Leicester Royal Infirmary (Children’s)

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.