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Gail Fox

(Photos: Sue Careless)

Sister Gail Fox is an Anglican Benedictine Sister who, as a chaplain at Belmont House, a Christian long-term care and retirement residence in Toronto, helps with the emotional and spiritual care of its residents. Sue Careless asked her about the role of music in palliative care and then listened as she played the harp at a resident’s bedside. 

TAP: How long have you played the harp?

GF: Six years.

TAP: Do you play any other instruments?

GF: I played piano as a child and have sung in a number of choirs.

TAP: When you first took up the harp did you intend to use it therapeutically?

GF: No. I was looking to retirement and wanted to learn for my own enjoyment – music has always been very important in my life. But God had another plan.  

My sister had bought a harp when the London Conservatory of Music was closing and selling all its instruments. I would look at it and think “I wish I could play you.” So one day I went on the internet and found a harp teacher in Toronto willing to take adult students. After my first lesson he said, “You’re further along because you know how to read music.” And I’ve never looked back.

Even though both instruments use the fingers, the difficulty was going from fingers in a horizontal position for piano to vertical for harp. You’re actually using different finger muscles and you feel it in your shoulders, too, especially if you’re playing the harp for a long time. 

TAP: Who trained you to use the harp in therapy? 

GF: After playing for about 12 months I learned of a music program in New York State called ‘Music, Healing and Transition,’ (MHTP) and for the first time it was being offered in Canada. I applied for the course not knowing if I’d be good enough – I’d let them decide. They told me, “You’ll be fine; people don’t want complex music when they’re ill.”

At the time, I was working as a chaplain at Toronto East General so I did my practicum in a palliative care unit in another hospital. I didn’t want people to confuse my role as a music student with being a chaplain. Providence Healthcare kindly accepted me for my practicum and when I graduated as a Certified Music Practitioner, they asked me to stay. I play there once a week for palliative care patients and residents; I also play for four sisters at the Sisters of St Joseph Convent who aren’t able to respond in any of the recreational programs. I’m here at Belmont House as chaplain twice a week.

Over 600 people from Canada and the States have graduated from MHTP as Certified Music Practitioners, but there are very few in Canada. That program was only offered here once, but there is a Music Therapy Degree offered in some Canadian universities and a therapist would have more training than a practitioner.

TAP: Do you ever sing with the harp?

GF: No. At one time I had a tube in my throat and there is scar tissue there now.

TAP: Why does the harp work well in palliative care?

GF: It’s a soft, gentle instrument, although larger ones can be more powerful. I play a 26-string therapy harp with levers  –  a Figured Cherry Dusty Strings harp. A concert pedal-harp would have 47 strings and pedals and be able to play in lower, louder octaves but at the bedside I only need two and a half octaves for the gentle sounds. I also have a 34-string harp at home.   

TAP: It is said that hearing is usually the last sense to go. But what about residents who have hearing loss? Can they still benefit?

GF: I think they can. Our body is made up of a lot of fluid so the vibrations of the strings resonate in the body. It’s also the energy in the room – they have a sense of what’s about them.

TAP: So residents not only hear but feel the music?

GF: Yes. When I tune my harp I lean against it and I can feel it. Fibro-acoustic harp therapy is used for various pains in the body. I don’t go into that but I know some people who have. 

TAP: What sheet music do you use?

GF: The Bedside Lap Harp Compendium by Cindy Kleinstuber Blevins is my main source for live music. The CDs I leave for residents are from the States. Tammy Briggs has some really lovely CDs as does Stella Benson.

TAP: Do you need family or patient permission before you play?

GF: No. If the family is there I say, “I’m a certified music practitioner. I wonder if I could play the harp?” If there is no family present and the patient can’t respond, I just quietly start playing. You can tell from the reaction of a patient if they’re not wanting this. I had one person in a palliative care unit who did not want any music – he could speak and told me he just wanted silence. 

TAP: Can you see them relax?

GF: You usually can see some kind of a response. With one person, the daughter was at the bedside and after I finished playing she said, “I watched her face relax.”

Some residents try to clap and smile. I visited one fellow for a number of weeks and he would clap. One day I went in and his family said he was not responding. I still offered to play and they agreed. When I went to change my music books he turned his head to where the music had been. When I finished and went to speak with the family he was trying to clap. He died shortly afterwards.  

TAP: Because you’re their chaplain, would you know some of these residents before they’re palliative?

GF: Yes, but not always. One woman who came to palliative care wasn’t responding. She was dying but had no family here in Canada; she didn’t speak any English. I played for her and that night when her mother called, a staff member was able to say that I’d been playing the harp for her. It helped the mother to know someone had been there, that her daughter didn’t die alone. So it’s not just the person in the bed; it’s the family members too. Knowing music was played for their loved one can comfort them even when they are not themselves present; I also like to tell family if I’ve prayed with the resident.  

TAP: So music can change the experience of dying?

GF: Yes. I played for one person whom I’d never had a conversation with before. I played by his bedside and I watched his breathing slow down. I could see that he was relaxing. After I stopped playing, he went back to his faster breathing. Music can help people let go.   

We don’t know what is going on in a person who is dying. Sometimes they die quickly, sometimes they go slowly. I liken it to when our mothers gave birth. Sometimes the labour was long and hard; other times it was easy and fast. [In dying] we’re being birthed into new life.

If someone is really anxious, if you go in and start playing at a faster pace and then start cutting back on your tempo, it can really help. You’re entering into their breathing pattern but then you slow it down a little. 

There are four different patient types that you can play for: Non-Acute; Dementia and Alzheimer’s; Critically ill/Acute; and Actively Dying – but I specialize in the latter, preferring to play in palliative care.

I see it as spiritual because I pray before playing. I pray for the person and for myself but I also pray for the gift of music and beauty that comes from God. If I’ve rushed and not taken the time to pray, I notice a difference in my playing. I do believe it is God using me. It was the same as when I became a chaplain – I felt I didn’t go into the room alone. I couldn’t go into the room alone and face the situations I had to face without that knowledge that I don’t go in alone.

TAP: I imagine performance on a stage is quite different.

GF: I had to play in a recital some years ago and I didn’t do very well. And one of my friends said, “It’s because you’re not an entertainer, you’re a healer.” 

TAP: What can a family who does not have access to a music therapist or practitioner do for a dying loved one?

GF: Years ago, when I was first a chaplain [but not a harpist], I went to the bedside of someone who was dying and I just automatically sang.  I remember also a nineteen-year-old who was dying and I took her a CD player with some soft gentle music. When I went back there were Irish Rovers singing about ‘green alligators’ because this was her favourite album, according to her parents.

TAP: When you’re close to death you may not want loud and boisterous music.

GF: It’s true. I don’t think people realize that the music that is important when someone is dying is the music that will help them to let go, not help them to stay here. When I was a chaplain-in-training I went to the bedside of a woman who had a stroke. There was nothing in her room, no cards, no flowers and I didn’t know whether she was religious so I didn’t want to pray aloud with her. I didn’t know how to communicate with her. And it came to me – music. I didn’t want to put earphones in her ears so with a Discman attached to computer speakers I knew immediately in her eyes that she was hearing the music. I would change the CD each visit. When I retired from fulltime chaplaincy I don’t know how many CD players and CDs I had left in my office. Music that they’ve enjoyed all their life is fine and dying is a process, but as they get closer to the end, the music that you choose is important. 

TAP: Do you play hymns if you know the person is religious?

GF: The ethics of my music program states that we are not to use any religious music unless we are asked. It is a little different here in Belmont House because it is a Christian facility. If I see a cross or crucifix, or a picture of Jesus, or a Bible by the bedside, I play something religious.

TAP: What community, outside of your work, gives you spiritual support?

GF: My religious community connection is with a Benedictine Order in the States; but here in Toronto, the Sisters of Loretto (Institute of the Blessed Virgin Mary) have provided and continue to provide wonderful spiritual support. My parish family of St.  Thomas’s Anglican Church, along with the Anglican Archbishop of Toronto, and my Spiritual Director who is a Jesuit have gifted me with on-going spiritual care.   TAP

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