Transcript
Speaker: Welcome to Critical Matters, a sound podcast covering a broad range of topics related to the practice of intensive care medicine.
Speaker: Sound provides comprehensive critical care programs to hospitals across the country.
Speaker: To learn more about our programs and career opportunities, visit www.soundphysicians.com.
Speaker: And now your host, Dr. Sergio Zanotti.
Speaker: In today's episode of Critical Matters, we will discuss music and critical illness.
Speaker: We will explore the topic through the lens of our guest, Andrew Schulman.
Speaker: Andrew is the first musician to be accepted as a professional member of the Society of Critical Care Medicine.
Speaker: He is a member of the SECM ICU Liberation Committee, where I met him and have had the opportunity to work with him.
Speaker: Andrew and his wife Wendy are the subjects of Josh Aronson's documentary film, Andrew and Wendy, released in 2015, which has been aired multiple times on PBS TV.
Speaker: In addition, Andrew is the author of Waking the Spirit, a musician's journey healing body, mind, and soul.
Speaker: Since its release in the United States in August of 2016, Waking the Spirit has been chosen as an Oliver Sacks Foundation Best Book of the Year selection, has been a finalist for the Books for a Better Life Award, and a People Magazine pick in nonfiction.
Speaker: As you will find out through our conversation, there is much more to this story.
Speaker: Andrew, welcome to Critical Matters.
Speaker: Well, pleasure to be here, Sergio.
Speaker: Thank you for asking me to do this.
Speaker: Well, I think that we're going to touch on a very important topic and a fascinating story.
Speaker: And I obviously can't think of anybody better than you to tell this story.
Speaker: But before we get into the story and to your story, Andrew, would you describe to us what you do today?
Speaker: How would you tell people?
Speaker: How would you answer the question?
Speaker: What do you do, Andrew?
Speaker: Oh, well, I do a few different things.
Speaker: The first is that I'm the executive director of the Medical Musician Initiative, which is based here in New York.
Speaker: Actually, it's based here in my apartment.
Speaker: And we have a wonderful team.
Speaker: Dr. Joseph Schlesinger is the medical advisor, and Javin Bose is our associate director, and our technical advisor is Gregory Silverman of University of Minnesota.
Speaker: Joe is at Vanderbilt University Medical Center.
Speaker: And our mission is twofold.
Speaker: It's to train professional musicians how to become a team member in an ICU.
Speaker: And the other mission is research.
Speaker: And we're working on, I was hoping...
Speaker: I would have the news to share with you today about a new study that we're hoping to do here in New York.
Speaker: I'll have to wait on that because the IRB hasn't finished yet.
Speaker: But I have finished
Speaker: a study for Georgetown University Medical Center where I provided all the music and we could talk maybe a little later, we'll talk about some detail about that.
Speaker: So that's the first thing that I do is medical music.
Speaker: I am also a visiting artist,
Speaker: as a medical musician at Georgetown University Medical Center.
Speaker: And I'm a consultant to the music and the ICU program at Vanderbilt.
Speaker: The second thing that I do is I'm a writer.
Speaker: And as you have read Waking the Spirit, that was my first book.
Speaker: And I have spent the last four years working on a historical novel set in the 18th century that has music at the very heart of it.
Speaker: And it involves a main protagonist who is invented named Andreas Schluter.
Speaker: I'm Andrew Shulman, he's Andreas Schluter.
Speaker: And in the novel, he's the grandson of a real 18th century Andreas Schluter, who was the most famous architect in Eastern Europe at that time, especially in Berlin.
Speaker: And the other two main protagonists are Frederick the Great and Johann Sebastian Bach.
Speaker: And I hope to be finished with the novel within a year.
Speaker: So that's the second thing that I do.
Speaker: And the third thing is I'm still what I call a regular musician.
Speaker: And I'm a classical guitarist who plays Bach, but also Gershwin and the Beatles, etc.
Speaker: So I have a pretty full day every day, fortunately.
Speaker: I'm 72 years old, and I have never been happier creatively than I am now, and I'm very grateful for that.
Speaker: I have the opportunity to also interact with you through the Society of Critical Care Medicine and our ICU Liberation Committee and really appreciate the insight you bring as a patient and advocate for the healing environment in the ICU.
Speaker: So why don't you start by telling us your experience briefly as a patient in the ICU?
Speaker: Well,
Speaker: I guess I should probably say a little bit what brought me in there.
Speaker: Should I start with that?
Speaker: Sure.
Speaker: Why I was a patient?
Speaker: Yeah.
Speaker: Yeah.
Speaker: All right.
Speaker: It's 15 years ago now, and it was in July 2009.
Speaker: I had a diagnosis from several doctors, basically 100% pancreatic cancer.
Speaker: During the surgery, frozen sections were done on the mess and miraculously, it was benign.
Speaker: And the results after the surgery continued to show it was benign.
Speaker: Very, very lucky.
Speaker: However, when the surgery was over,
Speaker: I was sewn up and I was put on the gurney.
Speaker: And by the time they got to the door of the OR, my blood pressure started plummeting.
Speaker: which you continue to do, there was a race to the SICU.
Speaker: And in one sense, we didn't make it in time.
Speaker: I was dead on arrival.
Speaker: But this was Beth Israel Hospital, downtown New York, before it's Mount Sinai takeover.
Speaker: So it was Beth Israel then.
Speaker: And there was a great...
Speaker: a SICU team, they resuscitated me, put me into a medically induced coma.
Speaker: But to show you just how sick I was, that was at 9 p.m.
Speaker: approximately.
Speaker: At 3 in the morning, I coded again.
Speaker: And they all had to rush over and bring me back a second time.
Speaker: That was the first day, second day, terrible.
Speaker: Third day, Saturday, terrible.
Speaker: At the middle of, at noon on the third day, I was really at the cusp.
Speaker: I was at the precipice.
Speaker: My lactic acid number was 17.
Speaker: I hadn't been stable for a second in three days.
Speaker: a lot of cardio issues, you know, nobody, not a single doctor or nurse thought I was going to live.
Speaker: And I'll hold you there, Andrew, for a second, because also, as I recall from reading the book, you were on multiple vasopressors, which our audience obviously will understand.
Speaker: And I can't I can't recall
Speaker: talking with somebody who was in shock after a cardiac arrest with a lactic acid of 17.
Speaker: Right.
Speaker: That's and I'm sure that all the clinicians working on you at that time and caring for you were thinking, like you said, that there's no chance that he will survive.
Speaker: However, you did survive and something happened on that third day.
Speaker: And I want you to tell us
Speaker: Your wife, Wendy, had an intuition.
Speaker: Yes.
Speaker: And there's also some serendipity, maybe, based on your iPod.
Speaker: But tell us what happened.
Speaker: Yeah.
Speaker: So here it is, noon on the third day.
Speaker: And as the SICU director, I found out later, it's in the book, actually.
Speaker: He actually told his chief PA, he said, this guy is toast.
Speaker: Yeah.
Speaker: So no one thought anything could happen.
Speaker: My wife had been at my bedside for three days, Wendy.
Speaker: And she had by the middle of the third day at this moment, she understood that they'd all given up on me and that the standard of care medicine was not saving me, I was dying.
Speaker: And she reached into her bed to call my mother, who was in Florida then and not able to come up.
Speaker: My mother was not well at that point.
Speaker: And when she reached for the phone, she saw my iPod.
Speaker: and the balloon bubble went off over her head with the exclamation in it, and she has this epiphany.
Speaker: And she turned to the attending, it was Dr. Simon Iriff at that point, who was a really cool doctor, I must say, I really liked Simon a lot.
Speaker: And she explained to the situation, what she said was that
Speaker: Her words were that my husband loves music more than anything.
Speaker: And his heart is beating right now, but his soul is not beating.
Speaker: And I believe that the only thing that can give him the will to live is music.
Speaker: And I think you can give me a better clue on this than most people.
Speaker: I think maybe a lot of doctors would have, she said I have his iPod, I wanna put it in.
Speaker: I think there are doctors who would have said no, but he said yes.
Speaker: He said I'll give you 30 minutes.
Speaker: If there's any sign of agitation, remove the earbud.
Speaker: And that was it.
Speaker: So she did that.
Speaker: And she didn't know what to play.
Speaker: And somebody said, just hit the first track.
Speaker: And that's the serendipity that you're referring to, because the first track was Bach BWV 244, which is the St.
Speaker: Matthew Passion.
Speaker: which is my ultimate favorite piece of music, and especially that recording, which is conducted by Leonard Bernstein with the New York Philharmonic and great singers.
Speaker: And so they put it in, and I'll tell you two things.
Speaker: of what happened that would be of interest to you and the people listening to this right now.
Speaker: The first was, as it approached 30 minutes, everybody is looking up at the vital signs monitor and people are amazed because blood pressure and heart rate start stabilizing.
Speaker: And you know the experience, doctor or nurse can actually look at the patient or look at the face.
Speaker: People saw a change that was happening.
Speaker: Now, as you know, there is something called coma dreams.
Speaker: which are not regular dreams, they're basically hallucinations caused by the situation the patient is in.
Speaker: I had a week's worth of coma dreams, which were fantastic, they really were fantastic.
Speaker: But there was a coma dream that had to have been at that very moment because, and it's worth my telling you how it played out.
Speaker: It was Christmas time.
Speaker: Now this is July 2009, but in the dream it's Christmas.
Speaker: And I'm walking down the street holding my coat tight because it's cold and I'm carrying my guitar.
Speaker: And I noticed that the guitar is so, so heavy.
Speaker: But the reason I'm there is that every year at Christmas time, I played
Speaker: music for the widow.
Speaker: In the dream, that was it.
Speaker: It was just the widow.
Speaker: And I remember it's an old suburban type street, the kind similar to what I grew up on, but not exactly my street.
Speaker: And I walk up the steps to knock on the door and the door opens and there was a woman there in her 80s.
Speaker: But somehow I knew, even it translated later, I didn't know in that moment, but when I remembered the dream, the widow was Wendy.
Speaker: Her blue eyes, her faded red hair, and she didn't say a word.
Speaker: She just said,
Speaker: come in.
Speaker: No, she didn't say a word.
Speaker: She motioned for me to come in to the house.
Speaker: And we went into the living room, which is where I played for her every year.
Speaker: And there was a table loaded up high with Christmas treats.
Speaker: And she sat in a chair against the back wall, and there was a chair in the middle of the room for me.
Speaker: And I sat down, and I kept noticing to myself how weak I was.
Speaker: And I didn't understand why I was so weak.
Speaker: I bent down to reach for the guitar, and I could barely open the case, and with every effort, I brought the guitar up to my lap.
Speaker: And then something happened.
Speaker: I started to hear beautiful music, astonishingly beautiful music.
Speaker: And I didn't recognize what the piece was because this is actually part of being in a coma dream.
Speaker: Reality is very distorted, but it was beautiful music and I didn't know where it was coming from.
Speaker: And then I looked down at my left hand, which was on the neck of the guitar, and I realized the music was coming from me.
Speaker: I was playing this music and I was bewildered because I said, how can I be playing music that I don't know?
Speaker: It was very, very strange.
Speaker: Now the dream fades from there.
Speaker: But before it starts fading, all of a sudden I go, I feel some strength.
Speaker: I feel better.
Speaker: Now, here's why I'm certain that this was the dream at the moment of the music being played.
Speaker: First of all, why did I think it's Christmas?
Speaker: Well, in that ICU, when the last ditch effort is made and there are two or three aluminum stands filled with medicine,
Speaker: and it's that last ditch effort to save the patient.
Speaker: The nurses in that ICU called it a Christmas tree.
Speaker: And they would have been saying that out loud.
Speaker: The other thing is the director of the ICU had an expression.
Speaker: He would tell his nurses that when a patient is right on the verge of death, come and get him so he can make his black bunting speech to the widow.
Speaker: So I had to, and after that, when I came back jumping ahead, I asked those nurses, were you saying, do you remember saying those things?
Speaker: And they said, well, almost certainly we always say that in that situation.
Speaker: So that's what I was hearing.
Speaker: Now there's a little message here I have to everybody listening, which is this.
Speaker: be very aware of how much a patient in a coma is hearing and registering.
Speaker: And it may not register in direct reality, it may be distorted in some way, but when you're in a coma, you hear everything.
Speaker: So be very careful what you say around somebody who's in a coma.
Speaker: Anyway, that was the key story
Speaker: My life was saved.
Speaker: The doctors and nurses there all later attested to, and it's in the chart.
Speaker: You can see it in my chart.
Speaker: That was the turning point.
Speaker: The acid is leaching from my tissues.
Speaker: I'm stabilizing.
Speaker: The kidney, urine output improves dramatically, and that's the turnaround.
Speaker: And certainly we've all seen things that we can't explain, but it seems that obviously the music and the connection it made in your mind and your brain at that time was a turning point that was very critical.
Speaker: And obviously from there, it wasn't an easy road, but it was moving forward, right?
Speaker: You eventually left the ICU, you eventually left the hospital, eventually you realized you didn't have cancer, which was great news.
Speaker: But there were still a lot of things, I think, worth mentioning that were hard for you, right?
Speaker: One of the things that struck me, Andrew, and I don't know, I mean, you can mention that, and I know it improved over time, is that at one point, you realize that your ability to play from memory was no longer there, right?
Speaker: Yeah.
Speaker: And there's a lot of...
Speaker: cognitive maybe changes or things that happen to patients who survive critical illness that are very important for them that we maybe in the ICU don't appreciate because it usually happens once they're out of the ICU.
Speaker: But the good news is that I think over time you rewired your brain and your neuroplasticity.
Speaker: And I understand that you're back to playing by pieces from memory, which is what you used to do before all this happened, correct?
Speaker: Yeah, well, here's what happened.
Speaker: First of all, one little thing I'll add in terms of my hospital stay is that McMillan, the ICU director, had made a plan on the third day
Speaker: that I would be in the ICU for 30 days, I'd be in step down for two weeks and a regular room for two weeks.
Speaker: And that was the conservative plan.
Speaker: Now, as he made that plan, he said, we don't really need this because he's not gonna live anyway, but we have to make a plan.
Speaker: That was the plan.
Speaker: because when, I'll say it this way, I was not in the SICU for 30 days.
Speaker: I was in for 10 days.
Speaker: They skipped step-down.
Speaker: And I went into a regular room where I was only there for two days.
Speaker: They kept coming in and laughing.
Speaker: Doctors kept coming and looking at my chart and looking at me and said, there's nothing we need to do for you here.
Speaker: You can go home.
Speaker: All right.
Speaker: Now, why was it so fast?
Speaker: There are a variety of reasons, but the most important one, which is pertinent to this podcast right now, is what I had said about...
Speaker: finding out that music had saved my life and deciding that I would come back and dedicating my life to it is I was on a mission.
Speaker: And because I was in a mission, I had a lot of energy.
Speaker: Okay, now on the 12th day, I go home.
Speaker: And the very first thing I did is go to my guitar, pick it up and start to play.
Speaker: And on that first day, only a few minutes, because I could barely play.
Speaker: I was really...
Speaker: so weak from what was going on.
Speaker: The second though, feeling a little stronger, I went to play and I started playing some of my music.
Speaker: Now as a professional musician in New York City at that time, I had about 15 hours of music memorized, classical and popular music.
Speaker: And I start trying to play some pieces.
Speaker: I remember the first one was Wendy's favorite piece, a Prelude by Villa Lobos.
Speaker: and I could only get a couple of notes and then I couldn't remember.
Speaker: And I start going through my repertoire.
Speaker: I can't remember anything.
Speaker: So just jumping ahead on this issue of the brain damage, what I discovered over that first week is there were only six pieces I could play, two Bach, two Spanish, two Beatles.
Speaker: And an important clue is that all of those were learned and memorized before the age of 20.
Speaker: Because I was... My situation could be described by Rebo's gradient.
Speaker: And that the damage...
Speaker: extended from the age I was in it during the time the damage was done, going back to about the age of 20.
Speaker: Everything I learned after the age of 20 was gone.
Speaker: Couldn't play it.
Speaker: Now, this was very upsetting, of course,
Speaker: But I wasn't giving up music, not by a long shot.
Speaker: And it just meant that I have to read, I could read, I could still read music and play.
Speaker: And it just meant that except for those few memorized pieces that left to me, I'd be reading music from then on and I accepted that.
Speaker: Perfect.
Speaker: Well, you talked about your mission and I wanted to move now forward.
Speaker: And obviously you believed at that time and believe now that Wendy's intuition of playing music for you and the fact that it was your favorite piece of music made a real difference in your life.
Speaker: So now you said, I want to give back.
Speaker: Yeah.
Speaker: To the to the surgical ICU or to the ICU that cared for me and the patients who are there.
Speaker: And tell us a little bit about that return and how you found a way at the bedside in the ICU at the hospital there.
Speaker: When I left.
Speaker: the hospital on the 12th day, Wendy arranged it that we would stop by the SICU so I could see Dr. Marvin McMillan, the director, who had been there just for the first two days of my illness.
Speaker: And she had already given him one of my CDs.
Speaker: which he had enjoyed a lot.
Speaker: And the result of that short little meeting I had with him was that after we chatted a couple of minutes, I thanked him.
Speaker: It was a very interesting answer he gave.
Speaker: He said, you don't have to thank me.
Speaker: We just keep you alive long enough so your body can save your life.
Speaker: It was a great answer.
Speaker: And then he said that standard line, we're so happy you're doing well and we never wanna see you again.
Speaker: And I was very fierce and I said, no, I want you to see me again.
Speaker: I want to come back here with my guitar.
Speaker: And he just said, go home, get better and call me.
Speaker: Six months later, I called him and I did return.
Speaker: I returned in January, 2010, six months after the surgery.
Speaker: And I thought that I would just go a couple of times as a little thank you.
Speaker: But on the very first day, and it was uproarious when I entered the SICU with my guitar in its case and my winter coat on, because very quickly the nurses realized who it was.
Speaker: Because I was famous in that hospital because of how catastrophic my situation had been.
Speaker: And they were thrilled that they took part in saving my life.
Speaker: After all, it wasn't just the music that saved me.
Speaker: Obviously, it was great medical care that saved me.
Speaker: So I didn't know anything.
Speaker: I have no formal, to this day, I've never had formal training.
Speaker: I'm not a music therapist, and I have never had formal training in this field.
Speaker: And on that first day, all I thought to do was pull up a chair next to the nurses station and just put some beautiful music in the air.
Speaker: So I did that.
Speaker: And at the end of the one hour that I was gonna be there, the two nurses who had been my nurses when I came out of the coma, Madeline and Rozievic, came over and one stood on one side, the other on the other side.
Speaker: And there were three beds nearby where they could see the vital sign monitors.
Speaker: And as I was playing, th is is the end of the hour, they looked at the monitors and then looked at each other and did a thumbs up.
Speaker: That was the galvanizing moment.
Speaker: In that moment, I said, I think I just found a new path in my life.
Speaker: And so I kept going.
Speaker: And my background with this is that for six years, I played three days a week at Beth Israel.
Speaker: Then I...
Speaker: I went over to NYU Langone where I was for a year and I played, not just SICU, I was SICU, MICU, neuro, SICU, and cardio, a big hospital.
Speaker: And then I started, I did a residency of once a month at Berkshire Medical Center in Pittsfield, Massachusetts.
Speaker: I would drive up there, I live in Manhattan.
Speaker: And I went out there once a month for a week.
Speaker: I did that for four years.
Speaker: And then the pandemic kicked in.
Speaker: And that ended all of that.
Speaker: And that's also when the pandemic kicked in in 2020 is when I started the visiting artist relationship with Georgetown, which has mainly been research and occasionally teaching Zooms, teaching medical students about medical music.
Speaker: Perfect.
Speaker: And I think that as you detail in the book, your experience at the first place where you worked at Mount Sinai was really remarkable in terms that you mentioned a lot of very interesting cases, Andrew.
Speaker: The Russian lady, Alice in blue gown, the jazz musician.
Speaker: I mean, there's a phenomenal, I think, connection that you eventually played for one of the singers of that piece of music that saved your life, right?
Speaker: And when that person was...
Speaker: No, I didn't play for that person.
Speaker: What it was is I had met, I had a lovely gig, steady gig at that time at a bistro, a French bistro up on Broadway.
Speaker: And there was a woman in her 80s who would come in and...
Speaker: Her husband had brain surgery and was very sick and we befriended each other.
Speaker: And she really joined in playing.
Speaker: She was herself a great musician, one of the best Bach players orchestrally in New York.
Speaker: And we had dessert together one night and she said, tell me the story, what happened?
Speaker: And I said, St.
Speaker: Matthew Passion.
Speaker: And then I said, it was the Leonard Bernstein version.
Speaker: And she freezes.
Speaker: And I thought, oh, did I say something wrong?
Speaker: And then she goes, no, it was my husband who was the tenor in that recording.
Speaker: So that was a phenomenal thing.
Speaker: And her name is Barbara Wilson.
Speaker: And to this day, we're very good friends.
Speaker: Which is, I think, obviously, the best part of life is just the connections we make with people.
Speaker: But what I did want to ask you is, as you were developing your skills and trying to figure out, how do I do this?
Speaker: Like you said, I mean, become a medical musician.
Speaker: And you really have made a path for other professional musicians to follow this.
Speaker: Could you share with us some of the things that you noticed, Andrew,
Speaker: I think that repeatedly I sensed that you were able to decrease heart rates and blood pressures likely due to decreasing how people perceived pain.
Speaker: It seemed that you also had a great impact on patients who were having ICU delirium.
Speaker: Could you just tell us a little bit of what you were observing over and over again?
Speaker: Sure.
Speaker: Well, I think the first thing,
Speaker: which is pretty remarkable, is the effect of therapeutic music on blood pressure.
Speaker: And,
Speaker: And I'll give you a little anecdote here about that because it also connects into how do you become a team member in an ICU.
Speaker: When I went up to Berkshire, in New York at Beth Israel, and even at NYU Langone, there were people that I knew, a lot of people that I knew, who accepted me and accepted what I was doing, and it was an easy fit.
Speaker: But up in the Berkshires, they never had music in their ICU.
Speaker: And there was one nurse in particular that was very antagonistic and very skeptical.
Speaker: She was a very, very tough nurse.
Speaker: And for the first couple of months that I was up there, she was not friendly and
Speaker: It was obvious she didn't want me there.
Speaker: It was probably on the third month, I think, when I went up for my week.
Speaker: On the first day, I went to a bedside where there was a patient with blood pressure in the 160s.
Speaker: And 20 minutes later, it was in the 120s.
Speaker: It was her patient.
Speaker: And from the corner of my eye, I could see she still had a scowl on her face.
Speaker: She didn't believe, it wasn't the music that did it.
Speaker: On the second day, this is a true story, and it's the only time in the 10 years I did this where it happened like this three days in a row.
Speaker: The second day, another patient of hers, blood pressure in the 160s, 20 minutes later, it's 120s.
Speaker: And this time I look at her from the corner of my eye and it looked like she's thinking about it now.
Speaker: On the third day, same thing happens, 160s goes down to 120s.
Speaker: And after 20 minutes of playing, she walks over to me and she leans in close and she says, Andrew.
Speaker: could we go to bed too now?
Speaker: That's the moment she accepted me as a team member.
Speaker: She said, yeah, this actually really works.
Speaker: So there's your blood pressure.
Speaker: And of course you do see the heart rate.
Speaker: I'll tell you an interesting thing that you'll appreciate that I learned is there's always a desire for homostasis.
Speaker: But if you put them, if the musician, if I am at that bedside and the patient is not responsive and you play for them,
Speaker: And if you do not see any change in heart rate or blood pressure, that's a sign of just how desperately ill they are.
Speaker: Because when you listen to music, music is an emotional experience after all.
Speaker: When you listen to music, music has phrases and has an arc of rising and releasing tension.
Speaker: and good tension, not bad tension.
Speaker: And so you should see a little bit of movement.
Speaker: And that's one thing that I learned.
Speaker: If I was at the bedside and playing, their eyes are closed and you see nothing, that's a bad sign.
Speaker: Now, ICU delirium, music, in all of these years that I have done this, I have noticed
Speaker: that music can be one of the most effective things for bringing the patient back in.
Speaker: You remember in my book, Waking the Spirit, the chapter's called On the Other Side of the Rainbow.
Speaker: And that was the chapter of a specific woman who was in terrible state of ICU delirium.
Speaker: And it took three days
Speaker: visits over, I went on Monday, Wednesday, and Friday.
Speaker: By the end of Friday, the difference was really tremendous.
Speaker: And the opening story of the prologue in the book is what we call the Russian patient, you mentioned the Russian woman.
Speaker: That was ICU delirium.
Speaker: And there was a Bach prelude
Speaker: that calmed her down literally in 10 seconds, the opening phrase of the piece.
Speaker: However, if I then finished the piece and stopped, she'd go back into ICU delirium state, and I stayed there for 90 minutes.
Speaker: And by the end of the 90 minutes, and by the way, for that patient, I only played Bach.
Speaker: And you, I think, were mentioning this, why do I talk about Bach in the book?
Speaker: And there was actually a study done by Dr. Arthur Harvey, a neuromusicologist, in the early 90s at University of Louisville, Kentucky Medical School.
Speaker: It was a three-year study, and they tried seven different kinds of music, popular and classical.
Speaker: And they found, the quote is something to the effect, I don't remember exactly, but the quote was, we found that the music of Bach balanced the brain better than any other form of music.
Speaker: And then in that chapter in the book, Harvey has a long, there's a long quote for him where he's describing why that is so.
Speaker: And you did mention Bach and obviously we're talking about music as a therapeutic instrument.
Speaker: First, I wanted to ask you about harm, right?
Speaker: Like everything we do in medicine, I think sometimes we forget, but there's potential harm.
Speaker: I think you have a great story of heavy metal, but I don't think we need to go there.
Speaker: But tell me more about
Speaker: how you as a medical musician sometimes might notice that a patient is not receptive or this might not be the right selection for them.
Speaker: Absolutely.
Speaker: So the...
Speaker: Most people like music.
Speaker: I think there's only, there's a term called amusia, which is not liking music, and it's a very, very small number.
Speaker: I think it's about 5% of the population.
Speaker: Once you go above that, you probably have, I'm guessing about 10% of the population
Speaker: uh maybe a little more who i i am in that category where music could actually save your life okay you love music you are so moved by music you do that and everybody else there's a huge middle huge middle where it's just people like music you know it's a positive okay so
Speaker: even with that in consideration.
Speaker: And McMillan actually once said, his guess was, in terms of the interventions at the bedside that I did, he thought I had about an 80% success rate.
Speaker: And he said that was very, very high.
Speaker: That was very good.
Speaker: Now, what happens when you go to the bedside and you start playing?
Speaker: Now, if the patient is awake,
Speaker: you always ask them anyway.
Speaker: And there are people who will say no, they don't wanna hear music.
Speaker: That takes care of that.
Speaker: But if the patient is not awake, not responsive, and you go there,
Speaker: I'll give you a perfect example of what can happen when it's not working.
Speaker: You start playing, and first of all, you always have your eye on the vital signs monitor.
Speaker: And if you see bad things happening there, that's a real warning.
Speaker: Or you see the face grimace,
Speaker: or hands clenching or something.
Speaker: So what I do in these situations is, the very first thing I do is I change what I'm playing immediately.
Speaker: And the thing is, you can't do it in an abrupt way.
Speaker: You have to do it in a smoother way.
Speaker: But you can do a modulation still within two or three seconds where you modulate out.
Speaker: You have to be very aware, very alert.
Speaker: and you wanna do that smoothly.
Speaker: You try the second piece.
Speaker: I think basically I give myself two minutes with three or four different attempts.
Speaker: If it's not working, then you segue out.
Speaker: You stop playing, but not abruptly.
Speaker: You take five seconds.
Speaker: It's almost like fading out with turning the volume down.
Speaker: And you know it's not working for that person.
Speaker: It's as simple as that.
Speaker: And you have those situations going on.
Speaker: And I always say that there's no...
Speaker: better gig in the world than being a medical musician in an ICU for keeping your ego in control.
Speaker: You leave your ego at the door completely.
Speaker: It's not about you at all.
Speaker: It's completely about your three constituencies, the patients, the family, friends,
Speaker: and family and friends and the medical staff.
Speaker: That's who you're there for, has nothing to do with you.
Speaker: And it's a wonderful feeling actually having it set up that way.
Speaker: So, you know, that's it.
Speaker: And I think, Andrew, that obviously you get a lot of immediate feedback.
Speaker: And the idea, when you mentioned 80% success, what we're talking about is having a positive impact in assisting in the healing of a very critical patient, right?
Speaker: It's not like you play a song and everybody gets extubated and wakes up.
Speaker: But like you said, I mean, there are objective signs.
Speaker: but people really turning around.
Speaker: Now, you did mention Bach and you did talk that there's studies that suggest that Bach perhaps because of the way it's constructed, I guess.
Speaker: What I understood is that it really has a very positive effect on both sides of the brain and that might be a balancing act and it might be a good recipe.
Speaker: But you also mentioned, or could you mention,
Speaker: What are other tunes or music that seem to work very well in the ICU?
Speaker: Well, in my repertoire, now here's the thing.
Speaker: We talked about my brain damage before.
Speaker: At the end of the, what was it?
Speaker: It was about a year and a half in, and here's a long story I'll make very short.
Speaker: This is the next to last chapter of my book.
Speaker: My brain did rewire and I wound up having Music Brain 2.0.
Speaker: I had actually better functionality in my Music Brain than I had before.
Speaker: And that's, you know, people who know this stuff know that's not surprising.
Speaker: And the reason it rewired was only because I returned to the ICU and I was doing it three days a week and I was dedicated to it and so on and so forth.
Speaker: Now, the...
Speaker: Fact though, that in the first year, especially, I couldn't play from memory.
Speaker: meant that I brought in a very heavy black bag full of sheet music, because I had to read.
Speaker: And therefore, I had the experience of trying a lot of different music, popular and classical repertoire.
Speaker: And what I noticed, to answer your question about the best medicine, and I call these penicillin pieces, the music that over and over shows the ability to be effective.
Speaker: Uh, I noticed Bach.
Speaker: I noticed Gershwin, I had a lot of Gershwin, I had about 15 Gershwin arrangements, and I noticed the Beatles, and Beatles is, Bach and Beatles is my formative music, so I have a lot of Beatle repertoire, this is arrangements.
Speaker: Now, one of the things that ties them all together, especially the Gershwin and the Beatles, is this is vocal music of which I'm playing instrumental arrangements.
Speaker: And what that does, I believe,
Speaker: is it gets the fact that I'm not singing.
Speaker: Now people, by the way, a lot of people always ask me if I sing, and I always say, I only sing if I want people to leave the room quickly.
Speaker: And I would tell my patients that, and I'd say, you can't leave the room quickly, you have too many lines going into you.
Speaker: But the fact that I'm not singing, but I'm playing melodies that are well known, causes the patient to be
Speaker: to sing in their head, to hear it.
Speaker: Yeah, now, you know, there's a fabulous Dr. Oliver Sacks quote, which I have to memorize, because I never get it exactly right.
Speaker: But what he said was through the effect of,
Speaker: music stimulates more of the brain than anything else.
Speaker: So when music is being played, the whole brain lights up.
Speaker: And when the whole brain lights up, the other thing that happens is that the brain creates more dopamine and serotonin and norepinephrine and whatever else.
Speaker: A lot of chemicals.
Speaker: Dr. Connie Tomeno,
Speaker: who is a music therapist who's in my book, because I knew her in college, long story, but she's towards the end of the book.
Speaker: She has the best layman's description of what happened to me that I've heard.
Speaker: She's, you know, I'll just tell you, the description she said is that Bach St.
Speaker: Matthew Passion played through my iPod,
Speaker: entered through the auditory nerve into the auditory cortex, and then that lit up the rest of my brain and it created chemicals that traveled throughout my body carrying a message.
Speaker: And the message was, it's not time to shut down yet.
Speaker: Now, of course, I listened to this, and I have to tell you something interesting about that opening of the St.
Speaker: Matthew Passion.
Speaker: For about six months after this happened, every time I put it on, I started crying.
Speaker: I could not control, I thought I would never be able to listen to it again without crying.
Speaker: And that did eventually change.
Speaker: So I don't cry.
Speaker: But when I hear it, the degree to which that opening movement moves me, and not just that, the whole piece, it's one of Bach's greatest works, and it's actually one of the greatest musical works ever created.
Speaker: And I have to say, we were talking about this before we were recording that I like music.
Speaker: I listen to a lot more jazz.
Speaker: But as I was reading the book, I was adding all these songs to my playlist and and some of them I had heard and some of them I had not.
Speaker: But that was one that I had not.
Speaker: And and I was very particular about making sure I got the Bernard Birdstein with the New York Philharmonica version.
Speaker: Yeah, I know.
Speaker: It's a great, great, great version.
Speaker: I think you were asking, but I probably didn't answer your question, because what do I recommend to people?
Speaker: And at the back of the book and the resource section, I have a little place where I say, people ask me that, and I always say, I actually really...
Speaker: in one level I can't recommend because it's not, the right music is the right music for you.
Speaker: And what I would tell people, especially anybody who's going in for surgery, I think you should bring a device in
Speaker: where you have your favorite music and medium tempo especially, more in major key, and anything that really moves you.
Speaker: But you did ask me earlier, before we started the podcast, you asked me about what I'd recommend.
Speaker: I've mentioned it now a bunch of times, the St.
Speaker: Matthew Passion.
Speaker: I think the Leonard Bernstein version is something that's a remarkable piece of music.
Speaker: The other thing is Debussy's orchestral work called Nuage, which means clouds.
Speaker: The Debussy is something that I would say to people, I don't think you could go wrong with that.
Speaker: And the third thing I'd recommend is something very off the beaten path,
Speaker: Bach had a contemporary named Silvius Leopold Weiss, as in Weiss, W-E-I-S-S.
Speaker: Weiss was probably the greatest luteinist of all time, lute being the instrument that's a cousin to the guitar, string-plucked instrument.
Speaker: And he wrote a great, great amount of music,
Speaker: I'm gonna give a specific recommendation.
Speaker: There is a luteinist named Robert Bartow, B-A-R-T-O.
Speaker: In my opinion, he is the best lute player there is.
Speaker: He's an extraordinary musician.
Speaker: He's an American who's been living in Sweden, Switzerland for many years.
Speaker: And I...
Speaker: When I was writing Waking the Spirit, and as I write Frederick's tune, the novel that I'm working on, I have my headphones on.
Speaker: I have all 12 CDs of Bartow's Vice music in my computer, and I put it on at a low volume.
Speaker: And I think if you like,
Speaker: even if you don't like, even if you're not a classical music person, that music is very relatable.
Speaker: It's pluck string, it's a lute, it's a guitar.
Speaker: All of them have these similarities.
Speaker: And I recommend that music.
Speaker: It's very, very, very, I think it's very healing music.
Speaker: And I think that so we'll definitely put links to all of these in the show notes, Andrew.
Speaker: And I think that also for our audience to realize is that music, musical therapy or music as an adjunct to healing is not new.
Speaker: It might be new for us in the ICU, or you haven't heard it maybe, but there's a rich history of literature and studies that have looked at this, especially true in settings outside of the ICU mostly, but there's a lot of ways that connecting people with music has helped control pain and improve other outcomes.
Speaker: And we'll put some references also in the...
Speaker: in the show notes to that effect.
Speaker: But as we move forward, I wanted to read a quote from your book to get us to the final portion of our conversation.
Speaker: Is that okay?
Speaker: Sure.
Speaker: So this is from the chapter Wild Horses.
Speaker: That's towards the end, Andrew.
Speaker: And you say here that there is no such thing as a panacea in medicine or in medical musics.
Speaker: However, a healing environment that includes music will provide a better chance at the best possible medical outcome.
Speaker: Logic indicates that the more therapeutic music is available in a critical care unit, the greater the chance that seemingly miraculous events will occur more frequently.
Speaker: And I think that that is really what I want to take to our audience, because at the end of the day, education should not be about knowledge, it should be about action.
Speaker: And I know that you are on a mission to call and a call for action.
Speaker: So what would you recommend to ICU doctors and ICU clinicians who are listening today, if they say, I want to bring some music to my ICU, what would be your recommendation?
Speaker: Okay.
Speaker: The field that I'm part of, the big tent is called the field of music and medicine.
Speaker: The core profession in the field of music and medicine is music therapy, which became a profession in 1950.
Speaker: And they're doing wonderful things in music therapy.
Speaker: And there is an organization, the American Music Therapy Association,
Speaker: what is that what it is?
Speaker: I think it's American Music Therapy Association or Google.
Speaker: It'll bring you something like that.
Speaker: It's a very, very, very good website.
Speaker: And I would call that a starting point.
Speaker: Another website to go to is called Music for Transition and Healing.
Speaker: That is another group of therapeutic musicians that go through a program, a rigorous program, and they're called Music Practitioners.
Speaker: So music for transition and healing.
Speaker: The third website is my organization, the Medical Musician Initiative.
Speaker: If you go to Medical Musician Initiative, you'll see a lot of information for critical care because we're the only organization that is specifically critical care.
Speaker: That's all that we do.
Speaker: And you could contact us from the website and we can start a conversation.
Speaker: So I think those are a few.
Speaker: Now, you and I were talking earlier about books.
Speaker: And there's two books that I would recommend.
Speaker: The Musicophilia by Dr. Oliver Sacks.
Speaker: And This Is Your Brain on Music by Daniel Levitin.
Speaker: And the funny thing is, I read both of those books in 2007 and 2008, not knowing that, of course, in 2009, I was gonna have this change happen in my life.
Speaker: But I had read them and...
Speaker: thought it was all fascinating and I'm sure that was a huge factor why when I came out of the coma I decided to dedicate my life to doing this because I already had a lot of information that I had gotten from those books so
Speaker: I think that's a good starting point for anybody.
Speaker: Perfect.
Speaker: And we'll include in the show notes links to the books you mentioned.
Speaker: It's something that we usually ask our guests.
Speaker: We'll also include a link to some of the music that you've mentioned and definitely to all the resources that you've provided.
Speaker: As we close,
Speaker: What I really learned is three important things here, Andrew, that I think are very valuable for us as clinicians and as healers, right?
Speaker: Number one is be aware that your patient who you think is in a coma might be taking inputs from what is said around them.
Speaker: Yeah.
Speaker: And use that in a positive way, right?
Speaker: And there's actually studies that talk about what's called cognitive motor dissociation.
Speaker: where when you do like a quantitative EEGs or functional MRIs to people who are perceived to be in a coma and you give them certain instructions, like imagine you're doing this, it lights up.
Speaker: So they're obviously listening.
Speaker: Number two, be more curious about the people, the person that you're treating.
Speaker: You do mention throughout the book how sometimes learning from a family member or from the patient itself
Speaker: a connection with a special piece of music could be very instrumental in helping them heal.
Speaker: And I really liked the story of the English patient who was a big Rolling Stones fan.
Speaker: That connection, I mean, you probably wouldn't have not made unless somebody shared with you or asked what type of music do they like.
Speaker: I mean, I think knowing that is very important.
Speaker: Do they like music?
Speaker: What type of music do they like?
Speaker: And number three, I think is also something that is always a humbling reminder for me is that we see a lot of patients like yourself underwent a cardiac arrest.
Speaker: We're very nihilistic in terms of their ability to recover from the brain injury.
Speaker: And the truth is we don't know.
Speaker: And there is something described as neuroplasticity that in many people, I mean, comes back and it can help them.
Speaker: So I think that keeping that in the back of our mind, I think is always very important in terms of our patients.
Speaker: So this is a fascinating conversation.
Speaker: Andrew, I really learned a lot from talking with you, but also from reading the book, which I would recommend every critical care practitioner should really take the time to read.
Speaker: And as we close, is there one final thought or comment you want to make to our listeners?
Speaker: Well, I have been enjoying this a great deal, Sergio.
Speaker: We know each other, as you said earlier, from the ICU Liberation Committee.
Speaker: And I love that you're doing what you're doing with this podcast and so grateful that you gave me the opportunity to join you for a conversation.
Speaker: And I just really want to impart
Speaker: how valuable music is as medicine.
Speaker: You talked about the history and it's chapter seven in my book is Everything Vibrates.
Speaker: And Dr. Brian Hunter, the official historian of the American Music Therapy Association was my guest in that chapter.
Speaker: And I'll just bring you up to date with that and saying that music was part of medicine
Speaker: in every culture and in Europe and America, by the time you get to the early 19th century, it started getting pushed out because doctors became much more scientific and they said music is not science.
Speaker: The Civil War helped bring music back because in the veterans hospitals, they brought in local musicians and noticed things improved.
Speaker: It went a little bit more in World War I. And World War II is actually where you have a much greater amount of that going on.
Speaker: But we were still, in the background, we were still not considered science.
Speaker: And science is actually what brings us back fully because in the 1980s and 90s, when the FMRIs are being done and they're doing scans of the brains of people who are listening to music, that's where it's learned that music lights up the whole brain.
Speaker: And then there's this awareness that it helps the brain produce all the good chemicals.
Speaker: So we're moving in the right direction.
Speaker: And like I said, I'm 72 years old going on 17 because I'm a guitar player without children.
Speaker: So there was never any reason to really become an adult.
Speaker: And I'm just gonna keep doing this.
Speaker: My mother, God bless her, is 99 years old.
Speaker: and I take after her.
Speaker: So I may be doing this for a while longer, and I'm just going to keep at it.
Speaker: You have a medical musician in your ICU, and it will make a difference, a positive difference.
Speaker: Beautiful.
Speaker: Andrew, could we end with some Bach?
Speaker: From me?
Speaker: Yes.
Speaker: Well...
Speaker: I'm gonna not play a whole piece.
Speaker: I'm gonna play the opening of a Bach Sarabin.
Speaker: Thank you for listening to Critical Matters, a sound podcast.
Speaker: Make sure to subscribe to Critical Matters on Apple or Google Podcasts and share with your network.
Speaker: Sound's transforming the way critical care is provided in hospitals across the country.
Speaker: To learn more, visit www.soundphysicians.com.
