It is about 7:30 a.m. when I walk into the hospital most days. It is too early to see patients but a good time to get on the computer and get organized. I review the hospital census and check for the location of my patients to make sure they are in the same rooms in which I last visited. I also read some of their charts to find out who is having a surgery or a test where my assistance may be helpful. In addition, I learn who is getting discharged and will need an appropriate farewell song. Within the hour, my colleague and our music therapy interns arrive, and we spend some time talking about new referrals, who will take new patients, and our plans for the day. Music therapy is responsible for all of the hospital’s music performances, ranging from small ensembles from the Pittsburgh Symphony Orchestra, the Pittsburgh Opera, The Sonny Pugar Memorial, Inc., and the Opera Theater of Pittsburgh, plus endless other local and national talents that visit the hospital to perform. We need to be organized and prepared so our staff figures out who will take care of each task involved with special guests and performances.
By around 10 a.m., the physicians are completing their rounds and patients become available for music therapy services. I head up to the Neonatal Intensive Care Unit (NICU) to find out which infants need lullabies to calm them, which need sensory stimulation, and which infants, parents, and staff would benefit from relaxing music. Whenever possible, I hold or at least touch each infant who can tolerate tactile stimulation, since being touched and held is a normalizing activity for babies. Sometimes, I support an infant who is going to be stuck with a needle for a blood draw, or one who is getting a surgical dressing changed. The soothing music I provide is usually in 3/4 or 6/8 meter and helps the young patients stay calm, even when the sting of a procedure invades their environment.
Today, I get to interact with a two-month-old baby who has a tracheostomy and a ventilator, and I hold, rock, and sing to him. His family lives in another state and cannot be with him daily, so I get to provide him with a little grandmotherly TLC and music therapy. His heart rate is 155 and his eyes are wide open when I begin holding him and singing to him, but 45 minutes later, he is asleep in my arms with a heart rate of 125. It seems that the music and snuggling has done its magic and he is in a more relaxed state than when we first began, meaning that, at least temporarily, his stress is reduced and his little body has a better chance to heal. A sense of fulfillment, success, and love of my job overwhelms me. After I return him to his crib and ensure that his lines and tubes are clear and untangled, I walk down the hall and a nurse asks if I would have a few minutes to spend with a three-year-old sibling.
This toddler is having a hard time understanding why her infant brother has to stay in the hospital and cannot come home to play with her. She has been hearing about the arrival of the new baby for months, and the sudden turn of events (her new brother’s birth defect is in need of immediate attention) challenges the little girl to find sense in the derailment of her plans of being a big sister. For a few minutes, in three-year-old language, we talk about “baby brother” needing special medicine and the special crib that keeps him warm and safe. Then, I invite her to sing to her brother with me and help her stand on a chair as I guard her with my body and guitar. I ask her, “What shall we sing to him?” She quickly replies, “Twinkle Twinkle.” She has a sweet little voice, and I let her take the lead as I strum softly so her voice is the main sound her brother hears. She focuses on her baby brother, and he looks at her as she sings. Perhaps he recognizes her voice from when he was in the womb. There is a connection between them, and it is beautiful to see. The magic continues with another song, “Old McDonald.” She names her favorite animals in the song and giggles as I replicate the sounds each animal makes. I have been doing “Old McDonald” for years, and I am a little “famous” around the hospital for my animal noises. Big sister mentions one more song, “Edelweiss,” and I am happy to comply. We sing it together because she only knows some of the words. After “Edelweiss,” she announces that she is finished singing, and I tell her that I think her little brother loved her songs because “look how happy he is.” With my help she gets down from the chair and is content that she was able to do something for her brother. Mom sits to the side and watches her children with misty eyes.
One more stop in the NICU and it is noon. Patients and families are eating lunch, and it is time for me to return to my desk, write a few chart notes, ingest some lunch, and check for new referrals. This afternoon, we have a Drum Circle in the Eat’n Park Atrium, and I still have patients to see in their rooms. My colleague, Nicole Steele, is a percussionist and takes charge of this event, but the interns and I help set up drums and small percussion instruments. We arrange 1o to 15 chairs in a circle and set instruments by each chair. Around 2 p.m., Nicole, the interns, and I start to drum. Although the Drum Circle has been advertised on the hospital message boards and TV screens, it is the actual drumming that usually brings people to the event. They cannot resist the lure of the beat, and they want to be a part of the music-making.
A few teens saunter in with their nurses and sit down at drums, and several toddlers sit on their parents’ laps and play small drums and maracas. There are no mistakes here…just about anything goes…and everyone can be successful. Some participants join in with a simple beat and are content to hold a steady rhythm, while others try out complicated rhythms they have heard on the radio or from their favorite musicians. We all watch and help direct so that each person has an opportunity to shine, be it a ten second solo, or the chance to lead a beat that we will all repeat as in “Follow the Leader.” Patients who haven’t smiled in days are smiling and happy with their success in the circle. Parents and nurses are relaxing, smiling, and aware that for a short time, the children have forgotten about their pain and anxiety and are having good, old-fashioned fun.
As we are wrapping up, my pager alerts me that I am needed. One of my “frequent flyer” patients is going to Interventional Radiology (IR) for a new central line. She is eight years old and tends to be anxious when she has to leave her comfort zone and go to another part of the hospital for a procedure. I grab my guitar and go to her room so that I can lead a music parade down the hall, into the elevator, and all the way to IR. Once we have arrived and begin waiting in a curtained cubicle, I pull out some of her favorite “silly song” books and allow her to choose what we sing. She looks around warily when the anesthesiologist comes into the room but is distracted while we sing “The Cranky Poodle” together.
She chooses several songs before the team arrives to take her into the room where she will get her new line. I walk her to the door of the sterile room and remind her that she is doing great and I will see her later when she has her new line. She will likely be a little groggy for a few hours, and I will not see her until tomorrow, but she feels buoyed by the idea of being on the “other side” of the procedure and seems okay as she is wheeled into the room. As I exit, I offer to take the parents to the room where they will wait for the procedure to be completed.
By now I am thinking of getting back to my desk to write my clinical notes, but there is one patient I have yet to see. Dave is 12 years old and waiting for a multivisceral transplant. He needs a new bowel, stomach, intestines, pancreas, liver, and kidneys due to a rare medical condition. Pain is his constant companion, and music therapy offers a distraction from pain. Although Dave has an iPod and can listen to recorded music, he prefers having live music at times, particularly when he is having his wound dressings changed or when his pain is particularly challenging.
Dave has favorite songs he likes to hear, and sometimes he permits me to create lyrics that address his needs and sing them to familiar tunes. For example, a simple song like “Amazing Grace” can have an extra verse in which Dave’s name and request for improved health are sung, or we can work out ridiculously silly lyrics for a fun song.
Laughter is sometimes good to help alleviate pain, but there is a fine line in figuring out when to be goofy and when to be serious in my approach. Patients provide input when they are able to converse with me about their pain, and, as much as possible, we try to figure things out together. Today, Dave tells me that he is having a lot of pain and needs quiet, relaxing music. I provide a simple chord pattern, A major to e minor, back and forth, in a monotonous, rocking 3/4 time. I improvise a hummed melody on top of the chords and provide a relaxing rhythm with which Dave can breathe deeply, in and out. His eyes are closed and his face is scrunched in pain, but after about 10 minutes I see evidence that the music is decreasing Dave’s heart rate, which had been elevated with the pain, and his face has softened from a grimace to a relaxed expression. I insert a few words into the melody to try to affirm Dave’s relaxed state, but today he gently shakes his head “No” and tells me in a lazy voice to return to my humming. No lyrics today…the music is enough. While I continue to provide the simple but effective music, Dave’s RN enters the room and checks IVs and drain lines, but Dave barely stirs. Within 20 minutes, Dave appears to be sleeping, so I wrap up my music and quietly place my guitar in its case while I continue to hum. Once outside Dave’s room, I approach Dave’s nurse to tell her he is sleeping. She is happy that he is having a little break from his pain, and I remind her to call me if his pain worsens.
I return to the music therapy office feeling a little tired, but satisfied. I think I am a little tired because of sadness I feel for my patients who suffer, and with gratitude, I briefly think about my children and grandchildren who are blessed with excellent health. But when I sit down and enter my clinical notes in each patient’s electronic record, I am able to see the positive impact of my work as a music therapist.
Normalization…check. Emotional and procedural support…check. Decrease in blood pressure and heart rate…check. Cognitive and sensory stimulation…check. Family support…check. Relaxation and decrease in pain…check. It has been a good day.