Betty's Story

I know, I know. I shouldn’t pick favorites. I try to uphold each individual to the same level and value all of my experiences equally, but sometimes you can’t help having more of an affinity to one situation/person over another. So, I want to tell you about a “favorite” patient of mine. It is more a favorite string of sessions or a favorite response to music therapy. It is a favorite way of conducting a session, or rather, a patient who challenged me to utilize music in a different way than I had ever done before. This patient is not one of my “favorites” because of who she was, she was just like many of my patients previous to her, but there was something special that happened in our sessions together, unlike what I usually see.

Betty* was on hospice and referred to music therapy for improved quality of life. She was bed-bound, in her 90’s, and blind. There was seemingly not much for her to live for. As I learned over our time together, she did not have any family around and the one person she still had a relationship with did not live in the same state, nor have interest in visiting at this time.

I was a little taken aback when I first met Betty. Her skin was pale and bumpy, her eyes were glazed with possible cataracts and no sight, and her figure was thin and stiff. She lay there, with her long limbs, and did not even see my daze at first sight of her. I was embarrassed at my thoughts, my response to this beautiful human being, but I was just an intern. I had no real exposure to the elderly and dying, except for my few visits to a memory care unit while in college. Seeing people in this state of life, frail with decaying bodies, was new to me. My senses were picking up on what to expect on a daily basis – urine bags, medicine bottles, putrid smells, nurses in scrubs, stretchers, and even a person covered by the thinnest of sheets whose life had just left us and whose body was being wheeled onto an elevator as if nothing out of the ordinary had happened. I was quickly adapting to my environment and retraining my responses to such stimuli.

When first meeting Betty, I found myself enjoying conversation with her. Her voice was round and low with the charm of old-English vocabulary. She had gratitude for life and there was an element of richness to her speech. Her stories held meaning and worth to her. Betty was a musician her whole life. She sang and played piano. She conducted choirs and mastered the organ. She was even in the chorus of a Broadway show. Her life was enmeshed in this art form that was pleasant to the ears. Betty shared her cherished memories, and I wish I could remember more to share with you.

Sessions with Betty consisted of trying new interventions and touching the edge of my musical limits. Betty expressed her lament for her voice as it was not what it used to be. She could not support herself singing anymore, and so she closed her eyes and listened. She requested songs and shared her thoughts on the music. Each day, I walked into her room with the sound of a radio faintly projecting the classical station. When asking to turn off the radio, I always promised to turn it back on upon leaving her room.

Betty’s main goal in music therapy was pain management as she was most often in pain each day I arrived. There were some days when she would cancel a session due to her pain. But the times she let me visit were the days when she saw the value of music in relation to pain. One day in particular, I asked her what her pain level was from 0 to 10. She gave me a number and I responded with, “We’ll do some music together and I’ll ask you again what your pain is in a little while.” We went through the session, I played guitar and sang, I may have played a short song on the flute that day as well, and we discussed the music. At the end of the session, I asked her once again what her pain level was and she replied with, “Oh, I know how powerful music is. Music definitely helped me feel better today.” Besides her words, I observed her body, her breathing. I took notice that her body looked less tense and rigid after the music therapy session. I noticed that she appeared to be more comfortable in her bed because of the increased relaxation. Music assisted Betty in being distracted from the pain, in turn, increasing her comfort.

Over the weeks that I worked with Betty, I watched as her memory faded like the top of a pencil’s eraser after multiple uses. I arrived at her door, greeted her as usual, and listened as she said, “Oh, who are you? What are you going to do?” I explained to her that I am the music therapist and have come to bring music in order to help increase comfort. Sometimes she accepted my visits, allowing me to conduct the session, and other days she did not.

One day after she let me in the room, Betty said, “I can’t help you.” I was confused at this statement and why she said this. Was she talking to me or saying this in general? I pried, and she responded, “I am blind and in my bed. I cannot move and I cannot help you with anything.” I could hear in her voice a sense of hopelessness. Her addition to the world had depleted as her body had lost its function. I could not imagine being in her shoes, remaining in this bed for the rest of her days, listening to the classical station, and having little interaction besides short visits from medical staff. This was her life. If it was mine,  I would be so lonely!

To her concern, I began talking about what she still has to offer to the world. Besides her infrequent memory loss and forgetfulness, she was still cognitively present. Her speech was sharp and clear, and her thought was deep and vast. I validated her understandable feelings and proposed a new structure to our sessions. “Betty, I can see that you are still cognitively sharp, you can hold a conversation and have little memory loss. How about I learn a song for you each week and you critique me as my teacher?” I set this up for her to have purpose in the world. I wanted to offer her another chance to feel useful, a small opportunity for autonomy. And so, our sessions from that point on consisted of me singing a new song for her each week as a vocal student and Betty giving me constructive criticism to sing the song better. It opened the door to Betty’s past, present and future.

I came back week after week and noticed how Betty’s role as “music teacher” gave her a sense of accomplishment. She had meaning and purpose. She interacted regularly with another human being, and had something to still offer the world. I saw an increase of smiles in these sessions, and I had a glimpse into Betty as the choir director. Sessions arrived when she did not remember me, but at times I convinced her to let me sing at least one song, and halfway through the song she had the light bulb turn on. Betty remembered her student and the song she asked her to work on from the previous week. From my perspective, she taught me about breath support and finding meaning in the music. I was not pretending for the sake of the session, but structuring the session for the sake of my patient.

Betty had a fondness for the 1930’s songs I would sing, and requested specific songs. I played Sunny Side of the Street and she would bob her head back and forth with a constant grip of the beat. She tapped her hands and wiggled her toes with the tempo of the tune. I imagined what it was like to walk down the city streets in the 40’s (when the song was popularly sung) with a wide skirt and pinned up hair. I could see her walking with red lipstick and shoes that clicked and clacked to the cadence of the song. What a sight!

A favorite song of ours together was Fly Me To the Moon. We analyzed the lyrics and talked about its meaning (lyric analysis is a common music therapy intervention). I asked Betty what lyrics she liked and she asked me to reread them. She stopped me at the lyrics about music, “Fill my heart with song and let me sing forevermore.” Betty liked these lyrics the best. She reiterated, “Music will always be in my heart. No matter what, I will always have music. Music is so powerful.”

One day she requested I Wonder as I Wander, an old Christian folk song. I knew it as a Christmas carol, having grown up in the evangelical christian church, yet I had never used it in a music therapy session thus far. The lyrics are as follows:

I wonder as I wander out under the sky
How Jesus my Saviour did come for to die
For poor on’ry people like you and like I
I wonder as I wander out under the sky

I sat with Betty as she contemplated life. She talked about walking through the world, uncertain and uneasy. She encouraged me to hold onto the dear things around me, my treasured friendships and all things lovely. We talked about the end of life, and Betty expressed that she lived a good life. She also talked about how the world had gotten so ugly. She was saddened by all of the violence in the world, the natural disasters, and the hate. She explained that it wasn’t this way when she was a young woman. There was not as much hostility, so she claims.

Betty died soon after that session. It was the last time I saw her and the last time we spent together. She felt like a friend of mine, one with quaint speech and a profound love of music. Our relationship was kept professional, but I cannot deny that there was a fondness there.

I called the one person who was listed in her chart to express my condolences. He was an old coworker of hers. They had worked in shoe sales together, and Betty apparently climbed the ladder of success in the business, being second to the CEO. Betty had talked about this friend with affection. She listed him as one of her closest friends, the one person who would visit her. There was no sorrow in his voice as I talked with him that day; he was sad but happy that she was out of pain and misery. I shared some of my stories with him, and it brought him solace knowing there were people there for Betty at the end.

I take away a greater appreciation for music from my time with Betty. Here was a woman who had more to extend to the world but no way in which to do this. I was able to make a bridge between her and the universe at this time of her life, using my own creativity, music therapy skills and intuition, and the excellent power of music. Leaving Betty behind in my work was not easy; I look back on those days tenderly. She died right before we saw several natural disasters occurring around the globe, and I was happy about her absence at this time. I was glad that she was spared the horrendous sounds of police sirens, and the agony of lament over her city. She ended her time on earth with music and conversation, not with news reports of tragedy and trauma. I was hopeful that she was now at peace and out of pain, singing forevermore.

*Name has been changed to conceal identity

Photos from canva.com