Music therapist draws SSM hospice patients into life's rhythms

October 1, 2017


ST. LOUIS — It's a special day at Charlie and Barbara Pellegrini's home in St. Louis' famed Italian neighborhood, The Hill. Barbara's mother, Juanita Ward, is celebrating her 93rd birthday.

Music therapist sings to a client
Juanita Ward brightens as SSM Health at Home Hospice music therapist Brian Hilderbrand serenades her in her daughter's St. Louis home. Photo courtesy of SSM Health

Listen to Ward and Hilderbrand sing ‘Amazing Grace’

But despite the hoopla, including a visit from Ward's great-grandchildren Sophie, Jack and Ryan Gayer, ages 8, 5 and 3, Ward is not in a festive mood when Brian Hilderbrand, a music therapist with SSM Health at Home Hospice, arrives for his twice-monthly visit.

Ward, who suffers from congestive heart failure, moved into her daughter's home seven months earlier, after her last hospital stay. Widowed for 37 years, she was used to living independently.

"I feel so useless now," she tells Hilderbrand.

Hilderbrand acknowledges her feelings and reminds her that her grandson has moved into her house. "I am glad that someone I know is living there now," she admits.

With that, Hilderbrand pulls out his guitar and begins to play one of Ward's favorite songs, "There is Power in the Blood," a song she learned as a member of a Baptist church choir while growing up in Piedmont, a small town in southern Missouri. Ward joins in the duet, followed by another hymn she has taught Hilderbrand, "The Nail-Scarred Hand."

From there, the two reminisce about other songs they have shared since Hilderbrand first began visiting in February — from "Big Rock Candy Mountain" to Jim Croce's "I'll Have to Say I Love You in a Song."

The conversation takes off after that, covering everything from Ward's World War II-era wedding to her career as a bank teller and the neighborhood news in the tight-knit Hill community where, by coincidence, Hilderbrand's family also lives.

Watching nearby, Barbara shakes her head in amazement.

"When my mother first moved in with us, we couldn't get her out of her shell. Brian came over, and she didn't even want him to play," she recalls. "But by the time he left, the two of them had sung 'Amazing Grace' and I was in tears. "

Nowadays, she adds, her mother has "practically adopted him.

"Brian is just so compassionate and gracious, and he always has a smile and a half on his face," she says.

By the time Hilderbrand's visit ends, he has coaxed Ward's great-grandchildren into accompanying him on a round of "Happy Birthday."

"I guess 93 is only 39 backwards," Ward laughs as Hilderbrand make plans to visit again soon.

'Music touches everyone'
Music therapy is "so much more than just listening to music," says Carol Leverett, regional director at SSM Health at Home Hospice. "It is truly therapy for hospice patients as well as their families, who are also going through a difficult time."

SSM's hospice program has been in existence since 1985, providing chaplain visits as well as alternative ways — from massage therapy to life reviews — to provide peace and comfort to patients at the end of life. Music therapy is a relatively new offering; SSM added it in 2014.

"Some people don't like touch and don't want to share their lives. We were looking for some other service we could provide when we realized that music touches everyone," she says. "It's astonishing to see patients that are totally withdrawn, even in the fetal position, react to music by tapping their toes or clapping their hands."

"Research shows that hearing is the last sense we lose, so it's a way to connect with even unresponsive people," adds Hilderbrand, 28, who joined SSM in January and sees about 20 hospice patients per week in addition to working with bereavement groups (see sidebar). By measuring a patient's respiration or heart rate, he says, he can even sync the music's rhythm to make the experience as calming as possible.

Hymns to hard rock
Hilderbrand, who holds a bachelor's degree in psychology as well as a master's degree in music therapy, likes to begin a visit to a new client by learning about that person's background in a conversation that includes family members. If the patient is not responsive or has advanced dementia, Hilderbrand may revert to just singing songs to elicit interaction.

"I like to make it a collaborative experience," he explains. "I am there to not only comfort the patient, but also keep family members healthy so they can provide the best possible care as well."

After that, it's a matter of building bonds to enhance coping abilities. Frequently patients prefer familiar old songs, such as "You Are My Sunshine" and "Meet Me in St. Louis," as well as popular spirituals. But requests for Elvis songs, country music numbers from Johnny Cash or Willie Nelson and even hard rock selections from Led Zeppelin and Pink Floyd are not uncommon.

Hilderbrand has been playing guitar since he was 12, and his repertoire is varied. But if there's a request he doesn't know, he'll use resources from YouTube to GarageBand to locate and learn songs.

Musical legacy
He also composes songs and produces CDs when clients request them. Often those songs are life reviews set to music — something tangible a patient can leave for family members. Hilderbrand remembers a particularly poignant one: a client with amyotrophic lateral sclerosis composed a three-verse song for her husband — the first about the couple's first date, the second about their marriage and children, and the third about how much she appreciated the care and support her husband provided. When the client died, her family played the song at the funeral parlor.

Though Hilderbrand acknowledges that sometimes his job can take an emotional toll, there are many more good days than bad.

"I turn to music myself to process my experiences and self-reflect," he says. "But overall, I derive a tremendous amount of satisfaction from what I do to support others."


Music unlocks sweet memories, spiritual depth for bereaved

ST. LOUIS — It's the final formal meeting of a bereavement group led by SSM Health at Home Hospice social worker Kara Koenig and chaplain Mary McDonough, and members are both reflecting about the loved ones they lost and focusing on finding a path forward with their lives.

SSM Health at Home Hospice music therapist Brian Hilderbrand, far right, plays "Love Me Tender" and "With a Little Help from my Friends" during a bereavement group session at the organization's St. Louis headquarters. He performs music that unlocks happy memories for participants who include, from left, Jim Fultz, Jim Loraine and Richard Albert.
Photo courtesy of SSM Health

When it comes time for Richard Albert, 81, to talk about his late wife, Shirley, who died in June 2016 after a seven-year battle with Alzheimer's disease, he describes the over-the-top Christmas decorations the couple enjoyed for years. "The whole house looked like Broadway — very Elvis and Dolly Parton," he recalls. Now he's finally cleaning out closets and painting his bedroom, but after 60 years of marriage, he says, "being alone at night still bugs me."

That's when music therapist Brian Hilderbrand begins to strum his guitar and sing a song Albert had previously requested: Elvis' "Love Me Tender."

"You know, the last years were the hardest; I barely left Shirley's side because she depended on me for everything," Albert recalls. "But that's actually when I found a closer love."

That kind of insight doesn't surprise McDonough. In her ministry to prepare people for death, she has seen it time and again — music as a means of opening a spiritual conversation.

"Brian began coming to our group last spring, and his songs have helped to bring precious memories more vividly to life," she says. "It gives our members the chance to reminisce about the good times they shared, and to savor those moments."

Adds Koenig: "Brian has definitely been good therapy for us; he's such a gentle guy and a good listener. Families have even asked him to play at funerals; they say it's comforting to have someone there who knew their loved one."

Jim Fultz, 64, whose late wife, Chris, died in May 2016 after suffering from lung cancer, says that the couple shared a love of Three Dog Night and James Taylor songs. "We heard 'Joy To The World' on our first date 45 years ago. For a while after Chris died, it was so painful I couldn't listen to that. But Brian played it for me at a meeting and it absolutely transported me," he recalls. "Now it's a pleasant reminder of a special time."

After members share more memories and talk about things in their life they are happily anticipating — a new grandchild, a trip to Mexico — Hilderbrand picks up his guitar one last time and begins singing a Beatles song, "With A Little Help From My Friends."

"That seems like a good ending prayer," says McDonough. "One thing we've all learned here that it's better not to go through the grieving process alone."



Copyright © 2017 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3490.

Copyright © 2017 by the Catholic Health Association of the United States

For reprint permission, contact Betty Crosby or call (314) 253-3490.