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Justine Flynn, MA, CM-Th
Providing spiritual care through music

Justine is certified to practice music-thanatology by the Music-Thanatology Association International, which describes music-thanatology as "a subspecialty of palliative care which provides emotional, physical, and spiritual care for patients and loved ones through the prescriptive use of music".

Justine's primary music-thanatology mentors are Margaret Pasquesi, CM-Th and Tony Pederson, CM-Th. Under their supervision, Justine was the first music-thanatology intern at the Midwest Palliative and Hospice CareCenter of Glenview, Illinois, where she was an integrated member of the interdisciplinary team.

After certifying in 2012, Justine worked with Presbyterian Medical Services The Hospice Center in Santa Fe, New Mexico, providing music-thanatology coverage while Judith Shotwell, CM-Th was away during the summer. Later in 2012 and into early 2013, Justine provided music-thanatology coverage for Hospice of Missoula, while Lawrence Duncan was on leave. Currently, Justine provides on-call music-thanatology services to Partners Hospice in Missoula, and her work has garnered several awards, including 2013 Hospice Program of the Year Award from the Hospice Care Foundation.

Justine's musical background is quite different than the realm she finds herself in these days. Four years at Juilliard and ensuing adventures in rock, jazz, and experimental music projects took Justine through worlds of experience over two decades. While traveling and playing, she performed with everyone from Dave Brubeck, Clark Terry, and James Galway to Johnny Mathis and the rock bands of Albuquerque, New Mexico (while holding a horn position with the New Mexico Symphony). Her passion for improvisation, composition, and band leading led her to collaborate with poets and musicians of all kinds. It also led to a graduate degree in composition & experimental music at Wesleyan University, where she enjoyed the richness of the World Music program, and had the opportunity to work with Anthony Braxton, Ron Kuivila, and Alvin Lucier.

Frequently Asked Questions

Thank you for your interest! Here are brief responses to questions music-thanatologists are most frequently asked. For more information, please visit the website of the Music-Thanatology Association International: www.mtai.org


What is a music-thanatologist?
Why is the word vigil used?
Is this a religious thing?
What usually happens in a music-thanatology vigil?
Do you take requests?
What does a workday look like for you? How many patients do you see in a day?
How do you get referrals? How do people refer patients to you?
What do you do, when you get a referral?
Do you make referrals?
How do you approach patients? Do you use the words 'music-thanatology' when you speak with patients and loved ones?
How long are you usually with a patient?
How is the music-thanatologist trained?
What are the certification requirements?
Who pays for music-thanatology? How much does it cost?
Why is music-thanatology so much in demand?
What's the difference between music therapy and music-thanatology?
How do you get along with music therapists?
What are some positive things you hear about music-thanatology?
Isn't it hard to be around all that grief, all that suffering?
Why music-thanatology? How did you come to music-thanatology?

Resources



What is a music-thanatologist?   To the Top

A music-thanatologist is a person who has been specifically trained to use harp and voice prescriptively in the care of the dying and their loved ones. A certified music-thanatologist has met criteria demonstrating his or her suitability and competency for this specialized work, in the areas of personal, musical, medical, clinical, thanatological, and professional competency. Certification is offered by the Music-Thanatology Association International (MTAI), or Therese Schroeder-Sheker, the founder of this field.

According to the MTAI, the "Music-Thanatologist (CM-Th) works to provide a musical presence that draws together and responds to the various streams of diagnosis, prognosis, personal, spiritual and social context, as well as the presenting and ever changing physiological parameters of the patient."


Why is the word vigil used?   To the Top

The word vigil refers to the "watching" that we do, as a community, to accompany our loved ones as they die. As a music-thanatologist, I attend the dying patient and loved ones with focused, compassionate attention.


Is this a religious thing?   To the Top

There is a difference between religious and spiritual. While they can be the same thing for some people, spiritual care seeks to support people in their uniqueness while recognizing each individual has the potential for spiritual, also known as "existential", suffering. Music-thanatology is both clinical and spiritual care.

Particularly at the end of life, as in any transformational process, existential concerns may become the center of an individual's experience. As multi-dimensional beings, humans are best supported by a multi-disciplinary approach. This is part of why good quality end of life care emphasizes support of patient and loved ones by the entire interdisciplinary team, as well as community members.


What usually happens in a music-thanatology vigil?   To the Top

The music-thanatologist introduces her/himself to the patient, whether or not the patient appears to be conscious, and communicates what she/he is doing: gently touching upper extremities and forehead to check pulse, skin temperature and moistness. All this goes into the clinical note. Patients are sometimes painful from various medical procedures, bruised, or experiencing disorientation or agitation such that being touched by a stranger, however gently, is contraindicated. In this case, we do not use touch for pulse and skin assessment.

The music-thanatologist helps create a peaceful environment: perhaps turning off a bright overhead light, raising or lowering a window shade, setting up chairs at the bedside so that loved ones may draw nearer to the dying patient, and other alterations that assist in relaxation and the turning of attention toward the patient. Our focus is on the patient, and we model how to be with a dying person.

Setting up at the bedside, but not in the way of loved ones, the music-thanatologist then takes time to contemplate the musical "prescription", including the method of delivery. Attending closely on many levels of observation, the music-thanatologist watches respirations of the patient and their quality, rate, sound, and effort. When ready, either harp or voice, or both together may begin. All depends on the patient. The music-thanatologist "follows", utilizing musical elements to support the patient's process.

The music-thanatology vigil is not a performance, but rather an offering to accompany the patient, a support for where the patient is in his or her process in that moment. I have observed loved ones draw closer to the patient, get into bed with and hold their dying loved one. Sometimes patients and loved ones cry, laugh, moan, sing, fall asleep, and other things that come up for people as emotions come to the surface. The music-thanatologist never knows what a music-thanatology vigil will hold. Our job is to support the patient and loved ones. To this end, we practice.

Often, within the clinical context, patients and loved ones are grappling with resentments, attachment, profound love and loss, and decades-old conflict within these relationships - all while having to make serious decisions about medical care. This is often a situation people have not been in before. There can be so much going on that having 30-60 minutes to just rest, to not be asked to say or do anything, is an incredible gift.

Music-thanatology seeks to provide whatever is needed, in each moment of the vigil. By bringing a peaceful presence to the bedside, being an "open field" to patients and loved ones, and utilizing musical elements to address the changing physiology of the patient, music-thanatology can offer a space of rest, relief, and release.


Do you take requests?   To the Top

Not really! Music-thanatology uses elements of music, so we don't approach music for patients as pieces or songs, so much as a combination of elements in service. Because we are thinking prescriptively on a moment-to-moment basis, we need to be conscious of the elements we are using. Those elements include: meter, timbre, volume, long or short melodic phrases, repetition, range, text, vowel sounds, and silence. We are attending closely to physiological changes in the patient, so we need to be very open and flexible in order to follow, while simultaneously skilled and grounded. The work of music-thanatology is both a clinical and contemplative discipline.


What does a workday look like for you? How many patients do you see in a day?   To the Top

A typical day can look like this:

Respond to all phone messages and emails, prioritizing those who are most imminent or in crisis. Review patient notes electronically. Schedule the day based on patient need, taking into account traffic, weather, etc.

If the day includes a visit to the hospice inpatient unit (IPU), there will often be an additional patient or two that has come in, or who now has a referral to music-thanatology. That patient is worked into the schedule as possible, again evaluating and responding based on status (how imminent is death?) and level of need.

We may see 3-5 or more patients in a day, traveling to each location or seeing a few at one facility. After each visit, a detailed clinical note is written that include pulse, respiration, skin temperature and moisture. Similar to a nursing assessment, this information is noted both before and after the vigil. The respiration in particular is closely attended to, noting all changes that occur during the vigil. The music-thanatology clinical note includes any movements and expressions offered by loved ones, as well any change in grimace, clenching or unclenching, furrow or un-furrowing of brow that occurs in each patient, as well as how musical elements were prescriptively delivered.

This level of detail can be enormously helpful to other members of the interdisciplinary team (IDT), who do not have the time to spend 30-60 minutes observing each patient. We record observable date, "phenomenological" information, as well as what is happening with music at the time. Our narrative tells the story of what happened in the vigil, without judgment.


How do you get referrals? How do people refer patients to you?   To the Top

The doctor, nurse, chaplain, social worker, or any other member of the interdisciplinary team may refer a patient to music-thanatology. The patient and loved ones may request a music-thanatology vigil at any time.


What do you do, when you get a referral?   To the Top

I gather information. First I get back to whoever referred me by phone, email or in person. I read all the clinical notes in the patient's electronic chart, and confirm patient status. I usually will talk with the nurse who is providing care for the patient, and gather additional information. Sometimes the nurse will ask if they would like a musical visitor, or I will go in and introduce myself and ask if they would like to have some music.

I protect patient confidentiality at all times, according to HIPAA ( http://www.hhs.gov/ocr/privacy/) guidelines.


Do you make referrals?   To the Top

As a member of the interdisciplinary team, I also make referrals. I remember one patient who was referred to music-thanatology by the music therapist because the patient was in a pain crisis. This pain crisis was an obstacle to music therapy being a helpful modality for this patient. We went to offer a vigil for the patient, who seemed to have pain under control through a new medication. After the visit, we referred her back to music therapy! Through the combination of tools used in managing her pain: medication, music-thanatology, and the mystery of her own process, she was appropriate for music therapy again. In a typically unpredictable turn of events, two weeks later I visited this patient in the hospice IPU (inpatient unit) and offered a vigil for her during which she died, surrounded by her family.


How do you approach patients? Do you use the words "music-thanatology" when you speak with patients and loved ones?   To the Top

Sometimes the nurse will ask patients and loved ones if they would like a musical visitor, or I will go in and introduce myself and ask if they would like to have some relaxing, beautiful music.

I don't usually use the terminology of "music-thanatology" when speaking with patients. Patients and loved ones have enough going on without my introducing some weird new terminology! Of course, if people want to talk about what I am doing and how, I am available. As in all aspects of hospice care, the patient leads.


How long are you usually with a patient?   To the Top

The vigil usually lasts between 30-60 minutes, but may go longer. Also, patients and loved ones can let us know if they have had enough at any time. Sometimes 10 minutes is just right.


How is the music-thanatologist trained?   To the Top

The field of music-thanatology is young. Founded by Therese Schroeder-Sheker in the 1970s, training in this work has only recently begun to branch out from its rich and deeply rooted center.

There are currently two training programs for music-thanatology: the Chalice of Repose Project based in Oregon, and the Lyra Precaria Program (described as "a pastoral care adaptation of the clinical-contemplative field of Music Thanatology") in Japan. These two differ in their approach to music-thanatology. Below is contact information for each.

Chalice of Repose Project
Therese Schroeder-Sheker, CM-Th
info@chaliceofrepose.org
http://chaliceofrepose.org/


Lyra Precaria
Carol Sack, CM-Th
csack@jela.or.jp
http://www.jela-foundation.org/servicemusic.htm


What are the certification requirements?   To the Top

Graduates of the Chalice of Repose Program are often certified by Therese Schroeder-Sheker, and are also eligible to apply for certification with the MTAI.

Music-thanatologists certified by the MTAI are certified in six competencies: personal, musical, medical, thanatological, clinical, and professional. The certification process requires the completion (or partial completion) of a music-thanatology training program, writing from each candidate that shows integration and demonstration of these competencies in great detail, and recommendations from certified music-thanatologists and other healthcare professionals attesting to each candidate's suitability for certification and entry into this specialized field.

For more information on music-thanatology certification requirements, please see the MTAI website: http://www.mtai.org/index.php/certification


Who pays for music-thanatology? How much does it cost?   To the Top

Patients and loved ones do not pay for music-thanatology. Insurance does not pay for music-thanatology. Hospitals and hospices often budget for music-thanatology through spiritual care or nursing departments, or write grants in order to fund this service.


Why is music-thanatology so much in demand?   To the Top

Patients and loved ones are often in a state of crisis, as they come to the end of life. Whether they are dying after a long illness or suddenly through unforeseen circumstances, death is a reality all its own. It often brings people into an experience they have never had before as loved ones, and as patients preparing to die.

There are often physical, emotional, and existential issues that arise during this time. Music-thanatology addresses the multi-dimensionality of each patient, including the physiology that may change moment to moment.


What's the difference between music therapy and music-thanatology?   To the Top

I cannot describe music therapy because I don't have that background. Having several music therapy colleagues, though, I feel at least informed enough to share the following.

Music therapy often uses interactive singing, composing, storytelling - it is wonderful work. I saw a music therapist work with an elderly patient who was 110 years old. She was not appropriate for music-thanatology. She was singing along with the music therapist, remembering different times of her life that the therapist asked her about, and she was very engaged.

Music-thanatology comes in often when people are more sort of "dissolving". In a way, they themselves are returning to the elements, and as music-thanatologist I approach them with this way of utilizing music - elementally.

Music-thanatology says, "There's nothing you have to do (you're busy enough preparing to leave your body). You can let yourself rest deeply." Music-thanatology supports the patient in the process they are already in, whichever way they're going, and we have no way of knowing that outside of following in the moment. That is perhaps our most defining difference.


How do you get along with music therapists?   To the Top

I collaborated with music therapists while interning at the Midwest Palliative and Hospice CareCenter, in Glenview. This was a fabulous team. I went along a few times with the music therapists, to observe their work. Their work is very different than ours, and having both disciplines available to patients makes for outstanding care. I witnessed beautiful, compassionate care for people dealing with terminal illness through life review, musical relaxation, and the attendance to neural processes. I greatly appreciated the ability to refer patients to them, and vice versa.


What are some positive things you hear about music-thanatology?   To the Top

  • We are welcome back, when we visit.
  • We are becoming part of a "standard of care" for end of life care and palliative care.
  • We are highly sought-after. Our training is intensive, the most intense and clinically disciplined of all the harp-based approaches to caring for the ill.


Isn't it hard to be around all that grief, all that suffering?   To the Top

It can be. Sometimes a patient is in intractable physical, emotional, and existential pain, and music-thanatology supports the ventilation of feelings - despair, rage, grief, physical or emotional agony, abandonment... Other times the patient is silent, apparently unresponsive, and the loved ones are expressing emotions. Still other times, all appears unchanged except the respirations that have been closely attended to, by the music-thanatologist. Respiratory changes, such as ease in labor and decrease in rate, often occur. Patients often fall asleep, as well as their loved ones. The music-thanatologist never knows what a vigil will be, how it will go or what the patient and loved ones will do, because each death is unique. Each of us dies in our own way, and the music-thanatologist supports the individual's process.

What I have found is the incredible beauty that can be present in death. Some deaths I have witnessed have appeared peaceful, graceful, and easy. Of course I cannot say what the patient's experience was, I can only state what I observed. Breath slowly becoming lighter, more shallow, more spacious, until it stops moving through the physical body. The breath has left the body.


Why music-thanatology? How did you come to music-thanatology?   To the Top

I'm glad you asked! I had been playing brass instruments for many years, it being the one thing that defined my life and me in the world. In 2008, after several malfunctions of my new horn, I sent it back to the maker and decided to have a break. I had taken a regular day job working for my friend's business, so I could let go of playing horns for money. This was a great opportunity.

I felt very good without an instrument, and free for the first time in about 28 years. I was given the realization of my lovability just for being me, and my deserving to live because I was alive. This was important.

In the fall of that year, I entered into the SEEL retreat (Spiritual Exercises of Saint Ignatius) through our local Jesuits and Holy Names sisters, here in Portland. For the next nine months, while I went about my regular daily activities (work), I made extra time for prayer, meditation and contemplation.

During this retreat, I was asking for guidance (from God, Creator, Universe, Great Reality Deep Within, Infinite Love, call it what we will) as to how I could make the highest return on the gifts I've been given.

There were people from the Providence healthcare system (they have music-thanatologists on staff at many of their hospitals) on this retreat with me, and I began to hear about music-thanatology, even running into one at a party. This is unusual, because there are only about 100 music-thanatologists worldwide.

I called one of the local music-thanatologists for referrals to harp and voice teachers, to see about it. I started both harp and voice, and little by little, with each step I took I found confirmation. This was the way. There was a training getting started in January 2010, and by the start of the program I had let go of my job and committed myself completely to learning this sacred work.

I have been a performer all of my life. Really. And it is a relief to find that music-thanatology is not performance. Other than the way one uses this term, as in "job performance", our work is not performance in any way I have ever known it.

It is a great relief to find work in which my skills as a musician can be put to use in service of someone else, hopefully to provide what is needed: beauty, reverence, and respect.





Resources   To the Top

Books

Hollis, Jennifer L. Music at the End of Life: Easing the Pain and Preparing the Passage. California: Praeger, 2010.

Singh, Kathleen Dowling. The Grace in Dying: How We Are Transformed Spiritually as We Die. San Francisco: HarperSanFrancisco, 1998.

Links

National Hospice and Palliative Care Organization www.nhpco.org

Music-Thanatology Association International www.mtai.org

Midwest Palliative & Hospice CareCenter www.carecenter.org

The Joint Commission www.jointcommission.org

Circle of Love www.comfortcaremusic.com

Thank you for listening! If you enjoy this music, please consider sending a donation to the post office box listed below, or simply donate online.



Justine is a Juilliard graduate and an MTAI certified music-thanatologist, clinically trained and certified in personal, musical, clinical, medical, and thanatological competencies. While this training is specific to those with a terminal illness or in the dying process, Justine has found it beneficial to people in all sorts of transitions, i.e. divorce, job change, life transitions, bad days...

Justine Flynn, MA, CM-Th utilizes harp and voice to assist your release from overwhelming stress. Justine will spend about an hour with you, attending to your respirations and offering a musical "prescription" uniquely for you in that ever-changing moment. Things people say:

"The music just makes the pain float away." ~ patient

"It's like I can just rest, not do anything." ~ patient's daughter

"I can never meditate. While you were playing, my mind finally calmed down." ~ group class participant

"It is so beautiful. I can't believe how beautiful your music is." ~ patient

"I've never seen her rest like that." ~ patient's daughter


link to below article in The Missoulian

How can someone describe death as 'beautiful'?

November 13, 2012 6:30 am - By JUSTINE FLYNN for the Missoulian


Q: Recently, a friend's father died of asbestosis. A construction worker in the 1960s and '70s, he was regularly exposed to asbestos. From what I understand, there is no cure for this illness, and he died within a few months of diagnosis. My friend loved his father very much and is grieving his loss. However, he described his father's death, and the time leading up to it, as "beautiful". I have never been with someone as they die, and have a hard time understanding this. What is a "beautiful" death? How is beauty possible when someone is dying?

- Frank M.

A: Frank, thank you for this question. It can be difficult to imagine how beauty combines with the end of life. The experience of beauty is so personal - as individually unique as our birth and death.

The dictionary defines beauty as "the quality or aggregate of qualities in a person or thing that gives pleasure to the senses or pleasurably exalts the mind or spirit." How can we be "exalted" when our hearts are breaking? How is beauty present within each of us, and our relationships, when they are undergoing such a transformation?

From my own experience, my grandmother's death was "beautiful". Here is my description of it for you, in reply to your question:

The house was full of dogs, children and adults noisily enjoying our traditional Christmas Eve: tables full of food, including seven kinds of fish and delicious Italian pastry, sports on TV, my uncles arguing about who was more bald and alleged sightings of Santa out the window. There was even snow falling outside.

Although Christmas Eve is second only to Easter in our family holiday calendar, this night was of profound importance because my grandmother was in the last hours of her life. People came to her bedside to express love and gratitude, as they had been doing for weeks. We comforted each other with hugs, kisses and shared tears. We were saying goodbye.

Throughout that night her face appeared to smooth and brighten, even as she no longer opened her eyes and her respirations became more congested, shallow and further apart.

She was dying of congestive heart failure, renal failure and a general shutdown of organs, but she did not appear to be in any pain or discomfort. She was 83 and had lived a long, loving life devoted to her family. She was dying within the beauty she lived and created.

During Grandma's dying, we had hospice care. Hospice supported all of us - patient and family - from many directions. Our spiritual, emotional, social and physical needs were addressed before we even knew we had them. We were supported in ways that allowed us to be more fully present to Grandma, and each other. Hospice helped create a space for our family within which we could experience the grief, mystery, joy, pain, confusion, and other aspects of death. I look back on that time as both painful and beautiful.

What was beautiful about it? Washing Grandma's hair for the last time, cooking her special foods while she was still eating, massaging her feet, doing her nails, remembering stories of her life and ours together, old friends coming to visit. Being together. The beauty of my grandmother and our family, the family she nurtured, accompanied us in her dying.

For my grandmother, the beauty of life was family, food and nature. Growing up in Italy, she spent hours walking through orchards, climbing rocks and trees, and helping her grandmothers cook and sew. Once in America, she kept those values as she grew into a wife and mother. She taught me that love is the most important thing in life, and caring for our loved ones is the most fulfilling thing we can do. One of the gifts of her passing was my own awakening to a role in caring for the terminally ill and dying. Today, I bring beauty, peace and comfort to the bedside as a music-thanatologist.

Music-thanatologists Lawrence Duncan and Mary Werner will introduce the topics of beauty and meaning-making during end of life, at this month's Community Conversation. How do you imagine beauty being a part of your end of life experience? Have you had an experience of beauty, or the lack of it, at the end of a loved one's life? Bring your experiences and ideas to The Loft in Missoula this Thursday from 6 to 9 p.m. Live harp music and refreshments provided.


Justine Flynn is a certified music-thanatologist. If you have a question for Life's End and our team of experts, email theresan@hospiceofmissoula.com and we will respond to you directly or in the Missoulian.

Justine Flynn, MA, CM-Th
Thursday, November 14th, 6pm
Candlelight Memorial Service
The Springs
Missoula, MT
Wednesday, November 20th
7:45pm-8:45pm
Justine's Talk & Demonstration
Missoula Public Library
Small Board Room
Missoula, MT
Tuesday, December 3rd
Tree of Life
6:30pm Tree Lighting at Rose Park
7pm Reception at
St. Paul's Lutheran Church
Missoula, MT
Sunday, December 15th, 2pm
Candle-lighting Memorial Service
Garden City Funeral Home
Missoula, MT
Providing spiritual care through music
Vacant2

text for Vacant2 goes here.....


Justine Flynn, MA, CM-Th    (406) 241-6206    justine@justineflynn.com