Music for Palliative Care Staff

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This talk was presented at the 2010 American Academy of Hospice & Palliative Medicine Annual Assembly in Boston, MA. I apologize for no music being present since it could not be uploaded into slideshare.

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  • Not about music therapy for patientsNot about music thanatology/music vigilsExplain Art
  • Sinclair
  • Sinclair
  • Hurt Nine Inch Nails 1:26-2:15Johnny Cash  0:56-1:37 Genre: NIN-Heavy Metal/Industrial Metal   Johnny Cash-Country Western Context:NIN- the last song on an album entitled The Downward Spiral which many fans believe should   be taken as a whole with the entire album being largely about self destruction-the downward spiral of an individual with Hurt being the end Johnny Cash-serves as an epitaph (another end) for an aging country singer with failing health, looking back on a long career-it was made in the year before his death Themes:Grief/loss -“everyone I know goes away in the end”,  Regret-“what have I become?” “I wear this crown of thorns/upon my liar's chair/full of broken thoughts/I cannot repair”Voice of an elderly man adds to the theme Video: NIN-  images of violent death brings violent, angry, despairing emotions.  Johnny Cash- shows old family movies, pictures on the wall evokes are sadness, loneliness, grief, regret, loss of people, time, health Music  Elements: Mostly the same for both songsTempo-start very slow, singer is resigned to be sad-build up speed for the refrain, becoming angry then settles back down like bursts of emotionVolume-mostly the same until the end.  NIN version ends loudly with white noise following it.  Johnny Cash version gets louder then drifts off into silence.I hurt myself today To see if I still feel I focus on the pain The only thing that's real The needle tears a holeThe old familiar sting Try to kill it all away But I remember everything [Chorus:]What have I become My sweetest friend Everyone I know goes away In the end And you could have it all My empire of dirt I will let you down I will make you hurt I wear this crown of thorns Upon my liar's chair Full of broken thoughts I cannot repair Beneath the stains of time The feelings disappear You are someone else I am still right here [Chorus:]What have I become My sweetest friend Everyone I know goes away In the end And you could have it all My empire of dirt I will let you down I will make you hurt If I could start again A million miles away I would keep myself I would find a way
  • Hurt Nine Inch Nails 1:26-2:15Johnny Cash  0:56-1:37 Genre: NIN-Heavy Metal/Industrial Metal   Johnny Cash-Country Western Context:NIN- the last song on an album entitled The Downward Spiral which many fans believe should   be taken as a whole with the entire album being largely about self destruction-the downward spiral of an individual with Hurt being the end Johnny Cash-serves as an epitaph (another end) for an aging country singer with failing health, looking back on a long career-it was made in the year before his death Themes:Grief/loss -“everyone I know goes away in the end”,  Regret-“what have I become?” “I wear this crown of thorns/upon my liar's chair/full of broken thoughts/I cannot repair”Voice of an elderly man adds to the theme Video: NIN-  images of violent death brings violent, angry, despairing emotions.  Johnny Cash- shows old family movies, pictures on the wall evokes are sadness, loneliness, grief, regret, loss of people, time, health Music  Elements: Mostly the same for both songsTempo-start very slow, singer is resigned to be sad-build up speed for the refrain, becoming angry then settles back down like bursts of emotionVolume-mostly the same until the end.  NIN version ends loudly with white noise following it.  Johnny Cash version gets louder then drifts off into silence.
  • The God that Failed  (1991) Metallica (Black Album) 1:14-1:38 Context: Metallica singer/songwriter James Hetfield states the song is based on his early life, being raised as a Christian Scientist.  Per music lore, the death of Hetfield’s mother from cancer while practicing this faith also influenced the song. Themes:  Science vs Religion-“The healing hand held back by the deepened nail” Loss of Faith- “broken is the promise betrayal”  Death-“trust you gave, a child to save/left you cold and him in grave”Meant to shock, aggressive lyrics Music Elements: all fairly common of the Heavy Metal or thrash metal genre Tempo-fast, angry  Tone-almost yelling  Instruments-Bass guitar, drum (very percussive), guitar Works Cited: Classic Albums - Metallica: Metallica (2001)  (this is the video that contains the interview I talked about)Pride you tookpride you feelpride that you felt when you'd kneelnot the wordnot the lovenot what you thought from aboveit feedsit growsit clouds all that you will knowdeceitdeceivedecide just what you believeI see faith in your eyesnever your hear the discouraging liesI hear faith in your criesbroken is the promise, betrayalthe healing hand held back by the deepened nailfollow the god that failedfind your peacefind your sayfind the smooth road in your waytrust you gavea child to saveleft you cold and him in graveit feedsit growsit clouds all that you will knowdeceitdeceivedecide just what you believeI see faith in your eyesnever you hear the discouraging liesI hear faith in your criesbroken is the promise, betrayalthe healing hand held back by the deepened nailfollow the god that failedpride you tookpride you feelpride that you felt when you'd kneeltrust you gavea child to saveleft you cold and him in graveI see faith in your eyesnever you hear the discouraging liesI hear faith in your criesbroken is the promise, betrayalthe healing hand held back by deepened nailfollow the god that failed
  • The God that Failed  (1991) Metallica (Black Album) 1:14-1:38 Context: Metallica singer/songwriter James Hetfield states the song is based on his early life, being raised as a Christian Scientist.  Per music lore, the death of Hetfield’s mother from cancer while practicing this faith also influenced the song. Themes:  Science vs Religion-“The healing hand held back by the deepened nail” Loss of Faith- “broken is the promise betrayal”  Death-“trust you gave, a child to save/left you cold and him in grave”Meant to shock, aggressive lyrics Music Elements: all fairly common of the Heavy Metal or thrash metal genre Tempo-fast, angry  Tone-almost yelling  Instruments-Bass guitar, drum (very percussive), guitar Works Cited: Classic Albums - Metallica: Metallica (2001)  (this is the video that contains the interview I talked about)Pride you tookpride you feelpride that you felt when you'd kneelnot the wordnot the lovenot what you thought from aboveit feedsit growsit clouds all that you will knowdeceitdeceivedecide just what you believeI see faith in your eyesnever your hear the discouraging liesI hear faith in your criesbroken is the promise, betrayalthe healing hand held back by the deepened nailfollow the god that failedfind your peacefind your sayfind the smooth road in your waytrust you gavea child to saveleft you cold and him in graveit feedsit growsit clouds all that you will knowdeceitdeceivedecide just what you believeI see faith in your eyesnever you hear the discouraging liesI hear faith in your criesbroken is the promise, betrayalthe healing hand held back by the deepened nailfollow the god that failedpride you tookpride you feelpride that you felt when you'd kneeltrust you gavea child to saveleft you cold and him in graveI see faith in your eyesnever you hear the discouraging liesI hear faith in your criesbroken is the promise, betrayalthe healing hand held back by deepened nailfollow the god that failed
  • *I’ll Fly Away(1929)O brother Where art thou soundtrack, Alison Krauss/ Gillian Welch00:55 -1:40Context: Albert E. Brumley age 24, working in cotton fields, wanting to escape- singing “prison song” (Now if I had the wings of an angel/Over these prison walls I would fly, And I'd fly to the arms of my poor darlin',And there I'd be willing to die.” Thought he could make it religious.Themes:  Faith traditions (context); Hope (bright morning, when this life is over); afterlife (God’s Celestial shore), escape (Like a bird from these prison walls, no more cold iron shackles on my feet, weary days) Death (When I die…)Music Elements: Instruments: guitar and ukulele Tempo Fast, upbeat. (hope?) Melody (mode: Dorian (d chord), this is the ancient church mode and bases for blue grass music), associates it with religion,  Harmony bluegrass-  high pitched harmony (high lonesome/ tenor), and dissonance – adds to the feeling of hardship – thus wanting to escape. Lyrics:Some glad morning when this life is o'er, I'll fly away; To a home on God's celestial shore, I'll fly away (I'll fly away). Chorus I'll fly away, Oh Glory I'll fly away; (in the morning) When I die, Hallelujah, by and by, I'll fly away (I'll fly away). When the shadows of this life have gone, I'll fly away; Like a bird from prison bars has flown, I'll fly away (I'll fly away) Chorus I'll fly away, Oh Glory I'll fly away; (in the morning) When I die, Hallelujah, by and by, I'll fly away (I'll fly away). Just a few more weary days and then, I'll fly away; To a land where joy shall never end, I'll fly away (I'll fly away) Chorus I'll fly away, Oh Glory I'll fly away; (in the morning) When I die, Hallelujah, by and by, I'll fly away (I'll fly away). 
  • *I’ll Fly Away(1929)O brother Where art thou soundtrack, Alison Krauss/ Gillian Welch00:55 -1:40Context: Albert E. Brumley age 24, working in cotton fields, wanting to escape- singing “prison song” (Now if I had the wings of an angel/Over these prison walls I would fly, And I'd fly to the arms of my poor darlin',And there I'd be willing to die.” Thought he could make it religious.Themes:  Faith traditions (context); Hope (bright morning, when this life is over); afterlife (God’s Celestial shore), escape (Like a bird from these prison walls, no more cold iron shackles on my feet, weary days) Death (When I die…)Music Elements: Instruments: guitar and ukulele Tempo Fast, upbeat. (hope?) Melody (mode: Dorian (d chord), this is the ancient church mode and bases for blue grass music), associates it with religion,  Harmony bluegrass-  high pitched harmony (high lonesome/ tenor), and dissonance – adds to the feeling of hardship – thus wanting to escape. Lyrics:Some glad morning when this life is o'er, I'll fly away; To a home on God's celestial shore, I'll fly away (I'll fly away). Chorus I'll fly away, Oh Glory I'll fly away; (in the morning) When I die, Hallelujah, by and by, I'll fly away (I'll fly away). When the shadows of this life have gone, I'll fly away; Like a bird from prison bars has flown, I'll fly away (I'll fly away) Chorus I'll fly away, Oh Glory I'll fly away; (in the morning) When I die, Hallelujah, by and by, I'll fly away (I'll fly away). Just a few more weary days and then, I'll fly away; To a land where joy shall never end, I'll fly away (I'll fly away) Chorus I'll fly away, Oh Glory I'll fly away; (in the morning) When I die, Hallelujah, by and by, I'll fly away (I'll fly away). 
  • *Gustav Mahler’s 9th Symphony 19104th Movement, sehrlangsam und nochzuruchhaltend. (0:00-48)Context: 1907 dtr Maria dies at 4 ½, Gustav Dx with endocarditis, doctor tells him he will die.  Earlier work on Kindertotenleider (the death of children) –reworks this theme in final movement. Themes: Love, Grief, Death, ResolutionMusic Elements:  Tempo: (Adagio: very slow, held back or reserved), Unusual for a 4th movement to be slow.  Instruments: Violin primary – more closely aligned to human voice, can sound like weeping.  Otherwise full orchestra: Brass, Woodwinds, Percussion, etc). Tone/Pitch: D flat major, unusual as 1st movement/(home) was D Major it is considered the “saddest” major key! Melody:abide with me (abide with me fast falls the eventide, the darkness deepens; Lord with me abide) and Kindertotenleider (the day is fine on yonder heights(heaven).  Harmony: Dissonance and discord contrast with resolution in the unusual harmonic progression.  
  • By working through these next few challenges you will feel more confident in presenting music to your teams, colleagues and learners as a way to reflect upon their own experiences and practicesThese are meant to be short quick tasks so don’t worry about the perfect answer or deep personal introspection. Save that for later. This is time for brainstorming. Choose one person to be the scribe. This will change with each new challenge. New challenge, new scribeAt the end one person in each group will collect the scribed documents and hand them in to us.Check arts.pallimed.org in the next week and the edited summaries of all the groups will be posted in one meta documentHandoutsScribe packets 3 pages double sided on different color paper with promptsHandouts for everyone else 1 page double sided with prompts
  • Sinclair start, Amy finishLyrics:In my rear view I watch youWatching the twilight behind the telephone linesWith nothing to prove or to assumeJust thinking that your thoughts are different than mineIn my rear view I watch youI gave you your life, but you gave me mineI see you slowly swim awayAs the light is leaving townTo a place that I can't beBut there's no apologiesJust go on, Just go onThere are still so many things, I wanna to say to youBut go on, Just go onWe're bound by blood that's moving, the moment that we startedThe moment that we startedI see perfect little eyes, watch the shadows of the cloudsAnd the surface of the ocean out the window of a planeI get nervous when I fly I'm used to walking with my feetTurbulence is like a sigh that I can't help but over thinkWhat is the purpose of my life if it doesn't ever doWith learning to let it go live vicariously throughYou can do the same it's the least you can doCause it's a lonely little chain if you don't add to itSo go on, just go onThere's so many things I wanna say to youGo on, just go onWe're bound by blood and love from the moment that we startJust go on, just go onThere are still so many things I wanna say to youJust go on, just go onWe're bound by blood that's moving from the moment that we startedThe moment that we started
  • Lyrics:Iwish that I had known in that first minute we met, the unpayabledebt that I owed you. Because you'd been abused by the bone thatrefused you, and you hired me to make up for that. Walking in thatroom when you had tubes in your arms, those singing morphine alarmsout of tune kept you sleeping and even, and I didn't believe them whenthey called you a hurricane thunderclap.When I was checking vitals I suggested a smile. You didn't talk forawhile, you were freezing. You said you hated my tone, it made youfeel so alone, and so you told me I ought to be leaving. But somethingkept me standing by that hospital bed. I should have quit, but insteadI took care of you. You made me sleep and uneven, and I didn't believethem when they told me that there was no saving you
  • Lyrics:Steve walks warily down the street, With the brim pulled way down low Ain't no sound but the sound of his feet, Machine guns ready to go Are you ready, Are you ready for this Are you hanging on the edge of your seat Out of the doorway the bullets rip To the sound of the beat Chorus Another one bites the dust Another one bites the dust And another one gone, and another one gone Another one bites the dust Hey, I'm gonna get you too Another one bites the dust How do you think I'm going to get along, Without you, when you're gone You took me for everything that I had, And kicked me out on my own Are you happy, are you satisfied How long can you stand the heat Out of the doorway the bullets rip To the sound of the beat Chorus Another one bites the dust Another one bites the dust Another one bites the dust Another one bites the dust There are plenty of ways you can hurt a man And bring him to the ground You can beat him You can cheat him You can treat him bad and leave him When he's down But I'm ready, yes I'm ready for you I'm standing on my own two feet Out of the doorway the bullets rip Repeating the sound of the beat
  • Lyrics:I don’t wanna die in the hospital No I don’t wanna die in the hospital No I don’t wanna die in the hospital You gotta take me back outsideI don’t wanna hear all those factory soundsLooking like the girl in the sleeping gownI don’t wanna die in the hospital You gotta take me back outside Can you make a sound to distract the nurseBefore I take a ride in that long black hearseI don’t wanna die in the hospital You gotta take me back outsideHelp me get my boots onHelp me get my boots on Help me get my boots back on Help me get my boots onHelp me get my boots on Help me get my boots back on I gotta go, go, goCause I don’t have longYeah I don’t give a damn what those doctors sayI don’t wanna spend another lonesome dayI don’t wanna die in the hospital You gotta take me back outside They don’t let you smoke and you can’t get drunkAll there is to watch are these soap operasI don’t wanna die in the hospital You gotta take me back outside Can you get this tube out of my armMorphine in my blood like a slow sad songI don’t wanna die in the hospital You gotta take me back outside Help me get my boots onHelp me get my boots on Help me get my boots back on Help me get my boots onHelp me get my boots on Help me get my boots back on I gotta go gogoCos I don’t have long Is there still a world at my windowsillAll there ever was I remember stillI don’t wanna die in the hospital You gotta take me back outside Don’t know when it’s day or when its nightAll I ever see are florescent lightsI’m not gonna die in this hospital You gotta take me back outsideThey give me all these flowers & big balloonsBut I’m not gonna stay in this little roomI’m not gonna die in the hospital You gotta take me back outsideAre the stars still in the skyIs that fat moon on the riseFeel the earth against my feetAs the cold wind calls for meI ain’tgonna die in the hospital No I ain’tgonna die in the hospital No I ain’tgonna die in the hospital You gotta take me back outsideI ain’tgonna die in the hospital No I ain’tgonna die in the hospital No I ain’tgonna die in the hospital You gotta take me back outside
  • Music for Palliative Care Staff

    1. 1. AAHPM/HPNA Annual Assembly<br />Boston, MA<br />March 6, 2010<br />Music for Hospice and Palliative Care Staff<br />
    2. 2. Presenters<br />Amy Clarkson, MD<br />Kansas City Hospice & Palliative Care<br />Christian Sinclair, MD, FAAHPM<br />Kansas City Hospice & Palliative Care<br />Amber Wollesen, MD<br />Saint Luke’s Health System, Kansas City, MO<br />
    3. 3.
    4. 4.
    5. 5. Objectives <br />Analyze palliative care themes in songs from various eras and genres to help palliative care staff avoid burnout<br />Utilize music as a teaching tool with staff and learners in palliative care environments <br />
    6. 6. Elements of Music<br />Melody<br />Harmony<br />Rhythm<br />Tempo<br />Instrumentation<br />Volume<br />Lyrics<br />Context (Artist/Song)<br />Context (Listener)<br />Audience<br />Genre<br />
    7. 7. Genres<br />Classical<br />Jazz<br />Electronica<br />Traditional<br />Folk<br />Popular<br />Heavy Metal<br />Country<br />Rock<br />Reggae<br />Gospel<br />Blues<br />
    8. 8. Shared Experience<br />Candle in the Wind by Elton John<br />Dust in the Wind by Kansas<br />Knockin’ on Heaven’s Door by Bob Dylan<br />Tears in Heaven by Eric Clapton<br />Live Like You Were Dying by Tim McGraw<br />I’ll Be Missing You by Puff Daddy<br />
    9. 9.
    10. 10.
    11. 11. The God That Failed<br />“The God That Failed”<br />Metallica<br />(1991)<br />
    12. 12. The God That Failed<br />I see faith in your eyes<br />Never you hear the discouraging lies<br />I hear faith in your cries<br />Broken is the promise, betrayal<br />The healing hand<br />Held back by the deepened nail<br />Follow the God that failed<br />
    13. 13. “I’ll Fly Away”<br />Allison Krauss<br />(1929)<br />
    14. 14. When the shadows of this life have gone, <br />I'll fly away; <br />Like a bird from these prison walls I’ve flown, <br />I'll fly away <br />I'll fly away, Oh Glory <br />I'll fly away; (in the morning) <br />When I die, Hallelujah, by and by, <br />I'll fly away <br />
    15. 15. Mahler’s 9th Symphony<br />
    16. 16. “Casimir Pulaski Day”<br />Sufjan Stevens<br />(2004)<br />
    17. 17. Part 2: Small Group Section<br />
    18. 18. Challenge #1 – Palliative Themes<br />Using the Worksheet in front of you what are some of the themes and ideas you see in your daily palliative care and hospice work that could be reflected in a song. <br />Feel free to be broad or specific<br />Make a long list or start to categorize<br />
    19. 19. New Challenge, New Scribe<br />
    20. 20. Challenge #2 - Goals<br />Thinking of your different work environments brainstorm the following two things:<br />potential different groups /individuals/contexts<br />Goals of working with these groups<br />
    21. 21. New Challenge, New Scribe<br />
    22. 22. Using the following song and lyrics, answer the following questions:<br />What characteristics of the song echo palliative care themes?<br />What audience would you potentially focus this song on?<br />What goals would be best suited to achieve with this song?<br />Challenge #3Go On – Jack Johnson<br />
    23. 23. In my rear view I watch youWatching the twilight behind the telephone linesWith nothing to prove or to assumeJust thinking that your thoughts are different than mineIn my rear view I watch youI gave you your life, but you gave me mineI see you slowly swim awayAs the light is leaving townTo a place that I can't beBut there's no apologiesJust go on, Just go onThere are still so many things, I wanna to say to youBut go on, Just go onWe're bound by blood that's moving, the moment that we startedThe moment that we startedI see perfect little eyes, watch the shadows of the cloudsAnd the surface of the ocean out the window of a planeI get nervous when I fly I'm used to walking with my feetTurbulence is like a sigh that I can't help but over thinkWhat is the purpose of my life if it doesn't ever doWith learning to let it go live vicariously throughYou can do the same it's the least you can doCause it's a lonely little chain if you don't add to it<br />
    24. 24. New Challenge, New Scribe<br />
    25. 25. Challenge #4 – Ketterling/Bedside Manners by The Antlers<br />Using the following song and lyrics, answer the following questions:<br />What characteristics of the song echo palliative care themes?<br />What audience would you potentially focus this song on?<br />What goals would be best suited to achieve with this song?<br />
    26. 26. I wish that I had known in that first minute we met, the unpayabledebt that I owed you. Because you'd been abused by the bone thatrefused you, and you hired me to make up for that. Walking in thatroom when you had tubes in your arms, those singing morphine alarmsout of tune kept you sleeping and even, and I didn't believe them whenthey called you a hurricane thunderclap.<br />When I was checking vitals I suggested a smile. You didn't talk forawhile, you were freezing. You said you hated my tone, it made youfeel so alone, and so you told me I ought to be leaving. But somethingkept me standing by that hospital bed. I should have quit, but insteadI took care of you. You made me sleep and uneven, and I didn't believethem when they told me that there was no saving you<br />
    27. 27. New Challenge, New Scribe<br />
    28. 28. Challenge #5Another One Bites The Dustby Queen<br />Using the following song and lyrics, answer the following questions:<br />What characteristics of the song echo palliative care themes?<br />What audience would you potentially focus this song on?<br />What goals would be best suited to achieve with this song?<br />
    29. 29. New Challenge, New Scribe<br />
    30. 30. Challenge #6I Don’t Want to Die (in a Hospital)ConorOberst<br />Using the following song and lyrics, answer the following questions:<br />What characteristics of the song echo palliative care themes?<br />What audience would you potentially focus this song on?<br />What goals would be best suited to achieve with this song?<br />
    31. 31. I don’t wanna die in the hospital No I don’t wanna die in the hospital X2You gotta take me back outsideI don’t wanna hear all those factory soundsLooking like the girl in the sleeping gownI don’t wanna die in the hospital You gotta take me back outside Can you make a sound to distract the nurseBefore I take a ride in that long black hearseI don’t wanna die in the hospital You gotta take me back outsideHelp me get my boots on X6I gotta go, go, goCause I don’t have longYeah I don’t give a damn what those doctors sayI don’t wanna spend another lonesome dayI don’t wanna die in the hospital You gotta take me back outside They don’t let you smoke and you can’t get drunkAll there is to watch are these soap operasI don’t wanna die in the hospital You gotta take me back outside Can you get this tube out of my armMorphine in my blood like a slow sad songI don’t wanna die in the hospital You gotta take me back outside Help me get my boots on X6I gotta go gogoCos I don’t have long Is there still a world at my windowsillAll there ever was I remember stillI don’t wanna die in the hospital You gotta take me back outside Don’t know when it’s day or when its nightAll I ever see are florescent lightsI’m not gonna die in this hospital You gotta take me back outsideThey give me all these flowers & big balloonsBut I’m not gonna stay in this little roomI’m not gonna die in the hospital You gotta take me back outsideAre the stars still in the skyIs that fat moon on the riseFeel the earth against my feetAs the cold wind calls for meI ain’tgonna die in the hospital (to outro)<br />
    32. 32. arts.pallimed.org<br />

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