Hopkins surgeons enjoy music on the cutting edge.
It's early on a Wednesday, and Keith Lillemoe hurries down a long hallway in Blalock, past slow-moving patients and anxious families. He's on his way to change, scrub in, and start a five-hour operation that will remove a dangerous tumor from the bile duct of his patient. The operating room will be ready when he arrives, but nurse Beth Putonen goes down the list on Lillemoe's preferences sheet one last time, making sure the patient will be in the correct position for the procedure, that all the necessary surgical tools and meds are assembled, and finally, that the beat-up boombox is working.
Lillemoe's extensive CD collection includes James Taylor, Eagles, Chicago and even the Bee Gees, but it's the music of achy heartbreak that Lillemoe, a native of South Dakota, favors while he operates. As he calls for suction, Garth Brooks sings quietly of ropin' the wind, never obscuring the beeps of the anesthesiologist's monitors and Lillemoe's instructions to the residents and nurses.
Lillemoe isn't alone in wanting some audio ambience for his operations. An informal survey shows that most Johns Hopkins surgeons prefer music in the OR, from jazz to classical, rap to alternative rock. They find it helps put them in the right frame of mind, relaxes the other members of the surgical team, and contributes to the feeling that the OR is a refuge from their incredibly busy lives, a place where they can focus solely on the patient, the surgery and their skills.
"During some difficult aspects of the case, I'm not even aware that the music's on," Lillemoe says. "At other times, I've noticed third-year medical students singing along down the line after the intricacies of a case are done. Music can help the team relax."
Orthopedic surgeon James Michelson is another doctor who believes in the power of music. "The few times I've forgotten to bring music, I get desperate!" he says. Michelson leans toward big-band jazz, from the current crop of artists including Squirrel Nut Zippers and Cherry Poppin' Daddies, to the classic jazz of Joe Farrell, Chick Corea and Duke Ellington. Michelson has always enjoyed music and listens to it all the time, in his car and at home. He tunes in to college and non-commercial radio for new and different music, and he's one of those people who will hear a few seconds of a song on National Public Radio and have to track it down.
"I think music lightens the overall mood in the OR and helps keep people focused by giving them a little bit of background noise that can distract them from getting nervous," he says. "There are relatively few times when you need to be incredibly serious and the music is turned off."
For Lillemoe, the music was a bit of a surprise when he first visited an OR as a medical student. "You expect that everything is very austere and formal and no one speaks except for the surgeon to the scrub nurse," says Lillemoe. "It is a very serious place, but even in 1976 when I came here, there was music in many of the ORs. Since then, the level of acceptance has expanded."
Acceptance, yes. But not always approval. While some Hopkins doctors, like trauma surgeon Edward Cornwell, don't have strong feelings either way about music in the OR, some doctors think that music can be a distraction that could undermine communication and the crucial teamwork necessary to pull off a difficult operation. "It's my bias that the ORs should be extraordinarily quiet, and even conversation should be at a minimum in order to increase team focus," says James Fackler, an anesthesiologist. "It's just hard to imagine going into the cockpit of an airplane, where concentration on what you're supposed to be doing is crucial, and hear them listening to rock 'n' roll."
Fackler adds that classical music in the OR is "totally acceptable background music that doesn't require your mind to be focused elsewhere."
But research suggests that whether it's the Rolling Stones or Sergei Rachmaninoff, the type of music should be something the surgeon likes. A study published in the Journal of the American Medical Association in September 1994 found that surgeons had lower blood pressure and pulse rates and performed stressful nonsurgical mental exercises better when they listened to their choice of music. The researchers saw no benefit when surgeons listened to music chosen by others.
Lillemoe is flexible. "I liken the operating room to the family car," he says. "If dad's driving, he usually controls the radio." But like any happy family, there's room for discussion. If a member of the nursing or anesthesia staff brings in some CDs, they'll generally get airtime. "To be honest," he says, "if you ask me at the end of the day what CDs we listened to I probably won't remember. I'm obviously focused on something else."
In addition to being good for surgeons, recent research supports the idea that music helps patients heal, and studies have found some evidence that music can reduce anxiety, agitation, depression and even a patient's level of pain during a surgical procedure. Lillemoe's patient this morning asks for music to be played even though he'll be asleep. Still, he's adamant about what kind of music he'll sleep through. "I'm allergic to rock 'n' roll," he says. "But country would be good. It's beautiful and mournful." Some patients believe the music filters through the anesthesia into their subconscious, and if it's music they like, they'll do better during surgery, nurse Beth Putonen says.
While it's often the surgical team or the patient who decides what will be played, sometimes the surgery picks the music. To paraphrase Rod Stewart, every surgery tells a story, according to gynecologist Paul Blumenthal. "There's an opening act, and there's conflict, usually a climax at some point, and then there's resolution and the epilogue," he says. And like a good John Williams score, Blumenthal's choice of music varies with the level of tension and conflict. "Surgeons may have one kind of music they like during the opening, or maybe they don't even want any music during the part of real conflict and the climax," he says. "But once the climax has been reached and you're on resolution and getting towards the epilogue, you can put on your closing music. In my case, this tends to be Motown."
Once the surgeon is scrubbed, there's no flipping through CDs or adjusting a radio dial. In addition to her duties as circulating nurse, Putonen has also been DJ'ing Lillemoe's operations four days a week for about two years. She knows his taste in music well and is always glad to find some new additions to his large, well-worn, collection. She says he generally likes "lighter music" when the intricacies of a surgery are over, like the Dixie Chicks and Faith Hill.
For Marion Couch, the job falls to nurses Norma Gorsuch and Greg Ruff. Although Couch doesn't play music during every operation, the nurses know she does have a favorite song for closing -the worldwide smash "Macarena," composed in 1993 by the Spanish flamenco duo Los Del Rio. While no one in her OR will be doing the accompanying 16-step dance, Couch might occasionally sing along "if you use the term loosely."
Like many surgeons, Couch sees the OR as an oasis from daily cares and a chance to do something she loves. Music only makes it better. Stranded at a conference in Denver on Sept. 11, Couch was looking for a place to get some perspective on the terrorist attacks. She chose going into surgery with a friend instead of a long hike in the mountains.
"You can never lose sight that you're there to help someone," Couch says. "The steady beeps of the monitors, the sound of suction-that is the true music of the OR."