of coming here was to connect with Kate Munger who founded the Threshold Choirs. There are now thirty-five of these choirs in the US. Members go out on music vigils with people who are seriously ill and dying and much of the music is especially composed. This meeting was hugely inspirational and the prospect of setting up something similar in the UK is attractive. Although I already do this work independently it would be wonderful to involve more people. So the three days were well worth all the travelling and being nudged out of my comfort zone. In fact it was life-enhancing, and participating in a practicing spiritual community was an insight.

21

Later on I had the opportunity to join a Threshold Choir rehearsal in San Francisco and to sing with the choir during a conference.

More on THRESHOLD CHOIRS…

The all-women Threshold Choirs honour the ancient tradition of singing at the bedsides of people who are struggling: some with living, some with dying. The voice, as the original human instrument, is used as a true and gracious vehicle for compassion and comfort. The choirs provide opportunities for women to share the sacred gifts of their voices at life's thresholds.

A choir for men – Midnight Choir - has also been formed which takes music to the homeless on the streets of San Francisco.

Kate explained ‘When we are invited to a bedside, we visit in small groups. We invite families and caregivers to join us in song or to participate by listening. We choose songs to respond to musical taste, spiritual direction, and physical capacity. The songs may include rounds, chants, lullabies, hymns, spirituals, and choral music. The service is our gift; there is no charge. We gratefully accept donations for our ongoing expenses.’

I have returned to the UK enriched by the choir’s eclectic but specific repertoire of songs for use at the bedside. Here is an example of the lyrics of a song by Kate. This song is sung as a round, creating beautiful harmonies.

Let the healing begin with music

May our singing ease the pain

May we know that we carry you here in our hearts

In each flower and drop of rain.

I travelled Back to San Francisco where, this time, I found it enormously difficult to keep warm against the famous fog and winds blowing in from the ocean.

22

Whenever I was in SAN FRANCISCO I stayed in the unique and endearing Red Victorian - a ‘peace hotel’ for ‘world peaceful travellers’ in the Height Ashbury area. It seemed symbolic that I should ‘do a gig’ in this historical place – the birthplace of the 60’s psychedelic sound and legendary bands, and where there had been a new quest for spirituality, for finding a universal oneness, for looking within and then creating community.

San Francisco’s Red Victorian - ‘A peace centre that smiles on the world.’

… and the billboard for my ‘gig’

Towards the latter part of my stay I had arranged to have meetings with both Eileen Hadidian and Patrice Haan of HEALING MUSES. MUSIC FOR HEALING is a programme designed by Healing Muses to create a peaceful sound environment for hospitals, clinics, hospices, convalescent homes, retreat centres and homebound individuals. Using a combination of Medieval, Renaissance, Celtic music, American folk tunes and spirituals, they promote relaxation and reduce anxiety during stressful hospital stays and procedures. Patients and staff can experience the power of music to calm and soothe in a noisy, high-anxiety environment.

Eileen Hadidian, who plays flute, recorder and harp, has appeared in concert throughout the Western United States. Her involvement with music for healing grew out of her own experience with breast cancer, in 1994 and again in 1997.

23

She used music for her own healing, and began to play for other cancer patients. She has been exploring ways in which music can be used to help soothe critically and chronically ill people

Patrice Haan, harpist and vocalist, is best known for her vocal performances with the Oakland-based jazz ensemble Leftover Dreams. Since her first experience of music for healing, while she was part of a care-giving team for a friend dying of cancer, she has continued to look for ways music can touch and comfort the deep part of the self.

Both of these hugely impressive women left me with much to think about. I loved their company – we found so much in common in our approach to healing music – and to life. I felt sure that out of these meetings was to emerge a long-lasting connection.

Some of the benefits towards healing that Healing Muses call attention to are:

• Reduced anxiety • Decreased pain • Lower heart and respiratory rates • Lower blood pressure • Increased level of endorphins – the body’s natural pain-reliever • Lower stress-related hormones • Increased quality of life for patients and staff

ART FOR RECOVERY provides a safe environment where adults can express the intense feelings that arise in life-threatening illnesses; nurturing the aesthetic sensibilities of patients, visitors, and medical staff at the various campuses of UCSF MEDICAL CENTRE and in the community, and creating a safe haven for patients and staff to be heard, to express their feelings and find support.

Here I was to work for a day with Jim Murdoch, a clown and musician, at the

24

Mount Zion Comprehensive Cancer Centre. Jim’s work encompasses performance, co-ordinating guest artist concerts and working with patients, staff and medical students using music and visual art to express their creativity.

We began – even before we conversed – with Jim playing his flute in the lobby of this busy, buzzing-with-life, cancer hospital. A lovely way to connect. Later, like travelling minstrels, we played together in the infusion centre, in-patient area, intensive care unit, and in odd corridors with people passing by, finding songs in common and sharing others. Our music was completely unobtrusive and we kept the level low. Again the lesson for me was that ‘less is often more’. The collaboration of his dulcimer, Native American flute, gentle mouth organ and voice together with my guitar, voice and singing bowl was poignant, interesting, inspiring and exciting to explore. A blind patient asked to borrow my guitar – he was an exceptionally gifted guitarist who had not played in years - he appeared to benefit enormously from this musical interlude in his otherwise medically-focussed day. It was heartening for me to be in a busy hospital environment where live music was considered to be the norm, and to see a musician regarded as a valued team member.

Jim Murdoch with his curious and endearing combination of instruments

25

I travelled back to Napa (where I hoped to warm up in some welcome Napa sunshine) to make a presentation to the Napa Interfaith Council and then to meet with the hospice chaplains to talk about the use of sound and song in their care of the dying.

NAPA INTERFAITH COUNCIL – for people of diverse faiths and traditions - meets monthly for discussion on issues relating to the consciousness, spirituality and personal growth of both individuals and the community throughout Napa Valley. With a focus on quest for spiritual growth, speakers are invited to guide in expanding knowledge and insight. I had been invited as that month’s speaker – my presentation, ‘Music and Healing’. I had decided to make this an intuitive presentation with time for participation and discussion. I found I enjoyed this approach enormously, and with such a varied gathering of people from diverse traditions we had a most stimulating shared experience.

The same afternoon I was to meet with the spiritual care team of the HOSPICE OF NAPA VALLEY. This hospice has an inter-disciplinary team which allows patients facing incurable illness to receive care in the comfort of their residence, wherever that may be. The team works with the patient and his/her family to provide a comprehensive program of medical, emotional and spiritual support. The focus is on providing comfort, symptom alleviation and specialized services based on each person’s individual needs. The Hospice offers services

related to coping with loss and grief to any who wish it and caregivers are taught

26

what to expect relating to the course of illness. No one is turned away from care because of inability to pay or insurance coverage.

I found that music was used here but in a limited way – mainly through the playing of recordings. In discussing the possibility of incorporating some live music into their care, the chaplains warmed to the idea, and Rev. Connie, their lead, felt she could continue and encourage this idea in further workshops. It appears to me that once people are given permission to work intuitively with their sound, trusting in their own truthful intent and beauty of their resonance – in a less inhibited way – a wonderful release can happen.

I returned to SAN FRANCISCO and again to the ZEN HOSPICE PROJECT at Laguna Honda Hospital. By now I had been a number of times and had also been joined by Carolyn, one of the talented harp therapy interns from San Diego. Every Friday afternoon tea-time is ‘Happy Hour’ and I had been invited to return and make music with the patients and staff for this event. Being so warmly welcomed back I felt quite at home in this unique unit. The consultant, Dr Kerr,

abandoned his doctor’s white coat for the character of a bar-tender and the bar was duly declared open! The patients were able to choose ‘medicinal’ liquor and a fabulous spread of food had been prepared. I played my guitar and sang ‘cabaret’ style – taking requests. And I used my singing bowl to give a ‘sound bath’ to everyone present. It was a wonderful affirmation – in a hospice setting - of life being lived right up until the time that death actually takes place.

Before departing for the UK I was to participate in the two-day cancer conference, 'Healing Journeys - Surviving and Thriving', where I would be singing with the Threshold Choir.

I was delighted to be able to attend an enlightening Threshold Choir rehearsal for this conference where we were to open the second half of the day and to also sing at San Francisco’s beautiful Grace Cathedral where conference attendees were invited to walk the meditative labyrinth while we sang for them. I loved it all. Again, it felt so complete to be making music with others with healing intent.

27

CANCER AS A TURNING POINT -

FROM SURVIVING TO THRIVING

The purpose of this ‘Healing Journeys’ annual conference is to inspire, celebrate, educate, and network with all whose lives have been touched by cancer or any life-altering illness. This includes those living with a diagnosis as well as their friends, family, support persons, and health professionals. This amazing free event includes quality speakers, performers, music, humour, healing stories, and sharing time - all aimed at inspiring and encouraging people to strengthen their own healing potential and their ability to thrive. For many patients, there is no ‘cure’, but often healing is available. ‘We strive to create an experience that makes a genuine difference in the recovery of patients and the practice of healthcare’ says Jan Adrian, the conference founder. ‘Because this event is free of charge, it is accessible to everyone and attracts an average of over a thousand people each year. Attendees leave the conference empowered with knowledge to augment their medical program, inspired by the stories of others, uplifted by knowing they’re not alone, and stirred by the power of music and laughter.’ I am so thankful to have been present at this conference – without doubt the best medical conference that I have ever attended. From surgeon to stand-up comic; from patients as thriving survivors to Taiko drummers; from psychiatrist to theatre project, ‘Touched by Cancer; Humouring the Tumour’ – and much, much more – the approach was entirely holistic, creative and sensitively and professionally presented. The music content touched me deeply and has enriched my collection of meaningful songs that speak to the heart. During the conference, seeds of ideas for projects were planted in my mind and I remain highly motivated to cultivate them.

28

REPRISE

A remark is sometimes made to me about how depressing it must be to work with people who are dying. It might be for some, but for me, to be alongside people who have so often shed the superfluous things of life, who frequently have a shining clarity, and who are full of grace, is the most beautiful and timeless space to be in. I feel inspired to leave behind the clutter of my daily life and enter a place within the sound that is prayerful and quiet, and where I can make contact with that which is the best in me. The experience is of contemplative musicianship, where I also can draw strength from the songs. It is indeed life-affirming to work with people encountering death. In the past, my optimum learning has been heightened through whole-hearted participation in situations and not merely by observation. I am indebted to the countless people (many un-named here) who have been instrumental in generously allowing me to be a team member – even when I was an unknown player. Through contributing in this way my self-awareness has been enhanced and my horizons expanded. My best education has also come from the stories and songs of the patients and staff that I worked with and I am touched by their insights. I have returned to the UK enriched and inspired and with a confirmation of my understanding of the role of music in this context. I hope to see more musicians working in end-of-life care accepted as equal players in the care giving team. I also return with a hunger to be better acquainted with the world’s spiritual practices and music, thereby increasing the depth of my work.

AND FINALLY…

Song of a Winged Spirit (‘Song for Jeremy’) Lou Beckerman

Home, I’m home again, and free from pain I am healed, I am whole, I am the sound of a peaceful soul And I am more alive than I have ever been I am more alive than I have ever been

29

From where I am, I can tell you - angels hear; I know your whisper Angels sing; I’m in the songs you hear Angels feel for you; I’m only a sigh away Still your mind; in the quiet spaces here I am, I am, I am, Om My friends for you I’m always near, I’m free from fear I fly in the light so high - please don’t grieve, no don’t cry For I am more a friend than I have ever been I am more a friend than I have ever been From where I am, I can tell you - angels hear; I know your whisper Angels sing; I’m in the songs you hear Angels feel for you; I’m only a sigh away Still your mind; in the quiet spaces here I am, I am, I am, Om Thank you for all your love; I still feel it here above But I am wind and I am sea, I am spirit, and I’m free And I am more alive than I have ever been I am more alive than I have ever been From where I am, I can tell you - angels hear; I know your whisper Angels sing; I’m in the songs you hear Angels feel for you; I’m only a sigh away Still your mind; in the quiet spaces here I am, I am, I am, Om Still your mind; in the quiet spaces here I am, I am, I am, Om

You Are All You Need (‘Irena’s Song’) Lou Beckerman You are beautiful deep in your being; you have vision in your seeing You are fine, you are whole; you have music in your soul You are all you need for your journey; you carry all you need – you are YOU Shining of a star; you are the fragrance of a flower You are the vastness of the skies; a light being that can fly You are all you need for your journey; you carry all you need – you are YOU You are the richness of the earth; you are the miracle of birth You are the wisdom of a sage; the spirit of our age You are all you need for your journey; you carry all you need – you are YOU

30

You are the gold of ripened corn; you are a baby newly born You are the bending of a tree; the flowing of the sea You are all you need for your journey; you carry all you need – you are YOU Beautiful deep in your being; you have vision in your seeing You are the warmth of a sun; empowered from within You are all you need for your journey; you carry all you need – you are YOU You are the gold of ripened corn; you’re now a baby newly born - you are YOU

And a poem by Joyce Grenfell:

If I should go before the rest of you Break not a flower or inscribe a stone. Nor when I’m gone speak in a Sunday voice, But be the usual selves that I have known Weep if you must, Parting is hell But life goes on SO SING AS WELL

To Sue Pegler, who recognised and encouraged this life-enriching opportunity for me, I thank you enormously.

My appreciation and thanks to the Winston Churchill Memorial Trust for entrusting me with this honoured Fellowship.

My gratitude also to the numerous people, both in the UK and USA who in various ways helped me (sometimes unknowingly) to fulfil

the potential of this experience.

Lou Beckerman

T: 07778 553109 E: info@loubeckerman.com W: www.loubeckerman.com Lou is happy to be contacted for more information about her Fellowship, her work, or her CD of songs for relaxation and wellbeing, ‘My Gift to You’.