andrew schulman

[nyc]

reading Andrew’s waking the spirit.. (thanks Al)..

notes/quotes/highlights..

medicina sanat animam per corpus, musica autem corpus per animam. – Giovannin Pico dellA Mirandola

(medicine heals the mind, soul and sprit by the body, but music heals the body by the mind, soul and spirit.)

prologue

p 8

the study concludes, ‘music is a noninvasive, safe, and inexpensive intervention that can be delivered easily and successfully in a hospital setting…

p 9

music used for healing is one of the oldest brancehes in the field of medicine…… romans saiid to have used musicians in their battlefield hospitals as form of anesthesia

p 10

arthur harvey: of all the music we tested in med school w/patients, colleagues, and others, bach’s music consistently made the brain work in a balanced way better than any other genre’

James Rhodes

p 49

you can’t thank god enough, .. or your loved ones.. to give thanks you have to give something…i was thinking only of myself in this moment as the thought of survivor’s guilt filled me with trepidation…. i would be committing an act of collateral kindness

p 57

embodied cognition – takes place only in brain..

p 78

my first decision was to provide variety…i kept my playing at a medium tempo in major key with a flowing steady rhythm. at the very least, it drew the patents’ attention away from the incessant beeps of the medical machines. later i’d learn that playing like this was a good choice..

it matches the human heart, when beating in its normal range…

alex on reggae hb – and how i learned/got to improv ing..

p 79

i’d just found a new path to express myself as a musician, on that was unlike anything i’d done before. it was about making music solely to help others, and it felt really good.

anxiety is one of the common denominators in a sicu…. recovering… unclear.. away from loved ones. body’s bio reaction … is to power up the fight-or-flight response and release stress hormones into the blood. the body then preps itself to fight/flee w help of rapid breathing and higher heart rate to increase supply of oxygen and glucose to the brain. blood vessels are constricted to send more blood to the body’s core, temporarily raising blood pressure… which is all fine if there is a specific threat. but generalized anxiety means that patients in a sicu are often in a constant state of ‘fight or flight,’ with high heart rate and high blood pressure – which can negatively impact their recovery..

p 80

music reducing anxiety…

[..]

music reaches neural networks, including some of the most primary and lowest0on-the-evolutionary-calendar-of-development parts of the brain such as the brain stem, the cerebellum and the amygdala… music then initiates brain stem responses that, in turn, regulate heart rate, pulse, blood pressure, body temp, and muscle tension in much the same way as a fight-or-flight response – ‘stimulating’ music heightens sympathetic arousal (heart rate, pulse, and breathing) whereas ‘relaxing’ music decreases it – although there can be exceptions..

p 81

… reminding patients that they are part of the world beyond the sicu..

p 82

w/in a few minutes, the writing slowed, and then stopped, and the pained expression on his face started to disappear. i has his attention. he was listening to music he’d certainly played many times… now i wanted him to do more than listen. i wanted him to think about playing.

i switched from a solo style, left out the melody part, and began to play on the chords of the tunes. i wanted him to imagine an ensemble…

p 83

his eyes remained closed but his brow began to furrow, just as a musician’s would when he is deeply in the flow of playing.. i’m convinced he was playing the melody..

his heart rate and blood pressure had been very high, and now they were back in the normal range… as an experienced nurse.. she could tell he was moving past a crisis…. by getting mr g to interact, he had reengaged in his life and reconnected to a core part of himself. he was pulling himself up from the bottom of the well…

p 84

it was astonishing to me that 45 min or so of music could have turned the ship around to that degree. mcmillen explained that there is a blossoming effect once things start moving in the right direction.

i saw how much reached beyond everything that was going on with him, mentally and physically, found his essence, and pulled him back..

p 86 – encouraged to be music therapist.. but that had lots of pre req’s and lots of added jobs…. this was way beyond the scope of what i was doing in the sicu… i charted my journey as a medical musician…..

we need people like you.. he said.. artists like you who are under the supervision of an established music therapy dept..and adjunct that reinforces the existing clinical music therapy program..

p93

pythagoras was one of the first to recognize the profound effect of music upon the senses and emotions. he developed his own musical healing method, which he called ‘musical medicine.’

your song ness

p 94

all the drs and nurses i knew in the sicu said they learned the most, and best, by talking to each other

p 111

there’s something in music therapy called entrainment. it’s a term from physics that explains that two objects moving together use less energy than two objects moving in opposite directions; so, if they are placed next to each other, they will, eventually, begin to move together in sync.. for ie: one pendulum will begin swinging at same rate..lock into phase, so they vibrate in sympathetic harmony…

our internal rhythms – heart rate and respiration rate – will speed up or slow down to match a stronger external rhythm such as weaves lapping a beach or speeding traffic…. music can reach out to a patient to get in sync and balance and disharmony.

p 114

from that moment on i have always assumed that there is someone home, no matter how critically ill the patient is

p 117

music and sound have a primary and direct gateway to our state of arousal and consciousness

p 119

adrian owen research: close to 20% of patients who are thought to be vegetative are actually conscious, but are nevertheless incapable of demonstrating their consciousness thru standard clinical assessments.

p 120

there are always exceptions and you have to be constantly vigilant

p 121

perhaps music could be used as a diagnostic tool in the future. it could be a way of letting the patient say, ‘i’m still here. there’s somebody home.’

music is strongly associated with the brain’s reward system – the region of the brain that tells us if something is important or has a survival value. when we listen to music, especially music that is pleasurable to us to the extent it sends shivers down the spine, activity is triggered in the nucleus accumbens, the part of the brain that releases the chemical dopamine. this feel=good hormone is also released in response to food or sex, evolutionarily important activities.

p 128

years of perfect work can be ruined by one disastrous mistake….. at the same time, i knew i couldn’t let a mistake paralyze me.. i had to learn from it, let ti go, and move forward. keep it in perspective..

p 129

i remembered a rehearsal with my string quintet when one of the players flubbed a passage but got it perfect on the repeat. she looked up and said, ‘god created repeats so you get a second change’ i wanted a repeat, a second change..’

we all do..

let’s go for a global do-over.. that sets in motion.. life in perpetual do over ness..

equity: everyone getting a go (do over) everyday

p 130

playing for both of us.. always a patient.. i’m completely aware that i could turn cancerous.. a any moment…..

i lost myself in pure musical feeling and left behind the swirling thoughts of whether or not i could heal him. i entered a state of flow,.. in the zone..

p 132

although i couldn’t see into this patient’s heart and mind, i could look at the computer monitor, see the numbers of his physiological response, and see the color returning to his face, and know unquestionably that he was feeling better..

p 139

some of the most serious infections occur inside the knew joint where the body’s immune system has a difficult time fighting infections

p 141

there’s no explaining those hunches.. for decades now i’d been ‘playing the room’ an old musicians’ term fro being able to read an audience and i just went with my gut

p 148

each song i’d played had plucked a a memory of hers layered deep in her brain. the music had made it past her brain stem and stimulated higher areas of brain function, such as the hippocampus and other areas of the limbic system, those associated with memory and emotion – where those tunes had been recognized and reminded deena of who she was

musical memories are stored as procedural memory, usually associated with routines and repetitive activities. delirium can affect the parts of the brain responsible for focusing episodic memories, the memories that correspond to events in our lives – whereas it leaves the parts of the brain responsible for procedural memory intact. this is why many patients recall very little of their time in the sicu: ;delirium replaces their memories with a state of confusion

p 149

her brain must have processed the music and used it as a way to access moments of her life and give her a sense of emotional stability.

for people suffering from dementia, and especially alzheimer’s disease, music is a way of tapping into their past. as oliver sacks has said, ‘the past which is not recoverable in any other way is embedded, as if in amber, in the music, and people can regain a sense of identity.’

musical memory, buried in the oldest parts of our brain, survives the ravages of the disease and can create a bridge to the past both for the patient and for family and friends. when patients who are ‘locked in’ in so many ways – unable to speak or socialize or interact with their environment – listen to music from their past, an d immediate change can be seen.

p 154

you try to understand the physiology and the psychology and the interpersonal aspects for what she’s experiencing when she’s writing in pain. but there’s also an expectation that she’s supposed to have pain, and i imagine that she’s living up to that expectation in part. every time the nurse comes by and asks her if she’ sin pain that reinforces it

p 155

the vast majority of the pain experience is only what you can interpret in your brain.. so, medicine affects the interpretation of pain. music therapies affect the interpretation of pain..

in short, pain is an intensely personal experience

p 158

perhaps the fact that pain is an emotional experience is a crucial entry point in understanding why music can be so effective in pain management..

p 181

on music and language..

p 183

artists who used their music to alleviate their own suffering (disproportionate number of the greatest composers have suffered… psych disorders) composed some of the greatest music every written, which in turn has the effect of ameliorating the suffering of others

george gershwin had a host of behavioral problems as a youngster. he regularly engage in fistfights, stole food from pushcarts, and even set fires.. all of this changed when he heard a classmate play the violin at a school assembly

bach was no stranger of emotional suffering.. mother.. wife.. children dying..

p 186

bach: the aim and final reason of all music should be none else but the glory of god and the recreation of the mind and spirit

p 203

emotionally charged writing (both prose and poetry), as well as familiar writing, arouse those very same brain areas that respond to music that produces ‘shivers down the spine’ specifically, a brain region associated with reward. interestingly these neural patterns correlate with similar patterns of brain activity found during euphoria, sex, and the use of addictive drugs…

p 205

eva vescelius (1918): the object of music therapy was to return the sick person’s discordant vibrations to harmonious ones.. the cures affected by music were based on the law of harmonious rhythmic vibration*

*as akin to sympathetic vibrations… the harmonic phenom in which a formerly passive string or vibratory body responds to external vibrations to which it has a harmonic likeness

p 208

the brain cannot function when the heart has stopped beating, and it typically shuts down w/in twenty to thirty seconds… conscious awareness can continue after this time.. patients who’ve reported watching themselves being resuscitated or hearing specific beeps from medical machines..

p 226

memory back.. even when reading.. now inside the music

p 227

neuroplasticity

when your head hurt so much in the beginning when you got home… that was your brain creating a work around, making new connections to other parts of the brain so you could at least play and read music. but the memory area was too badly damaged to function. however, because you kept playing, even that repaired. you are experiencing increased neurological function, you hear more and memorize faster, because the brain doesn’t discard a workaround it has created. it blends it into the repaired nerve network….

p 228

wanting to know more about this.. friend suggests i contact oliver sacks

p 229

you didn’t forget any of that music it was just that the connections the nerve networks had been badly damaged… playing in the sicu was the most perfect rehab you could ever have had.. it had all the right ingredients:

repetition, you were there three days a week, intensity – nothing could have been more intense for you than playing a sicu, a room of life and death where you yourself almost died – and a focus on healing others and not yourself..you never had to judge your own progress and so never risked getting frustrated to the point where you might have quit.

if you hadn’t gone back to the sicu your brain might still have healed and the music memory might have returned but it would have taken years longer, at least five to ten in my experience. .. it is very likely if you hadn’t played in the sicu that you would have quit music altogether in the first year out for sheer frustration…

by helping to heal others you defragged your hard drive…

p 232

committing yourself to playing in the sicu you forced your brain to rewire. the consistent and deliberate exercise every day of what you had to do to become what you call a medical musician, the constant auditory attention, the intense thinking as you watched the patients’ responses and the changes, , or lack of changes, in the viral signs monitors over their beds, your constant awareness of all the sounds surrounding you so you could be attuned to other needs should an emergency like a cod blue arise, and very importantly, making sure all your fine motor functions were at their best to guide you in making soothing and healing music for your patients – all these factors combined to force different parts of your brain to make new connections, to talk to each other,

you did repair your own brain and gave yourself an upgrade at the same time..

p 242

music in med is a noninvasive approach w/o side effects tat does as a good a job – if not better – as many very expensive and invasive drugs and techs, many of which have terrible and longlasting side effects. however, music therapy is not yet included as a covered service under many public and private insurance plans….. p 241 – on musicians not getting paid but by donors er al..

it’s a lot of paperwork.. something needs to change so that ins co’s will consistently include music therapy as a covered service..

perhaps.. no money ness.. common ing ness

p 248

i moved in much closer and began playing music conducive to deeper breathing – faster, more dynamic, and dramatic. not specific music, but improvisations. i’d discovered early on that this made it easier for me to just concentrate on the rhythm.

p 254

music may have a power over us that visual art does not have, going back to our mothers singing to us while still in the womb..

your own song ness

music has the power to help us reboot…

p 255

for the last few years, i have advised my friends to include a playlist on their advance directives ..

live music – 2 way relationship

p 256

his insight is not that he knows how they feel, but that he remembers how he felt..it is impossible to join the patient or family in their isolation and fear, but he introduces them to the brotherhood of the desperately ill who understand they can no longer pretend to be immortal. he works with the family and patient to find the ‘prescription’ of that music most meaningful to help the patient in their journey.

a new medical specialty, palliative care, emphasizes patient centered treatment… it may seem surprising that a patient’s physical and emotional care has not always been the top priority in modern medicine, but patients have long had to be treated in a way that works best for the health care industry.

palliative care

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3 min video on indiegogo site

https://www.indiegogo.com/projects/a-musician-s-journey-healing-body-mind-and-soul#/

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Music As Medicine: 5 Songs That Help Patients In The ICU – 2016