Berklee Today

Coda

Healing Art
By Dr. Maria Hernandez '04

	Maria Hernandez (left) works with a patient during a music therapy session.

Several years ago, I was in a hospital in my hometown in the Dominican Republic wearing a white coat and a stethoscope around my neck, nearing the end of my training to become a medical doctor. The hospital had become my second home, a place where the smells and sounds were so familiar to me; it was the place where I slept, showered, and ate. My life revolved around patients' problems, diseases, family suffering, and poverty, and I struggled with how to provide the best medical attention. I found it hard to be in the intensive care unit next to a 12-year-old child pleading for her mother, who the girl knew was in critical condition; to attend to a 54-year-old man who could no longer bear his pain; or to be in the presence of an 84-year-old Alzheimer's patient who could no longer communicate coherently and just stared out the window.

After I completed my medical training, I became aware of music therapy and how music could be used clinically to help patients. Finding a way to explore my musicianship was a childhood dream. But it was a revelation to learn that music could affect not only patients' moods but also their immune system, blood pressure, heart rate, respiratory rate, muscle tone, and motor system when applied systematically.

During my music therapy studies at Berklee and now as a music therapist, I've had many meaningful experiences with patients. Entering a patient's room for the first time is almost like going onstage for a performance. The day I walked into the room of Mrs. Jenkins with a

guitar, I saw how a familiar song could lessen the nervousness and anxiety by creating a safe environment.

Maria Hernandez became an M.D. at Instituto Tecnologico Santo Domingo before studying music therapy at Berklee.

Mrs. Jenkins was a 54-year-old African-American woman referred to us by a clinical nurse specialist. Jenkins had a neuromuscular disorder that produced weakness and fatigability and impeded her breathing, swallowing, and mobility. She was apparently depressed. I learned that she was a spiritual person, and when I introduced the song "Amazing Grace," she remarked excitedly, "That's one of my favorites! My father and I used to sing it together." The song prompted her to share memories of her father and express her sadness at being unable to attend his funeral because of her hospitalization. She was trying to cope with her illness as well as her father's recent death.

I sensed her anxiety and gave her a relaxation exercise to do while I improvised instrumentally on the guitar. As she closed her eyes, I guided her through deep breathing and muscle relaxation, and told her to imagine a place that offered her peace. When the music ended, she opened her tearful eyes and her voice cracked as she said, "I pictured seeing my father up on the hill above Friendship Baptist Church. He was doing fine." A few days later, I learned that Mrs. Jenkins had been discharged. She left a letter for me describing how the music had relieved her gloom and showed her the way up the hill to her old church and her father anytime she wanted.

I was also humbled while working with a young, loving mother diagnosed with cervical cancer and a poor prognosis. Ms. Hamlet was 34, a soft-spoken and gentle woman who was referred to music therapy for pain management. During our first encounter, I explained how many patients have benefited from singing, playing instruments, writing songs, analyzing lyrics, and relaxing with music, where music provides a distraction from pain. She told me that she enjoyed listening to relaxing instrumental music. Before we started, I asked her to rate her pain on a scale from 1 to 10. She said she was at an 8. As I improvised on the piano, she closed her eyes and listened peacefully. By the time the session ended, she rated her pain at a 4. Her perception of pain had decreased after listening to the music.

After several encounters with Ms. Hamlet, I learned that her condition was worsening and that she was receiving palliative care. She had shared stories with me about her family, so I proposed the idea of writing a song. She chose to write one for her children that she titled "Perfect Combination." Her lyrics described her love for them, the days they spent on her bed together, sometimes playing Nintendo, and her future hopes for them. I returned with her completed song, and as I plucked the guitar and sang her words, I realized for the first time that she could forget for a few moments how ill she was and acknowledge the beauty of her life as expressed in her heartfelt song. She was later transferred to a hospice; two weeks later, she passed away.

"I'll bring the studio to you," I told another patient I knew as Ethel M. Her face brightened as I proposed writing and recording a song in her room for her family.

Ethel had been airlifted to the hospital for life-threatening medical complications due to intestinal perforation. When I first met her, she was lying on a bed unable to speak. She could only nod or mouth words. I learned through her chart that she was a postsurgical patient experiencing physical pain and discomfort. Our initial sessions involved relaxation, and I had her focus on a good experience and the most beautiful place she could imagine as she listened to the music. She said the beach was a special place for her, and her daughter's wedding was a highlight of her life. One day after she requested her favorite song, I got to hear her voice. Ethel was not only talking but also singing: Somewhere, beyond the sea / Somewhere, waiting for me ...

Although I've found songwriting to be a powerful therapeutic experience, I always wait for the appropriate moment to introduce the idea to the patient. Three weeks before Ethel's discharge, during the last stage of her recovery, I suggested that she write a song. It was time for her to take control and give closure to her hospitalization. I was confident that music would help.

Usually it takes time to assist patients in writing a song and to find a theme and words they want to include in the lyrics. But when I returned to Ethel's room, she had written a page and a half of ideas. She had been hospitalized for more than four months and had much to say about her experience and all the people who helped her along the way.

"Let's use the tune to 'What a Wonderful World,'" she said. I brought my laptop "studio" to her, and we recorded the lyrics she titled "All the People Who Cared." Before her discharge, Ethel performed her song for her physical therapist and her nurse, the music therapy staff, and her daughter. As she sang, a flood of emotions and tears overwhelmed those in the room. As Ethel left the hospital in a wheelchair, her daughter remarked, "Mom, do you remember when you couldn't even talk? Now you're singing."

Working as a music therapist at University Hospitals of Cleveland, I've seen music improve people's lives: One of my patients was afflicted with dementia and was no longer capable of constructing organized thoughts. He has since found structure through drumming. Another 67-year-old patient with dysarthria had difficulty articulating words but can now vocalize a melody fluidly while listening to live music. And a young man with ataxia has regained some steadiness in his gait as he locks in to the rhythm of a metronome.

Just a few years ago, seeing the daily suffering of my patients brought me to the point of abandoning medicine completely. Music therapy renewed my passion for the healing profession and helped remind me of my purpose. Music allows us to laugh, cry, remember, walk, sing, and dance and can bring wisdom and humanity to the world of medicine. In music therapy, art and science intertwine in a natural way. When integrated, music and medicine make a perfect combination.