Professional musicians play to impress audiences and build a fan base, but not harpists Elizabeth Markell and James Excell.

Professional musicians play to impress audiences and build a fan base, but not harpists Elizabeth Markell and James Excell.

Their songs often are the last their audience will ever hear.

"The music we play can make space for patients who might be near the end of their lives or are receiving treatment for serious conditions to relax," Markell says.

She and Excell are trained in music-thanatology, a subset of hospital palliative care that unites medicine and music, often for patients nearing the end of their lives.

Markell and Excell are part of Rogue Valley Medical Center's push for increased palliative care options for its patients.

Palliative care, which includes hospice care, is designed to ease the suffering of patients who are terminally ill, have debilitating symptoms or are enduring grueling treatments such as chemotherapy.

Markell and Excell wheel their 25-pound Celtic harps into the hospital each week to play for the sick and dying. Upon entering the room, they ask the patient or the family for permission to play, Excell says.

"I will then introduce myself and try to get a reading on the patient and those in the room," Excell says. "I rarely have a set plan when I play. My head might be telling me one thing and my fingers another. The fingers are usually right."

The musicians draw from spiritual songs, lullabies, Gregorian chants and Irish songs dating back to the ninth century, Excell says.

It might sound like New Age mumbo jumbo, but Sue Kilbourne, RVMC's clinical manager of medical oncology and palliative care, says music-thanatology can play a significant role in easing patient suffering.

"We have seen such positive results from music-thanatology," Kilbourne says. "We now have nurses and even doctors who are recommending the musicians to patients. They believe it really does improve patient outcomes."

The musicians are required to fill out medical observation charts with each patient. The hospital is collecting the data to share with other organizations looking to expand their palliative care programs.

Not just anyone with a harp or a guitar can enter a hospital to play for those who are suffering. Licensed music-thanatologists receive 324 hours of training, about one-third of it in medicine.

"We are taught to recognize changes in patient behavior and reactions to different medications," Excell says.

The goal is not to entertain, but to improve a patient's hospital experience, Excell and Markell say.

Excell says he once played for a patient who was suffering from intense anxiety.

"When I entered the room, he was experiencing 56 breaths per minute, which is a lot," Excell recalls. "After I played for a while, his breathing slowed down and he was able to relax."

The musicians listen to patient respirations and other medical equipment within the room. They select their songs with these sounds in mind, seeking to incorporate them into the music.

The experience is meant to give a patient a reprieve from the often stressful and impersonal hospital experience.

"We are trained to react to things in a moment's notice," Excell says. "If a heart monitor starts to do something disharmonious with us, we can switch to a different key."

The pair steers away from playing old standards that everyone knows. They don't want to trigger memories tied to certain songs, such as "Amazing Grace," that can be stressful for the patient.

"A song that they may not know gives them space to relax and focus on the music and not a memory," Markell says.

Others in the hospital room also benefit from their playing, the pair say.

"Often, these times are very hard on families who are seeking an outlet for their grief," Excell says. "We've played in rooms after the person has died, just for the benefit of the family. It is difficult for some to find an outlet for their grief. We can provide that outlet."

The musicians sometimes set up near nursing stations to play for stressed-out hospital staff.

"They really appreciate having the music available," Kilbourne says. "Working in a hospital can be a very hard job some days."

The music-thanatology program is funded by a recent $238,000 grant intended to increase RVMC's palliative care offerings. Markell and Excell spend about 10 hours a week at RVMC. They also play for a hospice service in Ashland.

For more on Oregon's music-thanatology program, see

Reach reporter Chris Conrad at 541-776-4471 or email