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Heartbeat Music, Memory Making

Author: Annabelle Keevers & Philly Smith
17 May 2018

“Memory is a way of holding onto the things you love, the things you are and the things never want to lose.” (Kevin Arnold, The Wonder Years).

Human memories are the basis of life and constantly remake and reshape our brains. When you are a parent, memories are important, but if that child has a life shortening diagnosis, the concept of memory making has greater significance but is arguably, more difficult to achieve.

At Bear Cottage, our motto is “life is for living” so memory making is a fundamental part of what we do. For our parents, there may be many sad and traumatic memories.  In an effort to balance these memories, staff at Bear Cottage also encourage and give families permission for making happy memories.

Families are supported to make memories at every opportunity throughout their journey. This could be achieved through encouraging families to do normal activities that they may not think they can participate in, snuggling in bed with their child, watching a movie all together or dipping their toes in the ocean. 

Alternatively, these memories may be surrounding the tangible objects that families can hold onto after their child has died. When creating these tangible items, it is important to reaffirm to families that the memories created throughout the process are as important as the end product.


One such tangible memory that Bear Cottage is lucky enough to be able to facilitate is heartmusic. As the name suggests, this is a form of memory making which incorporates the child’s heartbeat into the making of special music for memory making.

Some of Beethoven’s most intense and profound music was written after the onset of deafness, a time when he may have turned increasingly inward, becoming attuned to the arrhythmic rhythms of his own heart. The changing rhythms of late works including the Cavatina String Quartet have been analysed by musicologists and cardiologists who confirm that they are indeed consistent with patterns of arrhythmia and may in fact be deeply reflective of his inner experience and sense of Self.

According to Professor Joel Howell, a medical historian and professor Internal Medicine at the University of Michigan, there is a synergy between our minds and bodies which reflects much of our innermost experiences. (1)

This synergy is being harnessed by some music therapists in the Sydney Children’s Hospital Network to create an intense and lasting form of memory making for parents whose children are terminally ill or who have passed away. Technology is coupled with art when the heartbeats of child patients are digitally recorded and then paired with a piece of music, one of very special significance to the family, using the heartbeat as the underlying pulse for the work.

In this way, an enduring and irreplaceable form of memory making is given to the family to keep.  The result is utterly unique, a bespoke piece of music carefully matched to the rhythms of their child’s own heart. 

The music takes the form of a multitrack recording.  The heart is the first track which is laid down and it always remains clearly audible in the finished piece, a piece which may be instrumental or vocal or a combination.


The concept of Heartbeat Music was the brainchild of Brian Shreck, an innovative music therapist from Cincinnati Children’s Hospital. (2)

At the Sydney Children’s Hospital Network, the Heartbeat Program was begun first at the Randwick campus by Registered Music Therapist, Matthew Ralph. A colleague, Annabelle Keevers, has since also incorporated the concept into her work with families at Bear Cottage, Manly, a children’s Hospice, also part of the Sydney Children’s Hospital Network. 

As with any new project, there were many challenges in setting up the new programme and so there was for Annabelle a considerable sense of triumph when the first piece was finally completed.  Its creation had been the outcome of a great deal of team discussion and support.  One of the Child Life Therapists with an interest in IT for example, suggested purchasing a digital stethoscope for the recording of heartbeats. This stethoscope, which greatly simplified the process of recording the heart, was generously donated by the Ottomin Foundation.

Similarly, all the nursing staff have been patiently supportive, assisting by ensuring that good quality recordings are taken, sometimes under challenging circumstances.

Technical difficulties

There were also many technical difficulties which were encountered along the way. One early and seemingly insurmountable frustration came from the discovery that heartbeat recordings were inaudible on the small speakers of a laptop computer when time came for mixing it with the piece of music.  Here, the expertise of Steve, the husband of Jane, one of the Administrative Officers was offered.

Another constraint has been in the other recording equipment used for the music recordings.  It is hard not to compare the finished product with professionally made song recordings. These heartbeat recordings are something of a cottage industry, completed on the home piano of Annabelle with a small laptop computer for the purpose of recording. There are no soundproofed studios available, nor any qualified sound engineers!

What is important to remember, however, is that heartbeat music is not the same as any commercial production.  It is the product of relationships: the relationship of the child and parents and siblings and also the entire team at Bear Cottage. It is a gift, an irreplaceable gift for once a child has died, the sound of that heart can never again be heard. 

Annabelle says, “When I am making the recording of the song for the family, I have to find a way to re-enter the emotional space I was in at the time of being with them…I need to be able to feel those emotions again and for those emotions to become part of my music.”

And while it may be assumed that the child whose heartbeat is recorded is a passive participant in the process, nothing could be further from the truth. Just as Beethoven came to be acutely sensitive to his own heartbeat, so, too, does the music therapist need to be sensitive to the rhythms of the child’s heart. These rhythms profoundly influence the final piece of music. Indeed, the speed of the heart, the changes in its rhythm and its volume all affect the way the music is expressed.

Sometimes, for example, the final song will be much slower than the original because that is the speed of the child’s heart. However, speed is not the only component. The heartbeat may be quite a fragile sound. If music with a thick harmonic texture is put with this, the child’s heartbeat will be lost – quite literally - in the mix. The heartbeat must always be the essence of the finished product because it is expressing the essence of the child.

Annabelle says, “I often find that the best way to complete the song is to carefully lay down my bass line on the piano with the heartbeat, then gradually add layers of simple harmony. Usually the finished harmonic texture is quite thin so that the heart is clearly heard. I also offer the parents three recordings. One is of the heartbeat, the second is instrumental and the third one includes my vocals if their chosen piece of music is a song.”

Deep significance

The music which parents ask to be paired with their child’s heartbeat is always of deep significance and there is always a story to accompany it. The very first heartbeat recording, for instance, was made with a song which the baby’s mother had sung to her little boy when he was in utero.  The lyrics were changed slightly so that the song was directly addressed to him, a song in which mother was making special promises about the ways in which she would always love him and care for him.

Another mother chose a theme taken from a movie which had a story of love and loss as its theme.  It was a song which was shared by the whole family and her son used to play it as a way of drawing her emotionally close to him.

Yet another was chosen because in early days, before her son had been diagnosed, a mother had beautiful memories of joyfully dancing around her living room with him on her hip.

The feedback from families has made the project one which is close to the heart of Annabelle. It is one of the most important of her duties as a Music Therapist. Kept on her desk is a copy of an email from parents who went travelling not long after their son had died. The heartmusic recording of their son was emailed to them during their travels. Their return correspondence of thanks reads: Thank you for the beautiful music…Although we are in Vienna, a city renowned for its music….this is the most significant piece of music we could ever listen to….”




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