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Hopkins Medicine Magazine - Groovin’ in the OR

Hopkins Medicine Spring/Summer 2013

Groovin’ in the OR

From the smooth jazz of Miles Davis to the pulsing beat of the Beastie Boys, we share the playlists that give Hopkins surgeons their inspiration.

By: Neil A. Grauer
Date: June 7, 2013


Illustration by Anthony Freda
Illustration by Anthony Freda

What does a Deadhead do when he’s done touring?

“Become a surgeon so the music never stops!” says Andrew Singer, a kidney and liver transplant surgeon at Hopkins and “a huge Grateful Dead fan.”

“A quiet, stressed room is no good, and it helps my inner happiness to be listening to good music,” says Singer. “Therefore, I listen to music all the time. It’s one of the reasons I like doing surgery. I’m lucky to have a job where I get to listen to music most of the time. It really helps.”

Singer is hardly alone. In operating rooms across Johns Hopkins Hospital, surgeons and their teams routinely find energy and inspiration in a broad array of musical artists and genres—from the contrapuntal complexities of Johann Sebastian Bach to the throbbing hard rock of AC/DC.

Otolaryngologist Charles Limb, the only School of Medicine faculty member who holds a joint appointment at the Peabody Conservatory, knows more than most physicians do about the power of music.

Limb is a cochlear implant specialist who has conducted innovative studies into “the brain on jazz”—using fMRI to track how jazz performers’ brains react when they’re improvising. The fact that many surgeons listen to music while operating makes considerable sense to him. 

“Music is perhaps better than almost any other stimulus at providing a nearly instantaneous affective context in which to work—one which is, in my opinion, markedly better than the context of the otherwise at times unpleasant noise of the OR.  

“For me, music in the operating room enhances the ambient environment so that I can concentrate better and also think more clearly,” Limb continues. “I think it’s particularly good for microsurgery, where intense focus on a tiny field is the nature of the task at hand.”

So what kind of music does Limb—a saxophonist and self-described “music addict”—prefer in the OR?

“In the morning, I often like Miles Davis—Kind of Blue [considered by some to be the greatest jazz album of all time]—with something slightly more up-tempo as the day progresses. But if everybody here hates jazz, Bruno Mars is just fine, as well,” says Limb, referring to the artist whose work has included elements of soul, rock, reggae, rhythm and blues, and hip-hop.

“Actually, I don’t really distinguish between genres, although others definitely do,” he adds.

Anne Lidor, a bariatric and laparoscopic GI surgeon at Johns Hopkins Bayview, for instance, prefers the songs of her middle and high school years. “I mostly listen to ’80s music in the operating room—a lot of Michael Jackson and Madonna and all that sort of ’80s pop stuff. It’s totally mindless listening. It’s familiar and it’s background and I know all the songs, and it’s comforting. I don’t have to really concentrate.

“I hate operating when there’s nothing going on in the operating room. If it’s totally quiet, it bugs me,” says Lidor. 

Liver transplant specialist Andrew Cameron couldn’t agree more. He finds that the pounding rhythms of AC/DC, the Beastie Boys, and hip-hop help him best concentrate.

“The reason that my playlist may be different from others’ is because I think the liver transplant operation requires a very high, sustained energy level,” says Cameron.

“To get that liver out, everybody’s got to be gunning the engine, even as they approach the jump over the canyon. If we have a different playlist, it might be for different times during that operation. When we are moving toward reperfusion [the restoration of blood flow], which is a very tense, quiet portion of the operation, we may break down and put on some mellow classic rock—maybe some Grateful Dead, maybe some Allman Brothers, maybe some Dave Matthews.

“But when we’re trying to win the wrestling match of getting that liver out and there may be a lot of bleeding and a lot of high pulses, that requires the high-energy Beastie Boys, AC/DC mix.”

Fortunately for Cameron and his surgical colleagues, it’s easier than before to get high-fidelity sound in the ORs of the new Sheikh Zayed Tower and The Charlotte R. Bloomberg Children’s Center.

In the old ORs, surgeons often had to bring in their own speakers, tape decks, or CD players if they wanted music, notes Julie Freischlag, director of Surgery, “but now in the new ORs, we have a music system that’s attached to all the equipment, which is really great.” 

Four speakers are installed in the ceiling of each OR. “The electronic component that produces the sound is an iPod docking station located at the nurse’s desk in the room. You simply place your Apple iPod or iPhone on the dock and start your pre-recorded music list that’s in your device and it is played through the ceiling speakers,” explains Chris Smith, project executive of the Johns Hopkins Health System’s facilities design and construction office.

Not every Hopkins surgeon likes to have music playing while scalpels are flashing. Chief of cardiac surgery Duke Cameron, an accomplished guitarist, used to listen to music—guitarist Mark Knopfler of the British rock band Dire Straits reportedly was his favorite—but no longer.

“Though I love music and have it on almost constantly in my life, I forbid it in the OR,” Cameron says. “It interferes with communication and can distract people from important tasks. I think the situation is analogous to an airplane cockpit, where music is also forbidden for similar reasons.

“I’m not a curmudgeon and I used to have OR music on every case, but I’m convinced it’s not a good idea—at least in cardiac surgery.”

Luca Vricella, the Italian-born director of pediatric cardiac surgery and transplantation, respectfully disagrees. He prefers the classical baroque strains of Bach, Vivaldi, and Tomaso Albinoni as he performs some 250 surgeries annually—and, ironically, cites Duke Cameron in support.

“I always like to quote my partner Duke Cameron. He views the OR as a sanctuary—you know, a place where conversations are unnecessary and should really be kept at a minimum. I think classical music really fosters concentration and focus.

“In my field, a whole operating room with 12 people focuses on a little operative field that’s three inches by three inches. Classical music really sets the tone for that. You really keep everything that’s unnecessary out of the operating room.”

Although Hopkins surgeons usually have the final say on what kind of music is played, most are willing to compromise in order to maintain OR collegiality.

Director of Surgery Julie Freischlag allows her fellow, Brandon Propper, to compile the playlist on his iPod. “He’ll bring in things from the ’70s and ’80s, so we’ll listen to Cat Stevens, Fleetwood Mac, all sorts of things like that. And then he’ll bring in some newer things as well, so that’s how I’ve learned to appreciate Adele,” she says.

And while Andrew Singer is a fanatic Deadhead—often making his musical selections as carefully as an oenophile chooses wine, by the date and location of a particular Grateful Dead concert—he will defer to the likes and dislikes of others. He even makes playlists for the members of his scrub team.

“For a while we made a disco playlist, which is very retro, and everybody goes, ‘Oh, my God, disco?’ but it was a crowd-pleaser. People would kind of peek into the operating room to see what the party was all about. The disco music was a huge hit,” he says.

For some at Hopkins, a natural link seems to exist between surgeons and musicians. Both professions require intense practice, precision—and perfection.

That potential connection was tested during last year’s interviews with candidates for general surgery residency, says Freischlag. “We asked some unusual questions, and one of the questions was, ‘If you could be a musical instrument, what would you be and why?’ And I’d bet you that 90 percent of them had played an instrument when they were younger.”

Although many of the candidates had played the piano, violin, or guitar, those were not the instruments most of them said they would like to be.

“We had a lot of drums,” Freischlag said. “Sort of, drums-I-control-the-beat-I-make-everything-happen type of thing. That’s surgical-like.” 

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What’s on Their Playlist?

Otolaryngologist Charles Limb: “In the morning, I often like Miles Davis, with something slightly more up-tempo as the day progresses. But if everybody here hates jazz, Bruno Mars is just fine, as well.” 

Anne Lidor, bariatric and laparoscopic GI surgeon at Johns Hopkins Bayview: “I mostly listen to ’80s music in the operating room—a lot of Michael Jackson and Madonna and all that sort of pop stuff.”

Andrew Cameron, liver transplant specialist: “When we are moving toward reperfusion, which is a very tense, quiet portion of the operation, we may break down and put on some mellow classic rock—maybe some Grateful Dead, maybe some Allman Brothers, maybe some Dave Matthews. But when we’re trying to win the wrestling match of getting that liver out and there may be a lot of bleeding and a lot of high pulses, that requires the high-energy Beastie Boys, AC/DC mix.”

Luca Vricella, director of pediatric cardiac surgery and transplantation: “In my field, a whole operating room with 12 people focuses on a little operative field that’s three inches by three inches. Classical music really sets the tone for that. You really keep everything that’s unnecessary out of the operating room.”

 
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