Comments on Nicholas Kofie's "Reflections on a First Time Experience with a Coma Patient"
Nicholas Kofie's reflections on his experience with a coma patient interest me very much, especially because I have also seen a patient getting up from a similar condition after music was played. Kofie has not specified the cause of problem for his client. I know that many causes are attributable to the condition of coma. The ones I have been interested in are particularly explained with religious beliefs. What I have learnt from some people in Kenya who have experienced the same, is that spirits can bring someone into such a condition. One of them said he was still in lower primary school when he began to "die and resurrect" when a specific song was sang to him.
Spirits in African traditions are believed to have been at one time human beings or even animals. When people die, their bodies decay of course, but it is believed that their spirits not only continue to exist around the home, but they can act to protect a family against "evil spirits" and witches. Rituals would be normally organized to appease such spirits (not to worship them as some people think) through music, dance and pouring of libation in return to their protection. These beliefs also necessitated decent burial rituals for the dead.
In Africa, one way these spirits could affect a family is through possession. This means that the spirit is impersonated, and the possessed individual behaves like the person whose spirit is believed to have possessed him/her. If a woman is possessed by a spirit of a person who was a man, she would be allowed to do a thing that is forbidden for women in that condition, because she is possessed by "a male spirit." In other words she is a "man" because a spirit of a man controls her actions at this time, and would even reject normal female dress and mannerism. If an individual is possessed for the first time, one of the symptoms is unusual forms of illness. For example insanity, body pains which doctors cannot diagnose or treat, and the condition of a coma. Such people may even fall into a coma even though not possessed for their first time. This is where music is often vital. It may be the only means to have the person "resurrect" besides few other things a skilled healer may do.
What I find even more interesting is that Kofie decided to act. It would of course have been embarrassing to try such an experiment and fail. Deciding to try specifically the Ebenezer song that the patient often sang, he uses his informed mind in a rather unusual context. I am not surprised at the results he got. The friend of mine, who used to 'die and resurrect', named a specific song that once sang he would resurrect. But he said the reason is that the song is addressed to a spirit of his late grand father who often possessed him and enabled him to treat patients. He would fall into coma if this spirit got into him unexpectedly. Kofie does not get into such stories; perhaps illustrating how well music can "resurrect" without referring to spirits.
He raises a number of questions about the possibility of having a music therapy that "resurrects" coma patients world over. With all considerations I doubt that that is possible. If it was, it would mean so much to music therapy. Unfortunately we seem to be absolutely different in our understanding and appreciation of music, so that different music would only be expected to work with different individuals. The same happens in professional music therapy too.
More important, I think more experiments would be good in such circumstances.
About Bernard M. Kigunda
Biography
M.Mus, Kenyatta University - Nairobi / Kenya, since 2004 he is a PhD-student at Otto-von-Guericke-University Magdeburg / Germany (musicology) and at University of applied sciences Magdeburg-Stendal / Germany (music therapy); theme of dissertation: Music and Health in Kenya.
When perusing through the articles on this web site, I was drawn to Nicholas Kofie's article entitled, "Reflections on a First Time Experience With a Coma Patient". It caught my attention because I have had some personal and professional experiences with people in coma states.
When I was in my teens, both my brother and then later my father had different accidents that put them both in intensive care for a while with comas. (Luckily they both came out of them fairly quickly.) I especially remember being with my dad in intensive care when I was 19 years old. He was unconscious and many of the nurses told us to talk or even to sing to him if we wanted to, as long as it was in a loving and peaceful manner. They had heard about and personally witnessed many coma patients who had reported upon waking that they had heard loved ones and/or medical staff talking about them, and some had even heard music as well. I sang some familiar songs to him that we both liked. These songs had always had good memories about hiking in the Rockies attached to them. He came out of the coma, and later on he told me that he remembered people talking and singing to him, but it was hard for him to recall details. But it was comforting to him. Who knows if it helped him or not, but I doubt if it hurt him. It definitely helped me deal with my feelings of anguish and helplessness at the time.
I have also been working in rehabilitation with adults with traumatic brain injuries for a long time as a certified brain injury specialist/counselor (CBIS), and although I have not worked with coma patients in this work, I had to study and learn about coma and brain injury in order to pass the CBIS exams. I remember coming across numerous coma case studies in the medical literature that were similar to the ones that the nurses had told me about years before.
Currently I am doing my first year music therapy practicum and internship at a hospital north of Boston. There I have been working with my supervisor with two patients who have been diagnosed with minimal consciousness state for many years. I believe that this term is used with people who are in a coma state, but who demonstrate some meaningful, although sometimes minimal, response to sensory stimulation and human contact. For example, sometimes they can visually track people when they walk into a room, or occasionally smile at people with seemingly meaningful direct eye contact. But there is still so much more we do not know about people's experiences in comas and minimally or diminished consciousness states. Given all of this, I was curious to read about Mr. Kofie's experience using music on a coma patient.
Mr. Kofie's work with a coma patient in Kumasi, Ghana was very interesting. Given that there were not any certified music therapist coming forward to work with this coma patient, even after his condition was advertised in the local news, I was impressed by this man's courage and dedication to travel 250 km in order to try to help this man as best as he could with music. The whole story is quite intriguing and inspiring, and well worth reading.
However, at the end Mr. Kofie put forth some interesting and valid questions for the readers to answer and discuss. Rather than try to give my answers to these clinical questions, as I am only a first year graduate student, I will leave that up to more experienced music therapist. But one question stood out to me that I would like to address here. He asks his readers, "If I had encountered a failure and embarrassed myself, would I have had another opportunity to redeem my profession?" (Kofie, 2005). The issue about professional failure and embarrassment is a real one, especially since we are in such a new profession. I am assuming that most of us in this field really want to help people, as well as to have our relatively new profession understood, validated and supported.
But what really stood out to me in this question was his definition of "failure" in this case. I do not doubt that his efforts probably helped this man come out of his coma sooner than later, even though no one can empirically prove this. Thus, indeed he was successful. However, what I would like to stress here is simply this; if a coma or minimally conscious patient does not come out of a coma with the help of music therapy efforts, is the work considered a failure? Even if it does not end up leading to a return to full consciousness, as could have been the case here, does caring for a patient, by providing tactile and auditory stimulation and genuine human contact, in and of itself make it worth all the effort and time? If it is at all possible that we might be providing a better quality of life to these patients, even though it may seem unlikely to some, is that not enough to consider this therapy as being successful? I know that getting real results and even cures for people in this work is a good and noble aim as well. Nevertheless, does caring or walking with a patient on part of their journey count as being "successful"? I think it does.
All I can say is that after my two personal experiences with comas in my family, then studying it, and now working with my two minimally conscious patients at my music therapy internship, I strongly believe that this kind of work is helpful and stimulating to them. Nobody can know for sure, but there have been so many testimonials from former coma patients that claim they remembered what was being said and what was going on around them while in a coma state. Sometimes it was upsetting to them, and other times it was comforting to them, depending on what was going on around them.
Intuitively I feel that when I sing and play the guitar to my patients at the hospital, and genuinely hold their hands and talk to them, that sometimes they really feel like they are with me for a few moments. It is very moving to be a part of; I get direct eye contact and a smile sometimes when singing and play music and holding their hands. Sometimes I even see a few tears rolling down one patient's face when The Beetles' music is being played. My dad also remembered me singing and talking a little, and it certainly helped me to deal with my sadness and helplessness. So for all of these reasons, and more, I would just like to say that I believe this work can be considered successful, even if they remain in a coma and/or in a reduced consciousness state. Indeed, it is amazing that he woke-up soon after he worked with this man. Nevertheless, I think Mr. Kofie was successful beyond this, because he really cared for and about this man and his family, and genuinely tried to help him.
"Reflections on a First Time Experience with a Coma Patient" written by Nicholas Kofie caught my attention while browsing through the many different articles on this website. As a music therapy student trying to decide on what area of music therapy I would like to work in, I found this article to be very interesting. The area of music therapy and its use in a hospital setting as medical music therapy holds a strong interest in my life. I remember once a few years ago when my grandfather was in intensive care in the hospital. He was having a bad day and would not corporate with the nurses for anything. Before we were getting ready to leave, my mom asked my two sisters and me to go in a sing him a song. We decided to sing "You Are My Sunshine" to him. As we started singing and as he began listening he gradually started to calm down. He allowed the nurses to do what they needed and he was becoming less "fussy." His heart rate, which had been relatively high because of his agitation also dropped back into a normal range. It was pretty amazing to see. I realize this has nothing to do with being in a coma, but it is music being used to help in a medical situation. This occurrence helped develop my interest in medical music therapy.
When I read Mr. Kofie's article about his experience in working with a coma patient I realized that this is something I believe I would like to do. Mr. Kofie describes how he used music to help a patient wake up from a coma. Using a song the patient was familiar with, Mr. Kofie softly sang this song to him. The music elicited a response from the patient and he gradually awoke. The patient recovered and was discharged from the hospital three months later. This is really incredible. I realize that not all cases turn out such as this particular one, but when there are the successes it make life seem more rewarding. This is what I want to experience. I know that music can heal and I want to be able to help others in situations such as these. I have read other cases like this one where a person is in a coma and a music therapist is asked to come in and work with the coma patient. Eventually (or sometimes never) the patient shows response to the music and/or the person presenting the music. With time, the patient gradually becomes more aware of their surroundings or wakes up completely and the music is what helps to aid them in this process. It really is amazing and exciting when you sit back and think about it. Music can and does heal. I am glad that Mr. Kofie presented this article for me and others to read.
Reading Nicholas Kofie's "Reflections on a First Time Experience with a Coma Patient" ignited in me a fire that I have been trying to extinguish since I started my music therapy training in the US-that of proving to others that what I was proposing to come and study in the US(Music Therapy) did exist and did work. It was quite a task with occasional questions of "but what is Music Therapy?" With the definitions that I could draw from the two Nordoff-Robbins books that existed in my university library then, I would go into the explanation of what I figured music therapy to be and how it could be of significance to children with special needs in Kenya. To my response, my inquirers would continue with more questions, "You mean the music healing thing of the past? The Kilumi and Pepo dances-kind-of-thing?"(These refer to two dances in two Kenyan ethnic groups which were primarily performed for healing purposes). Many comments (some positive but majority of them negative and discouraging) would follow as some colleagues and others openly displayed their skepticism on music healing as they knew it and even of music therapy which they knew nothing about.
Back to Kofie's reflection, it brings up the realities of practicing music therapy not only in cultures where music therapy is being initiated, but in every situation where our services are needed. As music therapists, our role goes beyond the clinical work we do with our clients. I found out that I had to occasionally 'educate' the program aides in my practicum about my role in music therapy group sessions at a home for elders suffering from Alzheimer's disease - and their role too. This is an ongoing undertaking for all music therapists wherever they are based but more so for those introducing music therapy as a new discipline. We have a big role of educating others about what we do and the benefits of our work
Kofie also talks about his awareness of "the risk involved in failing and the consequences thereof" with his statement of "somehow [feeling] that [he] would succeed" really touching me at a personal level. I am reminded of a phrase I have constantly heard and subsequently embraced in my training so far, "believing/trusting in the process". I am of the opinion that without this intuitive belief, it would almost be impossible for many music therapists to do the work they do.
When I think of the work I am hoping to initiate in my country after my training, the risk of failure and the consequences that might result often bears hard on me. This may probably be as a result of the initial reaction I received when I proudly announced my intentions to study music therapy as highlighted in my opening statement. I see myself in Kofie's position of convincing interested parties that what I am doing is worthwhile and I am not doing it for the sake of 'entertaining' my clients. It is a hard place to be but I have had first-hand experiences of the 'success' of music therapy in my practicum and internship, and even listening to professionals present the work they do in conferences. More so, I now fully 'believe in the process'.
On reflecting on the questions that he poses at the end of his article, I am reminded of two other phrases I have picked up, "living with the question" and "being in a place of not-knowing". This far in my training, I cannot ascertain that for any music therapy session I have lead or co-lead, I knew what my clients would do or what would happen! Not in any one single session. I prepare myself mentally that I am going to be present for and with my client , prepare some of the music I might use and then walk into the therapy room, 'not-knowing' what will eventually happen in the session but at least confident that whatever happens, I will be there to support the client in his/her needs.
Kofie brings out a point about encountering failure and embarrassing oneself as a professional. Sometimes 'meaningful moments' do happen when a client responds in a way I did not envision- how do I explain such situations? What if I attempt the same thing a second time and I do not get the same response? Or better still, when I attempt an intervention and I do not get a response from my client; do I count this as failure? At a personal level of wanting to succeed and 'prove' that music therapy works, I may think that 'I' probably failed in that one intervention; that I did something wrong and that is why the client did not respond. However, my supervisor always brings me back to the reality of the work we do: We want it to work! We want to make contact with our clients! We want them to respond to us! When all these happen, it brings a feeling of gratification within us. However, when moments of "failure" happen, I believe this is when we really become better in our work. With deep analysis and reflection, such occurrences should alert us to what we did in the session that 'did not work'; whether another way of presenting the same intervention might yield a better response; it might even lead to a revision or modification of the goals we are addressing for the specific client. But in all these, one thing that we always forget is that the 'success' of our work does not only rely on us as the music therapists and the interventions we bring into each session. There is also the persona of the client! In most cases, it is not easy to find out where 'they-are-at' when they come to music therapy and this is a big piece to consider when thinking about whether we 'failed' or 'succeeded' in our work.
Lastly, one of Kofie's main concerns is on not knowing what music is relevant for each client. I am from Kenya and I have worked with clients here in the US using all sorts of songs so to say. Sometimes, clients have not always responded to songs that are notably 'familiar' to them. In other situations, I have found clients who do not respond to any vocal intervention- thereby turning to using different instruments. I might sing a song from Kenya in Swahili language while working with a client originally from say Romania, and we establish a contact via this song, opening more areas of interaction between my client and myself as a therapist. The notion of music as a universal language comes true for me when this happens and it marks a 'meaningful moment' for me and my client in the therapy session.