As I get out of the elevator on a Friday morning at Penn Hospice at Rittenhouse, I follow angelic voices to the unit’s volunteer Threshold Singers practicing for a day of spreading comfort to patients.
Since 2012, when co-director Doris Mogen began the all-volunteer, 15-member chapter, she and other members visit the unit every Friday to sing to patients at the bedside. The group warms up in the lobby to announce to the floor that they are here before they visit patients.
Periodically throughout their visit, patients and family members ask them if they will stop at their room too.
The Philadelphia Threshold Singers, a local chapter of the International Threshold Choir Organization, is currently all female (although male singers are welcomed to join).
The dedicated group memorizes songs from the international choir’s repertoire created especially for patients and families at various thresholds of life. Their music is intended to soothe and comfort, and purposefully is unfamiliar to patients, so as not to draw on previous uncomfortable associations a patient may have to a song. If requested by the patient, the singers will do their best to respond with hymns or other songs. (The singers even revamped one of their own songs in Motown style for the nursing staff when asked.)
This local chapter follows an extensive history of music being used for the sick or dying. Chapter Co-Director Lana Noel explained to me that music has comforted ill patients for centuries and across cultures, dating back to at least as early as the 4th century B.C. Greeks’ exploration of music’s cathartic effects. We also know of Benedictine Monks in medieval times singing or chanting for the sick in their communities. Many cultures in present day employ the use of sacred singing or chanting at bedside, such as found in some Hindu, Buddhist or Orthodox Jewish communities.
Ms. Jeri A. Timm, manager of volunteer services for Penn Wissahickon Hospice, appreciates the group because of all the benefits of music at the bedside and has witnessed the change a patient has had after listening to the group. If the singers see a patient is having physical or spiritual difficulty they will consult staff for next steps.
“It’s an up and coming field that they’re starting to identify the benefits of these complementary therapies,” said Timm. “It doesn’t always have to be a medication that will produce that reduction in anxiety or sleeplessness. Often it’s a psychosocial issue in which the patient needs a volunteer, community support, or music to enhance their care.”
With nearly 130 chapters in the U.S. and a few other countries, including England and Australia, Threshold Choir participates in an emerging practice in long-term health care facilities, prisons, neonatal wards of hospitals, and other areas that support those making transitions in life.
With the exception of special events, such as singing to hospital staff around the holiday season or singing at memorial services, the choir typically sings with two-four people at a time to avoid overwhelming the patient.
When the choir approaches the patient’s door, they listen and look for cues in the patient’s room, as well as insights from nurses and social workers to tailor the experience whenever possible. “It’s about being in the present moment and using your intuition,” said Noel. “You get a sense of what’s appropriate in the moment.”
The choir looks for clues around the room as they enter to evaluate what they can bring to that space; seeing if family members have visited, if there is a Bible or other religious symbols, or flowers or cards to get a sense of whether they might have had recent visitors.
“It takes a few moments to stand, listen, and watch their breathing and engage that breath,” said Mogen. “That will usually be the rhythm that we’ll pick up on when we sing.”If the patient is fragile, the group will sing a slow, soothing song, without a complex rhythm.
“There are other times when we visit a patient who is very alert and we come in and offer songs of comfort and they say, ‘Why would we want songs of comfort?,’ Mogen said. Then I ask, ‘Would you like an upbeat song?’”
The choir has experienced scenes of loved ones visiting a patient and grieving in varying ways, yet unable to attend to the patient meaningfully. Around the room, kids are playing video games, adults are talking on the phone or watching television. When the choir begins singing, clearly focused on the patient in the bed, the visitors turn their attention to the patient and the present situation.
“We’ve watched family members come over and put hands on a patient then begin weeping,” said Noel. “You go into the room with unconditional love, it doesn’t matter who is in the bed, where they have been, or what they have done.”
The group finds songs that flow well into the next for patients and loved ones who need a little more time to express their feelings before they compose themselves.
“You never know what to expect,” said Noel. “A lot of times it’s simply delivering the songs and stepping out and letting music be the voice.”
For Penn hospice patient and musician John Ricks, the singers came in when he really needed them.
“They came in at the right time,” said John Ricks, a musician who plays piano, guitar, and drums and a patient in the unit. “I was thinking about material I was going to put together and the direction of that material. Music doesn’t have to be loud to get the point across; it can be smooth and soft, like their voices.”
For patients and their families, the choir’s visit echoes a commitment by a dedicated team looking to make the most of a difficult time.
“These can be bleak and scary moments for families when they are just beginning to acknowledge that their loved one is going to die,” said Mogen. “We bring unexpected beauty. Death happens to all of us. It’s not something to resist and can be beautiful too. That’s what we bring, the possibility of acceptance and seeing the beauty where it is often hard to find.”