J an Booth knows death all too well. She spent years working as a nurse across hospice and end-of-life care. But after helping others for so long, she found herself disillusioned. Not with the patients and families, or even the maddening U.S. healthcare system, but with society’s relationship with death. “When I left hospice back in 2014, I went out on my own to carve another path for myself professionally because I wanted to get out into the community and open up this conversation and encourage nurses to open up this conversation, too,” Booth says. “I had seen so many people come into hospice over many years completely unprepared and families that didn’t know how to talk about it.” While exploring options in Washington, D.C., where she lived at the time, Booth came across an intriguing, altogether unfa- miliar group. “There was a flyer for a thing called the threshold choir,” Booth says. “And it said, ‘Singing quiet songs at the bedside of dying people and on the thresholds of living and dying.’” A lifelong singer to boot, Booth signed up right away. Fast-forward a decade or so, and Booth, who now resides in Boulder, Colo., is the co-chair for the national threshold choir board. There are 200 or so choirs across the U.S., Mexico, Canada, Australia and New Zealand. But it started back in the early 2000s with entertainer Kate Munger. “Kate was living in California at the time, and she was [caring] for a friend who was dying of HIV, and he was kind of restless,” Booth says. “And because she was a singer, she didn’t really know what to do; words didn’t seem to really be helping. So she started singing and she just saw the impact.” The board’s formation, Booth explains, was a natural extension for Munger and other performers. “It’s basically the folk singing tradition that’s alive in every culture where people just come together who love to sing. It’s not about performance necessarily, but people enjoying singing together,” Booth says. The Phoenix West Threshold Choir is led in part by Marilyn Rampley and Cindy Gattorna, who both self-describe as long- time singers and community organizers. For Gattorna, the appeal of the threshold choir is its simple approach with far- reaching applications. “We sing to put people [at ease] who are on a threshold of life through gentle, orig- inal music — whether that’s entering hospice, they’ve had a terrible trauma in their lives or they’re looking toward a long recovery,” Gattorna says. Gattorna adds that while hospice- centric care is their focus, that lone conno- tation can often prove limiting. “The last thing we want is to be known as that choir that comes to sing when you’re ready to die,” Gattorna says. “Like, there’s a real branding issue there, right?” “We have sung for people who are shut in, and they could live another 10 years, but they can’t get out of their care facility. We’ve sung for family members at funerals and at very public settings, including for traumatic incidents, like a mass shooting,” she adds. Some of the issues that Booth mentions have to do with the religious undertones people often associate with end-of-life care. But members are adamant that their work isn’t faith-based. “We don’t promote any particular reli- gion or dogma, but our music is very spiri- tual,” Rampley says. It’s often about balancing certain reli- gious backgrounds and trying to present something universal. “I think it’s important to note that just in our little choir, we have practicing Buddhists, practicing Christians and athe- ists,” Gattorna notes. “Our very acceptance of other belief systems is really important; we bring that into the room with us.” There are times when the choir’s work even helps them connect with faiths beyond their own. “I remember once walking in a room of Latino people,” says Rampley, who guessed based on visual clues that the family was Catholic. “I think the reaction was that we were, in that case, helping them with that transition in a way that a chaplain would, but [one] wasn’t available at that precise moment. So I asked if they would like to sing with us, and we sang ‘Amazing Grace.’” Finding a lullaby Booth says that threshold choirs learn from other cultural groups to expand their song list and better connect with the shared act of death and grieving. “In many spiritual traditions, there are practices of preparing for death because of this very idea that coming to terms with all of this on your deathbed is asking a lot, or coming to terms with the loss of your dear person. You’ve missed so many opportunities,” Booth explains. Rampley, who coaches other groups, says that U.S.-based choirs can look to overseas groups in learning about fostering a reverence for life and death alike. “One of the things [I’ve learned] since I’ve worked with international groups is that they have within their culture and their traditions songs that would fit [a threshold choir],” she says. “You can almost always find a lullaby in another language that fits for the kind of things that we do. So I’m working with a group in India, and they taught me one of the songs. Their lullabies really fit the situation for when you would be in the presence of someone who needed to relax and who needed to feel peaceful.” Susan Wadell, whose 50-plus-year friendship with Rampley persuaded her to join the Phoenix choir, says their faith-free approach is part of this larger duty to their audience. “We always say, ‘If there’s any time that you want us to stop, just let us know,’” she says. “It’s not going to hurt our feelings because we’re there to be of service to them. I’ve been privileged to share in some of the most profound moments of people’s lives. It’s very humbling. It’s such a privi- lege that we are welcomed into that time.” ‘We are all just walking each other home’ So, given all of this, the question begs: Just what songs are best suited for threshold choirs? “Most of our songs are written by people who are in threshold organizations all across the world,” Rampley says. “One that I wrote, that I felt like we didn’t have anything in our repertoire, pointed toward feeling honored to be in the presence of this audience, how we’re deeply honored to be here with you.” Rampley adds that the choirs have a collective repertoire of about 500 songs. The best tunes all share some essential characteristics. “They shouldn’t have too many words,” she says. “There’s either beautiful harmo- nies or they’re able to be sung in the round.” Booth, meanwhile, notes that the songs often offer resounding themes. “The messages are very uplifting: they’re love, peace, grace, family, kindness and solidarity,” she says. “It’s like the song, ‘We are all just walking each other home.’” Gattorna, meanwhile, notes that songs must facilitate a very specific experience for patients. “We provide what we call a sound bath, and that literally is using the beautiful vibration that the human voice creates to put people at ease,” she says. “What I’ve learned is to never underes- timate the power of personal energy and vibration. And I mean that in a pretty literal sense. I was always aware of, because I’ve sung my whole life, how singing impacts people and can change the mood even in a crowd. But how deeply it can impact people, I didn’t really see that until I was doing [threshold choir],” she adds. SING ME HOME How a threshold choir in Phoenix — and hundreds across the globe — reframes death for both the living and dead. BY CHRIS COPLAN >> p 12 Illustration by Anna Karakalou
