How a Phoenix threshold choir reframes death for both the living and dead

Threshold choirs in Phoenix and across the globe reframe death for both the living and dead.
Threshold choirs in Phoenix and across the globe reframe death for both the living and dead. Anna Karakalou

Jan 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 unfamiliar 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.

click to enlarge
Members Marilyn Rampley and Cindy Gattorna sing during an undated event/practice.
Marilyn Rampley
The Phoenix West Threshold Choir is led in part by Marilyn Rampley and Cindy Gattorna, who both self-describe as longtime 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, original 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 connotation 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 religion or dogma, but our music is very spiritual," Rampley says.

It's often about balancing certain religious 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 atheists," 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 privilege that we are welcomed into that time."
click to enlarge
The Phoenix West Threshold Choir perform during an inurnment for Greg Rampley, husband of member Marilyn Rampley.
Marilyn Rampley

‘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 harmonies 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 underestimate 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.

The choir routinely utilize what they call "the chair" during practices. With a member — or a willing Phoenix New Times writer reclined in a zero gravity seat, a group of three or four gathers and sings in the round. It's an experience for sure, and one that reminds you of the earnest but potent power of being sung to, especially nondenominational ditties like "Sending You Light." It's a powerful reintroduction to music, and how it can strip away stress, tension and even a sense of physical space.

"It's important to learn what it feels like to receive as well as to give," Rampley says of the chair practice. "So that's a good way of letting people begin to feel like they're emotionally ready."

Choir members, though, get to see the true power when they perform. They each have handfuls of stories that highlight how their work impacts people.

"One of the most poignant times was going into a private home to sing for someone that [the choir] knew personally," Gattorna says. "It's that intimate sharing of this fragile moment, whether it's a healing moment, or indeed a moment for setting up the passing of life."

"We can visibly watch them slow their breathing and calm down. Sometimes they'll just go into a calm sleep because they've not been able to because of pain or medication's side effects," she adds.

Rampley remembers two especially poignant moments. The first involved an older man, a demographic several members said is notorious for being unreceptive to the choir's efforts.

"One time a man who had a real strong Texas accent said, 'Well, ma'am, I don't think anybody ever sang a song to me,'" she says. "And I said, 'Your mom might have sung a lullaby to you long ago.' So music is a direct route to the heart."

‘Will the singers be here today?’

The other story involved someone who'd spent his life seemingly disconnected from the world.

"There was a young man that was developmentally challenged and also had some physical handicaps," Rampley says. "And we didn't know whether it would be appropriate to sing for him or not. So we quietly within our little group decided we'd try one song and we'd see how it went. At the end of the song, he reached up and touched my cheek and said, ‘Mama.’ I had to hold it together for a couple more songs."

As Wadell points out across a couple of her own stories, their singing not only touches the lives of patients, but their families and friends, too.

"Just the other day, we were singing to a patient when a family member walked in," she says. "Before we sang the next song, we introduced ourselves. And she said, 'I'm so grateful that I came before you left. I don't know if it's helped Dad, but this is what I needed to hear today.'"

It's even about going beyond moments of relief to forge deeper connections.

"There was one family that we had sung for the gentleman the week before," Wadell says. "Then the next week when we went, he was actively passing. The nurse told us before we went in that his wife had said, 'Will the singers be here today?'"

"We had a nice conversation with the family and then we sang. Typically we sing three or four songs with some space in between. We probably spent 30 minutes in that room with a family and they wrote a note afterward and left it with the nurse," she adds.

Oftentimes, it's less about healing and more about providing peace of mind.

"One woman told us that she had an elephant on her chest, and after we sang to her, the elephant was gone," Rampley recounts.

And through that act of relief, big things can take root.

"Our hope would be that we would bring comfort or open a door, perhaps, that's been closed for someone," Wadell says. "[These songs] allow people to go to a place within themselves that they hadn't been able to before. Or realized that they wanted to be there."

Oversized emotions

The door-opening metaphor goes both ways; the choir members have seen their own relationships with dying shift over the years.

"I will say that it was my expectation when I thought we'd be singing bedside that we'd have some trouble," Gattorna says, that "it would be troubling to me to see these people near death."

But Gattorna, and some others, had the decidedly opposite reaction.

"Probably 99.9 percent of the time, I don't feel moved to tears," Gattorna says. "And maybe on three [occasions] I've seen people pass away right in front of me. While it was a very moving experience, I didn’t feel traumatized myself. That was a surprise to me."

Gattorna says she and other choir members rely on one another for working through those oversized emotions.

"Sometimes I do feel it's necessary to shutter what I am feeling," Gattorna says of singing. "At rehearsal, we process. 'What did you hear? What were you seeing? Is there anything we need to talk about? How could we change it?' We un-shutter whatever I was feeling that I couldn't show at the time."

Their cohesion as a unit keeps people coming back for years. Wadell calls it "being a part of the journey."

Booth adds that the experiences help choir members bond.

"For many people, this is a really important part of their circle of friends and support. You become quite close. It seems to draw people who want to relate in that way. I think a lot of people are surprised at how important their rehearsal time is in bonding with each other," she says.

In the case of Rampley, she knows firsthand how the choir can help make death feel less all-consuming.

"In 2022, my husband was bedridden, became a paraplegic and passed away," she says. "Well, during that time, I had nothing to give to the choir. I was giving everything I had at home. Cindy just picked up for the whole year and was the leader, and I was so grateful for that."

"The day after he [my husband] died in my living room, nine or 10 women came and sang to me. And I couldn't tell you specifics — I just remember being so grateful and so touched and felt so loved and supported," she adds.

Wadell echoes these sentiments, adding, "It's the most welcoming, nurturing group of people that you could be a part of."

Honoring the end of life

For Booth, who is less connected with the day-to-day efforts of a choir, she's often tackling those aforementioned issues with death's place in our larger culture.

"We've lost this idea that end of life is a valuable part of human development," she says. "We focus on child development and becoming independent and raising families and retirement. But we don't see the end of life; we don't talk about it or teach it or study it with that same kind of honoring of its own particularities."

It's an especially vital issue considering how it directly affects threshold choirs.

"There's a reason why I think more of us are over 55; we have more room in our lives," Booth says. "I know many of us, when we were busy working full-time or raising families, it would have been hard to commit to regular rehearsals and bedside things."

One of the more obvious reasons for the shift, Booth says, is simple progress.

"When we developed this more biomedical and technological way of curing diseases, or saving people's lives, we went so far in that direction that death became a failure," she says. "We do everything we can to try to stop it."

She adds that we're a "more materialistic culture — we're a more individualist culture — and we're not a collective culture generally." As such, there tends to be a focus on the joys of life and not its accompanying, inevitable ending.

"We've lost our familiarity with the purpose of grief," Booth says. "In a culture like the U.S., which is a hyper-positive culture ... you can be anything you want to be and just be happy. So you have family systems where somebody's dying and no one can talk about it. 'Let's just stay positive. You're going to get better, Mom.'"

There are also notions about how societal structures have evolved.

"In the last 30, 40 or 50 years, we have fewer families living multi-generationally," Booth says. "So now we have people in their 30s, 40s and 50s until they see or might be around people who are dying."

But perhaps the biggest reason, she argues, is that we forget just how powerful grieving is in actively acknowledging life.

"There's this wonderful phrase, the intelligence of grief," Booth says. "It's not just a kind of sad mistake that we have to get through it. It turns out that feeling that loss, and being able to go through it and not just shut it down, allows us to also feel more gratitude."

Drawn to the singing

That's why Booth, the board, and the choirs are trying to grow their numbers. While Gattorna mentioned that "nine out of 10 people have never heard of us," there are clear signs of that changing.

"We took a hit with COVID, with chapters being unable to even get together and rehearse," Booth says. Yet there "was a bit of an uptick in people wanting to start and join chapters [amid COVID]. So we have many new chapters in formation right now. It takes a good six months to a year to really get a chapter off the ground."

Booth explains that there's also an effort to recruit more young people. While the board is still early along with this push, Booth says young folks have responded positively in years prior.

"In the D.C. chapter, we had a number of younger people," Booth says. "They were drawn to the singing, and they were intrigued by the end-of-life part. What they found once they got there was they were most touched by the community and the sense of being part of something."

But threshold choirs aren't just for the very young or the retired. It's for anyone who can meet some fairly open-ended criteria.

Potential members should have "a certain comfort with the mission that we're not just singing out in the community; we're singing for people who are in the last hours, days or weeks of their life," Booth says. "But what we need is someone who can hold a tune."

Wadell adds that choir members should understand that their work is about more than singing.

"Sometimes when you first start, you might be a little self-conscious, but only in your ability to sing the way you want to sing. But you soon get past that because you realize the gift you're bringing," she says.

The nature of threshold choirs mean that there's always more work to be done — practices to organize, outreach to schedule and, of course, more songs to be sung. Though the mission never gets easier, even as it gets more fulfilling, the members remain resolute in their efforts. Death is all around us, after all, but so too is community.

"It’s about not being afraid of that process, but rather knowing there are ways to support yourself and your loved ones in the midst of that really, really sad time," Rampley says. "I think that's a gift that I would want people to know. There are so many resources, but this is one where all the effort it takes is just to give a call. Suddenly you have people that can be there for you and with you."

If you're interested in learning more, visit the websites of the Threshold Choir and the Phoenix West Threshold Choir.
KEEP PHOENIX NEW TIMES FREE... Since we started Phoenix New Times, it has been defined as the free, independent voice of Phoenix, and we'd like to keep it that way. With local media under siege, it's more important than ever for us to rally support behind funding our local journalism. You can help by participating in our "I Support" program, allowing us to keep offering readers access to our incisive coverage of local news, food and culture with no paywalls.
Chris Coplan has been a professional writer since the 2010s, having started his professional career at Consequence of Sound. Since then, he's also been published with TIME, Complex, and other outlets. He lives in Central Phoenix with his fiancee, a dumb but lovable dog, and two bossy cats.
Contact: Chris Coplan

Latest Stories