By Corinna da Fonseca-Wollheim
In the five years my father was languishing in a nursing home in Hamburg, I often brought my violin to play by his bedside. I would prop up my copy of Bach with the help of a water bottle and read through sonatas and partitas I had learned as a teenager, when I was considering a career in music.
My father’s reaction was hard to read. His gaze was unchangingly stoic during that final stage of his struggle with Alzheimer’s and Parkinson’s disease. Sometimes my mother saw him attempt to clap. After a halting reading of Bach’s majestic “Chaconne” that would have drawn scorn from the critic in me, we both clearly heard him say “thank you.”
One day, a caregiver buttonholed me in the corridor and requested that I play in the day room where they wheeled residents for a change of scenery. As it was, she said, they could all hear me through the walls. She might have picked up on my hesitation: Playing in front of any kind of audience always triggered my anxiety.
I agreed, mostly for my father’s sake. But on the appointed day, with my audience fanned out in their beds in various states of consciousness, I found myself playing freely. Nurses glided by on soundless sneakers, a lunch cart clattered in the distance; one woman let out sighs. Afterward, I realized that I had never entered into such a state of flow while playing in public. What had been intended as an act of care for the residents had also healed a tiny bit of the rift in my relationship with the violin.
Vocke, Okundaye, Sean Brennan, Lara Bruckmann and Tamara Wellons practice before making their rounds at the Johns Hopkins Hospital. Credit: Maansi Srivastava for The New York Times
I shared this story on a brisk January morning in Baltimore in the old boardroom at Johns Hopkins Hospital, where I sat in on a peer supervision session of professional bedside artists. These musicians, all faculty members at the Peabody Institute, are part of a nationwide trend to bring the arts into health care settings.
Sarah Hoover, the associate dean at Peabody who started the program at Johns Hopkins Hospital in 2018, calls this kind of work “music as care.” Unlike music therapy, in which licensed practitioners use music to achieve specific clinical objectives, she said, “this work addresses the whole person, not just the medical need.”
Music in health care often requires dramatic shifts in priorities, especially for anyone trained in the classical conservatory tradition. Instead of virtuosity, textual fidelity and the pursuit of excellence, music making around vulnerable people calls on a mix of ethical values and social skills — chief among them the Hippocratic injunction to do no harm.
The consent of the patient or visiting family members is crucial. I thought back to the moans I had heard during my concert. Had I considered the possibility that it was the sound of my instrument that was causing distress?
Okundaye and Vocke doing their rounds. Nurses gave them a list of patients eligible to receive musical bedside visits that morning. Credit: Maansi Srivastava for The New York Times
ETHICAL STANDARDS like these are one reason Hoover published a book in 2021, “Music as Care,” which seeks to define standards and delineate areas of practice in a field that has long been the province of volunteers. Now institutions collect evidence on the impact the arts have on patient experience, ratings that can affect how much money a hospital receives from federal sources, J. Todd Frazier wrote in an essay in “Music and Mind,” edited by the soprano Renée Fleming. For experts like Hoover, it’s time to professionalize the sort of music making I had — accidentally, inexpertly — offered in my father’s nursing home.
Programs can be found around the country. Musicians from the Curtis Institute play for people with dementia in memory care centers in Philadelphia. The Juilliard School sends musicians to senior living facilities in New York. At the University of Florida Health, patients can book songwriting sessions with professionals. Many hospitals now place musicians in lobbies, waiting rooms and dialysis suites to reduce stress, boredom and anxiety.
Houston Methodist Hospital employs eight staff pianists and four artists in residence. Frazier, who is the director of the hospital’s Center for Performing Arts Medicine, said these programs have a measurable positive effect on patients and staff. He cited the example of a harpist who was assigned to a skilled nursing facility. Research had shown high levels of anxiety and isolation among the patients, who need to spend an average of 30 days in recovery there. “We embedded the harpist in that unit, and it was almost night and day with the comments and patient experience,” he said. “And with the staff as well.”
Especially in the wake of the coronavirus pandemic, growing awareness of burnout and stress among health care workers has been another driver behind arts programs in health. “It really is a win-win,” Redonda Miller, the president of Johns Hopkins Hospital, said about the partnership with musicians from Peabody. “My first inclination was: Patients are going to love this. We bring light, peace and joy into what is a very stressful time for them. But what I have since realized: Staff love it.”
But even as hospitals embrace live arts in care, there are few established structures. Patricia Dewey Lambert, the author of a book about managing arts programs in health care, said institutions can’t even agree where to place it in the budget: Programs might fall under patient experience, human resources, chaplaincy or even under “buildings.”
Andres Palacios Rodas plays at the Johns Hopkins Hospital’s outpatient clinic. Credit Maansi Srivastava for The New York Times
“It’s currently the Wild West in terms of training and credentialing people, how they are hired and whether they are paid,” Lambert said. In Baltimore, Miller, the hospital president, said the program was at first supported by discretionary funds and a grant from the patient and family advisory councils. It has since been sustained by donations from a former patient.
AHEAD OF MY VISIT to Johns Hopkins, Hoover talked in a phone interview about some of the qualities that people need for this work. “First of all,” she said, “they have to emancipate themselves from the rules of the concert game.” Health care settings require a musician to be able to improvise, take requests in a number of genres and stay attuned to the listener’s body language.
At Peabody, Hoover recruited musicians from different backgrounds and created faculty positions for them at the conservatory. They include Jonathan Vocke, a former street musician who sings and plays folk guitar, the R&B vocalist Tamara Wellons and Nicole Okundaye, who sings and plays ukulele. As I talked with Sean Brennan, a classically trained guitarist, about how his work in the hospital has changed him, I thought I recognized something of the shift I had experienced playing in that day room in Hamburg, where all my received notions of performance as potential judgment had melted away.
“My relationship with playing music leading up to this job felt very athletic and constantly competitive,” Brennan said. “This feels right.” He said he had found, to his surprise, that some of the most rewarding experiences were now times when he played for patients on the threshold of death and their families.
Nurses on the comprehensive transplant unit had given Vocke a list of patients eligible to receive musical bedside visits that morning. (These one-on-one concerts are contraindicated for some: those in acute drug withdrawal or in psychotic states, people whose vitals are fluctuating precariously, patients who can’t give consent because they’re intubated or drowsy.)
I watched through the open door as Vocke pulled up a chair across from Belisha Brooks, who sat in a recliner next to her neatly made bed, her hair in a turban and the lower half of her face covered by a surgical mask. I noticed the respectful ease with which Vocke engaged her in conversation.
“What are you in the mood for?,” he asked.
“Something spiritual,” she said.
“Do you sing at all?” Vocke asked, as his fingers picked out the instrumental introduction to “Amazing Grace.”
Brooks laughed: “No.”
As Vocke began to sing, she listened with eyes closed, chin slightly lifted. At times she slowly shook her head as if in wonder.
Okundaye asking for consent to play for a patient. She has performed songs like “Sweet Child O’ Mine” and “I Wanna Be Sedated” for patients. Credit: Maansi Srivastava for The New York Times
“Yeah, that’s a good one,” she said when he was done.
He waited for her verbal assent before playing again, this time a gently upbeat Irish jig. When he left, I asked Brooks about her experience.
“It means everything when you are in a room, away from home, and you want to be home,” she said. She gestured to her phone on a side table. “I can turn on music all day long. But to have someone, an artist, come in here personally and sing — that really was inspiring.”
As I was leaving, Guy Chapman, the unit’s clinical customer service coordinator, stopped me to share a story. They recently had a patient from Hawaii. Knowing that Okundaye plays ukulele, Chapman arranged for her to serenade the patient and his wife, who was visiting on the couple’s wedding anniversary. The patient requested something by the Ramones. Consulting the library on her iPad, the only title Okundaye found was “I Wanna Be Sedated.”
“So she starts playing and singing, and the wife starts singing, I start singing,” Chapman said. “His whole demeanor changed, he was laughing and smiling. By the time Nicole left he said: ‘You have no idea how much that cheered me up. I was bummed out I was in here for my anniversary, but there we were rocking out to a ukulele playing ‘I Wanna be Sedated’ — in a hospital.’”
When I entered the Medical Intensive Care Unit, Okundaye was already seated in the doorway of Amanda Omans’ room, scrolling through her iPad for the lyrics and chords to Guns N’ Roses’s “Sweet Child O’ Mine.” Omans was under contact precautions requiring anyone entering her room to gown up and wear gloves, so Okundaye delivered her concert from the hallway.
Over the pearly accompaniment of a ukulele, the song rang out sunny and sweet. On the chorus, Omans’ lips moved in sync with the lyrics. When the nurses in the corridor broke out in applause, Omans grinned and raised a hand in a rock ‘n’ roll salute.
After a final request of Shania Twain’s “You’re Still the One,” I donned gloves and gown so I could get close enough to hear Omans speak. She apologized for her brittle voice; she was running out of gas. But, she said, “music always helps with the pain.” She said it was “very exciting” to receive a personalized concert of songs that were so meaningful to her. “Sweet Child O’ Mine” made her think of her daughter. The Twain song was how she felt about her partner of 20 years.
The importance of requests — what scientific studies call self-selected music — turns out to be crucial in health care applications. In part, it relates to the issue of consent and confers agency on people who, as Vocke said in the peer support session earlier, “don’t often get to say no in the course of their day.”
Clinical studies on music and Alzheimer’s have also shown that the positive effects on a listener’s mood and memory are strongest when the music has some personal significance. As Hoover put it bluntly, “The idea that Bach is good for everyone is just wrong.”
Even had I had this information at the time, I would not have been in a position to take requests in my father’s nursing home. In addition to performance anxiety, my rigid musical education had left me with an almost paralytic inability to improvise or play by ear. And at that stage, my father was unable to request or give consent to anything.
Then again, I thought as I peeled off the surgical gloves and turned to follow Okundaye, who was now singing Fleetwood Mac’s “Landslide” at another patient’s door, I had not been playing for a stranger, but for a parent whose deep attachment to Bach had been a constant, audible, fact throughout my childhood. However scratchy my reading of that “Chaconne” had been, to him it was the sound of home.
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