July 18, 2006

Therapy of note: A spoonful of music helps the medicine go down, so to speak

photo by Cary Stemle: Music therapist Jenny Branson works with Linda Toborowsky, who recently had a hip replacement at Norton Audubon hospital.The woman has cancer, and, just four days after being discharged from Norton Audubon Hospital, she’s back again because she can’t keep food down. Sitting forlornly on the edge of her bed, she tries to be philosophical. “When you look around,” she says, “you see other people worse than you.” Still, she’s worried and scared. The last thing on her mind is music.And then she meets Jenny Branson.“You say you like gospel music,” Branson says, “and your chaplain has been by today. Has your faith been important to you?”“Yes,” the patient says, nibbling at some hospital food she hopes to digest. “How about, ‘He’s Got the Whole World in His Hands’?”Still eating, she begins to sob.“We do,” she says, “but people don’t understand it. To some people it’s just a song — but you don’t never give up.”And then, softly and sweetly, Jenny Branson begins to sing.Norton Audubon Hospital looks about like any other hospital. An ominously marked driving lane for the Emergency Room right out front, admissions desks close inside entry doors, and ever-changing levels of anxiety, hope, dread, joy, sadness, relief and confusion alternating on myriad faces moving about hallways and waiting lounges and elevators and gift shops and cafeterias.If you happen to visit a patient on an upper floor, you might glance out and see people wearing hospital clothing, perhaps sitting in wheelchairs and tethered to one of those rolling IVs, congregated right outside the ER and having a smoke. Such environments bear such incongruities.Inside, a visual lexicon moves about inexorably — colorful scrubs on people whose roles are obvious only to insiders, impressive medical equipment on desktops and carts, long hallways and large closed doors that lead to areas you dare not go without an invitation.In such an intense environment, where everyone is perpetually preoccupied, it’s easy to miss Jenny Branson moving softly through the corridors. The only thing that might catch your attention is the cart she wheels. It has a guitar atop and various smaller musical instruments underneath.Branson, 30, is a music therapist — something that didn’t exist in Louisville hospitals until very recently. She earned undergraduate degrees in music and English literature from Western Kentucky University, then a third bachelor’s (equivalency) from the University of Louisville in music therapy. She began working at Audubon as an independent contractor in June 2004, operating from the Lerman Memorial Music Library.A pathologist who worked out of the hospital, Robert Lerman died from bile duct cancer in 2000, six weeks after he’d undergone surgery at Sloan-Kettering in New York, where he’d studied medicine years before. Amid those difficult weeks, something magical happened to his wife, Joanie, something she didn’t quite grasp at the time.Music was omnipresent at Sloan-Kettering.Julliard music students would drop by to play for anyone who happened to be around. The hospital had a large music therapy program and a library of recordings that patients could borrow. When Robert had surgery, the medical staff happily arranged for him to listen to a tape of his favorite classical music recordings, which he’d always done to unwind.After Robert’s death, Joanie channeled her pain in the direction that seemed natural. Her queries of Audubon leadership led her to chaplain Keitha Brasler, who thought the idea of integrating music into health care sounded terrific. The hospital easily said yes to giving up some physical space, and two former offices on the second floor gave way to the Lerman Library.It’s a smart room, with bright walls and comfortable seating and a door that stays open to maintain a connection to what goes on in the hospital, and also because the room must be understood as a place where anyone can walk in and let go and really escape those persistent forces just outside. The kind of space Joanie Lerman needed when she was in New York with a dying husband. Friends donated labor for the renovation, and money and musical instruments and hundreds of CDs and tapes to build a library. The Norton Healthcare Foundation matched the seed money. As more patients began borrowing instruments or recordings for their own use, it was obvious something profound was happening. But one challenge remained inescapable. Great ideas need someone to carry them to their full extent. The program needed a practitioner.And then Jenny Branson began to sing.Music therapy, a recognized part of the health services field, goes back more than five decades and is supported by the American Music Therapy Association, an organization that grew out of the merger of two prior organizations. The AMTA literature, thick with research citings, lays out how the practice fits into a world where empiricism rules.Music therapy reduces pain.Music therapy reduces the need for sedation and shortens exam time during colonoscopy.Music therapy reduces physiological indicators of pre-operative stress. Engaging in group music therapy and listening to music reduces anxiety associated with chemotherapy and radiotherapy.And so on.By studying at U of L, which in 2000 started Kentucky’s first music therapy program, Branson prepared to become a board certified music therapist. When she and Norton Audubon found each other, the beneficiaries were the patients who discovered that music is, indeed, good for the soul.Bringing Branson on as an independent contractor was no hard sell, but it took time for her value and effectiveness to become apparent. In the meantime, she worked every channel, making a point to ingratiate her services to nurses, and to doctors, and to patients themselves.It worked. Branson became a full-time hospital employee six months ago. She won’t miss the endless fundraising activities that kept her busy after hours, and this year, instead of five benefit events spread over a month, as she organized last fall, she will gladly scale back to a single annual celebratory concert.Audubon’s music therapy program has already won widespread accolades, including an AMTA advocacy award for Lerman and Brasler, which they accepted in front of thousands at the group’s national convention last fall. It also seems to have inspired other hospitals. Two other Norton facilities — Kosair Children’s and Suburban — will soon add music therapy programs.As for Branson, she works 32 hours a week and has a caseload so large that she can’t see all of the patients who request services. It’s a triage system; if someone is undergoing something particularly stressful, that case gets priority. Often it’s the nurses who see where she can help, and doctors are increasingly keying into the dynamic as well. Music therapy is provided by Audubon at no extra charge.As traditional medicine continues to grasp the usefulness of less traditional methods of healing, and with music therapy demonstrating the ability to shorten stays and reduce costs, chances are it will become as ubiquitous in Kentucky medicine as physical therapists and dieticians. That would be a nice note, indeed.Because she spends more time with patients — anywhere from 15 to 90 minutes — and because she’s not wearing a white coat, Branson is more likely to get them to disconnect from the moment and let their brains go elsewhere.Her methods vary. She may ask a patient to pick a song from her songbook, which she’ll then play and sing. She takes requests. She may ask a patient to help out on an autoharp or percussion instrument. She may ask a visiting family member to do the same.In the course of these interactions, she’s talking to the patient, learning about them but also asking leading questions. Often that information is new and helpful to the medical staff.So there she was one day last fall, dropping in on a female patient just after lunch. Through quiet, steady small talk, Branson learns much about the woman, a retired secretary in her early 80s.She has just had her hair done for the first time in weeks. A seizure forced her to give up driving five years ago. She’s more of a TV than music fan, but she did she take piano lessons as a young girl.Now the woman is talking to the therapist as if they’re old friends. She talks about how she used to go to Derby Dinner Playhouse. She recalls seeing the Louisville Orchestra in Tyler Park. She still wears a T-shirt from “Carmen” that she bought at Memorial Auditorium.Branson shows her a list of songs. The woman tells her she’s sad about being in the hospital, but adds, “I’m happy you came today … that’s wonderful.”Before she leaves 25 minutes later, Branson has played three songs, each punctuated by interjected conversation. She’s subbed out a verse of the song and improvised, to play off the woman’s remarks about getting out of the hospital soon. “I’m in the mood to get well, how ‘bout you/I’m in the mood to get well, how ‘bout you/Hey, hey, what do you say, I’m in the mood to get well.”The cancer patient who couldn’t keep her food down is warming up to the music therapist. They discuss her career. She worked in the medical field, scrubbing surgical instruments, among other duties. After retirement, she began visiting older people without families. When her friends asked why in the world she’d visit senile old ladies, she’d tell them to MYOB.“I feel fortunate to have cancer and be able to go out and do a few things I want to,” she says.The woman says she likes music, religious songs and country in particular. Branson asks her for a request.“You pick one,” the woman says, and keeps eating slowly.Branson props the songbook up on her knees against the food tray and sings, “I’ve got peace like a river …” More tears. Branson lays her guitar aside and says, “That’s OK.” She resumes playing and singing as the woman eats. “I’ve got love like an ocean in my soul …”“You play good.”“Is there anything you want to put in the song?”“I’ve got everything,” she says, and cries again.The door opens and three visitors walk in. The woman is effusive about her visitor with the guitar. She thanks Branson for brightening her day.Smiling, the angel of music moves on to her next patient. Contact the writer at cstemle@leoweekly.com