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SFmedSoc_ad_12.05.07.indd 1 12/12/07 5:39:59 PM CONTENTS

SAN FRANCISCO MEDICINE March 2008 Volume 80, Number 2

FEATURE ARTICLES Music and Medicine MONTHLY COLUMNS

10 Healing the Healer: The Blues for Docs with the Blues 4 On Your Behalf Roy Rogers 6 Executive Memo 11 Musicophilia: A Feeling for Music Mary Lou Licwinko, JD, MHSA Ashley Skabar 7 President’s Message 13 Living with Music: One Musician’s Perspective Steven Fugaro, MD Nolan Gasser, PhD 9 Editorial 15 Soothing the Sick with Sound: Music at Stanford Hospital Mike Denney, MD, PhD Greg Kaufman 44 Hospital News 17 The Power of Music: The Transformed Moment Susan Mazer 46 In Memoriam Nancy Thomson, MD 19 Music Therapy at Langley Porter: The Union of Clinical and Musical Skills Tom Benson, MT-BC SFMS 2008 Annual Dinner

21 Healing Muses: Adding Sound to Silent Technology 40 Annual Dinner Photos Eileen Hadidian 42 A Note from the Keynote Speaker 22 Enriching Hospice Care: Music at the End of Life We Can Do Better: Improving the Kris Montgomery Health of the American People Steven A. Schroeder, MD 24 The Threshold Choir: Singing to Assist Transitions Kate Munger

25 The Healing Harp: The Oldest Healing Musical Instrument Editorial and Advertising Offices Claire Dunne 1003 A O’Reilly San Francisco, CA 94129 Phone: 415.561.0850 ext.261 27 Calming the Surgeon and the Patient: The Positive Effects of Music in the OR Fax: 415.561.0833 John Maa, MD, FACS Email: [email protected] Web: www.sfms.org 28 Jake Leg: A Public Health Mystery is Solved through the Blues Eisha Zaid Subscriptions: $45 per year; $5 per issue Advertising information is available on our 29 From Mind to Heart: A Healing Musical Journey website, www.sfms.org, or can be sent upon Gary Malkin request.

31 Life in the Vortex: Introductory Notes from a Physician-Musician Printing: Bruce S. Victor, MD Sundance Press P.O. Box 26605 Tuscon, AZ 85726-6605 33 Doctor of Harmony: Care of Musical People and Musical Hands Robert E. Markison, MD

35 Living Both Music and Medicine: Where the Two Practices Intersect As Told by Various San Francisco-Based Physician-Musicians March 2008 Volume 81, Number 2 ON YOUR BEHALF A sampling of activities and actions of interest to SFMS members Editor Mike Denney Managing Editor Amanda Denz Notes from the Copy Editor Mary VanClay Membership Department Cover Artist Amanda Denz photographic or fine art for the Directory, Staff Photographer Ashley Skabar Membership Events contact Therese Porter in the Membership Department at (415) 561-0850 extension Editorial Board The Golf Mixer at the Presidio Golf Club 268 or [email protected]. Chairman Mike Denney Thursday, April 17, from 5:30 to 7:30 Obituarist Nancy Thomson Enjoy hosted beverages, appetizers and Attention, Young Physicians! Stephen Askin Shieva Khayam-Bashi lively conversation in a beautiful setting while The San Francisco Medical Society has Toni Brayer Arthur Lyons learning about this historic course from the formed an active and vibrant Young Physi- Linda Hawes-Clever Terri Pickering Club’s Golf Pros. The Presidio Golf Club cians section to better address the needs Gordon Fung Ricki Pollycove has developed a special arrangement for San and concerns of members age forty-five and Erica Goode Kathleen Unger Francisco Medical Society members who wish under. A variety of social and educational Gretchen Gooding Stephen Walsh to join the Club. Learn more about the Golf gatherings are a featured part of this newest Club by visiting their website www.presidio- component of SFMS membership. If you SFMS Officers golfclub.com are interested in participating, contact Tom President Steven H. Fugaro The cost for this Mixer is just $10.00 Lee, MD, at [email protected]. President-Elect Charles J. Wibbelsman for members and $15.00 for non-members. Secretary Gary L. Chan Nonmember physicians who join the Medical Mark Your Calendars Treasurer Michael Rokeach Society at this event will have their event fee The California Medical Association Editor Mike Denney deducted from their already discounted first Legislative Leadership Day is scheduled for Immediate Past President Stephen E. Follansbee year dues, making this a great event to bring Tuesday, April 15, in Sacramento. More your physician peers who are not yet SFMS information will be coming soon, but all SFMS Executive Staff members. members are encouraged to attend this Executive Director Mary Lou Licwinko For more information, or to RSVP, interesting and exciting day dedicated to Director of Public Health & Education Steve Heilig contact Therese Porter in the Membership bringing the State’s lawmakers and physi- Director of Administration Posi Lyon Department at (415) 561-0850, extension 268 cians together to promote the health of Director of Membership Therese Porter or [email protected]. We need your RSVP no California. Director of Communications Amanda Denz later than Thursday, April 10. SFMS Seminar Schedule Board of Directors A Night at the deYoung Museum! Advance registration is required for Term: Donald C. Kitt Friday, May 9, from 5:30 to 7:30 all SFMS seminars. Please contact Posi Jan 2008-Dec 2010 Jordan Shlain Join SFMS members for a reception with Lyon at [email protected] or (415) 561- George A. Fouras Lily M. Tan access the entirety of this stunning museum. 0850 extension 260 for more informa- Keith Loring Shannon Udovic- Just $20.00 (includes museum admission). tion. All seminars take place at the SFMS William Miller Constant Contact Therese Porter for more information offices, located in the Presidio in San Jeffrey Newman Term: or to RSVP. Francisco. Thomas J. Peitz Jan 2006-Dec 2008 The San Francisco Medical Society is Daniel M. Raybin Mei-Ling E. Fong interested in your feedback and suggestions April 18, 2008 Michael H. Siu Thomas H. Lee for membership events that are interesting and Customer Service/Front Office Telephone Term: Carolyn D. Mar fun for our members. Contact Therese Porter Techniques Jan 2007-Dec 2009 Rodman S. Rogers in the Membership Department at (415) 561- 9:00 a.m. to 12 p.m. (8:40 a.m. registra- Brian T. Andrews John B. Sikorski 0850 extension 268 or [email protected]. tion/continental breakfast). This half-day Lucy S. Crain Peter W. Sullivan practice management seminar will provide Jane M. Hightower John I. Umekubo Calling All Artists! valuable staff training to handle phone calls The Medical Society is looking for and scheduling professionally and efficiently. CMA Trustee Robert J. Margolin cover art for its 2008–2009 Membership $99 for SFMS/CMA members and their staff AMA Representatives H. Hugh Vincent, Delegate Directory, which will be published in late ($89 each for additional attendees from the Robert J. Margolin, Alternate Delegate spring. If you are interested in submitting same office); $149 each for nonmembers.

 San Francisco Medicine March 2008 www.sfms.org May 16, 2008 Concordia-Argonaut Club, San Francisco Physicians are invited to attend this con- Managing the Team (for office managers David S. Pisetsky, MD, PhD, will present ference, featuring nationally recognized and administrators) “The Role of Alarmins in Inflammatory Dis- cardiologists and heart researchers, to aid 9:00 a.m. to 12:00 p.m. (8:40 a.m. registra- ease: The Danger from Within.” Alarmins, their understanding and management of tion and continental breakfast) a new class of proinflammatory mediators, coronary artery disease. For more informa- Motivating and Managing Your Office deliver endogenous “danger” signals to the tion, visit www.montereyheart.org. Manager (for physicians) immune system when released from dead 12:15 to 1:45 p.m. (12:00 p.m. regis- and dying cells, stimulating inflammation. June 12–15, 2008 tration and lunch). These two semi- They are of high clinical interest and are Living on the Fault Line: Advances in nars are designed to help physicians and the target of novel therapies. For more Occupational Medicine their office managers set expectations, information e-mail [email protected], The Claremont Resort and Spa, 41 Tunnel manage change, and design a practice call (415) 356-5484, or visit www.arthritis. Rd., Berkeley, 8 a.m. to 6 p.m. culture that helps the practice thrive. org/chapters/northern-california/events. The California Society of Industrial Medi- $99 for Managing the Team for SFMS/ php. cine and Surgery (CSIMS) in conjunction CMA members and their staff ($85 each with faculty from UCSF is offering a con- for additional attendees from same of- April 16–18, 2008 tinuing education seminar that will address fice); $149 each for nonmembers. AMA Medical Communications Conference cutting-edge concepts regarding practice, $69 for Motivating and Managing Your Paradise Point Resort & Spa, San Diego research, and policy in the field of occupa- Office Manager for SFMS/CMA mem- Whether you are a physician broadcaster tional medicine. Visit www.csims.net for bers ($59 each for additional attendees combining medical practice with medical more information. from same office); $109 for nonmembers. news reporting, a spokesperson on the front $150 for both sessions for members; $225 lines delivering health care messages, or a June 15–18, 2008 for nonmembers. public relations professional behind the ENDO 08: The Endocrine Society’s 90th scenes pitching stories, the 28th annual Annual Meeting October 3, 2008 American Medical Association (AMA) The Moscone Center, San Francisco Customer Service/Front Office Telephone Medical Communications Conference This meeting offers an unprecedented op- Techniques promises to broaden your horizons, sharpen portunity to learn about the latest advances This half-day practice management seminar your skills, build your network, and make in endocrine research and clinical care will provide valuable staff training to handle you a more effective medical communicator. while networking and collaborating with phone calls and scheduling professionally E-mail [email protected] for more than 7,000 colleagues from around and efficiently. 9:00 a.m. to 12:00 p.m. (8:40 more information. the world. Discover and evaluate the latest a.m. registration/continental breakfast). $99 advances in endocrinology. Hear from lead- for SFMS/CMA members and their staff May 2–4, 2008 ers in the field. Choose from among more ($89 each for additional attendees from the 2008 CMA Leadership Academy than 200 educational programs, including same office); $149 each for nonmembers. Disney’s Grand Californian Hotel in Anaheim plenary symposia, updates, debates, and Continuing the Academy’s standard of more. For more information, visit www. November 4, 2008 programming excellence, the 11th Annual endo-society.org. “MBA” for Physicians and Office Managers Leadership Academy looks from the past 9:00 a.m. to 5:00 p.m. (8:40 a.m. registra- to the future to assess both broad trends August 10–15, 2008 tion/continental breakfast). This one-day and specific key developments affecting Essentials of Primary Care: A Core Cur- seminar is designed to provide critical the practice of medicine in California and riculum for Ambulatory Practice business skills in the areas of finance, op- beyond. The realities of the present will also Resort at Squaw Creek, North Lake Tahoe erations, and personnel management. be addressed with a series of practical and This course will serve as an excellent update $250 for SFMS/CMA members and their powerful workshops designed to help meet and review for current primary care physi- staff ($225 each for additional attendees today’s medical practice challenges. cians and other primary care professionals, from same office); $325 for nonmembers. Visit www.cmanet.org/leadership for more and as an opportunity for specialists to information. expand their primary care knowledge and Other Upcoming Events skills. For more information, visit www. April 10, 2008 May 2–3, 2008 cme.ucsf.edu. Arthritis Foundation 42nd Annual Monterey Bay Regional Heart Symposium Knowles Lecture Quail Lodge, Carmel Valley, California

 San Francisco Medicine March 2008 www.sfms.org www.sfms.org march 2008 San Francisco Medicine  Executive Memo Mary Lou Licwinko, JD, MHSA

Health Care Reform

bout a year ago, I traveled with the San Francisco Cham- means more Medi-Cal patients will end up in emergency rooms and ber of Commerce to Sacramento to learn about Governor leave more conditions untreated, adding to the cost of health care A Schwarzenegger’s new proposal for universal health care cov- for everyone. In addition, California will forgo federal matching erage. Because there are nearly 6.6 million individuals in California funds by cutting Medi-Cal reimbursement rates. California receives without health insurance, many of them working people and their $1 in federal matching funds for every Medi-Cal dollar spent. This families, everyone agreed something needed to be done. More than means that the $544 million in state cuts will have the effect of 18 percent of Californians do not have health insurance; California cutting $1.1 billion from Medi-Cal. ranks fifth in the nation by percent of those without insurance. The health care crisis has been growing for some time and In Sacramento, we were briefed by several of the Governor’s is particularly evident in Los Angeles, where the county recently staff members, who told us that there would definitely be health proposed closing all but one county health clinic and reducing care reform for California in 2007. We then heard from other services at outpatient health centers because of budget shortfalls. Republicans who thought the Governor’s plan went too far and The latest round of cuts will only make matters worse across the from Democrats who thought it did not go far enough. Everyone, state and is likely to have a dramatic impact on San Francisco’s however, pointed to the cost of providing health care to a large, clinic system, as well as on San Francisco General Hospital, St. uninsured population who often use emergency rooms for primary Luke’s Hospital, and others. care or let conditions go untreated until the cost of treatment is The San Francisco Medical Society and the California Medi- astronomical. cal Association are committed to restoring these cuts to Medi-Cal All concluded that there certainly should be system that would and remain committed to health care reform for California, if not provide greater access to care for all Californians. the nation. We need to educate and encourage patients to join us We all know what became of the various health care reform in our efforts. plans. There was difficulty between the legislators and the Governor in reaching agreement. When the leaders of the Assembly and the Governor finally did agree to a plan, the Senate refused to approve it, citing budget restraints. Not only was health care reform stopped Send Your Message to dead in its tracks but the legislature and the Governor decided to balance the budget on the back of Medi-Cal by slashing Medi-Cal 2,500 Health Care provider rates by 10 percent, effective July 1. In February, these cuts were rushed through the legislature with little public comment as Professionals part of an emergency spending plan. So now California still has more than 6 million uninsured and The San Francisco Medical Society offers multiple is soon to have Medi-Cal recipients with less access to care then advertising opportunities ranging from full-page, they had last year, when health care reform was all the rage. Cur- 4-color display ads to classified ads with discounted rently, fewer than half of the physicians in California take Medi-Cal because, at its current rate, Medi-Cal does not cover the costs of rates for members. Please contact Ashley Skabar for the physician’s time, overhead, and other expenses. For example, a more information, (415) 561-0850 extension 240 or primary care office visit is reimbursed at $20. Anyone who has taken [email protected]. a pet to a veterinarian lately will know that you can not even get in the door for $20. Not only is it shameful that we are cutting access for Medi-Cal patients but it is also costly. Less access to providers

 San Francisco Medicine March 2008 www.sfms.org president’s Message Steven Fugaro, MD

Music and Medicine

hen one contemplates music and medicine, a number lower blood pressure, regulate breathing, decrease anxiety, and feel of thoughts come to mind. Many physicians possess spiritual comfort. She remarked on how often the gentle playing of W wonderful musical talent and employ music as an avo- her harp would result in patients being more comfortable, over and cation as well as a means of entertaining the less talented among above the effects of pain relievers, sedatives, and tranquilizers. us. The study of the interaction of the brain and music has chal- The rigor of the program is also quite impressive. The Institute lenged neurologists over the years. Psychologists have marveled at for Health and Healing at CPMC offers internships in the Healing the effect of music on the mind—not to mention that numerous Harp Program. These internship require a 500-hour commitment extraordinary composers have also had significant psychological over a one-year period for both training and clinical practice. In conditions. (Charles Ives and Robert Schumann are just two ex- addition to playing at CPMC and Marin General, harpists in the amples.) Finally, music has been used as a therapeutic instrument program also play for patients at home and in hospice programs for thousands of years. Dr. Oliver Sacks, the prominent neurologist, (see page 22 for an article describing the role of music in Hospice regards music therapy as a tool of great power because of its unique by the Bay). capacity to organize or reorganize cerebral function when it has In recent years integrative medicine, with guided imagery, been damaged. acupuncture, massage, meditation, and music therapy, has slowly All of these topics are explored in greater detail in this issue of begun to achieve a greater level of acceptance in the mainstream San Francisco Medicine. My own experience with music in a medi- medical community. Music therapy, whether with a harp or with cal context was quite recent. I had the opportunity to view music other instruments, clearly has a role in helping our patients in ways being employed as therapy in the Healing Harp Program at both that are beyond our usual areas of expertise as physicians. And California Pacific Medical Center and Marin General Hospital. This providing music to our patients has the power to augment our most unique program, sponsored by the Institute for Health and Healing, important roles—as healers and comforters. enables harpists to play in hospital waiting rooms, in the NICU, For more information regarding the Healing Harp Program, for cancer patients undergoing chemotherapy, and for patients in please contact Susie Shipley at (415) 925-7623. To find out about their last few moments of life. music therapy in general, the American Music Therapy Association, In a bed at the end of a ward, a patient lay dying, attended by at www.musictherapy.org, is an excellent resource. her family and friends. In the room was a harpist, playing a small portable harp—a 19-string, seven-pound Westover Adian harp. The atmosphere was a far cry from the usual technological bustle of the Stay Up-to-Date with hospital ward. Instead of the chirps and beeps of the various bedside machines, the lilting sound of harp music floated through the air. www.sfms.org! As she played lullabies and Gregorian chants, the mood was serene and remarkably peaceful. The patient, who had been agitated and was breathing rapidly before the music began, was by all appearances Read the SFMS monthly e-mail bul- quite calm. The family members seemed comforted by the tranquil letin, Action News, read San Francisco sounds of the harp as they awaited the inevitable. I was struck by the contrast between this tableau and what Medicine archives, and check the events we as clinicians usually observe—the somewhat clinical, cold, and calendar for upcoming SFMS events and institutional end-of-life setting in most hospitals. At a presentation by the Healing Harp Program, Portia Diwa (one of the Harp supervi- seminars. Visit sfms.org today! sors) described how harp therapy has helped patients reduce pain,

www.sfms.org March 2008 San Francisco Medicine  integrity

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Music, Science, and Healing

erhaps the most familiar poetic description of music and rituals to heal the sick. Among the Huichol Indians of Northern healing is found in the play The Mourning Bride (1697) by Mexico, the mara’akame, shaman priests, use peyote to enter into P the English dramatist William Congreve: the spirit world and then, with accompaniment of drums, violin, and guitar, sing the acantos de curación, songs of cure for individuals, Music has charms to soothe a savage breast, the community, and the earth itself. In Tibet, in the Bon Buddhist To soften rocks, or bend a knotted Oak. tradition, gurus teach the Five Warrior Syllables to bring sound I’ve read that things inanimate have moved, into meditation practices, while others play by hand the Tibetan And, as with living Souls, have been informed, Singing Bowls for healing. By magic numbers and persuasive sound. When modern doctors and other healers try to explain these ancient methods of musical healing, they do their best to apply The phrase “living Souls” in this text refers to the experience of science, a method that excludes the sacred. In their books and human beings who are “informed” by music. The “magic numbers” articles, some use loosely defined terms such as “vibrations,” “wave refer to Pythagoras, that friend of the hypotenuse, who demonstrated motions,” or “the etheric” to attempt theories by which to impose that the sounds of music were produced mathematically, in such cause-and-effect measurements upon the immeasurable influence intervals as fourths and fifths, in methodical patterns that were pleas- of music within the human body and soul. Others talk in vague ing to the ear. This was the beginning of the “science” of music. terms about “sound essence” and “the healing resonance,” and one Long before objective mathematics and science, however, the author refers to Einstein’s theory of relativity, noting the relation- subjective pleasing and healing charms of music were practiced ship of energy to mass, thereby concluding that a kind of musical throughout the world. Mythological tales, archeological findings, “energy” has an effect upon the “mass” of the body. As though in and studies of surviving indigenous cultures all attest to the ubiquity extension of these scientific “theories,” a recent clinical empirical of music as a healing method. In her book Music Healers of Indigenous study by Krucoff et al at Duke Research Institute (2005), which Cultures (2004), Pat Moffitt Cook describes the ancient practices she included 748 patients who underwent percutaneous coronary discovered in her extensive travels to Southeast Asia, India, Nepal, intervention, concluded that there was no effect of music upon Japan, and North and Central America. A musician and teacher clinical outcomes—a conclusion that goes against the collective and the founder of Open Ear Center, an organization on Bainbridge wisdom of human beings since the beginning of time. Island, Washington, dedicated to cross-cultural music, Cook says, And so it is that, as in this issue of San Francisco Medicine we “Healing sounds are part of a ‘sacred therapy’ still practiced among contemplate music and medicine, we may notice a disharmony holy men and women, shamans and healers among the indigenous between the objective, scientific, and mathematical approach to peoples of the earth.” music and the profound subjective experience of music within human In Northern India, a man named Babaji, a shopkeeper who was beings. To integrate this dissonance, we might recall that although mystically called by a Muslim saint to be an ojha, or healer, sings Pythagoras began the mathematics of music, he also believed that ancient holy melodies, and soon his patient joins in the chant and numbers themselves were magical and sacred. Relating his num- is relieved of pain, stress, and suffering. In Nepal, Ram Tampa and bers to the stars, the planets, indeed the entire cosmos, Pythagoras Suni Ram practice “folk psychiatry” by beating on a two-headed declared mathematics to be “the music of the spheres.” drum, a dhyangro, and performing a hopping dance, while around Thus, in addition to our science, we may give credence to their necks garlands of bells jingle in rhythm. In Haiti, Micheline the poetic nature of our appreciation of music and healing, as did Forestal, a Vodou manbo, or healing priestess, contacts the myste by William Congreve in 1697, when he said, “Music has charms to listening to the divine in rocks, trees, plants, rivers, wind, and rain soothe a savage breast . . . living Souls, have been informed by magic and then leads a group in prayers, songs, dances, and drumming as numbers and persuasive sound.”

www.sfms.org March 2008 San Francisco Medicine  Music and Medicine

Healing the Healer The Blues for Docs with the Blues

Roy Rogers, Bluesman

s a professional musician, I have I can only imagine what a “hard day” in of the reasons I play. Most of all, I still fondly performed around the world for an ER room would be like: traumas of all recall some of those rockin’ nights at The A many years now, having played in kinds, accident survivors, gunshot wounds, Saloon, and getting the thumbs-up sign and all types of venues—from clubs to festivals burn victims, heart attack patients—just to smiles of approval from those ER Docs. They and casual parties to formal affairs. Through mention a few. Plus people with psychologi- always kept coming back for their “healing,” it all I have also been fortunate to meet all I’m happy to say. kinds of people, and I have come to realize “One night, one of [the I realize now how fortunate I was to the great importance of music in people’s ER Docs] came up to understand the power of music at an early lives. In fact, in the truest sense of the word, age—how it can move people—because music can “heal” people. me and said that he just I myself was moved by what I heard. For Many years ago, I performed regularly wanted to thank me, me, it was the blues, and although my at The Saloon, a small club in North Beach, because he considered me musical horizons have expanded, the blues San Francisco. It was a classic blues joint. still moves me the most. I am known for The patrons were from every conceivable his ‘therapist.’ I was his a particular style of slide guitar, and with social strata, from the regulars (who started ‘healer.’ And although I more than twelve recordings of my own, I way too early) to the never-ending stream had never been referred am fortunate to be able to make the music of tourists visiting The City from around and tour worldwide. I am no doctor, but I the world, plus the many music lovers in be- to this way before, I do know that music is a healer, and that the tween. They all came to The Saloon, which immediately understood experiencing of it can be theraputic, as re- is on record as the oldest bar in the city. It what he meant.” vealed by my doctor friends some years ago. was truly amazing to see such a wide array of When the music is cookin’ and everyone people from such diverse backgrounds come cal problems who come to hospitals because is smiling and dancing and having a great together on a Friday or Saturday night to they’re sick. And, of course, sometimes the time—they are happy, and that is good for have a great time. most severe cases never make it out of the them on any number of levels. It must also There were hookers, down-and-out ER. have something to do with renewal as well war veterans, housewives, street people, Over the years quite a few ER Docs as purging some of the “bad stuff” from your businessmen, and, yes, doctors—emergency became friends of mine. On one particular mind and body. Ultimately, life is about re- room doctors, to be specific. At The Saloon, night, one of them came up to me and said newal, is it not? If we don’t renew ourselves they were known as the ER Docs. They that he just wanted to thank me, because physically and mentally, we will die. Music would come into The Saloon after their he considered me his “therapist.” I was his can help. It is for us to explore. long shifts in the emergency rooms. With “healer.” And although I had never been I leave you with a line John Lee Hooker the music wailing, these Docs let loose. referred to this way before, I immediately and I wrote together for the song The Healer: Why? Because they needed to, like everyone understood what he meant. “The blues is a healer all over the world, else. Often I would talk to them during my Now, looking back, I think that the all over the world. It healed me and it can breaks, and they would tell me stories about whole scene of the club was part of the heal you.” their difficult jobs administering to sick and healing for most of the people there—not A Bay Area native, Roy Rogers is one of the sometimes dying patients in the emergency just the music, but the atmosphere, the premier slide guitarists performing today. Since his rooms of the Bay Area. I cannot imagine dancing, the “vibe” of experiencing music first recording in 1976, his eclectic approach has a more high-stress job than that of an ER in a collective way with a group. I have constantly stretched the boundaries of slide guitar. doctor. To have someone’s life in your hands been fortunate to witness this many times As a recording artist, producer and composer, he is the ultimate responsibility. Everyone can in a variety of places around the world, and continues to combine diverse music influences to have a “hard day” at work sometimes. But it will never get old, that’s for sure. It is one achieve his vision.

10 San Francisco Medicine March 2008 www.sfms.org

Music and Medicine

Musicophilia A Feeling for Music

Ashley Skabar

s someone who has been involved every emotion imaginable.” brain in a different way than any other form in music in some capacity for her Sacks’ new book seeks to demonstrate of study,” Sacks stated at the discussion in Aentire life, it would be impossible our embedded connection with music, San Francisco. “You can look at a brain and to imagine a world without it. Although, through a collection of case studies of per- say, ‘This man is a musician.’” if asked exactly what it is, or why it is that I sons who have been blessed, tortured, and This begs the question, then, that if our feel compelled to play musical instruments, brains are so physically affected by the study listen to music or hum when I walk, or why “‘Chimpanzees don’t of music, what is it in us that determines our I respond to certain types of music rather dance,’ stated Oliver musical capabilities, our musical inclina- than others, I could no sooner answer why tions and preferences? In other words, do we it is that I breathe, other than to say that it Sacks, ‘Humans, have control over our musical preferences comes “naturally.” however, dance to real and capabilities, or are these determined by We generally speak of music as though or imagined music. neurology and our biological makeup? it is something outside of us, something that In Musicophilia, Sacks states that while we take in like air, something that is super- Music is a mysterious “most of us can hope that there may be some fluous to some degree—yet we also refer to phenomenon. It is harmony, some alignment, between our “musical” persons and “nonmusical per- entirely abstract, yet has desires and our powers and our opportunities sons,” as well as those with “perfect pitch” … no one has all the talents, cognitively or and those who are “tone deaf,” which would the power to illicit every emotionally.” He continues, “Many of the indicate at least to some degree that music is emotion imaginable.’” patients or correspondents I describe in this within us, that its hold on us originates from book are conscious of musical misalignments somewhere deep. tormented by unwanted melody, patients of one sort or another. The ‘musical’ parts of To witness the relationship we as who experience confusion with the percep- their brains are not entirely at their service, humans nurture with this thing called tion of music and other senses, persons who and may indeed seem to have a will of their music, one only has to regard the myriads have suffered the loss of musical capabilities own.” (p. 92) of iPods roaming the streets, the pop songs after injury, as well as those who undergo This is evident in the cases in Musi- slipping out of car windows, or the many violent seizures and other music-related cophilia in which patients suffer “musical formalized ways in which we enjoy music maladies. These he explains through neu- hallucinations,” often hearing imagined and the way that it comes “naturally” for us, rological connections and disconnections, music that seems to be originating from as humans, to move our physical bodies in evidencing our brain’s “natural” musical some unidentifiable source, as it is also dem- response to melody and rhythm. It is even tendencies, or our inborn “musicality.” onstrated in patients with perfect pitch or a more curious that we do all of these things In the preface, Sacks declares that natural inclination to musical ability. unconsciously. “humans are a musical species no less than One such intriguing case study Sacks Music, it would seem, is a part of hu- a linguistic one. All of us … can perceive details is that of a woman named Diana man nature. music, perceive tones, timbre, pitch in- Deutsch, who writes to Sacks in a letter: “Chimpanzees don’t dance,” stated tervals, melodic contours, harmony, and “My realization that I had absolute Oliver Sacks, noted neurologist and author, … rhythm. We integrate all of these and pitch—and that this was unusual—came in a discussion of his latest book Musicophilia ‘construct’ music in our minds using many in the form of a great surprise when I dis- (2007) at the Palace of Fine Arts in San different parts of the brain.” (p. xi) covered, at age four, that other people had Francisco in October of last year. “Humans, Indeed, whether we practice or com- difficulty naming notes out of context. I still however, dance to real or imagined music. pose music or not, these perceptions are remember vividly my shock at discovering Music is a mysterious phenomenon. It is more or less present from birth. that when I played a note on the piano, entirely abstract, yet has the power to illicit “Attention to music … develops the Continued on the Following Page...

10 San Francisco Medicine March 2008 www.sfms.org www.sfms.org March 2008 San Francisco Medicine 11 Continued from the Previous Page... much in the same way that we are able to cultures proportionally decreased as well. others had to see what key was being struck increase our vocabularies through study. (p. 127) in order to name it.” (p. 125) For example, while “there does not seem Music is, as evidenced by Sacks’s re- To most of us, the concept of perfect to be any innate neurological preference search, a part of our brains and a part of the pitch, the ability to associate notes with for particular types of music, any more human experience as much as language, their verbal labels, seems incredible. How- than there are for particular languages, the something that may be altered by social ever, to someone like Deutsch, the phenom- kind of music to which we are exposed in influences but that relies in large part on our enon is not “why some people possess it, but the formative years plays a role in ‘cultural “natural” capabilities and neurology. Music rather why it is not universal. It is as though forms of rhythm deafness.” (p. 100) Citing is inextricable to the human experience; it most people have a syndrome … which is a report conducted on music and the devel- is a part of all that we do. like color anomia, in which the patient can oping brain, Sacks explains that “infants at In the final chapter of Musicophilia, recognize colors, and discriminate between six months can readily detect all rhythmic Sacks declares, “One does not need to have them, but cannot associate them with verbal variations, but by twelve months their range any formal knowledge of music—nor, in- labels.” (p. 125) has narrowed … they learn and internalize a deed, to be particularly ‘musical’—to enjoy The notion that there are persons who set of rhythms for their culture. Adults find music and to respond to it at the deepest “naturally” connect musical perception with it harder still to perceive ‘foreign’ rhythmic levels. Music is part of being human, and verbal distinctions is akin to cases in which distinctions.” (p. 99) In other words, while there is no human culture in which it is persons make connections between music we, as humans, may claim to dislike a certain not highly developed and esteemed. Its and other sensory perceptions. Sometimes, type of music, we may simply, through lack very ubiquity may cause it to be trivialized according to Sacks, the parts of the brain of exposure, be deprived of the neurological in daily life: we switch on a radio, switch it that respond to and decipher music also tools necessary to decipher “foreign” tonal off, hum a tune, tap our feet, find the words become confused with other senses, a con- patterns and rhythms. of an old song going through our minds, and dition known as “synesthesia,” in which a Diana Deutsch, mentioned earlier, has think nothing of it.” (p. 347) “person may perceive individual letters or studied the relationship between musical Ashley Skabar is both a published writer days of the week as having their own par- abilities such as perfect pitch and linguistics, and photographer who has written articles on ticular colors; another may feel that every to find that those populations that speak a topics of health, nutrition, and current events color has its own peculiar smell, or every tonal language have a higher incidence of for various publications. Skabar holds a BA in musical interval its own taste.” (p. 166) perfect pitch than those of cultures speaking English Literature and Creative Writing and Sacks goes on to describe the case study nontone languages. In a study conducted currently lives in San Francisco, where she of the contemporary composer Michael on two student populations, one from the works as the Marketing Specialist and Staff Torke, who experiences what he calls Eastman School of Music in Rochester, Photographer for the San Francisco Medical “colored music.” As a child, Torke told New York, and the other from the Central Society. his piano teacher that he loved “that blue Conservatory of Music piece.” Torke has been experiencing this in Beijing, Deutsch and sort of “colored music” as far back as he can her colleagues found that remember. “The colors have been constant “for students who had and fixed since his earliest years and they begun musical training appear spontaneously.… They seem com- between ages four and pletely natural to him and preordained. five … approximately 60 The colors are highly specific. G minor, for percent of the Chinese High Resolution PET/CT scans example, is not just ‘yellow,’ but ‘ochre’ or students met the criterion Fusion Diagnostic Group’s advanced technology ‘gamboge.’” (pp. 168, 169) for absolute pitch, while and software bring evaluation and measurement These cases serve to, if nothing else, only about 14 percent tools to the Physician to use in the clinical setting. we also have a full time physician on staff. demonstrate our brains’ dependence on mu- of the U.S. nontone- sic; it is almost as if “musicality” is a sort of language speakers met Mon - Saturday 8-5 + (flexible hours with advance request) sixth sense to which we are predisposed. the criterion.” The study While a significant portion of our incli- found that while there is Positron Emission Tomography (PET) nations toward a kind of “musicality”, as well a relationship between the Computed Tomography (CT) as our musical abilities, seems to be a part of beginning age of musical Molecular / Functional Imaging our neurological makeup, Sacks’s book also study and the incidence Accurate & Precise Imaging does much to demonstrate how our brains’ of perfect pitch, even as 1700 California St. #260 abilities to perceive and recognize music the incidence of Chinese California at Van Ness in San Francisco, CA are also altered and strengthened by outside students decreased, stu- (415) 921-7226 • 1 (800) 334-0336 • (415) 921-7225 FAX www.fdg-inc.net influences, both physical and cultural, very dents of nontone language

12 San Francisco Medicine March 2008 www.sfms.org The width is 3.5 by 4” high CALL Kae with any questions or concerns 415-567-5888 Music and Medicine

Living with Music One Musician’s Perspective

Nolan Gasser, PhD

n his impressively accessible introduc- ity of the Middle Ages, expanded upon Representation. tion to theoretical physics, The Elegant Pythagoras’s notion of a musica mundana Psychology, too—following an inauspi- I Universe, Brian Greene enthusiastically (heavenly music) with the term musica cious start (Freud was famously apathetic summarizes, with a metaphor, the essence of humana, defined as the music that runs toward music)—has invoked music as a string theory and its unique promise to unify unique and vital presence in our lives, with Einstein’s general relativity with quantum “Philosophers have ties to both our early, pre-ego development mechanics: “At the ultramicroscopic level, (e.g., infusing us in an ocean of sound that the universe would be akin to a string sym- long commented on recalls the womb) and to our collective un- phony vibrating matter into existence.” Be- the ‘power’ of music in conscious, as a link to prehistoric archetypes yond the pride I feel in reading of Greene’s forging our character and that may hold a key to our personal survival. conceptual alignment of the very nature of Among the most articulate psychologists the early universe and the discipline of mu- connecting our souls to writing on the subject in recent years is sic, which is my own life’s work, I am struck our inner nature, our Anthony Storr in such books as Music and at just how common such metaphors are. society, and the world the Mind and The Dynamics of Creation. Storr Music as the window through which we can argues that music is more than a language of hope to better understand the world—or the around us. Plato and emotion but one that synthesizes the inner universe—appears as old as time itself. Aristotle each invested and external worlds, yet “belonging wholly The first well-known exponent of this considerable attention to neither.” It is the stubbornly abstract concept was Pythagoras, the ancient Greek nature of music—at once intelligible yet musician-mathematician, who, according in describing the risks untranslatable, to use Claude Levi-Strauss’s to legend, first recognized the inherent link and rewards of exposing expression—that, for psychologists such as between these two disciplines as manifest in the young to varying Storr, raises music to the very pinnacle of the mathematical perfection of key musical human achievements. intervals, which were perfect numerical modes (that is, styles) of Finally, an interest in exploring a proportions: the octave as 2:1, the fifth as music.” more empirically verifiable connection 3:2, and the fourth as 4:3. Such beautiful between music and our lives has enjoyed a symmetry was more than coincidence, the through the human body, connecting the present-day renaissance, highlighted by the Pythagoreans argued, and must be an expres- functions of the flesh with the actions of publication and popular success of several sion of a higher “harmony”—a Music of the the soul and spirit. recent books, among them Oliver Sacks’ Spheres—where the planets and stars move Similarly, philosophers have long com- Musicophilia (see review on page 11) and according to a musical logic, sounding the mented on the “power” of music in forging Daniel Levitin’s This Is Your Brain on Music. silent pitches of an endless celestial melody our character and connecting our souls to Both explore the neuroscientific basis of our as they make their way around the heavens. our inner nature, our society, and the world fascination with and dynamic response to From ultramassive stars to ultramicroscopic around us. Plato and Aristotle each invested music, as a significant part of what defines particles, music seems to make the universe considerable attention in describing the us as human—emotionally as well as cogni- more graspable and relevant to our lives. risks and rewards of exposing the young tively. Dr. Sacks employs his forty years of The idea that music forms an intrinsic to varying modes (that is, styles) of music. work as a clinical neurologist to document a connection to the human body is, like the Perhaps the most enthusiastic philosopher- wide and fascinating array of cases in which metaphoric relationship between music and advocate was Schopenhauer, who saw in music exhibits a commanding presence in the universe, an ancient one. The sixth- music the direct reflection of the Will (the the human brain, producing at times strik- century Christian philosopher Boethius, fundamental world-stuff), in contrast to ingly therapeutic, and in other cases sadly perhaps the most revered musical author- the other arts, which merely reflect their Continued on the Following Page...

12 San Francisco Medicine March 2008 www.sfms.org www.sfms.org March 2008 San Francisco Medicine 13 Continued from the Previous Page... physical confines to another realm, where But once again, it takes effort. The disturbing, responses in patients—often in clock-time disappears and where emotion development section of the opening move- association with a traumatic event or the and intellect merge to the point of being ment of Mozart’s Piano Concerto No. 21, onset of a serious neurological condition. Dr. indistinguishable. But the rub, as I see it, is for example, contains an extended set of Levitin, a cognitive psychologist and former that, like any transcendent experience, feel- musical sequences, rising one after another, music producer, has focused his attention on ing the “living force” of music takes work; like a huge row of waves slowly making their detailing the neurological and brain chemi- it is not a passive stimulus, like receiving a way to the sandy beach of the movement’s cal responses arising from our interaction massage, but an active dialogue between primary theme. The effect is amazing if fol- with music, and especially its significance that which resides within us and that which lowed intently passage-by-passage, though to our emotional life. His research using enters our awareness from the outside. It is a merely pleasant if listened to casually. To functional magnetic resonance imaging conversation between our expectations, our cite another, more obscure example, the (fMRI) to map the neural and metabolic memory, and the visceral reality of what en- Renaissance master Josquin des Prez’s six- responses to music, moreover, may be seen ters our ears. Even with repeated encounters part motet Praeter rerum serium is among as but a modern corroboration of Boethiu’s with a familiar piece of music, the experi- the most profound works ever written, earlier notion that music triggers a complex ence is never the same twice, provided we and the emotional-intellectual payoff is interplay between our minds, bodies, and are actively engaged with it. unrivaled—if the narrative is intently spirits. Many of the writers mentioned above followed; otherwise, it sounds like pretty Both Sacks and Levitin emphasize the speak of the specific quality of tension and church music. startling power of musical memory: Sacks, release within a piece of music or a musical Now, to be sure, there is nothing for example, highlights cases in which a performance (as in a jazz improvisation) as wrong with casual music listening; like a patient whose mind is wholly ravaged by a key component of music’s emotional and recreational massage, it can be wonder- Alzheimer’s disease can still sing a melody cognitive gravitas. Manifestations of this fully pleasant. But with just “pleasant,” we learned in childhood, without missing a admittedly vague notion are multiple and will not quite rise to the heady and poetic pitch or lyric; similarly, Levitin cites studies vary considerably, from a simple harmonic powers assigned music by the writers noted of nonmusicians singing their favorite pop cadence (e.g., dominant-tonic) to a larger above. A key ingredient here, of course, songs with no external aid, matching the structural progression (e.g., from develop- is education; the more one knows about pitch and tempo of the original recording ment to recapitulation in a symphony; music—historically, theoretically, practi- with remarkable accuracy. Clearly, music from bridge to chorus in a pop song). But cally—the more one can retrieve during one is hardwired into our brains in a manner whatever the case, the tension must be of those encounters. Perhaps, indeed, when that defies narrow explanations of auditory perceived and the resolution experienced for conditions are right—whether “living” with reception and memory, lending credence to the full effect to take place. The overriding the music of Bach, the Beatles, or Dave Sacks’s notion that indeed “we humans are encounter is one of musical narrative—a Brubeck—we’ll glimpse what Pythagoras a musical species no less than a linguistic concrete progression in “aesthetic time” and Boethius were really talking about: that one.” without a concrete story line, where the the heavens, as well as the human body, are While the observations, case studies, “subject” is sound itself. made more harmonious by the inexplicable and scientific data derived from these inqui- This is indeed the miracle of music: power of music. ries and commentaries are fascinating, they that tones, rhythms, harmonies, or timbres Dr. Nolan Gasser is a professional com- act largely as confirmation of a truth that in succession can have meaning at all, a poser, pianist, and musicologist, who received most of us already know: music is important meaning experienced as it happens, and his Ph.D. in Musicology from Stanford Univer- to our lives and has a powerful effect on us where precise semantic translation is impos- sity, where he has taught as an Adjunct Profes- that defies easy explanation. So, what can sible or irrelevant. When the living musical sor. His compositions have been performed by we do with this knowledge? What actions experience is powerful enough, we can be orchestras and artists around the country, with a can we take to enhance the positive role truly lifted into an altered state, where a res- performance this month [March 10] at Carnegie music plays in our lives? How do we best onance imaging of our brain would undoubt- Hall. Among his current commissions include “live” with music? edly reveal it as coming alive, triggering a a work celebrating the launch of NASA’s next I am a practicing musician, and my myriad of salutary effects on our sympathetic space telescope mission, GLAST, entitled perception of the “power” of music is most and parasympathetic nervous systems. In Cosmic Reflection, “depicting” the history of keenly derived from my professional expe- an age of increasing societal and personal the universe. Dr. Gasser is the architect of the riences with the medium as a performer, stress, not to mention rising environmental Music Genome Project for the popular Pandora musicologist, and composer. From this risks, a counterbalance of engaged music- music service, and is the Artistic Director of the vantage point, the chief reality I perceive is listening seems a painless—indeed pleasur- Classical Archives website. He lives in Peta- that music—when conditions are right—is able—means to help ward off the prospect luma with his wife and two children. a living force, one that has the potential to of cardiovascular disease or cancer. Think transport us from our normal spiritual and of it as musical exercise.

14 San Francisco Medicine March 2008 www.sfms.org Music and Medicine

Soothing the Sick with Sound Music at Stanford Hospital

Greg Kaufman

middle-aged man enters Stanford Ambient piano, guitar, and harp music The effects of the music on patients, Hospital’s Cancer Center for a in the Cancer Center and weekly concerts their families, and the musicians themselves A second opinion consultation with for transplant families are also part of the are heartfelt and moving. the Tumor Board. He has never been to Stanford Music Program. A summer outdoor One patient, Anne, was recovering Stanford Hospital before and his apprehen- concert series and an additional ambi- from heart surgery at Stanford Hospital. sion as to what the prognosis may reveal is ent piano day were added to the Cancer She became restless after a week in bed. But palpable. Center’s schedule in June 2007. throughout her stay, there were two bright As he enters the building, he is sur- “Live music is becoming a regular spots in her week: visits from her family and prised to notice the lack of clinical ambi- feature in the life and care of patients and the twice-weekly concerts. ence—it seems more like an upscale hotel residents in hospitals, homes, hospices, etc. Every Wednesday and Friday at 12:30 than a medical clinic. He walks down the throughout the U.K.,” wrote Sylvia Lindsay p.m., Anne looked forward to a professional hallway, noticing the waiting areas are in the British Journal of Hospital Medicine. ensemble performing in the Atrium, a large warmly lit with flat-screen panels displaying “The response to music is intensely public area on the ground floor surrounded peaceful scenes from nature. He hears beau- individual, depending on many factors such by outdoor gardens viewed through large tiful harp music and, as he turns a corner, as age, culture, and upbringing,” she says. picture windows. On this day it was Eric he sees a musician perched on the edge of a “However, it is evident that music can bring & the In-Crowd, a wonderful jazz and pop sofa playing her instrument. He approaches emotional release, revive memories, and standards band that has been performing at slowly and tells her the music is wonderful, act as a means of communication beyond Stanford for nine years. Eric had recently and that he’s never experienced anything words.” been named “Piano Man ’07” by San Fran- like this in a hospital. She nods, thanks him, The centerpiece of the Stanford cisco Magazine and his booking calendar and responds she hears that quite often. For Hospital Music Program is the Bing Music was full, but he always made time to per- a moment, his anxiety is gone. Series. This series provides concerts every form in the Bing Music Series at Stanford This is the Stanford Hospital Music Wednesday and Friday afternoon from Hospital. Program in action. Its mission is simple: to 12:30 to 1:30 p.m. Open to all patients, visi- Eric had seen firsthand the benefits his integrate music as a primary element of the tors, and staff, these concerts are performed music provided the attendees. His attitude health care offered. Its commitment is to by professional musicians covering a variety was mirrored by most of the performers make Stanford Hospital a more comfort- of genres, including classical, ethnic, jazz, who are a part of this series. They see the able, soothing, and healing environment for popular, folk, and choral. difference it makes to bring live music to a patients, family, and staff through music. The concerts are held in the Hospital healing environment. And its results are undeniable, uplift- Atrium, a large indoor area surrounded by Jeff Buenz, one of Stanford Hospital’s ing, therapeutic, and personal. beautiful outdoor gardens and decorated house musicians, relates this story: “As I with contemporary artwork. The audience is walked onto the unit, a nurse asked me ‘if I Concerts in the Atrium given a brief overview of the music services could play for the girl in room 33.’ The Stanford Hospital Music Program, available to them, all free of charge, before “I went to the room and saw this little which is part of Guest Services, was created the concerts start. They are also invited to girl, perhaps five or six years old, crying and in 1992 as a weekly concert for patients’ write down any impressions they have in a screaming alone in her bed. As I began to family and staff. Since that time, the Music comment book provided at each concert to play calming music, I could immediately see Program has expanded its services. It now document the positive effects the music has her crying turn to whimpers, then silence. provides concerts twice a week in the Stan- on its listeners. She then lay still and simply stared at me as ford Hospital Atrium, plus music six days a I continued to play. week on the units at Stanford Hospital and Music for Recovery and “The nurses gave me a thumbs-up,” Jeff Lucile Packard Children’s Hospital. Communication Continued on the Following Page...

14 San Francisco Medicine March 2008 www.sfms.org www.sfms.org March 2008 San Francisco Medicine 15 Continued from the Previous Page... visit bedside to perform for patients who are The Importance of Live continues, “and I knew that the music had unable to attend a concert or who just prefer Performance been a positive force for this little girl. the privacy of a live musical experience. The “Experience has shown that a live “When I finished the first piece, I asked musicians will often develop a relationship performance is infinitely more valuable the girl if she liked the music. She stared with long-term patients, and many of these than the finest recording: it enables the lis- at me for several seconds and then gave a patients cite the healing and stress-reducing tener to cross the line between just hearing barely visible single nod of her head. I started effects these visits bring. something and becoming totally involved playing ‘A Whole New World’ and asked in the more active pursuits of listening and her if she knew the piece. She continued Solace at the End of Life participating,” writes Lindsay in the British with her contented stare. The musicians are often requested to Journal of Hospital Medicine. “It’s so beautiful to experience the assist during the dying process, their pres- “At Coppercliff Hospice, Brighton, a magical way music can calm someone. She ence bringing solace to the patients and member of staff stated, ‘I believe we under- never took her eyes off me as I played several their families. estimate the value of music.’ The positive more familiar songs for her, including ‘Un- “One day, as I was walking through results thus far have made all the staff aware der the Sea’ and music from Toy Story. the back hallways, I saw Susan, one of the of this and of the need for us to provide “I played for another fifteen or twenty chaplains at Stanford Hospital,” says harp- more music. Live artists provide that special minutes. As I got up to leave, she nodded ist Barbra Telynor. “Susan explained to me atmosphere,” writes Lindsay. two times without further expression.” that there was a group of family members An important feature of a live per- The other five house musicians’ sto- gathered in a nearby room, saying good- formance is the visual aspect, watching ries related similar calming effects on their bye to their loved one, who was critically instruments being played. Of equal signifi- listeners, regardless of age, nationality, or ill. I asked Susan if they would like to have cance are the warmth, communication, and even musical tastes. Examples of stress and some music. presentation skills of the musicians, who are anxiety reduction experienced by patients, “After I set up in the room, I played able to move within the audience, adjusting families, and staff are cited through their quietly in the corner as family members took the music at a moment’s notice and singing anecdotes—as are other important benefits, turns holding their beloved’s hand, wiping or playing individual requests. such as helping with end-of-life transitions, his brow, kissing him on the forehead. A Music reinforces a sense of time and providing motivation, and improving com- few days later, Susan and I met up again. place, increases physical output, stimulates munication. She said the whole family had expressed to those who lack motivation, and brings Many of the comments revealed the her how helpful and supportive the music relaxation. profound effects the attendees experienced had been.” With the generous support of donors while listening to the music, from temporary While no situation is typical, patients and sponsors, the Stanford Hospital Music relief of their depression to cathartic resolu- and their families are consistently apprecia- Program will continue to provide these most tion in accepting their condition or that of tive of the music and its positive effects. important services to its patients, staff, and a family member. The benefits of music in a healing visitors. Stanford Hospital contracts six musi- environment have long been recognized in Greg Kaufman is the director of Stanford’s cians who perform throughout the hospital many cultures, and programs like Stanford’s music program. six days a week. They provide ambient are gaining popularity worldwide. music in waiting or admitting areas and also Welcome New Members! The San Francisco Medical Society would like to welcome the following new members:

ACTIVE REGULAR MEMBERS

Paul Abramson, MD—Online Application

Roderick Pettis, MD—Online Application

Allan Treadwell, MD—Online Application Referred by Steve Fugaro, MD

16 San Francisco Medicine March 2008 www.sfms.org

Music and Medicine

The Power of Music The Transformed Moment

Susan Mazer

hilosopher Alan Watts described were not there at 3:00 a.m. opened the door to revisit the means that music as “an expanded present.” Music and medicine have been part- patients have used for centuries to comfort, P He had a “thing” about time, ners for hundreds of years. Beginning with soothe, remedy the symptoms of stress and about how we experience it, manipulate the Aesclepian temples, where the “high anxiety, improve quality of living, and en- it, and can use it to gain some semblance tech” of the day included alchemy, prayer, hance physical capacity to fend off disease of control in a life uncontrollable, and to and illness. find peace amid chaos. Perhaps that is part “Few of us have not Music therapy researchers have pro- of what inspired me, as a musician, to look experienced that magical vided more than fifty years of scientific data past the notes and melodies, the harmonies regarding the positive effects of music on and phrases, to the way music changes the moment after the relieving pain, reducing stress, improving way we breathe, the space in which we find last note of a song or immune system response. Sixty years of data ourselves. Few of us have not experienced symphony fades into the have shown that using music as a partner to that magical moment after the last note of other clinical protocols renders improved a song or symphony fades into the air, when air, when all of life holds effectiveness, relieves anxiety, and enhances all of life holds its breath and sighs in ecstasy. its breath and sighs in recovery—and that neither method negates It is in that very moment, that experience of ecstasy. It is in that very the other. Major health care centers of ex- timelessness, of selflessness, when we are one cellence, such as Stanford University Medi- with the moment, that, perhaps, “healing” moment, that experience cal Center, UCSF Medical Center, Kaiser is evidenced. of timelessness, of Permanente Hospitals, Oakland Children’s If experience counts as evidence and selflessness, when we are Hospital, Johns Hopkins University Medical if evidence can be described as much as one with the moment, Center, and Scripps Hospitals and Clinics, measured, then my many decades as a harp- include music, art, and other humanities- ist have reinforced this most powerful role that, perhaps, ‘healing’ is based tools to improve patient experience music plays for most of us: changing time evidenced.” and outcomes. M.D. Anderson Cancer and space, altering the moment, taking Center has a notable and recognized arts our minds away from where we are sitting, nature, music, and drama, the history of program. University of Pittsburgh Medical removing for a brief time our deepest fears, medical care has been one that shows the Center partners with the Pittsburgh Sym- replacing them with serenity, and unbur- relentless search for effective methods by phony and its members to bring concerts dening us from our anxiety and concerns, which physicians can relieve the suffering into the hospital on a regular basis. if only for a moment. of their patients and, through miracles not All of these programs are episodic, Following a full-time career as a per- always understood, diseases could be con- when a musician or music therapist works forming musician, I moved into health care, quered or, at least, survived. with a patient for a specific amount of time. hoping that this magical moment might be Today’s evidence-based medicine de- It was because of the effectiveness of music possible if the environment were created mands science as the sole basis for practice. for patients, and the fact that their needs appropriate to the needs of patients. It was Nonetheless, when we consider any of the were not limited to one time of day at one not a straight-line process, however. My arts, science relying solely on quantifiable particular hour, that we looked at providing husband, Dallas Smith, and I performed measures may be at odds with itself, in part a tool that would bring music to the bedside on oncology units, in emergency rooms, because the human process seems to reveal to be available whenever the patient wanted on med-surg floors, and in hospital lobby itself in implications and ambiguities rather or needed it. waiting areas. All of these events were only than absolutes. The strong push for using We noted also that there are ongoing events. We remained concerned about what complementary and alternative methods challenges with patients being separated happened when the music stopped, when we to support positive clinical outcomes has Continued on Page 20...

16 San Francisco Medicine March 2008 www.sfms.org www.sfms.org March 2008 San Francisco Medicine 17 7524_AdBelaK_102507.qxd 10/25/07 3:47 PM Page 1

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Music Therapy at Langley Porter The Union of Clinical and Musical Skills

Tom Benson, MT-BC

n the days after the Second World War, body of research many veterans suffering from what literature (posted I we now know as Posttraumatic Stress in the Journal of Disorder (PTSD) found themselves hospi- Music Therapy talized under psychiatric care in Veteran’s and elsewhere) hospitals throughout the country. Starting to support music in Kansas and then elsewhere, musicians therapy practices began visiting these hospitals, playing live as evidence-based music for the veterans. The positive physi- and founded in cal and emotional responses were quickly research. Never- noted by doctors and nurses, who called for theless, the actual musicians to be hired for this purpose. Soon implementation it was clear that these musicians required of music therapy additional training to more fully understand brings out the and respond to the conditions of their “au- highly individu- diences,” and thus the profession of music alized creativity and musicianship of each and musical expressions. Patients begin to therapy was born, eventually organized into music therapist. Thus, music therapy will wonder, “How is it that I’m able to change the American Music Therapy Association never look the same twice. my emotions and thoughts through such a (AMTA). As a music therapist in a psychiatric simple musical activity?” In the ensuing dis- Because music therapists are musi- hospital, I am personally predisposed to the cussions, they explore ways of creating such cians first, the academic training of music metaphorical qualities of the weather for therapeutic change in their lives outside of therapists occurs under the auspices of musical inspiration in caring for my patients. the hospital as well. university music schools. Rigorous aca- There’s something about the many different Again I turn to the rain, this time demic musical training is later paired with kinds of rain, for example, that powerfully with the help of Johann Sebastian Bach, training in therapist and clinical skills. connects with the difficult emotions and specifically the tender and sweet Largo from This focus on musicianship is key to what thought patterns that bring patients into his Concerto for Two Violins. A wonderful makes music therapy work so well. In light our care. “What kind of rain is most wel- music therapy intervention is to use guided of the profound physiological, emotional, come to you?” “What kind of weather best imagery with music, and the music of Bach social, cognitive, and behavioral responses describes your inner life today?” As I sit with can be the best for this purpose. I’ll invite that music can elicit, a music therapist will a group of patients struggling with depres- the patients to sit comfortably and relax always be keenly interested in bringing ex- sion, isolation, or even suicidal tendencies, their bodies. Then I’ll start the music. As the cellent-quality musical experiences to his or I might introduce them to a simple chant melody lines of the two violins intermingle her patients. In his recent book Musicophilia, while I play the guitar: “Hear the rainstick and dance around each other, I suggest that Oliver Sacks beautifully describes some of sound, tumble all around….”, and then pass the patients allow their minds to fill with im- the profound effects of music on a variety of the Native American rainstick around the ages and sensations (sounds, smells, tactile conditions. It has been said that when good circle. One patient creates sounds of a thun- experiences) of a cleansing, healing rain that music is used by a music therapist, “there is derstorm, another creates a steady drizzle, yet washes away distress, worries, or anything a second therapist in the room.” another creates a gentle sun shower. Soon that they would like to let go of. When Music therapists are held to the high the members of the group are rising above the imaginary rain lifts, they are invited to standards of clinical care required for board their isolation and inner distress, coming visualize where the music would take them certification (MT-BC). The profession is to life in mutual recognition and support once the sky has cleared, and then to write accumulating a growing and convincing brought about by their collective creative Continued on the Following Page...

www.sfms.org March 2008 San Francisco Medicine 19 Music Therapy at Langley Porter The Power of Music may love the nature and be neutral about the Continued from the Previous Page... Continued from Page 17... music; another may be too ill to watch the down or draw what they felt, thought, and from the familiar, finding themselves in a television monitor; one may watch it as the discovered. The immediacy and depth of hospital room that is laden with technolo- last defense against commercial banter. And these kinds of musically generated experi- gies over which they have neither control yet, the outcome is the outcome: patients feel ences give the patients a wealth of material nor understanding, pillows and blankets that better for reasons unknown. to explore in the subsequent group therapy are not theirs, surrounded by people whom What does this say about evidence- process as they struggle with finding ways they do not know. Research has shown that based medicine? It says that evidence is made to make new beginnings, learn fresh skills, nature is universally familiar and comforting obvious in more ways than merely cellular and build hope. across generations and ethnic or religious investigation. The very core of being human Because my cotherapist, music, is backgrounds. carries with it strengths of the whole interac- so good at drawing patients into healing Therefore in 1992, using the television tion of mind, body, spirit, relationship, and experiences, my role as music therapist is as the delivery system, we started producing sensory response to caring that is experienced to know the patients and their conditions the CARE Channel, which includes instru- through the arts and music and that may not well, so that I can set up musical experiences mental music and nature imagery over the be accessed only through pharmaceutical to allow music to do its work. Maybe we’ll full twenty-four-hour day. A closed-circuit modalities. sit around a table-sized gathering drum and television channel, the CARE Channel is The many anecdotes that describe play together to ease patients out of their available for the patient when needed. It has, how the CARE Channel has been viewed, isolation; maybe we’ll listen to a song and from its beginnings, been based on research whether the focus was the images or the discuss how the lyrics and emotions relate to regarding music, imagery, the required pac- music, include measurable outcomes reflect- struggles in our lives. Maybe we’ll improvise ing of the day-night cycle, and the value of ing positive patient experience. Whether together on a collection of xylophones to positive distraction in mitigating pain and patients are in need of less pain medication strengthen the experience of being truly in anxiety. or they can sleep without sleeping aids, the reality of the present moment and fully Unlike commercial music program- whether an elderly agitated patient calms attentive to each other. Maybe we’ll sing or ming, music on the CARE Channel is down without restraints or an Alzheimer’s chant together to rebuild trust, lift spirits, original and selected based on the needs of patient is able to focus on mountains and or notice the healing and anxiety-reducing patients to experience minimal stress. Fur- streams rather than wander, the effectiveness effects of filling our lungs deeply for song. ther, the channel has been developed from of nature and music to create an environment So the next time you might be feel- the outset to transcend issues of age, gender, of its own, to transform a hospital room into a ing like a “rainy day,” see if you can get ethnicity, religion, and culture. Rather, we therapeutic space and the endless moments of your hands on a recording of Bach’s Largo have looked at the nature of “patient-hood” suffering into moments of peace—all of these from his Concerto for Two Violins (or an- as universal. are as real as any other kind of pharmaceuti- other piece of calming instrumental music Our hospitals now number almost 400. cal intervention. More powerful, however, to soothe the soul). Relax in a comfortable Many have arts programs, live music, and use is the fact that the arts (whether through chair and let the music awaken in you im- the CARE Channel as an environmental the CARE Channel or a live performance) ages of soothing, cleansing rain. You can component to hold the hand of the patient embrace and mobilize the consciousness decide if you’d like your visualization to when the staff is not there. The program- of patients and families, putting the power include an umbrella or not. ming is day- and night-sensitive, uninter- of healing back into the hearts and spirits Tom Benson received his bachelor’s degree rupted, and provides a virtual window to of those for whom cure may or may not be in Music Therapy from Michigan State Univer- the outdoors. possible. sity. During his studies, he interned at Langley The stories that come back to us from Acknowledged as a pioneer in the use of Porter Psychiatric Institute in San Francisco. patients are varied. One woman wrote that music as environmental design, Susan Mazer is He went on to become a board-certified music her mother was in the emergency room and, the President and CEO of Healing HealthCare therapist and to receive a Guided Imagery and in seeing images of a rural lake with ducks, Systems (www.healinghealth.com) and pro- Music (GIM) Level I and II certification. He began talking about her childhood. This was duces the CARE Channel. She is a classically has worked since 1993 as a music therapist a welcome shift from the panic she had been trained jazz harpist, having done her graduate and as the training director of music therapy at experiencing. The use of the CARE Channel work at Stanford. In her work in health care, she Langley Porter Psychiatric Hospital and Clinics for palliative care, for pain management, and has authored and facilitated educational training at UCSF. to improve restfulness and sleep has been for nurses and physicians and is well published told and retold. Nonetheless, its availability in the field of the effects of noise on patients. In at the bedside does not dictate how a patient March, she will be speaking at the second annual might use it, when, or what it will mean to Environments for Aging conference in Tuc- each one of them. In fact, the outcome is not son, Arizona. She can be reached at smazer@ always the motivation for its use. A patient healinghealth.com.

20 San Francisco Medicine March 2008 www.sfms.org Music and Medicine

Healing Muses Adding Sound to Silent Technology

Eileen Hadidian

n 1994, I received the diagnosis so Celtic harpist, I founded Healing Muses and mood, gradually slowing it down to allow many women dread: breast cancer. The set up a pilot program at Kaiser Permanente their vital signs to stabilize. On the other I prognosis, however, was excellent and Medical Center in Oakland, bringing music hand, if the energy is low and people need to various treatments kept things in check for to the hospital floors and lobbies of two build- be invigorated, we start with slow music that three years. But in 1997 it returned with a ings. Celtic harpists Maureen Brennan and echoes their mood, then gradually pick up vengeance, having jumped from Stage I to Patrice Haan have since joined the team. the speed.Our repertoire includes medieval, Stage IV metastatic cancer. Tests confirmed In 2002, Healing Muses became a non- Renaissance, and Celtic music, American that the cancer had spread to the spine and profit organization. The program’s intent is folk songs and spirituals, and music from ribs. Had I believed the medical statistics, this not to try to cure the physical body but rather different world traditions. We avoid disso- Stage IV diagnosis would have shortened the to heal on emotional and spiritual levels. We nant twentieth-century music and the more remainder of my life to eighteen months. have repeatedly seen Healing Muses’ music bombastic Romantic composers, focussing on Ten years later, I continue to beat those relieve anxiety, diffuse pain, and encourage beautiful, simple melodies from a variety of odds because I knew then that my life was not relaxation during stressful hospital stays and cultures. We study how different music affects over—in part because I had a loving husband procedures. I am continually awed by the people differently, and we group sets of pieces and a young daughter I wanted to see grow power of music to soothe and calm agitated to create a healing environment. up and launch on her life’s path, and in part patients in comas, to shift noisy hospital floors Healing Muses’ goal of bringing music because of the work I do with healing music. to lower decibel levels, and to act as a sedative to medical settings has gotten support from a As I see it, doctors are technicians; they can with no negative side effects. number of administrators and health profes- save our lives using emergency medicine. But Music can be either stimulative or sionals, including my surgeon, Dr. Richard as far as maintaining our life, or improving sedative. Stimulative music has an assertive Godfrey, who says that adding music to the its quality, we as patients have a large role rhythm that elicits reactions: hand-clapping, “silent technology” of modern medicine can to play. toe-tapping, dancing. In working with pa- “awaken the positive forces of healing that In my own struggle with cancer, I have tients who are recovering from a major trau- come from within.” Many administrators used a wealth of alternatives. In addition to ma, such as stroke, music with a pronounced agree that the music benefits staff as much mainstream treatments, I rely on a combi- rhythm is often preferred. It stimulates the as the patients. nation of nutritional therapy, traditional heart rate, increasing metabolism, pulse, We never know whom our music will Chinese medicine, and Tibetan medicine. As blood pressure, and muscular energy, and it touch. For every person who comes up and a professional musician who plays recorder, may provide exactly the energy some people talks with us, there are all those others who wooden flutes, and some Celtic harp, I turned need to build better health. By contrast, pass by, anxious or frantic, who may be to music right from the start as part of my sedative music is slower and more soothing: soothed by the sounds of our playing. All healing process. It has an easy, flowing melody, a slow tempo, the Healing Muses concur that their music From the time my surgeon supported my and no major changes in pitch, dynamics, or appeals to a broad range of people. Patients wish to have soothing music in the operating rhythm. It has a calming, anxiety-reducing or their families often ask about the instru- room, my experience with cancer, combined effect, even when the listener is unconscious, ments we play; staff sometimes request that with my natural curiosity, has led to the ger- and it reduces levels of adrenaline and other we play for a particular patient who loves mination of projects that combine music and stress hormones. music. Patients in the laboratory say that healing. Convinced through reading how In this practice, the ultimate goal is en- their blood pressure readings are lower on music could be used to help people with life- trainment, a process intended to synchronize days when we play there. threatening illness by alleviating some of the the patient’s vital signs with the music. Before The spiritual power of music can be es- discomfort and pain, I became an advocate playing for a room full of patients, we gage pecially useful to people facing the transition and practitioner of music as a healing art. their energy. If they are agitated, we start between life and death, and it can help the With Natalie Cox, a professional concert and with faster-paced music that matches their Continued on Page 23...

20 San Francisco Medicine March 2008 www.sfms.org www.sfms.org March 2008 San Francisco Medicine 21 Music and Medicine

Enriching Hospice Care Music at the End of Life

Kris Montgomery

“Music and rhythm find their way into Goldberg, a Hospice by the Bay Patient limiting illnesses, some after a health crisis the secret places of the soul.”—Plato Care volunteer who has been playing flute of their own or a loved one’s. Billings says music to hospice patients for more than that playing for her father during his last umans have long recognized the three years, says, “There are different ways to illness caused her to see the value of the significant effect of music in our reach a patient: words, therapeutic touch, and harp when someone is sick or dying. She H lives. That’s why hospices around other forms of nonverbal communication. says, “When you play to someone who needs the country, including the Bay Area’s own Sometimes when nothing else works, music healing, music can help speed that healing. Hospice by the Bay, are now using music does.” Goldberg cites Daniel J. Levitin’s When playing to someone who is dying, you to enrich the lives of patients with serious book, This Is Your Brain on Music, which frequently see peace come over them. I feel illnesses. To add depth and value to its care theorizes that music taps into a part of the privileged to be with individuals during this of patients and their families in Marin, San brain that doesn’t require interpretation to sacred time.” Francisco, Northern San Mateo, and So- communicate, as words do, and that allows The volunteers agree that music can noma counties, Hospice by the Bay (formerly a direct connection to feelings. calm both those with illness and the “worried Hospice of Marin) added musical activities Cheryl Wilkins, the volunteer services well.” Taussig recounts a visit to a cardiac pa- to its volunteer Patient and Complementary manager who oversees the Patient and Com- tient: “Her granddaughter told me her grand- Care program four years ago. plementary Care program, says that musical mother had been very anxious, and she hoped “Studies show that musical activities and activities were added to Hospice by the Bay’s the music would soothe her.” While Taussig massage are the two most popular forms of program after requests from its clinical staff, played, the granddaughter watched the heart complementary services,” says Mary Taverna, who saw the benefit of offering a variety of monitor. The granddaughter wept with joy Hospice’s president and CEO. “We want to modalities to enhance the lives of patients as it showed her grandmother’s heartbeat offer our patients a rich range of care op- and families. Currently, several Hospice vol- slowing as she fell peacefully asleep. tions to make their remaining time the most unteers play in hospitals, residential and nurs- When playing, the musicians watch the meaningful and comfortable possible. We ing facilities, and patients’ homes in Marin patient’s breathing and facial expressions for also want to comfort their families during and San Francisco. Some have training in the a response. Often they play steady, rhythmic a difficult time of life—music helps provide use of music to heal and comfort those with sounds, “sometimes even just a single, soft some comfort.” terminal illnesses; others are trained Hospice tone,” says Taussig. It’s best to keep the music Brain wave studies suggest that even volunteers who offer their musical talents as simple, Billings notes. “You wouldn’t carry nonresponsive patients and those who are an extra gift to clients. on long conversations with someone whose actively dying can hear sounds, indicating After the first “music thanatology” pro- systems are shutting down either. You’d just that hearing may be the last sense lost before gram opened in 1973, teaching the use of live use simple words: ‘I love you.’ ‘You can let death. A review of several studies about harp music in the care of the dying, interest go.’ ‘I’ll be fine.’” the efficacy of music therapy in end-of-life grew in using music as medicine. Hospice Several of the musicians improvise as care shows that both seriously ill and dying by the Bay volunteer Barbara Rose Billings they play, watching to see what sounds the patients experience positive changes in pain is certified by the Bedside Harp program patient responds to. Called to play to a pa- levels, physical comfort, fatigue versus energy, in Pennsylvania. She now teaches in the tient who was dying, very weak, and in pain, anxiety versus relaxation, time and duration Healing Harp program at San Francisco’s Goldberg played the flute for many hours over of medical treatment, mood, spiritual well- Institute for Health and Healing at the two days. Goldberg watched the man’s face being, and quality of life (see Russell E. California Pacific Medical Center, where and posture relax. He said to the patient, “It Hilliard, “Music Therapy in Hospice and another Hospice volunteer harpist, Judith looked like you were taking a trip somewhere Palliative Care: A Review of the Empirical Taussig, is an intern. while I was playing.” The patient smiled, say- Data,” in Evidence-based Complementary Many of the musicians feel they were ing he had indeed taken a trip to a “special and Alternative Medicine, April 2005). Stan “called” to play music to those with life- private place,” carried there by the music.

22 San Francisco Medicine March 2008 www.sfms.org Volunteers also offer music as a form Healing Muses and began to play quietly. Almost immedi- of companionship, especially for patients Continued from Page 21... ately, the family in the next room came out whose family can’t always be present. “It’s dying let go in relative peace and acceptance. to see what was going on. ‘Is this heaven,’ a way of being with a patient when small As my good friend Susan was dying of breast they asked, ‘where there are angels playing talk feels silly,” says Cinder Ernst, a Patient cancer, I began to play my Celtic harp for harps?’ Another family walked down the hall Care volunteer who plays guitar and sings her one afternoon a week and witnessed the to offer thanks for the peaceful effect of the for her patients when they request it. Some power of music to soothe. The first week I harp. The noise at the nursing station began of her patients ask for a specific song and sing went to Susan’s home, she was conscious, to reduce from slamming clipboards, rattling along. Others listen quietly or with their eyes confined to her bed, surrounded by caretakers carts, and loud voices to a quieter, calmer closed, as the song or sounds can evoke deep and their incessant talking; she seemed very level of activity. feelings—happy memories of good times, or tired of the constant input. I asked people “After playing for an hour and a half, I grief about their illness—feelings that the to leave; as soon as I started playing, Susan’s checked on Eileen to tell her I was leaving for Patient Care volunteer can help them express eyes closed, her breathing became slower, the day. I noticed she was breathing a little and explore. and she rested quietly for the next two hours, more easily, although she was still deeply Families and medical staff also report occasionally opening her eyes to ask for a sedated. As I packed the harp to leave, one of benefit from the volunteer’s music. Taussig favorite piece. the nurses called out to me, ‘You should come was called to play at the bedside of a patient The last time I played for Susan, there every day. I started out this shift feeling very in the hospital whose family members had had been a shift in her condition; she had tense and now I am more relaxed.’ made the difficult choice to disconnect their moved inward and stopped eating and re- “Another day I was playing in the father from a ventilator. She played for more sponding. She had also been very agitated, lobby of one of the big hospitals—a hub of than an hour, as the family said prayers and not wanting anyone to touch her or admin- activity, central to the entrance, laboratory, their good-byes. She continued to play after ister anything, whether fluids or medication. information desk, gift shop, waiting room, nurses disconnected the patient’s breathing As soon as the music started, she calmed and cafeteria. Chairs lined the open walls tube and the monitors went flat. She says, down and rested deeply for the next few and a parade of people passed by my harp. “The family was grateful that I was there to hours. Her caretakers occasionally came in An older woman in a windbreaker stood create a soft human atmosphere during such and commented that this was the first time nearby, listening intently, her eyes averted, a sad time.” in twenty-four hours she had been so calm. with tears streaming down her cheeks as I Unlike core hospice services, Comple- Moving the music away from regular rhythm played several songs. Finally she came up and mentary Care offerings—including music, and words, like the fluidity of medieval chant, grasped my hand, telling me that her husband massage, energy work, and animal visits—are my voice became another instrument, along was upstairs dying. ‘I just needed a moment to not reimbursed by health care insurance with the harp. Early the next morning, Susan collect myself and had no idea you would be programs. Financial donations from com- died peacefully. here. I have not cried before, but now I feel munity members and corporate partners to Fellow Muse Patrice Haan also shares that my heart can bear what will come.’” the nonprofit Hospice by the Bay Foundation some of her personal experience with heal- In some senses this way of offering music support the program. ing music. is closer to its original intent in traditional Hospice by the Bay, which has been serving “Often I enter the hospital full of hope, cultures—as a ritual and tool used by healers Marin, San Francisco, Northern San Mateo, yet with some trepidation that I will be able to and spiritual leaders. The musician becomes and Sonoma counties since 1975, is a 501(c)(3) ascertain what is appropriate in this moment a vessel through which the music flows. This nonprofit organization dedicated to ensuring that and situation. And so it was the morning is not about performance, competition, or all who need hospice care and services receive I went to play for my friend who had had product, but about process and service. them. Through its community grief support major spinal surgery and was recovering on While music is no cure-all, research program, Hospice by the Bay also serves people the surgery floor. I knew the music would shows that this natural therapy has a remark- whose lives have been altered by the loss of a speak to her even in her slumber, and that it able variety of healing benefits. Hospitals, loved one. Hospice by the Bay programs are would speed her healing, but how would the hospices, nursing homes, and a variety of funded through health care reimbursement and staff feel in that busy, highly charged environ- health care professionals are now using music, financial donations from community members, ment? Approaching the nurses’ station, I told both recorded and live, as a regular part of businesses, and corporations to the Hospice by them I had come to play for Eileen and could their programs and treatments. the Bay Foundation. For more information about be either in her room or just outside the door. Many thanks to Patrice Haan for her contri- Hospice by the Bay services or how to support The closest answered with a half-nod that I butions to this article and for her editing assistance. our work, call (415) 927-2273 or visit www. could do what I wanted provided I stayed Healing Muses gets its support from donations, small hospicebythebay.org. out of the way. grants, CD sales, and matching funding from the sites “Peeking into Eileen’s room, I saw she it serves. To find out more about Healing Muses, was sleeping fitfully, tossing a little but deeply please visit its website at www.healingmuses.org. sedated. I set up my harp outside her room

22 San Francisco Medicine March 2008 www.sfms.org www.sfms.org march 2008 San Francisco Medicine 23 Music and Medicine

The Threshold Choir Singing to Assist Transitions

Kate Munger

he inspiration for the Threshold ways seems to have the precious few minutes our most treasured songs for bedside singing Choir came one day in 1990 while to share for the sake of our singing. have been written by choir members. Our T I was caring for my friend Larry, When we arrived at the home, the singing might include rounds, chants, lul- who was comatose yet restless, dying of mother, father, and uncle greeted us. The labies, hymns, spirituals, and classical choral HIV/AIDS. All morning, I washed dishes, dad was Middle Eastern and the mom and music. The service is our gift. weeded his garden, and organized his quilt her brother were from Germany. Baby The Threshold Choirs provide oppor- fabrics. All afternoon I sat by his bedside and Violet’s tiny body was in the bassinet in the tunities for singers to share their voices, their sang the same song over and over again, for center of the living room, wrapped tightly in compassion, and their truth with others hours. As I sang, we both became calmer. a blanket surrounded by rose petals and facing life’s thresholds. It is a sacred way to At the end of the afternoon, I was sure I soft toys. We sat close to Baby Violet and build community and be part of a unique, had given him a gift—a gift that had come started with the St. Francis Prayer—softly, cocreated adventure. Most of all, it is a great from the deepest and most essential part of so softly. comfort to those who face thresholds of ill- myself. As I reflected on the experience, I “May I be an instrument of Peace.…” ness, suffering, and dying. wondered if other singers might want to give For more than thirty minutes, we sang Kate Munger’s earliest memories are and receive that same kind of gift. After the simplest songs at our softest tone. The of her mother singing lullabies every night to reaching out to friends and other singers, family sat together on the couch, each one her and her siblings. These memories—her I discovered that there were, indeed, many weeping and holding the others. The father’s mother’s voice and her joy in singing—were very who were interested in tending to the dying huge tears tumbled down his cheeks. profound influences on her. Kate has sung in this same way, and so began the Threshold It was a tremendous honor to give several choirs over the years and feels that sing- Choir. this family a way to express their grief and ing has been one of the most important threads Today, as we approach our eighth anni- to honor their baby and her short life. As we that runs through her life. In 1975 she started versary, there are fifty-two Threshold Choirs finished, Mom asked if we knew Dona Nobis leading monthly rounds singing circles, which across the country performing this healing Pacem. She and her brother sang one part gradually expanded and gave her the confidence service. These choirs honor the ancient together, beautifully, and we sang the rest. I and contacts to move onto her current project. tradition of singing at the bedsides of people was so glad we were able to sing together. It As the founder of the Threshold Choir, she who are struggling, some with living, some was physically and emotionally satisfying to enjoys sharing the gift of music and song with with dying. We sing for a diverse group of give them something that penetrated to the those facing life’s transitions. people: those who are feeble or in coma, core of their grief. It also validated, in the those with end-stage disease, newborns just deepest way, our choir’s mission: providing opening to the world, and women who are a container for accessing the sacred. Three incarcerated. singers, a tiny baby’s body, and three griev- In December 2007, our Threshold ing family members—intimate, deep, and Choir, headquartered in Inverness, Califor- right in the middle of daily life. nia, was asked by an attending nurse if we The human voice, as our original musi- could hurry over to a nearby home and sing cal instrument, is a true and gracious vehicle for a family whose baby, named Violet, had for compassion and comfort. When invited, just died at the age of two months. we visit the bedsides a few times a week in “Yes, of course,” I said, and immedi- small groups and we invite families and ately called Pamela, who had sung with the caregivers to join us in song or to participate choir five years ago and herself had lost an by listening. Our repertoire is chosen to infant son. Then I called Laura, a lawyer and respond to individual musical taste, spiritual psychotherapist in San Francisco, who al- direction, and physical capacity. Some of

24 San Francisco Medicine March 2008 www.sfms.org Music and Medicine

The Healing Harp The Oldest Healing Musical Instrument

Claire Dunne

he harp, as an instrument, has been Remembered sounding human life and healing they keep. T since earliest records began. Its un- B i r t h a n d folding story is evolving still, cutting-edge death, enchant- in our own time. ment, prophecy, love, magic, and healing resound in sympathy and harmony with Five thousand years of this history we are age-old characteristics of the harp. The the nerves and muscles of the body … by know. The oldest urban civilizations had healing lineage continues into the Biblical plucking strings tension is released through harps. Excavation of the royal tomb of Ur time of David (1,000 B.C.), asked to play the sympathetic resonance” (Sarajane Williams, in Mesopotamia (dating from 2,700 B.C.) harp to calm the raging, depressive swings The Mythic Harp). yielded fragments of three harps and nine of King Saul. America is now leading the world in lyres. Tombs of Egyptian rulers of the same “With the harp I will solve my prob- harp music as healing. Although harp con- period depict harps, some seventy inches lem” (Psalm 48) is one of forty-three Old certs listed in the U.S. date from 1790s, it tall, with up to thirteen strings, played Testament references to the harp. It was was the import of European harp innovators by white-robed priestly figures, male and Pythagoras, in the sixth century B.C., who such as Carlos Salzedo (1909) that helped female, in standing, kneeling, or sitting made music a science as well as an art in make the U.S. a modern center for the harp. postures. Ancient Persia, Assyria, Baby- the West, introducing into Greek civiliza- The instrument was by then expanded to a lonia, and Greece had harps known by a tion ancient knowledge of Memphis and fully chromatic twelve-note scale, giving it variety of names—all representatives of Babylon. the ability to play complex classical music. the plucked-string music family, the world’s Setting up experiments to discover The harp’s extension back into healing oldest melodic instruments. how music worked, he expressed its primary began in 1923, when harpist Willem van Myth, often representing collective consonances in mathematical formulae, de Wall initiated the first music therapy levels of the unconscious, tells us universal developed the Western scale by calculat- program at a Pennsylvania State Hospital. stories of beginnings. At one end of the spec- ing intervals on the harmonic series, found About seventy U.S. universities and col- trum, the harp appears as a ready-made gift exactly which mode affected what emo- leges now offer graduate and undergraduate of the gods for worship, celebration, healing, tions, played specially created music to courses in music therapy. While certified and soothing the soul. At the other end, as heal physical and spiritual illness (inclining music therapy covers a wide range of hu- inspiration for the harp’s physical creation, particularly to stringed instruments such as man rehabilitation, it is in the expanding music of the wind breathes through the the lyre), and then passed on the knowledge field of palliative care that the harp plays a bleached skeleton of a whale, healing love to his students to apply in their lives. prominent, though not exclusive, role. relations along the way. A classic Irish myth Two thousand years later, the great Music thanatology (the study of death tells of the interplay of gods, nature, and psychiatrist C.G. Jung gave a psychological and dying), with its focus on sonic death- archetypal human moment originating the perspective of music: “It expresses in sounds bed vigils, was pioneered from 1973 by power of music as support. As nature god what fantasies and visions express in visual singer/harpist/composer Therese Schroeder- Boinn struggled in her birthing time, her images.… Music represents the movement, Sheker. As an undergraduate music student, husband, the chief god Dagda, was attuned development, and transformation of motifs Therese supplemented with a job as an with her travails on his harp. The emotional of the collective unconscious.” An invita- orderly in a geriatric hospital. Appalled by range was experienced by her giving name to tion to hear pianist/music therapist Marga- the paucity of human care, she soon reached their three sons and the corresponding triple ret Tilley at work in 1956 moved Jung to a fork in the road: she could quit, or follow strains of Irish music still current. conclude that, “used therapeutically from the advice from a friend in the ministry to One is Joy Song, one Sorrow’s, this level, music should be an essential part “protect them.” Later, in what she describes One, “song that gives Sleep,” of every analysis.” Therapeutic harp lan- as a turning point, she responded compas- And the harp’s strains, their father’s, guage of today simply says “… harp strings Continued on the Following Page...

24 San Francisco Medicine March 2008 www.sfms.org www.sfms.org March 2008 San Francisco Medicine 25 Continued from the Previous Page... offering a two-year course covering seventeen these groups is under way. sionately to a testy, thrashing man dying of different subjects over five semesters in five Reaching out internationally, a deter- emphysema, intuitively holding him from tracks—an interface of musical, academic, mined collective effort in 1995 inaugurated behind in the bed and singing, falling into clinical, medical, and inner development the first International Healing Harps Sym- synchronisation of breath and bone conduc- teachings. Schroeder-Sheker serves as aca- posium, held in Pennsylvania and hosted by tion of sound, as he trusted, relaxed against demic dean and is the author of Transitus: A nurse/psychologist/vibroacoustic harp thera- her, and eased into the mystery of death. It Blessed Death in the Modern World. The course pist Sarajane Williams. Soon afterward, she was, Schroeder-Sheker says, “a completely has become a service pointing to a hunger of launched the Harp Therapy Journal in order life-changing experience for me.” It was also need: Schroeder-Sheker has been known to to gather information worldwide. In 2005, an example of “deathbed healing” as opposed receive 3,000 e-mails in one day in response the ninth triennial World Harp Congress, to “cure,” and a dawning of some prime mo- to a single television interview. held in Dublin, included for the first time dalities of palliative care. Essentially, the accredited music thana- a panel session on harp therapeutic music. Schroeder-Sheker continued with her tologist begins a vigil by centering herself, Harpist/teacher/Director of IHTP Christina “destiny”—doing, learning, defining, and then focussing entirely on the client, observ- Tourin now presents modules of the work refining by experience, a slow process guided ing the vital signs. Working from “interior as far afield as Ireland and the U.K., Japan, by intuition. Reaching back for historical tuning,” these providers echo, synchronise, and Mexico. October 2007 saw the first inspiration, she turned to the eleventh- accompany, and entrain. Trained to use mu- Symposium on Medicine and Music in century Benedictine monastic tradition of sic clinically as sonic medicine, they choose Sydney, emphasizing harps in palliative care. accompanying the dying with music, noting scales, texture, consonance, and dissonance U.S. special guest Stella Benson, certified its twofold “care of the body, cure of the soul” to suit. They can relate melodic content with music and harp practitioner and author of as a building-block philosophy. She also read the nervous system, harmonic with respira- several teaching manuals, is now offering and studying widely, meeting with interested tory/circulatory, rhythmic with metabolic, international training modalities for “artist professionals in many fields. to stimulate or suppress pulse, heartbeat, healers” via the Internet, in individual aural The polyphonic harp, with its noninva- body temperature, and skin secretions. They instruction by long-distance phone. sive tonal substance, warm low strings, and relieve physiological and interior pain, help- It may seem a long way from prehistoric capacity to play multiple notes simultane- ing people die well. harps in Egyptian tombs and Irish myths. ously, proved “perfect” in deathbed vigils Just as physics demonstrates that sound Yet in healing and palliative care, most of that delivered customized music suited to organizes and reorganizes matter (Ernst the harps used are the Celtic variety, “the patients’ physiological and emotional condi- Chladni and Hans Jenny), so does music- purest sounding of all string instruments” tions in the early to imminent stages of dying. thanatology reorganize the human being. (Kay Gardner, Sounding Inner Landscape). It Sometimes two harpists would play, one on It is art, science, vocation; music, medicine, is their easy portability, diatonic (white notes each side of the bed, in homes, hospitals, spirit; human, harp, service. on the piano) modal structure, pure sound, and hospices, creating a surround of music Midway between music therapists and and whole-note pentatonic (five-tone) scales, that accumulated overtones, helping sound music thanatologists are practitioners of heal- hearkening back to the historic Irish harpers, penetrate into and soothe the body and soul ing music, with two U.S. national programs that makes them so suitable for the simpler of the client. The music often elicited distinct offering certificated courses. As well as pro- music needed for healing. inner shifts within recipients, reconciling, viding palliative care, practitioners of healing What this age-old story of harp, healing, forgiving, loving, accepting, radiating Pres- music may work in pediatric, preoperational and humans repeatedly sounds for us is recur- ence before death. There were empirical anxiety, and pain management, facilitating ring patterns of continuity and meaning, the discoveries as well: the effectiveness of dis- emotional catharsis and release in other instrument’s renewals an uplifting spiral of notes tinct modal music, which also linked with arenas. In different schools, philosophic and in each era of its long, bestowing life. early sacred literature, lullabies, and some training emphases may vary; some have cre- Claire Dunne, Irish born author/lecturer/ emerging twentieth-century music. Most ated their own old/new methodologies, while broadcaster, has produced radio documentaries important was the realization that the playing basics such as entrainment and the modes in and articles on Irish and concert harp history and of nonmetrical music at the end could help palliative care have commonality—as does presented on healing music at the World Harp patients unbind from time and life. the importance of self-awareness develop- Congress 2005. Her books include Carl Jung: Shcroeder-Sheker’s pioneering trek ment in practitioners. “Applying healing Wounded Healer of the Soul and People Un- became a music thanatology course, taken music as healing art” can affect body, soul, der the Skin: an Irish immigrant’s experience to bachelor’s and master’s levels in Denver’s and spirit. of Aboriginal Australia. academic institutions; rehoused as a medical The Music for Healing and Transition modality attached to a hospital in Missoula, Program (MHTP) delivers training to all Montana, for a decade; and now indepen- instrumentalists and vocalists. The Interna- dently based in Mt. Angel, Oregon, as a tional Harp Therapy Program (IHTP) is for multifocussed Chalice of Repose program harpists. Board accreditation for graduates of

26 San Francisco Medicine March 2008 www.sfms.org Music and Medicine

Calming the Surgeon and the Patient The Positive Effects of Music in the Operating Room

John Maa, MD, FACS

instein should have studied relativ- ever, surgeons may have an advantage that with concerns about the potential negative ity in an operating room. When an quarterbacks do not—studies have shown effects of interfering noise on patient safety E operation is proceeding well, hours that music in the OR can improve a surgeon’s and comfort. For that reason, if the operation can race along and feel like mere minutes. I performance. I believe that music helps many becomes unexpectedly difficult, then the mu- remember starting a vascular procedure at surgeons remain calm and focused, especially sic is turned off immediately and extraneous 7:30 a.m. during residency: harvesting the when they are tired and operating in the conversations and pager interruptions are saphenous vein, exposing the femoral vessels, middle of the night. For me, the effect of kept to a minimum. And if the patient will and performing a distal bypass to the tibial Mozart not only stimulates creative think- be awake during the procedure, he or she has vessels. As I removed my gown at the end of ing in challenging cases, it also forestalls the the first choice of what we listen to during the case, contemplating the many inpatient approach of anxiety. Music softly playing in the operation. tasks awaiting me, I thought I might try to the OR lends a sense of elegance and har- Consider this: The average operating have lunch beforehand. I was surprised to mony, and it signals to the entire operating time for a liver transplant is nine hours, and discover that it was almost 4:00 p.m. At room team that things are proceeding well. the flying time from San Francisco to London other times though, the sun rises and sets Conversely, anyone walking into a silent OR is ten hours. Could you imagine flying to before a complex operation is completed, soon recognizes that the operation is likely at Europe, or driving from San Francisco to Los and surgeons mark the passage of time by a particularly difficult juncture. Angeles, in silence? What made the vascular counting the number of changes in personnel Music can also provide the proper case during my residency seem to go by so around them. rhythm for what one of my attendings called quickly was the music of Louis Armstrong, Throughout his football career, Joe the choreographed ballet of surgeon and as- Beethoven, the Rolling Stones, and Faith Montana demonstrated an extraordinary sistant, who must move in synchrony to prop- Hill. I wonder what Einstein would make ability to perform well in high-pressure erly expose, transect, and anastomose tissues. of that? circumstances by remaining calm in dif- Moreover, music provides an important sense John Maa, MD, FACS is an Assistant ficult situations. Like a football game, every of movement when an operation is temporar- Professor in the Department of Surgery and the operation has its unique pitfalls that can ily stalled by ambiguous or unexpected find- Associate Clerkship Director of Surgical Educa- generate tense moments and anxiety. How- ings, until clarity emerges. However, I agree tion for UCSF.

In the Works for 2008 Upcoming San Francisco Medical Society Events SFMS deYoung Museum Night The Togonon Gallery and Jazz Mixer Annual SFMS Nutcracker Night Don’t miss the SFMS night at the deYoung Returning in late August! Watch for de- This December look for the exciting and Museum! Join SFMS members on Friday, tails. family-friendly fun of the second Annual May 9 for a reception—catered by Bon SFMS Nutcracker Night! Appetit—from 5:30 to 7:30 with access SFMS Night at the Symphony the entirety of this stunning museum until In October or November (date tba) join Visit our website often for event and it closes at 8:30. The cost for this exciting your physician peers for an evening of warm membership updates, or contact Therese new event is just $20.00 (includes museum fellowship and great music at the SFMS Porter at (415) 561-0850, extension 268 admission) for SFMS members and their Night at the San Francisco Symphony, com- or [email protected]. guests. Contact Therese Porter in the Mem- bining a terrific Symphony performance and bership Department at (415) 561-0850, an exciting pre-performance reception. www.SFMS.org/events extension 268 or [email protected] for more information or to RSVP.

26 San Francisco Medicine March 2008 www.sfms.org www.sfms.org March 2008 San Francisco Medicine 27 Music and Medicine

Jake Leg A Public Health Mystery Is Solved through the Blues

Eisha Zaid

ake leg, jake leg, what in the world liquid made from Jamaica ginger extract. carry any lovin’ on.” you trying to do? Seems like everybody Composed of 85 percent alcohol, it packed The first documented case of jake leg “J in the city’s messed up on account of the equivalent of four jiggers of scotch. Jake was reported by Dr. Ephraim Goldfain, the drinking you.” When Ismon Bracey, a blues was marketed to treat catarrh, flatulence, director of a 135-bed hospital in Oklahoma singer, mentioned jake leg in his 1930s City. Goldfain reports that “the patient’s song, he was referring to an epidemic that “When Ismon Bracey, a feet dangled like a marionette’s, so that swept through the United States during the walking involved swinging them forward Depression, which left thousands of men blues singer, mentioned and slapping them onto the floor,” a descrip- limping from paralysis and suffering from jake leg in his 1930s tion that mirrors the lyrics of many jake leg impotence. song, he was referring songs. But Goldfain did not know what was Dr. John Morgan, a pharmaco- causing this mysterious condition. Interest- ethnomusicologist and professor at the City to an epidemic that ingly, the Allen Brothers made reference to University of New York Medical School, swept through the the mysterious condition and its associated has been researching jake leg by tracking United States during symptoms in their song “Jake Walk Blues” its appearance in music for the last thirty- the Depression, which in 1930: “I can’t eat, I can’t talk, drinking two years and has compiled a collection mean jake, Lord, I can’t walk.” of seventeen songs that make reference to left thousands of men The jake leg outbreak was not just the disorder. He shares his findings in an limping from paralysis limited to Oklahoma. The epidemic swept article that appeared in 2003 in The New and suffering from across the nation from Rhode Island to Yorker entitled “Jake Leg: How the Blues Massachusetts to Kansas to Mississippi to Diagnosed a Medical Mystery.” impotence.” Tennessee, generally affecting the alcoholic, Morgan believes that the jake leg trag- unemployed, poor man who lived alone or edy would have been forgotten had it not and late menstruation but transformed into in the seediest parts of the city. been for the development of an entire new a new source of alcohol. During the time of the jake leg epi- genre of folk music. Blues singers, includ- The jake leg tragedy influenced a demic, the paralysis was attributed to polio. ing the Allen Brothers, Ishmon Bracey, generation of blues artists, whose music But as more and more cases emerged, it be- Tommy Johnson, the Mississippi Sheiks, chronicles the progression, symptoms, and came apparent that the “bizarre palsy” that Willie Lofton, and Daddy Stovepipe and physical manifestation of a disease that was referenced in the music of the time was Mississippi Sarah reported the association of mysteriously appeared and impacted the due to a different cause. Autopsies of jake paralysis with jake consumption well before entire nation. The first connection to jake leg victims revealed central nervous damage any epidemiologists, government agency, or consumption and paralysis was noted in to the anterior horn cells, similar to the pa- doctor could put the pieces together. Ishmon Bracey’s song “Jake Liquor Blues” thology observed in polio and amyotrophic The new genre of music appeared dur- in 1930. In addition, Tommy Johnson lateral sclerosis (Lou Gehrig’s Disease). In ing Prohibition, an era of desperation that made a similar association in “Alcohol and addition, the spinal column pyramid cells left the poor consuming whatever alcohol Jake Blues.” were also injured, which may have caused they could get their hands on, including rub- Men suffered from impotence in addi- the spasm and rigidity observed in patients. bing alcohol, hair oil, doctored antifreeze, tion to paralysis, and the songs of the time Some regained mobility; others remained and patent medicines. Despite passage of the echoed the frustration and embarrassment immobile though higher brain function Volstead Act in 1919, which initiated a dry that came with this jake-consumption was preserved. spell through most states, alcoholic patent symptom. Bracey sings, “It’s the doggonest Fingers started pointing to jake as the medicines were not outlawed. Among the disease ever heard of since I been born. You culprit of the mysterious condition, and patent medicines was jake, a pale orange get numb in front of your body, you can’t Continued on Page 32...

28 San Francisco Medicine March 2008 www.sfms.org Music and Medicine

From Mind to Heart A Healing Musical Journey

Gary Malkin

“Love and intimacy are the root of what makes is a kind of music, based on vibrations. In television sets protruding out of every wall, us sick and what makes well, what causes sadness fact, vibration is the common denominator demonstrates what health care’s priorities and what brings happiness, what makes us suffer of the universe. are, with respect to creating environments and what leads to healing.”—Dean Ornish Therefore, I find it no mere coincidence that are suitable for healing. And why are televisions literally here’s an old adage that says the “Through powerful everywhere in health care environments, most significant journey we’ll ever vibrational frequencies, while institutional music-playing devices are T make in this life is when we travel often in rare supply? Our eyes (in cahoots the distance from our minds to the region timbres, harmonies, with the parts of our brain that process of our hearts. Throughout the world’s rhythms, and melodies, information) use 90 percent of our linear spiritual disciplines, the act of deepening discriminative faculties, constantly seek- our relationship to the Heart and to the we innately respond to ing data that can funnel through our optic many expressions of Love is considered the music in ways that we’re nerves, endlessly ravenous for stimulation. epicenter of all true healing. It is my belief only just beginning to This cultural obsession with our visual that music, especially when played or cre- portals often successfully distracts us from ated with an intent to soothe, inspire, and understand.” what we’re feeling, preventing us from ever heal, has the power to awaken us to this uncovering the partial truth that we are, in inherent birthright we all share, this innate that the very first sense humans develop in essence, existentially alone, and that we are, capacity to love and be loved. utero is hearing, and the very last sense to in fact, going to die one day. After nearly fifty years of creating go before we take our last breath is hearing Ironically, what this cultural bias music, I’d like to share a bit of what I’ve as well. This biological fact has always sug- toward constant visual information also learned about its healing power, especially gested to me that, for human beings at least, does is deprive us of the simple beauty of when the music is intended to serve as a there is a kind of primacy to our listening presence and silence, of reverie and of a catalyst for the feelings associated with love, sense. Music allows us to experience life’s wordless connection with others, and with forgiveness, compassion, and gratefulness, to complexities in a language all its own, espe- the remarkable atmospheric and emotional name a few—resulting in a palpable con- cially effective when attempting to explore benefits of music. Therefore within health nection with ourselves and others in ways our relationship to the unseen worlds, with care, despite best intentions, very rarely are that can measurably accelerate healing on Great Mystery, and with Love itself. the emotional and spiritual dimensions and many levels. their correlation to healing addressed in ef- Our Obsession with Visual fective and meaningful ways. Somehow, the The Primacy of Listening Stimulation absence of sound that awakens our hearts Of all the art forms, music is an aston- When you look at the contemporary and spirits is often overlooked and, even ishing emotional language that communi- modalities for healing (conventional and disregarded. cates to us in the most visceral and immedi- integrative), specifically regarding proactive ate of ways. Through powerful vibrational strategies that have been shown to inspire Love as an Immune System Tonic frequencies, timbres, harmonies, rhythms, emotional states of contentment, connec- While there’s reams of evidence and melodies, we innately respond to mu- tion, and deep relaxation (which can be supporting the revelations in the field of sic in ways that we’re only just beginning useful in the midst of healing crises), these mind/body medicine, and of the value of to understand. From the Big Bang to the psychosocial strategies are often completely feeling connected to something larger than vibrational frequency of the earth to every ignored, or, at best, regarded as superflu- ourselves, our culture’s institutions have sound and word we’ve ever heard or spoken, ous. A cursory look at the very design of relegated these heretofore unquantifiable everything we are and everything we know most hospital rooms, with the ubiquitous Continued on the Following Page...

28 San Francisco Medicine March 2008 www.sfms.org www.sfms.org March 2008 San Francisco Medicine 29 Continued from the Previous Page... the room’s emotional tonality, subtly calling can affect how we think, feel, learn, grow, matters of the heart to the more analytical forth feelings from deep within the son who and relate to one another. However, we’ve mental health fields, or to our faith-based in- was present. He quietly started to cry, feeling lived in a Cartesian paradigm for so long (“I stitutions. Historically, rarely have the twain the weight of his mother’s illness, perhaps for think, therefore I am”) that cavalier skepti- (the realms of health care and experiential the first time. And then, something surpris- cism still automatically greets any suggestion modalities designed to inspire feelings of ing occurred. He woke up to the horror of that our emotional and spiritual states can Love and well-being) formally overlapped. what he and his brothers were perpetuating significantly influence our immune system’s In fact, the thought that any obstructions by remaining out of contact with one an- capacities to recover from dis-ease, and actu- to feeling love could in any way undermine other during this challenging time. Within ally assist in our healing process. our ability to respond to healing protocols a few hours, he summoned the courage to Music is one of the most underestimat- is something that has been viewed with contact the one brother with whom he had a ed healing modalities, especially when used cynicism and derision. tiny opening, asking him if he would be will- subtly as an environmental support tool, However, the times are changing. ing to just listen to some music together. In the way that it was used in Sarah’s hospital that room, they sat together for the first time room. When the right music is integrated One Family’s Story in years, listening quietly to this music. And sensitively it can help us unravel our fears, A few years ago, I received a call from as they did, they mutually acknowledged the soften our ability to feel again and become a man who had just lost his wife through a shifting tectonic plates within their hearts, open to looking at the glass as half full for protracted illness and end-of-life process. It gradually moving toward one another in a change. And as you’ve seen with Bernie’s was a day after the memorial service, and spite of themselves. family, it can induce emotional states of be- from the sound of the elation in his voice, Bernie told me that one by one, a dif- ing that could dramatically and beneficially one would not have thought that this man ferent brother was invited to listen to this influence the outcome of seemingly intrac- had just lost his life partner of fifty years. music. It took all of forty-eight hours for table situations and circumstances. But he proceeded to share with me a deeply each of the four sons to come to their senses When you can use music, subliminally moving story. and get out of their petty positions in order or overtly, to instill direct experiences of This man, whom I will call Bernie, to show up for an event in their family’s life what cultural anthropologist Angeles Arian had four sons, all embroiled in a nasty feud. that would be remembered forever. For the calls “the Arms of Love”—compassion, This feud was of such proportion that not next month, they laughed together, cried service, kindness, appreciation, forgiveness, one of his sons would tolerate being in together, forgave one another together, and presence, for example—chances are one another’s presence, including in their listened to music together, and, most im- you’ve significantly increased the propensity mother’s hospital room, even though their portant, loved their mother together as she for healing, if not of the body, then most mother, Sarah, was seriously ill. This feud found her way home. assuredly of the heart and soul. had been going on for years, and I can only While telling me this story on the Next time you find yourself in an en- imagine the despair, frustration, and exhaus- phone, Bernie was by now in tears. Tears vironment where dis-ease is present, allow tion Bernie was going through. There was of gratitude to me for creating this music yourself to experiment with this phenom- his beloved wife, sick with a life-challenging that had become an indelible part of their enon by integrating, however subtly, deeply illness, probably on the threshold of an end- journey, tears of joy for being a part of help- soothing music that you truly love into the of-life process, while all of his sons remained ing his family heal its wounds, and tears of environment. You’ll see that music can pro- staunchly committed to their anger, to their fulfillment for helping them all learn to be vide a powerful support tool for the healing self-righteousness, and to their determina- a family together again. And I was in tears, journey, keeping us open, porous, humane, tion not to “cave in.” not only because of the enormous honor he and grateful for being alive. During this time, a dear friend came had bestowed upon me by sharing his story, Gary Malkin is an Emmy award-winning to the hospital room to visit while one of but also because of the extraordinary gift composer and producer whose career in film, the sons was present. This friend came I’ve been given to use music as a language television, and commercial music spans nearly in, turned off the television, and, as luck for loving, for healing, and for supporting thirty years. As founder and creative director would have it, brought with him a small people to remember what matters most in of Wisdom of the World and as cofounder of CD player, on which he started playing the this life. the nonprofit Companion Arts, he brings his instrumental music from Graceful Passages, passion for social change and spiritual aware- one of the projects for which I created mu- Healing Environments with Music ness to the world by using the power of music sic specifically to assist people in soothing We live in a time when revelations and spoken word to create innovative tools for fears while traversing life’s transitions and in neuroscience, quantum physics, and contemplative practice, as well as for cultivating challenges. molecular biology have simply not yet been spiritual and emotional wellness. Malkin’s work After a few minutes of allowing the mu- integrated into the way we live and the way has gained national attention through the book sic to gently permeate the room’s ambience, we approach healing. We now know that and CD set Graceful Passages (coproduced by something barely perceptible started to shift there are subtle yet significant factors that Michael Stillwater).

30 San Francisco Medicine March 2008 www.sfms.org

Music and Medicine

Life in the Vortex Introductory Notes of Physician-Musician

Bruce S. Victor, MD

t’s not clear when the transition to hours. However, this concert then tripped as well as reconceptualize what it’s about. physician-musician really occurred. off a string of seemingly coincidental events And this has grown in parallel with, and has I Perhaps it started about four years that led to my hosting (and continuing to been profoundly influenced by, my recent ago, when I was looking at a website of host) a series of house concerts. This concert development as a musician. well-known guitar makers. Amid the series is called “The Acoustic Vortex House When I was young, I admired clever wonderful guitars was a reference to the Concert Series,” named (by Stevie Coyle, a men.… The allure of psychoanalytic theory general manager’s ten-year-old daughter, master finger-style guitarist) for this whirl- was its belief in the power of “insight” as who had recently been hospitalized with ing, unseen force that seems to link people both transformative an liberating. Yet nearly juvenile-onset bipolar disorder. Without the and events despite themselves. absent from Freud’s writings, as well as those awareness of something audibly “clicking,” The establishment of the concert se- of his acolytes, is any reference to altruism, I was quite clear that I needed to organize a ries, in turn, triggered a series of events and empathy, even compassion—thus quietly, benefit concert for this girl and her family. meetings with other musicians and music covertly, but no less inexorably reifying the After all, I had been the Chairman of the aficionados that led the Acoustic Vortex “clever” or “insightful” man as the ontologic Professional Education Committee for the to comprise an ever-expanding collective of touchstone. Even further, the relentless re- Northern California Psychiatric Society, I’d people who are present for, and do things for, ductionism of Freud and his followers, while given more than a hundred talks on mood others through music. Most of the musicians providing an interesting starting point in my disorders, and—hell, I had been a guitar in the Vortex have played concerts for Bread search for the meanings of behavior, became player for more than forty years. There was and Roses, an organization started by Mimi analogous to (in the words of Woody Allen) no subjective feeling of actual decision, Farina that brings live music and other forms “taking all of the music and dancing out because there was no conscious experience of entertainment to people in institutions of My Fair Lady and turning it back into of deliberation that preceded initiating this (visit www.breadandroses.org). In Decem- Pygmalian.” And while the efficacy of recent course of action. ber 2007, members of the Acoustic Vortex psychopharmacologic advances helped elu- In retrospect, then, the transition to put on a benefit concert for Bread and Roses cidate the importance of the right carburetor Physician-Musician involves trusting a part in conjunction with the breathtakingly tal- mix at the synapses, it too lacked a theoretic of one’s self that is not always encouraged ented Tuck and Patti. New Year’s Eve was fulcrum by which we could understand both by the mores and areas of cerebral emphasis spent playing at a drug rehabilitation center. transcendent experience and more profound that have achieved value and emphasis in A May 23 concert at the 142 Throckmorton interconnection with one another. psychiatric culture. It involves doing things Theatre (www.142throckmortontheatre. However, my increasing fascination that will not always seem purposive or ra- com) in Mill Valley will also benefit Bread with and subsequent study of the inter- tional at the time. It is analogous to being and Roses. And the Acoustic Vortex will relationship between music, healing, and Kevin Kostner’s character in the movie continue to stage benefit concerts for social the nature of enhanced human intercon- Field of Dreams: “If you build it, they will organizations that reach out to improve the nection began on the deck of my friend come.” Inchoate as are the dictates of this lives of others. Stevie Coyle. On one beautiful morning aspect of one’s psychospiritual development, The great theologian Abraham Joshua in May, we are playing a guitar duet on there is the sense that one ignores them at Heschel wrote, “When I was a young man, a tune entitled (I’m not making this up) one’s peril. I admired clever men; now that I am older, “One Morning in May.” We were playing The concert was a great success. I col- I admire kind men.” Perhaps the transition in complementary tunings and the harmony laborated with music legends John Sebastian from physician to physician-musician paral- simply emerged, without a musical blueprint and David Grisman and felt the synergy of lels that sense of psychospiritual growth to or battle plan. Sure, I was listening to Stevie their energy behind the overall effort and which Rabbi Heschel referred. I simultane- and had some forethought regarding what I the enthusiastic response of the audience. It ously honor but acknowledge the limitations was going to do next; it wasn’t really one of was a “healing community” indeed, for those of psychiatric training and physicianhood, Continued on the Following Page...

30 San Francisco Medicine March 2008 www.sfms.org www.sfms.org March 2008 San Francisco Medicine 31 Continued from the Previous Page... oneself to continue in music. How many referred to “soul,” not “mind,” despite the those mystical fusion experiences, despite times have I heard in my own practice, “I modern conflation of these two entities. As I the aforementioned deck’s location in deep- love playing music, but I quit because I just continue to evolve as a physician-musician, est Marin County. wasn’t good enough....” I increasingly see the overlap of spirit in the But I began to wonder, how is all this Of course, self-denigration and hope- service of healing. In music I am reminded harmony possible? How did we tune into lessness, no matter how focused, circum- of my true province as a psyche-trist. one another? And is the way we did so scribed, or even seemingly rational, has Bruce S. Victor is Clinical Professor of musically a metaphor for how individuals always constituted a clinical focus for us Psychiatry, School of Medicine, University of can “tune into one another” without in- psychiatrists. Patients feel isolated, alone, California at San Francisco; he also maintains struments in their hands, conversing rather and especially anxious that their sense a private practice in San Francisco. than singing? of isolation and loneliness will continue. It occurred to me that certain factors Part of the core of the dynamic basis for Jake Leg that are the process and the product of these painful states is the feeling that one Continued from Page 28... successful psychotherapy also apply in this isn’t “good enough” and will therefore be investigators from the Hygienic Laboratory, kind of musical exchange. For openers, the sentenced (even as self-fulfilling prophesy) the predecessor of National Institutes of process is predicated on a reduction of anxi- to, in the words of H.D. Thoreau, “lives of Health, finally analyzed the chemical com- ety about the process itself. If I was anxious quiet desperation.” position of jake later in 1930. Subsequent about judgment or retribution for either In my own practice, I have seen this analysis uncovered triorthocresyl phosphate wrong notes, excessive ornamentation, slip- disqualification from participating in music (TOCP), a plasticizer that was being added ping out of rhythm, or any of the other musi- taken not only metaphorically but literally. to increase solid composition in jake to meet cal inevitabilities, then my fingers and hand And there was much healing to be had in the Treasury Department’s order that solids would lose the dexterity needed for delicate addressing both simultaneously. Albert, for in patent-medicines be doubled. TOCP was finger-picking. Plus, any preoccupation with instance, was a fifty-year-old man whose ob- a cheap and easy solution that increased the the contents of my own mind would have sessive self-recriminatory ruminations and solid mass without altering the taste of the meant I wouldn’t be able to really hear Ste- depression had kept him from enjoying life. jake, which is what made it so attractive to vie. Further, while I probably have my own While there were solid dynamic, familial customers despite the toxic effects. idiosyncratic sound and intonation when I reasons for his self-contempt and hopeless- The music of the time also conveys a play, I can neither be wedded to it nor be ness, the actual symptoms of his depressive powerful social message about jake and the unable to modify it—indeed, I need to play disorder required prodigious doses of Prozac government: “You thought the lively man with it as I play. and Buspar. But still life was joyless, almost would die when you made the country dry, Further, there was—as in any good psy- colorless. Last year he mentioned that when you made it so that he could not get chotherapy—an underlying structure here: the only thing in life to give him any real another drop of rye. Well, I know you will agreed-upon rules about trying to stay in the pleasure was English madrigal singing—a feel bad when you see what he has had…. same rhythm, about playing pretty much the statement he made without realizing that He’s got those jake limber-leg blues.” The same chords (even in different tunings) or I was about to devote myself to a six-week Mississippi Sheikhs capture the prevailing complementary ones, and about following musical sabbatical. antiprohibition view of most victims, who when the spirit moved one of us further out Over the next few months, however, attributed their condition to a restrictive on a harmonic trail (with a reciprocal obli- Albert purchased and began to use an iPod government policy that led individuals to gation on the part of the trail leader to make that provided him with a ready source of desperate measures that had irreversible sure he didn’t lose the follower). And there mellifluous auditory stimuli that gave an consequences. was also an implicit understanding that alternative to the nasty commentary of the The collective voices of the time chron- adherence to the structure made it possible malevolent Greek chorus inside his head. icle more than the history of jake, paralysis, to barrel out of one’s own confines in a way He became happier than I had ever seen and government disapproval. Their songs that produced more euphony and harmony him. He realized that “music takes me into tell a story of victims affected by a disease, than propulsive, cacophonous escape. the moment, into the present … and I then and their voices reveal the power of music to Sitting on Stevie’s deck, it therefore realized that what was inside my head was convey a cautionary tale and valuable medi- struck me as unfortunate that psychiatrists neither in the moment nor in the present…. cal information that might have otherwise and nonmedical psychotherapists have paid It helps me be aligned with that which is gone overlooked, never making it into the so little attention to the transformative beautiful.” annals of medical epidemiology. power of music—especially as it acts upon As comedian Emo Phillips once noted, Eisha Zaid is a first-year medical student at the player, not just the listener. “I used to think that the mind was the best the University of California at San Francisco. It is similarly unfortunate that most part of a human being … until I remembered Works Cited: Baum, D. Jake leg: How the blues people believe that a certain amount of what was giving me that thought.…” This diagnosed a medical mystery. The New Yorker. “talent” is the prerequisite for permitting statement is a fitting reminder that psyche 2003; 9.5:50-57.

32 San Francisco Medicine March 2008 www.sfms.org Music and Medicine

Doctor of Harmony Care of Musical People and Musical Hands

Robert E. Markison, MD

nitial Interest, 1960: Finger Flexors and the Physics of I Woodwinds Three years after our family acquired a hi-fi sound system, I developed a fanatical interest in classical and jazz clarinet, listen- ing endlessly to the classical recordings of British clarinetist Reginald Kell and French clarinetist Gervase de Peyer alongside jazz recordings by Benny Goodman, Artie Shaw, and Buddy de Franco. Fortunately, my clarinet teacher, Peter Ferrara, was equally nimble at playing clas- sical music and jazz. Unfortunately, I made a mess of the mid range of the instrument because my right little finger was simply too clumsy to move from the lower register to the upper register. My pinky stumbled all over the cluster of four keys as it tried to work independently. I played in the third clarinet section in the school band and felt that there was no hope of reaching the front of the line. I later learned that 37 percent of people are born with hands with congenital linkage Bob Markison, MD, with his new custom-designed twelve-string lap steel guitar. of the ring and little finger flexor tendon systems, certainly a blight for a fledgling little finger-activated four-key cluster to 75 Mistakes Musicians Make, and clarinetist and of no particular concern to percent of normal size, thereby reducing the How to Correct Them young trumpeter. need for independent travel of my right little Cold hands: Much of medicine is Nonetheless, 1960 was a rather magical finger. The sudden improvement in my play- focused on the integrity of cerebrovascular year because it included the publication of ing fortified my belief in the workability of and coronary flow, but I humbly advise at- A.H. Benade’s “Physics of Woodwinds” in the human-musical instrument interface. tention to vascular homeostasis of the upper Scientific American. The landmark article Forty-eight years later, I remain en- limbs, because blood flow matters greatly described the acoustics and mechanics thusiastic about design of new musical in the support of large and small muscle of woodwind instruments, and it became instruments and hand tools, modification of repetitive usage and static loading. Cool obvious that a reasonably adventurous and existing instruments, and musical technique hands often fail, and warm hands gener- motivated person could bend some rules across various instrumental categories, as ally prevail. Cool-handed musicians benefit without compromising tone. My teacher well as hand surgery and medicine, the study from wearing custom-made fingerless gloves encouraged me in my studies of instrument of brain-hand linkages and biomechanics, whenever the hands register as cool on the modification, including metal casting and and long-term follow-up on a fascinating cheeks. Keyboard and string players do not metal and wood machining and smithing. international population of fine musicians. breathe as well as wind players, so they must I managed to scale down the clarinet’s right Continued on the Following Page...

32 San Francisco Medicine March 2008 www.sfms.org www.sfms.org March 2008 San Francisco Medicine 33 Continued from the Previous Page... the opposite hand in the event that the Davis built a career on well-chosen notes be taught diaphragmatic breathing and dominant hand is injured. Musical patients and carefully schooled silence between “breathing there musical phrases.” Many are advised to cultivate ambidexterity in those notes. He also painted. Irving Berlin players foolishly avoid food or drink before and out of music, writing and drawing well copyrighted 917 songs, and then decided performing, running the risk of dehydration with either hand, executing piano keyboard to paint. Django Reinhardt was the only and shrunken peripheral vascular volume. passages with either hand or both hands offshore jazz musician to substantially influ- All players are advised to prehydrate with simultaneously, right- and left-hand trumpet ence the course of American jazz, and he noncaffeinated beverages before any prac- playing, intentional use of a left-handed also painted. Musicians are “time smiths” tice, rehearsal, or performance. guitar, ambidextrous use of silverware or who should be equally attuned to working Inappropriate warm-up: Many musi- chopsticks. Those who heed this advice are in space. cians jump into Hanon exercises, Paga- richly rewarded. Social reclusion: Beethoven spent his nini Caprices, or similarly daunting and Inability to improvise and compose: fifty-seven brilliant years in social isolation. hand-injurious warm-up exercises before Many classically trained musicians, particu- Ellington walked easily and effortlessly on checking their hand temperatures, sitting larly keyboard and string players, are afraid the world stage. A surprising number of mu- or standing in an ideal and relaxed posture, to improvise and rarely compose. They sicians fail to value genuine social fluency, or generating long tones with minimal key acknowledge that Bach, Beethoven, Mozart, and I strongly advise them to develop great or string pressure; and few are focused on Schubert, Ellington, Parker, Coltrane, and friendships and collaborations. diaphragmatic breathing. I advise musicians dozens of other composers have also been Too much computing: Thrashing to record their warm-up routines and bring extraordinary improvisers, but they have not away on computer keyboards can result in the audio or video to their colleagues for learned or even cared about improvising in unnecessary wear and tear on the upper kind comment. their own musical works. I remind them that extremities. Patients with good command Too much finger force: Biofeedback failure to compose a picture would leave a of English should master voice recognition has much to offer musicians of any age. The painter or photographer out of work. software in order reduce unnecessary hand goal of any biofeedback is to simultaneously Focus on a single style or idiom: I have use. monitor temperature and proximal/distal never forsaken my classical musical training, Side effects of medication, neglect of muscular EMG activity. Patients quickly and I remain comfortable playing classical general health: Over the past thirty-odd learn that proper posture and relaxed use music, but I certainly do not regret cultivat- years, I have seen a remarkable number of of statically loaded and repeating muscle- ing fluency within other types of music. musicians who eat poorly, do not exercise, tendon units result in much less effort in Single-instrument focus: It is always and suffer side effects from medications. mastering the instrument. This “least force” surprising to learn that many or perhaps Thirty-three percent of statin consumers concept applies equally to all musical instru- most musicians do not play multiple instru- suffer side effects, mostly aches and pains; ments and musicians. ments, often for fear of “diluting” their power this is particularly troublesome in the upper Overpractice and failure to self- or technique on a primary instrument. Dizzy limbs of musicians. I routinely recommend record: Serious young musicians assume Gillespie advised all wind players to study that musicians find a primary care physician that the only way to scale the psychophysical the piano. Curiously, pianists do not advise who has plenty of time to ask questions, and mountains of repertoire is to spend four to students to study wind instruments. Each who orders appropriate blood tests. eight hours per day at the instrument. I am instrument category informs the others. Coda: Physicians and musicians have lucky to care for a fair number of young A basic understanding of guitar fretboard a great deal in common. They have studied prodigies, some of whom dare to spend logic helps explain much of what is done hard to build repertoire, style, judgment, eight to twelve hours per day at the piano on the piano keyboard. The natural sound and even some ESP. And the good ones or violin. frequency spectrum generated by each valve love to listen. I advise musicians of all ages to record position on a trumpet can further tune and Dr. Markison is a solo practice hand themselves, and they can compress the develop the ear of a violinist or any other surgeon in San Francisco. He is also an As- recordings down to .mp3 files and listen single-note or polyphonic instrumentalist. I sociate Clinical Professor of Surgery at UCSF. to them on their playback device while often vary my own instrumental “par course” He studied music composition at Julliard while doing some nonmusical activity. Ideally, within practice sessions, generally running majoring in biology at Columbia University. His they should play for ten to fifteen minutes, the following instrumental sequence: drums, book, entitled Creativity and Health, should be listen back to the recording, and then repeat parallel and contrary single lines on the pia- available soon. the cycle. no, piano chords, cello, acoustic or electric Neglecting ambidexterity: I am con- guitar, twelve-string lap steel guitar, ending stantly surprised that the general population with a wind instrument such as clarinet, does not cultivate ambidexterity. Extreme saxophone, English horn, or trumpet. Each single-handed dominance is risky for the of these instruments informs the others. dominant part and perhaps even riskier for Failure to pursue other arts: Miles

34 San Francisco Medicine March 2008 www.sfms.org Music and Medicine

Living Both Music and Medicine Where the Two Practices Intersect

As Told by Various San Francisco-Based Physician-Musicians

such as going out for tual challenge of doing surgery. Neurosurgery football or marching in has a pace, rhythm, and flow. Like drumming, my high school band; doing surgery is a performance piece. It takes taking a date to the years of practice to do well—but, surprisingly, prom or playing in the not nearly as many years as playing music dance band; accepting requires. The allure for me was the melding a drum major scholar- of physical activity with intellectual problem ship or becoming a solving and emotional satisfaction, much like philosophy major and playing jazz. Each operation has an opening, premed student. a critical portion, and a closure, similar to the The time de- introduction, development, and final chorus mands of college, of a jazz piece. medical school, and Performing each is an intense, sponta- residency increased neous, disciplined, and timeless experience. pressure on my rehears- There is a repetitive format: an artistic impro- al time, and I shifted visation of a melody, harmony, and rhythm from performing with in jazz and an anatomical improvisation of symphony orchestras repair of brain, spine, and nerve function and concert or show (when possible) in surgery. The results in bands to jazz groups. both of these endeavors are overwhelmingly Philip R. Weinstein, MD My musical memories echo with moments satisfying. Performing neurosurgery as a profes- of performance anxiety and reward over So in each of these realms, “I’ve got sion and playing drums as a hobby happen the years. Taking a bow as the drummer for rhythm!” Cherished friendships and collec- in different worlds. I do them both and find the Princeton Triangle Show annually on tive memories formed on stage and in surgery each complementary and gratifying. Rarely Broadway with the pit band to inaugurate are treasured rewards. Recently I had the do I think about one while doing the other, our ten-city Christmas Holiday Tour, and opportunity to combine the two when our except when an operation is running late on hearing the applause echo after perform- Neurosurgical Jazz Quintet (NJQ) had the an evening when I have committed to a jazz ing at Carnegie Hall with our jazz combo, opportunity to not be paid for performance performance. the Minstrels of Modern Jazz, top the list. (P4P) in the Smithsonian Air and Space My percussion career began in Balti- Another highlight was my annual summer Museum Lobby, during the American As- more at age five, after my father answered trans-Atlantic gigs on Holland-America sociation of Neurological Surgeons (AANS) a classified ad and bought me a four-octave Line student ships, where seasickness never annual meeting in Washington, D.C. As we xylophone from a Navy ensign shipping out interfered with a single drum solo. Free pas- found, music binds together individuals in a during World War II. Dad had always liked sage afforded me the opportunity to spend community. Rhythm can integrate hearts and the mellow and lively sounds of a wooden the remainder of my vacation appearing in minds. Therapeutically, music can facilitate keyboard and hoped for virtuosity on my part. European jazz clubs with the band, an expe- photographic memory and restore aphasic- To Mom’s chagrin, he failed to predict the rience that has inspired an ongoing “have speech. In the brain, it has greater cortical evolution of the study of percussion he offered drum, will travel” attitude. representation than language and, according into a roomful of drums, endless hours of prac- In medical school I found myself drawn to some theories, song and dance preceded tice, and a lifetime of rhythmic exhibition- to neurosurgery as a specialty because of a the evolution of linguistic communication. ism. Ultimately, this commitment brought wonder and fascination with how the brain Functional MR imaging studies demonstrate with it many conflicting youthful choices, works, as well as the kinesthetic and intellec- Continued on the Following Page...

34 San Francisco Medicine March 2008 www.sfms.org www.sfms.org March 2008 San Francisco Medicine 35 Continued from the Previous Page... in-cheek “Scott Joplin/Cole unique connections between the temporal Porter/Don’t Shoot the Piano lobe auditory cortex and dorsal prefrontal Player He’s Doing the Best He regions—connections that are found only in Can” Award, shared with Dr. humans, which may explain the absence of Herb Peterson, with whom rhythm perception and performance in lower I have often played duo gigs. primates and other mammals. Our SFMS Annual Dinners For me, drumming feels good and sounds have been among my favorite great. It celebrates the motion, life rhythm, venues, playing for our col- and continuity that I hope to restore and leagues during the predinner sustain for my patients with surgical treat- cocktail party. ment of neurological disorders. Stay tuned For me, playing piano for many encores to come. has been a great way to con- Dr. Weinstein is Professor of Neurological nect with musical medical Surgery at UCSF, Chief, Neurosurgical Service, colleagues and friends old and Veterans Administration Hospital, and Principal new. Playing piano helps me Investigator, Brain and Spinal Injury Center. experience the here-and-now more vividly. It evokes for me Steve Walsh, MD a sense of joy, of the poignance Three or four years ago I was playing and preciousness of life, a wide piano for a benefit dinner and auction for a spectrum of feelings and emo- local high school football team. The crowd tions, and the great pleasures of was looking over the donated goods and en- the imagination and of creative joying the conviviality of the evening. SFMS activity. Happily, it evokes member Dr. Mel Blaustein’s lovely wife Mari- similar feelings in my partner lyn stepped up to my piano and said sweetly, and the love of my life, Dr. “Keep playing, Steve. You make people feel Kristin Razzeca, confirming my discovery at situations, alone and with small groups. Prob- that life is good.” She made me feel some of age fourteen that girls like piano players. ably my personal favorite is a setting where that good life with her comment, reminding “There’s something to be said for keep- I play solo piano for a small gathering, and me again why I love playing piano. ing at a thing,” said Frank Sinatra. “Keeping they are kind enough to listen and request I remembered that at age fourteen I at” playing piano, along with hiking and other songs that I might know. I, in return, discovered that playing piano at social events reading, balances my daily therapeutic work will sometimes play an old tune and see if attracted girls. This gave me solid motivation with patients wonderfully. I’m grateful for someone in the group knows it. That person to play more piano during a hormone-brim- the part making music plays for many of us then gets to request my next song. Then the ming Iowa adolescence. Previously I had in the practice of this most interesting and process repeats. I can play for hours like that, resolutely defeated parental efforts to train useful profession of medicine. and sometimes do. their young prodigy in serious piano playing. I Dr. Steve Walsh (pictured top right) is a In recent years, I have taken special then took a few lessons in nearby Des Moines private-practice psychiatrist in San Francisco and pride in being able to play a request for an with Spec Redd, an African-American piano Mill Valley. He is past president of the SFMS, obscure song, one written perhaps fifty to sev- genius who had played on Mississippi River the Northern California Psychiatric Society, and enty-five or more years ago. Sometimes the boats in his youth. I loved his rich, soulful, of the UCSF Association of the Clinical Faculty. “bridge” or connecting portion of the song is bluesy style and tried to emulate it. Other He is a member of the editorial board and of the the hardest part to resurrect, both for myself African-American piano men, like Erroll psychiatric services committee of the SFMS. and for the listener. But in recent years, Garner, Oscar Peterson, and Horace Silver, this process seems to have become easier, have also been important influences for me. Herb Peterson, MD especially for the older melodies. I play a few Jazz improvisation and playing show What I’m about to describe is certainly notes and wait, and the remainder will often tunes and music for singing and dancing not unique to physicians, or to musicians present itself to my mind. I then realize it has at parties are the most joyous parts of mak- either. However, it probably helps to be been there all along, but I’m simply not inter- ing piano music for me. Done right, this one or the other (or both) to appreciate the fering with its recall. Sometimes I’ll awaken can transform a gathering of friends and process a bit better. with a song in my mind and will quickly run colleagues into a vivid and memorable I have been a physician and psychiatrist and play it before it becomes obscured by experience. Psychiatric colleagues recently for more than forty years, and I’ve been in- the pressure of daily activities and thoughts. rewarded my twenty years of playing piano volved in performing music most of that time. Often my wife will recognize and name this at our social events with the slightly tongue- I have played in a number of informal and jazz Continued on Page 38...

36 San Francisco Medicine March 2008 www.sfms.org Northern California Physician Opportunities

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36 San Francisco Medicine March 2008 www.sfms.org Matthew L. Springer, PhD work on a project for a whole year without I’m not sure how loudly I should say necessarily seeing tangible evidence of prog- this, but I suspect that I might have finished ress, even if progress is indeed occurring. my PhD thesis at Stanford a couple of weeks With music, you put in the effort, you see a earlier had I not been commuting to Oakland result; whether we are referring to practicing in the evenings to fiddle in the pit orchestra a difficult passage, learning how to improve for a musical theater production of Big River. tone, or watching ideas from your head and I even had a role on stage as a fiddler. I would beyond accumulate on paper in a composi- write parts of my thesis and do experiments at tion. For me, this aspect has been a great lab during the day, then drive up to Oakland tonic for the frustration that is so frequently to change and put on the stage makeup, play dominant in scientific research. the show, wash up, and drive back to Stanford But the most important and direct im- to continue writing into the middle of the pact that music has had on my scientific life night on the“lab computer” (which gives you is that it provides the balance that so many a hint about how long ago this was). people lack. Science is cerebral; it is think- This kind of double life has been a ing, questioning, experimenting, doubting, frequent occurrence throughout my years as proving, with much less room for “feeling” a scientist, although typically not involving than one might expect from listening to as much mileage. As a UCSF professor, I Captain Kirk explain to Spock about the unfortunately do not have time these days role of human intuition in decision making. Living Both Music and Medicine to participate in long-term theater engage- It is this analytical component of our lives Continued from Page 36... ments, but I do still manage to play in the that benefits from a scientific career, but we song even if I can’t, since many were popular Peninsula Symphony and have published are more than our cerebrums. I tell people in when we were both young. several musical arrangements, as well as a my lab to take breaks from sectioning tissue I really can’t claim any special “talent” couple of articles for Strings Magazine. While with a cryostat to avoid straining their back, for this, for the following reasons: First of all, I’ve been tempted occasionally to add these take breaks from the microscope to avoid it seems to be getting stronger as I become arrangements and articles to my CV, the straining their eyes; and music allows one older, and the songs are often associated with medical and musical aspects of my life inter- to avoid straining one’s mind and allows the joyful times and experiences from long ago. twine but usually don’t merge. To describe it more innate part of one’s humanity to take Second, other friends have mentioned that in twenty-first century terms, my home page over for a while. they experience the same thing, and for them has one link to my lab’s website and another On rare occasions, I have allowed these too, it appears to develop with age. link to my music website, but you can’t move two aspects of my life to collide, usually with And third, it seems a lot like other directly from one site to the other. surreal and unique consequences. Take for forms of recall that have been reported by In what way, then, has my music had an example “The Myoblast Song,” which I many others—the POWs who, attempting impact on my scientific life? Well, it has done wrote about my research during my postdoc- to keep their minds sharp, would enable so on several levels. On one level, playing toral years and which has been performed at themselves to remember the entire composi- music alone and in groups, and arranging or more than a few conferences and seminars; or tion and seating position of their grade school composing music, enriches my life in gen- the couple of scanning electron micrographs classes, or the adults who can paint entire, eral. That may sound like a cliché, but as I that I took of my violin bow hair while I was elaborate street scenes that they have not discovered during more than half a year in taking hundreds of other pictures of fungal seen since childhood. Dr. Oliver Sacks has 2001–2002, when I had to completely stop spores back in graduate school (see figure). written about this. It’s simply that music is playing music due to a physical problem, life But in general, I do manage to switch gears, very meaningful to me and has always been devoid of musical involvement went from be- temporarily forgetting about frustrating ex- an important complement and background ing in color to being in black and white. On a periments and grant proposals and instead to my medical practice; so it’s natural that it level more spe- would be the “language” of my recall. cific to science, I would encourage others to probe and it’s important experiment as I have, whether with music for clinicians or with some other form of experience. I’m to realize that sure you’ll find a treasury of nearly forgotten while they can memories awaiting you. watch people Dr. Herb Peterson (pictured top left) is get better in a Clinical Professor of Psychiatry Emeritus at real time, the UCSF. lab scientist can

38 San Francisco Medicine March 2008 www.sfms.org century, was also a talented violinist and close Medicine as Art: As Told by a friend of the composer Johannes Brahms. Medical Student-Musician Schweitzer, on the other hand, was already a theologian and accomplished organist when he decided to become a medical missionary in French Equatorial Africa. Even today, doctors’ orchestras thrive in many cities, paying tribute to an unseen highway connecting medicine and music. This also makes music a wonderful way to connect with both colleagues and patients. At a recent Messiah performance, I found myself smiling at a string player in our shared joy at performing Handel’s classic. Only later, at the reception, did I learn that she, too, was a physi- cian, struggling as I do to maintain this passion for music, this beloved avocation, against the demands of career and family. Another colleague of mine, who professes no special performing talent, nonetheless possesses an focusing entirely on playing the music for a encyclopedic knowledge of classical music and while. Sometimes scales are exercises to be its history, and I learn something from every Interview by Whitley Hill practiced, and other times they are used to conversation. The connection with some of Photograph by J. Adrian Wylie weigh chemicals, but either way they func- my patients is equally strong. When I mourned Jane Lee is a first-year medical student tion as a balance. the loss of Lorraine Hunt Lieberson’s powerful originally from Steilacoom, Washington, and a Matthew L. Springer (above) is an Assistant voice and presence with a patient recently, violinist with the Life Sciences Orchestra. The Professor of Medicine in the UCSF Division of she not only commiserated but thoughtfully orchestra consists of members of the life sciences Cardiology and a violinist/percussionist in the brought to her next visit a copy of the New community from across the University of Michi- Peninsula Symphony. “The Myoblast Song” can Yorker’s eloquent eulogy to Lieberson. Others gan and is part of the Health System’s Gifts of be seen and heard at http://homepage.mac.com/ have appeared at my concerts, sometimes un- Art program. matthewlspringer/MyoblastSongPointer.html. intentionally but more often to cheer on their “I started playing when I was five years singing doctor. Whether we are discussing jazz old. Initially, it took a lot of practice and rep- Kirsten E. Fleischmann, MD, MPH, saxophone, hopes for a nascent rock band, or etition—and squeaking. Being a violinist has FACC the tranquility of an unaccompanied cello taught me the value of years of training and I am a musician. I’m also a mother, physi- suite, music forms invisible bonds between practice, the attention to detail and all the cian, wife, researcher, and teacher—but my people. It is a language that largely transcends time it takes to produce a finished product, involvement with music predates all the oth- cultural and linguistic barriers, allowing for a to master a skill. Once the foundation is set, ers. Music, with its ability to both reflect and fuller and more three-dimensional relationship you develop your own style and expression. shape my mood, has supported me through the with patients and colleagues. It’s the same with medicine. That’s why I like rigors of medical training, even when it meant It is said that the brains of musicians the depiction of medicine as an art. getting up at 5:30 a.m. to ensure that rounds are different than those of others in auditory, “The Life Sciences Orchestra was a huge and notes were done before an afternoon motor, and visual-spatial areas, and that they draw for me. At the audition, I asked one of performance, or stealing away from a rehearsal have a larger corpus callosum (Gaser and the organizers if he taught in the School of when the muted buzz of my pager called. I Schlaug 2003). As a cardiologist, I have no Music and learned he’s actually a professor am by no means unique in this double life. firsthand knowledge in this area, but I do know of dermatology. It gave me some perspec- In this calling to both that my life has been different, and infinitely tive—that I can continue playing music medicine and music, I richer, because of music. Like many others, I throughout my medical career. follow in the footsteps play multiple roles in life. I like to think I’m “I saw one of my professors after our of eminent physicians better at all of them than I would be otherwise, last rehearsal. It’s great to be able to talk to such as Theodor Billroth because “musician” is on the list. her about medicine, but also to be playing and Albert Schweitzer. Dr. Fleischmann (Pictured lower right) is music alongside her without being in a hier- Billroth, a well-known a cardiologist and Associate Professor of Clinical archy.”—Jane Lee surgeon in the second Medicine at the UCSF, as well as a mezzo-so- Reprinted with permission from Medicine half of the nineteenth prano who performs in the Bay Area. at Michigan Magazine.

38 San Francisco Medicine March 2008 www.sfms.org www.sfms.org march 2008 San Francisco Medicine 39 2008 San Francisco Medical Society Annual Dinner

Held on January 24, 2008, at the Concordia-Argonaut Club in San Francisco, the 2008 SFMS Annual Dinner was a great suc- cess! SFMS members enjoy a fan- tastic meal while Steven Fugaro, MD, was installed as the 2008 SFMS president. Dr. Fugaro then honored the fifty-year members of the SFMS, as well as the Past Presidents and the SFMS staff before moving on to present the keynote speaker, Steven Schro- eder, MD. Dr. Schroeder spoke about healthy lifestyle choices and the importance of reducing obesity and smoking in America. As usual, the SFMS Annual Din- ner was a fantastic opportunity for members to meet and mingle with other members and is not to be missed next year!

Above: SFMS 2008 Officers from left to right: Editor Mike Denney, MD, PhD; Treasurer Michael Rokeach, MD; Immediate Past President Stephen Follansbee, MD; President Steven Fugaro, MD; President-Elect Charles Wibbelsman, MD; and Secretary Gary Chan, MD

Below: SFMS Member and Editor of San Francisco Medicine, Mike Denney, MD, PhD, playing the piano alongside his wife, Leonie

Above: Steven Fugaro and Stephen Follansbee with SFMS Executive Director Mary Lou Licwinko, JD, MHSA Top Right: SFMS Past-Presidents Xavier Barrios, MD, and Art Lyons, MD Above: Steven Fugaro honors the 50-year members

Right: Steven Fugaro, Mary Lou Licwinko, Stephen Follansbee, Richard Wolitz, MD, and Annette White enjoying the dinner

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

California Pacific Medical Center Chinese Hospital Medical Staff Kaiser Permanente San Francisco Marsh Affinity Group Services Saint Francis Memorial Hospital Saint Mary’s Medical Center

With special thanks to: Duramed Pharmaceuticals, Inc., a subsidiary of Barr Pharmaceuticals, Inc. Medical Insurance Exchange of California Union Bank of California

This program was also sup- ported in part by an educa- tional grant from Eli Lilly and Company (which had no control over its content).

Right: SFMS Director of Public Health and Education Steve Heilig, MPH, with SFMS member Katherine Margolin, MD, and her hus- band and SFMS Board Mem- ber Rob Margolin, MD A Word from the Keynote Speaker Steven A. Schroeder, MD

We Can Do Better Improving the Health of the American People

Editor’s Note: This year at the San Francisco Medical Society’s advocates, initially isolated, became emboldened by the cascade Annual Dinner Steven Schroeder, MD, presented the audience with a of scientific evidence, especially about the risk of secondhand keynote speech on the health of the American people. What follows is a smoke exposure. Laws, regulations, and litigation, particularly at shortened version of his paper on which the speech was based. the state and community level, led to smoke-free public places and raises of the tax on cigarettes—two of the strongest evidence-based he United States spends more on health care than any tobacco control measures. In this regard, local governments have other nation in the world, yet it ranks poorly in nearly every been far ahead of the federal government, and new medications T measure of health status. How can this be? What explains augmented face-to-face and telephonic counseling techniques to this apparent paradox? increase the odds that clinicians could help smokers quit. But there are still 44.5 million smokers in the United States, Pathways to Improving Population Health— and tobacco use kills 435,000 Americans each year. They die up Addressing Personal Behaviors to fifteen years earlier than non-smokers, with those final years Health is influenced by five domains—genetics, social, en- often ravaged by dyspnea and pain. In addition, smoking among vironmental, behavioral, and that of health care. When it comes pregnant women is a major contributor to premature births and to reducing early deaths, medical care has a relatively minor role. infant mortality. Smoking is increasingly concentrated in the Even if the entire American population had access to excellent lower socioeconomic classes as well as among those with mental medical care—which it does not—only a small fraction of these illness and/or substance abuse. Our Smoking Cessation Leadership deaths could be prevented. By contrast, the single greatest op- Center at UCSF estimates—based on the high rates and intensity portunity to improve health and reduce premature deaths lies of tobacco use in these populations—that as many 200,000 of the with personal behavior. Behavioral causes of deaths in the 435,000 premature tobacco deaths occur in persons with chronic United States, account for nearly 40 percent of all deaths. It is mental illness and/or substance abuse problems. Understanding clear that obesity and smoking are the top two behavioral causes why these patients smoke and how to help them quit should be of premature mortality. a key national research priority. Clinicians and policymakers may question whether behavior The United States is approaching a tobacco “tipping point.” is susceptible to change or whether attempts to change behavior Some segments of the American population already have very low lie outside the province of traditional medical care. If the public’s rates of smoking. When Kaiser Permanente of Northern California health is to improve, however, it is more likely to come through implemented a multisystem approach to help smokers quit, its behavioral change than technological innovation. Experience smoking rates dropped to 9 percent. Two basic strategies would demonstrates that it is possible to change behavior, as illustrated enable the United States to meet its Healthy People 2010 tobacco by seat belt use and consumption of products high in saturated use objectives of 12 percent population prevalence: prevent young fats. But tobacco best demonstrates how rapidly positive behavior people from starting to smoke, and help smokers quit. Of these, change can occur. smoking cessation brings by far the largest short-term impact. Of the current 44.5 million smokers, 70 percent claim they would The Case of Tobacco like to quit. Merely increasing the baseline quit rate from the Smoking prevalence among American men declined from current 2.5 percent of smokers who quit to 10 percent—a rate 57 percent in 1955 to 23 percent today, and among women from seen in placebo groups in most published trials of new cessation 34 percent in 1965 to 18 percent. Why did tobacco use fall so drugs—would prevent 1,170,000 premature deaths. No other rapidly? The Surgeon General’s 1964 report linking smoking and medical or public health intervention approaches this degree of lung cancer was followed by multiple reports connecting active impact! And we already have the tools to accomplish it. and passive smoking to myriad other diseases. Early antismoking

42 San Francisco Medicine March 2008 www.sfms.org Could Obesity be Concentrating on the Next Tobacco? the Less Fortunate Although there is still Since all the ac- much to do in tobacco tionable determinants control, it is neverthe- of health—personal be- less touted as a model for havior, social factors, combating obesity, the health care, and the en- other major potentially vironment—dispropor- preventable cause of death tionately affect the poor, and disability. Smoking strategies to improve and obesity share many national health rank- characteristics. Obesity ings must concentrate on differs, however, from to- this population. Citizen bacco in many ways. The health advocacy in the binary definition of smok- United States commonly ing status (smoker or not) coalesces around particu- does not apply to obesity. The body mass index, the closest to an lar illnesses, such as breast cancer, HIV/AIDS, or autism. These obesity gold standard definition, misclassifies as overweight persons efforts are led by middle-class advocates whose lives have been with large muscle mass—such as California’s governor. It is not touched by the disease. There have been a few successful public biologically possible to stop eating, and minimal amounts of food advocacy campaigns on issues of population health—efforts to ban are not hazardous, in contrast to light smoking. There is no addic- exposure to secondhand smoke or to curtail drunk driving—but tive analogue to nicotine in food. Nonsmokers mobilize against these are relatively uncommon. Because the biggest gains in popu- tobacco because they fear injury from secondhand exposure, a peril lation health will come from attention to the less well off, the lack absent for obesity. The food industry is less concentrated than the of a political voice arguing for more resources to improve healthy tobacco industry, and while its advertising practices have been behaviors, reduce social disparities, increase access to health care, criticized as predatory to children and deceptive regarding content and reduce environmental threats will perpetuate the status quo. of ingredients, it has yet to fall into tobacco’s ill repute. For these Additionally, America’s rhetorical emphasis on individual responsi- reasons, litigation is a more problematic strategy and industry pay- bility creates a reluctance to intervene in what are seen as personal ments less likely. Finally, except for the invasive option of bariatric behavioral choices. surgery, obesity treatment has even fewer clinical tools than does tobacco cessation. How Can the Nation’s Health Improve? Some policy instruments, however, do exist to combat obesity. Improving population health would be more than a statisti- Selective taxes and subsidies could be used as incentives to change cal accomplishment. It could enhance the workforce and national what foods are grown, brought to market, and consumed, though economy, reduce health care expenditures, and—most impor- the politics involved in designating favored and penalized food com- tantly—improve the lives of those affected and their families. But ponents would be fierce. Restrictions could also apply to the use of absent a strong political voice from the less fortunate themselves, it food stamps. Given recent data that children see from twenty-seven becomes incumbent upon health professionals, especially physicians, to forty-eight food advertisements for each single ad promoting to become champions for better population health. Such a role reso- fitness or nutrition, regulations could require shifting that balance nates with our deepest professional values, and it is why many of us and/or participating in sustained social marketing efforts, such as chose medicine as a profession. It is also one of the most productive the truth® campaign in tobacco. Requiring more accurate labeling expressions of patriotism. We take great pride in asserting that we are of caloric content and ingredients, especially in fast-food outlets, number one in wealth, Nobel prizes, and military strength. Why could sensitize customers to what they eat. Better pharmaceutical don’t we try to become number one in health? products and counseling programs could motivate clinicians to Dr. Schroeder is Distinguished Professor of Health and Health Care, view obesity treatment more enthusiastically. In contrast to these Division of General Internal Medicine, UCSF, where he also heads the policies, which require either national legislation, regulation, or Smoking Cessation Leadership Center. Between 1990 and 2002 he research investment, momentum is already building at the local was President and CEO of the Robert Wood Johnson Foundation. Dr. level. Some schools have banned the sale of soft drinks and now Schroeder graduated from Stanford University and Harvard Medical offer more balanced lunches. Opportunities for physical activity at School. This paper is an edited version of the “Shattuck Lecture” published work, in school, and in the community have been enhanced in a in the New England Journal of Medicine, 2007;357:1221-8. The full small but expanding number of locations. original article, with references, is posted at www.sfms.org.

42 San Francisco Medicine March 2008 www.sfms.org www.sfms.org March 2008 San Francisco Medicine 43 The Art Corner Hospital News Cabinet Walnut and Glass KPSF Saint Francis George Kimmerling, MD Robert Mithun, MD Wade Aubrey, MD

The fact that many physicians are also At Saint Francis Memorial Hospital, we’re accomplished musicians comes as no surprise. pleased to announce the award of $80,000 in Overlaps between the two disciplines are many, grants to five local organizations promoting com- and each informs the practice of the other. To wit, munity health. The grant-making is part of the the intense training, the fundamental acquisition hospital’s ongoing commitment to improve the of skills, and the necessary attention to detail are health of Bay Area residents most at risk. Saint all obligatory for mastering the finer points of both Francis is particularly committed to programs medicine and music. that impact discharge services for the homeless; “I think many physicians have become the disenfranchised and isolated; and frail, elderly excellent musicians because they have discovered hospital patients. the similarities between the two,” notes William Grantees were selected on the basis of Strull, MD, an internist and assistant physician- meeting the hospital’s core funding principles, in-chief at Kaiser Permanente San Francisco. “The which include providing for unmet health analogy between music and medicine—the actual needs, primary prevention, continuum of care, mechanics, individual expression, finding creativ- and capacity building. Other selection factors ity within the structures that exist, and making included the organization’s long-term stability informed decisions—are all key aspects to practic- and proximity to SFMH. ing sound medicine and being an accomplished The following organizations received Dr. Kimmerling, an endocrinolo- musician.” What happens within the structures is grants that range from $10,000 to $25,000: St. gist by day, has been an amateur wood where individual expression comes into play. Anthony’s Free Medical Clinic Recuperation worker for the past thirty years. Over Repetition is another area of overlap be- Program; Glide Health Services Recuperation that time he has “enjoyed switching tween the two areas. When a physician sees a Program; South of Market Health Center gears from my day job” to work on patient, there are certain protocols and procedures Recuperation Program; San Francisco Senior projects such as this one. This cabinet that are done routinely that become the “practice” Center; and San Francisco Community Clinic currently calls Dr. Kimmerling’s family of the daily functions. A musician brings that same Consortium. Recipients were honored at the an- dining room home. set of rules to his or her instrument. “Depending nual grants award breakfast cohosted by SFMH’s on the day or the situation, both a physician sister hospitals, Saint Mary’s Medical Center and Would you like to submit and musician may bring something new to the Sequoia Hospital. artwork to be featured in San work, and that’s where creativity happens,” says These grants are part of more than $3 Francisco Medicine? Dr. Strull. Additionally, many physicians have million in grants awarded by SFMH’s parent Contact Amanda Denz, the man- explored both the therapeutic aspects of music for company, Catholic Healthcare West. CHW’s aging editor, to find out how to submit themselves and their patients. Organizations such community grants program is funded through paintings, drawings, sculpture, poems, as the American Music Therapy Association use donations from its member hospitals, which short stories, and any other creations music to address the physical, emotional, cogni- contribute .05 percent of their previous year’s you would like to share, at adenz@ tive, and social needs of individuals in various audited expenses to the program. Grant awards sfms.org or (415) 561-0850 extension stages of both illness and wellness. Music therapy typically range from $2,000 to $50,000. Since 261. SFMS is also currently seeking and interventions help to promote wellness, man- 1990, CHW has awarded nearly $30 million in submissions to be considered for the age stress, alleviate pain, enhance memory, and grants to local nonprofit organizations. 2008 SFMS Directory cover. Contact improve communication, among other things. In closing, I’d like to offer my thanks to Therese Porter, [email protected] or As a therapeutic tool, used in conjunction with all my Bay Area colleagues in recognition of (415) 561-0850 extension 268. medically established protocols, music is one of our National Doctors’ Day on March 30. greatest aids and means of communication.

44 San Francisco Medicine March 2008 www.sfms.org Hospital News

St. Mary’s UCSF Veterans Richard Podolin MD Ronald Miller, MD Diana Nicoll, MD, PhD, MPA

The ability of music to promote healing was Arts and medicine have integrated to create The San Francisco V.A. Medical Center studied by Pythagoras, the Greek mathematician, the UCSF Dance Medicine Center, a new clini- (SFVAMC) recently opened its newly remod- physician, and musicologist, in about 500 B.C. cal program of the Department of Orthopaedic eled 3D Imaging Laboratory—an expanded But the use of music in healing significantly Surgery. Designed to meld education, research, state-of-the-art laboratory that offers the latest predates that. Modern studies have documented and medical and surgical care into a premier in 3D visualization methods. many salutary effects of music, including deceas- facility for dance injury diagnosis, treatment, and The concept of a 3D imaging laboratory was ing heart rate and blood pressure, decreasing the prevention, the Center is under the direction of developed in 2002 by SFVAMC’s Chief of Ra- need for analgesic medications and anesthesia, Nancy Kadel, MD, associate professor and a former diology Services Judy Yee, MD, who conducted and lowering stress-induced catecholamine lev- dancer and dance teacher. In addition to screening novel research on virtual colonoscopy (CT els. Music therapy has been used for patients who evaluations and treatment, dancers will be able to colonography) as a new technique for colorectal have brain injuries, physical disabilities, chronic participate in research projects. The Center will cancer screening. This test made use of the data pain, Alzheimer’s disease, and other disorders, provide injury-prevention programs for dancers, obtained from CT scanners and combined it with and it has enough empiric support that it is now dance teachers, parents, and health care providers. graphic software to create two- and three-dimen- a reimbursable service under Medicare. The Center can be reached at (415) 885-3668. sional images of the colon that the radiologist In recent years, the scientific study of the A UCSF neurosurgery team has reported sig- can use for patient diagnosis. The clinical impact way we process and recall music has advanced our nificant results of a new brain mapping technique of the virtual colonoscopy has been significant, understanding of how the brain functions, not that allows for the safe removal of tumors near and the SFVAMC was one of the first facilities just in auditory processing but also in its ability language pathways in the brain. The technique in the country to make it available to veterans. to organize information and make and recall minimizes brain exposure and reduces the amount This test is now used clinically at other sites memories. As Daniel Levitin, a neuroscientist of time a patient must be awake during surgery. throughout the world. at McGill University, has so lucidly described Reported in the New England Journal of Medicine The new 3D Imaging Laboratory houses in his recent book, This is Your Brain on Music, (January 3, 2008), the UCSF findings also provide many state-of-the-art postprocessing worksta- processing music requires almost every region new data that refines scientific understanding of tions with the multiple different computer of the brain, including the cochlear nuclei, the how language is organized within the human platforms needed to address the expanding use of auditory cortices, the brain stem, the hippocam- cortex. Senior study author is Mitchel Berger, 3D imaging in everyday patient care. This imag- pus, the amygdala, the frontal lobes, and perhaps MD, chair of the Department of Neurological ing is now used for coronary CT angiography, most surprisingly, the cerebellum. The influence Surgery and director of the UCSF Brain Tumor aneurysm evaluation, musculoskeletal applica- of musical experiences can start even before we Research Center. tions, CT urography, and brain/body perfusion are born. In one carefully controlled study, one- In the largest study to date that evaluates techniques. year-old infants preferentially selected music the outcome of in-hospital care by various physi- Because of this expanded technology, re- that had been played repeatedly while they were cian types, findings show that care by hospitalists searchers are now able to perform cutting-edge in utero, even if they were not exposed to that resulted in shorter stays and lower costs to pa- research using the best imaging tools available. music after birth. This scientific, utilitarian aspect tients. Researchers from UCSF co-led the study, The various computer platforms are also used to of music as a therapeutic or investigative tool published in the December 20, 2007 issue of the teach advanced 3D imaging to the medical stu- should not obscure its more profound—if more NEJM. Compared to general internists, patients dents, residents, and fellows that rotate through common—effect: the enrichment music brings to cared for by hospitalists had modestly lower costs SFVAMC’s Department of Radiology. our lives by enhancing our emotional experience and a length of stay shortened by 12 percent. This laboratory will allow the SFVAMC to and bringing its own joy. At St. Mary’s Medical The two groups exhibited similar mortality and continue to be a leader in the field of 3D imaging Center, we recognize that excellent medical care hospital readmission rates. The study is based on and will provide for excellence in clinical care, requires attention to the emotional and spiritual, data from forty-five hospitals nationwide. Andrew research, and teaching. as well as the physical, needs of our patients and Auerbach, MD, MPH, UCSF associate professor their families. of medicine, is senior author.

44 San Francisco Medicine March 2008 www.sfms.org www.sfms.org March 2008 San Francisco Medicine 45 In Memoriam Nancy Thomson, MD

Rudi Schmid, MD Rudi Schmid, MD, a liver specialist and medical educator, medical education. In response, Dr. Schmid introduced faculty passed away at his home in Kentfield on October 20, 2007 of pul- evaluations, undertook an initiative to improve the effectiveness monary failure. He was 85. of the teaching, and helped establish a track on the curriculum for Dr. Schmid was an early champion of establishing organ the study of primary care and community medicine. He also pro- transplant centers to make donor livers widely available. In 1983, moted an international exchange program for students and faculty sixteen years after the first successful liver transplant, he led a panel members, particularly with Peking Union Medical College. convened by the National Institutes of Health to consider the ef- His work in hepatology had begun in the 1950s with studies ficiency of performing the transplants on a larger scale. In that year, of porphyrias. He and others developed a rat model to study the the survival rate in the first year after a liver transplant was 20 to 25 enzymes of heme (in hemoglobin), which, when disrupted, lead to percent. Now it is offered by about 100 facilities around the country neurological problems and mental disturbances. He also investigated and the survival rate in the first year is 85 to 90 percent. the chemistry of bilirubin and, with neurologist Dr. Ivan Diamond Dr. Schmid was born in Ennenda, Switzerland, the son of and others, looked at ways to prevent this product of heme break- two general practitioners. He received his medical degree from down from passing into the brain in cases of childhood jaundice, the University of Zurich before earning a doctorate in medical sci- an event that can cause brain damage. ences from the University of Minnesota in 1954. He also became Dr. Schmid was a former president of the American Associa- an American citizen in that year. tion for the Study of Liver Diseases and the Association of Ameri- He taught medicine for more than thirty-five years, beginning can Physicians. He was also a member of the National Academy at Harvard before moving to the University of Chicago and finally of Sciences. to San Francisco, where he was dean of UCSF from 1983 to 1989. He is survived by his wife, the former Sonja Wild of Kentfield; a He retired in 1995. son, Peter, of Daly City; a daughter, Isabelle Franzen of Cape Town, While he was dean at UCSF, some students raised concerns South Africa; and a grandchild. that the school was emphasizing research at the expense of basic

Continuing mediCal eduCation The 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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