As a practicum student my academic advisor drilled into students' minds the importance of a session plan. And as students, we greatly needed those session plans. We not only needed, but we DEPENDED on those session plans. If we happened to forget the flow of our plan or something went wrong, we quickly looked wide-eyed at our supervisors begging for mercy. However, when you're working with hospice patients, you might as well chuck that session plan out the window. You also might want to start learning more songs.
Internship brought me my first hospice experience. I am continually reminded that if you think one thing to happen in a hospice session, the opposite is what usually occurs. After reading Russel Hilliard's Hopsice and Palliative Care Music Therapy: A Guide to Program Development and Clinical Care, I became more terrified than I already was.
Walking in to a hospice session is a world of wonder. You're wondering what kind of state the patient will be in. Will they be sleeping or alert and awake? Will they be in pain? Whatever their situation may be, it is the job of the music therapist to improve their quality of life: distract them from their pain, further relax them, provide stimulation, and/or provide a chance to socialize with other people. Not knowing what the situation will be means that having a session plan probably isn't a good idea.
As I am beginning my third month as an intern, I realize hospice is a struggle for me. It is hard to find things to say in between songs. My supervisor has told me to find clues within songs to use as conversation starters, such as asking the patient where they called home if we just sang "Home on the Range." Other times, it is hard for me to figure out what I should be doing in the hospice session. If they are asleep and do not wake up, I know to softly finger pick chords or hum melodies to further relax them. However, if they do wake up what should I do? I still haven't quite figured that out. If the client is awake, I try to keep the famous bell curve in mind. The MT wants to build the client up to a high point and then slowly bring them back down. However, with a small repertoire it is hard to come up with songs that start out steady, grow to upbeat, and then back to steady and slow at the end of the session.
Hospice highlight: It was the second day of my internship, and we were visiting a hospice patient. He was lying in bed, had minimal eye contact, and had a flat affect. My supervisor knew he liked bluegrass so he was playing bluegrass songs. Little response. My supervisor started singing "The Crawdad Song." The patient had the biggest grin on his face throughout the entire song and began tapping his feet with the music.
Hospice low: We received a referral for an elderly gentleman. We arrived at his house, and he informed us he liked jazz and bluegrass. He used to play guitar and played with his buddies when he was younger. He reminisced about where he worked and about being in the military. He tried to sing along with us, but his shortness of breath was making it a struggle for him to continue for long periods of time. I was playing guitar but my supervisor was the one leading the session and guiding the conversations. Even though I didn't say much to the patient, I felt as if I had made a connection with him. I only saw him once. A week later, my supervisor informed me that the patient had died. I was bummed when I heard the news. However, I kept in mind that the last time he heard live music was when we played music he truly enjoyed. I remembered the joy he had on his face. That's the reward of this job.