Music Therapy, Stat!

The healing power of song in the emergency department

By Danielle Musat, Mu Phi, Cleveland Area Alumni

Walking into the emergency department — palms sweaty, knees weak (no, this isn’t the start of an Eminem song), I can’t catch my breath, feeling dizzy, panic setting in — I look to a nurse for reassurance. I get a cold stare back. Wait. I need help! I don’t feel good! I take a deep breath and close my eyes. Just breathe. I see a familiar face, the charge nurse. His question, “First day?” and a smile put me slightly at ease. I was here to help. I was here to relax other people; I had to start with being relaxed myself. This was my first day working as a music therapist in the emergency department at TriPoint Hospital in Painesville, Ohio. Interesting, huh? Unheard of, yes.

For several years, I had been working several years for The Fine Arts Association (FAA) in Willoughby, Ohio. As a music therapist (MT) at FAA, I saw several individual, peer and group clients on-site. I also was contracted to work providing music therapy services to the Lake Health hospital system in Lake County, Ohio. Part of my contract at Lake Health was to walk room to room, seeing admitted patients in various states and reasons for being in the hospital. The other part was working on the geriatric psychiatric unit in the hospital, holding two groups a week and seeing individual patients as needed. A colleague of mine, who started the music therapy contracting position at Lake Health, asked if I would be interested in working with her on a three-year study in the hospital on music therapy in the emergency department. Before putting much thought into it, I said “Sure … what does it involve?”

I sat down in several meetings with the two writers of the study. This was a blind study, which meant I was not given all the information for what they were looking for during the study. What did I know? I knew that I was going to be providing music therapy services to patients in the emergency department, focusing on stress and pain identification and relief. During our meetings, we spoke about what type of interventions would be utilized, what instrumentation would be needed, how I was to document sessions and the protocol of patients I was allowed to see according to the study parameters. I could only see patients who were 18 years and older, not admitted into the hospital and not pink-slipped into behavioral health.

To say I was met with some resistance is being gentle. Don’t get me wrong, not everyone was difficult to convince that I was there to help, not hinder. But I was in an emergency department with a keyboard and guitar. Not something you typically see. Think about it …

You walk into the emergency department for treatment for an illness or injury, and you see a woman holding a guitar in the hallway — how do you react? I’ve seen it all, from laughter, rolled eyes, expressions of concern and confusion, to smiles and a thumbs up. When I started my music therapy career, I never thought I’d end up here. Standing with my guitar in an emergency department. But here I was. Now … what do I do?

Finding My Way

Resistance came in many forms, from side glares, asking me to leave a room and saying “no, thank you” when asking the nursing staff if they had any patients to recommend for services. I had to make myself known and respected by not only the patients but by the staff. I started making personal connections with staff members, EMTs, nurses, doctors, cleaning staff. I let them know I was a person who was there to help not only the patients but them. How could I help the staff? When an environment is calm, it typically heeds calm people and experiences.

I began my shift by checking in with the charge nurse and accepting referrals, if there were any. I then began to softly finger-pick my guitar as I walked up and down the emergency department halls. Not only did this allow me to be seen and heard, but it allowed me to make eye contact with potential music therapy subjects and to show the staff that I was a professional and knew what I was doing.

More and more staff started greeting me on the floor. There were a couple of EMTs who noticed that when they needed to start an IV or blood draw, the sound of the guitar music helped them remain calm as well as decrease the stress of the patient. Soon, they were finding me prior to the start of the procedure and requesting my services. This was progress! Patients, family members or caregivers would poke their heads out of their room, looking for where the music was coming from, leading to an interaction between them and me.

From this initial meet, I could make the move into asking about why the patient was in the emergency department, how they were doing and if they would be interested in hearing some more music. Many patients said “sure,” some said “no, thank you,” but, again, this was progress.

Now it was time for the assessment. Many of these patients were either in pain or distressed by being in the emergency department. Anxiety and stress levels were high thinking about all the unknowns of their scenarios. I first asked them to rate their stress and/or pain levels from 0-10. We did this pre- and post- session. From there, we spoke about their preference in music genre and what they felt may help them to relax at this time. When looking for a referral from staff, the following were reasons they could refer a patient for music therapy: pain management, relaxation, distraction/diversion, stress management, procedural support and waiting time before/after tests. Referrals could come with a high or low priority. A high priority may mean that someone needs immediate intervention to help calm them, decrease pain, decrease frustration, etc. A low priority would be more appropriate for a lower trauma score patient or someone who would be in the emergency department for a longer period and was more stable.

When asked about music preferences, most patients gave me a few genres they prefer and don’t prefer. I occasionally had a request to play/sing a specific song. If I did not know the song, I was able to pull it up on my iPad and play it for the patient, sometimes singing along and sometimes just sitting quietly. Other times, the patient would ask me to choose a song for them. This could be chosen with additional questioning by me, including: What kind of mood are you in? Do you want a fast or slow song? Would you prefer me to sing or just play the guitar? With these questions answered, I was able to make a more therapeutic selection for the patient.

The interventions utilized during my time in the emergency department included music-assisted relaxation, therapeutic listening/musical requests, musical diversion, song-writing and therapeutic singing.

• Music-assisted relaxation was a technique used in which I played recorded music or sang/played live music to assist in relaxation. This technique could be guided or nonguided. Guided music-assisted relaxation involves the music therapist verbally instructing the patient to work on specific thinking or breathing exercises, while either live or recorded music is being played. Nonguided music-assisted relaxation would allow the patient to work on their own internal relaxation techniques with the assistance of music, provided by the music therapist.

• Therapeutic listening/music requests was a popular intervention. By utilizing therapeutic listening, the patient was able to focus on the music or a selected piece which provides stimulation to the auditory system and gives them controlled sensory information.

• Music diversion could be grouped into most of the interventions as music was a diversion in what the patient was going through at the time. The fact that music therapy was new in this environment was a piece of information the patient was not planning on receiving. Thus, it diverted their attention from stress or pain, even for a split second, and allowed them to engage in a musical experience while in the emergency department.

• Although not used as often as other interventions, songwriting was used to assist the patient in processing their current situation and also, at times, lightening the mood with comedy. Taking a well-known song and changing the lyrics to fit the occasion was the quickest way to write a song in this acute setting. Topics such as sciatica, panic attacks, accidents, etc. were turned into songs in which the patient could openly express their thoughts and feelings on their circumstances. Sometimes there were laughs, sometimes tears, but overall, a healthy expression of emotion.

• Therapeutic singing is a neurologic music therapy technique that involves the unspecified use of singing activities to facilitate initiation, development and articulation in speech and language as well as to increase functions of the respiratory apparatus. Therapeutic singing can be used with a variety of neurological or developmental speech and language dysfunctions. Therapeutic singing can help some patients slow their breathing and increase breath control. It also can trigger the release of endorphins and serotonin, increasing a natural high and improved mood which in turn decreases stress and pain levels.

Through trial and error, I determined that one part of the study interventions was not as effective as others. This was the use of an MP3 player, for music assisted relaxation, which had pre- recorded guided imagery and music selections. The MP3 player was not very user-friendly and the earbuds were uncomfortable in patients’ ears. Patients still had the opportunity to take advantage of the guided imagery and music through a drop card — a card with a code on it that the user could use to access the guided imagery and music. Both a positive and a negative, the user would need to use a computer, tablet or smart phone to access the music. Most of the older patients were not familiar with this type of technology. If family members were with them, they were given the instructions to help the patient utilize this form of relaxation.

I truly enjoyed my time in the emergency department, although not every day was easy or uplifting. As you can imagine, some very serious events happen in life that bring people into the emergency department. I held the hands of family members who did not know if their loved ones were going to ever get better. I played music to patients enduring painful procedures, from blood draws, numbing for sutures, to fracture reductions, and more.

I became a familiar and friendly face to patients and loved ones who needed someone to look to and offer some peace and understanding.

Each patient eligible for the study was mailed a questionnaire to complete regarding their time in the emergency department. When asked about being provided music therapy, 100% of eligible participants — 1,113 patients — would request music therapy services if admitted to the emergency department again. Wow! It is one thing to feel as though I made a difference in someone’s experience in the emergency department, but another to have the acknowledgement from the patients after they left. Due to the overwhelmingly positive response to my work during this this time, I was able to stay and continue working seeing patients in the emergency department following the completion of the study.

Patient Stories

To help you gain a better understanding of the work I did while in the emergency department, I wanted to share a few patient stories. In one case, a 34-year-old woman came into the emergency department with complaint of abdominal pain. When I walked down the hall, I heard some crying coming from one of the rooms. The curtain was not drawn, and I could see the patient, sitting up in the hospital bed, and crying hysterically. Also in the room was a nurse and medic, attempting to triage the patient and prepare her for an IV and blood draw. I quietly began to play my guitar in the hallway. Seeing there was a stool at the foot of the patient’s bed, I asked if the medic was about to draw blood to which she responded, “yes.”

I then asked if the patient needed a blanket, to which she responded, “no.” I sat on the stool, continuing to finger pick on the guitar and softly talk with the patient about the pain she was feeling. During this time, I gave a few verbal instructions on breathing and continued to play the guitar. The patient’s anxiety level went from a 10 to a three in less than five minutes. At one point, the patient was joking with me and the medic, turning to me, saying “You are amazing. You are the best at your job. You have calmed me down so much. I have never even heard of music therapy, let alone expected this on my visit. You are definitely doing the job you need to be doing. I cannot thank you enough.”

I continued to play as the medic and nurse finished triaging the patient. Following the completion of triage, blood draw and IV insertion, I spoke with the patient asking if she needed anything additional at this time. The patient had just been given pain medication and had started to feel woozy. I suggested the patient lie back on the bed and continue to relax, breathing slowly. I made closure with the patient as she started to close her eyes and left the room to see another patient.

Another story I’d like to share involved a 79-year-old man who entered the emergency department complaining of back pain. I had already been playing my guitar in the hallway, walking up and down, and stopped at the doorway of this patient’s room. The patient looked up and said, “are you here to play a song for me?” The patient was lying on his side in the bed with his daughter at his bedside. I responded “of course!”

I verbally checked in on the patient and assessed how he was feeling. He and his daughter explained that he has had back surgeries over the years, and he has been dealing with severe back pain for a week. The back clinic could not get him in until the end of the month and he needed relief. After some more conversation, I played and sang “Down in the Valley,” to which the patient sang along.

During this time, the patient’s daughter became very tearful. When the song was finished, I asked the daughter if she was OK, and if she would like to share why she became emotional during the song. The patient’s daughter said that “Down in the Valley” was her mother and father’s song “back in the day.” The patient’s daughter explained that her mother now has dementia and both the patient and his daughter shared stories of how it seemed as though the onset of the dementia had “softened” their loved one. They went on to explain that that the small things that used to anger her do not seem to have an effect on her anymore. They both agreed they have been blessed by the way the dementia is affecting their loved one. The patient listened to another song, seeming to relax more and not focus on the pain. The patient and his daughter seemed to need to verbally process through the current situation and recent findings, given from the doctor. They shared their appreciation with me for listening to their stories and sharing, feeling grateful they came on a day I was working. The physician’s assistant entered the room to speak with the patient and stated that he would be writing up a couple of prescriptions. The patient responded, “Can you please write me a prescription to take her home?” as he pointed to me. The patient continued to say, “she has helped so much, we want to take her with us!”

“Make it stop!”

— Sung to the tune of “Let it be” by The Beatles

When I find myself in lots of pain, My sciatica is acting up.

Spouting words of profanity … Make it stop!

And when the doctor tells me that I’ve had enough pain medicine.

More words of profanity …

Make it stop!

Make it stop

Make it stop

Oh, dear Lord, Make it stop!

I may blow my top!

Make it stop!

Danielle Musat, MT-BC, NMT, (Mu Phi, Cleveland Area Alumni) has been a board-certified music therapist since 2001. Her work experience includes children and teens diagnosed with behavioral disorders; individuals with intellectual and developmental disorders, from birth through older adult; individuals with physical disabilities; psychiatric disturbances; and many other physical, emotional and mental health needs. She has worked for The Fine Arts Association in Willoughby, Ohio, since 2012. She sees individuals, small and large peer groups, and instructs an adapted dance class for individuals who may have difficulty being successful in a typical dance studio.

Musat earned her bachelor’s in music therapy with a minor in psychology from Baldwin-Wallace College in 2000. She serves as vice president on the board of directors for In Harmony Therapeutic Services, a nonprofit that focuses on trauma informed music therapy services. She also plays viola in the Parma Symphony Orchestra and Hermit Club Orchestra in downtown Cleveland, with her parents, John and Kathy, and her brother, John.

“I believe that music can heal the mind and soul. Sharing my passion for music and helping others has become my life’s mission. I know how much music has meant to me and I strive to help others reach their own understanding through the therapeutic experience called music therapy.”