Alive Hospice music therapy volunteer     Matt Coffman.

When I moved back to Nashville two and a half years ago, I immediately began looking around for a good place to volunteer. I’m a guitarist, guitar teacher, and singer-songwriter, and I was specifically looking for somewhere that could use my musical skill to bring smiles to folks in need.

Alive is an incredible organization staffed by some of the most caring and big-hearted human beings I’ve ever met. When I first got started volunteering doing musical therapy at Alive in May 2008, I had never played for patients in hospice. The volunteer coordinators at Alive helped usher me right into the flow of musical therapy, and I was lucky enough to get to follow some more experienced musical volunteers as I figured out the many ins and outs of music therapy at Alive.

On a typical morning when I’m volunteering, I head into Alive Hospice Residence Nashville and chat with Jane at the front desk for a bit as a sort of warm-up for the therapeutic work ahead. Then, I tune my guitar and begin my walk around the Residence. I stop into patients’ rooms and say good morning, and if they feel like some music, then I do my best to play something they might like.

The most often requested repertoire at Alive consists of gospel tunes, folk standards, instrumental pieces, and the occasional surprise pop hit. If I don’t know a song, I’ll try to learn it for the next time I’m at Alive.

I’ve met some extraordinary people through volunteering at Alive. And I’ve come to appreciate the power of the right song played in the right way at the right moment. If I’ve helped someone smile a bit wider or feel like someone’s caring right there with them, then my work has been a success.

Matt Coffman is an Alive Hospice volunteer who plays in the Brazilian/South American and classical guitar styles. Listen to a sampling of his music here.

Dr. David Tribble

The New York Times recently featured an article regarding palliative sedation. The author depicted rows of hospice rooms in which patients were sedated to their demise; where the line between palliation and euthanasia became faint to absent; and the care rendered relied heavily on the ethical principle of double effect. (”Double effect” is a term that is used to describe instances in which it is considered acceptable for therapy rendered for patient comfort to shorten the patient’s life, as long as the intent was to comfort the patient, not to take his or her life — with the knowledge and agreement of the patient or a surrogate that such an outcome is possible.)

Palliative sedation is a treatment of last resort, to be used only when all other therapies have been ineffective in controlling a patient’s suffering. It is a rare event, even in very large hospices, and many hospices go years at a time between cases.

At Alive Hospice, palliative sedation, when it is necessary, is performed under the oversight of our Ethics Committee using a protocol that specifies the level of sedation such that respiration is not threatened by the medications used. Additionally, we specifically avoid the use of opioids for sedation (though we may still use them as needed to control pain), and do not prescribe palliative sedation for the treatment of emotional/spiritual suffering.

There is literature evidence that, at the end of life, the presence or absence of alimentation (oral feedings, tube feedings or intravenous calorie support) makes no difference in survival. Thus, sedation properly managed neither turns off respirations nor causes the patient to die sooner on the basis of calorie deprivation.

Palliative sedation, then, is a procedure performed rarely and under Ethics Committee supervision where the alternative would be uncontrolled suffering. The medications used allow for sedation without threat to respiration, and the decreased oral intake has little, if any, impact on survival.

Euthanasia, on the other hand — which is not employed in hospice care – involves the use of known lethal doses of medication for the express purpose of ending life. Palliative sedation is used only for the purpose of symptom relief, using only as much medication as is necessary to render the patient comfortable, and specifically monitored so as to avoid doses that shorten survival.

The inaccuracies in the article notwithstanding, we should be thankful that it opened up a public discussion of the issue. It is important, however, that the truth of this issue is not lost in the rhetoric.

Dr. David Tribble is Alive Hospice’s chief medical officer.

• Finucane TE, Christmas C, Travis K. Tube feeding in patients with advanced dementia: a review of the evidence. JAMA.1999;282:1365-1370.
• Plonk W. To PEG or Not to PEG. Practical Gastroenterology, July 2005, pp 16-31.
• Koretz R, et al. Does enteral nutrition affect clinical outcome? A systematic review of the randomized trials. American Joural of Gastroenterology, Feb 2007, 102(2), 412-429.

We would love to hear our readers’ thoughts about the Alive Hospice Blog! What do you like? Have you found our blog entries helpful? What would you like to see more of? Other comments?

Just click here. We want to hear from you!

Nanette Mathe

Many people make New Year’s Resolutions. Do you?

Our patients don’t often make New Year’s Resolutions. Occasionally they will talk about their hope to stay alive to see a new grandchild born, or to experience a favorite holiday or family gathering. Most of them have already found what was important to them and are living it to the best of their ability every day of their lives.

We can learn from their example and not wait until January 1 to begin to change our lives.

This year, I challenge you to think about this basic teaching stated by many of the world religions:

Blessed are those who prefer others before themselves. –Baha’u’llah, Tablets of Baha’u’allah 71

Hurt not others in ways that you yourself would find hurtful. –Buddhism, Udana-Varqu 5:18

In happiness and suffering, in joy and grief, regard all creatures as you would your own self. –Jainism, Lord Mahivir 24th Tirthankara

What is hateful to you do not do to your neighbor. That is the entire Torah. The rest is commentary. Go and Learn. –Judaism, Rabbi Hillel to Shammai, Talmud Shabbat 31A

Be not estranged from one another for God dwells in every heart. –Sikhism, Sri Guru Granth Sahilo

No one is a believer until you desire for another that which you desire for yourself. –Islam, Sunnah

Human nature is good only when it does not do unto another whatever is not good for its own self. –Zoroastrianism, Dadistan 1 Dink 94:5

Do unto others as you would have them do unto you. –Christianity, Jesus, Luke 6:13

Perhaps treating others as you want to be treated – a resolution that can be made any time – would be the best of all!

Nanette Mathe is an Alive Hospice chaplain who serves on the agency’s Murfreesboro team.

Ruth Williams

Our noses are something many of us take for granted. We may not even be aware of it sitting there on our face until something tickles it or makes it run or sneeze. Then a powerful smell enters in and suddenly our concentration shifts.

Maybe it’s chocolate chip cookies baking in the oven or apple pie spices flavoring the air that make you smile. Or maybe your favorite scent is a perfume or hand lotion or even a brand new set of tires.

When loved ones die, one of the things we often realize we miss is their smell. I’ve had family members tell me they’ve chosen not to wash a blanket or a shirt or nightgown of one who died, just to hold onto the treasure of their special scent. They may even wrap themselves in the blanket, stick a special something in their pocket, or even wear that favorite shirt to bring them closer.

We can’t usually hold on to the actual scent forever, but we can hold onto the memories triggered as we breathe them in. My grandmother passed away many years ago; but, often, when I smell bacon cooking or coffee brewing, I remember her and smile.

Ruth Williams is a counselor with Alive Grief Support Services, the bereavement support program of Alive Hospice.

Music lovers and Alive Hospice supporters have been lining up to see the great songwriters who are participating in the Alive at The Bluebird concert series this month. The above photo was from the January 14 concert featuring Kathy Mattea, Suzy Bogguss and their husbands, songwriters Jon Vezner and Doug Crider. Others who have performed this month have included Amy Grant, Alison Krauss, Vince Gill, Dan Tyminski, and many others.

The shows aren’t over yet. There are lots more left in the line-up this month! Check out the calendar at www.bluebirdcafe.com (look for “Benefit for Alive Hospice” in the listings).

Janny Adkins

I often am asked to do information visits to provide families and patients with correct information about hospice services. I am always frustrated and sad when I hear from a family what other health care providers have incorrectly told them about hospice services.

Unfortunately, well-meaning health care providers who are not informed about hospice services can provide false information, thereby increasing the patient and family’s anxiety levels and confusion regarding hospice.

Incorrect belief: If you enroll in hospice too early, you will not receive treatments such as antibiotics, intravenous fluids (IVs), suctioning, or palliative chemotherapy or radiation. Also, you have to stop all medications.

Truth: The truth is that Alive Hospice offers a high level of expertise and comfort management which may include antibiotic therapy, IVs, and suctioning. The focus of hospice is on quality of life; therefore, comfort that can be brought about by a round of antibiotic therapy, suctioning, and pain and symptom management is always a priority.

Every treatment is weighed against the benefit versus burden to the patient.

Research indicates that the majority of patients and families, when surveyed, wish they would have enrolled in hospice much sooner.

If you or your family would like to have an information visit about Alive Hospice services, or if you have questions or concerns, please e-mail me or call 615-332-4003. There is no obligation to enroll with Alive Hospice when you request an information visit.

Janny Adkins is an Alive Hospice account executive who informs health care professionals, patients, and families about hospice care.

Songwriters Cory Batten and Kent       Blazy playing in Studio C at Nashville       Public Radio.

Two of this year’s Alive at The Bluebird songwriters and Alive Hospice’s own Jeanna Kinnebrew will be featured this weekend on Nashville Public Radio. One segment of WPLN 90.3 FM’s “Studio C” program will showcase the music of songwriters Kent Blazy and Cory Batten, and Alive Hospice Annual Fund Manager Jeanna Kinnebrew will talk about the mission of Alive Hospice and the Alive at The Bluebird concert series.

“Studio C” will air on 90.3 FM on Sunday afternoon at 3 p.m. and again on Tuesday evening at 8:07 p.m. be sure to tune in!