'Threshold Choir' Brings Songs of Comfort to the Dying

Three women climb the stairs of a beautiful Victorian in San Francisco. They hold nothing in their hands, but they bring a precious gift. These women are members of the Threshold Choir, and the home they are visiting is the Zen Hospice Project. They sing to people at the last threshold of life, and today, when they reach the second floor, they find Luca Sager, a 38-year-old chef with terminal brain cancer.

Sager’s hands, tattooed with a salt and pepper shakers, rest on the top of his covers as he listens as the women sing, a cappella:

You are not alone
I am here now
We are not alone
We are here together

Sager speaks slowly through medication and pain. He says peace fills him when the women sing. “It feels like a good time for me to gather my feelings about gratitude and being calm and appreciation. I just smile a lot.”

Kate Munger founded the Threshold Choir in Marin County and the East Bay 16 years ago. She says it grew out of her own experience of sitting with a friend of who was dying of AIDS back in the '90s.

“It was very distressing to see him comatose and agitated,” Munger recalls. “I did what I did at the time when I was nervous or afraid, and I started singing --  instinctively.”

She says her friend “calmed, settled and got positively serene,” and her own feelings mirrored those of her dying friend. “I felt like I had discovered, or rediscovered, something -- an ancient practice that tribal humans do for one another when someone’s struggling.”

The Threshold Choir has spread since then -- across North America and to other countries. It is devoted to lifting others up, to creating a place for reflection, especially for people who may be outside the traditional reaches of religion. The singers speak of the healing quality of music and the power of the human voice to soothe and to make beautiful the process of dying, which is so often accompanied by great fear.

Choir singer Katharine Rose Kirner says she knows what it is like to lie powerless in bed facing the fear of death. In 2001, as the country was reeling from the 9/11 attacks, Kirner faced a different kind of threat, a brain tumor the size of a grapefruit. She says she was gripped by fear of death and feelings she had not done what she needed to do in her life. She vowed to do something “important” if she recuperated.

When she did eventually heal, she learned of the Threshold Choir and became a devoted member singing at least once a week. She says being part of the choir has given her a chance to see how gentle dying can be.

“Most of us think of death as an event, but it’s a process," she says. "That gave me great comfort.” Watching the process has moved her to think of what she wants at her own death, something she says she would not have contemplated without being in the choir. "I would have sat in the fear.”

Singer Peggy Cadbury, a retired nurse, saw a fair amount of death while working in hospital settings. But as a member of the choir, she has the chance to tend to the dying with a different intention.

“When you're nursing at the bedside of somebody who is dying, you're constantly concerned about their physical wellbeing, their pain level, ” Cadbury says. But as a member of the choir, “I can just be there to hold space for that person in the room and create an environment of comfort and caring.”

Munger says the harmonies are particularly powerful in creating a sense of calm and wellbeing. “It’s a visceral experience. It’s not just the ears; it's full body absorption of vibration.”

Cadbury says singing quietly and softly the simple songs written by choir members is much like singing a lullaby to a child.

“It is like a gentle caress, and it feels right,” she says.

Sager, the patient, says the singing not only helps bring him emotional calm, but it also reduces the physical pain he has in his head around the tumor.

Research suggests that listening to live music can help reduce pain in palliative care patients. A 2012 study found that patients found that patients who had the harp played to them for 20 minutes -- along with breathing exercises and visualization -- reported a significant decrease in pain compared to a control group.

Registered nurse and certified music therapist Kathy Jo Gutgsell at University Hospitals in Cleveland was lead author of the study. She believes music “may awaken the body’s own endorphins" -- those much-chased-after chemicals that make us feel better about the world.

The human brain "doesn’t multitask very well," she explains. "When we are paying attention to the music, we can't pay attention to the pain.”

Gutgsell says music is tied to memories and can connect us to times of great joy and sadness. “I think humans are hardwired for music. Some people think we were singing before we were speaking back at the beginning of humanity.”

The Threshold Choir singers say they, too, are helped by the act of singing together and for a person in need. “You see them calm, and then you calm, and it’s a reciprocal thing,” Cadbury says.

Kirner says singing in the choir is one of the best things in her life. “I get a sense of purpose.” Choir singers may benefit in other ways. A growing body of research finds that people who take part in choral singing have a better sense of wellbeing than those who don’t sing.

The research suggests that singing itself can raise levels of oxytocin, the hormone associated with trust and bonding. So people who sing in chorus may feel a strong bond with those they sing with together. Right now in San Francisco, a five-year study is underway looking at both the possible physical and emotional benefits of choral singing for seniors.

Munger says songs are “ethereal, evanescent, and mysterious” and she believes they can serve as a bridge “from the purely physical, temporal, body experience ... to what lies beyond.”

As for Cadbury, she says watching others die has helped her frame her daily life and what she hopes for her death. “Singing at the bedside of people who are dying has helped me appreciate being alive, has made more feel more alive and more into being the moment and enjoy life. I hope that when I am on the threshold someone will come and sing to me these beautiful, peaceful songs of comfort.”

Sager, the patient, says he believes as human beings our purpose in life is to be givers however we can. He says he did that as a chef, serving homemade nourishing food. He says he is proud of the Threshold Choir for offering their songs as a gift, “to receive that gift is an act of love and support, an act of care, which is what I need most in my life right now."