ANN ARBOR, Mich. — Death, she meets with an Alvarez guitar and a big, floppy bag stuffed with maracas, jingle sticks, wood blocks, shaker eggs and bells — a bag that some have joked, but only half-laughing, that is part magic because of the surprises it holds.
Oh, she knows Death will win. It always does, of course.
But Norma Nichols, a music therapist for Ann Arbor-based Arbor Hospice, also knows something else: Music burrows deep inside the brain, even as disease and dementia begin shutting down its operation.
Light in darkness.
[PHOTO: Avery VanSumeren, 10, left, shares a smile with Arbor Hospice musical therapist Norma Nichols during an in home visit after Nichols played Christmas songs on Thursday, Dec. 5, 2013 in Jackson, Mich. VanSumeren, who has cerebral palsy and several other conditions, often sings along and enjoys her specially written songs featuring her. (AP Photo/Detroit Free Press, Jarrad Henderson) ]
“It’s emotion in tone form. It bypasses the cognitive. It somehow just reaches right through, straight to the heart, before the mind even knows what’s going on,” Nichols, 54, a board-certified music therapist, told the Detroit Free Press.
Nichols often provides the music, which a small but growing body of research suggests has a profound impact on the way we face the end of life, for her patients. Several small studies have concluded music reduces stress and pain.
In one study, patients’ heart rates dropped, and breathing slowed. An increase in body temperature suggested increased circulation from relaxation.
For Nichols, folk music and “Amazing Grace” are staples, as are Elvis, Patsy Cline and Glenn Miller. But music is tricky.
“The songs need to be about them and where they’re at and what they need at that time,” Nichols said.
Lady Gaga and Kid Rock tunes offered escape to a teen in her last days.
A young boy who loved fish was soothed by impromptu songs accompanied by an ocean drum, in which beads in the bottom swoosh in time like waves in an ocean.
And one patient — a woman in her 90s with a particular wit and bravery as she approached death — rewrote with Nichols “The 12 Days of Christmas,” inserting into the lyrics the things she’d really like: a fur coat and a Lincoln Continental.
She left her humor in permanent form: “We recorded it and gave it to her daughters,” Nichols said.
Music is pervasive, offering structure in times of celebration as well as those of reflection and sorrow, said Debra Burns, an associate professor of music therapy at Purdue University’s music and arts technology department.
“Look around any day, you’re never really in silence,” she said.
For those with memory loss, music also can be a lifeline to the outside world.
“We might lose family members or their names, but those areas of the brain that assign meaning to music are the last to go,” Burns said.
Music does not prolong life. But it appears that music therapists can provide what a nurse or doctor rushing to complete rounds cannot: Time to reflect. To calm.
And to accept death’s mandate to let the past slip away, embracing instead the joy in moments that remain.
“It’s an opportunity to process their experience, talk about that experience, and talk about what’s important,” Burns said.
In Ann Arbor, Parkinson’s occasionally shoves Bruno Giordani out of his present reality.
Family members do not know where his mind has taken him on those occasions, but with Nichols around, it doesn’t matter.
An Italian immigrant, the opera enthusiast would be hard to please, Nichols knew. So she studied. And at his home earlier this year, she sat at the piano starting with “Ave Maria” and “Santa Lucia.”
Nichols did her best Italian, even though she doesn’t speak it. She’d stop, asking Giordani for the correct pronunciation. He leaned forward, helping her with the words.
Does this remind you of Italy? she asked. He nodded. Smiled.
And the 96-year-old former attorney began conducting the music, his hands whipping through the air.
Granddaughter Helen Giordani was stunned.
“For every hour she spends with a person, she must spend hours finding out the best way to engage them,” she said of Nichols.
And of her grandfather: “I don’t think he’s anywhere but in the music, to be honest. We don’t have to worry about it — whether he’s in the present or the past. He’s just fully, 100 percent in the music.”
In Jackson, plastic Christmas lights recently draped the doorway to the living room at Avery VanSumeren’s home.
Nichols began singing: Bells were jingling all the way, and Santa Claus was pretty clearly coming to town.
But 10-year-old Avery didn’t seem interested, staring unflinching at Nichols. The therapist reached over her guitar, running her fingers though the girl’s bright purple hair — something done on the prompting of her 14-year-old sister, Hannah, who has blue and red hair for now.
Nichols leaned in, locking onto Avery’s gaze.
She cooed: “Ahhh, I just love the purple, Avery. So pretty. So funny, Avy-baby.”
It’s not unusual. Avery has never been able to speak more than a few words. But even more so these days, as Avery’s tiny body — twisted and bent by cerebral palsy — begins to shut down, she has become more distant, said her mother, Beth VanSumeren, 32.
Nichols was undaunted. She rummaged deep in her bag, pulling out jingle bells on a leather bracelet.
Nichols instructed her mom to remove the fuzzy pink socks the girl wore, and she maneuvered the too-small feet onto her 12-string Alvarez, wrapping the bells gently around the tiny ankles.
This time, “Deck the Halls” reverberated on little bare feet. The bells tinkled. Avery’s mother sang in her ear.
“You’re jingling all the way, Avy. Avy’s jingling all the way,” Nichols teased, jiggling the girl’s feet.
And there it was.
Avery blinked, her mouth breaking into a wide grin.
“Norma always plays such fun songs, and you can’t help but laugh. The combination of Norma playing and including Avery’s name — Avery loves to hear her name,” VanSumeren said. “It reaches her.”
Nichols loves the work. Clients have invited her into a brief time in their lives that arguably may be the most important.
“Of course, there is sadness. There is always sadness,” Nichols said. “It’s anticipatory grief. This person will be gone in the near future. But for this day, this moment right now — it’s about celebrating living with the person we love. That’s powerful stuff.”