Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

The power of music in the ICU

Nomi C. Levy-Carrick, MD
Physician
August 23, 2019
Share
Tweet
Share

“I just don’t know what to do, how to help.”  My patient’s wife was slumped in the plastic chair by her husband’s side, fatigued and beleaguered.  She had been there for hours, days, as we waited for antibiotics to start fighting back against the infection that had overwhelmed his body.

“What sort of music does he like to listen to?”

“Depends on what he’s doing.  Zeppelin to work on the car.  Jazz for road-trips.  He’ll tolerate my Velvet Underground when he wants to hang around in the kitchen and taste-test what’s cooking.”  A faint smile crept into her face.

“Play it all.”

The helplessness experienced by families sitting by the bedside of a patient who is intubated can be traumatizing. I’ve served for two years as the embedded psychiatrist in a medical intensive care unit (ICU) of an academic medical center.  My learning during this period has extended beyond clinical experience: one does not, after all, live with prolonged daily exposure to extraordinary vulnerability and strength evident in people from such a heterogenous mix of ages, backgrounds, and diseases without evolving new perspectives on meaning and memory-making.

One way of engaging patients who appear withdrawn, dysphoric, apathetic – or, alternatively, bored, restless and floundering for ways to fill the hours as they gradually stabilized from their critical illness – has been to stream music of their choice at some point in the interview.   When I look through the music apps on my iPhone, the lists conjure images and narratives of many of the patients for whom an alliance was struck by a shared listening experience.

There was the young man who was intubated for weeks, whose father said he liked The Eagles, which we thus played routinely.  When the breathing tube was finally removed, the patient noted that actually he was not at all a fan.  (Hence my queries to the healthy about their ventilator music:  perhaps it could be a suggested part of the advanced directive!)  There was a woman starting to stabilize after several critically ill days who requested the rapper Twista’s Slow Jamz – her daughter jumped up and said, “Oh, Mom, that’s just so wrong in so many ways!”  They shared a laugh, a moment of lightness amidst significant tension.  And they settled on Marvin Gaye instead.  There are, of course, the challenges of the “whatever you like” request – those I punted, reaffirming to the patient the choice was theirs alone.  Sometimes that meant no music.  Other times it prompted a request later during the interview, or the next day.

We are learning a lot about music and the mind, the ways listening activates the brain, the differential ways it does so depending on whether you learned an instrument from an early age.  The research ranges from neuroimaging to music therapy.  I could intellectualize the experience, reasonably justify these engagements from a neurobiological basis:  activating the hippocampus, which stores memories great and small; the auditory cortex for most and visual cortex for those who at some point played an instrument intensively.  The point of choosing their favorites has a strong physiologic rationale as well:  it’s not necessarily about the type of music, per se, but about music preferences that activate limbic and cortical circuits, provoking a neurochemical milieu with dopamine, serotonin, and oxytocin awash in musical and autobiographical nostalgia, mobilizing the pleasure, reward and motivation centers in the brain.

Ultimately, though, this exercise felt more consistent with a trauma-informed engagement: one can have limited voice and choice as a patient in the critical care setting: here was a chance to choose.  Sometimes the choice not to listen to anything was equally empowering.  Other times it created space for a connection that derived from the patient’s own cultural and lived experience.   One opportunity here was to share the experience of listening to a piece of music – not critically or analytically, but narratively.  It gave patients an opportunity to drift back to a time and place that was generally much more positive than the one in which they found themselves.   When it worked, out of the silence that followed the song’s end, meaningful history-taking and symptom reports would emerge.

A recent patient’s playlist remains salient. She was elderly woman with end-stage COPD, irritable and withdrawn on admission, who opted for music of the 1980s because it reminded her of her only daughter, who had died a decade ago.  Music, for this patient, “makes me feel nearer my girl.”  I was surprised by her ice-breaker request of UB-40 I can’t help falling in love with you.  She reached out to take my hand when the lyric indicated accordingly.  What followed was a substantive and helpful discussion about how she understood her survivorship of significant traumas as a child, and devastating losses as an adult and parent.

When it was time to go, I asked, “What should we hear next when I stop by?”  Her answer: Squeeze, Pulling Mussels from a Shell.  And winked.  The next morning, it was The Cure’s Lovecats.  The discussion that followed the song’s finish addressed how, on the one hand, she welcomed death as a chance to stop feeling chronic shortness of breath, pain, and the frailty connected with it, afraid to hope that she would reunite with her daughter in some way, while on the other hand still having more movies she hoped to watch and other activities she wished to do.

Her request for the next morning: INXS Never Tear Us Apart.  She passed away overnight, so the next morning I listened to the song anyway, in its entirety.  She had told me her husband didn’t really know what to do when he was at the bedside. He couldn’t just keep her company; they would argue, but she missed him.  She had passed away with a nurse at her side instead.   I wished I’d called and given him her next song request.  Perhaps they could have listened to that together, just once more.

Nomi C. Levy-Carrick is a psychiatrist. 

Image credit: Shutterstock.com

ADVERTISEMENT

Prev

Who are the real superheroes of medicine?

August 23, 2019 Kevin 1
…
Next

Quality improvement: Helping boost everyone’s triple aim

August 23, 2019 Kevin 1
…

Tagged as: Critical Care

Post navigation

< Previous Post
Who are the real superheroes of medicine?
Next Post >
Quality improvement: Helping boost everyone’s triple aim

ADVERTISEMENT

More by Nomi C. Levy-Carrick, MD

  • A psychiatric services response to the COVID-19 crisis

    Nomi C. Levy-Carrick, MD

Related Posts

  • Think deeply about ways you can use your power as a physician to make change

    Danielle Plattenburg Arnold, MD
  • Power at the top of health care in America

    Wendy Hind, PhD, JD
  • Millions of Americans without ICU doctors due to the “Biden ban”

    Seth Rabinowitz
  • Understanding critical care in the ICU: then and now [PODCAST]

    The Podcast by KevinMD
  • A place for music in the emergency department

    Thomas Scary
  • Physician Suicide Awareness Day: Where are the patients? 

    Jennifer M. Sweeney

More in Physician

  • Why more doctors are choosing direct care over traditional health care

    Grace Torres-Hodges, DPM, MBA
  • How to handle chronically late patients in your medical practice

    Neil Baum, MD
  • How early meetings and after-hours events penalize physician-mothers

    Samira Jeimy, MD, PhD and Menaka Pai, MD
  • Why medicine must evolve to support modern physicians

    Ryan Nadelson, MD
  • Why listening to parents’ intuition can save lives in pediatric care

    Tokunbo Akande, MD, MPH
  • Finding balance and meaning in medical practice: a holistic approach to professional fulfillment

    Dr. Saad S. Alshohaib
  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • Facing terminal cancer as a doctor and mother

      Kelly Curtin-Hallinan, DO | Conditions
    • Online eye exams spark legal battle over health care access

      Joshua Windham, JD and Daryl James | Policy
    • FDA delays could end vital treatment for rare disease patients

      G. van Londen, MD | Meds
    • Pharmacists are key to expanding Medicaid access to digital therapeutics

      Amanda Matter | Meds
    • Why ADHD in women requires a new approach [PODCAST]

      The Podcast by KevinMD | Podcast
    • AI is already replacing doctors—just not how you think

      Bhargav Raman, MD, MBA | Tech

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • Facing terminal cancer as a doctor and mother

      Kelly Curtin-Hallinan, DO | Conditions
    • Online eye exams spark legal battle over health care access

      Joshua Windham, JD and Daryl James | Policy
    • FDA delays could end vital treatment for rare disease patients

      G. van Londen, MD | Meds
    • Pharmacists are key to expanding Medicaid access to digital therapeutics

      Amanda Matter | Meds
    • Why ADHD in women requires a new approach [PODCAST]

      The Podcast by KevinMD | Podcast
    • AI is already replacing doctors—just not how you think

      Bhargav Raman, MD, MBA | Tech

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...