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Script For A Presentation To Medical Students On Music And Its Uses For Patients In Addressing Anxiety, Post-Op Recovery And Rehab

Introduction
In July 1999 I was diagnosed with breast cancer through a routine mammogram. Over the next two months I had a biopsy, 3 diagnostic surgeries and a mastectomy, followed by four rounds of chemotherapy. At the 18-month mark I had a six-hour free-flap reconstruction and three months later the final touches on reconstruction. Soon after chemotherapy was completed I started playing for patients in the hospital. For nine months a music therapist and I visited the transplant area in Montefiore Hospital every Monday, and the next day I played for people in the radiation oncology waiting area, as well as in its ovarian cancer inpatient area, at Magee Women’s Hospital.
I continue to do this, though not so regularly, now that music therapists have been hired at Children’s Hospital and more musicians and staff have experience playing for patients in different settings. I do, however, continue to play for a semiannual memorial service at Children’s Hospital for families and caregivers.
So my talk today about how to use music in the hospital setting is based on my own experience with diagnosis and treatment, my experience with the music therapy community, and the interaction I have had over the years with patients and their families.

I want to address three topics, Anxiety associated with diagnosis and pre-surgery, Post-op recovery and Rehabilitation

Anxiety

My diagnostic phase lasted for months, with a great deal of uncertainty about what my diagnosis would mean for my family: will I die tomorrow, or will I live a normal lifespan? What do I say to my 7- and 9- year old children? My employer?

I have a limited time that I spend with the doctor who gives me the diagnosis, but where do I go for the support I need? Because I will be actively seeking support wherever I can find it, you as doctors, or your support staff, have an opportunity to steer me, the patient, toward legitimate complementary therapies and activities. This may include suggesting joining a support group, speaking to a social worker, or identifying someone who could do meditation or guided imagery with me, perhaps an oncology psychologist; or I could work with a music therapist to find support in the music I choose to listen to.

Why is addressing anxiety important? What effect does anxiety have on being able to make good medical decisions, on taking in information, on handling stress, on the immune system, on pain perception, or on attitude? How can I address the sense of helplessness, or the feeling that I have lost control?

OK, lets put this into another everyday context: we have 200 players applying for one viola position in the orchestra, and many of them will be playing for the audition committee of which I am a member at the end of this week; and my Dad is having a pacemaker put in and is nervous about it; and the house next to my sister’s just burned to the ground while she watched, with the neighbor just barely getting out in time, and the whole block threatening to go up in flames. So what kind of music would be helpful for this daily or weekly stress?

(Play Asturias) What do you think this music does? It recognizes my anxiety and unrest, and transforms it. I could then play something slower following that piece, and be much calmer by the end… But now, let’s compare this to what I listened to and played when I was first diagnosed:

(Play Irish tune Lannigan’s Ball)

How is this different? I needed more support. And this is more dance-like: instead of running away I could listen and take in what the surgeon or radiologist was telling me, so I could make better decisions. It has a minor feel to it, validating my sense of crisis, but a message of hope. For the diagnosis phase I liked Take 6, a male A cappella group, because they sang, or almost shouted their faith into me, supporting me, holding me up.

There is other music I could play to slow down respiration and heart rate before surgery: Bedtime Beats or Ocean Surf.  I needed to feel held, surrounded by people, and warm, so I chose cello and male voices to address the uncertainty surrounding the diagnostic surgeries.  At a later time, without the uncertainty of what cancer the surgeon would find, the music I preferred for reconstruction surgery was quite different.

Post-op Recovery

Some of the most helpful conditions for recovery were: lots of natural light, a view of nature, and music.

Let’s examine this more closely: what do I as a patient need to be doing the most right after surgery, and what gets in the way of this? I need the ability to sleep and to get back to sleep, or at least to a restful state. Strange or loud noises, checking for vital signs, talking in the hallway, pagers and beeping equipment can seriously impair my (the patient’s) ability to sleep. So I used noise cancellation headphones that I could fall asleep wearing, and music with no or very little pulse such as Gregorian or other types of chant, or thumb piano music, or ragas, depending on what I liked and what seemed to help support my needs. A variety of music is good since if I am in the hospital for days I will get tired of hearing the same things over and over! For me at that moment, Bach Goldberg Variations, Baroque solo guitar or other music with a uniform texture and no sudden changes were good. A music therapist can help the patient find music that works for them. The success of use of music can be seen in studies that show reduced need for pain meds and reduced hospital stays for many patients. (e.g. studies of knee surgery patients in recovery, many of whom needed dramatically less pain medication) Patients are more comfortable and can be more cooperative during procedures where pain medication or sedatives are not an option. Music that the patient helps to choose, in partnership with a music therapist, is a particularly good option for special needs patients and children. Having a music therapist provide music during medical procedures for these populations can be invaluable.

With neonates a music therapist can make a recording which includes the mother’s heartbeat. A baby’s heart rate and respiration respond so that they are able to rest and thrive, rather than spend a lot of energy crying, so many are able to leave the hospital many days earlier, and experience fewer complications.

Rehab

If I as a patient am in the hospital for longer than a few days, I can feel very disoriented and isolated from all that is familiar. I can use songs and other music to reconnect to time of year, religion, memories or home and family.

Let’s try singing something and see what you notice happening as we do it:

(Sing something) What do you notice as we sing the beginnings of different songs? How do you respond even in the first few seconds as we start the song? Which ones would you choose to help support you during diagnosis and treatment? The key is to pick the right song, the one that gets the result you want: positive associations, connections, hope. For someone who needs to improve their breathing, singing songs that work for the patient gets them to do their breathing exercises for a longer time while connecting to the music therapist and the outside world at the same time.

Now let’s try one more thing: Stand up and walk in place, about this speed:

(Demonstrate)

First we’ll do it without music and I want you to pay attention to what you notice as we do this.

Now I am going to start playing. Notice what happens and any differences.

(Play two Irish songs. Play the second one faster, and speed up, changing tempo as you play it)

This is called entrainment, or, in the language of exercise, cadence training. It is useful for people just regaining strength or confidence in their walking, recovering from surgery. It can also be very useful in working with people who have Parkinson’s. Oliver Sacks talks about his leg, temporarily not working, that somehow was able to function effectively again when he thought of a particular piece of music; in his case Mendelssohn’s violin concerto.

During my recovery from reconstruction surgery I used a CD entitled Shakti Yoga, focusing on grounding, then expansion (including expansion of breathing) and reawakening, and then on gradually speeding up.

Listening suggestions to help expand and explore your music choices in preparation for diagnosis and treatment. What helps you? What else could you choose?

  • Chant the Benedictine monks of Santo Domingo, or Chanticleer
  • Eight String Religion David Darling
  • Ocean surf with no other sounds, or with bird sounds
  • Agnus Dei I   The choir of New College, Oxford. What other spiritual music would help support you?
  • The Three Masses of William Byrd   The Tallis Scholars. How about other music by this same group?
  • St Matthew Passion Bach, later movements. Is there music Bach wrote for the current time of year that would work better for you? How about Bach for solo violin, viola or cello?
  • Mbira Healing music of Zimbabwe Erica Azim. Are there any other instruments you respond to in ways that help?
  • The London Viola Sound Dvorak and Ravel cuts. How about all cellos, or all violins?
  • Raga Sindhi Bhairavi Ali Akbar Khan, Sarod and L Subramaniam, violin. How about other ragas?
  • Dream Melodies Vol. 1 Baroque   How about lute, oud or other instruments? Or Classical, acoustic guitar?
  • Shakti Yoga Russill Paul
  • Ambient 1 Music for Airports Brian Eno
  • Drumming, Double drumming Michael Harner

For further exploration:

What music is used in different cultures for meditation?

For creating a trance-like state? For self-hypnosis? For self-calming?

What music is used to nourish or strengthen the spirit?

What music is used to energize the body?

Who would be able to help you answer these questions more fully? An ethnomusicologist? A music historian? A music therapist?

Taking it back to the concert hall:

What orchestral or chamber music pieces fall into those categories?

Could you have a music for meditation, a music for the spirit, or some other themed concert series using some of the music you discovered? What acoustic music from other cultural traditions could you introduce in a western music concert? How does this change your idea of who you could invite to be a soloist?

For more information on music and wellness visit http://wellness.pittsburghsymphony.org/

March 2007 Pitt, updated April 2016

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