St. Joseph’s Patients Get a Dose of Music to Help Fight the Pain

There were times, the bearded young cancer patient said, when the pain was so intense that even morphine could not make a dent in it.

The relief finally came, Jeff Wright said from his bed at St. Joseph Hospital in Orange--but not from a syringe or an intravenous drip. It was piped through stereo headphones.

With a cassette player at his side, Wright found relief from the agony of a tumor on a nerve in his hip by listening to a sequence of 12 classical pieces designed to lessen pain. The first piece, the fiery “Sabre Dance” by 20th-Century Soviet composer Aram Khachaturian, was loud and intense, matching his pain. Then, with each succeeding piece, the tempo and volume slightly decreased.

The tape next plays “Roman Carnival Overture” by Hector Berlioz. As the music matches the intensity of the pain at the beginning of the tape, pain can lessen as the music becomes more relaxing, ending with the allegro movement of “Concerto Grosso in D minor,” by baroque master Antonio Vivaldi.

Physical, Emotional Comfort

“And as the music goes softer, the pain goes with it,” said Wright, 28. “After three or four songs, it eased the pain so much I was able to drift off to sleep. I couldn’t do that before, even with morphine.”

Wright was undergoing music therapy in a St. Joseph Hospital program that provides comfort--both physical and emotional--to cancer patients. Music makes their days of stress and pain more bearable and helps terminal patients communicate feelings as they think back on their lives, officials involved in the program said.

“Music is a very powerful tool in the healing process,” said Jo Ann Quak (pronounced kwahk), St. Joseph’s registered music therapist. “It helps in expressing feelings, which is so very important when a person gets sick, and in diversion and relaxation.”

Music therapy is most commonly used with developmentally disabled and psychiatric patients, but its role in helping the terminally ill is “a new direction,” said Kay Roskam, professor of music therapy at Cal State Long Beach.

UCI Unit to Offer Therapy

St. Joseph is one of the few hospitals in the Southland that use music therapy for the pain-ridden and terminally ill, she said. UC Irvine Medical Center plans to offer music therapy at its new cancer rehabilitation program when it opens in February.

Financed by donations to St. Joseph’s hospice auxiliary, music therapy is provided at no cost to cancer patients and has been expanded to chronic kidney patients. Quak estimates that she treats about 30 patients a month.

She makes rounds every Wednesday morning, talking with patients and lending them music and cassette players. Because the idea is to relax patients, she gives them the kind of music they request. Occasionally, she will serenade patients with a song or two, accompanying herself on an electric keyboard.

She may use music to buoy a patient’s spirits as a new round of cancer treatment begins, or to help a patient--or even a patient’s healthy relative--relax and sleep. Perhaps the most wrenching work for Quak is helping terminal patients deal with their intense emotions as they face death.

“One of the processes that people go through in the final stages is they have an opportunity to review their lives,” said Lee Ann Donaldson, a marriage and family counselor and manager of St. Joseph’s community outreach and counseling services department.

“It’s a time to finish business, to remember how life was good, as well as to say ‘I’m sorry’ when they feel they need to or to say, ‘Gee, I did that pretty well, even though I had all these problems.’ That remembering is very important.

Music ‘Touches People’

“Very few things will trigger that like music does. Music is something that universally touches people,” Donaldson said.

“We’re quite defenseless against it too,” Quak added. “It touches our feelings, and they just erupt. I also think music brings an awful lot of comfort. Certain songs can say some things that I can’t say, and they say it in such a beautiful way.”

Quak, whose training emphasized the behavioral sciences as well as music, has helped a few terminally ill patients write lyrics to popular songs, which they then use as an expression of their feelings.

Quak recalled one patient who wrote lyrics for a love song to his wife. The therapist then helped him set the words to a song, and Quak and the patient sang it for the wife. “That was his gift to her,” she said.

A few other patients have likewise customized lyrics to songs.

Helps Patients Write Songs

More often, she helps patients find existing songs that are especially meaningful to them, and then provides the lyrics or a tape of the song for the patient to share with loved ones.

“Sometimes it’s hard to communicate feelings that are inside. We can’t do it verbally, but I can communicate it through a song,” Quak said. “Through music, it’s not so threatening. You can say a lot in a song: ‘Stay by my side, I have a lot to share with you.’ . . . That can open up the lines of communication between a patient and a family.”

Some patients have also asked Quak to help them choose music for their funerals, and hospice volunteers have assisted in writing the funeral or memorial service programs, Donaldson said.

Among the songs Quak uses most often in working with patients are “Amazing Grace,” “How Great Thou Art,” “You’ll Never Walk Alone,” “We Can Cope” (written by a music therapist) and “A Walk in the World,” which has lyrics, Quak said, that tell the listener, “Don’t let my death diminish your life; go on with your life.”

Music can communicate thoughts and feelings in a way that the spoken word alone cannot, music therapy professor Roskam said. For example, the lyrics to a song can be much more meaningful and powerful when sung than when read, she said.

Music is so effective because every organism seems to have an innate need for rhythm, and music appears to be an “elaborate auditory game that the brain responds to in a positive way,” she said.

It would be simplistic to say that the spoken word is processed in one area of the brain and that music is processed in another, Roskam said. But “when sound is coupled with language, it encompasses a much wider area of the brain, and it does seem that there is more complete, responsive processing when music and language are put together,” she said. “You’ve got something going on there that goes beyond your connection with the words.”

Social Experience

In addition, music is often listened to or produced with others, reinforcing the positive social experience, she said.

“So years down the way, people respond in an emotional way to music when they can’t even remember why. It’s a comprehensive response, a total emotional and physical response,” Roskam said.

That was just what hospice auxiliary members at St. Joseph had been seeking to help cancer patients.

“We were really looking for some non-traditional type of therapies,” Donaldson said. “We tried the idea of other expressive arts therapies, but the patients we’re working with, their energy level is low and their ability to participate in any of this is very minimal. . . .

“Music is a therapy they can participate in without having that energy level be that high. It is an ideal modality,” she said. The program is 2 years old and costs the auxiliary $10,000 to $15,000 a year, she said.

On a recent morning, Quak visited with Jo Ann Rapp, a lung cancer patient undergoing chemotherapy in the hospital. Rapp, whose daughter once considered becoming a music therapist, said she was looking forward to the few minutes of music as a source of comfort and relaxation. She smiled as Quak began playing the keyboard and singing:

We can cope

We can cope

If there is a lesson in life,

There is hope

But tears unexpectedly began to fall as Quak sang a second song:

. . . Walk on, walk on

With hope in your heart

And you’ll never walk alone . . . “It really pulls it out of you,” Quak told the woman softly. “But you’ve got this wonderful person here beside you,” she added, gesturing to Rapp’s husband.

The nurses on the oncology ward, too, have enjoyed and benefited from the music therapy, Donaldson said.

“The stress level on this kind of a unit is very high. It’s their loss too when a patient dies, and it brings out a lot of emotions. When the census (patient load) is high, they don’t have a lot of opportunity to talk. The music can help to alleviate some of the stresses, some of the emotional struggles they go through,” she said.

And it is gratifying for them to see the patients respond, Donaldson said.