Wings of song for the dying

IT was a simple visit to a sick friend. In the morning, Kate Munger weeded Larry’s garden and did chores around his house. In the afternoon, she sang sweet, soothing songs at his bedside.

For a music teacher and lifelong member of one chorus or another, singing was as natural as herbal tea. But over those hours in 1990, she felt she was delving into deep reaches of herself and pulling out glittering, unexpected gifts for her comatose friend, a San Francisco quilter who was dying of AIDS.

Larry’s bedside would be the first of thousands at which Munger and a legion of women she has trained would try to help the terminally ill die in a state of musical grace.

Today, about 30 groups called Threshold Choirs rehearse twice a month in cities throughout California and several other states. In small clusters, they are invited into hospices, homes and hospital rooms where death is near, singing soft, ethereal melodies to people who might or might not be conscious.

Depending on whom they are singing to, the 700 women of the Threshold Choirs might throw in a show tune or a love song. But mostly, they create a veil of tranquil sound for the dying and a balm for the grieving family members around them.

“The women who sing are willing to be curious about death,” said Munger, 57. “We like to say that our audition process is a shiver when you hear about our work.”

A minister’s daughter who grew up in the Santa Ynez Valley, Munger has a zest for the sacred. She says “If Spirit wills it” the way other people say “We’ll see.” She wears a frog pendant not just because she likes frogs but because they symbolize transformation. Her dog is named Surely, as in the 23rd Psalm: “Surely goodness and mercy shall follow me all the days of my life.”

After Larry died, Munger did not instantly transform herself. She taught elementary school and raised a son with her husband, Jim Fox. For more than 14 years, she and Fox, Inverness’ volunteer fire chief and head of the water system in the Marin County community, lived in a trailer while they built an airy, secluded hilltop retreat that gazes out toward Tomales Bay.

Meanwhile, she organized groups that specialized in singing rounds, those complex compositions that depend on themes repeating and voices entering at different points.

But she didn’t forget the simpler gift she had given her dying friend.

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ABOUT 10 years ago, Munger was driving back from Montana to California when she found herself singing to dead animals she’d passed on the roadside:

May your spirit rise safely.

May it soon become a cloud....

It’s a practice she follows to this day.

In 2000, Munger gathered 15 Bay Area women to form her first Threshold Choir, inaugurating their service with weekly visits to an ailing psychiatrist who ultimately died of lupus.

Now, she puts more than 30,000 miles a year on her 1990 Plymouth van, guiding singers in the Bay Area and beyond through lengthy, emotionally freighted rehearsals. Groups are starting in Santa Barbara and Los Angeles as well.

Two or three times a week, Munger is summoned to bedsides.

“We always have to be invited in,” she said. “We don’t press this on anyone.”

One autumn afternoon at Dominican Hospital in Santa Cruz, 94-year-old Miriam Sherwin lay ashen and unconscious as three of Munger’s singers hovered over her. Her head was tilted back, and her breathing was labored.

“We’re going to sing to you now,” one of the chorus members said quietly, stroking the woman’s forehead.

Leaning in, the three joined in a subdued harmony. The lyrics were simple and calming, repeated numerous times:

We walk not into the night

We walk up toward the stars.

In a few minutes, the halting breath of the bedridden woman became regular. Soon it stopped.

The three singers stared at one another.

Then Miriam started breathing again.

The women recognized the prolonged pause as just another bump on the road to death. After another few minutes of singing, they tiptoed out, and, in the hallway, embraced.

The next day, Miriam died a death made easier, her son Rob believes, by music.

“It was just a very beautiful, peaceful thing, both for my mother and for me,” said Rob Sherwin, a retired hotel executive.

Earlier, he had argued with a nurse who refused to provide more painkillers for his agitated mother. And he had rejected the Catholic hospital’s offer of pastoral counseling.

In a sour mood, he came across Munger and a half-dozen choir members singing in a corner of the lobby. He asked them to visit his mother and ended up so taken with them that he played their CDs at her memorial.

“A few minutes of gentle singing seemed to quiet her, and it certainly quieted me,” he said. “For the rest of that evening, things were peaceful.”

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MUSIC therapists often bear witness to such scenes.

“There are many situations where we don’t go peacefully,” said Russell Hilliard, director of the National Center for Music Therapy in End-of-Life Care. “You might have patients groaning and grimacing, shaking their hands and reaching into the skies.”

Agitation can feed upon itself in a terrible cycle, Hilliard said. As a patient’s breathing becomes difficult, her anxiety increases, making breathing even tougher. But using what’s known as the “isoprinciple,” skilled therapists might offer an agitated patient fast, loud sounds that match her frame of mind. Gradually, the music grows calmer and so, Hilliard said, does the patient.

“Over time, that rapid breathing gets softer and quieter and slower,” said Hilliard, who is based at the State University of New York at New Paltz. “We’re always amazed at how beautifully this works.”

Scientific studies are sparse. In one that Hilliard conducted, cancer patients who received music therapy appeared happier than their counterparts, responding more positively to 29 questions about their pain, their relationships and their faith.

“The closer they got to death, the higher they rated their quality of life,” Hilliard said.

For Munger, clinical trials are beside the point.

“I’m not a scientist,” she said. “I do this from a more intuitive, seat-of-the-pants perspective.”

In rehearsals, she stresses empathy, saying that chorus members should confer with a patient or the family members to make sure their music will be welcome. She ruefully recalls the time a nurse nagged her into singing for a man who was drifting in and out of consciousness: “He suddenly opened his eyes and said, ‘Stop it! What the hell do you think you’re doing here?’ ”

Sometimes the best intentions yield exactly the wrong music for people at their most vulnerable, Hilliard said. A soft “Ave Maria” may stir painful feelings in an elderly Catholic once abused by a priest. A Simon and Garfunkel ballad from the ‘70s may fuel memories of a bitter divorce.

To acquaint her singers with the experience of hearing the music as a dying person might, Munger unfolds a green reclining chair at rehearsals. From time to time, one of the women will lie down as others cluster around, somberly chanting.

A cherubic woman with a broad face and a ruddy complexion, Munger frequently drops joking spiritual references.

Asked about her long hours on the road, she replies: “Yes, I’m on intimate terms with the great goddess Asphalta.”

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In addition to soothing melodies with titles such as “Deeply Quiet” and “Breathe Easy,” her repertoire includes quirky originals such as her “Anti-Tailgating Song.”

You never know when the guy

In the car in front of you

Might be the Dalai Lama.

The singers are mostly middle-aged and veterans of church choirs or amateur productions. About half volunteer at hospices. All but one of Munger’s choirs is strictly female, a choice Munger said she made for the gentle clarity of their sound.

During a break at a Santa Cruz rehearsal, singers offered from-the-heart updates on their day-to-day lives. They spoke of struggles with aged parents, of plans to visit an elephant sanctuary in India, of a husband’s leukemia coming back, of old friends and new jobs.

Many were dealing with the deaths of people close to them.

Before her mother died of Lou Gehrig’s disease, Marti Mariette gathered some of her fellow singers around the bedside of the emaciated, immobile 80-pound woman.

“She was on morphine,” Mariette said, “and we couldn’t really tell if she was present with us or not.” But knowing that Colleene Mariette loved Broadway tunes, they launched into “Shall We Dance?”

“It was absolutely amazing,” said Mariette, 50, an artist and massage therapist. “My mother tapped her fingers on my hand in time to the music. It gave us a way to communicate and to know we were together.”

Ten days later, Mariette again summoned her friends.

There were 15 women singing in Colleene’s room when she died.

“It was a really sweet moment,” her daughter said. “My mother had a tenacious hold on life, and the music made letting go much more peaceful. Her face relaxed. You could see the worry lines on her forehead disappear. It gave her this gentleness she could slip away in.”

Whether music can help a dying person let go is an open question, said Hilliard, the music therapist.

“If music therapy really facilitates the dying experience, we would find that therapists were the last people at the bedside,” he said. But one of his studies showed that people died at random times, regardless of who last visited.

Also unknown, and probably unknowable, is whether a person’s favorite music matters in the final moments.

Therese Schroeder-Sheker, who created the field of music-thanatology to provide musical comfort for the dying, doubts it.

“Somehow, in the deeply layered process of ‘letting go,’ many aspects of identity, including ‘favorite things,’ cease being essentials,” she wrote in an article.

If the precise mechanics of letting go remain a mystery, Munger is certain that music eases the troubled path to that moment. In their final hours, people have asked to hear songs they lost themselves to in high school, songs from their weddings, from Cole Porter, from the Beatles.

“But if there’s anything people ask for more often than not,” Munger said, “it’s a lullaby.”

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steve.chawkins@latimes.com

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