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From Music Therapy – Intimate Notes – case studies compiled by Mercedes Pavlicevic

Based on an interview with Nigel Hartley who works at the Nordoff-Robbins Music Therapy Centre in London and Sir Michael Sobell House in Oxford.

I like to think that I would respond in a certain way if I knew I was going to die - but we don't know until we are actually there, until something happens. Three years ago…, I had an awful car crash that changed my life. My car turned over on the motorway, and I was unconscious.... At that very moment I knew I wasn't going to die, that this wasn't it. Here I am, working in a hospice with people who have all this time to die, and yet you can go bang, like that, with no preparation. The accident made me realize that however it happens, it is going to happen to all of us, and whatever we go through, whether it is quick, whether it is long, whether we know it, whether we don't, it is inevitable. There are lots of different ways death happens....

To me death is part of living - and sometimes with death there is an enormous ego thing, of letting go the importance of oneself within the world and realizing the smallness of who we are; the minuteness, in comparison to what it is that we belong to. And here, it is not dying that worries people, it is what is going to happen on the way there, the suffering, the pain, it is the living part of it. I can't help but feel anxious about that in relation to my own death, how will it happen, will I go through enormous suffering... the other thing is that we are alive to suffer. All of us suffer, and we carry it around with us and we go into it from time to time. It is a huge part of life, and we try and be in control of it. We are not in control at all.

Here at Sir Michael Sobell House, people come to music therapy not because they want to change, or want me to change them. They want to be with me, with another person, to experience being with someone, to be intimate. They don't come to music therapy because there is something 'wrong 'with them. People come and experience themselves as being musicians, artists, as creating and being creative - at a time in their lives when it would seem unthinkable to be so. There is a quickness about our work together, because you get to the heart of the matter much more quickly. Our society sees death as a time of giving up, of deterioration, letting go, and here they are, dying and being creative and having new experiences of themselves that would have seemed impossible, unthinkable! It is a paradox of working with people who are dying.

For example, an elderly woman, Mary, asked could she see me. She had been in hospice for only a few days and was very quiet and timid. I brought her over in her wheelchair. She was completely wrapped in blankets all round her head. She was shaking. I talked a bit about music with her and she didn't say very much, I asked her could I put the tape recorder on, which I did. Off the blankets all came, and she said, 'I want to write a song... and the song is going to be called "why do I worry"...could you play a chord on the piano please'. So I did and off she went, making it up as she went along. Afterwards she listened back to the tape and said she wanted to change this and that, so we changed it all, and within an hour we'd written this song, and that was it. She was enormously worried about dying; her death was imminent. What she released in the song was some kind of affirmation that it didn't matter whether you worried or not, it was going to happen because it is part of being alive. I thought that her song was going to be incredibly moving, very sad, but it was quite happy in the end... she was saying things like 'I am not worried about dying because my husband loves me and he's going to be there and I'm going to see him again....' Her husband had died two years earlier. She needed to say this, say it in a complete way, and I was not going to interrupt her. I was not going to focus on what she was saying even though it was vitally important, I was going to provide a space for it to be said, held and put together.

She never came again. She didn't know what music therapy was, what it could be, but she knew what she wanted from me... it was this sense of time: it is now, and if I don't do it now I am not going to do it. . ..

This event released something: music helped her make a complete, uninterrupted and affirmative statement at the end of her life... and even after that one session nurses on the ward were noticing how much more outgoing she was: she was asking for things, talking to people, there was some kind of relaxing, letting go. This allowed her to live - instead of dying for her remaining weeks.