Leicester Royal Infirmary (Children’s)

One visit to a Children’s Hospital in November 2013 we were passing through one ward on our way to work in another, or so we thought……we were spotted and invited into one young patient’s room by his Mum.

She already knew us and knew of our work, as we had met before when her older daughter had been in the same hospital previously. Recently, her young baby had been having difficulty in passing faecal matter over the last four days and as a result was constipated and unable to take in much milk when hungry. He was crying in Mum’s arms as she struggled to get him to drink 30 ml of milk, and then appeared in pain.

We entered the room and played a variety of suitable pieces from our repertoire. The doctors came by the room and went away again, encouraging us to stay as if to see what result might occur from our music…..we stayed about 15-20 mins. The baby calmed and Mum was able to lay him down for a rest. We left and went off to another ward where we worked for the rest of the morning.

On our way back through to break for lunch, we put our heads around the door of the room with Mum and baby. She reported that the little one had had a massive bowel movement, had taken some more milk, and had slept for the rest of the morning uninterrupted.

Tuesday 29th Jan at Leicester Children’s Hospital, working with Sarah Steenson and Nick Cutts. We began work playing on Ward 12, progressed through to Ward 28 and finished the morning in Ward 14. A busy morning that finished quite late. The afternoon was productively spent only on Ward 10 for the whole time. I was very pleasantly surprised by the amount of movement to music on this particular day, all day long…..

A father joined us in our music, singing to his daughter in her wheelchair initially. She was smiling so much that her gas breathing mask kept slipping off. We played Twinkle Twinkle, and a few other songs, and then progressed to a gentle waltz with the suggestion that they might share some rocking movements together. Dad needed no encouragement from us really and for several minutes the two of them engaged in lovely eye contact and moved back and forth with the wheelchair rolling to and fro on the floor fullly engaged in a beatiful dance.

Over to another ward, and we met up with an enthusiastic mother and her autistic son. She spent quite a while talking to me about how she had worked with her son in his early youth to develop his tolerance to touch, and this was evident as they danced together to our music while we played a mixture of Polkas, Hornpipes and Schottisches in the waiting area and outside their private room.

Another ward led us to meet a family with a toddler sitting in a toy car. She listened to our playing and started to wiggle from side to side. Her dancing developed and became more exaggerated. Nick started to sing “I’m in a Dancing Mood” which enabled us to progress through the song, changing the lyrics to suite the occasion – “I’m in a Singing Mood” ….”Wiggling Mood” etc etc.

Just around the corner, we found a mother and little baby, seemingly with some learning difficulties, and across the other side of the room a young girl in a wheelchair with the most amazing stripey tights on! We played Twinkle Twinkle and the mother sang to her baby and held her in the closest hug in her arms, and began to dance. Those stripey tights also started moving in time to the music. We played the Mazurka de St Pierre and Off to California, and there was much movement to be seen and pleasure exchanged just by the sharing of those musical moments.

In the afternoon we met up with a male patient we had seen before the previous visit and shared some music on the guitar. We all had a similar experience today with the young man playing on Sarah’s guitar with her as we sang. Nick then approached with an improvised song and music in Em. The chord progression was predictable enough for me to join in with an improvised melody. The lyrics Nick created were all about the patient’s name and how the song was made specially for him. The patient beamed with joy and his upper body became energised enough to lean away from the pillow and move about in the bed to the music.

In all the days that I have worked in hospital so far, I don’t think I have ever noticed quite as much of a physical response by so many people on the same day. Just coincidence? Maybe it was the way we were playing this day – I cannot say. But I did go away thinking of the uplifting feeling that I know I get when I have been dancing – the positive hormones that are released when you share music and movement with another human being – and I felt very strongly that we had brought a pretty special cultural dimension to these people’s day in hospital.

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Leicester- 15/1/2013
Today was my first day working with Richard Kensington and Sarah Matthews at Leicester children’s Hospital. It was interesting to work in this new environment; the staff at Leicester’s Children’s Hospital were very welcoming and enthusiastic towards the musicians and it was inspirational to see photographs of some of the work Opus had already done in this children’s hospital.
We entered the space with Sarah and Richard playing ‘The Maid and The Palmer’. It is an upbeat and lively piece of music. I was able to observe how the music added a positive energy to the space. This was then physically reflected by the carer of a young boy who performed a little dance to the music. During this time I began to engage with the musicians and played a gentle musical drone. I was standing close to the young boy whose carer had been dancing; he was lying in bed and reaching out his hand. I felt that he was communicating with me and so I wandered in his direction, still playing the guitar. Once close to his bed side it became clear that this young boy was unable to verbally communicate. However, his eye contact indicated that he was excited by the guitar. His carer then informed me that at home this young boy had three guitars of his own and that he was passionate about music. He was then focusing his gaze up on the guitar and reaching out to play it. As the musicians continued playing I held down the G Major chord and the young boy strummed the guitar. It was a very intimate situation and I was moved to witness the expression of joy the young boy was experiencing during this musical interaction.
We then began to play ‘Zamina’; this was also performed in an upbeat expression. The young boy was more intermittent with his strumming on this song and I read this to be because he was listening to the three of us singing the song and then he would reach out for the guitar and I would step up to his bed side for him to strum the guitar. Sarah then indicated to us all to bring the song to a close, the timing was perfect as I also felt that it was time to leave this young boy’s space and move to another area of the children’s ward.
As a result of this experience I have been able to reflect on literature I have read about children and musical interaction. Especially were the non –verbal child is concerned, the main thing I experienced was the importance of eye contact. Bunt (2007) suggests that this kind of non –verbal communication is vital when tuning into the child. Especially, when engaging in musical play in order to witness the emotion, to understand how intensely the child is interacting and in order to know when to deliver more musical interaction or to end it (90). It was a rewarding experience and I had the opportunity to see theory in action.

A very busy day in hospital and so many potential reports to write…….so I shall choose one scenario from our afternoon visit to intensive care.

I was working with Richard today and our short-term placement student, Sarah Steenson. We were invited in to meet a very enthusiastic and welcoming staff and a very full room – I think every bed was taken.

We began with ‘Off to California’ and played to a familiar family in a private room. Then ‘Out on the Streets there is Sunshine’ as we moved down the room. We came to a young girl, slightly sitting up in her bed, looking fairly subdued and quiet. We were still playing the same song at this time, and had begun leaving a 3 beat space. Our young observer decided it was time to join in and waved her left hand in time with the missing 3 notes. This developed into 3 claps the next time round. After a little consideration I invited her to use both arms for ‘Wind the Bobbin Up’.

We played and sang through the song a few times and towards the end she was wriggling in bed, leaning away from her pillow, doing all the actions, smiling, and making those around her smile and laugh.

Richard said later that day, ‘I don’t think I’ve ever been so close to tears with Wind the Bobbin up before’!

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.

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.

All three Opus musicians were present in Leicester Hospital for this morning – we had a very positive training session for an hour with staff, who engaged and came up with brilliant ideas and went forth to find many great resources we could all use in our musical play work together.

The latter part of the morning was spent in Ward 11. We played for patients recovering from operations, and then moved through to the day treatment waiting area.

We were then specifically asked by staff to go and play for one young lady who was a teenager, with autistic tendancies, waiting in another area because that area was too busy for her to be comfortable. We entered her room gently playing a positive major tune on fiddle, guitar and bodhran. She seemed to calm and engaged with us easily and quickly. She smiled and began moving gently with the music. I stopped playing the tune and started humming the melody whilst I found her a hand-held drum so she could join in with us. She seemed delighted with this and displyed a broad smile. She used her voice also singing along with us.

We played together for about 3 or 4 minutes and then we all seemed to come to a natural finish. She appeared pleased and calm, and the specialist was ready to see her, so we made our exit.

Later that day, her Mum posted comments to indicate how delighted she and her daughter had been with the music, and how much it had relaxed both of them and set the tone for the rest of their day there.