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Walking the last mile with music therapy

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The afternoon sun streams through Carmen's window and colors everything a bright yellow. Her room is cheerfully and simply decorated. A comfy chair sits in the corner. Fresh flowers adorn the TV. If it weren't for the hospital bed and the get-well cards on the wall, it would look like an ordinary bedroom. But this room is in Benincasa, a hospice care facility in Mendon. Carmen is dying.

Yet the mood in the room is more alive than all the day-to-day activity outside. To Carmen's delight and to that of her cousin and primary caregiver, Cassie, music therapist Phillip Marshall has just arrived for his weekly visit.

With his guitar slung over his shoulder and a notebook full of songs under his arm, Marshall strolls into the room and sits down in the chair next to Carmen's bed. He takes her hand and gently strokes her arm. She smiles.

"Carmen, are you in any pain?" he asks. "Are you feeling anxious at all?" Carmen indicates she's fine, so Marshall launches softly and earnestly into "Amazing Grace." Carmen quietly sings along, frequently closing her eyes. The whole scene is serene. As Marshall strums and croons, the weight in the room lifts. A calm descends. Other spirituals follow: "In The Garden," "What A Friend We Have In Jesus," "Precious Lord."

Brought together by a social worker, Marshall and Carmen have been singing every Friday for close to two months now.

"She enjoys singing," Cassie says. "Most of the time she closes her eyes, she relaxes completely, and doesn't even think of being ill. She loves music." And she loves Marshall's visits.

"He's a blessing to us," Cassie says. "And Carmen likes him. That's all that matters."

Benincasa ("good home") opened in October 1996. The house has a small paid staff and relies almost exclusively on volunteers, fundraising, donations, and "a lot of hard work and community support," says house manager Laurie La Salle, who lights up with Marshall's visits as well.

"Everybody that he's played for has really found a great benefit," La Salle says of Marshall. "He's magic."

Marshall found himself at a crossroads in 1997. Already an accomplished musician and former member of the acclaimed Colorblind James Experience, he wanted more than to play one-nighters and languish in retail.

"I had a bachelor of arts in music," he says, "which is really the most worthless degree you can get. It doesn't prepare you for anything. Working in a music store, that's about it."

Going back to school seemed like a viable option.

"I was really thinking 'I'll wind up with a teaching certificate,'" he says. "But I hated the idea of going and getting my teaching certificate. I didn't want to teach at all. It was the music department chairman at Nazareth who mentioned music therapy. As soon as I heard that, I loved it. I'd played a lot of music and been in a lot of therapy, so I knew a lot about both just from experience. I said 'OK, this makes sense. I can do this.' I just loved the concept."

In its broadest application, music therapy is used to improve the quality of life for anybody, whether they're well, disabled, or dying.

After graduating from Nazareth in 2001 and completing an internship at Hochstein School of Music, Marshall began teaching guitar to music-therapy students at Nazareth and working with the disabled.

"That was my first exposure to people with disabilities," he says. "It was a really meaningful experience. So right away I understood music therapy was gonna be something like that."

But Marshall wanted to go further.

"I wanted to get into a more holistic kind of healing thing," he says, "where you're talking about your mental state, your emotional state, your spiritual state." And this is what he does daily in his visits to patients receiving hospice care.

While music therapy seems to be growing in popularity, there are still many people who don't understand the concept and many more who haven't even heard of it.

"For the entire history of the profession we've had to continually educate people about what it is and how it works," says Dr. Brian Hunter, coordinator of the music therapy program at Nazareth College. "And through that process it's been a slow and steady growth. It's sort of an ongoing process."

Music therapy doesn't offer a cure, which might cause some people to question its purpose.

"I think sometimes there can be misconceptions," Hunter says. "But usually when physicians work with a music therapist and see the benefits to the patient, they're pretty supportive."

Dr. Russell Hilliard, director of music therapy at SUNY New Paltz and double bassist in the Newburgh Symphony Orchestra, blames the practice's obscurity not on medical ignorance, but on social tastes.

"I think the general population recognizes music for healing," he says. "Music is good for you, and everybody listens to music. But I think we live in a culture that doesn't always appreciate the arts."

And it's still relatively new. General music therapy was first introduced as a way to treat veterans after World War II, and publications like The Journal of Music Therapy have been around since 1964. But it took until 1983 for Medicare to reimburse for hospice, where music therapy tends to be administered.

When applied in hospice, music therapy is still about improving the patient's quality of life, regardless of how short that life may be. In order to sign on with hospice care, a patient must have a prognosis of six months or less. Also, a DNR (do not resuscitate) order must be signed by the patient or guardian.

After all curative measures have been exhausted, the patient's comfort --- mentally and physically --- is the only objective. And providing this comfort --- or palliative care --- is exactly what Marshall wanted to do.

It wasn't long before he got his chance. Lifetime Care, a regional agency providing home health care and hospice services, received a grant to experiment with music in hospice during Marshall's senior year. The agency approached Dr. Hunter, who turned to Nazareth's senior class. Marshall was the only one to express interest.

"I think that's basically because I was a 42 year old, I had experienced a lot of death and tragedy," he says. "I was no stranger to it. It didn't turn me off; I wasn't scared of it. Most of my student colleagues were 20 year olds with very little life experience and I think the idea was just a big turn off."

Lifetime Care didn't know what to expect. Neither did Marshall.

"So I just kinda walked into it," he says, "without any knowledge of what hospice was and how what I did would be applied there. But they turned out to be very happy with me just kinda feeling my way through it."

Years on stage have taught Marshall to improvise. He can play gospel songs to black Baptists and white Pentecostals. He keeps the songs flexible, allowing the situation and the patient to dictate.

"I've got patients who have sung all their lives and they want to sing along with me," Marshall says. "I've had other people where basically it's more like music ministry where they're just very passive and they just want you to play songs."

"Music can help fill a void or a gap when it's difficult for verbal interaction," Hunter says.

Often, Marshall goes beyond the music. He once set a scene to spark a memory for a dying jazz fan.

"What he loved more than anything," Marshall says, "was going to a bar, getting a beer, smoking a cigarette, and listening to jazz. So we turned his room into a little nightclub. And I just sat there like a lounge act and played 'Stardust' and all these old songs because that's what gave him joy."

A far cry from "Amazing Grace."

"It doesn't have to be dour and down," he says. "Very often it's a party."

"I met this man who was in his mid-50s and he had played rock 'n' roll in bands all his life," Marshall says. "And he loved The Everly Brothers, loved Elvis, loved The Beatles, and he liked to sing harmony parts."

Marshall and the man's older brother would jam together on old rock 'n' roll classics, creating an atmosphere the patient was familiar with.

Despite all this shared comfort and joy comes the dim inevitability.

"One of his favorite songs was 'All I Have To Do Is Dream,'" Marshall says. "I started playing it instrumentally, and he took his last breath while I was playing. I just broke down after that."

Marshall now takes comfort in advice he got early on from a nurse practitioner.

"He said, 'If you fall in love with everyone you work with, you're in the wrong line of work. If you don't fall in love with anybody, you're in the wrong line of work.'"

"I often have this feeling of 'Why did I meet this person now?'" he says, his sadness matched only by his awe.

"It's almost indescribable," he says. "It's just knowing that in a moment that's so extraordinary you've been allowed to be a part when somebody is passing and you become close and you become intimate and it's intense. It's referred to as 'walking the last mile.' You're walking the walk with them. And yeah, you invest a lot. You invest a lot emotionally when you're doing that."

Early on in his career, Marshall found himself distancing himself from friends. He was jaded.

"I'm so hyper aware of our own mortality," he says, "that I kinda want to deny it in my friendships."

He now strives for a stable balance between his personal and professional lives. But sometimes the grief won't be denied and you have tocry.

"When you do cry," he says, "you're weeping for everybody at that point. You know, grief is... it's cumulative. When I cry for somebody that I've been dealing with in hospice, part of that grief is for Chuck [his bandmate in Colorblind James who passed suddenly]. Part of it is for my brother. Part of it is for the miscarriage my wife had before Roy. Part of it is for [fellow musicians] Brian Horton, for Luke Warm... just everybody. Grief is grief."

And yet in this emotional continuum, Marshall gains renewal through his teaching. And more students are called to music therapy each year.

"Nazareth is something I do because I have a pool of kids who are fresh-faced and eager to embrace life, who wanna learn how to play guitar," he says. "And it balances off all the dark realities of what I deal with day to day. It's a balancing act for me."

Sam Snyder graduated last month with a degree in music therapy from Nazareth. He credits Marshall for his interest in hospice.

"I actually had my first death yesterday," he says. "I really only knew the person for about 10 minutes before they passed away. The minute I walked into the room was the first time I met them."

Snyder welcomed the experience with the same reverent awe of his teacher and mentor.

"It's a very intimate part in their life," he says. "If you think about it, we have very few moments as humans that are intimate moments in life. Birth is one of them and marriage is another. And death is a very intimate moment whether it lasts 10 minutes or six months."

Like Marshall, Snyder stumbled into music therapy after initially pursuing a career in teaching.

Another one of Marshall's students, recent music-therapy graduate Christina Lewandowski, knew right away.

"About three weeks after the attacks on the World Trade Center," she says, "a bunch of music students went down to New York City and sang on street corners, in firehouses, hospitals, things like that. And basically what I saw --- you know, grown men bawling as we were singing, strangers congregating in Union Square listening to us during rush hour after work, people just coming together and taking time out to listen and really be peaceful --- it had such an impact on me."

Lewandowski hopes to work in hospice. You get the impression it's something she needs to do.

"Hospice in general is an amazing, amazing area of social work," she says. "Just being able to help families and help patients is so important."

And it's a hard job Marshall won't try and soft sell or downplay.

"You know, yeah, I keep going because this is my job,"he says. "But at the same time, there's definitely an emotional connection with me when somebody is responding in that way to my music and to me as a person. Then thatbecomes the primary motivation."

Between tunes, Marshall congratulates Carmen on her singing. When his hands aren't on his guitar he's holding her hand or touching her gently, reassuringly. Cassie looks on from the corner, only interrupting to administer sips of water.

"He's so sweet," she says. "He's like medicine for her."

Amidst the peaceful music and sunshine, Carmen begins to chuckle. Marshall asks why.

"Because I love you," she says.

The session almost over and the hymns exhausted, Marshall begins to randomly fingerpick a soft little piece. It flutters and lulls as Carmen falls asleep. Marshall quietly pulls the door behind him as he tiptoes out.

For more information on music therapy go to: www.musictherapy.org and www.grhc.com. Benincasa can be found at www.home.eznet.net/~benincas/

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