The Chalice of Repose Project programs for the care of the dying take place in cities across the country, from coast to coast, and though Oregon is the national headquarter for the corporation, Chalice has offices in five states. We are currently working on bringing programs to France and England in 2010.
For your convenience, we provide you with fairly detailed information to help prepare you and your expectations. In general, we receive three kinds of music-thanatology referrals:
• Imminency Vigils, and
The Processing Vigil: The patient has a terminal diagnosis with a prognosis of six months or less, has a DNI or DNR status, is in a hospital, hospice, long-term care facility or home health care situation. (We go “wherever” the patient is dying, in every psycho-social setting). The patient would benefit from supportive end of life care to deal with either physiological pain or interior suffering. The interior suffering may include a wide range of elements such as emotional shock, grief, anger, loss, fear, anxiety, hopelessness, confusion, etc. The patient may have excellent pain medication for tumors or degenerative conditions, but may be struggling with emotional, mental or spiritual anguish. The physiological pain may include such things as comprehensive exhaustion from lack of sleep, apnea, nervousness, tremors, irregular heart beat, pulse and respiratory patterns, severe respiratory compromise through pneumonia or flu, somatic/visceral pain, neuropathic pain, tumor pain and progressive metastases.
The processing vigil can be helpful for either the dying patient OR their loved ones. It is a non-talk therapeutic medical and pastoral modality. Music-thanatology, in delivering music at the bed-side, can help bring individuals and teams closer to the understanding, integration and acceptance of the end of life transition that is very close even if it has arrived suddenly. Each person is a mystery; their lives and deaths are also a sacred mystery. No deaths are alike, and everyone has different combinations of needs and responses to palliative end-of-life care. Some processing calls are made when the dying patient has already moved into complete acceptance of the upcoming death, and lives intensely in relative calm, but still, they experience very difficult physiological pain and have weeks and months remaining. This can occur, for example, when a persona has superior access to palliative care and pharmaceuticals, but is morphine intolerant. In these cases, the delivery of prescriptive music at the end of life has a history of extraordinary success, especially in oncology, pulmonary, geriatric, pediatric, cardiac, trauma, and neurology medicines.
The Imminency Vigil: Similar to the processing vigil above, but the patient is actively dying, with a prognosis of only days or hours remaining. They may be experiencing any combination of physical pain or spiritual suffering, or may not know any pain, and may be very calm. They want the beauty, intimacy and reverence possible with the music-thanatology death-bed vigil. Physicians, nurses, and chaplains also make the imminency referral especially for families and loved ones in the event of an end-of-life extubation.
Our highest goal is to be available and fully present to attend the physical and spiritual needs of these patients (and their loved ones) literally at the hour of their death. Some of our imminency patients have a large supportive network of family and friends; some have almost no-one. (This is especially true for those who may have been wards of the state, or institutionalized for many years, or for those who have suffered a divorce, cumulative trauma, or major loss of community). Our commitment is especially amplified when the dying person has outlived all family and friends, and has little or no supportive circle. In all cases, we work to help facilitate physiological and spiritual conditions that can help a person towards a peace-filled, blessed, or conscious death.
The Mercy-Run: please see dedicated page:
What is the Mercy Run?
Who can make a music-thanatology referral?
Any patient in need.
Any family member or loved one who is acting on behalf of the dying person (and has the consent of the patient).
Any staff physician, nurse, chaplain or social worker.
What to expect during a music-thanatology vigil?
A professional music-thanatologist will drive to the patient’s location and arrive with a harp. They will check in briefly with the nursing station for any last minute information. Before arrival, the primary care physician and charge nurse are notified that the vigil will take place. Wherever possible, there is attempt to coordinate schedules between practitioners and loved ones.
Once the vigil begins, quiet is ideal. We ask that people (professionals or loved ones) cease coming and going in or out of the room, and rather stay seated for the entire work, or, if preferred, step outside for the vigil. An increasing quietude and stillness is facilitated in order for the music to be most deeply experienced and most efficacious for the patient.
Routine medical or nursing activities are suspended for the duration of the vigil, which lasts about 45 minutes to an hour.
The vigil is not a bed-side concert; an increasing stillness and depth is created with the experience of the music, and the typical customs of audiences (clapping, responding, etc.) are suspended. The patient receives; if there is a loved one present, they receive. This time is exclusively reserved for the patient and the care-givers. They do not have to do anything but receive.
Before, during and after the vigil, you will see the musician-clinician checking vital signs and documenting data; this is an evidence based medical practice. Their actions however, will tend to look like quiet courtesies rather than invasive procedures.
Often, the patient (and their care-givers) will enter a very deep restorative sleep during the course of the vigil, and in this case, the music-thanatologist is not going to wake the patient up to say goodbye when the session is over. They will simply leave as quietly as is possible. However, if the family or providers want the musician to return, they are welcome to call and make further requests as often as needed.
Recording devices are a distraction; tape payers or videos are not permissible for a wide variety of reasons.
Please tell us about the cost of the music-thanatology vigil.
Routinely, your local hospital, hospice, geriatric home, or parish may have a program, a contract, or an understanding where one or more music-thanatologists offer this modality as a supportive component of end of life care. If an organization has done this, it is a very deep way of sending a clear message to the community at large that the quality of care for the patient and family is of the utmost concern. In these situations, the dying patient or their family members do not receive a bill for the services rendered; it is a standard component of care, offered throughout the system, the costs of which are absorbed internally, and the system reimburses the musician- clinician for hours or days rendered based on the kind of contract in effect.
Some music-thanatologists have or have had full time staff positions and are on salary. Because of the intensity of the work or other personal factors, many prefer to work part time. Some job-share. Still others choose or have chosen to work for free and donate their work in marvelous programs designed especially for the elderly, the indigent, the marginalized, those who might be abandoned or in some way disconnected from supportive friends or family systems. In any event, where formal music-thanatology programs exist, salaried or pro-bono, the contracts and/or understandings are between the individual music-thanatologist and the agency, not between the music-thanatologist and the patient. In hospitals and hospices, memorial and philanthropic donations often fund the costs associated with maintaining a clinical practice. The highest goal is that no dying person in need is ever turned away for lack of funding.
To learn about other Vox Clamantis programs, please go to Healing Arts Programs.