Music and Health

Angela Kang:

What does a hospital musician do? This was a question asked at the beginning of working with Opus Music CIC. It was a question that seemed straightforward and simple to answer. Truth be told, one cannot fully understand and appreciate the many diverse aspects of this role without actually physically being in the hospital wards, taking part in the music making, or watching first-hand. Reading a scholarly article, training manual, or a blog entry can only give you an impression of what might take place. The positive benefits of music in healthcare settings are well-documented. Watching a video is perhaps the closest you can get to understanding without being there, but it still cannot fully convey the emotional and multi-sensory experience of delivering and receiving music in a busy hospital ward. Explaining to others the work you do never seems to do justice to the magic that actually takes place. One thing is clear: a hospital musician needs to be empathic, understanding, creative, and able to adapt their approach to a range of medical situations. With these skills, an array of exciting possibilities can be explored to engage patients, visitors and staff in music-making and create open spaces for cultural exchange. Bringing music into healthcare settings is always personalised and uniquely directed towards the particular mood and setting of a ward, group, or individual – that is why it can be difficult to explain. As Plato writes “rhythm and harmony find their way into the inward places of the soul.” Music is a form of communication that is far more powerful than words, far more immediate, and can be far more effective.

Joe Danks:

Over the last 4 months I have been participating in a training programme delivered by Opus Music. The programme mostly involved me delivering musical interventions at the Queens Medical Centre, but also involved a day spent talking about our experience as mentees. It is with great sadness that I wave goodbye to what has become a part of my routine, and a part that I looked forward to each week. I would like to thank Opus for the high quality training I have received, and recognise the patient and gentle nature of the musicians I have worked with. I would also like to express what a joy it has been to spend time in the hospital school with the selfless hospital staff and teachers; the hospitality from everybody at the QMC Education Base has been wonderful.

I said in my first blog post that the real treasure in this work lay in the young people that we met on a day to day basis, and I am even more convinced of that after 10 weeks than I was after 3. The sheer diversity of character displayed throughout Nottingham Children’s Hospital is constantly astounding, and the positivity reflected back to us as musicians is immensely rewarding. The positive effects of music are very clear to me, and I have experienced its wide ranging benefits on a regular basis all the way through my life and I feel like the mentoring process has allowed me share a little bit of this with people when they need it the most, and that’s been really fantastic. I think its important also to recognise not only the social and psychological benefits but the educational benefits of this work. I’ve spent a lot of time talking about my instruments (Guitar, Ukulele, Percussion) to young people and parents, and I feel like people have really learnt about music as well as participating in playing it.

Music In Healthcare has gradually become a part of my life, and I am striving to make it a part of my future plans. I am hoping to visit projects across Europe, and hopefully engage in some music making with those projects. I have been instilled with a passion for the importance of this work and I intend to continue with it for many years to come. Huge thanks again to Opus, Hospital School and also to Angela Kang who has been my fellow mentee during the process. Its been a pleasure working with all parties.

Knowing what type of music will enhance the psychological and physical wellbeing of patients relies on empathy and intuition. There are two things that are always necessary for this type of work – appropriateness of musician, and the appropriateness of musical selections. Empathy (personal and musical) is of great importance. First and foremost, a hospital musician needs to survey the situation, and identify whether a patient would be happy to listen to or engage with music. In some cases, this can be quite obvious (a smile, a curious stare, parents directing attention of the children, a willingness to engage in conversation). For example, the other day a hospital teacher informed us that a teenage girl was struggling to complete a piano composition for her school exams, and would be delighted to meet Opus musicians for some inspiration. We created the opportunity for the young girl to develop her ideas, and encouraged her to feel confident in improvising as together we instigated a medley of improvised musical waltzes. Although focused on one patient, it was clear that others on the ward were happily watching.

In other cases, whether a patient is open to listen to or engage with music is much less obvious. In this situation, a gentle and tentative approach is best. It might also be appropriate to ask if they would like to hear a song – giving the option to a child patient (who often does not have choices concerning medical interventions) can perhaps be liberating. For example, the other day, a young child looking a little unhappy and fatigued was cuddling up to her mother in the corner of a ward. Her mother was clearly delighted to see musicians coming over to pay special attention to her little one, and this enthusiasm from mother triggered a little smile from the fatigued girl. We gently played ‘Yellow Bird’ as they happily watched, midway handing over a shaker to the little girl who (despite her tiredness) wanted to join in. At some point, her curiosity about the accordion led her to ask about it, and we let her press a few keys – which perhaps made the connection a little more personal. After this, realising she probably might want to rest, one of us asked if she would like some more music, or if she had enough for that day. She chose to rest, and looked happy as we gently said “thank you for playing, and goodbye”. Knowing how and when to end a musical interaction requires a good sense of empathy and intuition.

We have a range of musical pieces that we can play and improvise with. Sometimes a well-known and catchy song might be in order. However, sometimes, a well-known piece can evolve into a new and totally improvised piece of music – which can be equally effective and appropriate. According to Vescelius, “discrimination in the choice of music is essential; in ill- health one does not enjoy a musical banquet but a musical specific” (Vescelius, 1918).

There are lots of skills required for this work, and as I come to the end of ten weeks training I realise there has been a huge amount of progression in all areas. I also understand now probably more than ever that there is a long way to go and even were I to train for ten years there would still be situations and interactions that would surprise me, and situations I could learn from. This has been demonstrated throughout the process, with new challenges presented every week. I think this is best described as a non-linear learning experience, as some weeks you feel like you really feel like you have made progression and some weeks you feel like you are back to square one. The diversity of challenges is equally reflected in the diversity of reward, and there is a new joy to be found every time you meet someone new.

There are lots of musical skills that I have found to be invaluable in this process, I must say most of these have come from my experience in the folk tradition. I would like to focus on watching as a purely musical discipline. Whilst watching the young people, parents and staff is of paramount importance, I am focusing on the way we as musicians watch each other. In my opinion the way in which we watch each other is closest in style to the way that I would watch fellow musicians at a folk session. The music works in a very democratic way, far from the dictatorship of a classical conductor. This is intrinsic to the way we work, but it does bring its own obstacles. It certain situations it is necessary to communicate a vast amount of information in a very short amount of time. This usually takes the form of simple eye contact; I don’t think I’ve ever appreciated my eyebrows quite so much! There is also a lot of information communicated with body language. Little ducks down to designate volume or hand signals to gesture to drop to just voices for example. I’ve done an awful lot of discreet pointing. For this to work, is it crucial to have a good musical rapport with your colleagues. I think this comes from experience playing together, and experience playing in a hospital context. Knowing how each musician plays is really important as there is no set structure and the form is very loose. You need to be able to follow each other. This is something that you develop from getting stuck in and doing, and a skill I feel like I possessed before, but one that has developed hugely through my mentoring.

Spatial awareness is crucial to the success of this work, and takes 2 different forms. You need not only to be aware of your physical position in the space, but also your sonic position. There is a real difference between playing to a space and playing to an individual. Sometimes it seems appropriate to play for a whole bay from the adjacent corridor as opposed to entering the space to interact. Sometimes this is a doorway into interactions but often it is deemed more beneficial to simply play for a few minutes and move on from the space. Receiving music passively is often all that a patient can engage with, and this is a good way to provide stimulation without being overbearing. Conversely, the work that we do often requires us to get extremely close to patients. This requires a great deal of tactfulness and awareness. Moving towards a bed is very easy to get wrong. Awareness of your own size, and your instrument’s shape and appearance is very important; otherwise you run the risk of coming across as something to be feared. Learning to show your openness with your body is important. As hospital musicians we often joke about working in the hospital being a great workout, but it is very true. A huge majority of interactions happen whilst I’m on my knees or squatted next to a bed. Putting yourself below a patient can transfer control to them. It is also important as it helps you present your instrument. Feeling the sound is very different to just listening to it. I remember very clearly an occasion where my colleague Angela had a young man in a wheelchair simply holding the two halves of the accordion whilst she gently worked the bellows. He could feel and hear the air rushing through the accordion and it was having a huge impact on him, it was really wonderful to watch.

Whilst your position in a space is a tool, it is also something to be careful of. Angela and I have joked about being like the ‘Men In Black’ in a space, but it is a really useful comparison! We often enter a space back to back and face one half of the ward each. This allows us to see everything that is happening whilst we play, allowing us to mitigate any negative effects of the sound we are creating. Another way of doing this is to have one musician dedicated to observing the wider space and not engaging one to one with patients. The wandering musician in the middle of the bay acts as a lookout, and watches for anything that we might need to be made aware of. This becomes much trickier when all the musicians are engaged with patients, and this is why it is helpful to have 3 musicians in the hospital at any one time. We need to be careful of our position in a space, but when used well our body language and positioning are some of the most powerful tools we have.

Hi, I’m Joe and I’m a young musician from Nottingham. I have studied percussion for close to ten years now, and I also sing and play guitar and ukulele. I have worked in a wide variety of professional and community music environments including live theatre and even a french circus! I currently work as an apprentice with Nottingham Music Hub, teaching young people on a daily basis and organising projects for young people in Nottingham City.

My experience so far with Opus Music has been overwhelmingly positive. The warm welcome from hospital staff has been brilliant, as has the welcome from patients on the wards. Alongside this I have had the opportunity to work with some fantastic musicians and above all, friendly people. The tactful approach to the sensitive nature of this type of music making has been very tricky to master and I’m aware that I’m not there yet, but the training process has felt relaxed and safe and I feel like this has facilitated quick learning.

One of the fantastic things about Opus is that there is absolutely no pretence and no ego. All of the musicians I have met have only had one aim, and that is to improve other people’s quality of life. This is such an anomaly in the professional music world that it really takes you by surprise. The selfless nature of the practitioners of this work is astounding, and something I hope to mirror in the way I engage with not only this work, but in my wider engagement with community and professional music. I feel like this attitude may have evolved out of the environment in which we are working. In the hospital a tireless and dedicated medical team who show genuine care and empathy towards their patients surrounds you. This can only have a positive impact on the way that we work as musicians.

All that said, the real treasure and reward from this training lies not with personal development or heightened musical ability or awareness; it lies with the people that we meet. Engaging with a broad spectrum of complex, intricate people with a variety of different needs has shown me another aspect of the multi-faceted benefits of music. I am meeting people I would never meet in my day-to-day life, and making music with them and this can only be a positive thing.

My name is Angela Kang and I have taught and researched about music at the University of Nottingham, University of Hong Kong, and currently at Rose Bruford College of Theatre and Performance where I teach and design modules for the opera degree programme. As a flautist, pianist and accordionist trained in the classical music tradition, I maintain a strong interest in how music can improve physical health and well-being.

Smiles

A little smile can be the beginning of a musical adventure. It can open a door to interact with a child patient and create beautiful sounds which will gently filter down hospital corridors. Today we knocked on the door of an isolated room, and sensing a rather curious and friendly little girl with a beaming smile, we started to gently play music. After a while, we picked out a glockenspiel and some shakers from the percussion box and showed her the sounds that could be produced. She happily took these instruments from us and began to take part in the music making. Her relatives were clearly delighted to see her enthusiastically and creatively join in, as were we. Beginning with a soothing guitar medley, the delicate sound of the ukulele and glockenspiel added a glistening touch. Underpinning this was the lively and spirited sound of the bodhrán, accompanied by melodious accordion interludes.

It is sometimes nice to be fortunate enough to be able to see there and then the immediate positive effects a musical interaction can have on parents and their children. In the afternoon, we all softly sang ‘Sunshine’ in 4-part harmony to another little girl cradled in her father’s arms. As we wandered off to the next ward we all heard the father continue to sooth his daughter singing the very same song – and of course that left all of the OPUS musicians with a big smile.

Musical Bonds

Creating music in a clinical setting forms relationships of two kinds: first, those which are created between the sounds and, secondly, those which are created amongst the participants. As professional musicians, we must use our musical intuition and skills in order to produce quality music aimed for a very particular situation (eg, a parent carrying a child on a hospital corridor, a dialysis ward with a large central open space, or even a child patient undergoing some form of treatment in an enclosed area). A heightened sensitivity and empathy towards listening and perceiving situations is crucial. Creating music in these situations involves very careful listening and communication between musicians; sometimes we are located in awkward areas of the ward and not necessarily in close proximity. An acute sensitivity to changes in volume, harmony, texture, rhythm, and melodic direction is paramount, especially amidst the hustle and bustle of a busy hospital ward. There is also the desire to create music that is appropriate for the situation and that can gently welcome patients, carers, and staff to participate (if they so wish). When this delightful moment happens, we forge a unique and special relationship with all the participants. One cannot predict what lasting effects these moments will achieve. If it provides a momentary sense of relief, relaxation, or positive distraction from the humdrum of the clinical setting – that can only be a good thing. If it provides a charming musical memory to talk about, or a sense of pride felt in contributing to a musical piece – that also, can only be a positive.