“It’s magical!”
I’ve heard family members of loved ones receiving music therapy describe it precisely this way. Often, they are referring to an immediate and unexpected response. I’ve provided a few examples of this type of response in my previous blog posts. Yet, when supporting those living with dementia, the reality is that this “music magic” doesn’t occur in every case or even in every music therapy session. In my experience, when in the throes of severe cognitive decline, some folks may have a delayed response or what may appear on the surface to be no response at all. Such was the case for Louise.
Louise was 72 years old when I met her, seated in the common area of the memory community in which she resided. An activity director stood in front of the group, attempting to engage the residents in a game of balloon volleyball. Seated in a wheelchair, Louise was disinterested, her hands clasped on her lap, glancing down at them. From all appearances, she was oblivious to the activities of others around her, socially isolated in spite of the clamor of ongoing activity of those nearby.
I stooped next to her wheelchair so that we could meet at eye level. When I greeted her, Louise looked up to meet my eyes very briefly, then looked down once more as I continued to speak. One of the care staff knew the purpose of my visit and came over to transport Louise back to her room for music therapy, before returning immediately to the other residents. Louise’s demeanor never changed, nor did she look up as she was wheeled down the hallway to her room, which was dimly lit. I opened the blinds somewhat, to create a cheerier environment while not overwhelming Louise with sudden stimulation. I casually shared a bit about why I had come to see her, that her family had requested I visit. As an aside, I’ve discovered that when initially meeting someone living with dementia in a memory community, providing assurance that his or her family knows of and even requested the visit often makes the difference between that individual agreeing to the music visit or completely rejecting the idea.
Louise lifted her head momentarily to watch as I set up my piano keyboard near her wheelchair, then stared at the wall in her roommate’s area of the room. When I pulled out my portable stool, sat in front of the keyboard and began to sing, Louise’s gaze shifted to meet mine ever so briefly. I’d been pondering which song might be good to begin with, when I decided upon one she may have heard more than once during her lifetime, called “Louise” (by Maurice Chevalier). I sang:
“Every little breeze seems to whisper Louise,
Birds in the trees seem to twitter, Louise,
Each little rose, tell me it knows,
I love you, love you.”
Though I looked for a host of non-verbal responses as I sang and played “Louise” (e.g. making eye contact, a shift in facial expression, moving of a finger or tapping of toes, changes in position, changes in breathing pattern, etc.), alas none of these occurred. I want to interject here that there may have been physiological changes registering within Louise that were not observable. Music therapists working in hospital settings, for example, are able to detect the latter through patient monitors in use to monitor blood pressure and heart rate. This is not an option in memory care, of course.
I continued sharing a variety of songs from different popular genres and artists over the course of Louise’s lifetime. I interjected some related verbal commentary here and there as well. A few songs garnered some prolonged eye contact on her part, which was certainly a good start! At the conclusion of the session, I returned Louise to the common area. In no time at all, she was back to looking down at her hands.
For the 8 subsequent music therapy visits, I began each by singing “Louise.” I noticed that over time, Louise’s interest level seemed to grow, albeit inconsistently. I was pleased to see that she was looking at me, my keyboard and her belongings in the room with greater frequency. On one or two occasions, her mouth formed the slightest of smiles for a moment. Though slight, it was progress nonetheless.
Now, I must mention that since there was a waiting list for music therapy services in this particular memory community, I was encouraged to keep a close eye for those who might not seem to be benefiting and allow others the opportunity to do so. Unfortunately, we did not always see eye to eye about what “benefiting” meant. I found it common, in this community, for the administrators to prefer that music therapy be reserved for those who demonstrated some musical competence, specific interest or for whom music played an important role in their life history. With this in the back of my mind, I set out to visit Louise for what I guessed would likely be the last time.
Once comfortable in her room, ready to begin, I decided to shake things up a bit, changing from using “Louise” as my opening song to singing, “Oh What a Beautiful Morning.” This, my friends, is when the so-called “magic” happened! As I played the introduction and sang the first few lines, Louise spoke! Yes, she spoke for the first time in any of our sessions together!
“Where’s my song?” Louise asked. Apparently, she’d taken exception to the fact that I hadn’t begun with “Every little breeze seems to whisper Louise,” as I had for the previous 8 visits! I immediately stopped what I was doing and launched into “Louise’s song.” And that’s when Louise actually began singing some of the lyrics along with me! I made a conscious decision not to stop – to continue from one song to another without silence – to see if indeed Louise’s singing might continue. Sure enough, it did! For the next couple of songs, Louise filled in several of the lyrics to other familiar songs as we sang together. Truly magical moments, one after another!
When I shared what happened with Louise’s daughter by phone, she was astounded. To be honest, at first I wondered if she believed me at all. Yet, she was hungry for every detail, and I was eager to share. By the end of our conversation, she had learned more about the power of music to produce unexpected connections within the brains of those with dementia. I learned that I should always honor my intuitive response in situations like Louise’s. Not every person with dementia will have a dramatic response as Louise did on that day. Yet, there can be something going on beneath the surface that is making a difference – one we may not be able to observe or precisely measure. Patience is indeed a virtue, friends!
(Names and identifying details, including the song title in this case, have been changed to protect the privacy of individuals)