Richard Kensington, Author at OPUS Music CIC

Inspiration

When we work in hospital we never know who we are likely to meet and what reaction we will get to our music. Mostly people react positively to us when we arrive with our instruments, sometimes people join in with us but it is rare to find someone with instrument at the ready and desperate to do some playing!

The other day we were invited into a room where two nurses were just finishing a treatment on a little girl. Her mum and another visitor were with her. We played a piece and her face lit up. Then I noticed that she had a ukulele on her bed, so I switched from playing bodhran to ukulele. She was really pleased about that so I tuned up her uke for her and she showed us the song she knew and we all joined in and played together. She played really well and put so much energy into her song that it was a real joy to watch and play along with her. We had a little chat about music and then did some more playing. We played another song and as Sarah and Sarah played and sang the words I sang the chords and the girl started to join in on the Uke. After about 4 times round the song she had it and again she played along with real vigor even saying that she was enjoying herself so much she didn’t want to go home which she was scheduled to do later that day.

Sarah had a copy of the words and the chords with her so she let the girl have them. We left the room to the sound of the girl playing away on her ukuele with all the adults in the room singing along and saying that if she has to come back to hospital she will make sure it is on a Tuesday when we are in.

I play music everyday and although it is always a pleasure it was a real gift to be confronted with the unadulterated joy that this little girl had in playing her music. She devoured the chance of learning something new and delighted in everyone playing together. Seeing her play reminded me why I started playing in the first place.

Preconceptions are often misconceptions!

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We were asked to visit the room of a teen aged boy who we were told was under constant supervision and was really into music – especially heavy rock and rap. We were told that he was a DJ and played the drums.

Before starting to work in hospitals my response to this request would have included a certain amount of uncertainty as to how to connect with this boy. With the limited information that we’d been given it would be easy to develop the preconception that we were going to work with some one who had very defined musical tastes and that the success of the interaction would be dependent on these some how being reflected in the music we played. I remember how closely I identified with certain bands and musical styles when I was a teenager and how easily I would write off the most adept musical performances if they failed to make the grade in terms of some (often imagined) stylistic nuance.

The temptation given the circumstance outlined above is to reach out to the person by offering them something you think they may know and be able to identify with. The danger in doing this is that you may fall so far short of the mark in comparison to what’s on their iPod that you’ll come across as a fake, or worse an embarrassment. It is important to be yourself, have confidence in what you do and to act with integrity and then this won’t happen. If you don’t feel comfortable playing a particular song or if the piece of music isn’t you then you most likely won’t be successful in offering it to someone else.

We played a song for the boy that we were comfortable with and he listened, not giving much away. Then we got chatting about instruments and music. He wasted no time in telling us what a good DJ and drummer he was and how much he could do on his instrument. He talked with a lot of bravado and his barriers were up. The stories got taller as he went on. We listened and accepted what he said and when he realized that we weren’t going to challenge any of his claims the subject of the conversation changed to “What’s in the box?”. Together, we had a look through the instruments that we had with us; a small glockenspiel, some shakers and a little xylophone and he tried some of them out. He settled on the xylophone. He had one beater and I had the other. Gradually we went from random tapping of notes to taking turns making up four beat phrases. The phrases increased in length and complexity but maintained a steady tempo. There was a lot of eye contact and after a time quite a bit of humour. This went on for about ten minutes with Nick providing backing on guitar until we came to a very musical conclusion and he said he had had enough.

It is very easy to develop pre conceptions about people. Teenagers especially are often seen as always needing to be given something ‘cool’ in order for them to engage. Actually, what they and most people seem to respond to best is something genuine. In this instance it would have been easy to assume that this boy would have had little interest in playing completely freely on a small xylophone for 10 minutes but once he had seen that we were offering him something of ourselves in a non-judgmental way he was able to drop his barriers and just play with us.

Once again I was reminded of the importance of ‘expect nothing’. As musicians in hospital it so important that we accept people as we find them, don’t judge them and expect nothing from them. That way we give them space to be themselves and leave a space for the magic to happen!

Assessing impact in a different circumstance

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While in the hospital Nick and I were asked by a member of the play team to come and play for a little girl who was distressed and in a state of discomfort. She was suffering from involuntary movements in the limbs and mouth. He legs would kick out and at the same time her jaw would spasm.

When we arrived at her bedside at first there were a few people round the bed. We started playing and there was little discernable effect. The play specialist picked up the girl from her bed and sat down with her on a chair. Her father arranged cushions around the play specialist so that the girl was supported. Her father then left and we played. I was sitting on a small chair in front of the play specialist and the girl and Nick was to the side. We played for about 10 minutes and we sang and the play specialist joined in. Gradually through the singing the girl made eye contact with the play specialist and this continued for the rest of the interaction.

The small area we were in became a bubble of calm. The girl’s gaze was fixed on the play specialist as she lay there in her arms. We continued to support the interaction changing songs, accompaniment and sounds. Her involuntary movements became less. From where I was sitting I could see perfectly the read out on the heart rate monitor that the girl was attached to. From the time that the singing started her heart rate went down by 10 bpm and continued at this lower rate for the whole 20 – 25 minute period we were with her.

A group of doctors came over to examine the girl and as soon as the singing stopped and the eye contact was broken, her heart rate went back up and the involuntary movements returned.

Sometimes it is hard to assess the impact of what we do, other times it is there plainly to see.

Assessing Impact

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While working in hospital the other day Nick and I found ourselves robed in plastic aprons playing to a young boy in an isolation room. He was disabled and had limited sight. He looked about 7 and was lying on the bed wearing only a nappy with various tubes coming out of him and rocking from side to side seemingly agitated and in a state of discomfort.

We stood at the end of the bed and played for him. We started off with something quite upbeat to match his agitated state and then gradually changed what we were playing as he seemed to calm down. The rocking and movement became less and what we were playing seemed to be calming him. As we were playing a doctor came in and carried out a process involving syringes and tubes that were taped onto the boy. This took a few minutes and we continued to play as the process went on and after it had finished.

We continued to soften our playing and the boy became calmer and calmer and eventually fell asleep. As we left there was a feeling of calm in the room and gone was the sense of agitation and discomfort present when we arrived.

I was left wondering to what extent the music had calmed the boy and how much the medical process had resulted in him falling asleep. This ambiguity can leave a strange feeling at first. As musicians we hope that our music has a positive impact on everyone we encounter but when we work with people in hospitals there is so much that we don’t know about the patients circumstances that often we have to content ourselves with not knowing the impact of what we do or even in some cases if there is an impact. This requires the development of a certain resilience based on confidence in what we do and our ability to carry out this work sensitively and appropriately.

In a circumstance like this two words from our training come to mind: Beneficence and non-maleficence. Keeping in mind that what we do must have a benefit or at least must not be harmful to the patient. In the case above I was sure that the music was not causing any discomfort to the boy, I was guessing that he liked it and hoping that it was soothing him. I couldn’t be sure that the music had sent him to sleep but that didn’t matter.

Playing with spider man

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In Kings Mill hospital last Friday we were invited to play in a single bed room for a young boy who was connected to a lot of monitoring equipment and had an oxygen mask on. We played a song for him and his reaction was fairly muted but he did say that he liked it. We took our time and spoke a bit to his Dad who said that he himself was a song writer. We played some improvised music and offered the boy a shaker to see if he would like to join in. He declined it and just looked on. He was making his spider man doll move about a bit to the music and we picked up on this by changing the way that we were playing depending on how he moved the doll. Once he realised that spider man was conducting the band he couldn’t get enough of it. He had a great time determining the pace and duration of the music with his doll and he laughed and smiled as he did so. His Dad said we’d done well to get a smile out of him.

Before we left the room the boy’s dad asked if he could share some words he had written about his son being in hospital and we listened as he did so. He’d written a really moving rap about his love for his son and family. At the end he said ‘Thanks for listening to that… It’s quite hard to get people to listen’.

Music in hospitals gives people the time and space to reveal and express their emotions.

Whistle while you work!

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Last Friday was my first visit to Kings Mill Hospital in Sutton in Ashfield. While being guided round the wards for the first time by a member of the play team, Nick and I were invited to play for a young girl who was profoundly disabled and who had very restricted means communication. We played a song for her and her parents seemed very pleased to have us there. After we had played, they mentioned that the girl responded very well to whistling. This was only the second time that Nick and I had worked as a duo and we had discussed a variety of different ways of doing this without Sarah playing the lead melody. Whistling had not been on the list but we took up the gauntlet and set to whistling a version of ‘Maid and the Palmer’. The girl responded with a show of great pleasure, the parents were pleased and I was reminded of the importance of maintaining a versatile and light hearted approach to music making in hospital!

First Session in Children’s A&E

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On the 1st of June we were very pleased to be invited down to do some playing in the waiting areas of Children’s Accident and Emergency department. We spent about 45 minutes there in the afternoon and had some good musical interactions with the children who were waiting there. When we were reflecting on how the day had gone we all agreed that the space had a very different feel to the other wards. Unsurprisingly so, as the children who were there had almost certainly not got up that morning expecting to spend any time in hospital that day! Anxiety levels were higher among the children and they were more reticent about engaging with musicians. There was a lot more ‘playing for’ than ‘playing with’ in that space but the music did seem appreciated. We had some nice comments from parents and a number of people thanked us as we left the spaces. We now know that children’s A&E has a different pace to other wards and the patients who are there are in a very different state of mind to many of the other patients that we work with. This area has opened up another exciting and interesting challenge for us as musicians working in hospital.

Should I stay or should I go?

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Through playing music in hospital wards we are constantly learning to read patients reactions and developing our sensitivity as to whether a patient is happy for us to be there, wants us to be there or would rather we left. Sometimes this is easy as the patient gives a clear response to our arrival and we can feel confident as to whether we should stay and play or leave.

On Friday 1st of June I was part of an interaction in a day surgery ward that went something like this… We entered the 8 bed ward and played for the children and their families there. We were met with a variety of reactions from the patients on the ward, from interest, through indifference to excitement. We felt confident to stay and play. We played for about ten minutes and had engaged a couple of children who had interacted with us to varying degrees, but all positively.

While this was going on a child (who we later found out was just one year old) was brought back onto the ward from surgery. He was coming round from anaesthetic and was in some discomfort and distress and there was very little that mum could do to comfort him. He would not stop crying. At the end of the piece we had been playing Sarah moved over and started playing for the boy. Nick was playing behind her and I was some feet away able to view the scene from a distance but still able to provide musical accompaniment. As I watched and played and the piece progressed I couldn’t see that what we were doing was having any discernible effect on the boy or even that he had registered our presence, even though Sarah was only a couple of feet away and crouching down playing at the boys eye level.

I was starting to feel uncomfortable and that perhaps we were distressing the boy more and my reaction was to move away but Sarah continued to play so I stayed and played. After a few more seconds (that to me felt like a long while) the boy all of a sudden stopped crying and became transfixed by Sarah. He stared straight at her and became completely absorbed in the music that she was playing on her fiddle. Nick and I stayed in a supporting role continuing to play but leaving Sarah free to steer the interaction. She carried the piece on for a couple of minutes during which time the boys gaze did not leave her once. The boy seemed calmed, still and relieved of physical discomfort.

Mum made the comment “I wish we had you at home!” and both adults continued to remark at how soothed he was by the music. After a couple of minutes more the boy seemed to become aware of his physical discomfort once more and started to cry again. As he did so we started to leave but continued playing as we left the ward.

For me it was a lesson in gentle persistence. I would have left the interaction before anything had had a chance to happen. Trying to judge a patients reaction to the music you are playing in hospital can be very difficult and requires a mixture of self confidence, humility and to keep the mantra of ‘expect nothing’ at the forefront of your mind. Just remember not to ‘expect nothing’ too soon!

Richard Kensington

Inspiration

Preconceptions are often misconceptions!

Assessing impact in a different circumstance

Assessing Impact

Playing with spider man

Whistle while you work!

First Session in Children’s A&E

Should I stay or should I go?

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