Helping end-of-life patients and their families come to terms with extreme grief through legacy therapy.

When the life of a loved one is ebbing away, the first instinct is to try and hold on to that life for as long as possible. For the young wife and small child of a patient — in a coma at the intensive care unit (ICU) following a horrific road accident — suddenly seeing him and knowing they had just hours before having to let him go was unimaginably hard to bear. Their medical team proposed bringing in Singapore General Hospital’s (SGH) Art Therapy and Music Therapy Unit, which helps families cope with sudden grief through legacy projects.

Legacy work, part of end-of-life care, involves leaving something behind for loved ones to remember the patient by. “The act of creating or doing something with the intention of remembering may benefit both the patient and loved ones in a variety of ways. Legacy work may come in the form of a transitional object to provide comfort to loved ones as they process the grief of letting go. As a music therapist, our legacy projects tend to be auditory-based ones,” said Ms Stephanie Chan, a Music Therapist with the unit. Her Art Therapist colleague in the unit, Ms Phylaine Toh, added: “It’s a gentle method of encouraging a sense of closure, as well as a safe method of expressing grief and frustration with the loss.”

<Ms Stephanie Chan modified a stethoscope to help her record patients' heartbeats, while paintings help patients express their grief, anxiety and other emotions, says Ms Phylaine Toh.>

Once patients and loved ones give their consent to start the legacy project, they decide on their preferred medium — handprints, paintings, music heartbeat recordings, songwriting or curating a playlist. Depending on what they decide, the music or art therapist will facilitate the creative process and engage them in conversations about the significant moments in their lives.

A cancer patient dedicated a video of herself playing the ukulele to her family. “Watching the video after the patient’s death prompted her family to reminisce about her. It brought back fond memories for them and comforted them in their moments of grief,” said Ms Chan.

A daughter who felt extremely distressed with her mother’s poor prognosis had the idea to create a bracelet of prayer beads. “The process of making the beads and putting them on her mother gave her a sense of control over her mother’s diagnosis,” said Ms Toh. The comfort the daughter felt when her mother lived beyond her prognosis also helped her cope with depression and suicidal tendencies.

A family who wanted their handprints with the patient’s centred their discussions on the colour to be used and where the handprints should be placed. Having the patient’s handprint in the middle, surrounded by the wife’s and children’s, signified the father’s central role in the family and their continued support for him.

When families want to record and add the heartbeat of a dying loved one to music significant to them, Ms Chan had to modify a stethoscope to be able to capture the heartbeats, which are then edited and mixed on a computer. For one family, “having that recording was a way for them to remember that dad’s heartbeat continues to live on in their lives”, said Ms Chan.

Even the sterile and cold atmosphere of a hospital — particularly an ICU room — can be made a safe space for the family. Closing the door and drawing the curtains can offer a therapeutic and safe respite for the family and patient to be as emotional as they needed to be to explore and reflect on the end-of-life transition, said Ms Toh. “It may be challenging to process grief. We hope that, by listening to the music heartbeat recording or looking at the artwork created, it will bring the family some comfort,” said Ms Chan.

The process is cathartic and helps lead the family towards some sort of closure and acceptance, said Ms Toh. When the family who created the handprint artwork was asked where they intended to place it, the family’s reply of “the living room, where the patient used to spend a lot of time” was an indication that the family had begun to accept his demise and was moving forward in processing their grief.

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