Lloyd Goldstein

After five years of playing for patients in a cancer hospital, I don’t always come home and write in this blog, though I should. More and more often as I grow in my practice and repertoire, and in relationships, amazing things happen almost every day that I am here.

I walk into a large waiting room; people see me and wait without much expression. I introduce myself, and offer to play a few pieces for them while they wait. There are smiles here and there as I play and light applause between pieces, even from the staff at the registration desks behind me. We are in the infusion center waiting room. People sometimes sit here for hours. I invite them to visit our Arts In Medicine Studio where they can participate in a variety of expressive arts activities. I leave, feeling that my day is off to a good start, and that their day is a little different.

I am rolling my bass down the hallway; I make it a point to smile and make eye contact with everyone I pass in the hallway. After all it is hard to ignore an double bass rolling down the hall. There are giggles when none of us knows which path to choose. Doctors, nurses, administrators, patients, visitors, lift team, transport, environmental…all know me and my bass. Sometimes they are surprised when they see me without it. “Where is your large friend? I am not used to seeing you without it. Almost didn’t recognize you!”

Arriving at the radiology waiting room, I am doing essentially the same routine as before, but it is more intimate. There are people very nearby who can feel the bass right up close and we are interacting. One man nearby asks me for something jazzy. I play an arrangement of Let It Be that I have written, and he is moving with the music, smiling and enjoying himself. In fact most everyone is enjoying themselves. I look around as I play and notice two youngsters, maybe two and four with their young mother and we see each other from all the way across the long room and we lock eyes and smile and giggle a little together. In between pieces they wave to me. Their mom looks happy.

I check my email in the Arts In Medicine Studio and I move on to my main work of the day: Visiting patients one on one in the main hospital. Recently I have been spending a lot of time playing in one small lounge area for one or a few people at a time. I try to get to the units, but so many patients are out walking, getting their exercise, that this has become an ideal place to play for them outside the rooms. One patient and his wife have listened here at least three times now, and they seemings never get tired of listening to me play. That makes me feel great! Today they are sharing me with another family member and he is asking me a few questions, about my instrument, the pieces I am playing and so on. He is really relaxed and engaged. Finally I say thank you for listening to me, and move on to the unit.

Before I even get there, I am stopped by the spouse of a very special patient. We have developed a really warm rapport even though we really don’t have a great deal of conversation. He simply makes it abundantly clear that he considers listening to me play live here at the hospital to be a wonderful, enriching experience that he does not wish to miss, under almost any circumstance. We have had visits in the lounge and visits at the bedside. He is patient, attentive and kind, warm and considerate, and I do my best to emulate him. I take my time and do my best to play the most wonderful music I know, in the best way I know, allowing myself to be inspired by his warmth and appreciation. This is one of the marvelous phenomena that occur in this work. I am inspired by the people I play for. Each one is unique and they inform me by their presence what and how I must play. I must trust my mind and my intuition to know how to do this, moment by moment. What better training for any musician!!! Today this man is being discharged, in fact, in a matter of minutes. (we hope!) He is reorganizing all his cards and wallet, and seems a little distracted and preoccupied, yet he welcomes music once again, and settles down to accept the gift with his whole heart and mind. I encourage him to call my office to locate me when he visits the hospital as an outpatient and give him a card with the extension. If he calls and I can find him, I will play for him again, wherever he is in the facility. I bid him and his wife adieu.

On this same unit is a woman who wants to hear country or folk music. She asks me to play something from around Tennessee. I know one turn-of-the-century waltz that might fit the bill. I have been planning to record this, in fact tomorrow, with my music partner Ray, and until now have not felt comfortable with the piece, not really. But this woman, and they way she speaks to me, her pose, everything I sense tells me how to play this piece, finally! I take my time, slide into a few notes, make it like a hot night with torches flaming and a dance floor outside beneath the porch. It is such a relief to finally make sense of this music for myself, and it is she who has taught me how to play it. Remarkable!

There are a couple of other visits, one with an extraordinary patient who is a master massage therapist. She says that it doesn’t matter what I play, because each piece I make my own, and special. That makes me feel great! She is looking forward to being in remission, strong and healthy and treating my aching shoulder with her master massage skills. She says that there is a reason we met. I can’t wait!

On my way out, two nurses tell me now much they enjoyed the music and that they really look forward to my visits, in fact that it just about makes their day. That makes me feel GREAT! Well, it has been a beautiful day. What a great job I have. Thanks to God and to everyone who had a hand in that. I am grateful to all of you. Good night!

As the body lets go the spirit can fly free. It may be helpful to practice compassion and awareness through meditation and yoga. Through these practices my body and mind become clear and quiet. I begin to realize my connectedness to aging and dying persons. I sense their true spirit seeking its full expression and ultimate freedom, their bodies becoming less and less vital and important. I also begin to sense my own spirit readying itself for that transition. This feels like good practice for the time when I must face the challenges of aging and dying. If you don’t like the word “spirit”, think of quantum physics and the recent discoveries that time and space are not necessarily as we perceive them with our physical senses. There is more to us than meets the eye. And again, as Thich Nhat Hanh has said, “It is not a matter of faith, it is a matter of practice.”

This afternoon her face was yellowish, her fine skin stretched tight and shiny over a perfectly oval face, including a fine bald head. She was sleeping. She told me she dreams only of Russia, of her home town and flying over Moscow, not in a plane, but real dream flying, always over Moscow. She told told me her story one night. She turned to me and looked me in the eyes. “So you want to hear my story.” So she told me how she met her husband and how he went back to America, how her friend was living in the states and invited her to visit. How she and David found one another again here in America, and how they married. “He loves me so much.” She tells me. “No one has ever taken care of me like he has. We have three bedrooms and three baths.” She looks directly into my eyes. Giving me a great gift. She works hard for the words, but she makes the effort. The last time I visited we just held hands for a while and talked for a long time. This time the words came much more easily and I was hopeful. I left happier than before. That was the day I played for thirty or forty minutes and she had always tears in the corner of her eyes and she asked for “The Swan” a second time. I told her that as I played I was thinking of how she is like the swan, tall and thin and graceful. I remember the first time I played for her and how she sat up in bed in the corner room and said over and over “very interesting” with her innocent and genuine curiosity, generosity and energy. She couldn’t get close enough on our next visit, pulling her chair into the doorway of the room, tapping her toes on the floor and encouraging me on from one piece to the next. More, yes more. She has been more sad lately, worried, afraid maybe, sad for David. “He loves me so much.” “He wants me to be with him a while longer.” Today she was sleeping, she did not know I was there. I hope she was indeed flying over Moscow. David talked to me about hospice. Her liver is damaged, failing. They don’t give much hope. A couple of times ago I even played the didgeridoo, I was out of practice. Still she asked me for an encore. I so wish that she will live and stay with us a while longer.

A Certified Music Practitioner is a trained music professional providing live, therapeutic music at the bedside in hospitals and other healthcare facilities.

I am a Certified Music Practitioner. When I play my Double Bass at the bedside in the hospital people often tell me that they are moved by the music. It is very rare that anyone complains that the music is uncomfortable or inappropriate. I receive many compliments from patients, families and staff members, and I am routinely told what a wonderful thing it is to have live music in the hospital setting, how relaxing it is, how it changes the entire mood and atmosphere on a unit, that “You made my day!” or “I never expected anything like this to happen during my hospital stay.”

I am a professional musician and have played in a full time symphony orchestra for 21 years; my musical and technical skills are adequate to the task of performing solo music for willing listeners, but there is much more involved with playing music for patients, families and staff in a hospital setting than one would expect. When I first imagined volunteering to play music in the hospital I had no idea exactly what that might entail until I visited the Moffitt Cancer Center in Tampa Florida and met with Certified Music Practitioner Cheryl Belanger. The Moffitt Cancer Center boasts one of the most well developed and conceived Arts In Medicine Programs in the U.S. I was invited to learn about the program, and to try my hand at playing for patients in the public areas of the hospital, but I was not to play at the bedside, interacting with individual patients until I had appropriate training and experience.

I completed my training and earned my certification as a Certified Music Practitioner through The Music for Healing and Transition Program, MHTP.org, founded in 1995, based in upstate NY. This organization is dedicated to training already accomplished musicians to do meaningful, therapeutic work at the bedside in hospitals and other healthcare facilities. The Music for Healing and Transition Program’s one-year program is based around 8 weekend modules, and includes required reading, repertoire development for diverse patient populations, along with an extensive internship and supervised practicum. An experienced graduate of the program is assigned to each student as mentor, throughout his or her studies and internship. Modules include repertoire development for diverse populations, injury prevention for musicians, paradigms of healing, both traditional and holistic, hospital etiquette and protocol, introduction to major diseases, symptoms and physiological systems, and care of the dying. Specific strategies designed to help graduates effect positive connections with clients, and therapeutic relationships with patients, family and staff in the hospital, are discussed, demonstrated and practiced. I will share, briefly, a few of the most useful strategies that I employ as a Certified Music Practitioner in the hospital setting.

Music is organized sound in motion. The rate of change in music is tempo, and if there is a regular pulse in music, it is rhythmic. There is a tendency for the human body to entrain, or fall into step with music that is rhythmic. Often people will nod their head or tap their feet in time with the rhythmic pulse of the music. People tend to associate faster tempos with excitement, while slower music may encourage relaxation. The Certified Music Practitioner initially offers music that she believes will connect with, or mirror the patient’s current levels of energy, relaxation or anxiety. The CMPs motto is, “Meet the patient where they are.” When this strategy succeeds, when a CMP performs music that a patient is able to “get in sync with” in terms of tempo and pulse characteristics, MHTP refers to this phenomenon as Rhythmic Entrainment. Melody, key, harmony and tone are other musical characteristic that can encourage Psychological Entrainment. In order to make this connection, practitioners choose and perform music that they feel might match or complement the mood, and general affect of the patient. When both Rhythmic and Psychological Entrainment occur, there is usually a strong initial connection between patient and practitioner, and a positive response from the patient. Additionally, since live music at the bedside is occurring in real time the practitioner can adjust parameters quickly in response to the observed reactions of the patient.

From one perspective, what the CMP does is rather simple and straightforward. She introduces herself to the patient, offering the gift of music for an unspecified amount of time, without any cost or extra effort on the part of the patient. This is not Music Therapy. There are no in depth assessments, or specific clinical outcomes expected. The patient is not required to do anything at all, except be present. There are, however great benefits associated with the practice when administered by a sensitive and well trained Certified Music Practitioner.

We have observed many beneficial effects of music visits with CMPs. Patients often feel more relaxed, cared for, “special”, “made my day”, “broke up the monotony”. Patients tend to feel more at ease, breathe more deeply, fall asleep more easily, feel refreshed, energized, encouraged, release tension, have feelings of gratitude and comment in a more positive way about their overall hospital stay. Some have commented that they feel less isolated, that the music reminds them of their life outside the hospital. With my particular instrument, the Double Bass, (bass fiddle, upright bass, string bass) patients have often mentioned that they could feel the musical vibrations in their bodies as a physical sensation, like a sort of internal massage. Staff also routinely reports beneficial effects on tension levels in the unit, they say that they remember to breathe and feel tension drain from their bodies, they remember to smile and feel more relaxed in their work. They begin to look forward to visits from the CMP and welcome the positive effect on the mood and energy of their patients.

The positive impact on the whole hospital environment that the presence of one or more Certified Music Practitioners can have, is worth many times more than the actual cost of paying their modest salaries. They move about the hospital like pied pipers, uplifting and improving the attitudes of employees, patients, families, and visitors, literally changing people’s perceptions about what a hospital environment can and should be.

Outside yoga today, stiff, out of practice. Earth felt right, cool air nice, trees alive. Stiff, afraid of dying, Mom is old and may be dying sooner. I am older than I was. Afraid of those last moments of letting go. I work at the hospital so I can begin to understand death. Will I still work there once I get it, will I continue to serve for the sake of service? Will I actually serve when I have less to gain?

Grateful for lotus, but just barely sitting upright, work to move the energy up and to sit up. Am I paying for the testosterone with stiffness? Still it is another motivation to practice daily. One week and I am afraid again of dying.

The dog barks nest door during meditation, not a terribly annoying bark, but a plea to gain my attention, come play with me. When I am finished I go and I feel her life, her need and her joyful playing. She turns on her back, offering me her belly and pees a little with excitement. As I walk back into the house I sing a couple of lines of “Hallelujah” by Leonard Cohen.

“Are you on your way out?”

“I was about to head home, but I still have some time. Is there someone you would like me to visit?”

“If you have time, there is a super sweet lady in room 2702. She would love to hear some of your music. She is on isolation, they think she may have the H1N1 virus. You will have to wear a mask and go into her room. They want to keep the door closed, she is on droplet precautions and don’t want to spread the virus outside the room. You will be fine if you wear the mask, make sure to form the metal band snugly around your nose. I go in there all the time. 2702. Thank you Lloyd.”

“Excellent, I will visit her right now, before I leave.”

“She will love it, I know. Thanks for doing that.”

She is in a corner room. It is a quiet time of the evening since daylight savings has ended and there is only a little extra room for me and my bass. I position myself caddy corner to the foot of the bed.

“Hi, your respiratory therapist told me you might enjoy a bit of music tonight, a little quiet serenade.”

“Oh, I would love that!. I was the one who stood in front of you the other day while you played over in the hall on the other side. This is wonderful.”

“Would you prefer something quiet and gentle for this time of day?”

“Play what your body tells you it wants to play.”

I smile at that, and choose ‘Music of the Night’ from Phantom of the Opera. I begin in a whisper, shy and tentative, but like a passionate prayer. The music ebbs and flows beautifully. I am happy with the way everything is working and with the feeling that is coming through.

“Oh…you couldn’t have chosen anything more perfect! I feel things about people. I feel that I know you a little. You caress the music with your heart, so that the music can caress the soul.”

“I think that may be the nicest thing anyone has said to me in the several years I have been doing this.”

Later I play a piece by my teacher Francois Rabbath, something he wrote for his wife called, L’Infinte Martine. It is the second time I have played this for anyone. She says,

“I feel as if I have been swimming with whales as they dive and surface… they take me way down deep and then we rise up again. It is natural to imagine things while listening to music.”

I tell her that there is something beautiful and spiritual about her, almost angelic, and that I hope I will see her again. We say goodnight and I carry my bass out of the room, close the door, put down my bass and begin to write these notes.

So, I am almost at the end of my day and I am looking for one more patient to play for, when a nurse-tech comes up to me smiling, and asks me if I can play in her area. There is a man way down the hallway in a wheelchair, in a gown and mask. She says that he would like to listen and that she thinks it would make him happy if I came down there to play. I tell her that it is my pleasure. For some reason I am looking forward to playing for him. I smile as I approach but do not see much in the way of response. I ask him if it would be OK for me to play for him, and I am pretty sure I get a tiny nod. There is a room with the door open just adjacent to me, and I ask the patient there if it is alright to play there. She says no problem, but is not smiling. I begin with…I can’t remember, but the second or third song I play is my arrangement of ‘Let It Be’. I play this starting pizzicato in a kind of gospel feel, then work with the bow through the melody and in the end there is this slow descending run that end way low on the E string rising from a low F# in a glissando up to low A with vibrato. I look up smiling as this huge growling sound explodes from my patient in the wheelchair. From behind the yellow mask I hear this huge growling “YEAHHH!!!” Yeah man, that is the stuff!

She is in bed, husband in a chair by the window. She welcomes music, closing her eyes and listening, a bit of a smile on her face, very relaxed. I play, we talk a bit, she shares some memories of music and life in New York. She has seen Nathan Milstein play in person. The doctors have been in to visit today, from what she tells me, she is not sure which way things will go. Her children call all the time wanting news, and she doesn’t know what to tell them. She doesn’t want to give bad news, and isn’t sure anyway. When I am finished, she says, “You have no idea how wonderful this is. God knew to send you today. Today was a nervous day trying to absorb so much information from the doctors…The music is like a sanctuary, bringing me to a peaceful place.”

I am playing for Bud. BUD! Bud is the salt on your steak, he is a self made man, an iconoclast, and just good people. Every time I would see him at church he would ask me if I had made my wife breakfast in bed yet. He said that it was vital that I do this, a top priority. He always enjoyed my music, even when I was nervous and still making big changes in my playing. He supported me. Now I’m here playing in the ICU, and Merrin and Daniel are here, his kids and everyone is listening and it’s coming around again. This life, it never stops turning. We just have to run with it and catch the rings as we find them.

So Bud insists that I play one for the nurses, and they all gather around their semi-circular station and I move nearby so I can face them all, and I play a happy tune, and they are smiling and applauding, asking questions and I feel good. Bud wants me to play for his neighbor in the next room, but he is sleeping. Bud is getting sleepy so I say goodbye for now. I’ll be comin’ ’round.

A man is filming his wife’s treatment in the hospital, and the nursing manager is concerned about this. His wife had a fall in a public building, and he is planning a suit, and wants to keep a film record of her treatment. The nursing manager tells him that she thinks this may not be appropriate, and calls her supervisor. In the meantime she suggests that I might play music for the couple. I introduce myself and offer to play, and they warmly accept. I have time to play a couple of tunes before the supervisor arrives and begins to talk in slightly nervous, yet solicitous tones to the couple. They are completely understanding and appreciate the attention to their situation. I find it a little awkward standing there for the next few minutes with my double bass and the supervisor blocking my exit route. Finally, I find a chink in the conversation to make a hasty retreat and a thank you for listening to me. Over my shoulder I hear both the husband and wife saying, “This man is a blessing…what he’s doing here, it is a blessing.”