Singing at the Threshold

A growing movement to bring singing into hospice and hospital settings eases end-of-life transitions for patients and their families.

In 1990, Kate Munger signed on for a day-long volunteer shift at the home of her friend Larry who was dying of HIV/AIDS. Her assignment was to complete household chores in the morning, and to sit with him in the afternoon. 

The morning went well—there was a lot to do. But sitting down at her friend’s bedside, Munger recalled, “I was terrified. I didn’t know what to do. So I did what I do when terrified. I sang to myself. I sang the song that I sang for choir auditions—Gail McDermott’s ‘There’s a Moon.’” 

She sang for two-and-a-half hours and afterward, “there was this feeling in the room. I felt so calm, centered, and serene and so did Larry. I had given him exactly what I had to give and what he needed.”

Munger had found her calling, but it took another ten years to develop the tools she needed to realize it. She spent four summers in Orff training learning to sight-read, which equipped her to teach music in an elementary school. All the while, she was leading rounds at community sing events around the Bay area. When she started to write songs, “that’s when I really learned to read music,” she says.  “That’s when I figured out how I wanted to communicate something from me to somebody else.”

The Birth of a Choir

In 2000, Munger gathered a group of 15 women who had been regulars at her community sings in a friend’s living room in El Cerrito. From that evening bloomed the first Threshold Choir, and in short order a half dozen more around the Bay area. By 2012, there were more than a hundred Threshold Choir chapters in the U.S. and Canada, and a number of overseas affiliates. 

The concept is simple: Small a cappella choirs of primarily women’s voices singing for and with those at the thresholds of life—whether facing serious illness or impending death. Each Threshold Choir chapter is firmly rooted in its local community but the choirs sing from the same book of some 500 songs, many written by Munger and other choir members specifically to communicate ease, comfort, and presence. 

Typically, two to four, but no more than six, singers go to a bedside. The singers choose songs to respond to the patient and family’s musical taste, spiritual direction, and receptivity. Family members and caregivers are invited to join in the song or to participate by listening. The songs are not overtly religious, so they are appropriate for those who are deeply spiritual, whether religious or not.

Singers who participate in Threshold choirs say the impact—on them and on the patient and family members—is palpable. Melanie DeMore, a Bay area singer, choral director, and music teacher, is a charter member of the Threshold Choir and has composed many of the songs. “I am not a ‘woo woo’ person,” she says. “I was born in the South Bronx. But there is something about the power of the voice to shift molecular stuff and you can see that. You can see somebody, for even a moment, get back into the center of themselves because of the music, because of that vibration. It is just a fact.”  

Well-being During Health Crises and at the End of Life

The Threshold Choir chapters are part of a growing movement to bring music and the arts into health care and hospice settings for the purpose of easing, or palliating, the dying process for patients and their families. For some 30 years, the Chalice of Repose, created by Therese Schroeder-Sheker, has brought the soothing caress of harp music to bedsides, and in so doing has led the field of music thanatology. Musicians have created CDs of beautiful vocal and instrumental music that can be played at bedsides—Graceful Passages and Music for the Dying are two.

"There is something about the power of the voice to shift molecular stuff and you can see that. You can see somebody, for even a moment, get back into the center of themselves because of the music, because of that vibration." - Melanie DeMore 

Munger believes that the human voice, in close proximity, is unique in its power to soothe a troubled, ill, or dying person. “To me the voice is the ideal vehicle for this comfort and this connection,” she says. “Often people we sing for sing along with us. It might be their last physical activity.”

The songs are a gateway, she believes, to something unknowable. “When we take physical form, we make a deal that says, yes, we want to have a body. In exchange, we agree that we will never know what lies beyond taking physical form. It will remain a mystery,” she says. “To me, song is just a glimmer, an indication—‘oh, it could be like this’—so to offer that to somebody seems to be the most hopeful we can honestly be with them.” 

In 2004, Munger and a group of Threshold Choir singers were called to the cribside of a dying baby, just 17 days old. The father was Cuban, so Munger gathered several Spanish songs to sing for the circle of family gathered around. As it turned out, one of the grandmothers at the bedside was Irish. “We thought for a minute,” Munger recalled, “and sang something with an Irish feel. ‘From my heart to yours, may you find all the love that you needed is here.’ The family later told me it changed everything for them in that moment. They stopped measuring their baby’s life in hours and days. They started measuring it and weighing it in how much love was being shared, given, and received.”

The young couple went on to have two other children, Munger says. The mother is writing a book about the need for families to honor the grief of the loss of infants. “So often people don’t talk about the baby that died ever again. It is this giant hole, that sucks the life out of a family.”

Part of the work of the Threshold Choirs is to invite people to gently walk through the veil of grief.  “Our culture is terrified of grief,” Munger says. “We are so terrified that if we let it start, it will never stop. But when you are singing, you absolutely feel it.  If you are singing, tears will come.”

“What we want to sound like is a mother singing a lullaby,” she says. “These are just lullabies for the other end of life.”

This article was adapted from The Voice, Spring 2013. In this special issue devoted to singing and wellness, Chorus America explores current research and tells stories about how singing together contributes to the well-being of individuals, groups, and communities. Our Singing and Wellness Resource Guide explores the studies cited and further reading.

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