Critical care

We’ve only just started working on Critical Care wards and as a musician, you wonder what impact you can really have for people in such an extreme situation. It can be quite intimidating and nerve wracking to enter these bays and rooms and begin playing.

This week, we entered a High Dependency Unit where we’ve been asked to run a pilot scheme and were immediately made to feel very welcome by the staff. Two of them asked us if we could try playing for a lady who has learning disabilities, who had been very restlessness and vocal in expressing her distress and anxiety. As we approached her room there were about nine members of staff around the door. We went in and she was vocalising repetitively and seemed very confused and restless. We said hello and she asked us our names and we began playing. She became quite emotional and teary and asked a nurse at the door to come in and be with her. They held hands and the nurse sang along softly with us. We continued playing and over time, she settled down, relaxed, closed her eyes and fell asleep. We quietly left the room and saw all the staff had been watching, clearly happy to see the lady at peace. “That was amazing” said a consultant.

Critical Care

We recently began working in Critical Care wards at Nottingham University Hospitals, a completely new area for us, and one in which very few musicians are working. Over the first few sessions we’ve had some wonderful feedback, a friendly welcome and great response from the staff, and some memorable interactions, such as this one with a young woman, currently unable to speak due to a tracheostomy.

She had heard us in another part of the ward, and as James approached her she mimed playing a guitar. James greeted her and began playing and singing I Wanna Be Like You. She immediately began moving her shoulders to the music and James soon offered her a shaker for the rest of the song, which we could hear another patient behind curtains joining in with. James then brought the instrument box closer, and she chose the glockenspiel, the two of them then having a jam together which developed into The Lion Sleeps Tonight. Two doctors came to look at her charts and looked very pleased to see their patient enjoying herself. Other staff were also observing and smiling at the engagement, and a neighbouring patient was smiling in his sleep.

Next out were the Wah-Wah tubes, which can be very hypnotic and captivating, and there was a musical conversation between the two of them, while I played a simple and familiar chord progression. This became a song, and then another, and another, without interruption, while their conversation continued, the patient being fully absorbed in the activity. When it ended, she stood up and hugged us both, and wrote “it made me feel very relaxed and happy”.

 

STROKE

We entered a busy stroke ward where visitors and patients were gathered. One patient was on her own looking very bored and a bit upset so we decided to play a Beatles song in a slow and soothing way for her and the general space. She immediately looked at us and smiled. As we played, some visitors had to move to accommodate a patient’s care and they came nearer to us to watch and listen. One visitor and the patient started singing along quietly and she started tapping her hand and becoming more animated. Then she started tapping her foot and suddenly she became very excited and was beaming away. As the song ended she couldn’t contain her excitement any longer and burst out saying “That’s the first time I’ve moved that foot.” We’re just beginning to find out how our music can help people in these wards. [March 2017]

STROKE

We started playing for three female patients in a bay on a stroke ward. Several staff were present, and one lady woke up and immediately smiled and engaged with the music. Unable to speak, she was clearly appreciating the music, raising her hands, moving in time and nodding approval for us to continue. Very moved, a nurse came over, knelt beside her, held her hand, sang along and encouraged her to sing too. We played Wonderful World and she began vocalising and as the song progressed her vocalisations matched the words more and more. By the end of the song she managed “I Love You”. The nurse was overjoyed and so was she, continuing to use her voice lots to try and communicate. Two members of her family arrived and were clearly moved as we sang Wonderful World again, her words noticeably improving as we went along. The nurse commented afterwards that this had been a real breakthrough, saying “to see my patient respond so well to music is priceless”. As this unfolded six other members of staff were watching and really enjoying the moment. Over the subsequent weeks this patient always asked for us to visit her, with family and staff telling us how excited she is before we arrive. Each week she sings a bit more of each song as her speech improves and plays along more on shakers and the xylophone. As a nurse said at the end of one session “That’s the power of music.”

Stroke

Dave (not his real name) was a patient whose severe stroke had caused him to lose the use of all four limbs, and his speech. We had seen him and played to him a couple of times, with what we thought was very little response, but the staff said he was loving it (we have many examples of staff recognising a reaction we haven’t picked up on in people we don’t know).
On this occasion we were told by a staff member that Dave is very good at communicating Yes and No, and can spell out words, using his eyes. Wanting to play Dave something from his youth, I began playing Hotel California, which I thought he was bound to know. Before I got more than three chords into the introduction he was beaming with recognition, and when we got to the chorus his mouth was moving and he was clearly doing his best to sing along. When we’d finished Dave tried to speak but I couldn’t make out what he was saying, so I asked him to spell it out. H – O – R – S …horse? Horse With No Name? Yes! I’ve never learned the song but knew it well enough to “blag it” and Dave seemed very pleased. The next time we went there I had the chords and words with me to do it properly for him.
The last time we saw Dave, he had family visiting and we had not approached, but before we began to play, I overheard that he was spelling out “horse”. His family seemed confused by this, but I knew he was requesting his song, so we sang it again, with his family joining in. Dave and his family were all delighted with this shared activity and special moment of reminiscence and connectedness.

B47

In a bay we played for three ladies, Marc kneeling close to one alert lady, and James playing near two ladies, one of whom was in bed and very frail and distant. Very quickly the frail lady’s arms came up, dancing/conducting with the music and she made strong eye contact with James. The third lady who had been verbally aggressive earlier, calmed down and held the frail lady’s hand and talked to her soothingly.
Later a member of staff asked us to play for the frail lady again explaining that she had given up on life months ago and that music was one of the only things she still responded to. As soon as we played her arms came up again and she made strong eye contact and the member of staff held her hand with deep care and affection. Several nurses and doctors were watching and were clearly happy and moved by the scene.
When we stopped one of them started dancing and singing Wimoweh and passed a shaker to another patient who started playing. We joined in and two doctors in their office started singing and laughing too.
The music moved everyone in different ways but connected everyone together in joy and compassion.

Blog – Church Farm and Skylarks

Towards the end of our first year’s project at Church Farm and Skylarks Nursing Homes, both specialist dementia homes, we had instances in both that illustrate the significance of repeated, regular visits for music-making.

At Skylarks, ‘Sheila’ had always apparently disliked it when we played music in her lounge. She would call out negative comments, or loudly sing something else across us. We bore this with good humour and learned to stay away from her if possible, and her interruptions changed to simply ignoring us it seemed. On our last day there, I was heading across the room to someone I thought might like to try the xylophone, and as I went past Sheila she politely asked “can I have a go with that?”  She played for a good few minutes and really enjoyed it, then telling us that she had played the piano as a child and so she knew what the notes were. We had quite a chat about her past and music generally, and when we remarked it was the first time she’d played with us, she said “well you’ve never offered before!”

At Church Farm a very active resident, ‘John’, appears to be a foreman, constantly moving around the home and giving instructions and explanations of what’s happening, in jumbled sentences. He has frequently passed us and spoken to us, but never appeared to respond at all to the music, simply going about his work. On one of our last visits, he came by holding a tambourine, and I couldn’t resist saying “Hey, Mr Tambourine Man, we’ve got a song for you”. He looked at James and said “I know you” in a very friendly way, and James very positively affirmed that yes, he did know us. Looking at my guitar, John said, “Oh, I haven’t seen one of those since….I used to…” and gestured playing a guitar. Though the rest of his words were again cunfused, he was clearly delighted to realise what we were there for. He then played the tambourine in time while we sang Mr Tambourine Man, before moving off again on his rounds.

Another lady who had repeatedly told us to go away to begin with, also began to recognise us and appreciate the music, and later in the year would ask us to play for her, eventually also joining in on the glockenspiel.

In a training session on working with people with dementia, we had learned the importance of giving time for people to assimilate what’s going on, and have made sure we work slowly and stay with people longer than with other client groups. We had not anticipated these kinds of developments over such a long period, and realised that the impact of regular visits is enormous.