1. Klein, Jaclyn BA

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It is 7:00 a.m. when Norma Nichols, Arbor Hospice music therapist, begins her day. She makes herself a cup of coffee and logs onto her computer.

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"I check my e-mail and review our electronic medical records for updates on my patients," Norma says. "Then, I call the caregivers of patients I intend to visit to make sure today is still a good day."


With her schedule confirmed, Norma packs her car, her iPad holding song lyrics and recordings goes in first, followed by her laptop, her cell phone (to stay connected with Arbor Hospice coworkers), a guitar, a pink polka-dot bag filled with musical instruments, hand sanitizer, and wipes. When she leaves her home, Norma will not return until the evening; her car becomes her office, lunchroom, personal space, and sanctuary between patient visits.


Norma's first visit is at 9:00 a.m. in Farmington, Michigan. She's here to see Mark and his wife of 65 years, Diane. They live with their son and have both experienced a significant decline during the past few years. Mark has Alzheimer's disease and has been an Arbor Hospice patient for nearly 4 months.


Mark is sitting at the table when Norma arrives; Diane is in a nearby recliner. After a quick greeting, Norma begins to play her guitar. Having visited the couple several times before, Norma starts with a 1930s classic. Norma gives Mark hand bells and Diane maracas. They both play their instruments to the beat of the guitar. Without prompting, Mark claps his hands, nods his head, whistles, and sings a few nonsensical lyrics.


Mark smiles and Diane laughs when Norma sings "Mark, won't you blow your horn," as part of the famous tune. Norma closes her visit with a country-western blessing the couple enjoys. Diane graciously thanks Norma and tears up during their goodbye. "Your music is so important," Diane says. "I just love seeing Mark respond like this."


Back in her car, Norma spends 20 minutes on her computer documenting her visit. Then, she's back on the road and off to West Bloomfield to visit a patient at an assisted living facility. She's an 80-year-old woman with aphasia, cerebrovascular disease and Alzheimer's disease, yet she has her moments of clarity.


This time, Norma plays big band-era music on her guitar. The woman's focus increases, she musters additional eye contact, and follows along in the lyric book Norma pulled out of her bag. When Norma begins to play "Chattanooga Choo Choo," the woman moves her shoulders to the rhythm and smiles. Norma asks if the woman and her husband ever danced to that song.


"Oh yes," she says. "He was a good dancer." Norma asks about how the woman and her husband met, but she has trouble finding the right words to express her thoughts.


It's noon now-lunchtime. Norma typically eats in her car to save time, especially if she is driving several miles between her visits-she covers a seven-county service area. Today she also calls the daughter of the woman she just visited.


"I like to give the families an update," Norma says. "They appreciate hearing about my time with their loved one."


Next, Norma visits Nick, a resident in an Ann Arbor nursing home and new to hospice. His wife lives in a separate room on a different floor. Earlier that morning, Norma called the couple's daughter and nursing home staff on her floor. She asked the daughter if Nick had any favorite songs and the nursing home caregiver to bring Nick's wife to his room during the visit.


When Norma arrives, Nick's caregiver tells her that Nick is in a bad mood. This does not deter Norma. She approaches his bed and asks if he wants to hear some music. Nick tells her yes, but only if it is good music. Norma begins playing classical songs-the type of music Nick's daughter said he likes. Nick sings and even requests Italian songs.


Before long, Nick's wife is wheeled into the room. Nick's face brightens and he jokes that "it must be Thursday." Thursdays are the day his wife gets her hair done. His wife looks beautiful today, he says. Norma continues to play for the couple.


Half an hour later, Norma concludes. Nick tells Norma to come back and play more "excellent music."


Norma leaves Nick's room and takes a seat on one of the nursing home's couches. She documents her visit and calls the couple's daughter. Norma will be visiting again in 2 weeks.


The day is coming to a close, but Norma has one more visit at a patient's home 5 miles away. Nancy has chronic airway obstruction and difficulty breathing. Norma has been visiting Nancy for the past 5 months and the two have enjoyed a wide range of music.


Nancy immediately smiles and tells Norma how glad she is to see her. Norma grabs her guitar and hands Nancy a drum. Today Nancy has a specific request-music by Pete Seeger, "in honor of the man," she says. Norma uses her ipad to find videos of Pete Seeger singing songs familiar to Nancy.


When the visit concludes at 4:00 p.m., Norma drives to a little coffee shop around the corner. She completes her charting for the day and enjoys a cup of coffee.


"This is when I reflect on my visits," Norma says. "I sang big band to show tunes to polkas to Pete Seeger, but the common result that brings me joy is that during each visit, the patient's energy and awareness increased and their mood improved. Being Arbor Hospice's music therapist has changed my life in so many positive ways. It is a privilege to join patients and families on this beautiful, yet, challenging journey."