Carnival of Soul

When Carol Bird was in palliative care at St. Paul’s Hospital, nearing the end of her battle with cancer, her daughter Melody Arnett sat vigil.

Like many families who have spent time in that unit, Arnett heard an angelic voice floating in from the hallway. It was the voice of music therapist Ruth Eliason, who would sometimes wander the hallways, strumming her guitar and singing.

“If we needed a break, we got to step out of the room and have a little moment,” says Arnett. “I would take my daughters, who are musical, and we would come and watch Ruth and be kind of taken away for 10 or 15 minutes, just listening to her beautiful voice.”

Susan Goodwin, who also spent time on the ward when her father Malcolm McNiven was in palliative care, had the same experience.

“You’ve got loved ones dying and you’ve got families sitting around, you know, doing the vigil, focusing and fixating on their brewing thing,” says Goodwin. “And then along comes Ruth and she’s got the voice of an angel. You know, sometimes it’s not even that she has to come into the room. Sometimes she just sits in the hallway and she plays and the music takes the edge off of all the stuff going on in the room.”

Eliason has been a music therapist in the Palliative Care Unit at St. Paul’s for going on 15 years. While her music has brought many things to the patients, she is not an entertainer, nor a performer. She is a therapist — a trained professional who uses music within the therapeutic relationship.

It’s a holistic approach, using various aspects of music to effect change or promote health. Music therapy can be applied in different ways depending on the situation, but it has beneficial and often poignant effects in end-of-life care, where it can help a patient face the fear and sadness of their final journey.

“I have witnessed individuals living their last weeks and days from a place of power — even while they are confined to their bed, their strength diminishing,” says Eliason.

Music has always been part of her life. She grew up in a musical family near Swift Current, where she loved singing with her two sisters. Eliason studied piano, clarinet, bass, voice, and later on, guitar. She listened to everything from jazz and classical to her parents’ record collection, artists like Crosby Stills, Nash, and Young and The Eagles.

“I grew up in Southwest Saskatchewan, where you couldn’t escape country music,” she smiles. “So I heard a bit of that too.”

Eliason remembers being intrigued about a music therapist named Candace Ukrainetz, who still works at Sherbrooke Community Centre, but she doesn’t recall exactly when or how she got the idea to train in music therapy.

“I didn’t find the high school career counselling very helpful,” she says. “I’m pretty sure they told me I should be a hot air balloonist.”

Eliason knew she loved being with people and she loved music, so a profession that used music to help people seemed like a natural fit. After high school, she started a degree at the University of Saskatchewan and eventually transferred to Capilano University in Vancouver. The coursework she encountered was about music, but the training also reflected psychology and how music affects us.

She chose an internship in palliative care and found that she was drawn to it. The model for palliative care is not focused on curing the disease or illness; it focuses on quality of life, mitigating symptoms, and making things as comfortable as possible for the patient.

“(It is) a pace that allows time to connect with people,” Eliason explains. “A space for people to really grab onto the music and use it in meaningful ways.”

She has a variety of therapeutic approaches with patients, mostly directed by them. She will introduce herself and let them know what is available and how they might use the music. If someone’s having anxiety, it could aid in introducing them to relaxation exercises. If their family is gathered and reminiscence is important, Eliason’s role would be to support the sharing of memories and family connection. Music can also help them access their spirituality; it can be a familiar expression of a person’s faith.

How they choose to work with Eliason often depends on their interest and ability in music. It can be adapted to their ability and energy level.

“One individual may feel up to a jam session. Others may just want receptive music to listen to in a way that doesn’t demand interaction,” she says.

Carol Bird grew up on a farm in Margo, Saskatchewan. On Saturday nights, people got together and sang, played piano, accordion, fiddle and guitar. When Bird was in palliative care, she bonded with Eliason and they spent time talking about music.

“It was Ruth and her collaboration, finding music, talking about music, on the same level as Mom that made her feel alive,” says Bird’s daughter, Melody Arnett. “It was very special to see the joy on her face for us family.”

Music was also dear to Susan Goodwin’s father, Malcolm McNiven. He had played in an orchestra and had been a guitar player. At one point, McNiven named a few songs that Eliason didn’t know, so she went away, researched the songs, learned the music, and came back and sang with him. He would become more awake and coherent when they spoke about music.

“You’d watch Dad’s eyes light up because he remembers,” says Goodwin.

“She had a mini-jam session with my Dad. The two of them sang songs together and she actually recorded these seven songs, which she’s passed on to us. That’s beautiful.”

What Eliason calls “legacy work” is another valuable aspect of therapy.

“I believe people want to know they have made a difference in the world — that others will remember them,” she says.

One of the more touching techniques she uses is to record a patient’s heartbeat and use that as the basis for recording a song with them. Set to the beat of their own heart, it might be a favourite song from the past, or a song that was written by them. This can be to work out their own emotions or to say things to their family that they couldn’t say throughout their life. It can speak volumes about who the patient is and what they value, telling a story as a way of life review.

“This is a tremendously moving and personal gift that the patient can give to their loved ones,” says Eliason.

“It’s priceless,” Arnett says. “It’s Mom’s heart. The song was absolutely perfect and Mom chose it with Ruth, which makes it so special.”

“Our legacy will continue after we’re gone,” Eliason said. “But to be able to have it be reflected or put in something as tangible as a song is a really neat thing. It’s a good feeling to have been a small part of that.”

Anyone working in palliative care must have strength of emotion and empathy; they see joy, pain, life and death. Eliason is able to process these emotions personally, thanks to her training, which prepared her to be in “a certain space with people,” she says.

“But that doesn’t mean that there aren’t tears sometimes.”

Eliason feels the gravity of being with patients at the end of their lives, and the responsibility of encapsulating a small part of their legacy with music. She is strong for them and she often sees courage reflected back at her.

“I feel incredibly privileged to do this work because patients and their families are at a very tender time in their life,” she says. “It’s a privilege to be allowed to enter into their experience, and hopefully help. But I also find that I receive lots of gifts in the form of being encouraged by people’s strength.”

Musical therapy in palliative care, delivered by a special person like Eliason, can be transformative. Music is evocative, connected to our memories. It doesn’t have to be processed verbally. Creativity is powerful therapy.

“I think it really adds to the quality of people’s last days,” says Goodwin. “Ruth’s abilities make things easier on the family. When you hear that music it kind of resets your mind and it helps you take a nice deep breath, you know, and kind of just refocus.”

“She’s so calm and so gentle and nice, soft spoken and just a lovely, lovely person,” adds Arnett. “She just brought such a calmness, such a joy. It doesn’t have to be sad all the time.”

When people near the end of their lives, the little things can become the big things; holding the hand of someone you love, having a few bites of a favourite dessert, or hearing a beautiful piece of music. Eliason is helping her patients prepare for the end, but in many more ways, she is helping them realize they are alive.

“They are living their lives,” she says. “Making things right with others, sharing words of love and forgiveness, challenging others to live lives of deep meaning … and dreaming, still.”