A Lesson From Within: Palliative Care with the Noyana Singers

Written by Marissa Mendez ’15
When I arrived at Vermont Respite Home, it wasn’t anything like I had pictured.  I thought that I would be walking on checkered tiles, in a hallway lit up with fluorescent lights that bounced off of bare white walls.  Instead, I walked into a warmly lit home.  Pictures and paintings lined the walls of the living room with comfortable couches surrounding a fireplace; freshly baked cookies sat on a side table, waiting to be eaten.  And in this room a family sat together while centered around a loved one, sharing smiles and enjoying each other’s company.

I met with Joanna May, a coordinator for the Noyana singers.  The Noyana singers are a passionate and talented group of people who spend each Saturday at the Respite Home singing for the residents.  They also frequently sing at memorial services and funerals.  I was intrigued by the idea of these singers and was curious as to what led them to bring their talents to this particular audience.   I sat in a small conference room as the singers arrived and settled in.  I could tell immediately that I was in the presence of truly genuine people who were happy to be at the Respite house.  As soon as they began singing, I was filled with the warmth of their voices and the sincerity with which they sang.  During their warm up, they shared some updates about residents who had died since their last visit.  I tried to be in tune with what the singers may have been feeling, but at that point I couldn’t quite yet read singers’ emotions when they learned of residents who had passed.  It was clear that the Noyana singers were a routine part of the palliative care process at the Respite house, but I wondered if they still experienced some grief when they heard of a resident’s death.

During their warm up, Joanna briefed the group on which residents they would be seeing.  At the respite center, the rooms are not labeled by number, but by animal.  She mentioned they would stop by the elephant and giraffe rooms and then see about a couple others.  They discussed songs they would sing and then we were off.

The Noyana singers have a gentle presence as they walk through the halls of this home.  As we were on our way to the elephant room, a nurse walked out from across the hall and informed the group that an older man had just passed on moments ago.  Hearing this made my stomach drop.  I watched as the singers moved with tact and elegance into an arch outside of this man’s room, and then they started to sing.  I still couldn’t read the emotion on their faces and wondered if they were experiencing any of the same emotions that I was.  It was surreal to think that as I was walking down the hallway, a man’s life ended a few feet away from me.  The Noyana singers began their song, gentle and sincere.  I glanced at all of the singers and was warmed by the honest and heartfelt emotions on their faces.  A few verses in, the door to the room opened and my stomach dropped again.  I realized his family was still in the room with him, and I could hear a woman weeping inside. This already powerful experience had reached a new level.  I realized that the Noyana singers had quickly become part of the way this family was experiencing losing a loved one and part of the imminent coping process that had just begun.  I couldn’t help but think about how it would feel to watch a loved one pass, and then hear these gentle voices singing just steps away.   I imagine that it would make a heavily emotional experience beautiful and peaceful.  After the group finished two songs, the woman who was weeping in the room came out to express her thanks and the singers paid their respects, some with nods and others with a few words of regards.

The group moved along to another room.  This time they were welcomed into the room of an upbeat and happy older woman.  I couldn’t help but think to myself that this woman didn’t look sick at all!  They group got into their arch and began to sing with smiles on their faces, snapping their fingers, and tapping their toes.  These particular selections of songs made you want to shake your shoulders and clap your hands, and that is just what this older woman did.  She seemed so happy and expressed her thanks numerous times.  As we walked out she quickly said, “You make sure you reach everyone in this place!”  That comment must have made the singers feel great; it was a quick reminder about the contribution they are making to these people’s lives.

We continued on through the hallway and stopped outside of a room with the door closed.  The group formed their arch and began to sing softly.  I got the impression that the resident they were singing for was not having a great day.  Singing outside of his room was a non-invasive way of showing him that they were there, thinking of him, and I am sure the graceful sound of their voices offered a soothing feeling to this gentleman during a trying time.

On our way back to the conference room, Joanna noticed the woman, who I presumed just lost her husband, in the living room crying lightly with another loved one.  The group decided to assemble behind a wall next to the living room where they could be heard but not seen, and they sang.  It was a very beautiful and touching moment.  My experience thus far had come full circle, and I began to think about what a wonderful presence this group offers at the Respite house.  Not only do they touch the lives of residents who are nearing the end, they also touch the lives of family members who are experiencing their own bouts of acceptance and sadness about their loved ones’ situations.

I followed the group back into the conference room where they did a quick wrap up.  Joanna asked the group if anyone wanted to share their emotions or reflections about that afternoon.  One woman spoke about how she felt when they were singing in the hallway for the gentleman who passed away.  Once the door opened and she knew that family members were in the room, it changed the experience for her.  She said, “As soon as the door opened, it reminded me that this isn’t about me.”

The group was curious as to what I thought of the whole thing and so I explained why I was there.  I told them about how I am very uneasy when it comes to talks of death.  I haven’t exactly found my own way of thinking about it and dealing with it in a way that I feel comfortable.  I explained to them that experiences like this are important for growing physicians to have because I think that we can offer more to our patients if we have the time to process through our own thoughts about the death and dying process.  They passionately agreed that physicians should have these sorts of experiences.

Since I was wondering about what brought them here, I decided to ask why.  It seems as if they all had a lot of the same questions, worries, and confusions about death and dying.  A few of them mentioned that the act of being here and seeing death happen seems to offer calmness to worries about the unknown.  I imagine that all musicians try to discover the ways in which they want to express their talents to the world and I admire the Noyana singers for choosing this venue.  They are a truly remarkable group of musicians and human beings.

I remember the first week of medical school when we first started to talk about death and dying.  I was really nervous about the discussion and felt uncomfortable when thinking about what my role would be as a physician when it comes to having patients die.  I think what concerns me is that I really want to be the best I can be during these times for my patients.  I want it to be about them and not about me.  Dying is such a sacred time in one’s life.  As future physicians, I believe that one of our roles will be to guide our patients into this journey of death so that when their time comes, they don’t leave with pain and suffering.  This role certainly shouldn’t involve running away because we ourselves can’t deal with the thought of death or saying goodbye to a patient we may have become attached to.  In their end, it shouldn’t all be about us.

A couple of months ago, our Palliative Care interest group put on a week’s worth of events related to palliative care.  We heard from several amazing individuals who have dedicated a good part of their practice and professional lives to caring for terminally ill patients.  I was inspired.  I realized how important palliative care is and how it can be used in any specialty in medicine.  During this week I was also struck by how little experience medical students receive in terms of working with and caring for terminally ill patients.  The thing is, every one of us has our own ways of thinking about death and dying.  And upon entering medical school, students are coming in with all different experiences; some may have never dealt with losing a loved one and others may know what it feels like to lose someone close to them.  That being said, each person needs to come to terms with death and dying in our own time.  It is nothing that can be taught in a course because it is a lesson from within.  It’s a lesson that each of us must begin and finish on our own time.

There is no doubt though that we must eventually come to terms with our handling of death and dying if we are to treat patients who are terminally ill.  This is not to say that we must fully understand the concept of death and dying; I don’t even know if this is possible.  I think that we need to be present enough with our patients who are dying to really figure out and understand what they need from us, and to be strong enough to work with them and learn from our experiences.

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