I first heard Molly G. Hicks, MMT, MT-BC, perform a song last December at Penn Wissahickon Hospice’s annual “Light Up a Life” tree lighting ceremony. Each light on the tree honored a patient, friend or other individual dear to someone in attendance.
The music therapist and bereavement coordinator at Penn Wissahickon Hospice wrote it based on themes she encounters with bereavement clients, one of which is the concept of offsetting the darkness of grief with the “light” of enduring connections with the deceased. In addition to counseling the family members of former hospice patients, Hicks provides music therapy to hospice patients themselves, in the Penn Hospice at Rittenhouse in-patient unit, nursing homes and in even in patients’ homes.
A few months later, Hicks and I visited Penn patient Mattie Giles in her West Philadelphia row home to see the impact of Hicks’ music therapy in action.
Walking into Giles’ home, I see her eyes open wide with a renewed exuberance at the sight of Hicks and her guitar.
The two chat briefly about health problems that may be afflicting Giles.
I caught Giles on a good day.
“Are you having any pain today?” Hicks asks Giles.
“So far, so good -- thank God for that. I need a break,” Giles says. “You know, Molly goes over everything with me.”
Shortly after, the two sing in unison. On these visits, Giles reaches into the innermost recesses of her strength to belt out the chorus of some her favorite hymns.
“With Mrs. Giles, it’s very easy to see the spiritual and emotional effects of the music on her,” Hicks told me later. “Today, I didn’t need to change the musical elements in the same way as I would for someone in acute pain where I need to adjust the tempo or volume of the music.”
As I enjoy the angelic sounds next to me, I admire framed photos of Giles’ family members throughout her living room.
In addition to counseling, Hicks records her singing and guitar playing, coupled with Giles’ singing, for a compilation of hymns that Giles will leave behind to share her faith with those loved ones pictured around the room.
“Between the songs, Mrs. Giles extemporaneously talks about what they mean to her,” Hicks said. “Sometimes, that’s as simple as offering words of praise to God, other times she’ll point out which lyrics are most important in her life.”
After a few songs, Giles shares a story of her childhood.
As a child, Giles’ cousin was told that babies came from “stump holes in the woods,” so Giles as a young child and the other kids often spent afternoons in the woods searching in tree trunks for babies.
“Every child should have a good life, because this is what they go back on when they get old; they fall back to childhood days to remember,” Giles said.
When the patient and therapist are not talking about health, music, and memories, sometimes subtle non-verbal communication between them speaks volumes.
“Even though she doesn’t have any obvious physical symptoms, I’m always observing her physical and emotional status throughout the visit,” Hicks said, adjusting the music or communication precisely as needed. “There are times that I’ll move on very quickly to the next song, because I know she wants to keep the music going, and other times that we’ll stop for a while and talk.”The music creates an opening for these meaningful conversations to take place, Hicks explains. For Giles, talking about the music often leads to deeper introspection about her life and the lessons she’d like to leave for her family.
Music therapy is one component of the comprehensive Penn Wissahickon Hospice team that ensures patients are cared for by nurses, social workers, chaplains, volunteers, home health aides and those in other disciplines, as needed.
Hicks sees about five to 10 hospice patients per week and uses her specialized training as a board-certified music therapist to address specific symptoms unique to each patient. In the first visit, she conducts a music therapy assessment, discussing with the patient their music history, (or with their family or caregiver if the patient is unable to communicate), such as what music is meaningful for them and what songs they may like to hear, or definitely not want to hear.
A patient doesn’t need to have a specific music history to benefit from music therapy, but knowledge of familiar or preferred music can help lay the foundation for Hicks’ future interactions with her patients.
“Playing and discussing meaningful music enables me to build a therapeutic relationship with them that allows them to feel more comfortable sharing deep emotional and/or spiritual things or events in their lives,” she said.
Playing music during that first visit, Hicks seeks out signs for how the music could affect the patient.
“I look for any physical effects – such as noticeable relaxation, or sometimes patients will say their pain is going away,” Hicks said. “Or I’ll see them clapping their hands, or tapping their fingers, or their toes, nodding their head.”
If a patient is experiencing more agitation or tension, Hicks’ music therapy training kicks in and she reassesses, adjusting the qualities of the music or changing the intervention completely. Sometimes music may not be helpful or appropriate.
Emotionally and spiritually, one of the overall goals of hospice care is for patients and family members to reach a gradual sense of closure and acceptance.
“In order to help someone reach that state, whatever that means for them, they often spend time talking about their life, reminiscing,” Hicks said. “That’s one of the ways people process what we’ve been through, how we’ve gotten through it, where we are now, and what we might want for our family members going forward.”
These conversations can be difficult but are not always grim.
“There is a sadness and heaviness that care teams have to deal with, but there are also beautiful and meaningful moments that we feel honored to share,” Hicks said.
When Hicks first visited Giles at home, Giles had been in the hospital and was adjusting to being back home.
I could tell the music made her feel right at home.
“She’s always had those deep reservoirs of strength within her, and she’s benefited from the support the hospice team has given to help validate that strength and faith and allow her to share it,” Hicks said.
For now, I admittedly remain peacefully ignorant of when my final days will come. As I sat on Giles’ living room couch, I enjoyed witnessing a talented music therapist sharing in a small piece of her patient's vulnerability.
Although some of us are braver and more open than others, we all wrestle with the same things this patient is facing—the meaning of life, and what happens when we pass. For Giles, she is peacefully certain. She gets a twinkle in her eyes, bobs her head, closes her eyes—and sings.