by Melissa Crytzer Fry

Amid the hurried activity of the nurses’ station in the Palliative Care Unit at Phoenix’s Mayo Clinic, unlikely background music softly plays. Wood flutes carry the soothing vibrations of Native American history, harps play “Memory” from Cats, and lively acappella songs ranging from swing to ‘70s tunes float down the dimly lit hallways.

Even the music of the poet’s pen—as she searches for just the right phrase – blends to create a harmony that few would expect in a setting that cares for patients facing the end of life.

Students, artists, and researchers from Arizona State University are a vital part of this engaging environment. Since 2003, they’ve shared artistic programming recommendations, research, and their personal talents with Mayo Clinic physicians, administrators, and palliative care patients. Their artistic versatility has resulted in live music experiences at the bedside and celebrations of patients’ lives through poetry.

Sonata del Sol
Randy Kemp is an ASU Fine Arts alumnus and one of five musicians who visit critically ill patients. He can attest to the power of music.

“Some nights, it’s just an amazing experience,” he says, recalling a woman in her mid-20s, who could no longer verbally respond. “The family wasn’t there, but the nurse encouraged me to play. So I stood in the doorway and began to play flute music as if the patient could respond and hear.”

After playing a handful of songs, Kemp looked at the patient.

“That’s when I realized there were tears in her eyes. And that’s when I knew I was in the right place,” he says. “It’s a privilege to stand in front of folks and say, ‘I really don’t deserve to be here. But thank you for allowing me to come in and play for you.’”

Kemp’s experience is not unique, say ASU music professors Sandra Stauffer and Jeff Bush. They study the efficacy of similar bedside programs and provided programming leadership during the creation of Mayo’s effort, Sonata del Sol. They also were responsible for documenting the impact of such musical experiences.

Over a period of six months, Stauffer and Bush visited the rooms of seriously ill patients, observing musician-patient interaction.

“We documented what was said, body language, requests that were made, and what family members were saying,” explains Stauffer. “Our role was to document—not to say anything—remembering that these people are critically ill.

What the duo witnessed were quiet and active responses: a closing of the eyes, slowing of agitated movements, stillness, and, conversely, participation in the service—singing, humming or moving to the music. Changes in mood, anxiety, and even decreased levels of pain were reported by patients.

“These experiences give people an outlet for some of their suffering,” says Dr. Mark Edwin, chair of the Mayo Humanities and Medicine Committee. “Usually, that suffering is emotional or spiritual—something that we, as a Western medical culture, are not typically good at addressing. We feel we have developed a tool that can help patients channel that suffering.”

Stauffer and Busch conducted extensive interviews with Mayo staff members, nurses, doctors, and family members. Those talks revealed ancillary benefits, beyond those offered to the patient.

“We were going in focusing on the patient,” explains Bush, who quickly learned that families were receiving equally positive benefits. “The music provides an opportunity to see a loved one smile, laugh, and share with family,” he says.

Information from the interviews data suggested that the music also helps de-escalate the feelings of tense family members and even staff.

“The experience provides a mental or emotional break and counterbalances difficult or depressing moments,” says Stauffer, pointing to staff interview responses. “They describe the music as both motivational and calming.”

At Mayo Clinic, patients in the Palliative Care Unit are given preference for bedside music performances. However, oftentimes individuals in the ICU, rehabilitation, cancer, and transplant units are referred to the program as well. Since inception, more than 1,000 patients have been served during the two-hour musical visits held four times weekly.

“The goal of the program is to give patients an aesthetic experience through live music at the bedside,” says C. J. Kennedy, coordinator of the Mayo Center for Humanities in Medicine. “After consulting with nursing staff, musicians ask palliative care patients if they would enjoy live music in their rooms. If the response is ‘yes,’ the patient and musician select music together. Patients can say ‘no’ to this service at any time, because the first concern is the comfort-level of the patient.”

Patients may also request the service as often as they wish.

“There are no limits,” adds Kennedy. “This is an experience that takes patients out of their world of medical issues and into another place in their lives. We don’t want to limit that experience.”

A harpist, guitarist, flutist, vocalist, and folk singer/guitarist make up the five-person musician team. Each has received extensive training.

“They learn about the principles of palliative care philosophy, confidentiality, and how to work with the medical staff,” says Kennedy. “After they have completed their health screenings, they also mentor with an experienced musician in Sonata del Sol.”

With great sensitivity for the patient, Stauffer, Bush, and Mayo staff determined the instruments most suitable in the palliative care setting. They also jointly identified accomplished musicians for the program.

“This isn’t your average person off the street coming in to sing three songs they know,” explains Stauffer. “These are people who are courageous enough to look a critically ill person in the eye and ask, ‘May I play some music for you today?’”

Poesía del Sol
“If a kind ASU student appears at bedside and hears an ill person’s life as art, and then renders it as art—the moments spent there have a sweetness that is rare in this world,” says Karla Elling, manager of the Creative Writing Program at ASU.

As part of the Mayo Clinic’s Poesía del Sol program, ASU poets aim to create precisely that moment. Master of Fine Arts candidates and alumni compose poems based on conversations with terminally ill patients.

“We work with people who still want to say something,” says Regents’ Professor Alberto Ríos, who monitors the artistic quality of the program. “And we understand they’re not saying it for themselves anymore. But they are saying it for someone—sometimes it is their family, and sometimes it’s just what we say to the world because it’s worth saying.”

The key, adds Ríos, is the ability of the poet to capture moments.

“What we do is we speak to the moments that seem inconsequential, but, in fact, our lives are built on those moments. From our training as poets, what we help do is find words—put them in the right places so that somebody, when they read it, feels that’s exactly what they said.”

For the 25 patients and their families who have received the gift of a poem since the program began in 2005, this tangible proof of a life lived is often priceless.

“The patients are just amazed that something so beautiful came from something they said, which they thought was nothing,” explains Arreta Hamrick, a physician assistant in Mayo’s Palliative Care program.

“Particularly for the families of patients whose life expectancy was very short – for those who died soon in the hospital, or soon after leaving the hospital – this gives the families something to hold onto, and it just really means a lot to them,” she adds.

According to Ríos, that fleetingness is one factor that makes the poet’s job so challenging—and rewarding.

“Within an hour, the poet is typing up and printing off an elegant copy of the poetry,” he says. “We may not see that person ever again, so it is imperative that we find a way to conceptualize what the patient said.”

The medical environment, admits Doug Jones, is another challenge for the writer.

“All of my usual habits and routines—quiet, private space—are not available,” says Jones, an MFA alumnus who helped begin the program as a student. “Instead, it is a game of stay-out-of-the-way, which relegates me to the landing of the third floor, just by the two elevator doors.”

It is not uncommon for poets to be found in lobbies, their notes and laptop computers strewn across the floor, as they search for the perfect words. Once the words are identified, however, the poet still must select the proper printmaking medium—artistic paper, book materials, and framing supplies – and then present and read the poem to the patient.

“I had a patient recently—a very young man who was very ill—and when I read the poem to him, he closed his eyes,” says Sheilah Britton, MFA alumna and one of four Poesía del Sol poets. “When I finished reading the poem, he asked me to read it again. At that point, I thought I couldn’t make it through it. It’s just an amazing, emotional experience.”

“What our students get out of the program is important to us,” says Elling, admitting that emotion is a natural part of the package. “It changes students’ lives,” she says.

This reciprocal model, where both the artist and patient give and receive, is a concept that Ríos and Elling hope to share with others. While narrative storytelling – asking end-of-life patients to share their life stories—has been employed in multiple palliative care settings, the use of poetry—or lyric medicine, as Ríos defines it—is a novel concept.

“We hope to turn the program into a model so that it’s not simply us doing it,” says Ríos. “We can start to write a curriculum—instruction—for people in other places to be able to do it as well.”

Lasting Benefits
“My experience has taught me that just because a person may be dying, it doesn’t mean they no longer want to laugh,” says vocalist Vicki McDermitt. “Many want to laugh and laugh big—determined to live every moment in joy. Music is the catalyst for amazing things.”

Hamrick agrees, pointing to the opportunity for normalcy that the arts provide patients who are nearing the end of life. “It gives the patients the chance to not be a patient. In the hospital, they’re being poked and prodded, and everyone who walks through the door has news for them,” she says. “Music and poetry really gives them a chance to be a whole person again.”

The poets, musicians, and medical personnel all agree. What began in 2003 as a pilot bedside musician program and continued into the development of a personalized poetry program two years later, has brought a renewed sense of humanity to the medical field.

“We so often focus on the physical component that the others get left behind,” says Edwin. “Now we’re treating the spiritual, emotional, and medical component of the individual.”

Read notes on the experiences of muscians participating in Sonata del Sol

Read some of the poetry produced for patients through Poesia del Sol

Sonata del Sol and Poesía Del Sol are joint partnerships between Mayo Clinic in Arizona, ASU School of Music, and the ASU Creative Writing Program. Funding for artist participation and research is shared by all three entities. For more information, contact Karla Elling, Ph.D. at karla.elling@asu.edu or 480.965.3528; or Sandra Stauffer, Ph.D. at sandra.Stauffer@asu.edu or 480.965.4374.