March 2008

VOL.81 NO.2 March 2008 $5.00

SAN FRANCISCO MEDICINEJ O U R N A L O F T H E S A N F R A N C I S C O M E D I C A L S O C I E T Y

and Medicine

Music

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CONTENTSSAN FRANCISCO MEDICINE March 2008 Volume 80, Number 2

FEATURE ARTICLES Music and Medicine

10 Healing the Healer: The Blues for Docs with the Blues RoyRogers

11 Musicophilia: A Feeling for Music AshleySkabar

13 Living with Music: One Musician’s Perspective NolanGasser,PhD

15 Soothing the Sick with Sound: Music at Stanford Hospital GregKaufman

17 The Power of Music: The Transformed Moment SusanMazer

19 Music Therapy at Langley Porter: The Union of Clinical and Musical Skills TomBenson,MT-BC

21 Healing Muses: Adding Sound to Silent Technology EileenHadidian

22 Enriching Hospice Care: Music at the End of Life KrisMontgomery

24 The Threshold Choir: Singing to Assist Transitions KateMunger

25 The Healing Harp: The Oldest Healing Musical Instrument ClaireDunne

27 Calming the Surgeon and the Patient: The Positive Effects of Music in the OR JohnMaa,MD,FACS

28 Jake Leg: A Public Health Mystery is Solved through the Blues EishaZaid

29 From Mind to Heart: A Healing Musical Journey GaryMalkin

31 Life in the Vortex: Introductory Notes from a Physician-Musician BruceS.Victor,MD

33 Doctor of Harmony: Care of Musical People and Musical Hands RobertE.Markison,MD

35 Living Both Music and Medicine: Where the Two Practices IntersectAsToldbyVariousSanFrancisco-BasedPhysician-Musicians

MONTHLY COLUMNS

4 On Your Behalf

6 Executive Memo MaryLouLicwinko,JD,MHSA

7 President’s Message StevenFugaro,MD

9 Editorial MikeDenney,MD,PhD

44 Hospital News

46 In Memoriam NancyThomson,MD

SFMS 2008 ANNUAL DINNER

40 Annual Dinner Photos 42 A Note from the Keynote Speaker We Can Do Better: Improving the Health of the American People StevenA.Schroeder,MD

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4 SAN FRANCISCO MEDICINE MARCh 2008 WWW.SFMS.ORg4 SAN FRANCISCO MEDICINE MARCh 2008 WWW.SFMS.ORg

ON YOUR BEHALF

Membership Events

The Golf Mixer at the Presidio Golf Club Thursday, April 17, from 5:30 to 7:30

Enjoyhostedbeverages,appetizersandlivelyconversationinabeautifulsettingwhilelearningaboutthishistoriccoursefromtheClub’sGolfPros.ThePresidioGolfClubhasdevelopedaspecialarrangementforSanFranciscoMedicalSocietymemberswhowishtojointheClub.LearnmoreabouttheGolfClubbyvisitingtheirwebsitewww.presidio-golfclub.com

Thecost forthisMixer is just$10.00formembersand$15.00fornon-members.NonmemberphysicianswhojointheMedicalSocietyatthiseventwillhavetheireventfeedeductedfromtheiralreadydiscountedfirstyeardues,makingthisagreateventtobringyourphysicianpeerswhoarenotyetSFMSmembers.

Formore information,or toRSVP,contactTheresePorterintheMembershipDepartmentat(415)561-0850,[email protected],April10.

A Night at the deYoung Museum! Friday, May 9, from 5:30 to 7:30

JoinSFMSmembersforareceptionwithaccesstheentiretyofthisstunningmuseum.Just$20.00(includesmuseumadmission).ContactTheresePorterformoreinformationortoRSVP.

TheSanFranciscoMedicalSocietyisinterestedinyourfeedbackandsuggestionsformembershipeventsthatareinterestingandfunforourmembers.ContactTheresePorterintheMembershipDepartmentat(415)[email protected].

Calling All Artists!The Medical Society is looking for

coverart for its2008–2009MembershipDirectory,whichwillbepublishedinlatespring.Ifyouareinterestedinsubmitting

A sampling of activities and actions of interest to SFMS members

photographicorfineartfortheDirectory,contactTheresePorterintheMembershipDepartmentat(415)[email protected].

Attention, Young Physicians!TheSanFranciscoMedicalSocietyhas

formedanactiveandvibrantYoungPhysi-cians section tobetteraddress theneedsandconcernsofmembersageforty-fiveandunder.AvarietyofsocialandeducationalgatheringsareafeaturedpartofthisnewestcomponentofSFMSmembership. Ifyouareinterestedinparticipating,contactTomLee,MD,[email protected].

Mark Your CalendarsTheCaliforniaMedicalAssociation

LegislativeLeadershipDayisscheduledforTuesday,April15,inSacramento.Moreinformationwillbecoming soon,butallmembers are encouraged to attend thisinterestingandexcitingdaydedicated tobringingtheState’slawmakersandphysi-cians together topromote thehealthofCalifornia.

SFMS Seminar ScheduleAdvance registration is required for

all SFMS seminars. Please contact Posi Lyon at [email protected] or (415) 561-0850 extension 260 for more informa-tion. All seminars take place at the SFMS offices, located in the Presidio in San Francisco.

April18,2008Customer Service/Front Office Telephone Techniques9:00a.m. to12p.m. (8:40a.m. registra-tion/continentalbreakfast).Thishalf-daypracticemanagementseminarwillprovidevaluablestafftrainingtohandlephonecallsandschedulingprofessionallyandefficiently.$99forSFMS/CMAmembersandtheirstaff($89eachforadditionalattendeesfromthesameoffice);$149eachfornonmembers.

Notes from the Membership Department

March 2008Volume 81, Number 2

Editor Mike DenneyManaging Editor Amanda DenzCopy Editor Mary VanClayCover Artist Amanda DenzStaff Photographer Ashley Skabar

Editorial Board

Chairman Mike DenneyObituarist Nancy Thomson

SFMS oFFicErS

President Steven H. FugaroPresident-Elect Charles J. Wibbelsman Secretary Gary L. ChanTreasurer Michael RokeachEditor Mike DenneyImmediate Past President Stephen E. Follansbee

SFMS Executive Staff

Executive Director Mary Lou LicwinkoDirector of Public Health & Education Steve HeiligDirector of Administration Posi LyonDirector of Membership Therese PorterDirector of Communications Amanda Denz

CMA Trustee Robert J. MargolinAMA Representatives H. Hugh Vincent, DelegateRobert J. Margolin, Alternate Delegate

Stephen Askin Toni Brayer Linda Hawes-CleverGordon Fung Erica Goode Gretchen Gooding

Shieva Khayam-BashiArthur LyonsTerri Pickering Ricki Pollycove Kathleen Unger Stephen Walsh

Board of directors

Term: Jan 2008-Dec 2010George A. FourasKeith LoringWilliam MillerJeffrey NewmanThomas J. PeitzDaniel M. RaybinMichael H. SiuTerm: Jan 2007-Dec 2009Brian T. Andrews Lucy S. CrainJane M. Hightower

Donald C. KittJordan ShlainLily M. TanShannon Udovic-ConstantTerm: Jan 2006-Dec 2008Mei-Ling E. FongThomas H. LeeCarolyn D. MarRodman S. RogersJohn B. SikorskiPeter W. SullivanJohn I. Umekubo

4 SAN FRANCISCO MEDICINE MARCh 2008 WWW.SFMS.ORg WWW.SFMS.ORg MARCh 2008 SAN FRANCISCO MEDICINE 54 SAN FRANCISCO MEDICINE MARCh 2008 WWW.SFMS.ORg

May16,2008Managing the Team (for office managers and administrators)9:00a.m.to12:00p.m.(8:40a.m.registra-tionandcontinentalbreakfast)Motivating and Managing Your Office Manager (for physicians)12:15 to 1:45 p.m. (12:00 p.m. regis-tration and lunch). These two semi-narsaredesigned tohelpphysiciansandtheir office managers set expectations,manage change, and design a practiceculture that helps the practice thrive.$99 forManaging theTeam forSFMS/CMAmembersandtheir staff ($85eachfor additional attendees from same of-fice); $149 each for nonmembers.$69 forMotivating andManagingYourOffice Manager for SFMS/CMA mem-bers ($59 each for additional attendeesfromsameoffice);$109 fornonmembers.$150forbothsessionsformembers;$225fornonmembers.

October3,2008Customer Service/Front Office Telephone TechniquesThishalf-daypracticemanagementseminarwillprovidevaluablestafftrainingtohandlephonecallsand schedulingprofessionallyandefficiently.9:00a.m.to12:00p.m.(8:40a.m.registration/continentalbreakfast).$99forSFMS/CMAmembersand their staff($89eachforadditionalattendeesfromthesameoffice);$149eachfornonmembers.

November4,2008“MBA” for Physicians and Office Managers9:00a.m.to5:00p.m.(8:40a.m.registra-tion/continentalbreakfast).Thisone-dayseminar is designed to provide criticalbusinessskills intheareasoffinance,op-erations, and personnel management.$250forSFMS/CMAmembersandtheirstaff ($225each foradditionalattendeesfromsameoffice);$325fornonmembers.

Other Upcoming EventsApril10,2008Arthritis Foundation 42nd Annual Knowles Lecture

Physiciansare invitedtoattendthiscon-ference, featuring nationally recognizedcardiologistsandheart researchers, toaidtheirunderstandingandmanagementofcoronaryarterydisease.Formoreinforma-tion,visitwww.montereyheart.org.

June12–15,2008Living on the Fault Line: Advances in Occupational MedicineTheClaremontResortandSpa,41TunnelRd.,Berkeley,8a.m.to6p.m.TheCaliforniaSocietyofIndustrialMedi-cineandSurgery(CSIMS)inconjunctionwithfacultyfromUCSFisofferingacon-tinuingeducationseminarthatwilladdresscutting-edgeconcepts regardingpractice,research,andpolicyinthefieldofoccupa-tionalmedicine.Visitwww.csims.net formoreinformation.

June15–18,2008ENDO 08: The Endocrine Society’s 90th Annual MeetingThe Moscone Center, San FranciscoThismeetingoffersanunprecedentedop-portunitytolearnaboutthelatestadvancesin endocrine research and clinical carewhilenetworkingandcollaboratingwithmore than7,000colleagues fromaroundtheworld.Discoverandevaluatethelatestadvancesinendocrinology.Hearfromlead-ersinthefield.Choosefromamongmorethan200educationalprograms,includingplenary symposia, updates, debates, andmore.Formore information,visitwww.endo-society.org.

August10–15,2008Essentials of Primary Care: A Core Cur-riculum for Ambulatory PracticeResortatSquawCreek,NorthLakeTahoeThiscoursewillserveasanexcellentupdateandreviewforcurrentprimarycarephysi-ciansandotherprimarycareprofessionals,and as an opportunity for specialists toexpandtheirprimarycareknowledgeandskills. Formore information,visitwww.cme.ucsf.edu.

Concordia-ArgonautClub,SanFranciscoDavidS.Pisetsky,MD,PhD,willpresent“TheRoleofAlarminsinInflammatoryDis-ease:TheDangerfromWithin.”Alarmins,anewclassofproinflammatorymediators,deliverendogenous“danger”signalstotheimmunesystemwhenreleased fromdeadanddyingcells,stimulatinginflammation.Theyareofhighclinical interestandarethe target of novel therapies. For [email protected],call(415)356-5484,orvisitwww.arthritis.org/chapters/northern-california/events.php.

April16–18,2008AMA Medical Communications ConferenceParadisePointResort&Spa,SanDiegoWhetheryouareaphysicianbroadcastercombiningmedicalpracticewithmedicalnewsreporting,aspokespersononthefrontlinesdeliveringhealthcaremessages,orapublic relationsprofessional behind thescenespitching stories, the28thannualAmericanMedicalAssociation (AMA)Medical Communications Conferencepromisestobroadenyourhorizons,sharpenyourskills,buildyournetwork,andmakeyouamoreeffectivemedicalcommunicator.E-mailphernandez@q1productions.comformoreinformation.

May2–4,20082008 CMA Leadership AcademyDisney’sGrandCalifornianHotelinAnaheimContinuing the Academy’s standard ofprogrammingexcellence,the11thAnnualLeadershipAcademy looks fromthepastto the future toassessbothbroad trendsand specifickeydevelopments affectingthepracticeofmedicineinCaliforniaandbeyond.Therealitiesofthepresentwillalsobeaddressedwithaseriesofpracticalandpowerfulworkshopsdesignedtohelpmeettoday’smedicalpracticechallenges.Visitwww.cmanet.org/leadershipformoreinformation.

May2–3,2008Monterey Bay Regional Heart SymposiumQuailLodge,CarmelValley,California

6 SAN FRANCISCO MEDICINE MARCh 2008 WWW.SFMS.ORg

Mary Lou Licwinko, JD, MHSA

ExECUTIVE MEMO

Health Care Reform

Aboutayearago,ItraveledwiththeSanFranciscoCham-berofCommercetoSacramentotolearnaboutGovernorSchwarzenegger’snewproposalforuniversalhealthcarecov-

erage.Becausetherearenearly6.6millionindividualsinCaliforniawithouthealthinsurance,manyofthemworkingpeopleandtheirfamilies,everyoneagreedsomethingneededtobedone.Morethan18percentofCaliforniansdonothavehealthinsurance;Californiaranksfifthinthenationbypercentofthosewithoutinsurance.

InSacramento,wewerebriefedbyseveraloftheGovernor’sstaffmembers,whotoldusthattherewoulddefinitelybehealthcare reform forCalifornia in2007.We thenheard fromotherRepublicanswhothoughttheGovernor’splanwenttoofarandfromDemocratswhothoughtitdidnotgofarenough.Everyone,however,pointedtothecostofprovidinghealthcaretoalarge,uninsuredpopulationwhooftenuseemergencyroomsforprimarycareorletconditionsgountreateduntilthecostoftreatmentisastronomical.

AllconcludedthattherecertainlyshouldbesystemthatwouldprovidegreateraccesstocareforallCalifornians.

Weallknowwhatbecameofthevarioushealthcarereformplans.TherewasdifficultybetweenthelegislatorsandtheGovernorinreachingagreement.WhentheleadersoftheAssemblyandtheGovernorfinallydidagreetoaplan,theSenaterefusedtoapproveit,citingbudgetrestraints.NotonlywashealthcarereformstoppeddeadinitstracksbutthelegislatureandtheGovernordecidedtobalancethebudgetonthebackofMedi-CalbyslashingMedi-Calproviderratesby10percent,effectiveJuly1.InFebruary,thesecutswererushedthroughthelegislaturewithlittlepubliccommentaspartofanemergencyspendingplan.

SonowCaliforniastillhasmorethan6millionuninsuredandissoontohaveMedi-Calrecipientswithlessaccesstocarethentheyhadlastyear,whenhealthcarereformwasalltherage.Cur-rently,fewerthanhalfofthephysiciansinCaliforniatakeMedi-Calbecause,atitscurrentrate,Medi-Caldoesnotcoverthecostsofthephysician’stime,overhead,andotherexpenses.Forexample,aprimarycareofficevisitisreimbursedat$20.Anyonewhohastakenapettoaveterinarianlatelywillknowthatyoucannotevengetinthedoorfor$20.NotonlyisitshamefulthatwearecuttingaccessforMedi-Calpatientsbutitisalsocostly.Lessaccesstoproviders

meansmoreMedi-Calpatientswillendupinemergencyroomsandleavemoreconditionsuntreated,addingtothecostofhealthcareforeveryone.Inaddition,CaliforniawillforgofederalmatchingfundsbycuttingMedi-Calreimbursementrates.Californiareceives$1infederalmatchingfundsforeveryMedi-Caldollarspent.Thismeansthatthe$544millioninstatecutswillhavetheeffectofcutting$1.1billionfromMedi-Cal.

ThehealthcarecrisishasbeengrowingforsometimeandisparticularlyevidentinLosAngeles,wherethecountyrecentlyproposedclosingallbutonecountyhealthclinicand reducingservicesatoutpatienthealthcentersbecauseofbudgetshortfalls.ThelatestroundofcutswillonlymakemattersworseacrossthestateandislikelytohaveadramaticimpactonSanFrancisco’sclinicsystem,aswellasonSanFranciscoGeneralHospital,St.Luke’sHospital,andothers.

TheSanFranciscoMedicalSocietyandtheCaliforniaMedi-calAssociationarecommittedtorestoringthesecutstoMedi-CalandremaincommittedtohealthcarereformforCalifornia,ifnotthenation.Weneedtoeducateandencouragepatientstojoinusinourefforts.

Send Your Message to 2,500 Health Care

Professionals

TheSanFranciscoMedicalSocietyoffersmultipleadvertisingopportunities ranging from full-page,4-colordisplayadstoclassifiedadswithdiscountedratesformembers.PleasecontactAshleySkabarformoreinformation,(415)[email protected].

WWW.SFMS.ORg MARCh 2008 SAN FRANCISCO MEDICINE 7

PRESIDENT’S MESSAgE

W henonecontemplatesmusicandmedicine,anumberof thoughtscometomind.Manyphysicianspossesswonderfulmusicaltalentandemploymusicasanavo-

cationaswellasameansofentertainingthelesstalentedamongus.Thestudyoftheinteractionofthebrainandmusichaschal-lengedneurologistsovertheyears.Psychologistshavemarveledattheeffectofmusiconthemind—nottomentionthatnumerousextraordinarycomposershavealsohadsignificantpsychologicalconditions.(CharlesIvesandRobertSchumannarejusttwoex-amples.)Finally,musichasbeenusedasatherapeuticinstrumentforthousandsofyears.Dr.OliverSacks,theprominentneurologist,regardsmusictherapyasatoolofgreatpowerbecauseofitsuniquecapacitytoorganizeorreorganizecerebralfunctionwhenithasbeendamaged.

AllofthesetopicsareexploredingreaterdetailinthisissueofSan Francisco Medicine.Myownexperiencewithmusicinamedi-calcontextwasquiterecent.IhadtheopportunitytoviewmusicbeingemployedastherapyintheHealingHarpProgramatbothCaliforniaPacificMedicalCenterandMarinGeneralHospital.Thisuniqueprogram,sponsoredbytheInstituteforHealthandHealing,enablesharpiststoplayinhospitalwaitingrooms,intheNICU,forcancerpatientsundergoingchemotherapy,andforpatientsintheirlastfewmomentsoflife.

Inabedattheendofaward,apatientlaydying,attendedbyherfamilyandfriends.Intheroomwasaharpist,playingasmallportableharp—a19-string,seven-poundWestoverAdianharp.Theatmospherewasafarcryfromtheusualtechnologicalbustleofthehospitalward.Insteadofthechirpsandbeepsofthevariousbedsidemachines,theliltingsoundofharpmusicfloatedthroughtheair.AssheplayedlullabiesandGregorianchants,themoodwassereneandremarkablypeaceful.Thepatient,whohadbeenagitatedandwasbreathingrapidlybeforethemusicbegan,wasbyallappearancesquitecalm.Thefamilymembersseemedcomfortedbythetranquilsoundsoftheharpastheyawaitedtheinevitable.

Iwasstruckbythecontrastbetweenthistableauandwhatweascliniciansusuallyobserve—thesomewhatclinical,cold,andinstitutionalend-of-lifesettinginmosthospitals.AtapresentationbytheHealingHarpProgram,PortiaDiwa(oneoftheHarpsupervi-sors)describedhowharptherapyhashelpedpatientsreducepain,

lowerbloodpressure,regulatebreathing,decreaseanxiety,andfeelspiritualcomfort.Sheremarkedonhowoftenthegentleplayingofherharpwouldresultinpatientsbeingmorecomfortable,overandabovetheeffectsofpainrelievers,sedatives,andtranquilizers.

Therigoroftheprogramisalsoquiteimpressive.TheInstituteforHealthandHealingatCPMCoffersinternshipsintheHealingHarpProgram.Theseinternshiprequirea500-hourcommitmentoveraone-yearperiodforbothtrainingandclinicalpractice.InadditiontoplayingatCPMCandMarinGeneral,harpistsintheprogramalsoplayforpatientsathomeandinhospiceprograms(seepage22foranarticledescribingtheroleofmusicinHospicebytheBay).

In recentyears integrativemedicine,withguided imagery,acupuncture,massage,meditation,andmusictherapy,hasslowlybeguntoachieveagreaterlevelofacceptanceinthemainstreammedicalcommunity.Musictherapy,whetherwithaharporwithotherinstruments,clearlyhasaroleinhelpingourpatientsinwaysthatarebeyondourusualareasofexpertiseasphysicians.Andprovidingmusictoourpatientshasthepowertoaugmentourmostimportantroles—ashealersandcomforters.

FormoreinformationregardingtheHealingHarpProgram,pleasecontactSusieShipleyat(415)925-7623.Tofindoutaboutmusictherapyingeneral,theAmericanMusicTherapyAssociation,atwww.musictherapy.org,isanexcellentresource.

Music and Medicine

Steven Fugaro, MD

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DEPARTMENT TITLE HEREEDITORIAL

P erhapsthemostfamiliarpoeticdescriptionofmusicandhealingisfoundintheplayThe Mourning Bride (1697)bytheEnglishdramatistWilliamCongreve:

Music has charms to soothe a savage breast,To soften rocks, or bend a knotted Oak.I’ve read that things inanimate have moved,And, as with living Souls, have been informed,By magic numbers and persuasive sound.

Thephrase“livingSouls”inthistextreferstotheexperienceofhumanbeingswhoare“informed”bymusic.The“magicnumbers”refertoPythagoras,thatfriendofthehypotenuse,whodemonstratedthatthesoundsofmusicwereproducedmathematically,insuchintervalsasfourthsandfifths,inmethodicalpatternsthatwerepleas-ingtotheear.Thiswasthebeginningofthe“science”ofmusic.

Longbeforeobjectivemathematicsandscience,however,thesubjectivepleasingandhealingcharmsofmusicwerepracticedthroughouttheworld.Mythologicaltales,archeologicalfindings,andstudiesofsurvivingindigenousculturesallattesttotheubiquityofmusicasahealingmethod.InherbookMusic Healers of Indigenous Cultures (2004),PatMoffittCookdescribestheancientpracticesshediscoveredinherextensivetravelstoSoutheastAsia,India,Nepal,Japan,andNorthandCentralAmerica.AmusicianandteacherandthefounderofOpenEarCenter,anorganizationonBainbridgeIsland,Washington,dedicatedtocross-culturalmusic,Cooksays,“Healingsoundsarepartofa‘sacredtherapy’stillpracticedamongholymenandwomen,shamansandhealersamongtheindigenouspeoplesoftheearth.”

InNorthernIndia,amannamedBabaji,ashopkeeperwhowasmysticallycalledbyaMuslimsainttobeanojha,orhealer,singsancientholymelodies,andsoonhispatientjoinsinthechantandisrelievedofpain,stress,andsuffering.InNepal,RamTampaandSuniRampractice“folkpsychiatry”bybeatingonatwo-headeddrum,adhyangro,andperformingahoppingdance,whilearoundtheirnecksgarlandsofbellsjingleinrhythm.InHaiti,MichelineForestal,aVodoumanbo,orhealingpriestess,contactsthemyste bylisteningtothedivineinrocks,trees,plants,rivers,wind,andrainandthenleadsagroupinprayers,songs,dances,anddrummingas

ritualstohealthesick.AmongtheHuicholIndiansofNorthernMexico,themara’akame, shamanpriests,usepeyotetoenterintothespiritworldandthen,withaccompanimentofdrums,violin,andguitar,singthe acantos de curación,songsofcureforindividuals,thecommunity,andtheearthitself.InTibet,intheBonBuddhisttradition,gurusteachtheFiveWarriorSyllablestobringsoundintomeditationpractices,whileothersplaybyhandtheTibetanSingingBowlsforhealing.

Whenmoderndoctorsandotherhealerstrytoexplaintheseancientmethodsofmusicalhealing,theydotheirbesttoapplyscience,amethod thatexcludes the sacred. In theirbooksandarticles,someuselooselydefinedtermssuchas“vibrations,”“wavemotions,”or“theetheric”toattempttheoriesbywhichtoimposecause-and-effectmeasurementsupontheimmeasurableinfluenceofmusicwithinthehumanbodyandsoul.Otherstalkinvaguetermsabout“soundessence”and“thehealingresonance,”andoneauthorreferstoEinstein’stheoryofrelativity,notingtherelation-shipofenergytomass,therebyconcludingthatakindofmusical“energy”hasaneffectuponthe“mass”ofthebody.Asthoughinextensionofthesescientific“theories,”arecentclinicalempiricalstudybyKrucoffetalatDukeResearchInstitute(2005),whichincluded748patientswhounderwentpercutaneous coronaryintervention,concludedthattherewasnoeffectofmusicuponclinicaloutcomes—aconclusionthatgoesagainstthecollectivewisdomofhumanbeingssincethebeginningoftime.

Andsoitisthat,asinthisissueofSan Francisco Medicinewecontemplatemusicandmedicine,wemaynoticeadisharmonybetweentheobjective,scientific,andmathematicalapproachtomusicandtheprofoundsubjective experienceofmusicwithinhumanbeings.Tointegratethisdissonance,wemightrecallthatalthoughPythagorasbeganthemathematicsofmusic,healsobelievedthatnumbersthemselvesweremagicalandsacred.Relatinghisnum-berstothestars,theplanets,indeedtheentirecosmos,Pythagorasdeclaredmathematicstobe“themusicofthespheres.”

Thus, inaddition toour science,wemaygivecredence tothepoeticnatureofourappreciationofmusicandhealing,asdidWilliamCongrevein1697,whenhesaid,“Musichascharmstosootheasavagebreast...livingSouls,havebeeninformedbymagicnumbersandpersuasivesound.”

Music, Science, and Healing

Mike Denney, MD, PhD


MUSIC AND MEDICINE

A s a professionalmusician, Ihaveperformed around the world formanyyearsnow,havingplayedin

alltypesofvenues—fromclubstofestivalsandcasualpartiestoformalaffairs.ThroughitallIhavealsobeenfortunatetomeetallkindsofpeople,andIhavecometorealizethegreatimportanceofmusicinpeople’slives.Infact,inthetruestsenseoftheword,musiccan“heal”people.

Manyyearsago,IperformedregularlyatTheSaloon,asmallclubinNorthBeach,SanFrancisco.Itwasaclassicbluesjoint.Thepatronswerefromeveryconceivablesocialstrata,fromtheregulars(whostartedwaytooearly)tothenever-endingstreamof touristsvisitingTheCity fromaroundtheworld,plusthemanymusicloversinbe-tween.TheyallcametoTheSaloon,whichisonrecordasthe oldestbarinthecity.ItwastrulyamazingtoseesuchawidearrayofpeoplefromsuchdiversebackgroundscometogetheronaFridayorSaturdaynighttohaveagreattime.

There were hookers, down-and-outwarveterans,housewives, street people,businessmen,and,yes,doctors—emergencyroomdoctors,tobespecific.AtTheSaloon,theywereknownas theERDocs.Theywouldcome intoTheSaloonafter theirlongshiftsintheemergencyrooms.Withthemusicwailing, theseDocs let loose.Why?Becausetheyneededto,likeeveryoneelse.OftenIwouldtalktothemduringmybreaks,andtheywouldtellmestoriesabouttheirdifficultjobsadministeringtosickandsometimesdyingpatientsintheemergencyroomsoftheBayArea.Icannotimagineamorehigh-stressjobthanthatofanERdoctor.Tohavesomeone’slifeinyourhandsistheultimateresponsibility.Everyonecanhavea“hardday”atworksometimes.But

Icanonly imaginewhata “hardday” inanERroomwouldbelike:traumasofallkinds,accidentsurvivors,gunshotwounds,burnvictims,heartattackpatients—justtomentionafew.Pluspeoplewithpsychologi-

calproblemswhocometohospitalsbecausethey’resick.And,ofcourse,sometimesthemostseverecasesnevermakeitoutoftheER.

Over theyearsquitea fewERDocsbecamefriendsofmine.Ononeparticularnight,oneofthemcameuptomeandsaidthathejustwantedtothankme,becauseheconsideredmehis“therapist.”Iwashis“healer.”AndalthoughIhadneverbeenreferredtothiswaybefore,I immediatelyunderstoodwhathemeant.

Now, lookingback, I think that thewhole sceneof theclubwaspartof thehealingformostofthepeoplethere—notjust themusic, but the atmosphere, thedancing,the“vibe”ofexperiencingmusicinacollectivewaywithagroup. Ihavebeenfortunatetowitnessthismanytimesinavarietyofplacesaroundtheworld,anditwillnevergetold,that’sforsure.Itisone

ofthereasonsIplay.Mostofall,Istillfondlyrecallsomeofthoserockin’nightsatTheSaloon,andgettingthethumbs-upsignandsmilesofapprovalfromthoseERDocs.Theyalwayskeptcomingbackfortheir“healing,”I’mhappytosay.

I realizenowhow fortunate Iwas tounderstandthepowerofmusicatanearlyage—how it canmovepeople—becauseImyselfwasmovedbywhat Iheard.Forme, it was the blues, and although mymusicalhorizonshaveexpanded,thebluesstillmovesmethemost. Iamknownforaparticular styleof slideguitar,andwithmorethantwelverecordingsofmyown,Iamfortunatetobeabletomakethemusicandtourworldwide.Iamnodoctor,butIdoknowthatmusicisahealer,andthattheexperiencingofitcanbetheraputic,asre-vealedbymydoctorfriendssomeyearsago.Whenthemusiciscookin’andeveryoneissmilinganddancingandhavingagreattime—theyarehappy,andthatisgoodforthemonanynumberoflevels.Itmustalsohavesomethingtodowithrenewalaswellaspurgingsomeofthe“badstuff”fromyourmindandbody.Ultimately,lifeisaboutre-newal,isitnot?Ifwedon’trenewourselvesphysicallyandmentally,wewilldie.Musiccanhelp.Itisforustoexplore.

IleaveyouwithalineJohnLeeHookerandIwrotetogetherforthesongThe Healer:“Theblues isahealerallovertheworld,allovertheworld.Ithealedmeanditcanhealyou.”

A Bay Area native, Roy Rogers is one of the premier slide guitarists performing today. Since his first recording in 1976, his eclectic approach has constantly stretched the boundaries of slide guitar. As a recording artist, producer and composer, he continues to combine diverse music influences to achieve his vision.

Roy Rogers, Bluesman

Healing the Healer The Blues for Docs with the Blues

“One night, one of [the ER Docs] came up to me and said that he just wanted to thank me, because he considered me his ‘therapist.’ I was his ‘healer.’ And although I had never been referred to this way before, I immediately understood what he meant.”


MUSIC AND MEDICINE

Assomeonewhohasbeeninvolvedinmusic in somecapacity forherentire life, itwouldbe impossible

to imagineaworldwithout it.Although,ifaskedexactlywhatit is,orwhyitisthatIfeelcompelledtoplaymusicalinstruments,listentomusicorhumwhenIwalk,orwhyIrespondtocertaintypesofmusicratherthanothers,IcouldnosooneranswerwhyitisthatIbreathe,otherthantosaythatitcomes“naturally.”

Wegenerallyspeakofmusicasthoughitissomethingoutsideofus,somethingthatwetakeinlikeair,somethingthatissuper-fluoustosomedegree—yetwealsoreferto“musical” persons and “nonmusical per-sons,”aswellasthosewith“perfectpitch”andthosewhoare“tonedeaf,”whichwouldindicateatleasttosomedegreethatmusiciswithin us,thatitsholdonusoriginatesfromsomewheredeep.

To witness the relationship we ashumans nurture with this thing calledmusic,oneonlyhastoregardthemyriadsofiPodsroamingthestreets,thepopsongsslippingoutofcarwindows,orthemanyformalizedwaysinwhichweenjoymusicandthewaythatitcomes“naturally”forus,ashumans,tomoveourphysicalbodiesinresponsetomelodyandrhythm.Itisevenmorecuriousthatwedoallofthesethingsunconsciously.

Music,itwouldseem,isapartofhu-mannature.

“Chimpanzees don’t dance,” statedOliverSacks,notedneurologistandauthor,inadiscussionofhislatestbookMusicophilia(2007)at thePalaceofFineArts inSanFranciscoinOctoberoflastyear.“Humans,however,dancetorealorimaginedmusic.Music is amysteriousphenomenon. It isentirelyabstract,yethasthepowertoillicit

everyemotionimaginable.”Sacks’newbookseekstodemonstrate

our embedded connection with music,throughacollectionofcasestudiesofper-sonswhohavebeenblessed,tortured,and

tormentedbyunwantedmelody,patientswhoexperienceconfusionwiththepercep-tionofmusicandothersenses,personswhohavesufferedthelossofmusicalcapabilitiesafterinjury,aswellasthosewhoundergoviolent seizures andothermusic-relatedmaladies.Theseheexplainsthroughneu-rologicalconnectionsanddisconnections,evidencingourbrain’s “natural”musicaltendencies,orourinborn“musicality.”

In the preface, Sacks declares that“humansareamusicalspeciesnolessthanalinguisticone.Allofus…canperceivemusic, perceive tones, timbre, pitch in-tervals,melodiccontours,harmony, and…rhythm.Weintegratealloftheseand‘construct’musicinourmindsusingmanydifferentpartsofthebrain.”(p.xi)

Indeed,whetherwepracticeorcom-posemusicornot, theseperceptionsaremoreorlesspresentfrombirth.

“Attentiontomusic…developsthe

braininadifferentwaythananyotherformofstudy,”SacksstatedatthediscussioninSanFrancisco.“Youcanlookatabrainandsay,‘Thismanisamusician.’”

Thisbegsthequestion,then,thatifourbrainsaresophysicallyaffectedby thestudyofmusic,whatisitinusthatdeterminesourmusical capabilities,ourmusical inclina-tionsandpreferences?Inotherwords,dowehavecontroloverourmusicalpreferencesandcapabilities,orarethesedeterminedbyneurologyandourbiologicalmakeup?

InMusicophilia,Sacksstatesthatwhile“mostofuscanhopethattheremaybesomeharmony, somealignment, betweenourdesiresandourpowersandouropportunities…noonehasallthetalents,cognitivelyoremotionally.”Hecontinues,“ManyofthepatientsorcorrespondentsIdescribeinthisbookareconsciousofmusicalmisalignmentsofonesortoranother.The‘musical’partsoftheirbrainsarenotentirelyattheirservice,andmayindeedseemtohaveawilloftheirown.”(p.92)

This isevident inthecases inMusi-cophilia inwhichpatients suffer “musicalhallucinations,” oftenhearing imaginedmusic that seems tobeoriginating fromsomeunidentifiablesource,asitisalsodem-onstratedinpatientswithperfectpitchoranaturalinclinationtomusicalability.

OnesuchintriguingcasestudySacksdetails is thatof awomannamedDianaDeutsch,whowritestoSacksinaletter:

“My realization that Ihad absolutepitch—and that thiswasunusual—cameintheformofagreatsurprisewhenIdis-covered,atagefour,thatotherpeoplehaddifficultynamingnotesoutofcontext.Istillremembervividlymyshockatdiscoveringthatwhen Iplayedanoteon thepiano,

MusicophiliaA Feeling for Music

Ashley Skabar

Continued on the Following Page...

“‘Chimpanzees don’t dance,’ stated Oliver Sacks, ‘Humans, however, dance to real or imagined music. Music is a mysterious phenomenon. It is entirely abstract, yet has the power to illicit every emotion imaginable.’”


othershadtoseewhatkeywasbeingstruckinordertonameit.”(p.125)

Tomostofus,theconceptofperfectpitch, theability toassociatenoteswiththeirverballabels,seemsincredible.How-ever,tosomeonelikeDeutsch,thephenom-enonisnot“whysomepeoplepossessit,butratherwhyitisnotuniversal.Itisasthoughmostpeoplehaveasyndrome…whichislikecoloranomia,inwhichthepatientcanrecognizecolors,anddiscriminatebetweenthem,butcannotassociatethemwithverballabels.”(p.125)

Thenotionthattherearepersonswho“naturally”connectmusicalperceptionwithverbaldistinctionsisakintocasesinwhichpersonsmakeconnectionsbetweenmusicandothersensoryperceptions.Sometimes,accordingtoSacks,thepartsofthebrainthat respond toanddeciphermusicalsobecomeconfusedwithothersenses,acon-ditionknownas“synesthesia,”inwhicha“personmayperceiveindividuallettersordaysoftheweekashavingtheirownpar-ticularcolors;anothermayfeelthateverycolorhas itsownpeculiar smell,oreverymusicalintervalitsowntaste.”(p.166)

Sacksgoesontodescribethecasestudyof the contemporary composer MichaelTorke, who experiences what he calls“coloredmusic.”As a child,Torke toldhispianoteacherthatheloved“thatbluepiece.”Torkehasbeenexperiencing thissortof“coloredmusic”asfarbackashecanremember.“Thecolorshavebeenconstantandfixedsincehisearliestyearsandtheyappearspontaneously.…Theyseemcom-pletelynatural tohimandpreordained.Thecolorsarehighlyspecific.Gminor,forexample,isnotjust‘yellow,’but‘ochre’or‘gamboge.’”(pp.168,169)

Thesecases serve to, ifnothingelse,demonstrateourbrains’dependenceonmu-sic;itisalmostasif“musicality”isasortofsixthsensetowhichwearepredisposed.

Whileasignificantportionofourincli-nationstowardakindof“musicality”,aswellasourmusicalabilities,seemstobeapartofourneurologicalmakeup,Sacks’sbookalsodoesmuchtodemonstratehowourbrains’abilities toperceiveand recognizemusicarealsoalteredandstrengthenedbyoutsideinfluences,bothphysicalandcultural,very

muchinthesamewaythatweareabletoincreaseourvocabularies through study.Forexample,while“theredoesnot seemtobeany innateneurologicalpreferencefor particular types of music, any morethanthereareforparticularlanguages,thekindofmusictowhichweareexposedintheformativeyearsplaysarolein‘culturalformsofrhythmdeafness.”(p.100)Citingareportconductedonmusicandthedevel-opingbrain,Sacksexplainsthat“infantsatsixmonthscanreadilydetectallrhythmicvariations,butbytwelvemonthstheirrangehasnarrowed…theylearnandinternalizeasetofrhythmsfortheirculture.Adultsfinditharderstilltoperceive‘foreign’rhythmicdistinctions.”(p.99)Inotherwords,whilewe,ashumans,mayclaimtodislikeacertaintypeofmusic,wemaysimply,throughlackofexposure,bedeprivedoftheneurologicaltoolsnecessarytodecipher“foreign”tonalpatternsandrhythms.

DianaDeutsch,mentionedearlier,hasstudied the relationshipbetweenmusicalabilitiessuchasperfectpitchandlinguistics,tofindthatthosepopulationsthatspeakatonallanguagehaveahigherincidenceofperfectpitchthanthoseofculturesspeakingnontone languages. Ina studyconductedontwostudentpopulations,onefromtheEastmanSchoolofMusic inRochester,NewYork,andtheotherfromtheCentralConservatory of Musicin Beijing, Deutsch andhercolleaguesfoundthat“for students who hadbegun musical trainingbetween ages four andfive…approximately60percent of the Chinesestudentsmetthecriterionfor absolutepitch,whileonly about 14 percentof the U.S. nontone-language speakers metthecriterion.”The studyfoundthatwhilethere isarelationshipbetweenthebeginningageofmusicalstudy and the incidenceofperfectpitch, evenastheincidenceofChinesestudents decreased, stu-dentsofnontonelanguage

culturesproportionallydecreasedaswell.(p.127)

Music is,asevidencedbySacks’s re-search,apartofourbrainsandapartofthehumanexperienceasmuchas language,something thatmaybealteredby socialinfluencesbutthatreliesinlargepartonour“natural”capabilitiesandneurology.Musicisinextricabletothehumanexperience;itisapartofallthatwedo.

In thefinal chapterofMusicophilia,Sacksdeclares,“Onedoesnotneedtohaveany formalknowledgeofmusic—nor, in-deed,tobeparticularly‘musical’—toenjoymusicandtorespondtoitatthedeepestlevels.Musicispartofbeinghuman,andthere isnohumanculture inwhich it isnot highly developed and esteemed. Itsveryubiquitymaycauseittobetrivializedindailylife:weswitchonaradio,switchitoff,humatune,tapourfeet,findthewordsofanoldsonggoingthroughourminds,andthinknothingofit.”(p.347)

Ashley Skabar is both a published writer and photographer who has written articles on topics of health, nutrition, and current events for various publications. Skabar holds a BA in English Literature and Creative Writing and currently lives in San Francisco, where she works as the Marketing Specialist and Staff Photographer for the San Francisco Medical Society.

The width is 3.5 by 4” highCALL Kae with any questions or concerns 415-567-5888

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Continued from the Previous Page...

12 SAN FRANCISCO MEDICINE MARCh 2008 WWW.SFMS.ORg WWW.SFMS.ORg MARCh 2008 SAN FRANCISCO MEDICINE 13

MUSIC AND MEDICINE

Living with Music

I nhisimpressivelyaccessibleintroduc-tiontotheoreticalphysics, The Elegant Universe,BrianGreeneenthusiastically

summarizes,withametaphor,theessenceofstringtheoryanditsuniquepromisetounifyEinstein’sgeneralrelativitywithquantummechanics:“Attheultramicroscopiclevel,theuniversewouldbeakintoastringsym-phonyvibratingmatterintoexistence.”Be-yondtheprideIfeelinreadingofGreene’sconceptualalignmentoftheverynatureoftheearlyuniverseandthedisciplineofmu-sic,whichismyownlife’swork,Iamstruckatjusthowcommonsuchmetaphorsare.Musicasthewindowthroughwhichwecanhopetobetterunderstandtheworld—ortheuniverse—appearsasoldastimeitself.

Thefirstwell-knownexponentofthisconceptwasPythagoras,theancientGreekmusician-mathematician,who,accordingtolegend,firstrecognizedtheinherentlinkbetweenthesetwodisciplinesasmanifestinthemathematicalperfectionofkeymusicalintervals,whichwereperfectnumericalproportions:theoctaveas2:1,thefifthas3:2,andthefourthas4:3.Suchbeautifulsymmetrywasmorethancoincidence,thePythagoreansargued,andmustbeanexpres-sionofahigher“harmony”—aMusicoftheSpheres—wheretheplanetsandstarsmoveaccordingtoamusicallogic,soundingthesilentpitchesofanendlesscelestialmelodyastheymaketheirwayaroundtheheavens.Fromultramassivestarstoultramicroscopicparticles,musicseemstomaketheuniversemoregraspableandrelevanttoourlives.

Theideathatmusicformsanintrinsicconnectiontothehumanbodyis,likethemetaphoricrelationshipbetweenmusicandtheuniverse,anancientone.The sixth-centuryChristianphilosopherBoethius,perhapsthemostreveredmusicalauthor-

ityof theMiddleAges, expandeduponPythagoras’snotionofamusica mundana(heavenly music) with the term musica humana, defined as the music that runs

throughthehumanbody,connectingthefunctionsof thefleshwith theactionsofthesoulandspirit.

Similarly,philosophershavelongcom-mentedonthe“power”ofmusicinforgingourcharacterandconnectingoursoulstoourinnernature,oursociety,andtheworldaroundus.PlatoandAristotleeachinvestedconsiderable attention indescribing therisks and rewardsof exposing theyoungtovaryingmodes(thatis,styles)ofmusic.Perhapsthemostenthusiasticphilosopher-advocatewasSchopenhauer,who saw inmusicthedirectreflectionoftheWill(thefundamentalworld-stuff), in contrast totheotherarts,whichmerely reflect their

Representation.Psychology,too—followinganinauspi-

cious start (Freudwas famouslyapathetictowardmusic)—has invokedmusic as auniqueandvitalpresenceinourlives,withtiestobothourearly,pre-egodevelopment(e.g.,infusingusinanoceanofsoundthatrecallsthewomb)andtoourcollectiveun-conscious,asalinktoprehistoricarchetypesthatmayholdakeytoourpersonalsurvival.Among themostarticulatepsychologistswritingon the subject in recent years isAnthonyStorrinsuchbooksasMusic and the MindandThe Dynamics of Creation.Storrarguesthatmusicismorethanalanguageofemotionbutonethatsynthesizestheinnerandexternalworlds,yet“belongingwhollytoneither.” It is the stubbornly abstractnatureofmusic—atonce intelligibleyetuntranslatable,touseClaudeLevi-Strauss’sexpression—that,forpsychologistssuchasStorr,raisesmusictotheverypinnacleofhumanachievements.

Finally, an interest in exploring amore empirically verifiable connectionbetweenmusicandourliveshasenjoyedapresent-dayrenaissance,highlightedbythepublicationandpopularsuccessofseveralrecentbooks,among themOliverSacks’Musicophilia (see reviewonpage11)andDanielLevitin’sThis Is Your Brain on Music.Bothexploretheneuroscientificbasisofourfascinationwithanddynamicresponsetomusic,asasignificantpartofwhatdefinesusashuman—emotionallyaswellascogni-tively.Dr.Sacksemployshisfortyyearsofworkasaclinicalneurologisttodocumentawideandfascinatingarrayofcasesinwhichmusicexhibitsacommandingpresenceinthehumanbrain,producingattimesstrik-inglytherapeutic,andinothercasessadly

One Musician’s Perspective

Nolan Gasser, PhD

“Philosophers have long commented on the ‘power’ of music in forging our character and connecting our souls to our inner nature, our society, and the world around us. Plato and Aristotle each invested considerable attention in describing the risks and rewards of exposing the young to varying modes (that is, styles) of music.”



disturbing,responsesinpatients—ofteninassociationwithatraumaticeventortheonsetofaseriousneurologicalcondition.Dr.Levitin,acognitivepsychologistandformermusicproducer,hasfocusedhisattentionondetailingtheneurologicalandbrainchemi-cal responsesarising fromour interactionwithmusic,andespeciallyitssignificancetoouremotional life.His researchusingfunctional magnetic resonance imaging(fMRI) tomaptheneuralandmetabolicresponsestomusic,moreover,maybeseenasbutamoderncorroborationofBoethiu’searliernotionthatmusictriggersacomplexinterplaybetweenourminds,bodies,andspirits.

BothSacksandLevitinemphasizethestartlingpowerofmusicalmemory:Sacks,for example,highlights cases inwhichapatientwhosemind iswholly ravagedbyAlzheimer’sdiseasecanstillsingamelodylearned inchildhood,withoutmissingapitchorlyric;similarly,Levitincitesstudiesofnonmusicianssingingtheirfavoritepopsongswithnoexternalaid,matchingthepitchandtempooftheoriginalrecordingwith remarkableaccuracy.Clearly,musicishardwired intoourbrains inamannerthatdefiesnarrowexplanationsofauditoryreceptionandmemory,lendingcredencetoSacks’snotionthatindeed“wehumansareamusicalspeciesnolessthanalinguisticone.”

While theobservations,case studies,andscientificdataderivedfromtheseinqui-riesandcommentariesarefascinating,theyactlargelyasconfirmationofatruththatmostofusalreadyknow:musicisimportanttoourlivesandhasapowerfuleffectonusthatdefieseasyexplanation.So,whatcanwedowiththisknowledge?Whatactionscanwetaketoenhancethepositiverolemusicplaysinourlives?Howdowebest“live”withmusic?

I amapracticingmusician, andmyperceptionofthe“power”ofmusicismostkeenlyderivedfrommyprofessionalexpe-rienceswith themediumasaperformer,musicologist, and composer. From thisvantagepoint,thechiefrealityIperceiveisthatmusic—whenconditionsareright—isalivingforce,onethathasthepotentialtotransportusfromournormalspiritualand

physicalconfinestoanotherrealm,whereclock-timedisappearsandwhereemotionandintellectmergetothepointofbeingindistinguishable.Buttherub,asIseeit,isthat,likeanytranscendentexperience,feel-ingthe“livingforce”ofmusictakeswork;itisnotapassivestimulus,likereceivingamassage,butanactivedialoguebetweenthatwhichresideswithinusandthatwhichentersourawarenessfromtheoutside.Itisaconversationbetweenourexpectations,ourmemory,andthevisceralrealityofwhaten-tersourears.Evenwithrepeatedencounterswithafamiliarpieceofmusic,theexperi-enceisneverthesametwice,providedweareactivelyengagedwithit.

Manyofthewritersmentionedabovespeakofthespecificqualityoftensionandreleasewithinapieceofmusicoramusicalperformance(asinajazzimprovisation)asakeycomponentofmusic’semotionalandcognitivegravitas.Manifestationsof thisadmittedlyvaguenotionaremultipleandvaryconsiderably,fromasimpleharmoniccadence(e.g.,dominant-tonic)toalargerstructuralprogression(e.g., fromdevelop-ment to recapitulation in a symphony;frombridgetochorusinapopsong).Butwhatever the case, the tensionmust beperceivedandtheresolutionexperiencedforthefulleffecttotakeplace.Theoverridingencounter isoneofmusicalnarrative—aconcreteprogression in “aesthetic time”withoutaconcrete story line,where the“subject”issounditself.

This is indeed themiracleofmusic:thattones,rhythms,harmonies,ortimbresin successioncanhavemeaningatall, ameaningexperiencedas ithappens, andwhereprecisesemantictranslationisimpos-sibleorirrelevant.Whenthelivingmusicalexperienceispowerfulenough,wecanbetrulyliftedintoanalteredstate,whereares-onanceimagingofourbrainwouldundoubt-edlyrevealitascomingalive,triggeringamyriadofsalutaryeffectsonoursympatheticandparasympatheticnervous systems. Inanageofincreasingsocietalandpersonalstress,nottomentionrisingenvironmentalrisks,acounterbalanceofengagedmusic-listeningseemsapainless—indeedpleasur-able—meanstohelpwardofftheprospectofcardiovasculardiseaseorcancer.Thinkofitasmusicalexercise.

Butonceagain, it takes effort.Thedevelopmentsectionoftheopeningmove-mentofMozart’sPianoConcertoNo.21,forexample,containsanextended setofmusicalsequences,risingoneafteranother,likeahugerowofwavesslowlymakingtheirwaytothesandybeachofthemovement’sprimarytheme.Theeffectisamazingiffol-lowedintentlypassage-by-passage,thoughmerelypleasantiflistenedtocasually.Tociteanother,moreobscureexample, theRenaissancemasterJosquindesPrez’ssix-partmotet Praeter rerum serium is amongthe most profound works ever written,and the emotional-intellectual payoff isunrivaled—if the narrative is intentlyfollowed;otherwise, it sounds likeprettychurchmusic.

Now, to be sure, there is nothingwrongwithcasualmusic listening; likearecreationalmassage, it canbewonder-fullypleasant.Butwithjust“pleasant,”wewillnotquiterisetotheheadyandpoeticpowersassignedmusicbythewritersnotedabove.Akey ingredienthere,of course,is education; themoreoneknowsaboutmusic—historically, theoretically,practi-cally—themoreonecanretrieveduringoneofthoseencounters.Perhaps,indeed,whenconditionsareright—whether“living”withthemusicofBach, theBeatles,orDaveBrubeck—we’ll glimpsewhatPythagorasandBoethiuswerereallytalkingabout:thattheheavens,aswellasthehumanbody,aremademoreharmoniousbytheinexplicablepowerofmusic.

Dr. Nolan Gasser is a professional com-poser, pianist, and musicologist, who received his Ph.D. in Musicology from Stanford Univer-sity, where he has taught as an Adjunct Profes-sor. His compositions have been performed by orchestras and artists around the country, with a performance this month [March 10] at Carnegie Hall. Among his current commissions include a work celebrating the launch of NASA’s next space telescope mission, GLAST, entitled Cosmic Reflection, “depicting” the history of the universe. Dr. Gasser is the architect of the Music Genome Project for the popular Pandora music service, and is the Artistic Director of the Classical Archives website. He lives in Peta-luma with his wife and two children.



MUSIC AND MEDICINE

Soothing the Sick with SoundMusic at Stanford Hospital

Greg Kaufman

A middle-agedmanentersStanfordHospital’s Cancer Center for asecond opinionconsultationwith

theTumorBoard.Hehasneverbeen toStanfordHospitalbeforeandhisapprehen-sionastowhattheprognosismayrevealispalpable.

Asheentersthebuilding,heissur-prisedtonoticethelackofclinicalambi-ence—itseemsmorelikeanupscalehotelthanamedicalclinic.Hewalksdownthehallway, noticing the waiting areas arewarmlylitwithflat-screenpanelsdisplayingpeacefulscenesfromnature.Hehearsbeau-tifulharpmusicand,asheturnsacorner,heseesamusicianperchedontheedgeofasofaplayingherinstrument.Heapproachesslowlyandtellsherthemusiciswonderful,andthathe’sneverexperiencedanythinglikethisinahospital.Shenods,thankshim,andrespondsshehearsthatquiteoften.Foramoment,hisanxietyisgone.

This is theStanfordHospitalMusicPrograminaction.Itsmissionissimple:tointegratemusicasaprimaryelementofthehealthcareoffered. Itscommitment is tomakeStanfordHospitalamorecomfort-able,soothing,andhealingenvironmentforpatients,family,andstaffthroughmusic.

Anditsresultsareundeniable,uplift-ing,therapeutic,andpersonal.

Concerts in the AtriumTheStanfordHospitalMusicProgram,

whichispartofGuestServices,wascreatedin1992asaweeklyconcert forpatients’familyandstaff.Sincethattime,theMusicProgramhasexpandeditsservices.ItnowprovidesconcertstwiceaweekintheStan-fordHospitalAtrium,plusmusicsixdaysaweekontheunitsatStanfordHospitalandLucilePackardChildren’sHospital.

Ambientpiano,guitar,andharpmusicintheCancerCenterandweeklyconcertsfortransplantfamiliesarealsopartoftheStanfordMusicProgram.Asummeroutdoorconcert series and an additional ambi-entpianodaywereadded to theCancerCenter’sscheduleinJune2007.

“Live music is becoming a regularfeatureinthelifeandcareofpatientsandresidentsinhospitals,homes,hospices,etc.throughouttheU.K.,”wroteSylviaLindsayintheBritish Journal of Hospital Medicine.

“The response tomusic is intenselyindividual,dependingonmanyfactorssuchasage,culture,andupbringing,”shesays.“However,itisevidentthatmusiccanbringemotional release, revivememories, andactasameansofcommunicationbeyondwords.”

The centerpiece of the StanfordHospitalMusicProgramistheBingMusicSeries.ThisseriesprovidesconcertseveryWednesday and Friday afternoon from12:30to1:30p.m.Opentoallpatients,visi-tors,andstaff,theseconcertsareperformedbyprofessionalmusicianscoveringavarietyofgenres, includingclassical,ethnic, jazz,popular,folk,andchoral.

TheconcertsareheldintheHospitalAtrium,alargeindoorareasurroundedbybeautifuloutdoor gardens anddecoratedwithcontemporaryartwork.Theaudienceisgivenabriefoverviewofthemusicservicesavailabletothem,allfreeofcharge,beforetheconcertsstart.Theyarealsoinvitedtowritedownanyimpressionstheyhaveinacommentbookprovidedateachconcerttodocumentthepositiveeffectsthemusichasonitslisteners.

Music for Recovery and Communication

Theeffectsofthemusiconpatients,theirfamilies,andthemusiciansthemselvesareheartfeltandmoving.

Onepatient,Anne,was recoveringfromheart surgery atStanfordHospital.Shebecamerestlessafteraweekinbed.Butthroughoutherstay,thereweretwobrightspotsinherweek:visitsfromherfamilyandthetwice-weeklyconcerts.

EveryWednesdayandFridayat12:30p.m.,AnnelookedforwardtoaprofessionalensembleperformingintheAtrium,alargepublicareaonthegroundfloorsurroundedbyoutdoorgardensviewed through largepicturewindows.Onthisday itwasEric&theIn-Crowd,awonderfuljazzandpopstandardsbandthathasbeenperformingatStanfordfornineyears.Erichadrecentlybeennamed“PianoMan’07”bySan Fran-cisco Magazine andhisbookingcalendarwasfull,buthealwaysmadetimetoper-formintheBingMusicSeriesatStanfordHospital.

Erichadseenfirsthandthebenefitshismusicprovidedtheattendees.Hisattitudewasmirroredbymost of theperformerswhoareapartofthisseries.Theyseethedifferenceitmakestobringlivemusictoahealingenvironment.

JeffBuenz,oneofStanfordHospital’shousemusicians, relates this story: “As Iwalkedontotheunit,anurseaskedme‘ifIcouldplayforthegirlinroom33.’

“Iwenttotheroomandsawthislittlegirl,perhapsfiveorsixyearsold,cryingandscreamingaloneinherbed.AsIbegantoplaycalmingmusic,Icouldimmediatelyseehercryingturntowhimpers,thensilence.ShethenlaystillandsimplystaredatmeasIcontinuedtoplay.

“Thenursesgavemeathumbs-up,”JeffContinued on the Following Page...


continues,“andIknewthatthemusichadbeenapositiveforceforthislittlegirl.

“WhenIfinishedthefirstpiece,Iaskedthegirlifshelikedthemusic.Shestaredatmeforseveralsecondsandthengaveabarelyvisiblesinglenodofherhead.Istartedplaying‘AWholeNewWorld’andaskedherifsheknewthepiece.Shecontinuedwithhercontentedstare.

“It’s so beautiful to experience themagicalwaymusiccancalmsomeone.ShenevertookhereyesoffmeasIplayedseveralmorefamiliarsongsforher,including‘Un-dertheSea’andmusicfrom Toy Story.

“Iplayedforanotherfifteenortwentyminutes.AsIgotuptoleave,shenoddedtwotimeswithoutfurtherexpression.”

Theotherfivehousemusicians’sto-riesrelatedsimilarcalmingeffectsontheirlisteners, regardlessofage,nationality,orevenmusicaltastes.Examplesofstressandanxietyreductionexperiencedbypatients,families,and staffarecited through theiranecdotes—asareotherimportantbenefits,suchashelpingwithend-of-lifetransitions,providingmotivation,andimprovingcom-munication.

Manyof thecomments revealed theprofoundeffectstheattendeesexperiencedwhilelisteningtothemusic,fromtemporaryreliefoftheirdepressiontocatharticresolu-tioninacceptingtheirconditionorthatofafamilymember.

StanfordHospitalcontractssixmusi-cianswhoperformthroughoutthehospitalsix days a week. They provide ambientmusicinwaitingoradmittingareasandalso

visitbedsidetoperformforpatientswhoareunabletoattendaconcertorwhojustprefertheprivacyofalivemusicalexperience.Themusicianswilloftendeveloparelationshipwithlong-termpatients,andmanyofthesepatientscitethehealingandstress-reducingeffectsthesevisitsbring.

Solace at the End of Life Themusiciansareoftenrequestedto

assistduringthedyingprocess,theirpres-encebringing solace to thepatients andtheirfamilies.

“Oneday, as Iwaswalking throughthebackhallways,IsawSusan,oneofthechaplainsatStanfordHospital,”saysharp-istBarbraTelynor.“Susanexplainedtomethattherewasagroupoffamilymembersgathered inanearby room, sayinggood-byetotheirlovedone,whowascriticallyill.IaskedSusaniftheywouldliketohavesomemusic.

“After I setup in theroom,Iplayedquietlyinthecornerasfamilymemberstookturnsholdingtheirbeloved’shand,wipinghisbrow,kissinghimontheforehead.Afewdayslater,SusanandImetupagain.Shesaidthewholefamilyhadexpressedtoherhowhelpfulandsupportivethemusichadbeen.”

Whilenosituationistypical,patientsandtheirfamiliesareconsistentlyapprecia-tiveofthemusicanditspositiveeffects.

The benefits of music in a healingenvironmenthavelongbeenrecognizedinmanycultures,andprogramslikeStanford’saregainingpopularityworldwide.

The Importance of Live Performance

“Experience has shown that a liveperformance is infinitely more valuablethanthefinestrecording:itenablesthelis-tenertocrossthelinebetweenjusthearingsomethingandbecomingtotallyinvolvedinthemoreactivepursuitsoflisteningandparticipating,”writesLindsayintheBritish Journal of Hospital Medicine.

“AtCoppercliffHospice,Brighton,amemberofstaffstated,‘Ibelieveweunder-estimatethevalueofmusic.’Thepositiveresultsthusfarhavemadeallthestaffawareof thisandof theneed forus toprovidemoremusic.Liveartistsprovidethatspecialatmosphere,”writesLindsay.

An important featureof a liveper-formance is thevisual aspect,watchinginstrumentsbeingplayed.Ofequalsignifi-cancearethewarmth,communication,andpresentationskillsofthemusicians,whoareabletomovewithintheaudience,adjustingthemusicatamoment’snoticeandsingingorplayingindividualrequests.

Music reinforcesa senseof timeandplace,increasesphysicaloutput,stimulatesthose who lack motivation, and bringsrelaxation.

Withthegeneroussupportofdonorsandsponsors,theStanfordHospitalMusicProgramwillcontinuetoprovidethesemostimportantservicestoitspatients,staff,andvisitors.

Greg Kaufman is the director of Stanford’s music program.

Welcome New Members!TheSanFranciscoMedicalSocietywouldliketowelcomethefollowingnewmembers:

ACTIVE REGULAR MEMBERS

Paul Abramson, MD—Online Application

Roderick Pettis, MD—Online Application

Allan Treadwell, MD—Online ApplicationReferred by Steve Fugaro, MD



MUSIC AND MEDICINE

The Power of MusicThe Transformed Moment

Susan Mazer

P hilosopherAlanWattsdescribedmusic as “anexpandedpresent.”He had a “thing” about time,

abouthowweexperience it,manipulateit,andcanuseittogainsomesemblanceofcontrolinalifeuncontrollable,andtofindpeaceamidchaos.Perhapsthatispartofwhatinspiredme,asamusician,tolookpastthenotesandmelodies,theharmoniesandphrases,tothewaymusicchangesthewaywebreathe,thespaceinwhichwefindourselves.Fewofushavenotexperiencedthatmagicalmomentafterthelastnoteofasongorsymphonyfadesintotheair,whenalloflifeholdsitsbreathandsighsinecstasy.Itisinthatverymoment,thatexperienceoftimelessness,ofselflessness,whenweareonewiththemoment,that,perhaps,“healing”isevidenced.

Ifexperiencecountsasevidenceandif evidencecanbedescribedasmuchasmeasured,thenmymanydecadesasaharp-isthavereinforcedthismostpowerfulrolemusicplaysformostofus:changingtimeand space, altering themoment, takingourmindsawayfromwherewearesitting,removingforabrieftimeourdeepestfears,replacing themwith serenity,andunbur-deningusfromouranxietyandconcerns,ifonlyforamoment.

Followingafull-timecareerasaper-formingmusician,Imovedintohealthcare,hopingthatthismagicalmomentmightbepossible if theenvironmentwerecreatedappropriatetotheneedsofpatients.Itwasnota straight-lineprocess,however.Myhusband,DallasSmith, and Iperformedononcologyunits, in emergency rooms,onmed-surgfloors,and inhospital lobbywaitingareas.Alloftheseeventswereonlyevents.Weremainedconcernedaboutwhathappenedwhenthemusicstopped,whenwe

werenotthereat3:00a.m.Musicandmedicinehavebeenpart-

nersforhundredsofyears.BeginningwiththeAesclepian temples,where the“hightech”ofthedayincludedalchemy,prayer,

nature,music, anddrama, thehistoryofmedicalcarehasbeenonethatshowstherelentless search foreffectivemethodsbywhichphysicianscanrelievethesufferingoftheirpatientsand,throughmiraclesnotalwaysunderstood,diseasescouldbecon-queredor,atleast,survived.

Today’sevidence-basedmedicinede-mandsscienceasthesolebasisforpractice.Nonetheless,whenweconsideranyofthearts,sciencerelyingsolelyonquantifiablemeasuresmaybeatoddswithitself,inpartbecausethehumanprocessseemstorevealitselfinimplicationsandambiguitiesratherthanabsolutes.Thestrongpushforusingcomplementaryandalternativemethodsto supportpositiveclinicaloutcomeshas

openedthedoortorevisitthemeansthatpatientshaveusedforcenturiestocomfort,soothe,remedythesymptomsofstressandanxiety,improvequalityofliving,anden-hancephysicalcapacitytofendoffdiseaseandillness.

Music therapy researchershavepro-videdmorethanfiftyyearsofscientificdataregardingthepositiveeffectsofmusiconrelievingpain, reducing stress, improvingimmunesystemresponse.Sixtyyearsofdatahaveshownthatusingmusicasapartnertootherclinicalprotocols renders improvedeffectiveness,relievesanxiety,andenhancesrecovery—andthatneithermethodnegatestheother.Majorhealthcarecentersofex-cellence,suchasStanfordUniversityMedi-calCenter,UCSFMedicalCenter,KaiserPermanenteHospitals,OaklandChildren’sHospital,JohnsHopkinsUniversityMedicalCenter,andScrippsHospitalsandClinics,includemusic,art,andotherhumanities-basedtoolstoimprovepatientexperienceand outcomes. M.D. Anderson CancerCenterhasanotableand recognizedartsprogram.UniversityofPittsburghMedicalCenterpartnerswiththePittsburghSym-phonyand itsmembers tobringconcertsintothehospitalonaregularbasis.

All of these programs are episodic,whenamusicianormusictherapistworkswithapatientforaspecificamountoftime.Itwasbecauseoftheeffectivenessofmusicforpatients,andthefactthattheirneedswerenotlimitedtoonetimeofdayatoneparticularhour,thatwelookedatprovidingatoolthatwouldbringmusictothebedsidetobeavailablewheneverthepatientwantedorneededit.

Wenotedalsothatthereareongoingchallengeswithpatientsbeing separated

Continued on Page 20...

“Few of us have not experienced that magical moment after the last note of a song or symphony fades into the air, when all of life holds its breath and sighs in ecstasy. It is in that very moment, that experience of timelessness, of selflessness, when we are one with the moment, that, perhaps, ‘healing’ is evidenced.”

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MUSIC AND MEDICINE

Music Therapy at Langley PorterThe Union of Clinical and Musical Skills

Tom Benson, MT-BC

I nthedaysaftertheSecondWorldWar,many veterans suffering from whatwenowknowasPosttraumaticStress

Disorder(PTSD)foundthemselveshospi-talizedunderpsychiatriccareinVeteran’shospitalsthroughoutthecountry.StartinginKansasand thenelsewhere,musiciansbeganvisitingthesehospitals,playinglivemusicfortheveterans.Thepositivephysi-calandemotionalresponseswerequicklynotedbydoctorsandnurses,whocalledformusicianstobehiredforthispurpose.Soonitwasclearthatthesemusiciansrequiredadditionaltrainingtomorefullyunderstandandrespondtotheconditionsoftheir“au-diences,”andthustheprofessionofmusictherapywasborn,eventuallyorganizedintotheAmericanMusicTherapyAssociation(AMTA).

Because music therapists are musi-ciansfirst,theacademictrainingofmusictherapists occurs under the auspices ofuniversity music schools. Rigorous aca-demicmusicaltrainingislaterpairedwithtraining in therapist and clinical skills.Thisfocusonmusicianshipiskeytowhatmakesmusictherapyworksowell.Inlightof theprofoundphysiological,emotional,social,cognitive,andbehavioralresponsesthatmusiccanelicit,amusictherapistwillalwaysbekeenlyinterestedinbringingex-cellent-qualitymusicalexperiencestohisorherpatients.InhisrecentbookMusicophilia,OliverSacksbeautifullydescribessomeoftheprofoundeffectsofmusiconavarietyofconditions.Ithasbeensaidthatwhengoodmusicisusedbyamusictherapist,“thereisasecondtherapistintheroom.”

Musictherapistsareheldtothehighstandardsofclinicalcarerequiredforboardcertification(MT-BC).Theprofession isaccumulatinga growingandconvincing

bodyof researchliterature(postedin the Journal of Music Therapy and elsewhere)to supportmusictherapypracticesasevidence-basedand founded inresearch.Never-theless,theactualimplementationofmusic therapybrings out thehighly individu-alizedcreativityandmusicianshipofeachmusic therapist.Thus,music therapywillneverlookthesametwice.

Asamusictherapistinapsychiatrichospital,Iampersonallypredisposedtothemetaphoricalqualitiesof theweather formusicalinspirationincaringformypatients.There’ssomethingaboutthemanydifferentkindsofrain,forexample,thatpowerfullyconnectswith thedifficultemotionsandthoughtpatterns thatbringpatients intoourcare.“Whatkindofrainismostwel-cometoyou?”“Whatkindofweatherbestdescribesyourinnerlifetoday?”AsIsitwithagroupofpatientsstrugglingwithdepres-sion,isolation,orevensuicidaltendencies,ImightintroducethemtoasimplechantwhileIplaytheguitar:“Heartherainsticksound,tumbleallaround….”,andthenpasstheNativeAmericanrainstickaroundthecircle.Onepatientcreatessoundsofathun-derstorm,anothercreatesasteadydrizzle,yetanothercreatesagentlesunshower.Soonthemembersofthegrouparerisingabovetheir isolationand innerdistress,comingto life inmutual recognitionandsupportbroughtaboutbytheircollectivecreative

andmusicalexpressions.Patientsbegintowonder,“HowisitthatI’mabletochangemyemotionsandthoughtsthroughsuchasimplemusicalactivity?”Intheensuingdis-cussions,theyexplorewaysofcreatingsuchtherapeuticchangeintheirlivesoutsideofthehospitalaswell.

Again I turn to the rain, this timewith thehelpof JohannSebastianBach,specificallythetenderandsweetLargofromhisConcertoforTwoViolins.Awonderfulmusictherapyinterventionistouseguidedimagerywithmusic,andthemusicofBachcanbethebestforthispurpose.I’llinvitethepatients to sit comfortablyand relaxtheirbodies.ThenI’llstartthemusic.Asthemelodylinesofthetwoviolinsintermingleanddancearoundeachother,Isuggestthatthepatientsallowtheirmindstofillwithim-agesandsensations(sounds,smells,tactileexperiences)ofacleansing,healingrainthatwashesawaydistress,worries,oranythingthat theywould like to let goof.Whentheimaginaryrainlifts,theyareinvitedtovisualizewherethemusicwouldtakethemoncetheskyhascleared,andthentowrite



fromthe familiar,findingthemselves inahospitalroomthatisladenwithtechnolo-giesoverwhichtheyhaveneithercontrolnorunderstanding,pillowsandblanketsthatarenottheirs,surroundedbypeoplewhomtheydonotknow.Researchhasshownthatnatureisuniversallyfamiliarandcomfortingacrossgenerationsandethnicor religiousbackgrounds.

Thereforein1992,usingthetelevisionasthedeliverysystem,westartedproducingtheCAREChannel,whichincludesinstru-mentalmusicandnatureimageryoverthefull twenty-four-hourday.Aclosed-circuittelevisionchannel,theCAREChannelisavailableforthepatientwhenneeded.Ithas,fromitsbeginnings,beenbasedonresearchregardingmusic,imagery,therequiredpac-ingoftheday-nightcycle,andthevalueofpositivedistractioninmitigatingpainandanxiety.

Unlike commercialmusicprogram-ming, music on the CARE Channel isoriginalandselectedbasedontheneedsofpatientstoexperienceminimalstress.Fur-ther,thechannelhasbeendevelopedfromtheoutsettotranscendissuesofage,gender,ethnicity,religion,andculture.Rather,wehavelookedatthenatureof“patient-hood”asuniversal.

Ourhospitalsnownumberalmost400.Manyhaveartsprograms,livemusic,andusetheCAREChannelasanenvironmentalcomponenttoholdthehandofthepatientwhenthestaff isnotthere.Theprogram-ming isday-andnight-sensitive,uninter-rupted,andprovidesavirtualwindowtotheoutdoors.

Thestoriesthatcomebacktousfrompatientsarevaried.Onewomanwrotethathermotherwasintheemergencyroomand,inseeingimagesofarurallakewithducks,begantalkingaboutherchildhood.Thiswasawelcomeshiftfromthepanicshehadbeenexperiencing.TheuseoftheCAREChannelforpalliativecare,forpainmanagement,andto improverestfulnessandsleephasbeentoldandretold.Nonetheless,itsavailabilityatthebedsidedoesnotdictatehowapatientmightuseit,when,orwhatitwillmeantoeachoneofthem.Infact,theoutcomeisnotalwaysthemotivationforitsuse.Apatient

maylovethenatureandbeneutralaboutthemusic;anothermaybetooilltowatchthetelevisionmonitor;onemaywatchitasthelastdefenseagainstcommercialbanter.Andyet,theoutcomeistheoutcome:patientsfeelbetterforreasonsunknown.

Whatdoes this sayaboutevidence-basedmedicine?Itsaysthatevidenceismadeobviousinmorewaysthanmerelycellularinvestigation.Theverycoreofbeinghumancarrieswithitstrengthsofthewholeinterac-tionofmind,body,spirit,relationship,andsensoryresponsetocaringthatisexperiencedthroughtheartsandmusicandthatmaynotbeaccessedonly throughpharmaceuticalmodalities.

The many anecdotes that describehowtheCAREChannelhasbeenviewed,whether the focuswas the imagesor themusic,includemeasurableoutcomesreflect-ingpositivepatientexperience.Whetherpatientsareinneedoflesspainmedicationor they can sleepwithout sleeping aids,whetheranelderlyagitatedpatientcalmsdownwithoutrestraintsoranAlzheimer’spatient isableto focusonmountainsandstreamsratherthanwander,theeffectivenessofnatureandmusictocreateanenvironmentofitsown,totransformahospitalroomintoatherapeuticspaceandtheendlessmomentsofsufferingintomomentsofpeace—alloftheseareasrealasanyotherkindofpharmaceuti-calintervention.Morepowerful,however,is the fact that thearts(whether throughtheCAREChanneloraliveperformance)embraceandmobilize theconsciousnessofpatientsandfamilies,puttingthepowerofhealingback intotheheartsandspiritsofthoseforwhomcuremayormaynotbepossible.

Acknowledged as a pioneer in the use of music as environmental design, Susan Mazer is the President and CEO of Healing HealthCare Systems (www.healinghealth.com) and pro-duces the CARE Channel. She is a classically trained jazz harpist, having done her graduate work at Stanford. In her work in health care, she has authored and facilitated educational training for nurses and physicians and is well published in the field of the effects of noise on patients. In March, she will be speaking at the second annual EnvironmentsforAging conference in Tuc-son, Arizona. She can be reached at [email protected].

downordrawwhattheyfelt,thought,anddiscovered.The immediacyanddepthofthesekindsofmusicallygeneratedexperi-encesgivethepatientsawealthofmaterialtoexploreinthesubsequentgrouptherapyprocessastheystrugglewithfindingwaystomakenewbeginnings,learnfreshskills,andbuildhope.

Because my cotherapist, music, issogoodatdrawingpatients intohealingexperiences,myroleasmusictherapist istoknowthepatientsandtheirconditionswell,sothatIcansetupmusicalexperiencestoallowmusictodoitswork.Maybewe’llsitaroundatable-sizedgatheringdrumandplaytogethertoeasepatientsoutoftheirisolation;maybewe’lllistentoasonganddiscusshowthelyricsandemotionsrelatetostrugglesinourlives.Maybewe’llimprovisetogetheronacollectionofxylophonestostrengthentheexperienceofbeingtrulyintherealityofthepresentmomentandfullyattentivetoeachother.Maybewe’llsingorchanttogethertorebuildtrust,liftspirits,ornoticethehealingandanxiety-reducingeffectsoffillingourlungsdeeplyforsong.

Sothenexttimeyoumightbefeel-ing likea “rainyday,” see if youcangetyourhandsonarecordingofBach’sLargofromhisConcertoforTwoViolins(oran-otherpieceofcalminginstrumentalmusictosoothethesoul).Relaxinacomfortablechairandletthemusicawakeninyouim-agesof soothing,cleansing rain.Youcandecide if you’d like yourvisualization toincludeanumbrellaornot.

Tom Benson received his bachelor’s degree in Music Therapy from Michigan State Univer-sity. During his studies, he interned at Langley Porter Psychiatric Institute in San Francisco. He went on to become a board-certified music therapist and to receive a Guided Imagery and Music (GIM) Level I and II certification. He has worked since 1993 as a music therapist and as the training director of music therapy at Langley Porter Psychiatric Hospital and Clinics at UCSF.

Music Therapy at Langley PorterContinued from the Previous Page...

The Power of MusicContinued from Page 17...


MUSIC AND MEDICINE

Healing MusesAdding Sound to Silent Technology

Eileen Hadidian

I n 1994, I received the diagnosis somanywomendread:breastcancer.Theprognosis,however,wasexcellentand

varioustreatmentskeptthingsincheckforthreeyears.Butin1997itreturnedwithavengeance,havingjumpedfromStageItoStageIVmetastaticcancer.Testsconfirmedthatthecancerhadspreadtothespineandribs.HadIbelievedthemedicalstatistics,thisStageIVdiagnosiswouldhaveshortenedtheremainderofmylifetoeighteenmonths.

Tenyearslater,IcontinuetobeatthoseoddsbecauseIknewthenthatmylifewasnotover—inpartbecauseIhadalovinghusbandandayoungdaughterIwantedtoseegrowupandlaunchonherlife’spath,andinpartbecauseoftheworkIdowithhealingmusic.AsIseeit,doctorsaretechnicians;theycansaveourlivesusingemergencymedicine.Butasfarasmaintainingourlife,orimprovingitsquality,weaspatientshavealargeroletoplay.

Inmyownstrugglewithcancer,Ihaveusedawealthofalternatives.Inadditiontomainstreamtreatments,Irelyonacombi-nationofnutritional therapy, traditionalChinesemedicine,andTibetanmedicine.Asaprofessionalmusicianwhoplaysrecorder,woodenflutes,andsomeCelticharp,Iturnedtomusicrightfromthestartaspartofmyhealingprocess.

Fromthetimemysurgeonsupportedmywishtohavesoothingmusicintheoperatingroom,myexperiencewithcancer,combinedwithmynaturalcuriosity,hasledtotheger-minationofprojectsthatcombinemusicandhealing.Convincedthroughreadinghowmusiccouldbeusedtohelppeoplewithlife-threateningillnessbyalleviatingsomeofthediscomfortandpain,Ibecameanadvocateandpractitionerofmusicasahealingart.WithNatalieCox,aprofessionalconcertand

Celticharpist,IfoundedHealingMusesandsetupapilotprogramatKaiserPermanenteMedicalCenterinOakland,bringingmusictothehospitalfloorsandlobbiesoftwobuild-ings.CelticharpistsMaureenBrennanandPatriceHaanhavesincejoinedtheteam.

In2002,HealingMusesbecameanon-profitorganization.Theprogram’sintentisnottotrytocurethephysicalbodybutrathertohealonemotionalandspirituallevels.WehaverepeatedlyseenHealingMuses’musicrelieveanxiety,diffusepain,andencouragerelaxationduringstressfulhospitalstaysandprocedures. Iamcontinuallyawedbythepowerofmusictosootheandcalmagitatedpatientsincomas,toshiftnoisyhospitalfloorstolowerdecibellevels,andtoactasasedativewithnonegativesideeffects.

Music can be either stimulative orsedative.Stimulativemusichasanassertiverhythmthatelicitsreactions:hand-clapping,toe-tapping,dancing. Inworkingwithpa-tientswhoarerecoveringfromamajortrau-ma,suchasstroke,musicwithapronouncedrhythmisoftenpreferred.Itstimulatestheheart rate, increasingmetabolism,pulse,bloodpressure,andmuscularenergy,anditmayprovideexactlytheenergysomepeopleneed tobuildbetterhealth.Bycontrast,sedativemusicisslowerandmoresoothing:Ithasaneasy,flowingmelody,aslowtempo,andnomajorchangesinpitch,dynamics,orrhythm.Ithasacalming,anxiety-reducingeffect,evenwhenthelistenerisunconscious,anditreduceslevelsofadrenalineandotherstresshormones.

Inthispractice,theultimategoalisen-trainment,aprocessintendedtosynchronizethepatient’svitalsignswiththemusic.Beforeplayingforaroomfullofpatients,wegagetheirenergy. If theyareagitated,westartwithfaster-pacedmusicthatmatchestheir

mood,gradually slowing itdowntoallowtheirvital signs to stabilize.Ontheotherhand,iftheenergyislowandpeopleneedtobeinvigorated,westartwithslowmusicthatechoestheirmood,thengraduallypickupthespeed.Ourrepertoireincludesmedieval,Renaissance,andCelticmusic,Americanfolk songsand spirituals, andmusic fromdifferentworldtraditions.Weavoiddisso-nanttwentieth-centurymusicandthemorebombasticRomanticcomposers,focussingonbeautiful,simplemelodiesfromavarietyofcultures.Westudyhowdifferentmusicaffectspeopledifferently,andwegroupsetsofpiecestocreateahealingenvironment.

HealingMuses’goalofbringingmusictomedicalsettingshasgottensupportfromanumberofadministratorsandhealthprofes-sionals,includingmysurgeon,Dr.RichardGodfrey,whosaysthataddingmusictothe“silenttechnology”ofmodernmedicinecan“awakenthepositiveforcesofhealingthatcome fromwithin.”Manyadministratorsagreethatthemusicbenefitsstaffasmuchasthepatients.

Weneverknowwhomourmusicwilltouch.Foreverypersonwhocomesupandtalkswithus,thereareallthoseotherswhopassby, anxiousor frantic,whomaybesoothedbythesoundsofourplaying.AlltheHealingMusesconcurthattheirmusicappealstoabroadrangeofpeople.Patientsortheirfamiliesoftenaskabouttheinstru-mentsweplay;staffsometimesrequestthatweplay foraparticularpatientwholovesmusic.Patients in the laboratory say thattheirbloodpressurereadingsare lowerondayswhenweplaythere.

Thespiritualpowerofmusiccanbees-peciallyusefultopeoplefacingthetransitionbetweenlifeanddeath,anditcanhelpthe



MUSIC AND MEDICINE

Enriching Hospice CareMusic at the End of Life

Kris Montgomery

“Musicandrhythmfindtheirwayintothesecretplacesofthesoul.”—Plato

h umanshave long recognized thesignificanteffectofmusic inourlives.That’swhyhospicesaround

thecountry,includingtheBayArea’sownHospicebytheBay,arenowusingmusictoenrichthelivesofpatientswithseriousillnesses.ToadddepthandvaluetoitscareofpatientsandtheirfamiliesinMarin,SanFrancisco,NorthernSanMateo,andSo-nomacounties,HospicebytheBay(formerlyHospiceofMarin)addedmusicalactivitiestoitsvolunteerPatientandComplementaryCareprogramfouryearsago.

“Studiesshowthatmusicalactivitiesandmassagearethetwomostpopularformsofcomplementaryservices,”saysMaryTaverna,Hospice’spresidentandCEO.“Wewanttoofferourpatientsa richrangeofcareop-tionstomaketheirremainingtimethemostmeaningfulandcomfortablepossible.Wealsowanttocomfort their familiesduringadifficulttimeoflife—musichelpsprovidesomecomfort.”

Brainwave studies suggest thatevennonresponsivepatientsandthosewhoareactivelydyingcanhearsounds, indicatingthathearingmaybethelastsenselostbeforedeath.A reviewof several studies abouttheefficacyofmusictherapyinend-of-lifecareshowsthatbothseriouslyillanddyingpatientsexperiencepositivechangesinpainlevels,physicalcomfort,fatigueversusenergy,anxietyversusrelaxation,timeanddurationofmedicaltreatment,mood,spiritualwell-being, andqualityof life (seeRussellE.Hilliard, “MusicTherapy inHospiceandPalliativeCare:AReviewoftheEmpiricalData,” inEvidence-based Complementary and Alternative Medicine, April2005).Stan

Goldberg, aHospiceby theBayPatientCarevolunteerwhohasbeenplayingflutemusic tohospicepatients formore thanthreeyears,says,“Therearedifferentwaystoreachapatient:words,therapeutictouch,andother formsofnonverbalcommunication.Sometimeswhennothingelseworks,musicdoes.”Goldberg citesDaniel J.Levitin’sbook, This Is Your Brain on Music,whichtheorizesthatmusictapsintoapartofthebrainthatdoesn’trequireinterpretationtocommunicate,aswordsdo,andthatallowsadirectconnectiontofeelings.

CherylWilkins,thevolunteerservicesmanagerwhooverseesthePatientandCom-plementaryCareprogram,saysthatmusicalactivitieswereaddedtoHospicebytheBay’sprogramafterrequestsfromitsclinicalstaff,whosawthebenefitofofferingavarietyofmodalitiestoenhancethelivesofpatientsandfamilies.Currently,severalHospicevol-unteersplayinhospitals,residentialandnurs-ingfacilities,andpatients’homesinMarinandSanFrancisco.Somehavetrainingintheuseofmusictohealandcomfortthosewithterminalillnesses;othersaretrainedHospicevolunteerswhooffertheirmusicaltalentsasanextragifttoclients.

Afterthefirst“musicthanatology”pro-gramopenedin1973,teachingtheuseofliveharpmusicinthecareofthedying,interestgrewinusingmusicasmedicine.HospicebytheBayvolunteerBarbaraRoseBillingsis certifiedby the BedsideHarpprograminPennsylvania.Shenowteaches in theHealingHarpprogramatSanFrancisco’sInstitute forHealth andHealing at theCaliforniaPacificMedicalCenter,whereanotherHospicevolunteerharpist, JudithTaussig,isanintern.

Manyofthemusiciansfeeltheywere“called” toplaymusic to thosewith life-

limitingillnesses,someafterahealthcrisisoftheirownoralovedone’s.Billingssaysthatplaying forher fatherduringhis lastillnesscausedher to see thevalueof theharpwhensomeone is sickordying.Shesays,“Whenyouplaytosomeonewhoneedshealing,musiccanhelpspeedthathealing.Whenplayingtosomeonewhoisdying,youfrequentlyseepeacecomeoverthem.Ifeelprivilegedtobewithindividualsduringthissacredtime.”

Thevolunteersagree thatmusiccancalmboththosewithillnessandthe“worriedwell.”Taussigrecountsavisittoacardiacpa-tient:“Hergranddaughtertoldmehergrand-motherhadbeenveryanxious,andshehopedthemusicwouldsootheher.”WhileTaussigplayed,thegranddaughterwatchedtheheartmonitor.Thegranddaughterweptwithjoyas it showedhergrandmother’sheartbeatslowingasshefellpeacefullyasleep.

Whenplaying,themusicianswatchthepatient’sbreathingandfacialexpressionsforaresponse.Oftentheyplaysteady,rhythmicsounds,“sometimesevenjustasingle,softtone,”saysTaussig.It’sbesttokeepthemusicsimple,Billingsnotes.“Youwouldn’tcarryonlongconversationswithsomeonewhosesystemsareshuttingdowneither.You’djustusesimplewords:‘Iloveyou.’‘Youcanletgo.’‘I’llbefine.’”

Severalof themusicians improviseastheyplay,watchingtoseewhatsoundsthepatientrespondsto.Calledtoplaytoapa-tientwhowasdying,veryweak,andinpain,Goldbergplayedthefluteformanyhoursovertwodays.Goldbergwatchedtheman’sfaceandposturerelax.Hesaidtothepatient,“ItlookedlikeyouweretakingatripsomewherewhileIwasplaying.”Thepatientsmiled,say-inghehadindeedtakenatriptoa“specialprivateplace,”carriedtherebythemusic.


dyingletgoinrelativepeaceandacceptance.AsmygoodfriendSusanwasdyingofbreastcancer,IbegantoplaymyCelticharpforheroneafternoonaweekandwitnessedthepowerofmusictosoothe.ThefirstweekIwenttoSusan’shome,shewasconscious,confinedtoherbed,surroundedbycaretakersandtheirincessanttalking;sheseemedverytiredoftheconstantinput.Iaskedpeopletoleave;assoonasIstartedplaying,Susan’seyesclosed,herbreathingbecameslower,andsherestedquietlyforthenexttwohours,occasionallyopeninghereyes toask forafavoritepiece.

ThelasttimeIplayedforSusan,therehadbeenashiftinhercondition;shehadmovedinwardandstoppedeatingandre-sponding.Shehadalsobeenveryagitated,notwantinganyonetotouchheroradmin-isteranything,whetherfluidsormedication.As soonas themusic started, shecalmeddownand resteddeeply for thenext fewhours.Hercaretakersoccasionallycameinandcommentedthatthiswasthefirsttimeintwenty-fourhoursshehadbeensocalm.Movingthemusicawayfromregularrhythmandwords,likethefluidityofmedievalchant,myvoicebecameanotherinstrument,alongwiththeharp.Earlythenextmorning,Susandiedpeacefully.

FellowMusePatriceHaanalsosharessomeofherpersonalexperiencewithheal-ingmusic.

“OftenIenterthehospitalfullofhope,yetwithsometrepidationthatIwillbeabletoascertainwhatisappropriateinthismomentandsituation.Andso itwas themorningIwenttoplayformyfriendwhohadhadmajorspinalsurgeryandwasrecoveringonthesurgeryfloor. Iknewthemusicwouldspeaktohereveninherslumber,andthatitwouldspeedherhealing,buthowwouldthestafffeelinthatbusy,highlychargedenviron-ment?Approachingthenurses’station,ItoldthemIhadcometoplayforEileenandcouldbeeitherinherroomorjustoutsidethedoor.Theclosestansweredwithahalf-nodthatIcoulddowhatIwantedprovidedI stayedoutoftheway.

“PeekingintoEileen’sroom,Isawshewassleepingfitfully,tossingalittlebutdeeplysedated.Isetupmyharpoutsideherroom

andbegantoplayquietly.Almostimmedi-ately,thefamilyinthenextroomcameouttoseewhatwasgoingon.‘Isthisheaven,’theyasked,‘wherethereareangelsplayingharps?’Anotherfamilywalkeddownthehalltoofferthanksforthepeacefuleffectoftheharp.Thenoiseatthenursingstationbegantoreducefromslammingclipboards,rattlingcarts,andloudvoicestoaquieter,calmerlevelofactivity.

“Afterplayingforanhourandahalf,IcheckedonEileentotellherIwasleavingfortheday.Inoticedshewasbreathingalittlemoreeasily,althoughshewas stilldeeplysedated.AsIpackedtheharptoleave,oneofthenursescalledouttome,‘Youshouldcomeeveryday.IstartedoutthisshiftfeelingverytenseandnowIammorerelaxed.’

“Another day I was playing in thelobbyofoneofthebighospitals—ahubofactivity,centraltotheentrance,laboratory,informationdesk,gift shop,waitingroom,andcafeteria.Chairs linedtheopenwallsandaparadeofpeoplepassedbymyharp.Anolderwoman inawindbreaker stoodnearby,listeningintently,hereyesaverted,withtearsstreamingdownhercheeksasIplayedseveralsongs.Finallyshecameupandgraspedmyhand,tellingmethatherhusbandwasupstairsdying.‘Ijustneededamomenttocollectmyselfandhadnoideayouwouldbehere.Ihavenotcriedbefore,butnowIfeelthatmyheartcanbearwhatwillcome.’”

Insomesensesthiswayofofferingmusicisclosertoitsoriginalintentintraditionalcultures—asaritualandtoolusedbyhealersandspiritualleaders.Themusicianbecomesavesselthrough whichthemusicflows.Thisisnotaboutperformance,competition,orproduct,butaboutprocessandservice.

Whilemusic isnocure-all, researchshowsthatthisnaturaltherapyhasaremark-ablevarietyofhealingbenefits.Hospitals,hospices,nursinghomes,andavarietyofhealthcareprofessionalsarenowusingmusic,bothrecordedandlive,asaregularpartoftheirprogramsandtreatments.

Many thanks to Patrice Haan for her contri-butions to this article and for her editing assistance. Healing Muses gets its support from donations, small grants, CD sales, and matching funding from the sites it serves. To find out more about Healing Muses, please visit its website at www.healingmuses.org.

Volunteersalsooffermusicasa formofcompanionship,especially forpatientswhose familycan’talwaysbepresent.“It’sawayofbeingwithapatientwhensmalltalkfeelssilly,”saysCinderErnst,aPatientCarevolunteerwhoplaysguitarandsingsforherpatientswhentheyrequestit.Someofherpatientsaskforaspecificsongandsingalong.Otherslistenquietlyorwiththeireyesclosed,asthesongorsoundscanevokedeepfeelings—happymemoriesofgoodtimes,orgriefabout their illness—feelings that thePatientCarevolunteercanhelpthemexpressandexplore.

Familiesandmedical staffalso reportbenefitfromthevolunteer’smusic.Taussigwascalledtoplayatthebedsideofapatientinthehospitalwhosefamilymembershadmadethedifficultchoicetodisconnecttheirfatherfromaventilator.Sheplayedformorethananhour,asthefamilysaidprayersandtheirgood-byes.Shecontinuedtoplayafternursesdisconnectedthepatient’sbreathingtubeandthemonitorswentflat.Shesays,“ThefamilywasgratefulthatIwastheretocreateasofthumanatmosphereduringsuchasadtime.”

Unlikecorehospiceservices,Comple-mentaryCareofferings—includingmusic,massage,energywork,andanimalvisits—arenot reimbursedbyhealthcare insuranceprograms.Financialdonations fromcom-munitymembersandcorporatepartnerstothenonprofitHospicebytheBayFoundationsupporttheprogram.

Hospice by the Bay, which has been serving Marin, San Francisco, Northern San Mateo, and Sonoma counties since 1975, is a 501(c)(3) nonprofit organization dedicated to ensuring that all who need hospice care and services receive them. Through its community grief support program, Hospice by the Bay also serves people whose lives have been altered by the loss of a loved one. Hospice by the Bay programs are funded through health care reimbursement and financial donations from community members, businesses, and corporations to the Hospice by the Bay Foundation. For more information about Hospice by the Bay services or how to support our work, call (415) 927-2273 or visit www.hospicebythebay.org.

Healing MusesContinued from Page 21...


MUSIC AND MEDICINE

The Threshold ChoirSinging to Assist Transitions

Kate Munger

T he inspiration for theThresholdChoircameonedayin1990whileIwas caring formy friendLarry,

whowas comatose yet restless, dyingofHIV/AIDS.Allmorning,Iwasheddishes,weededhisgarden,andorganizedhisquiltfabrics.AllafternoonIsatbyhisbedsideandsangthesamesongoverandoveragain,forhours.AsIsang,webothbecamecalmer.Attheendoftheafternoon,IwassureIhadgivenhimagift—agiftthathadcomefromthedeepestandmostessentialpartofmyself.AsIreflectedontheexperience,Iwonderedifothersingersmightwanttogiveandreceive that samekindof gift.Afterreachingoutto friendsandothersingers,Idiscoveredthattherewere,indeed,manywhowereinterestedintendingtothedyingthissameway,andsobegantheThresholdChoir.

Today,asweapproachoureighthanni-versary,therearefifty-twoThresholdChoirsacrossthecountryperformingthishealingservice.These choirshonor the ancienttraditionofsingingatthebedsidesofpeoplewhoarestruggling,somewithliving,somewithdying.Wesingforadiversegroupofpeople: thosewhoare feebleor incoma,thosewithend-stagedisease,newbornsjustopeningtotheworld,andwomenwhoareincarcerated.

In December 2007, our ThresholdChoir,headquarteredinInverness,Califor-nia,wasaskedbyanattendingnurseifwecouldhurryovertoanearbyhomeandsingforafamilywhosebaby,namedViolet,hadjustdiedattheageoftwomonths.

“Yes,ofcourse,” I said,and immedi-atelycalledPamela,whohadsungwiththechoirfiveyearsagoandherselfhadlostaninfantson.ThenIcalledLaura,alawyerandpsychotherapistinSanFrancisco,whoal-

waysseemstohavethepreciousfewminutestoshareforthesakeofoursinging.

Whenwearrived at thehome, themother,father,andunclegreetedus.ThedadwasMiddleEasternandthemomandher brother were from Germany.BabyViolet’stinybodywasinthebassinetinthecenterofthelivingroom,wrappedtightlyinablanket surroundedby rosepetals andsofttoys.WesatclosetoBabyVioletandstartedwiththeSt.FrancisPrayer—softly,sosoftly.

“MayIbeaninstrumentofPeace.…”Formorethanthirtyminutes,wesang

thesimplestsongsatoursoftesttone.Thefamilysattogetheronthecouch,eachoneweepingandholdingtheothers.Thefather’shugetearstumbleddownhischeeks.

It was a tremendous honor to givethisfamilyawaytoexpresstheirgriefandtohonortheirbabyandhershortlife.Aswefinished,MomaskedifweknewDona Nobis Pacem.Sheandherbrothersangoneparttogether,beautifully,andwesangtherest.Iwassogladwewereabletosingtogether.Itwasphysicallyandemotionallysatisfyingtogivethemsomethingthatpenetratedtothecoreoftheirgrief.Italsovalidated,inthedeepestway,ourchoir’smission:providingacontainerforaccessingthesacred.Threesingers,atinybaby’sbody,andthreegriev-ingfamilymembers—intimate,deep,andrightinthemiddleofdailylife.

Thehumanvoice,asouroriginalmusi-calinstrument,isatrueandgraciousvehicleforcompassionandcomfort.Wheninvited,wevisitthebedsidesafewtimesaweekinsmall groups andwe invite families andcaregiverstojoinusinsongortoparticipateby listening.Our repertoire is chosen torespondtoindividualmusicaltaste,spiritualdirection,andphysicalcapacity.Someof

ourmosttreasuredsongsforbedsidesinginghavebeenwrittenbychoirmembers.Oursingingmightincluderounds,chants,lul-labies,hymns,spirituals,andclassicalchoralmusic.Theserviceisourgift.

TheThresholdChoirsprovideoppor-tunitiesforsingerstosharetheirvoices,theircompassion, and their truthwithothersfacinglife’sthresholds.Itisasacredwaytobuildcommunityandbepartofaunique,cocreatedadventure.Mostofall,itisagreatcomforttothosewhofacethresholdsofill-ness,suffering,anddying.

Kate Munger’s earliest memories are of her mother singing lullabies every night to her and her siblings. These memories—her mother’s voice and her joy in singing—were very profound influences on her. Kate has sung in several choirs over the years and feels that sing-ing has been one of the most important threads that runs through her life. In 1975 she started leading monthly rounds singing circles, which gradually expanded and gave her the confidence and contacts to move onto her current project. As the founder of the Threshold Choir, she enjoys sharing the gift of music and song with those facing life’s transitions.


MUSIC AND MEDICINE

The Healing HarpThe Oldest Healing Musical Instrument

Claire Dunne

T heharp,asaninstrument,hasbeensoundinghuman lifeandhealingsinceearliestrecordsbegan.Itsun-

foldingstoryisevolvingstill,cutting-edgeinourowntime.

Fivethousandyearsofthishistoryweknow.Theoldesturbancivilizationshadharps.ExcavationoftheroyaltombofUrinMesopotamia(datingfrom2,700B.C.)yieldedfragmentsofthreeharpsandninelyres.TombsofEgyptianrulersofthesameperioddepictharps, some seventy inchestall, with up to thirteen strings, playedbywhite-robedpriestlyfigures,maleandfemale, in standing, kneeling, or sittingpostures.AncientPersia,Assyria,Baby-lonia,andGreecehadharpsknownbyavariety ofnames—all representatives oftheplucked-stringmusicfamily,theworld’soldestmelodicinstruments.

Myth, often representing collectivelevelsoftheunconscious,tellsusuniversalstoriesofbeginnings.Atoneendofthespec-trum,theharpappearsasaready-madegiftofthegodsforworship,celebration,healing,andsoothingthesoul.Attheotherend,asinspirationfortheharp’sphysicalcreation,musicof thewindbreathes through thebleachedskeletonofawhale,healingloverelationsalongtheway.AclassicIrishmythtellsof the interplayofgods,nature,andarchetypalhumanmomentoriginatingthepowerofmusicassupport.AsnaturegodBoinnstruggled inherbirthingtime,herhusband,thechiefgodDagda,wasattunedwithhertravailsonhisharp.TheemotionalrangewasexperiencedbyhergivingnametotheirthreesonsandthecorrespondingtriplestrainsofIrishmusicstillcurrent.

One is Joy Song, one Sorrow’s, One, “song that gives Sleep,” And the harp’s strains, their father’s,

Remembered they keep.

B i r t h a n ddeath, enchant-ment,prophecy,love,magic,andhealingareage-oldcharacteristicsoftheharp.ThehealinglineagecontinuesintotheBiblicaltimeofDavid(1,000B.C.),askedtoplaytheharptocalmtheraging,depressiveswingsofKingSaul.

“WiththeharpIwillsolvemyprob-lem”(Psalm48)isoneofforty-threeOldTestament references to theharp. ItwasPythagoras,inthesixthcenturyB.C.,whomademusicascienceaswellasanartintheWest,introducingintoGreekciviliza-tionancientknowledgeofMemphisandBabylon.

Setting up experiments to discoverhowmusicworked,heexpresseditsprimaryconsonances inmathematical formulae,developed theWestern scalebycalculat-ingintervalsontheharmonicseries,foundexactlywhichmodeaffectedwhat emo-tions, played specially created music tohealphysicalandspiritualillness(incliningparticularlytostringedinstrumentssuchasthelyre),andthenpassedontheknowledgetohisstudentstoapplyintheirlives.

Two thousandyears later, thegreatpsychiatristC.G.Junggaveapsychologicalperspectiveofmusic:“Itexpressesinsoundswhatfantasiesandvisionsexpressinvisualimages.…Musicrepresentsthemovement,development,andtransformationofmotifsofthecollectiveunconscious.”Aninvita-tiontohearpianist/musictherapistMarga-retTilleyatworkin1956movedJungtoconclude that, “used therapeutically fromthislevel,musicshouldbeanessentialpartof everyanalysis.”Therapeuticharp lan-guageoftodaysimplysays“…harpstrings

resound in sympathyandharmonywiththenervesandmusclesofthebody…bypluckingstringstensionisreleasedthroughsympatheticresonance”(SarajaneWilliams,The Mythic Harp).

Americaisnowleadingtheworldinharpmusicashealing.Althoughharpcon-certslistedintheU.S.datefrom1790s,itwastheimportofEuropeanharpinnovatorssuchasCarlosSalzedo(1909)thathelpedmaketheU.S.amoderncenterfortheharp.Theinstrumentwasbythenexpandedtoafullychromatictwelve-notescale,givingittheabilitytoplaycomplexclassicalmusic.Theharp’s extensionback intohealingbeganin1923,whenharpistWillemvandeWall initiated thefirstmusic therapyprogramataPennsylvaniaStateHospital.About seventyU.S.universitiesandcol-legesnowoffergraduateandundergraduatecourses inmusic therapy.Whilecertifiedmusictherapycoversawiderangeofhu-manrehabilitation,itisintheexpandingfieldofpalliativecarethattheharpplaysaprominent,thoughnotexclusive,role.

Musicthanatology(thestudyofdeathanddying),withitsfocusonsonicdeath-bed vigils, was pioneered from 1973 bysinger/harpist/composerThereseSchroeder-Sheker.Asanundergraduatemusicstudent,Therese supplementedwith a job as anorderlyinageriatrichospital.Appalledbythepaucityofhumancare,shesoonreachedaforkintheroad:shecouldquit,orfollowtheadvicefromafriendintheministryto“protectthem.”Later,inwhatshedescribesasaturningpoint,sherespondedcompas-



sionatelytoatesty,thrashingmandyingofemphysema, intuitivelyholdinghimfrombehindinthebedandsinging,fallingintosynchronisationofbreathandboneconduc-tionofsound,ashetrusted,relaxedagainsther,andeasedintothemysteryofdeath.Itwas,Schroeder-Shekersays,“acompletelylife-changingexperienceforme.”Itwasalsoanexampleof“deathbedhealing”asopposedto“cure,”andadawningofsomeprimemo-dalitiesofpalliativecare.

Schroeder-Shekercontinuedwithher“destiny”—doing, learning,defining,andrefiningbyexperience,aslowprocessguidedby intuition.Reachingback forhistoricalinspiration, she turned to the eleventh-centuryBenedictinemonastic traditionofaccompanyingthedyingwithmusic,notingitstwofold“careofthebody,cureofthesoul”asabuilding-blockphilosophy.Shealsoreadandstudyingwidely,meetingwithinterestedprofessionalsinmanyfields.

Thepolyphonicharp,withitsnoninva-sivetonalsubstance,warmlowstrings,andcapacitytoplaymultiplenotessimultane-ously,proved“perfect” indeathbedvigilsthatdeliveredcustomizedmusic suited topatients’physiologicalandemotionalcondi-tionsintheearlytoimminentstagesofdying.Sometimestwoharpistswouldplay,oneoneachsideof thebed, inhomes,hospitals,andhospices,creatingasurroundofmusicthataccumulatedovertones,helpingsoundpenetrateintoandsoothethebodyandsouloftheclient.Themusicofteneliciteddistinctinner shiftswithinrecipients, reconciling,forgiving,loving,accepting,radiatingPres-encebeforedeath.Therewereempiricaldiscoveriesaswell:theeffectivenessofdis-tinctmodalmusic,whichalsolinkedwithearly sacred literature, lullabies,andsomeemerging twentieth-centurymusic.Mostimportantwastherealizationthattheplayingofnonmetricalmusicattheendcouldhelppatientsunbindfromtimeandlife.

Shcroeder-Sheker’s pioneering trekbecameamusicthanatologycourse,takentobachelor’sandmaster’slevelsinDenver’sacademicinstitutions;rehousedasamedicalmodalityattachedtoahospitalinMissoula,Montana,foradecade;andnowindepen-dentlybased inMt.Angel,Oregon,asamultifocussedChaliceofReposeprogram

offeringatwo-yearcoursecoveringseventeendifferentsubjectsoverfivesemestersinfivetracks—aninterfaceofmusical,academic,clinical,medical,and innerdevelopmentteachings.Schroeder-Shekerservesasaca-demicdeanandistheauthorofTransitus:A Blessed Death in the Modern World.Thecoursehasbecomeaservicepointingtoahungerofneed:Schroeder-Shekerhasbeenknowntoreceive3,000e-mailsinonedayinresponsetoasingletelevisioninterview.

Essentially,theaccreditedmusicthana-tologistbeginsavigilbycenteringherself,thenfocussingentirelyontheclient,observ-ingthevitalsigns.Workingfrom“interiortuning,”theseprovidersecho,synchronise,accompany,andentrain.Trainedtousemu-sicclinicallyassonicmedicine,theychoosescales,texture,consonance,anddissonancetosuit.Theycanrelatemelodiccontentwiththenervoussystem,harmonicwithrespira-tory/circulatory, rhythmicwithmetabolic,to stimulateor suppresspulse,heartbeat,bodytemperature,andskinsecretions.Theyrelievephysiologicalandinteriorpain,help-ingpeoplediewell.

Justasphysicsdemonstratesthatsoundorganizes and reorganizes matter (ErnstChladniandHansJenny), sodoesmusic-thanatology reorganize thehumanbeing.Itisart,science,vocation;music,medicine,spirit;human,harp,service.

Midwaybetweenmusictherapistsandmusicthanatologistsarepractitionersofheal-ingmusic,withtwoU.S.nationalprogramsofferingcertificatedcourses.Aswellaspro-vidingpalliativecare,practitionersofhealingmusicmayworkinpediatric,preoperationalanxiety,andpainmanagement,facilitatingemotional catharsis and release inotherarenas.Indifferentschools,philosophicandtrainingemphasesmayvary;somehavecre-atedtheirownold/newmethodologies,whilebasicssuchasentrainmentandthemodesinpalliativecarehavecommonality—asdoesthe importanceof self-awarenessdevelop-ment inpractitioners. “Applyinghealingmusicashealingart”canaffectbody,soul,andspirit.

TheMusicforHealingandTransitionProgram(MHTP)delivers training toallinstrumentalistsandvocalists.TheInterna-tionalHarpTherapyProgram(IHTP)isforharpists.Boardaccreditationforgraduatesof

thesegroupsisunderway.Reachingoutinternationally,adeter-

minedcollectiveeffortin1995inauguratedthefirstInternationalHealingHarpsSym-posium,heldinPennsylvaniaandhostedbynurse/psychologist/vibroacousticharpthera-pistSarajaneWilliams.Soonafterward,shelaunchedtheHarp Therapy Journalinordertogatherinformationworldwide.In2005,theninthtriennialWorldHarpCongress,held inDublin, includedforthefirst timeapanelsessiononharptherapeuticmusic.Harpist/teacher/DirectorofIHTPChristinaTourinnowpresentsmodulesof theworkasfarafieldasIrelandandtheU.K.,Japan,andMexico.October2007 saw the firstSymposium on Medicine and Music inSydney,emphasizingharpsinpalliativecare.U.S. specialguestStellaBenson,certifiedmusicandharppractitionerandauthorofseveral teachingmanuals, isnowofferinginternationaltrainingmodalitiesfor“artisthealers”viatheInternet,inindividualauralinstructionbylong-distancephone.

Itmayseemalongwayfromprehistoricharps inEgyptiantombsandIrishmyths.Yetinhealingandpalliativecare,mostoftheharpsusedaretheCelticvariety,“thepurest soundingofall string instruments”(KayGardner, Sounding Inner Landscape).Itistheireasyportability,diatonic(whitenotesonthepiano)modalstructure,puresound,andwhole-notepentatonic(five-tone)scales,hearkeningbacktothehistoricIrishharpers,thatmakesthemsosuitableforthesimplermusicneededforhealing.

Whatthisage-oldstoryofharp,healing,andhumansrepeatedlysoundsforusisrecur-ringpatternsofcontinuityandmeaning,theinstrument’srenewalsanupliftingspiralofnotesineacheraofitslong,bestowinglife.

Claire Dunne, Irish born author/lecturer/broadcaster, has produced radio documentaries and articles on Irish and concert harp history and presented on healing music at the World Harp Congress 2005. Her books include CarlJung:WoundedHealeroftheSouland PeopleUn-dertheSkin:anIrishimmigrant’sexperienceofAboriginalAustralia.



MUSIC AND MEDICINE

Calming the Surgeon and the PatientThe Positive Effects of Music in the Operating Room

John Maa, MD, FACS

E insteinshouldhavestudiedrelativ-ityinanoperatingroom.Whenanoperationisproceedingwell,hours

canracealongandfeellikemereminutes.Irememberstartingavascularprocedureat7:30a.m.duringresidency:harvestingthesaphenousvein,exposingthefemoralvessels,andperformingadistalbypasstothetibialvessels.AsIremovedmygownattheendofthecase,contemplatingthemanyinpatienttasksawaitingme,IthoughtImighttrytohave lunchbeforehand. Iwassurprisedtodiscover that itwasalmost4:00p.m.Atother timesthough, thesunrisesandsetsbeforeacomplexoperation iscompleted,andsurgeonsmarkthepassageof timebycountingthenumberofchangesinpersonnelaroundthem.

Throughouthis football career, JoeMontanademonstratedanextraordinaryability to perform well in high-pressurecircumstancesby remainingcalm indif-ficultsituations.Likeafootballgame,everyoperationhas itsuniquepitfalls thatcangeneratetensemomentsandanxiety.How-

ever,surgeonsmayhaveanadvantagethatquarterbacksdonot—studieshaveshownthatmusicintheORcanimproveasurgeon’sperformance.Ibelievethatmusichelpsmanysurgeonsremaincalmandfocused,especiallywhentheyare tiredandoperating in themiddleof thenight.Forme, theeffectofMozartnotonlystimulatescreativethink-inginchallengingcases,italsoforestallstheapproachofanxiety.MusicsoftlyplayingintheORlendsasenseofeleganceandhar-mony,anditsignalstotheentireoperatingroomteamthatthingsareproceedingwell.Conversely,anyonewalkingintoasilentORsoonrecognizesthattheoperationislikelyataparticularlydifficultjuncture.

Music can also provide the properrhythmforwhatoneofmyattendingscalledthechoreographedballetofsurgeonandas-sistant,whomustmoveinsynchronytoprop-erlyexpose,transect,andanastomosetissues.Moreover,musicprovidesanimportantsenseofmovementwhenanoperationistemporar-ilystalledbyambiguousorunexpectedfind-ings,untilclarityemerges.However,Iagree

withconcernsaboutthepotentialnegativeeffectsofinterferingnoiseonpatientsafetyandcomfort.Forthatreason,iftheoperationbecomesunexpectedlydifficult,thenthemu-sicisturnedoffimmediatelyandextraneousconversationsandpager interruptionsarekepttoaminimum.Andifthepatientwillbeawakeduringtheprocedure,heorshehasthefirstchoiceofwhatwelistentoduringtheoperation.

Consider this:Theaverageoperatingtimeforalivertransplantisninehours,andtheflyingtimefromSanFranciscotoLondonis tenhours.Couldyou imagineflying toEurope,ordrivingfromSanFranciscotoLosAngeles,insilence?WhatmadethevascularcaseduringmyresidencyseemtogobysoquicklywasthemusicofLouisArmstrong,Beethoven, theRollingStones,andFaithHill. IwonderwhatEinsteinwouldmakeofthat?

John Maa, MD, FACS is an Assistant Professor in the Department of Surgery and the Associate Clerkship Director of Surgical Educa-tion for UCSF.

In the Works for 2008

Upcoming San Francisco Medical Society EventsSFMS deYoung Museum NightDon’tmisstheSFMSnightatthedeYoungMuseum!JoinSFMSmembersonFriday,May9 for a reception—cateredbyBonAppetit—from5:30 to7:30with accesstheentiretyofthisstunningmuseumuntilitclosesat8:30.Thecostforthisexcitingneweventisjust$20.00(includesmuseumadmission) forSFMSmembersand theirguests.ContactTheresePorterintheMem-bershipDepartment at (415)561-0850,[email protected].

The Togonon Gallery and Jazz MixerReturning in lateAugust!Watch forde-tails.

SFMS Night at the Symphony InOctoberorNovember (date tba) joinyourphysicianpeersforaneveningofwarmfellowshipandgreatmusicat theSFMSNightattheSanFranciscoSymphony,com-biningaterrificSymphonyperformanceandanexcitingpre-performancereception.

Annual SFMS Nutcracker NightThisDecember look for theexcitingandfamily-friendly funof the secondAnnualSFMSNutcrackerNight!

Visit our website often for event and membership updates, or contact Therese Porter at (415) 561-0850, extension 268 or [email protected].

www.SFMS.org/events


MUSIC AND MEDICINE

Jake LegA Public Health Mystery Is Solved through the Blues

Eisha Zaid

J akeleg, jakeleg,whatintheworldyoutryingtodo?Seemslikeeverybodyinthecity’smesseduponaccountof

drinkingyou.”WhenIsmonBracey,abluessinger,mentioned jake leg inhis 1930ssong,hewasreferringtoanepidemicthatsweptthroughtheUnitedStatesduringtheDepression,which left thousandsofmenlimping fromparalysisand suffering fromimpotence.

Dr. John Morgan, a pharmaco-ethnomusicologistandprofessorattheCityUniversityofNewYorkMedicalSchool,hasbeenresearching jake legbytrackingitsappearanceinmusicforthelastthirty-twoyears andhascompiledacollectionofseventeensongsthatmakereferencetothedisorder.Heshareshisfindings inanarticlethatappearedin2003inThe New Yorker entitled“JakeLeg:HowtheBluesDiagnosedaMedicalMystery.”

Morganbelievesthatthejakelegtrag-edywouldhavebeenforgottenhaditnotbeenforthedevelopmentofanentirenewgenreoffolkmusic.Bluessingers,includ-ing theAllenBrothers, IshmonBracey,Tommy Johnson, theMississippiSheiks,WillieLofton,andDaddyStovepipeandMississippiSarahreportedtheassociationofparalysiswithjakeconsumptionwellbeforeanyepidemiologists,governmentagency,ordoctorcouldputthepiecestogether.

Thenewgenreofmusicappeareddur-ingProhibition,aneraofdesperationthatleftthepoorconsumingwhateveralcoholtheycouldgettheirhandson,includingrub-bingalcohol,hairoil,doctoredantifreeze,andpatentmedicines.DespitepassageoftheVolsteadActin1919,whichinitiatedadryspellthroughmoststates,alcoholicpatentmedicineswerenotoutlawed.Amongthepatentmedicineswas jake,apaleorange

liquidmade fromJamaicagingerextract.Composedof85percentalcohol,itpackedtheequivalentoffourjiggersofscotch.Jakewasmarketed to treatcatarrh,flatulence,

andlatemenstruationbuttransformedintoanewsourceofalcohol.

The jake leg tragedy influenced agenerationof blues artists,whosemusicchroniclestheprogression,symptoms,andphysical manifestation of a disease thatmysteriously appearedand impacted theentirenation.Thefirstconnectiontojakeconsumptionandparalysiswasnoted inIshmonBracey’ssong“JakeLiquorBlues”in 1930. In addition, Tommy Johnsonmadeasimilarassociationin“AlcoholandJakeBlues.”

Mensufferedfromimpotenceinaddi-tiontoparalysis,andthesongsofthetimeechoedthefrustrationandembarrassmentthat came with this jake-consumptionsymptom.Braceysings,“It’sthedoggonestdiseaseeverheardofsinceIbeenborn.Yougetnumbinfrontofyourbody,youcan’t

carryanylovin’on.”Thefirstdocumentedcaseofjakeleg

wasreportedbyDr.EphraimGoldfain,thedirectorofa135-bedhospitalinOklahomaCity.Goldfain reports that “thepatient’sfeetdangled like amarionette’s, so thatwalking involved swinging them forwardandslappingthemontothefloor,”adescrip-tionthatmirrorsthelyricsofmanyjakelegsongs.ButGoldfaindidnotknowwhatwascausingthismysteriouscondition.Interest-ingly,theAllenBrothersmadereferencetothemysteriousconditionanditsassociatedsymptomsintheirsong“JakeWalkBlues”in1930:“Ican’teat,Ican’ttalk,drinkingmeanjake,Lord,Ican’twalk.”

The jake leg outbreak was not justlimitedtoOklahoma.Theepidemicsweptacross thenation fromRhode Island toMassachusetts toKansas toMississippi toTennessee,generallyaffectingthealcoholic,unemployed,poormanwholivedaloneorintheseediestpartsofthecity.

During the timeof the jake legepi-demic,theparalysiswasattributedtopolio.Butasmoreandmorecasesemerged,itbe-cameapparentthatthe“bizarrepalsy”thatwasreferencedinthemusicofthetimewasduetoadifferentcause.Autopsiesofjakelegvictimsrevealedcentralnervousdamagetotheanteriorhorncells,similartothepa-thologyobservedinpolioandamyotrophiclateralsclerosis(LouGehrig’sDisease).Inaddition,thespinalcolumnpyramidcellswerealsoinjured,whichmayhavecausedthespasmandrigidityobservedinpatients.Someregainedmobility;others remainedimmobile though higher brain functionwaspreserved.

Fingersstartedpointingtojakeastheculprit of themysterious condition, and

“


“When Ismon Bracey, a blues singer, mentioned jake leg in his 1930s song, he was referring to an epidemic that swept through the United States during the Depression, which left thousands of men limping from paralysis and suffering from impotence.”


MUSIC AND MEDICINE

From Mind to HeartA Healing Musical Journey

Gary Malkin

“Love and intimacy are the root of what makes us sick and what makes well, what causes sadness and what brings happiness, what makes us suffer and what leads to healing.”—DeanOrnish

T here’s anold adage that says themostsignificantjourneywe’llevermakeinthislifeiswhenwetravel

thedistancefromourmindstotheregionof our hearts. Throughout the world’sspiritualdisciplines, theactofdeepeningour relationship to theHeartand to themanyexpressionsofLoveisconsideredtheepicenterofalltruehealing.Itismybeliefthatmusic,especiallywhenplayedorcre-atedwithanintenttosoothe,inspire,andheal,has thepower toawakenus to thisinherentbirthrightweallshare,thisinnatecapacitytoloveandbeloved.

After nearly fifty years of creatingmusic, I’d liketo shareabitofwhat I’velearnedaboutitshealingpower,especiallywhenthemusic is intendedtoserveasacatalystforthefeelingsassociatedwithlove,forgiveness,compassion,andgratefulness,tonameafew—resultinginapalpablecon-nectionwithourselvesandothersinwaysthatcanmeasurablyacceleratehealingonmanylevels.

The Primacy of Listening Ofalltheartforms,musicisanaston-

ishingemotionallanguagethatcommuni-catestousinthemostvisceralandimmedi-ateofways.Throughpowerfulvibrationalfrequencies, timbres,harmonies, rhythms,andmelodies,weinnatelyrespondtomu-sicinwaysthatwe’reonlyjustbeginningtounderstand.FromtheBigBangtothevibrationalfrequencyoftheearthtoeverysoundandwordwe’veeverheardorspoken,everythingweareandeverythingweknow

isakindofmusic,basedonvibrations.Infact,vibrationisthecommondenominatoroftheuniverse.

Therefore,Ifinditnomerecoincidence

thattheveryfirstsensehumansdevelopinuteroishearing,andtheverylastsensetogobeforewetakeourlastbreathishearingaswell.Thisbiologicalfacthasalwayssug-gestedtomethat,forhumanbeingsatleast,thereisakindofprimacytoourlisteningsense.Musicallowsustoexperiencelife’scomplexitiesinalanguageallitsown,espe-ciallyeffectivewhenattemptingtoexploreourrelationshiptotheunseenworlds,withGreatMystery,andwithLoveitself.

Our Obsession with Visual Stimulation

Whenyoulookatthecontemporarymodalities forhealing(conventionalandintegrative),specificallyregardingproactivestrategiesthathavebeenshowntoinspireemotionalstatesofcontentment,connec-tion,anddeep relaxation(whichcanbeusefulinthemidstofhealingcrises),thesepsychosocialstrategiesareoftencompletelyignored,or, atbest, regardedas superflu-ous.Acursory lookat theverydesignofmosthospital rooms,with theubiquitous

televisionsetsprotrudingoutofeverywall,demonstrateswhathealthcare’sprioritiesare,withrespecttocreatingenvironmentsthataresuitableforhealing.

And why are televisions literallyeverywhere inhealthcareenvironments,whileinstitutionalmusic-playingdevicesareofteninraresupply?Oureyes(incahootswith theparts of ourbrain thatprocessinformation)use90percentofour lineardiscriminative faculties, constantly seek-ingdatathatcanfunnelthroughouropticnerves,endlesslyravenousforstimulation.This cultural obsession with our visualportalsoftensuccessfullydistractsusfromwhatwe’refeeling,preventingusfromeveruncoveringthepartialtruththatweare,inessence,existentiallyalone,andthatweare,infact,goingtodieoneday.

Ironically, what this cultural biastoward constantvisual informationalsodoesisdepriveusofthesimplebeautyofpresenceand silence,of reverieandofawordlessconnectionwithothers,andwiththeremarkableatmosphericandemotionalbenefitsofmusic.Thereforewithinhealthcare,despitebestintentions,veryrarelyaretheemotionalandspiritualdimensionsandtheircorrelationtohealingaddressedinef-fectiveandmeaningfulways.Somehow,theabsenceofsoundthatawakensourheartsand spirits isoftenoverlookedand,evendisregarded.

Love as an Immune System TonicWhile there’s reams of evidence

supporting the revelations in thefieldofmind/bodymedicine,andof thevalueoffeelingconnectedtosomethinglargerthanourselves, our culture’s institutionshaverelegated theseheretoforeunquantifiable


“Through powerful vibrational frequencies, timbres, harmonies, rhythms, and melodies, we innately respond to music in ways that we’re only just beginning to understand.”


mattersofthehearttothemoreanalyticalmentalhealthfields,ortoourfaith-basedin-stitutions.Historically,rarelyhavethetwain(therealmsofhealthcareandexperientialmodalitiesdesigned to inspire feelingsofLoveandwell-being)formallyoverlapped.Infact,thethoughtthatanyobstructionstofeelinglovecouldinanywayundermineourabilitytorespondtohealingprotocolsis something thathasbeenviewedwithcynicismandderision.

However,thetimesarechanging.

One Family’s StoryAfewyearsago,Ireceivedacallfrom

amanwhohadjustlosthiswifethroughaprotractedillnessandend-of-lifeprocess.Itwasadayafterthememorialservice,andfromthesoundoftheelationinhisvoice,onewouldnothavethoughtthatthismanhadjust losthis lifepartneroffiftyyears.Butheproceededtosharewithmeadeeplymovingstory.

Thisman,whom Iwill callBernie,hadfoursons,allembroiledinanastyfeud.Thisfeudwasofsuchproportionthatnotoneofhis sonswould toleratebeing inoneanother’spresence,includingintheirmother’shospitalroom,eventhoughtheirmother,Sarah,wasseriouslyill.Thisfeudhadbeengoingonforyears,andIcanonlyimaginethedespair,frustration,andexhaus-tionBerniewasgoingthrough.Therewashisbelovedwife,sickwithalife-challengingillness,probablyonthethresholdofanend-of-lifeprocess,whileallofhissonsremainedstaunchlycommittedtotheiranger,totheirself-righteousness,andtotheirdetermina-tionnotto“cavein.”

Duringthis time,adear friendcametothehospitalroomtovisitwhileoneofthe sons was present. This friend camein, turnedoff the television,and,as luckwouldhave it,broughtwithhima smallCDplayer,onwhichhestartedplayingtheinstrumentalmusicfrom Graceful Passages, oneoftheprojectsforwhichIcreatedmu-sicspecificallytoassistpeopleinsoothingfearswhiletraversinglife’stransitionsandchallenges.

Afterafewminutesofallowingthemu-sictogentlypermeatetheroom’sambience,somethingbarelyperceptiblestartedtoshift

theroom’semotionaltonality,subtlycallingforthfeelingsfromdeepwithinthesonwhowaspresent.Hequietlystartedtocry,feelingtheweightofhismother’sillness,perhapsforthefirsttime.Andthen,somethingsurpris-ingoccurred.Hewokeuptothehorrorofwhatheandhisbrotherswereperpetuatingbyremainingoutofcontactwithonean-otherduringthischallengingtime.Withinafewhours,hesummonedthecouragetocontacttheonebrotherwithwhomhehadatinyopening,askinghimifhewouldbewill-ingtojustlistentosomemusictogether.Inthatroom,theysattogetherforthefirsttimeinyears,listeningquietlytothismusic.Andastheydid,theymutuallyacknowledgedtheshiftingtectonicplateswithintheirhearts,graduallymoving towardoneanother inspiteofthemselves.

Bernietoldmethatonebyone,adif-ferentbrotherwasinvitedtolistentothismusic. It tookallof forty-eighthours foreachofthefoursonstocometotheirsensesandgetoutoftheirpettypositionsinordertoshowupforaneventintheirfamily’slifethatwouldberememberedforever.Forthenextmonth,theylaughedtogether,criedtogether, forgave one another together,listenedtomusictogether,and,mostim-portant,lovedtheirmothertogetherasshefoundherwayhome.

While telling me this story on thephone,Berniewasbynowintears.Tearsofgratitudetomeforcreatingthismusicthathadbecomeanindeliblepartoftheirjourney,tearsofjoyforbeingapartofhelp-inghisfamilyhealitswounds,andtearsoffulfillmentforhelpingthemalllearntobeafamilytogetheragain.AndIwasintears,notonlybecauseoftheenormoushonorhehadbestoweduponmebysharinghisstory,butalsobecauseof theextraordinarygiftI’vebeengiventousemusicasalanguageforloving,forhealing,andforsupportingpeopletorememberwhatmattersmostinthislife.

Healing Environments with MusicWelive ina timewhen revelations

in neuroscience, quantum physics, andmolecularbiologyhavesimplynotyetbeenintegratedintothewayweliveandthewayweapproachhealing.Wenowknowthattherearesubtleyetsignificantfactorsthat

canaffecthowwethink,feel,learn,grow,andrelatetooneanother.However,we’velivedinaCartesianparadigmforsolong(“Ithink,thereforeIam”)thatcavalierskepti-cismstillautomaticallygreetsanysuggestionthatouremotionalandspiritualstatescansignificantlyinfluenceourimmunesystem’scapacitiestorecoverfromdis-ease,andactu-allyassistinourhealingprocess.

Musicisoneofthemostunderestimat-edhealingmodalities,especiallywhenusedsubtlyasanenvironmental support tool,thewaythatitwasusedinSarah’shospitalroom.Whentherightmusicisintegratedsensitivelyitcanhelpusunravelourfears,softenourabilitytofeelagainandbecomeopentolookingattheglassashalffullforachange.Andasyou’veseenwithBernie’sfamily,itcaninduceemotionalstatesofbe-ingthatcoulddramaticallyandbeneficiallyinfluencetheoutcomeofseeminglyintrac-tablesituationsandcircumstances.

Whenyoucanusemusic,subliminallyorovertly, to instilldirectexperiencesofwhatculturalanthropologistAngelesAriancalls “the Arms of Love”—compassion,service,kindness,appreciation,forgiveness,andpresence, for example—chances areyou’vesignificantlyincreasedthepropensityforhealing,ifnotofthebody,thenmostassuredlyoftheheartandsoul.

Nexttimeyoufindyourselfinanen-vironmentwheredis-easeispresent,allowyourselftoexperimentwiththisphenom-enonbyintegrating,howeversubtly,deeplysoothingmusicthatyoutrulyloveintotheenvironment.You’llseethatmusiccanpro-videapowerfulsupporttoolforthehealingjourney,keepingusopen,porous,humane,andgratefulforbeingalive.

Gary Malkin is an Emmy award-winning composer and producer whose career in film, television, and commercial music spans nearly thirty years. As founder and creative director of Wisdom of the World and as cofounder of the nonprofit Companion Arts, he brings his passion for social change and spiritual aware-ness to the world by using the power of music and spoken word to create innovative tools for contemplative practice, as well as for cultivating spiritual and emotional wellness. Malkin’s work has gained national attention through the book and CD set GracefulPassages(coproduced by Michael Stillwater).



MUSIC AND MEDICINE

Life in the VortexIntroductory Notes of Physician-Musician

Bruce S. Victor, MD

I t’snot clearwhen the transition tophysician-musician really occurred.Perhaps it started about four years

ago,when Iwas lookingat awebsiteofwell-known guitar makers. Amid thewonderful guitarswas a reference to thegeneralmanager’s ten-year-olddaughter,whohad recentlybeenhospitalizedwithjuvenile-onsetbipolardisorder.Withouttheawarenessofsomethingaudibly“clicking,”IwasquiteclearthatIneededtoorganizeabenefitconcertforthisgirlandherfamily.Afterall,IhadbeentheChairmanoftheProfessionalEducationCommitteefortheNorthernCaliforniaPsychiatricSociety,I’dgivenmorethanahundredtalksonmooddisorders, and—hell, Ihadbeenaguitarplayerformorethanfortyyears.Therewasno subjective feelingof actual decision,becausetherewasnoconsciousexperienceofdeliberationthatprecededinitiatingthiscourseofaction.

In retrospect, then, the transition toPhysician-Musicianinvolvestrustingapartofone’sselfthatisnotalwaysencouragedbythemoresandareasofcerebralemphasisthathaveachievedvalueandemphasisinpsychiatricculture.Itinvolvesdoingthingsthatwillnotalwaysseempurposiveorra-tionalatthetime.ItisanalogoustobeingKevinKostner’s character in themovieField of Dreams:“Ifyoubuildit,theywillcome.”Inchoateasarethedictatesofthisaspectofone’spsychospiritualdevelopment,thereisthesensethatoneignoresthematone’speril.

Theconcertwasagreatsuccess.Icol-laboratedwithmusiclegendsJohnSebastianandDavidGrismanandfeltthesynergyoftheirenergybehindtheoveralleffortandtheenthusiasticresponseoftheaudience.Itwasa“healingcommunity”indeed,forthose

hours.However,thisconcertthentrippedoffastringofseeminglycoincidentaleventsthatledtomyhosting(andcontinuingtohost)aseriesofhouseconcerts.Thisconcertseriesiscalled“TheAcousticVortexHouseConcertSeries,”named(byStevieCoyle,amasterfinger-styleguitarist)forthiswhirl-ing,unseenforcethatseemstolinkpeopleandeventsdespitethemselves.

Theestablishmentoftheconcertse-ries,inturn,triggeredaseriesofeventsandmeetingswithothermusiciansandmusicaficionados that led theAcousticVortextocompriseanever-expandingcollectiveofpeoplewhoarepresentfor,and do thingsfor,othersthroughmusic.MostofthemusiciansintheVortexhaveplayedconcertsforBreadandRoses,anorganizationstartedbyMimiFarinathatbringslivemusicandotherformsofentertainmenttopeopleininstitutions(visitwww.breadandroses.org).InDecem-ber2007,membersoftheAcousticVortexputonabenefitconcertforBreadandRosesinconjunctionwiththebreathtakinglytal-entedTuckandPatti.NewYear’sEvewasspentplayingatadrugrehabilitationcenter.AMay23concertatthe142ThrockmortonTheatre (www.142throckmortontheatre.com)inMillValleywillalsobenefitBreadandRoses.AndtheAcousticVortexwillcontinuetostagebenefitconcertsforsocialorganizationsthatreachouttoimprovethelivesofothers.

ThegreattheologianAbrahamJoshuaHeschelwrote,“WhenIwasayoungman,Iadmiredclevermen;nowthatIamolder,Iadmirekindmen.”Perhapsthetransitionfromphysiciantophysician-musicianparal-lelsthatsenseofpsychospiritualgrowthtowhichRabbiHeschelreferred.Isimultane-ouslyhonorbutacknowledgethelimitationsofpsychiatrictrainingandphysicianhood,

aswellasreconceptualizewhatit’sabout.Andthishasgrowninparallelwith,andhasbeenprofoundlyinfluencedby,myrecentdevelopmentasamusician.

When I was young, I admired clever men.… Theallureofpsychoanalytictheorywas itsbelief inthepowerof“insight”asbothtransformativeanliberating.YetnearlyabsentfromFreud’swritings,aswellasthoseofhisacolytes,isanyreferencetoaltruism,empathy,evencompassion—thusquietly,covertly,butnolessinexorablyreifyingthe“clever”or“insightful”manastheontologictouchstone.Evenfurther,therelentlessre-ductionismofFreudandhisfollowers,whileprovidinganinterestingstartingpointinmysearchforthemeaningsofbehavior,becameanalogousto(inthewordsofWoodyAllen)“takingallof themusicanddancingoutofMy Fair Lady andturningitbackintoPygmalian.”Andwhiletheefficacyofrecentpsychopharmacologicadvanceshelpedelu-cidatetheimportanceoftherightcarburetormixatthesynapses,ittoolackedatheoreticfulcrumbywhichwecouldunderstandbothtranscendentexperienceandmoreprofoundinterconnectionwithoneanother.

However,my increasing fascinationwith and subsequent studyof the inter-relationshipbetweenmusic,healing,andthenatureofenhancedhuman intercon-nectionbeganon thedeckofmy friendStevieCoyle.OnonebeautifulmorninginMay,weareplayinga guitarduetona tuneentitled(I’mnotmaking thisup)“OneMorninginMay.”Wewereplayingincomplementarytuningsandtheharmonysimplyemerged,withoutamusicalblueprintorbattleplan.Sure,IwaslisteningtoStevieandhad someforethoughtregardingwhatIwasgoingtodonext;itwasn’treallyoneof



thosemystical fusionexperiences,despitetheaforementioneddeck’slocationindeep-estMarinCounty.

ButIbegantowonder,howisallthisharmonypossible?Howdidwetune intoone another?And is thewaywedid somusicallyametaphorforhowindividualscan“tune intooneanother”without in-strumentsintheirhands,conversingratherthansinging?

Itoccurredtomethatcertainfactorsthat are theprocess and theproduct ofsuccessfulpsychotherapyalsoapplyinthiskindofmusicalexchange.Foropeners,theprocessispredicatedonareductionofanxi-etyabouttheprocessitself.IfIwasanxiousabout judgmentor retribution for eitherwrongnotes,excessiveornamentation,slip-pingoutofrhythm,oranyoftheothermusi-calinevitabilities,thenmyfingersandhandwouldlosethedexterityneededfordelicatefinger-picking.Plus,anypreoccupationwiththecontentsofmyownmindwouldhavemeantIwouldn’tbeabletoreallyhearSte-vie.Further,whileIprobablyhavemyownidiosyncraticsoundandintonationwhenIplay,Icanneitherbeweddedtoitnorbeunabletomodifyit—indeed,IneedtoplaywithitasIplay.

Further,therewas—asinanygoodpsy-chotherapy—anunderlyingstructurehere:agreed-uponrulesabouttryingtostayinthesamerhythm,aboutplayingprettymuchthesamechords(evenindifferenttunings)orcomplementaryones,andaboutfollowingwhenthespiritmovedoneofusfurtheroutonaharmonictrail(withareciprocalobli-gationonthepartofthetrailleadertomakesurehedidn’tlosethefollower).Andtherewas also an implicit understanding thatadherencetothestructuremadeitpossibletobarreloutofone’sownconfinesinawaythatproducedmoreeuphonyandharmonythanpropulsive,cacophonousescape.

SittingonStevie’sdeck, it thereforestruckmeasunfortunatethatpsychiatristsandnonmedicalpsychotherapistshavepaidso little attention to the transformativepowerofmusic—especiallyasitactsupontheplayer,notjustthelistener.

It is similarlyunfortunate thatmostpeoplebelieve that a certain amountof“talent” is theprerequisite forpermitting

oneself tocontinue inmusic.HowmanytimeshaveIheardinmyownpractice,“Iloveplayingmusic,butIquitbecauseIjustwasn’tgoodenough....”

Ofcourse,self-denigrationandhope-lessness,nomatterhow focused,circum-scribed, or even seemingly rational,hasalwaysconstitutedaclinical focus foruspsychiatrists.Patients feel isolated,alone,and especially anxious that their senseof isolationand lonelinesswill continue.Partof thecoreof thedynamicbasis forthesepainfulstatesisthefeelingthatoneisn’t“goodenough”andwillthereforebesentenced(evenasself-fulfillingprophesy)to,inthewordsofH.D.Thoreau,“livesofquietdesperation.”

Inmyownpractice,Ihaveseenthisdisqualificationfromparticipatinginmusictakennotonlymetaphoricallybutliterally.Andtherewasmuchhealingtobehadinaddressingbothsimultaneously.Albert,forinstance,wasafifty-year-oldmanwhoseob-sessiveself-recriminatoryruminationsanddepressionhadkepthimfromenjoyinglife.While therewere soliddynamic, familialreasonsforhisself-contemptandhopeless-ness,theactualsymptomsofhisdepressivedisorderrequiredprodigiousdosesofProzacandBuspar.Butstilllifewasjoyless,almostcolorless. Last year he mentioned thattheonlythinginlifetogivehimanyrealpleasurewasEnglishmadrigal singing—astatementhemadewithoutrealizingthatIwasabouttodevotemyselftoasix-weekmusicalsabbatical.

Overthenextfewmonths,however,AlbertpurchasedandbegantouseaniPodthatprovidedhimwithareadysourceofmellifluousauditory stimuli thatgaveanalternativetothenastycommentaryofthemalevolentGreekchorusinsidehishead.Hebecamehappier thanIhadever seenhim.Herealizedthat“musictakesmeintothemoment,intothepresent…andIthenrealizedthatwhatwasinsidemyheadwasneitherinthemomentnorinthepresent….Ithelpsmebealignedwiththatwhichisbeautiful.”

AscomedianEmoPhillipsoncenoted,“Iusedtothinkthatthemindwasthebestpartofahumanbeing…untilIrememberedwhatwasgivingmethatthought.…”Thisstatementisafittingreminderthatpsyche

referredto“soul,”not“mind,”despitethemodernconflationofthesetwoentities.AsIcontinuetoevolveasaphysician-musician,Iincreasinglyseetheoverlapofspiritintheserviceofhealing.InmusicIamremindedofmytrueprovinceasapsyche-trist.

Bruce S. Victor is Clinical Professor of Psychiatry, School of Medicine, University of California at San Francisco; he also maintains a private practice in San Francisco.

investigatorsfromtheHygienicLaboratory,thepredecessorofNational InstitutesofHealth,finallyanalyzedthechemicalcom-positionofjakelaterin1930.Subsequentanalysisuncoveredtriorthocresylphosphate(TOCP),aplasticizerthatwasbeingaddedtoincreasesolidcompositioninjaketomeettheTreasuryDepartment’sorderthatsolidsinpatent-medicinesbedoubled.TOCPwasacheapandeasysolutionthatincreasedthesolidmasswithoutalteringthetasteofthejake,whichiswhatmadeitsoattractivetocustomersdespitethetoxiceffects.

Themusicofthetimealsoconveysapowerfulsocialmessageaboutjakeandthegovernment:“Youthoughtthelivelymanwoulddiewhenyoumadethecountrydry,whenyoumadeitsothathecouldnotgetanotherdropofrye.Well,Iknowyouwillfeelbadwhenyouseewhathehashad….He’sgotthosejakelimber-legblues.”TheMississippiSheikhscapturetheprevailingantiprohibitionviewofmostvictims,whoattributed theircondition toa restrictivegovernmentpolicythatledindividualstodesperatemeasures thathad irreversibleconsequences.

Thecollectivevoicesofthetimechron-iclemorethanthehistoryofjake,paralysis,andgovernmentdisapproval.Their songstellastoryofvictimsaffectedbyadisease,andtheirvoicesrevealthepowerofmusictoconveyacautionarytaleandvaluablemedi-calinformationthatmighthaveotherwisegoneoverlooked,nevermakingitintotheannalsofmedicalepidemiology.

Eisha Zaid is a first-year medical student at the University of California at San Francisco.Works Cited: Baum,D.Jakeleg:Howthebluesdiagnosedamedicalmystery.The New Yorker. 2003;9.5:50-57.

Jake Leg Continued from Page 28...



MUSIC AND MEDICINE

Doctor of Harmony Care of Musical People and Musical Hands

Robert E. Markison, MD

I nitial Interest, 1960: Finger Flexors and the Physics of WoodwindsThreeyearsafterourfamilyacquireda

hi-fisoundsystem,Idevelopedafanaticalinterestinclassicalandjazzclarinet,listen-ingendlesslytotheclassicalrecordingsofBritishclarinetistReginaldKellandFrenchclarinetistGervasedePeyeralongsidejazzrecordingsbyBennyGoodman,ArtieShaw,andBuddydeFranco.

Fortunately,myclarinetteacher,PeterFerrara,wasequallynimbleatplayingclas-sicalmusicandjazz.Unfortunately,Imadeamessofthemidrangeoftheinstrumentbecausemyrightlittlefingerwassimplytooclumsytomovefromthelowerregistertotheupperregister.Mypinkystumbledallovertheclusterof fourkeysas it triedtoworkindependently.Iplayedinthethirdclarinetsectionintheschoolbandandfeltthattherewasnohopeofreachingthefrontoftheline.

Ilaterlearnedthat37percentofpeoplearebornwithhandswithcongenitallinkageof theringand littlefingerflexor tendonsystems, certainlyablight for afledglingclarinetistandofnoparticularconcerntoyoungtrumpeter.

Nonetheless,1960wasarathermagicalyearbecauseitincludedthepublicationofA.H.Benade’s“PhysicsofWoodwinds”inScientific American.The landmarkarticledescribed the acoustics and mechanicsofwoodwind instruments,and itbecameobviousthatareasonablyadventurousandmotivatedpersoncouldbend some ruleswithoutcompromising tone.My teacherencouragedmeinmystudiesofinstrumentmodification,includingmetalcastingandmetalandwoodmachiningandsmithing.Imanagedtoscaledowntheclarinet’sright

littlefinger-activatedfour-keyclusterto75percentofnormalsize,therebyreducingtheneedforindependenttravelofmyrightlittlefinger.Thesuddenimprovementinmyplay-ingfortifiedmybeliefintheworkabilityofthehuman-musicalinstrumentinterface.

Forty-eightyears later, I remainen-thusiastic about design of new musicalinstrumentsandhandtools,modificationofexistinginstruments,andmusicaltechniqueacrossvarious instrumentalcategories, aswellashandsurgeryandmedicine,thestudyofbrain-handlinkagesandbiomechanics,and long-term follow-upona fascinatinginternationalpopulationoffinemusicians.

Mistakes Musicians Make, and How to Correct Them

Cold hands: Much of medicine isfocusedontheintegrityofcerebrovascularandcoronaryflow,butIhumblyadviseat-tentiontovascularhomeostasisoftheupperlimbs,becausebloodflowmattersgreatlyin the supportof largeand smallmusclerepetitiveusageand static loading.Coolhandsoften fail, andwarmhandsgener-allyprevail.Cool-handedmusiciansbenefitfromwearingcustom-madefingerlessgloveswheneverthehandsregisterascoolonthecheeks.Keyboardandstringplayersdonotbreatheaswellaswindplayers,sotheymust


Bob Markison, MD, with his new custom-designed twelve-string lap steel guitar.


be taught diaphragmatic breathing and“breathing theremusicalphrases.”Manyplayersfoolishlyavoidfoodordrinkbeforeperforming,runningtheriskofdehydrationandshrunkenperipheralvascularvolume.Allplayersareadvisedtoprehydratewithnoncaffeinatedbeveragesbeforeanyprac-tice,rehearsal,orperformance.

Inappropriate warm-up:Manymusi-cians jump intoHanonexercises,Paga-niniCaprices, or similarlydauntingandhand-injuriouswarm-upexercisesbeforechecking theirhandtemperatures, sittingorstandinginanidealandrelaxedposture,orgeneratinglongtoneswithminimalkeyorstringpressure;andfewarefocusedondiaphragmaticbreathing.Iadvisemusicianstorecordtheirwarm-uproutinesandbringtheaudioorvideoto theircolleagues forkindcomment.

Too much finger force:Biofeedbackhasmuchtooffermusiciansofanyage.Thegoalofanybiofeedbackistosimultaneouslymonitor temperatureandproximal/distalmuscularEMGactivity.Patientsquicklylearnthatproperpostureandrelaxeduseofstaticallyloadedandrepeatingmuscle-tendonunits result inmuch lesseffort inmasteringtheinstrument.This“leastforce”conceptappliesequallytoallmusicalinstru-mentsandmusicians.

Overpractice and failure to self-record: Serious youngmusicians assumethattheonlywaytoscalethepsychophysicalmountainsofrepertoireistospendfourtoeighthoursperdayattheinstrument.Iamlucky tocare for a fairnumberof youngprodigies, some of whom dare to spendeighttotwelvehoursperdayatthepianoorviolin.

Iadvisemusiciansofallagestorecordthemselves, and they can compress therecordingsdown to .mp3files and listento themon their playbackdevicewhiledoing somenonmusical activity. Ideally,theyshouldplayfortentofifteenminutes,listenbacktotherecording,andthenrepeatthecycle.

Neglecting ambidexterity:Iamcon-stantlysurprisedthatthegeneralpopulationdoesnotcultivateambidexterity.Extremesingle-handeddominance is risky for thedominantpartandperhapsevenriskierfor

theoppositehand in theevent that thedominanthandisinjured.Musicalpatientsareadvised tocultivateambidexterity inandoutofmusic,writinganddrawingwellwitheitherhand,executingpianokeyboardpassageswitheitherhandorbothhandssimultaneously,right-andleft-handtrumpetplaying, intentionaluseof a left-handedguitar, ambidextroususeof silverwareorchopsticks.Thosewhoheedthisadvicearerichlyrewarded.

Inability to improvise and compose:Manyclassicallytrainedmusicians,particu-larlykeyboardandstringplayers,areafraidto improvise and rarely compose. TheyacknowledgethatBach,Beethoven,Mozart,Schubert,Ellington,Parker,Coltrane,anddozensofothercomposershavealsobeenextraordinaryimprovisers,buttheyhavenotlearnedorevencaredaboutimprovisingintheirownmusicalworks.Iremindthemthatfailuretocomposeapicturewouldleaveapainterorphotographeroutofwork.

Focus on a single style or idiom:Ihaveneverforsakenmyclassicalmusicaltraining,andIremaincomfortableplayingclassicalmusic,butIcertainlydonotregretcultivat-ingfluencywithinothertypesofmusic.

Single-instrument focus:Itisalwayssurprising to learn thatmanyorperhapsmostmusiciansdonotplaymultipleinstru-ments,oftenforfearof“diluting”theirpowerortechniqueonaprimaryinstrument.DizzyGillespieadvisedallwindplayerstostudythepiano.Curiously,pianistsdonotadvisestudents to studywind instruments.Eachinstrument category informs theothers.Abasicunderstandingofguitar fretboardlogichelpsexplainmuchofwhatisdoneonthepianokeyboard.Thenaturalsoundfrequencyspectrumgeneratedbyeachvalvepositiononatrumpetcanfurthertuneanddeveloptheearofaviolinistoranyothersingle-noteorpolyphonicinstrumentalist.Ioftenvarymyowninstrumental“parcourse”withinpracticesessions,generallyrunningthefollowinginstrumentalsequence:drums,parallelandcontrarysinglelinesonthepia-no,pianochords,cello,acousticorelectricguitar,twelve-stringlapsteelguitar,endingwithawind instrument suchasclarinet,saxophone,Englishhorn,ortrumpet.Eachoftheseinstrumentsinformstheothers.

Failure to pursue other arts:Miles

Davisbuiltacareeronwell-chosennotesand carefully schooled silence betweenthosenotes.Healsopainted.IrvingBerlincopyrighted917 songs,and thendecidedtopaint.DjangoReinhardtwas theonlyoffshorejazzmusiciantosubstantiallyinflu-encethecourseofAmericanjazz,andhealsopainted.Musiciansare“timesmiths”whoshouldbeequallyattunedtoworkinginspace.

Social reclusion:Beethovenspenthisfifty-sevenbrilliantyearsinsocialisolation.Ellingtonwalkedeasilyandeffortlesslyontheworldstage.Asurprisingnumberofmu-siciansfailtovaluegenuinesocialfluency,andIstronglyadvisethemtodevelopgreatfriendshipsandcollaborations.

Too much computing: Thrashingawayoncomputerkeyboardscanresultinunnecessarywear and tearon theupperextremities.PatientswithgoodcommandofEnglishshouldmastervoicerecognitionsoftwareinorderreduceunnecessaryhanduse.

Side effects of medication, neglect of general health:Over thepast thirty-oddyears,Ihaveseenaremarkablenumberofmusicianswhoeatpoorly,donotexercise,and suffer side effects frommedications.Thirty-threepercentof statinconsumerssuffersideeffects,mostlyachesandpains;thisisparticularlytroublesomeintheupperlimbsofmusicians.Iroutinelyrecommendthatmusiciansfindaprimarycarephysicianwhohasplentyoftimetoaskquestions,andwhoordersappropriatebloodtests.

Coda: Physiciansandmusicianshaveagreatdealincommon.Theyhavestudiedhard tobuild repertoire, style, judgment,andeven someESP.Andthegoodoneslovetolisten.

Dr. Markison is a solo practice hand surgeon in San Francisco. He is also an As-sociate Clinical Professor of Surgery at UCSF. He studied music composition at Julliard while majoring in biology at Columbia University. His book, entitled Creativity and Health, should be available soon.



MUSIC AND MEDICINE

Living Both Music and MedicineWhere the Two Practices Intersect

As Told by Various San Francisco-Based Physician-Musicians


suchasgoingout forfootballormarchinginmyhighschoolband;taking adate to thepromorplayinginthedanceband;acceptingadrummajorscholar-ship or becoming aphilosophymajorandpremedstudent.

The time de-mands of college,medical school, andresidency increasedpressureonmyrehears-al time,andI shiftedfromperformingwithsymphonyorchestrasandconcertor showbands to jazz groups.

Mymusicalmemoriesechowithmomentsofperformanceanxiety and rewardovertheyears.TakingabowasthedrummerforthePrincetonTriangleShowannuallyonBroadwaywiththepitbandto inaugurateourten-cityChristmasHolidayTour,andhearing theapplauseechoafterperform-ingatCarnegieHallwithourjazzcombo,theMinstrelsofModernJazz, topthe list.Anotherhighlightwasmyannualsummertrans-Atlantic gigsonHolland-AmericaLinestudentships,whereseasicknessneverinterferedwithasingledrumsolo.Freepas-sageaffordedmetheopportunitytospendtheremainderofmyvacationappearinginEuropeanjazzclubswiththeband,anexpe-riencethathas inspiredanongoing“havedrum,willtravel”attitude.

InmedicalschoolIfoundmyselfdrawntoneurosurgeryasaspecialtybecauseofawonderandfascinationwithhowthebrainworks,aswellasthekinestheticandintellec-

tualchallengeofdoingsurgery.Neurosurgeryhasapace,rhythm,andflow.Likedrumming,doingsurgeryisaperformancepiece.Ittakesyearsofpracticetodowell—but,surprisingly,notnearlyasmanyyearsasplayingmusicrequires.Theallureformewasthemeldingofphysicalactivitywithintellectualproblemsolvingandemotionalsatisfaction,muchlikeplayingjazz.Eachoperationhasanopening,acriticalportion,andaclosure,similartotheintroduction,development,andfinalchorusofajazzpiece.

Performingeachisanintense,sponta-neous,disciplined,andtimelessexperience.Thereisarepetitiveformat:anartisticimpro-visationofamelody,harmony,andrhythminjazzandananatomicalimprovisationofrepairofbrain, spine,andnerve function(whenpossible) in surgery.Theresults inbothoftheseendeavorsareoverwhelminglysatisfying.

So ineachof these realms, “I’vegotrhythm!”Cherishedfriendshipsandcollec-tivememoriesformedonstageandinsurgeryare treasured rewards.Recently Ihad theopportunitytocombinethetwowhenourNeurosurgicalJazzQuintet(NJQ)hadtheopportunitytonotbepaidforperformance(P4P) in theSmithsonianAirandSpaceMuseumLobby,duringtheAmericanAs-sociationofNeurologicalSurgeons(AANS)annualmeetinginWashington,D.C.Aswefound,musicbindstogetherindividualsinacommunity.Rhythmcanintegrateheartsandminds.Therapeutically,musiccanfacilitatephotographicmemoryandrestoreaphasic-speech.Inthebrain,ithasgreatercorticalrepresentationthanlanguageand,accordingtosometheories,songanddanceprecededtheevolutionoflinguisticcommunication.FunctionalMRimagingstudiesdemonstrate

Philip R. Weinstein, MDPerformingneurosurgeryasaprofes-

sionandplayingdrumsasahobbyhappenindifferentworlds.Idothembothandfindeachcomplementaryandgratifying.RarelydoIthinkaboutonewhiledoingtheother,exceptwhenanoperationisrunninglateonaneveningwhenIhavecommittedtoajazzperformance.

Mypercussioncareerbegan inBalti-moreatagefive,aftermyfatheransweredaclassifiedadandboughtmeafour-octavexylophonefromaNavyensignshippingoutduringWorldWarII.Dadhadalwayslikedthemellowandlivelysoundsofawoodenkeyboardandhopedforvirtuosityonmypart.ToMom’schagrin,hefailedtopredicttheevolutionofthestudyofpercussionheofferedintoaroomfulofdrums,endlesshoursofprac-tice,andalifetimeofrhythmicexhibition-ism.Ultimately,thiscommitmentbroughtwith itmanyconflictingyouthfulchoices,


in-cheek “Scott Joplin/ColePorter/Don’tShootthePianoPlayerHe’sDoingtheBestHeCan”Award,sharedwithDr.Herb Peterson, with whomIhaveoftenplayedduogigs.OurSFMSAnnualDinnershavebeenamongmyfavoritevenues, playing for our col-leaguesduring thepredinnercocktailparty.

For me, playing pianohasbeenagreatwaytocon-nect with musical medicalcolleaguesandfriendsoldandnew.Playingpianohelpsmeexperiencethehere-and-nowmorevividly.Itevokesformeasenseofjoy,ofthepoignanceandpreciousnessoflife,awidespectrumoffeelingsandemo-tions,andthegreatpleasuresoftheimaginationandofcreativeactivity. Happily, it evokessimilar feelings inmypartnerand the loveofmy life,Dr.KristinRazzeca,confirmingmydiscoveryatagefourteenthatgirlslikepianoplayers.

“There’ssomethingtobesaidforkeep-ingatathing,”saidFrankSinatra.“Keepingat”playingpiano,alongwithhikingandreading,balancesmydailytherapeuticworkwithpatientswonderfully. I’mgrateful forthepartmakingmusicplaysformanyofusinthepracticeofthismostinterestingandusefulprofessionofmedicine.

Dr. Steve Walsh (pictured top right) is a private-practice psychiatrist in San Francisco and Mill Valley. He is past president of the SFMS, the Northern California Psychiatric Society, and of the UCSF Association of the Clinical Faculty. He is a member of the editorial board and of the psychiatric services committee of the SFMS.



Herb Peterson, MDWhatI’mabouttodescribeiscertainly

notunique tophysicians,or tomusicianseither.However, itprobablyhelps tobeoneortheother(orboth)toappreciatetheprocessabitbetter.

Ihavebeenaphysicianandpsychiatristformorethanfortyyears,andI’vebeenin-volvedinperformingmusicmostofthattime.Ihaveplayedinanumberofinformalandjazz

Steve Walsh, MDThreeor fouryearsagoIwasplaying

pianoforabenefitdinnerandauctionforalocalhighschoolfootballteam.Thecrowdwaslookingoverthedonatedgoodsanden-joyingtheconvivialityoftheevening.SFMSmemberDr.MelBlaustein’slovelywifeMari-lynsteppeduptomypianoandsaidsweetly,“Keepplaying,Steve.Youmakepeoplefeelthatlifeisgood.”Shemademefeelsomeofthatgoodlifewithhercomment,remindingmeagainwhyIloveplayingpiano.

I remembered thatatage fourteen Idiscoveredthatplayingpianoatsocialeventsattractedgirls.Thisgavemesolidmotivationtoplaymorepianoduringahormone-brim-ming Iowaadolescence.Previously Ihadresolutelydefeatedparentaleffortstotraintheiryoungprodigyinseriouspianoplaying.IthentookafewlessonsinnearbyDesMoineswithSpecRedd,anAfrican-AmericanpianogeniuswhohadplayedonMississippiRiverboatsinhisyouth.Ilovedhisrich,soulful,bluesystyleandtriedtoemulateit.OtherAfrican-Americanpianomen, likeErrollGarner,OscarPeterson,andHoraceSilver,havealsobeenimportantinfluencesforme.

Jazz improvisationandplaying showtunesandmusic for singinganddancingatpartiesarethemostjoyouspartsofmak-ingpianomusic forme.Done right, thiscan transformagatheringof friendsandcolleagues into a vivid and memorableexperience.Psychiatriccolleaguesrecentlyrewardedmytwentyyearsofplayingpianoatoursocialeventswiththeslightlytongue-

uniqueconnectionsbetweenthetemporallobeauditorycortexanddorsalprefrontalregions—connectionsthatarefoundonlyinhumans,whichmayexplaintheabsenceofrhythmperceptionandperformanceinlowerprimatesandothermammals.

Forme,drummingfeelsgoodandsoundsgreat.Itcelebratesthemotion,liferhythm,andcontinuity that Ihopetorestoreandsustain formypatientswithsurgical treat-mentofneurologicaldisorders.Staytunedformanyencorestocome.

Dr. Weinstein is Professor of Neurological Surgery at UCSF, Chief, Neurosurgical Service, Veterans Administration Hospital, and Principal Investigator, Brain and Spinal Injury Center.

situations,aloneandwithsmallgroups.Prob-ablymypersonalfavoriteisasettingwhereIplaysolopianoforasmallgathering,andtheyarekindenoughtolistenandrequestothersongsthatImightknow.I,inreturn,willsometimesplayanoldtuneandseeifsomeoneinthegroupknowsit.Thatpersonthengetstorequestmynextsong.Thentheprocessrepeats.Icanplayforhourslikethat,andsometimesdo.

In recentyears, Ihave taken specialprideinbeingabletoplayarequestforanobscuresong,onewrittenperhapsfiftytosev-enty-fiveormoreyearsago.Sometimesthe“bridge”orconnectingportionofthesongisthehardestparttoresurrect,bothformyselfand for the listener.But in recentyears,thisprocess seemstohavebecomeeasier,especiallyfortheoldermelodies.Iplayafewnotesandwait,andtheremainderwilloftenpresentitselftomymind.Ithenrealizeithasbeenthereallalong,butI’msimplynotinter-feringwithitsrecall.SometimesI’llawakenwithasonginmymindandwillquicklyrunandplay itbefore itbecomesobscuredbythepressureofdailyactivitiesandthoughts.Oftenmywifewillrecognizeandnamethis


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workonaprojectforawholeyearwithoutnecessarilyseeingtangibleevidenceofprog-ress, even ifprogress is indeedoccurring.Withmusic,youputintheeffort,youseearesult;whetherwearereferringtopracticingadifficultpassage,learninghowtoimprovetone,orwatchingideasfromyourheadandbeyondaccumulateonpaperinacomposi-tion.Forme, thisaspecthasbeenagreattonicforthefrustrationthatissofrequentlydominantinscientificresearch.

Butthemostimportantanddirectim-pactthatmusichashadonmyscientificlifeisthatitprovidesthebalancethatsomanypeoplelack.Scienceiscerebral;itisthink-ing,questioning,experimenting,doubting,proving,withmuchlessroomfor“feeling”thanonemightexpect from listening toCaptainKirkexplain toSpockabout theroleofhumanintuitionindecisionmaking.Itisthisanalyticalcomponentofourlivesthatbenefitsfromascientificcareer,butwearemorethanourcerebrums.Itellpeopleinmylabtotakebreaksfromsectioningtissuewithacryostattoavoidstrainingtheirback,takebreaks fromthemicroscopetoavoidstrainingtheireyes;andmusicallowsonetoavoidstrainingone’smindandallowsthemoreinnatepartofone’shumanitytotakeoverforawhile.

Onrareoccasions,Ihaveallowedthesetwoaspectsofmylifetocollide,usuallywithsurrealanduniqueconsequences.Takeforexample “TheMyoblastSong,”which Iwroteaboutmyresearchduringmypostdoc-toralyearsandwhichhasbeenperformedatmorethanafewconferencesandseminars;orthecoupleofscanningelectronmicrographsthatItookofmyviolinbowhairwhileIwastakinghundredsofotherpicturesoffungalsporesbackingraduateschool(seefigure).Butingeneral,Idomanagetoswitchgears,temporarilyforgettingaboutfrustratingex-perimentsandgrantproposalsandinstead

Matthew L. Springer, PhDI’mnot surehowloudly I should say

this,butIsuspectthatImighthavefinishedmyPhDthesisatStanfordacoupleofweeksearlierhadInotbeencommutingtoOaklandintheeveningstofiddleinthepitorchestraforamusicaltheaterproductionofBig River.Ievenhadaroleonstageasafiddler.Iwouldwritepartsofmythesisanddoexperimentsatlabduringtheday,thendriveuptoOaklandtochangeandputonthestagemakeup,playtheshow,washup,anddrivebacktoStanfordtocontinuewritingintothemiddleofthenightonthe“labcomputer”(whichgivesyouahintabouthowlongagothiswas).

Thiskindofdouble lifehasbeenafrequentoccurrencethroughoutmyyearsasascientist,althoughtypicallynotinvolvingasmuchmileage.AsaUCSFprofessor, Iunfortunatelydonothavetimethesedaystoparticipateinlong-termtheaterengage-ments,butIdostillmanagetoplayinthePeninsulaSymphonyandhavepublishedseveralmusicalarrangements,aswellasacoupleofarticlesforStrings Magazine.WhileI’vebeentemptedoccasionallytoaddthesearrangementsandarticles tomyCV, themedicalandmusicalaspectsofmylifeinter-twinebutusuallydon’tmerge.Todescribeitintwenty-firstcenturyterms,myhomepagehasonelinktomylab’swebsiteandanotherlinktomymusicwebsite,butyoucan’tmovedirectlyfromonesitetotheother.

Inwhatway,then,hasmymusichadanimpactonmyscientificlife?Well,ithasdonesoonseverallevels.Ononelevel,playingmusicaloneandingroups,andarrangingorcomposingmusic,enrichesmylifeingen-eral.Thatmaysoundlikeacliché,butasIdiscoveredduringmorethanhalfayearin2001–2002,whenIhadtocompletelystopplayingmusicduetoaphysicalproblem,lifedevoidofmusicalinvolvementwentfrombe-ingincolortobeinginblackandwhite.Onalevelmorespe-cifictoscience,it’s importantfor cliniciansto realize thatwhiletheycanwatch peopleget better inreal time, thelabscientistcan

Living Both Music and MedicineContinued from Page 36...songevenifIcan’t,sincemanywerepopularwhenwewerebothyoung.

Ireallycan’tclaimanyspecial“talent”forthis,forthefollowingreasons:Firstofall,itseemstobegettingstrongerasIbecomeolder,andthesongsareoftenassociatedwithjoyfultimesandexperiencesfromlongago.Second,otherfriendshavementionedthattheyexperiencethesamething,andforthemtoo,itappearstodevelopwithage.

And third, it seemsa lot likeotherformsofrecallthathavebeenreportedbymanyothers—thePOWswho,attemptingtokeep theirminds sharp,wouldenablethemselvestoremembertheentirecomposi-tionandseatingpositionoftheirgradeschoolclasses,ortheadultswhocanpaintentire,elaboratestreet scenesthat theyhavenotseensincechildhood.Dr.OliverSackshaswrittenaboutthis.It’ssimplythatmusicisverymeaningfultomeandhasalwaysbeenanimportantcomplementandbackgroundtomymedicalpractice;soit’snaturalthatitwouldbethe“language”ofmyrecall.

IwouldencourageotherstoprobeandexperimentasIhave,whetherwithmusicorwithsomeotherformofexperience.I’msureyou’llfindatreasuryofnearlyforgottenmemoriesawaitingyou.

Dr. Herb Peterson (pictured top left) is a Clinical Professor of Psychiatry Emeritus at UCSF.


focusingentirelyonplayingthemusicforawhile.Sometimesscalesareexercisestobepracticed,andothertimestheyareusedtoweighchemicals,buteitherwaytheyfunc-tionasabalance.

Matthew L. Springer (above) is an Assistant Professor of Medicine in the UCSF Division of Cardiology and a violinist/percussionist in the Peninsula Symphony. “The Myoblast Song” can be seen and heard at http://homepage.mac.com/matthewlspringer/MyoblastSongPointer.html.

Kirsten E. Fleischmann, MD, MPH, FACC

Iamamusician.I’malsoamother,physi-cian,wife,researcher,andteacher—butmyinvolvementwithmusicpredatesalltheoth-ers.Music,withitsabilitytobothreflectandshapemymood,hassupportedmethroughtherigorsofmedicaltraining,evenwhenitmeantgettingupat5:30a.m.toensurethatroundsandnotesweredonebeforeanafternoonperformance,orstealingawayfromarehearsalwhenthemutedbuzzofmypagercalled.Iambynomeansuniqueinthisdoublelife.

Inthiscallingtobothmedicineandmusic,IfollowinthefootstepsofeminentphysicianssuchasTheodorBillrothandAlbertSchweitzer.Billroth,awell-knownsurgeoninthesecondhalfofthenineteenth

century,wasalsoatalentedviolinistandclosefriendof thecomposer JohannesBrahms.Schweitzer,ontheotherhand,wasalreadyatheologianandaccomplishedorganistwhenhedecidedtobecomeamedicalmissionaryinFrenchEquatorialAfrica.Eventoday,doctors’orchestrasthriveinmanycities,payingtributetoanunseenhighwayconnectingmedicineandmusic.

Thisalsomakesmusicawonderfulwaytoconnectwithbothcolleaguesandpatients.AtarecentMessiahperformance,IfoundmyselfsmilingatastringplayerinoursharedjoyatperformingHandel’sclassic.Onlylater,atthereception,didIlearnthatshe,too,wasaphysi-cian,strugglingasIdotomaintainthispassionformusic, thisbelovedavocation,againstthedemandsofcareerandfamily.Anothercolleagueofmine,whoprofessesnospecialperformingtalent,nonethelesspossessesanencyclopedicknowledgeofclassicalmusicanditshistory,andIlearnsomethingfromeveryconversation.Theconnectionwithsomeofmypatientsisequallystrong.WhenImournedthelossofLorraineHuntLieberson’spowerfulvoiceandpresencewithapatientrecently,shenotonlycommiseratedbutthoughtfullybroughttohernextvisitacopyoftheNew Yorker’seloquenteulogytoLieberson.Othershaveappearedatmyconcerts,sometimesun-intentionallybutmoreoftentocheerontheirsingingdoctor.Whetherwearediscussingjazzsaxophone,hopesforanascentrockband,orthetranquilityofanunaccompaniedcellosuite,music formsinvisiblebondsbetweenpeople.Itisalanguagethatlargelytranscendsculturalandlinguisticbarriers,allowingforafullerandmorethree-dimensionalrelationshipwithpatientsandcolleagues.

It is saidthat thebrainsofmusiciansaredifferentthanthoseofothersinauditory,motor,andvisual-spatialareas,andthattheyhavea largercorpuscallosum(GaserandSchlaug2003).Asacardiologist,Ihavenofirsthandknowledgeinthisarea,butIdoknowthatmylifehasbeendifferent,andinfinitelyricher,becauseofmusic.Likemanyothers,Iplaymultiplerolesinlife.IliketothinkI’mbetteratallofthemthanIwouldbeotherwise,because“musician”isonthelist.

Dr. Fleischmann (Pictured lower right) is a cardiologist and Associate Professor of Clinical Medicine at the UCSF, as well as a mezzo-so-prano who performs in the Bay Area.

Medicine as Art: As Told by a Medical Student-Musician

Interview by Whitley HillPhotograph by J. Adrian Wylie

Jane Lee is a first-year medical student originally from Steilacoom, Washington, and a violinist with the Life Sciences Orchestra. The orchestra consists of members of the life sciences community from across the University of Michi-gan and is part of the Health System’s Gifts of Art program.

“IstartedplayingwhenIwasfiveyearsold.Initially,ittookalotofpracticeandrep-etition—andsqueaking.Beingaviolinisthastaughtmethevalueofyearsoftrainingandpractice,theattentiontodetailandallthetimeittakestoproduceafinishedproduct,tomasteraskill.Oncethefoundationisset,youdevelopyourownstyleandexpression.It’sthesamewithmedicine.That’swhyIlikethedepictionofmedicineasanart.

“TheLifeSciencesOrchestrawasahugedrawforme.Attheaudition,IaskedoneoftheorganizersifhetaughtintheSchoolofMusicandlearnedhe’sactuallyaprofessorofdermatology. Itgavemesomeperspec-tive—that I cancontinueplayingmusicthroughoutmymedicalcareer.

“I sawoneofmyprofessorsafterourlastrehearsal.It’sgreattobeabletotalktoheraboutmedicine,butalsotobeplayingmusicalongsideherwithoutbeinginahier-archy.”—JaneLee

Reprinted with permission from MedicineatMichigan Magazine.

2008 San Francisco Medical SocietyAnnual Dinner

HeldonJanuary24,2008,attheConcordia-Argonaut Club inSanFrancisco,the2008SFMSAnnualDinnerwasagreatsuc-cess!SFMSmembersenjoyafan-tasticmealwhileStevenFugaro,MD,was installedas the2008SFMSpresident.Dr.Fugarothenhonoredthefifty-yearmembersoftheSFMS,aswellasthePastPresidents and theSFMS staffbeforemovingontopresentthekeynotespeaker,StevenSchro-eder,MD.Dr.Schroederspokeabouthealthy lifestyle choicesandtheimportanceofreducingobesityandsmokinginAmerica.Asusual,theSFMSAnnualDin-nerwasa fantasticopportunityformemberstomeetandminglewithothermembersandisnottobemissednextyear!

Above: SFMS 2008 Officers from left to right:EditorMikeDenney,MD,PhD;TreasurerMichaelRokeach,MD;ImmediatePastPresidentStephenFollansbee,MD;PresidentStevenFugaro,MD;President-Elect Charles Wibbelsman, MD; andSecretaryGaryChan,MD

Below:SFMSMemberandEditorofSanFranciscoMedicine,MikeDenney,MD,PhD,playing thepianoalongsidehiswife,Leonie

Above:StevenFugaroandStephenFollansbeewithSFMSExecutiveDirectorMaryLouLicwinko,JD,MHSA

Top Right: SFMSPast-PresidentsXavierBarrios,MD,andArtLyons,MD

Our thanks to the following corporate sponsors who helped make the 2008 SFMS Annual Dinner possible:

CaliforniaPacificMedicalCenterChineseHospitalMedicalStaffKaiserPermanenteSanFranciscoMarshAffinityGroupServicesSaintFrancisMemorialHospitalSaintMary’sMedicalCenter

With special thanks to:Duramed Pharmaceuticals,Inc., a subsidiary of BarrPharmaceuticals,Inc.MedicalInsuranceExchangeofCaliforniaUnionBankofCalifornia

Thisprogramwasalso sup-ported inpartbyaneduca-tional grant from Eli LillyandCompany(whichhadnocontroloveritscontent).

Above: Steven Fugaro honors the 50-yearmembers

Right: SFMS Director ofPublicHealthandEducationSteve Heilig, MPH, withSFMS member KatherineMargolin,MD,andherhus-bandandSFMSBoardMem-berRobMargolin,MD

Right: StevenFugaro,MaryLouLicwinko,StephenFollansbee,RichardWolitz,MD,andAnnetteWhiteenjoyingthedinner


We Can Do Better

Editor’s Note: This year at the San Francisco Medical Society’s Annual Dinner Steven Schroeder, MD, presented the audience with a keynote speech on the health of the American people. What follows is a shortened version of his paper on which the speech was based.

T heUnitedStates spendsmoreonhealthcare thananyothernationintheworld,yetitrankspoorlyinnearlyeverymeasureofhealthstatus.Howcanthisbe?Whatexplains

thisapparentparadox?

Pathways to Improving Population Health—Addressing Personal Behaviors

Healthisinfluencedbyfivedomains—genetics,social,en-vironmental,behavioral,andthatofhealthcare.Whenitcomestoreducingearlydeaths,medicalcarehasarelativelyminorrole.EveniftheentireAmericanpopulationhadaccesstoexcellentmedicalcare—whichitdoesnot—onlyasmallfractionofthesedeathscouldbeprevented.Bycontrast,thesinglegreatestop-portunity to improvehealthand reduceprematuredeaths lieswith personal behavior. Behavioral causes of deaths in theUnitedStates,accountfornearly40percentofalldeaths.Itisclearthatobesityandsmokingarethetoptwobehavioralcausesofprematuremortality.

Cliniciansandpolicymakersmayquestionwhetherbehaviorissusceptibletochangeorwhetherattemptstochangebehaviorlieoutsidetheprovinceoftraditionalmedicalcare.Ifthepublic’shealthistoimprove,however,itismorelikelytocomethroughbehavioral change than technological innovation.Experiencedemonstratesthatitispossibletochangebehavior,asillustratedbyseatbeltuseandconsumptionofproductshighinsaturatedfats.Buttobaccobestdemonstrateshowrapidlypositivebehaviorchangecanoccur.

The Case of TobaccoSmokingprevalenceamongAmericanmendeclinedfrom

57percentin1955to23percenttoday,andamongwomenfrom34percentin1965to18percent.Whydidtobaccousefallsorapidly?TheSurgeonGeneral’s1964reportlinkingsmokingandlungcancerwasfollowedbymultiplereportsconnectingactiveandpassivesmokingtomyriadotherdiseases.Earlyantismoking

advocates,initiallyisolated,becameemboldenedbythecascadeof scientificevidence, especially about the riskof secondhandsmokeexposure.Laws,regulations,andlitigation,particularlyatthestateandcommunitylevel,ledtosmoke-freepublicplacesandraisesofthetaxoncigarettes—twoofthestrongestevidence-basedtobaccocontrolmeasures.Inthisregard,localgovernmentshavebeenfaraheadofthefederalgovernment,andnewmedicationsaugmentedface-to-faceandtelephoniccounselingtechniquestoincreasetheoddsthatclinicianscouldhelpsmokersquit.

Buttherearestill44.5millionsmokersintheUnitedStates,andtobaccousekills435,000Americanseachyear.Theydieuptofifteenyearsearlierthannon-smokers,withthosefinalyearsoftenravagedbydyspneaandpain.Inaddition,smokingamongpregnantwomenisamajorcontributortoprematurebirthsandinfantmortality.Smoking is increasingly concentrated in thelowersocioeconomicclassesaswellasamongthosewithmentalillnessand/orsubstanceabuse.OurSmokingCessationLeadershipCenteratUCSFestimates—basedonthehighratesandintensityoftobaccouseinthesepopulations—thatasmany200,000ofthe435,000prematuretobaccodeathsoccurinpersonswithchronicmentalillnessand/orsubstanceabuseproblems.Understandingwhythesepatientssmokeandhowtohelpthemquitshouldbeakeynationalresearchpriority.

TheUnitedStatesisapproachingatobacco“tippingpoint.”SomesegmentsoftheAmericanpopulationalreadyhaveverylowratesofsmoking.WhenKaiserPermanenteofNorthernCaliforniaimplementedamultisystemapproachtohelpsmokersquit, itssmokingratesdroppedto9percent.TwobasicstrategieswouldenabletheUnitedStatestomeetitsHealthyPeople2010tobaccouseobjectivesof12percentpopulationprevalence:preventyoungpeoplefromstartingtosmoke,andhelpsmokersquit.Ofthese,smokingcessationbringsbyfarthelargestshort-termimpact.Ofthecurrent44.5millionsmokers,70percentclaimtheywouldliketoquit.Merelyincreasingthebaselinequitratefromthecurrent2.5percentofsmokerswhoquitto10percent—arateseeninplacebogroupsinmostpublishedtrialsofnewcessationdrugs—wouldprevent1,170,000prematuredeaths.Noothermedicalorpublichealthinterventionapproachesthisdegreeofimpact!Andwealreadyhavethetoolstoaccomplishit.

Improving the Health of the American People

Steven A. Schroeder, MD

A WORD FROM THE KEYNOTE SPEAKER


Could Obesity be the Next Tobacco?

Althoughthereisstillmuch to do in tobaccocontrol, it is neverthe-lesstoutedasamodelforcombating obesity, theother major potentiallypreventablecauseofdeathanddisability. Smokingand obesity share manycharacteristics. Obesitydiffers,however,fromto-baccoinmanyways.Thebinarydefinitionofsmok-ingstatus(smokerornot)doesnotapplytoobesity.Thebodymassindex,theclosesttoanobesitygoldstandarddefinition,misclassifiesasoverweightpersonswithlargemusclemass—suchasCalifornia’sgovernor.Itisnotbiologicallypossibletostopeating,andminimalamountsoffoodarenothazardous,incontrasttolightsmoking.Thereisnoaddic-tiveanaloguetonicotineinfood.Nonsmokersmobilizeagainsttobaccobecausetheyfearinjuryfromsecondhandexposure,aperilabsentforobesity.Thefoodindustryislessconcentratedthanthetobacco industry,andwhile itsadvertisingpracticeshavebeencriticizedaspredatorytochildrenanddeceptiveregardingcontentofingredients,ithasyettofallintotobacco’sillrepute.Forthesereasons,litigationisamoreproblematicstrategyandindustrypay-mentslesslikely.Finally,exceptfortheinvasiveoptionofbariatricsurgery,obesitytreatmenthasevenfewerclinicaltoolsthandoestobaccocessation.

Somepolicyinstruments,however,doexisttocombatobesity.Selectivetaxesandsubsidiescouldbeusedasincentivestochangewhatfoodsaregrown,broughttomarket,andconsumed,thoughthepoliticsinvolvedindesignatingfavoredandpenalizedfoodcom-ponentswouldbefierce.Restrictionscouldalsoapplytotheuseoffoodstamps.Givenrecentdatathatchildrenseefromtwenty-sevento forty-eight foodadvertisements foreachsingleadpromotingfitnessornutrition,regulationscouldrequireshiftingthatbalanceand/orparticipatinginsustainedsocialmarketingefforts,suchasthetruth®campaignintobacco.Requiringmoreaccuratelabelingofcaloriccontentandingredients,especiallyinfast-foodoutlets,couldsensitizecustomerstowhattheyeat.Betterpharmaceuticalproductsandcounselingprogramscouldmotivateclinicians toviewobesitytreatmentmoreenthusiastically.Incontrasttothesepolicies,whichrequireeithernationallegislation,regulation,orresearchinvestment,momentumisalreadybuildingatthelocallevel.Someschoolshavebannedthesaleofsoftdrinksandnowoffermorebalancedlunches.Opportunitiesforphysicalactivityatwork,inschool,andinthecommunityhavebeenenhancedinasmallbutexpandingnumberoflocations.

Concentrating on the Less Fortunate

Since all the ac-tionable determinantsofhealth—personalbe-havior, social factors,healthcare,andtheen-vironment—dispropor-tionatelyaffectthepoor,strategies to improvenational health rank-ingsmustconcentrateonthis population.Citizenhealth advocacy in theUnitedStatescommonlycoalescesaroundparticu-

larillnesses,suchasbreastcancer,HIV/AIDS,orautism.Theseeffortsare ledbymiddle-classadvocateswhose liveshavebeentouchedbythedisease.Therehavebeenafewsuccessfulpublicadvocacycampaignsonissuesofpopulationhealth—effortstobanexposuretosecondhandsmokeortocurtaildrunkdriving—butthesearerelativelyuncommon.Becausethebiggestgainsinpopu-lationhealthwillcomefromattentiontothelesswelloff,thelackofapoliticalvoicearguingformoreresourcestoimprovehealthybehaviors,reducesocialdisparities,increaseaccesstohealthcare,andreduceenvironmentalthreatswillperpetuatethestatusquo.Additionally,America’srhetoricalemphasisonindividualresponsi-bilitycreatesareluctancetointerveneinwhatareseenaspersonalbehavioralchoices.

How Can the Nation’s Health Improve?Improvingpopulationhealthwouldbemorethanastatisti-

calaccomplishment.Itcouldenhancetheworkforceandnationaleconomy, reducehealthcareexpenditures, and—most impor-tantly—improvethelivesofthoseaffectedandtheirfamilies.Butabsentastrongpoliticalvoicefromthelessfortunatethemselves,itbecomesincumbentuponhealthprofessionals,especiallyphysicians,tobecomechampionsforbetterpopulationhealth.Sucharolereso-nateswithourdeepestprofessionalvalues,anditiswhymanyofuschosemedicineasaprofession.Itisalsooneofthemostproductiveexpressionsofpatriotism.Wetakegreatprideinassertingthatwearenumberoneinwealth,Nobelprizes,andmilitarystrength.Whydon’twetrytobecomenumberoneinhealth?

Dr. Schroeder is Distinguished Professor of Health and Health Care, Division of General Internal Medicine, UCSF, where he also heads the Smoking Cessation Leadership Center. Between 1990 and 2002 he was President and CEO of the Robert Wood Johnson Foundation. Dr. Schroeder graduated from Stanford University and Harvard Medical School. This paper is an edited version of the “Shattuck Lecture” published in the New England Journal of Medicine, 2007;357:1221-8. The full original article, with references, is posted at www.sfms.org.


The fact thatmanyphysicians are alsoaccomplishedmusicianscomesasno surprise.Overlapsbetweenthetwodisciplinesaremany,andeachinformsthepracticeoftheother.Towit,theintensetraining,thefundamentalacquisitionofskills,andthenecessaryattentiontodetailareallobligatoryformasteringthefinerpointsofbothmedicineandmusic.

“I thinkmanyphysicianshavebecomeexcellentmusiciansbecausetheyhavediscoveredthesimilaritiesbetweenthetwo,”notesWilliamStrull,MD,aninternistandassistantphysician-in-chiefatKaiserPermanenteSanFrancisco.“Theanalogybetweenmusicandmedicine—theactualmechanics,individualexpression,findingcreativ-itywithinthestructuresthatexist,andmakinginformeddecisions—areallkeyaspectstopractic-ingsoundmedicineandbeinganaccomplishedmusician.”Whathappenswithinthestructuresiswhereindividualexpressioncomesintoplay.

Repetition isanotherareaofoverlapbe-tweenthetwoareas.Whenaphysicianseesapatient,therearecertainprotocolsandproceduresthataredoneroutinelythatbecomethe“practice”ofthedailyfunctions.Amusicianbringsthatsamesetofrulestohisorherinstrument.“Dependingon thedayor the situation,bothaphysicianandmusicianmaybringsomethingnewtothework,andthat’swherecreativityhappens,”saysDr.Strull.Additionally,manyphysicianshaveexploredboththetherapeuticaspectsofmusicforthemselvesandtheirpatients.OrganizationssuchastheAmericanMusicTherapyAssociationusemusictoaddressthephysical,emotional,cogni-tive,andsocialneedsof individuals invariousstagesofbothillnessandwellness.Musictherapyandinterventionshelptopromotewellness,man-agestress,alleviatepain,enhancememory,andimprovecommunication,amongother things.Asatherapeutictool,usedinconjunctionwithmedicallyestablishedprotocols,musicisoneofourgreatestaidsandmeansofcommunication.

AtSaintFrancisMemorialHospital,we’repleased toannounce theawardof$80,000 ingrantstofivelocalorganizationspromotingcom-munityhealth.Thegrant-makingispartofthehospital’songoingcommitmenttoimprovethehealthofBayArearesidentsmostatrisk.SaintFrancis isparticularlycommitted toprogramsthatimpactdischargeservicesforthehomeless;thedisenfranchisedandisolated;andfrail,elderlyhospitalpatients.

Grantees were selected on the basis ofmeetingthehospital’scorefundingprinciples,which include providing for unmet healthneeds,primaryprevention,continuumofcare,andcapacitybuilding.Other selection factorsincluded theorganization’s long-termstabilityandproximitytoSFMH.

The following organizations receivedgrantsthatrangefrom$10,000to$25,000:St.Anthony’sFreeMedicalClinicRecuperationProgram;GlideHealthServicesRecuperationProgram; South of Market Health CenterRecuperationProgram;SanFranciscoSeniorCenter;andSanFranciscoCommunityClinicConsortium.Recipientswerehonoredatthean-nualgrantsawardbreakfastcohostedbySFMH’ssisterhospitals,SaintMary’sMedicalCenterandSequoiaHospital.

These grants are part of more than $3million ingrants awardedbySFMH’sparentcompany,CatholicHealthcareWest.CHW’scommunitygrantsprogram is funded throughdonations from itsmemberhospitals,whichcontribute .05percentof theirpreviousyear’sauditedexpensestotheprogram.Grantawardstypicallyrange from$2,000to$50,000.Since1990,CHWhasawardednearly$30millioningrantstolocalnonprofitorganizations.

Inclosing, I’d like tooffermy thanks toallmyBayAreacolleagues in recognitionofNationalDoctors’DayonMarch30.

HOSPITAL NEWSKPSF

Robert Mithun, MDSaint Francis

Wade Aubrey, MD

The Art CornerCabinetWalnut and GlassGeorgeKimmerling,MD

Dr.Kimmerling,anendocrinolo-gistbyday,hasbeenanamateurwoodworkerforthepastthirtyyears.Overthattimehehas“enjoyedswitchinggears frommyday job” toworkonprojectssuchasthisone.ThiscabinetcurrentlycallsDr.Kimmerling’sfamilydiningroomhome.

Would you like to submit artwork to be featured in San Francisco Medicine?

ContactAmandaDenz,theman-agingeditor,tofindouthowtosubmitpaintings,drawings,sculpture,poems,shortstories,andanyothercreationsyouwould like to share, at [email protected](415)561-0850extension261.SFMSisalsocurrentlyseekingsubmissionstobeconsideredforthe2008SFMSDirectorycover.ContactTheresePorter, [email protected](415)561-0850extension268.


TheabilityofmusictopromotehealingwasstudiedbyPythagoras,theGreekmathematician,physician,andmusicologist,inabout500B.C.But theuseofmusic inhealing significantlypredatesthat.Modernstudieshavedocumentedmanysalutaryeffectsofmusic,includingdeceas-ingheartrateandbloodpressure,decreasingtheneedforanalgesicmedicationsandanesthesia,andloweringstress-inducedcatecholaminelev-els.Musictherapyhasbeenusedforpatientswhohavebraininjuries,physicaldisabilities,chronicpain,Alzheimer’sdisease,andotherdisorders,andithasenoughempiricsupportthatitisnowareimbursableserviceunderMedicare.

Inrecentyears,thescientificstudyofthewayweprocessandrecallmusichasadvancedourunderstandingofhowthebrainfunctions,notjustinauditoryprocessingbutalsoinitsabilitytoorganize informationandmakeand recallmemories.AsDanielLevitin,aneuroscientistatMcGillUniversity,has so lucidlydescribedinhisrecentbook,ThisisYourBrainonMusic,processingmusic requiresalmostevery regionofthebrain,includingthecochlearnuclei,theauditorycortices,thebrainstem,thehippocam-pus,theamygdala,thefrontallobes,andperhapsmostsurprisingly,thecerebellum.Theinfluenceofmusicalexperiencescanstartevenbeforeweareborn.Inonecarefullycontrolledstudy,one-year-old infantspreferentially selectedmusicthathadbeenplayedrepeatedlywhiletheywereinutero,eveniftheywerenotexposedtothatmusicafterbirth.Thisscientific,utilitarianaspectofmusicasa therapeuticor investigativetoolshouldnotobscureitsmoreprofound—ifmorecommon—effect:theenrichmentmusicbringstoourlivesbyenhancingouremotionalexperienceandbringingitsownjoy.AtSt.Mary’sMedicalCenter,werecognizethatexcellentmedicalcarerequiresattentiontotheemotionalandspiritual,aswellasthephysical,needsofourpatientsandtheirfamilies.

ArtsandmedicinehaveintegratedtocreatetheUCSFDanceMedicineCenter,anewclini-calprogramoftheDepartmentofOrthopaedicSurgery.Designedtomeldeducation,research,andmedical and surgical care intoapremierfacilityfordanceinjurydiagnosis,treatment,andprevention,theCenterisunderthedirectionofNancyKadel,MD,associateprofessorandaformerdanceranddanceteacher.Inadditiontoscreeningevaluationsandtreatment,dancerswillbeabletoparticipateinresearchprojects.TheCenterwillprovideinjury-preventionprogramsfordancers,danceteachers,parents,andhealthcareproviders.TheCentercanbereachedat(415)885-3668.

AUCSFneurosurgeryteamhasreportedsig-nificantresultsofanewbrainmappingtechniquethatallowsforthesaferemovaloftumorsnearlanguagepathwaysinthebrain.Thetechniqueminimizesbrainexposureandreducestheamountoftimeapatientmustbeawakeduringsurgery.ReportedintheNew England Journal of Medicine(January3,2008),theUCSFfindingsalsoprovidenewdatathatrefinesscientificunderstandingofhow language isorganizedwithin thehumancortex.Senior studyauthor isMitchelBerger,MD,chairof theDepartmentofNeurologicalSurgeryanddirectoroftheUCSFBrainTumorResearchCenter.

Inthelargeststudytodatethatevaluatestheoutcomeofin-hospitalcarebyvariousphysi-ciantypes,findingsshowthatcarebyhospitalistsresulted inshorter staysand lowercosts topa-tients.ResearchersfromUCSFco-ledthestudy,publishedintheDecember20,2007issueoftheNEJM.Comparedtogeneralinternists,patientscaredforbyhospitalistshadmodestlylowercostsanda lengthof stay shortenedby12percent.Thetwogroupsexhibitedsimilarmortalityandhospitalreadmissionrates.Thestudyisbasedondatafromforty-fivehospitalsnationwide.AndrewAuerbach,MD,MPH,UCSFassociateprofessorofmedicine,isseniorauthor.

TheSanFranciscoV.A.MedicalCenter(SFVAMC)recentlyopeneditsnewlyremod-eled 3D Imaging Laboratory—an expandedstate-of-the-artlaboratorythatoffersthelatestin3Dvisualizationmethods.

Theconceptofa3Dimaginglaboratorywasdevelopedin2002bySFVAMC’sChiefofRa-diologyServicesJudyYee,MD,whoconductednovel research on virtual colonoscopy (CTcolonography)asanewtechniqueforcolorectalcancerscreening.ThistestmadeuseofthedataobtainedfromCTscannersandcombineditwithgraphicsoftwaretocreatetwo-andthree-dimen-sionalimagesofthecolonthattheradiologistcanuseforpatientdiagnosis.Theclinicalimpactofthevirtualcolonoscopyhasbeensignificant,andtheSFVAMCwasoneofthefirstfacilitiesinthecountrytomakeitavailabletoveterans.This test isnowusedclinicallyatother sitesthroughouttheworld.

Thenew3DImagingLaboratoryhousesmany state-of-the-artpostprocessingworksta-tions with the multiple different computerplatformsneededtoaddresstheexpandinguseof3Dimagingineverydaypatientcare.Thisimag-ingisnowusedforcoronaryCTangiography,aneurysmevaluation,musculoskeletalapplica-tions,CTurography,andbrain/bodyperfusiontechniques.

Becauseofthisexpandedtechnology,re-searchersarenowabletoperformcutting-edgeresearchusingthebestimagingtoolsavailable.Thevariouscomputerplatformsarealsousedtoteachadvanced3Dimagingtothemedicalstu-dents,residents,andfellowsthatrotatethroughSFVAMC’sDepartmentofRadiology.

ThislaboratorywillallowtheSFVAMCtocontinuetobealeaderinthefieldof3Dimagingandwillprovideforexcellenceinclinicalcare,research,andteaching.

HOSPITAL NEWSUCSF

Ronald Miller, MDSt. Mary’s

Richard Podolin MDVeterans

Diana Nicoll, MD, PhD, MPA


IN MEMORIAM

Rudi Schmid, MDRudiSchmid,MD,a liver specialistandmedicaleducator,

passedawayathishomeinKentfieldonOctober20,2007ofpul-monaryfailure.Hewas85.

Dr.Schmidwas anearly championof establishingorgantransplantcenterstomakedonorliverswidelyavailable.In1983,sixteenyearsafterthefirstsuccessfullivertransplant,heledapanelconvenedbytheNationalInstitutesofHealthtoconsidertheef-ficiencyofperformingthetransplantsonalargerscale.Inthatyear,thesurvivalrateinthefirstyearafteralivertransplantwas20to25percent.Nowitisofferedbyabout100facilitiesaroundthecountryandthesurvivalrateinthefirstyearis85to90percent.

Dr.Schmidwasborn inEnnenda,Switzerland, the sonoftwogeneralpractitioners.He receivedhismedicaldegree fromtheUniversityofZurichbeforeearningadoctorateinmedicalsci-encesfromtheUniversityofMinnesotain1954.HealsobecameanAmericancitizeninthatyear.

Hetaughtmedicineformorethanthirty-fiveyears,beginningatHarvardbeforemovingtotheUniversityofChicagoandfinallytoSanFrancisco,wherehewasdeanofUCSFfrom1983to1989.Heretiredin1995.

WhilehewasdeanatUCSF,somestudentsraisedconcernsthattheschoolwasemphasizingresearchattheexpenseofbasic

medicaleducation. In response,Dr.Schmid introduced facultyevaluations,undertookaninitiativetoimprovetheeffectivenessoftheteaching,andhelpedestablishatrackonthecurriculumforthestudyofprimarycareandcommunitymedicine.Healsopro-motedaninternationalexchangeprogramforstudentsandfacultymembers,particularlywithPekingUnionMedicalCollege.

Hisworkinhepatologyhadbeguninthe1950swithstudiesofporphyrias.Heandothersdevelopedaratmodeltostudytheenzymesofheme(inhemoglobin),which,whendisrupted,leadtoneurologicalproblemsandmentaldisturbances.Healsoinvestigatedthechemistryofbilirubinand,withneurologistDr.IvanDiamondandothers,lookedatwaystopreventthisproductofhemebreak-downfrompassingintothebrainincasesofchildhoodjaundice,aneventthatcancausebraindamage.

Dr.SchmidwasaformerpresidentoftheAmericanAssocia-tionfortheStudyofLiverDiseasesandtheAssociationofAmeri-canPhysicians.HewasalsoamemberoftheNationalAcademyofSciences.

Heissurvivedbyhiswife,theformerSonjaWildofKentfield;ason,Peter,ofDalyCity;adaughter,IsabelleFranzenofCapeTown,SouthAfrica;andagrandchild.

Nancy Thomson, MD

Continuing mediCal eduCationThe California Medical Association is accredited by the Accredita-tion Council for Continuing Medical Education to provide continuing medical education for physicians. The California Medical As-

sociation designates this educational activity for a maximum of 19 AMA PRA Category 1 Credits ™. Physicians should only claim credit

commensurate with the extent of their participation in the activity. This credit may also be applied to the CMA Certification in Continuing Medical Education.


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March 2008

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