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I happened to listen to an ABC Australia interview with musician Andrew Schulman the other day and found it deeply moving, so here I'm sharing it with you..
- Guitarist Andrew Schulman's wife, Wendy, sat at the ICU watching as her husband's life slipped away from him. Everyone agreed he was just minutes away from dying.
- Following pancreas surgery in 2009, Andrew Schulman had suffered a cardiovascular collapse and was not expected to survive.
- In a desperate act to bring him back, or to ease his exit, she placed his iPod earphones in his ears and pressed PLAY.
- The first item was an inspirational piece by J.S Bach.
- Then a miracle occurred. Andrew slowly began to return to life. And he healed and survived.
- Not only that, but he became a medical musician, visiting hospitals and playing music to terminally ill patients, and seeing them react positively to his music.
- He is the author of Waking the Spirit: A Musician’s Journey Healing Body, Mind, and Soul, about the healing power of music.
On this page read a summary of his moving ordeal, and then a transcript of an interview by Australia's ABC, with a link to the audio.
International Musician - Following pancreas surgery in 2009, Andrew Schulman of Local 802 (New York City) suffered cardiovascular collapse and was not expected to survive. When he came out of the coma, doctors called it a medical miracle. But Schulman, a professional musician and guitarist knew it was music that had reached him and brought him back.
At his bedside in the intensive care unit, Schulman’s wife, Wendy, thought music would comfort him in the ICU, but desperately hoped for more, that it just might be a lifeline.
From his playlist she chose Bach’s St. Matthew Passion. Within an hour, Schulman’s vital signs began to stabilize. In three days, he emerged from the coma.
No one would know exactly how he survived the first night, but Schulman, whose case has been cited in medical journals and at major medical conferences, says, “The day I came back, six months after being in ICU, people said, ‘You’re famous in this hospital.’”
From his playlist she chose Bach’s St. Matthew Passion. Within an hour, Schulman’s vital signs began to stabilize. In three days, he emerged from the coma.
No one would know exactly how he survived the first night, but Schulman, whose case has been cited in medical journals and at major medical conferences, says, “The day I came back, six months after being in ICU, people said, ‘You’re famous in this hospital.’”
In his book, Waking the Spirit: A Musician’s Journey Healing Body, Mind, and Soul, Schulman recounts his experience, from survival and recovery to his new calling as a medical musician.
Drawing on the inspirational stories of the people he’s met, as well as experts in both music and neuroscience, Schulman reveals the powerful ways music helps patients negotiate illness.
After his medical crisis, Schulman became a volunteer musician three days a week in the surgical ICU, and in 2011, was officially appointed resident artist of the Louis Armstrong Center for Music and Medicine at the Beth Israel Medical Center.
Drawing on the inspirational stories of the people he’s met, as well as experts in both music and neuroscience, Schulman reveals the powerful ways music helps patients negotiate illness.
After his medical crisis, Schulman became a volunteer musician three days a week in the surgical ICU, and in 2011, was officially appointed resident artist of the Louis Armstrong Center for Music and Medicine at the Beth Israel Medical Center.
“The guitar is perfect for playing in this setting, especially if you need to make a modulation instantly,” Schulman says. Most patients in the ICU cannot make a request, but once in a while, someone will ask for Elvis or Gershwin. The right music, the right sound, makes a difference. A Bach prelude is typically calming. Music can make heart rhythms more regular, and lower stress hormone levels, heart rate, and blood pressure. Schulman says, “The key is finding the resonance frequency of a patient.”
Schulman has been working with trauma surgeon, Dr. Marvin A. McMillen, perioperative director at Berkshire Medical Center in Massachusetts, to develop a program of medical music specifically for post-op care.
He expects to attract many professional musicians, but Schulman emphasizes it’s not a regular gig. It requires natural empathy, extreme motivation, and a sense of humor, plus the confidence to handle some rather complex medical information.
He explains, “You’re the one who needs to keep up the spirits of patients. You have to play your Carnegie Hall best, all the while watching the patient’s face, hands, and feet because that’s where you can see agitation—checking the monitor and range of vital signs.”
He expects to attract many professional musicians, but Schulman emphasizes it’s not a regular gig. It requires natural empathy, extreme motivation, and a sense of humor, plus the confidence to handle some rather complex medical information.
He explains, “You’re the one who needs to keep up the spirits of patients. You have to play your Carnegie Hall best, all the while watching the patient’s face, hands, and feet because that’s where you can see agitation—checking the monitor and range of vital signs.”
Of his renewed passion for life and music, Schulman says, “It’s like being in three worlds—a triad of music, medicine, and writing. I’m using much more of my brain than I ever did before.”
He suffered brain damage during cardiac arrest—retrograde and anterograde amnesia. In cases like this, although the nerve network for memory was damaged, the brain compensates by reorganizing the neural pathways to work around the deficiency. Called neuroplasticity, the neural rerouting allowed him to continue to play and read music, eventually relearning all the songs he had forgotten.
He suffered brain damage during cardiac arrest—retrograde and anterograde amnesia. In cases like this, although the nerve network for memory was damaged, the brain compensates by reorganizing the neural pathways to work around the deficiency. Called neuroplasticity, the neural rerouting allowed him to continue to play and read music, eventually relearning all the songs he had forgotten.
Schulman continues to play professionally with the Abaca String Band, his own quintet, and as a soloist. His steady union engagements include landmark New York City venues, the Palm Court at The Plaza Hotel, The Mark Hotel, and The InterContinental/Barclay. He’s performed at Carnegie Hall, the Improv, and the Royal Albert Hall in London. His CDs include The Baroque Style, Lullabies, Reveilles, (and Siesta!), and two Live from Chautauqua recordings.
Schulman was just out of college in 1975 when he joined Local 802. A year before his surgery, which coincided with the 2009 recession, his wife learned she had breast cancer. He says, “If it hadn’t been for emergency relief fund of Local 802, if they hadn’t helped us after my surgery, I don’t know what we would have done. I might have been evicted, might have lost my apartment. They helped us through a crucial three months. I’m forever grateful.”
Back to work, in a new role, Schulman reflects on the turning point in his own ICU experience, when he heard St. Matthew Passion. He says, “The greatest grace a musician can have is to play for a patient who’s in a critical care unit. Instead of hearing the cold harsh beeps and alarms of a medical machine and impersonal voices, they hear a beautiful flow of Bach or a melody or tune that’s soothing.”
Source
ABC INTERVIEW WITH ANDREW SCHULMAN
There’s nothing like a favourite piece of music to lift your spirits, and for millennia music has been known to play a powerful role in the healing process. We hear the inspiring story of a musician who believes he was pulled from the brink of death after hearing the single piece of music that meant most to him—from Bach’s St. Matthew Passion. Now he uses music as medicine in hospital intensive care units, to help heal others.
You can listen to the interview here
http://www.abc.net.au/radionational/programs/allinthemind/the-medical-muso/8430626
Or read the transcript:
Source
http://www.abc.net.au/radionational/programs/allinthemind/the-medical-muso/8430626You can listen to the interview here
http://www.abc.net.au/radionational/programs/allinthemind/the-medical-muso/8430626
Or read the transcript:
Transcript
Lynne Malcolm: Hi, it's All in the Mind on RN, I'm Lynne Malcolm.
The opening movement of St Matthew Passion by JS Bach. It's a very beautiful piece of music by all accounts, and my guest today maintains that this music saved his life.
Andrew Schulman began playing the guitar as a child, and has been a professional guitarist in New York for more than three decades.
But about eight years ago, he and his wife Wendy shared an almost miraculous event at Mount Sinai Beth Israel Hospital in New York. This set Andrew on a new path, as what he calls a medical musician.
Andrew Schulman: What got me started in this path to become what I call a medical musician was my own catastrophic experience in critical medicine. I had a 99% diagnosis of pancreatic cancer, had a surgery. And the miracle at first was that I got the 1%.
The mass was benign. It happens sometimes that way. But what followed that was that as I was being put onto the gurney to go from the operating room to the surgical intensive care unit, what we call the SICU, I went into anaphylactic shock.
They'll never know exactly why but it probably had to do with the blood transfusion. I arrived five minutes later after a mad dash with them dashing me on a gurney into the SICU and I was clinically dead, which means I was in cardiac arrest, no respiration, no blood pressure. But I was resuscitated.
However, I was just massively ill from all kinds of complications. I was immediately put into a medically induced coma, and in the first three days of that coma, not a single doctor or nurse thought I would live. My wife didn't think I'd live either.
It's in the middle of the third day when it was clear to everyone, especially to my wife, that I was probably within an hour or two of being gone permanently, that she had an epiphany. She was looking in her bag for her cell phone to call my mother and she saw my iPod, turned to the attending physician and said, 'He loves music more than anything. Medicine is not working at this point, my voice isn't working to reach him, I think only music could reach him.' And they agreed to try it.
The earbuds went in, they didn't know what to play, they just hit the first track on the iPod, luckily for me it was my ultimate favourite piece, the St Matthew Passion of Bach, and I have my guitar right here, I'll just say that the base starts with a heartbeat, and the first melody [plays guitar]…well, it's very powerful music, very important music to me as was my favourite piece and very uplifting.
And 30 minutes into the piece, all of a sudden I started stabilising, which I hadn't done in three days. I was terminally ill at that point, meaning I had terminal acidosis, lactic acid had built up in my tissues, and you don't survive that. But the acid started leaching out of my tissues. And by the way, it's an amazing story but it's backed up by the fact that it's in an ICU and doctors and nurses were there and there's chart for this showing all this stuff really happened. By that evening I was out of danger, and I never regressed, there were no more complications. They kept me in the coma for three more days.
Lynne Malcolm: What was the reaction from the medical staff around when they saw that the readings had changed for the better?
Andrew Schulman: They at first could believe it. And for years in that ICU the nurses actually always talked about it as the St Matthew miracle. Dr Marvin McMillen who was the director of the surgical ICU at that time and has become my partner in developing medical musician as a specialty, said he'd never seen anybody survive terminal acidosis. So it was a very extraordinary event for all of them.
Lynne Malcolm: So can you explain to me how you found out later that your wife had played Bach's St Matthew's passion while you are in a coma, because he didn't know straight away, did you?
Andrew Schulman: No, she didn't want to tell me right away when I came out of the coma, she didn't think I was strong enough. So that was a Thursday morning when I'm out of the coma. And on Sunday at noon my roommate had guests and they were making a lot of noise and I didn't want to ask them to be quiet and I looked at the table next to me and saw my iPod, and I said, oh, put the iPod in and just play some loud music.
I did, and as a had said before, the first track is the St Matthew, my favourite piece, and within seconds I started not just crying but weeping, weeping uncontrollably, and I have no idea why all of a sudden I'm weeping like that. And it lasted for about 30 minutes, and it wouldn't stop, and I just was…I didn't turn off the music, but I was just totally baffled.
And Wendy comes back and she sees me crying like that, and she rushes over, she doesn't know what's going on, and I take out the earbuds and I say, 'I don't know what's going on, I started playing the St Matthew Passion and I just starting this weeping and grieving.'
And she nodded her head very quietly and that was the moment to tell me and then she told me. And we really figured out a number of things about that because I immediately also started thinking of my father who had died. And I had been with him when he died. And the first thing I said was, 'The body remembers.'
And there is actually a term that's called embodied cognition, that the mind is not just in the brain. Memory and cognition can be all through the body. And what it was is that my being, my brain and my full complete body, understood where I didn't consciously understand that that music had saved my life, and I was weeping for my father but I was weeping for myself too. That's how I understood the power of it, I just didn't know it consciously, and then Wendy explained it. It was a very amazing moment.
I knew that I had to give back and that the only thing of value I had to give then was music. So when we left the hospital several days later, Wendy made sure that I was brought back down to the surgical ICU. And Dr McMillen was there and it was a pretty terrific 10-minute chat that we all had.
But at the end of it he said something which is very typical in hospitals that the doctors and nurses say when you are leaving, especially if they saved your life, 'We are so happy that you are doing so much better, and we never want to see you again.' He said that to me and I looked at him and I was fierce and I said, 'No, I want you to see me again and I want to come back here with my guitar.'
All I wanted to do was work in critical care and use my professional musician skills, so I came up with the title Medical Musician, and it is now a new specialty. Dr McMillen and I are going to be starting to…we have already started teaching people how to do this. And it's a professional musician with medical training who specialises in intensive care units as part of the medical team.
Lynne Malcolm: Heading the team that saved Andrew Schulman's life was Dr Marvin McMillen. He's a musician himself and passionate about the healing power of music. Now they are collaborating on an initiative to provide music for critically ill surgery patients at Berkshire Medical Centre in Massachusetts.
After his discharge from Mount Sinai Beth Israel Hospital, Andrew Schulman was welcomed back to the ICU as a medical musician, where he spent seven years in the role. He developed a simple and effective method for working with critically ill patients.
Andrew Schulman: I go in, and once I've acclimatised to the room, you get a sense of the room for a few minutes, and you get the instrument out and tune very, very carefully, I then go to the main computer monitor and look at the vital signs of all the patients, and I spend a few minutes doing that, almost memorising everything. And then I do a stroll through the unit, and I play a very gentle little piece…again, I have the guitar…this little study from the early 19th century by Matteo Carcassi. I'll just play you a few seconds: [plays guitar]. A lovely little charming, flowing rhythm piece, very melodic.
And we learned early on that if I didn't do a stroll first so everybody can hear it as I walk past each bedside, if I didn't do that and a nurse or I went to a bedside and said, 'Would you like to hear music?' Most people would say no, they don't know what it sounds like, is the guy going to play Metallica? What is it going to be? As soon as I added that thing…that was the end of the three years actually, where one of my young doctors suggested I do that. Once the promenade was added, most people then, if they were asked if they wanted music would say yes.
So that promenade also has another function. Because I've looked at the vital signs of every patient in the place, I can match up what I saw on the computer monitor with what I'm seeing at the bedside. And what you do is a reverse triage. In the unit, I'm usually there two hours each session, you want to go to the sickest people first.
And it is on any given day possible that I will spend 90 minutes at one bedside. It could be somebody in a coma or a brain damage patient where music is extremely effective, both in coma, as I knew from my own situation. And in neurological situations with neurosurgery, music, especially the music of Bach, does a tremendous job balancing the patient. And it is often the case that music, properly applied, can be more effective than anything else in the unit.
Lynne Malcolm: Andrew Schulman, medical musician and author of Waking the Spirit: A musician's journey healing body, mind and soul. We're hearing Andrew's arrangement of Bach's prelude BWV 998.
You're with All in the Mind on RN, I'm Lynne Malcolm.
Compelling results are emerging from recent research into the use of music in medical settings. For example, a study from Queen Mary University of London was published in the Lancet journal in 2015, which concluded that: 'Music is a non-invasive, safe, and inexpensive intervention that can be delivered easily and successfully in a hospital setting. We believe that sufficient research has been done to show that music should be available to all patients undergoing operative procedures.'
Andrew Schulman describes the effect that his music had on a couple of patients in the intensive care unit at Mount Sinai Beth Israel Hospital. The first he calls the Russian patient.
Andrew Schulman: I walk into the unit, coat on, guitar in my bag, and I hear this very strange sound over the cacophony of noise you hear in an ICU, and it took a moment to realise that it was a person's voice, high-pitched, as I'm walking down the hall, I realise it's a woman's voice, and I could not make out the language at all. My closest guess was Russian. I played a concert tour in Russia.
That's what it sounded like. One of the nurses saw me and said, 'Grab your guitar, grab your music, go to bed 5 immediately.' And I go behind the curtain, there are three nurses that had been with this woman who was in a hyper state of ICU delirium, and she was just talking very loud and I had no idea…I'll quickly say right now I later found out she was from upstate New York, it was made-up language. She was hallucinating, she was talking to imaginary people.
And I intuitively grabbed my folder with my Bach music, and sat down, set up the stand and started playing. And a moment before I start I look at the clock on the wall to see how long is this going to take. If it works. It took 10 seconds of an arrangement I'd done of the prelude from the first cello suite. She immediately, as soon as the first notes played, looked at my face first, then at my hands on the instrument and was keenly listening.
And about 10 seconds in, her shoulders came down, she sank down back into the bed. Her arms had been restrained and she was pulling at the restraints. And the three nurses were so stressed out, they'd been there for two hours. And their shoulders came down, everybody relaxed. And I stayed with her for 90 minutes. And at the end of the 90 minutes she was out of the ICU delirium. The music had actually rebalanced her brain. In medical terms that's literally what had happened.
Lynne Malcolm: Andrew Schulman discovered around this time that musicologist Dr Arthur Harvey had conducted studies on Bach and the brain and concluded that Bach's music helps the brain in a balanced way more than any other music.
Andrew Schulman: It's the balance that is itself found in Bach's music. His music uses chordal music, strait harmonies, contrapuntal music. Counterpoint is when you have voices that are independent harmonically but interdependent but independent in rhythm. And a tremendous balance that is just natural to his writing of the music, use of long notes, short notes, soft, loud, high and low. If you listen to Bach very carefully you'll see what a tremendous range and a complexity that all comes together actually in a very, very beautiful way.
There is the issue that you deal with about cultural acclimation. If I know that a patient is a very classical music person I'll say I'm going to play Bach. But if I think that they are not used to hearing classical music, I never tell them that I'm playing Bach for them, I just say, 'I have something nice I'll play for you.' And I have my favourite Bach pieces, which are very soothing and healing, and I'm being honest when I tell you that in eight years of doing this I can't actually remember a single time when I played one of those pieces and somebody didn't like it.
Lynne Malcolm: However, Bach isn't always the magic bullet. Andrew Schulman describes his interaction with another patient in ICU. He calls him Mr G.
Andrew Schulman: This man was a man, I think he was around 80. I knew a little bit about him, he was a very well-known saxophone and jazz musician in New York City for many years, came from Kansas City originally. And he was very sick, it was a kidney disease, and he had been cheerful the first few days but then he started sinking into something called dysphoria. I remember when I started, Dr McMillen said one of the most important things I was there for was to help prevent dysphoria. Dysphoria is the opposite of euphoria, and it is more than just a depression, it's sinking down into a deep well, and especially with older patients who are very sick, if they really sink into dysphoria, it can be difficult or impossible to bring them back.
That day there was a note for me from Dr McMillen to go right to that bed. And so what I did is I started playing some tunes that I thought he would know. Let's see if I can do a little of this one: [plays guitar]. That's 'Can't Help Lovin That Man' from Showboat, a great tune that jazz musicians play. His eyes were closed. He was not heavily sedated or in a coma.
And as soon as I started playing, his vital signs started getting a little bit better. I played a few more tunes. And then again it was an intuitive leap, I'd never done this before, I started playing not the melody with the chords but I just started playing the cords of the tune, hoping that he would start playing his saxophone in his imagination, in his mind.
And that's literally what happened. In fact he started furrowing his brow as a musician would when they were playing. I spent about 30 minutes with him, played a whole bunch of tunes. And it was completely effective. His vital signs improved and it brought him out of that state of dysphoria.
Lynne Malcolm: So you say that one of the most important decisions you make as a medical musician is choosing what music you play. So how do you make those decisions, and are there particular pieces of music that work generally for most people?
Andrew Schulman: Yes, and the pieces that work generally are…I call them my penicillin pieces, and that Bach prelude with the Russian woman is one of the best penicillin pieces that I have. But let me just also address…you said how do you make those decisions. What you have to have when you go in there is a very large repertoire and very broad repertoire. And I really think it's important for a medical musician to be classically trained, but also have a lot of experience in popular music.
The three bodies of work over all of these years I notice provide the most material that is so often effective is the music of Bach, Gershwin and the Beatles. And a lot of it has to do, even with the Bach, because a lot of the Bach music is vocal music that I've arranged, I play a lot of music, as I did with 'Can't Help Lovin That Man', arrangements of vocal numbers. The idea is, even if that person is in a coma or sedated, is to hear this music and get them singing in their own mind, singing and dancing too, I have to tell you.
And ultimately what my goal is all the time is that when I'm at that bedside I want that person to be able to leave the SICU for 10, 15, 20 minutes or longer while I'm playing. In their mind it's a beautiful spring day and they are taking a walk through the countryside and hearing the sound of birds and evocative sounds. The music itself takes them there. Ultimately that's what you're doing.
You can imagine of course though when I talk about the music having to be done in the right way, you can very easily agitate people with music. And when I look at that patient all the time when I'm playing, I look at their face, their hands and their feet, that's what I'm looking for all the time. And if there are signs of agitation, you have to very smoothly modulate into another tune. Music doesn't work for everybody. So it could be a few minutes and going through a few tunes and I see it's not the right thing for that patient, and that's when you have to know to very quietly drop out of the sound and go somewhere else, it's not working for them. But most people like music. You will find that music as a medical modality, it's effective most of the time.
Lynne Malcolm: So what's your understanding of the mechanism that operates with music and how music actually has that healing power?
Andrew Schulman: One of the best descriptions was given to me by Dr Connie Tomaino who is the executive director of the Institute for Music and Neurologic Function. And she gave me a description good for the layman, because it gets very complicated, believe me. And her description was, music, it is processed in the old brain, also known as the reptilian brain, and in that sense it's non-cognitive.
And when the music is working for that person, essentially what happens is a series of chemicals are produced, some of the names are well known—serotonin, dopamine, norepinephrine—and these chemicals flow through your body. In fact the instance of her description was describing what happened to me and why the music saved my life.
She said those chemicals were created because I responded very positively to the music, they flowed through my body, carrying a message, and the message was it's not time to shut down yet. That literally saved my life because it stabilised me. And then the doctors were able to jump in and do things that they couldn't have done when I was completely unstable, they would have killed me if they had done those things.
In the same sense when it's a healing process, some of these chemicals are the same chemicals that are produced in your brain with very pleasurable sensation; drinking a glass of champagne or, if I may say so on Australian radio, when you are having sex, or eating chocolate.
It's very much the same chemistry. So this is what happens, and in these very complicated processes though, they all combine together, and some of the effects are simply that your blood pressure is lowered, your heart rate is lowered and may be smoothed out, and the stress you're feeling and trauma you're feeling is alleviated. And one of the most powerful effects is that, yes, music actually can in many people go a long way to lowering the sensation of pain.
Lynne Malcolm: Andrew Schulman has recently moved to NYU Langone Medical Center as a medical musician.
And he has one last piece of music to play for us.
Andrew Schulman: Now, this tune is something that is one of my most penicillin of all penicillin pieces, for a very specific situation where there is a patient who is very, very critically ill, may live, may die. And the music of course is for the patient but just as much for the family and friends that are now surrounding the bed.
And I found very early on that this music had a remarkable ability to bring them together in a psychic way, so to speak, because the very opening chord is very unstable but then it goes to a very stable chord. And there are other chords that have this quality of almost here and not here. And then you're going to hear a section which is very down-to-earth. We have seen over and over and over that people have come from hearing this piece and the thing that happens is hope.
he piece was written by a friend of mine, and he's not a professional musician or a composer. His name is Peter Williams. He is a very talented guy though and knew what I was doing and wrote this piece and sent it to me, and it has the nice simple little title of 'Little Theme in D'.
[Music]
Lynne Malcolm: Andrew Schulman, musician and author of Waking the Spirit: A musician's journey healing body, mind, and soul, it's published by Picador.
Thanks to the team Diane Dean, Isabella Tropiano and Judy Rapley.
I'm Lynne Malcolm, thanks for your company, until next time.
The opening movement of St Matthew Passion by JS Bach. It's a very beautiful piece of music by all accounts, and my guest today maintains that this music saved his life.
Andrew Schulman began playing the guitar as a child, and has been a professional guitarist in New York for more than three decades.
But about eight years ago, he and his wife Wendy shared an almost miraculous event at Mount Sinai Beth Israel Hospital in New York. This set Andrew on a new path, as what he calls a medical musician.
Andrew Schulman: What got me started in this path to become what I call a medical musician was my own catastrophic experience in critical medicine. I had a 99% diagnosis of pancreatic cancer, had a surgery. And the miracle at first was that I got the 1%.
The mass was benign. It happens sometimes that way. But what followed that was that as I was being put onto the gurney to go from the operating room to the surgical intensive care unit, what we call the SICU, I went into anaphylactic shock.
They'll never know exactly why but it probably had to do with the blood transfusion. I arrived five minutes later after a mad dash with them dashing me on a gurney into the SICU and I was clinically dead, which means I was in cardiac arrest, no respiration, no blood pressure. But I was resuscitated.
However, I was just massively ill from all kinds of complications. I was immediately put into a medically induced coma, and in the first three days of that coma, not a single doctor or nurse thought I would live. My wife didn't think I'd live either.
It's in the middle of the third day when it was clear to everyone, especially to my wife, that I was probably within an hour or two of being gone permanently, that she had an epiphany. She was looking in her bag for her cell phone to call my mother and she saw my iPod, turned to the attending physician and said, 'He loves music more than anything. Medicine is not working at this point, my voice isn't working to reach him, I think only music could reach him.' And they agreed to try it.
The earbuds went in, they didn't know what to play, they just hit the first track on the iPod, luckily for me it was my ultimate favourite piece, the St Matthew Passion of Bach, and I have my guitar right here, I'll just say that the base starts with a heartbeat, and the first melody [plays guitar]…well, it's very powerful music, very important music to me as was my favourite piece and very uplifting.
And 30 minutes into the piece, all of a sudden I started stabilising, which I hadn't done in three days. I was terminally ill at that point, meaning I had terminal acidosis, lactic acid had built up in my tissues, and you don't survive that. But the acid started leaching out of my tissues. And by the way, it's an amazing story but it's backed up by the fact that it's in an ICU and doctors and nurses were there and there's chart for this showing all this stuff really happened. By that evening I was out of danger, and I never regressed, there were no more complications. They kept me in the coma for three more days.
Lynne Malcolm: What was the reaction from the medical staff around when they saw that the readings had changed for the better?
Andrew Schulman: They at first could believe it. And for years in that ICU the nurses actually always talked about it as the St Matthew miracle. Dr Marvin McMillen who was the director of the surgical ICU at that time and has become my partner in developing medical musician as a specialty, said he'd never seen anybody survive terminal acidosis. So it was a very extraordinary event for all of them.
Lynne Malcolm: So can you explain to me how you found out later that your wife had played Bach's St Matthew's passion while you are in a coma, because he didn't know straight away, did you?
Andrew Schulman: No, she didn't want to tell me right away when I came out of the coma, she didn't think I was strong enough. So that was a Thursday morning when I'm out of the coma. And on Sunday at noon my roommate had guests and they were making a lot of noise and I didn't want to ask them to be quiet and I looked at the table next to me and saw my iPod, and I said, oh, put the iPod in and just play some loud music.
I did, and as a had said before, the first track is the St Matthew, my favourite piece, and within seconds I started not just crying but weeping, weeping uncontrollably, and I have no idea why all of a sudden I'm weeping like that. And it lasted for about 30 minutes, and it wouldn't stop, and I just was…I didn't turn off the music, but I was just totally baffled.
And Wendy comes back and she sees me crying like that, and she rushes over, she doesn't know what's going on, and I take out the earbuds and I say, 'I don't know what's going on, I started playing the St Matthew Passion and I just starting this weeping and grieving.'
And she nodded her head very quietly and that was the moment to tell me and then she told me. And we really figured out a number of things about that because I immediately also started thinking of my father who had died. And I had been with him when he died. And the first thing I said was, 'The body remembers.'
And there is actually a term that's called embodied cognition, that the mind is not just in the brain. Memory and cognition can be all through the body. And what it was is that my being, my brain and my full complete body, understood where I didn't consciously understand that that music had saved my life, and I was weeping for my father but I was weeping for myself too. That's how I understood the power of it, I just didn't know it consciously, and then Wendy explained it. It was a very amazing moment.
I knew that I had to give back and that the only thing of value I had to give then was music. So when we left the hospital several days later, Wendy made sure that I was brought back down to the surgical ICU. And Dr McMillen was there and it was a pretty terrific 10-minute chat that we all had.
But at the end of it he said something which is very typical in hospitals that the doctors and nurses say when you are leaving, especially if they saved your life, 'We are so happy that you are doing so much better, and we never want to see you again.' He said that to me and I looked at him and I was fierce and I said, 'No, I want you to see me again and I want to come back here with my guitar.'
All I wanted to do was work in critical care and use my professional musician skills, so I came up with the title Medical Musician, and it is now a new specialty. Dr McMillen and I are going to be starting to…we have already started teaching people how to do this. And it's a professional musician with medical training who specialises in intensive care units as part of the medical team.
who took inspiration from Andrew's book (with thanks to Kay Lipton)
Lynne Malcolm: Heading the team that saved Andrew Schulman's life was Dr Marvin McMillen. He's a musician himself and passionate about the healing power of music. Now they are collaborating on an initiative to provide music for critically ill surgery patients at Berkshire Medical Centre in Massachusetts.
After his discharge from Mount Sinai Beth Israel Hospital, Andrew Schulman was welcomed back to the ICU as a medical musician, where he spent seven years in the role. He developed a simple and effective method for working with critically ill patients.
Andrew Schulman: I go in, and once I've acclimatised to the room, you get a sense of the room for a few minutes, and you get the instrument out and tune very, very carefully, I then go to the main computer monitor and look at the vital signs of all the patients, and I spend a few minutes doing that, almost memorising everything. And then I do a stroll through the unit, and I play a very gentle little piece…again, I have the guitar…this little study from the early 19th century by Matteo Carcassi. I'll just play you a few seconds: [plays guitar]. A lovely little charming, flowing rhythm piece, very melodic.
And we learned early on that if I didn't do a stroll first so everybody can hear it as I walk past each bedside, if I didn't do that and a nurse or I went to a bedside and said, 'Would you like to hear music?' Most people would say no, they don't know what it sounds like, is the guy going to play Metallica? What is it going to be? As soon as I added that thing…that was the end of the three years actually, where one of my young doctors suggested I do that. Once the promenade was added, most people then, if they were asked if they wanted music would say yes.
So that promenade also has another function. Because I've looked at the vital signs of every patient in the place, I can match up what I saw on the computer monitor with what I'm seeing at the bedside. And what you do is a reverse triage. In the unit, I'm usually there two hours each session, you want to go to the sickest people first.
And it is on any given day possible that I will spend 90 minutes at one bedside. It could be somebody in a coma or a brain damage patient where music is extremely effective, both in coma, as I knew from my own situation. And in neurological situations with neurosurgery, music, especially the music of Bach, does a tremendous job balancing the patient. And it is often the case that music, properly applied, can be more effective than anything else in the unit.
Lynne Malcolm: Andrew Schulman, medical musician and author of Waking the Spirit: A musician's journey healing body, mind and soul. We're hearing Andrew's arrangement of Bach's prelude BWV 998.
You're with All in the Mind on RN, I'm Lynne Malcolm.
Compelling results are emerging from recent research into the use of music in medical settings. For example, a study from Queen Mary University of London was published in the Lancet journal in 2015, which concluded that: 'Music is a non-invasive, safe, and inexpensive intervention that can be delivered easily and successfully in a hospital setting. We believe that sufficient research has been done to show that music should be available to all patients undergoing operative procedures.'
Andrew Schulman describes the effect that his music had on a couple of patients in the intensive care unit at Mount Sinai Beth Israel Hospital. The first he calls the Russian patient.
Andrew Schulman: I walk into the unit, coat on, guitar in my bag, and I hear this very strange sound over the cacophony of noise you hear in an ICU, and it took a moment to realise that it was a person's voice, high-pitched, as I'm walking down the hall, I realise it's a woman's voice, and I could not make out the language at all. My closest guess was Russian. I played a concert tour in Russia.
That's what it sounded like. One of the nurses saw me and said, 'Grab your guitar, grab your music, go to bed 5 immediately.' And I go behind the curtain, there are three nurses that had been with this woman who was in a hyper state of ICU delirium, and she was just talking very loud and I had no idea…I'll quickly say right now I later found out she was from upstate New York, it was made-up language. She was hallucinating, she was talking to imaginary people.
And I intuitively grabbed my folder with my Bach music, and sat down, set up the stand and started playing. And a moment before I start I look at the clock on the wall to see how long is this going to take. If it works. It took 10 seconds of an arrangement I'd done of the prelude from the first cello suite. She immediately, as soon as the first notes played, looked at my face first, then at my hands on the instrument and was keenly listening.
And about 10 seconds in, her shoulders came down, she sank down back into the bed. Her arms had been restrained and she was pulling at the restraints. And the three nurses were so stressed out, they'd been there for two hours. And their shoulders came down, everybody relaxed. And I stayed with her for 90 minutes. And at the end of the 90 minutes she was out of the ICU delirium. The music had actually rebalanced her brain. In medical terms that's literally what had happened.
Lynne Malcolm: Andrew Schulman discovered around this time that musicologist Dr Arthur Harvey had conducted studies on Bach and the brain and concluded that Bach's music helps the brain in a balanced way more than any other music.
Andrew Schulman: It's the balance that is itself found in Bach's music. His music uses chordal music, strait harmonies, contrapuntal music. Counterpoint is when you have voices that are independent harmonically but interdependent but independent in rhythm. And a tremendous balance that is just natural to his writing of the music, use of long notes, short notes, soft, loud, high and low. If you listen to Bach very carefully you'll see what a tremendous range and a complexity that all comes together actually in a very, very beautiful way.
There is the issue that you deal with about cultural acclimation. If I know that a patient is a very classical music person I'll say I'm going to play Bach. But if I think that they are not used to hearing classical music, I never tell them that I'm playing Bach for them, I just say, 'I have something nice I'll play for you.' And I have my favourite Bach pieces, which are very soothing and healing, and I'm being honest when I tell you that in eight years of doing this I can't actually remember a single time when I played one of those pieces and somebody didn't like it.
Lynne Malcolm: However, Bach isn't always the magic bullet. Andrew Schulman describes his interaction with another patient in ICU. He calls him Mr G.
Andrew Schulman: This man was a man, I think he was around 80. I knew a little bit about him, he was a very well-known saxophone and jazz musician in New York City for many years, came from Kansas City originally. And he was very sick, it was a kidney disease, and he had been cheerful the first few days but then he started sinking into something called dysphoria. I remember when I started, Dr McMillen said one of the most important things I was there for was to help prevent dysphoria. Dysphoria is the opposite of euphoria, and it is more than just a depression, it's sinking down into a deep well, and especially with older patients who are very sick, if they really sink into dysphoria, it can be difficult or impossible to bring them back.
That day there was a note for me from Dr McMillen to go right to that bed. And so what I did is I started playing some tunes that I thought he would know. Let's see if I can do a little of this one: [plays guitar]. That's 'Can't Help Lovin That Man' from Showboat, a great tune that jazz musicians play. His eyes were closed. He was not heavily sedated or in a coma.
And as soon as I started playing, his vital signs started getting a little bit better. I played a few more tunes. And then again it was an intuitive leap, I'd never done this before, I started playing not the melody with the chords but I just started playing the cords of the tune, hoping that he would start playing his saxophone in his imagination, in his mind.
And that's literally what happened. In fact he started furrowing his brow as a musician would when they were playing. I spent about 30 minutes with him, played a whole bunch of tunes. And it was completely effective. His vital signs improved and it brought him out of that state of dysphoria.
Lynne Malcolm: So you say that one of the most important decisions you make as a medical musician is choosing what music you play. So how do you make those decisions, and are there particular pieces of music that work generally for most people?
Andrew Schulman: Yes, and the pieces that work generally are…I call them my penicillin pieces, and that Bach prelude with the Russian woman is one of the best penicillin pieces that I have. But let me just also address…you said how do you make those decisions. What you have to have when you go in there is a very large repertoire and very broad repertoire. And I really think it's important for a medical musician to be classically trained, but also have a lot of experience in popular music.
The three bodies of work over all of these years I notice provide the most material that is so often effective is the music of Bach, Gershwin and the Beatles. And a lot of it has to do, even with the Bach, because a lot of the Bach music is vocal music that I've arranged, I play a lot of music, as I did with 'Can't Help Lovin That Man', arrangements of vocal numbers. The idea is, even if that person is in a coma or sedated, is to hear this music and get them singing in their own mind, singing and dancing too, I have to tell you.
And ultimately what my goal is all the time is that when I'm at that bedside I want that person to be able to leave the SICU for 10, 15, 20 minutes or longer while I'm playing. In their mind it's a beautiful spring day and they are taking a walk through the countryside and hearing the sound of birds and evocative sounds. The music itself takes them there. Ultimately that's what you're doing.
You can imagine of course though when I talk about the music having to be done in the right way, you can very easily agitate people with music. And when I look at that patient all the time when I'm playing, I look at their face, their hands and their feet, that's what I'm looking for all the time. And if there are signs of agitation, you have to very smoothly modulate into another tune. Music doesn't work for everybody. So it could be a few minutes and going through a few tunes and I see it's not the right thing for that patient, and that's when you have to know to very quietly drop out of the sound and go somewhere else, it's not working for them. But most people like music. You will find that music as a medical modality, it's effective most of the time.
Lynne Malcolm: So what's your understanding of the mechanism that operates with music and how music actually has that healing power?
Andrew Schulman: One of the best descriptions was given to me by Dr Connie Tomaino who is the executive director of the Institute for Music and Neurologic Function. And she gave me a description good for the layman, because it gets very complicated, believe me. And her description was, music, it is processed in the old brain, also known as the reptilian brain, and in that sense it's non-cognitive.
And when the music is working for that person, essentially what happens is a series of chemicals are produced, some of the names are well known—serotonin, dopamine, norepinephrine—and these chemicals flow through your body. In fact the instance of her description was describing what happened to me and why the music saved my life.
She said those chemicals were created because I responded very positively to the music, they flowed through my body, carrying a message, and the message was it's not time to shut down yet. That literally saved my life because it stabilised me. And then the doctors were able to jump in and do things that they couldn't have done when I was completely unstable, they would have killed me if they had done those things.
In the same sense when it's a healing process, some of these chemicals are the same chemicals that are produced in your brain with very pleasurable sensation; drinking a glass of champagne or, if I may say so on Australian radio, when you are having sex, or eating chocolate.
It's very much the same chemistry. So this is what happens, and in these very complicated processes though, they all combine together, and some of the effects are simply that your blood pressure is lowered, your heart rate is lowered and may be smoothed out, and the stress you're feeling and trauma you're feeling is alleviated. And one of the most powerful effects is that, yes, music actually can in many people go a long way to lowering the sensation of pain.
Lynne Malcolm: Andrew Schulman has recently moved to NYU Langone Medical Center as a medical musician.
And he has one last piece of music to play for us.
Andrew Schulman: Now, this tune is something that is one of my most penicillin of all penicillin pieces, for a very specific situation where there is a patient who is very, very critically ill, may live, may die. And the music of course is for the patient but just as much for the family and friends that are now surrounding the bed.
And I found very early on that this music had a remarkable ability to bring them together in a psychic way, so to speak, because the very opening chord is very unstable but then it goes to a very stable chord. And there are other chords that have this quality of almost here and not here. And then you're going to hear a section which is very down-to-earth. We have seen over and over and over that people have come from hearing this piece and the thing that happens is hope.
he piece was written by a friend of mine, and he's not a professional musician or a composer. His name is Peter Williams. He is a very talented guy though and knew what I was doing and wrote this piece and sent it to me, and it has the nice simple little title of 'Little Theme in D'.
[Music]
Lynne Malcolm: Andrew Schulman, musician and author of Waking the Spirit: A musician's journey healing body, mind, and soul, it's published by Picador.
Thanks to the team Diane Dean, Isabella Tropiano and Judy Rapley.
I'm Lynne Malcolm, thanks for your company, until next time.
Source
Related
Andrew Schulman's book - Waking the Spirit
https://www.amazon.ca/Waking-Spirit-Musicians-Journey-Healing-ebook/dp/B00MELYIFG
Music as Medicine - Penicillin Music - Andrew Schulman's video
https://www.youtube.com/watch?v=-VYX0cWhhGI
His website - Abaca Productions - More about Andrew Schulman and his art
http://www.abacaproductions.com/andrew.html
How Andrew Schulman heals with music
http://www.stonybrook.edu/happenings/sb_medicine/andrew-schulman-74-heals-with-music/
Mount Sinai Beth Israel Hospital - Music as Therapy - Articles
http://www.wehealny.org/services/bi_musictherapy/news.html
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