Nicola Tagoe Reflective Essay for Musicians in Healthcare Mentoring Programme Delivered by rb&hArts and Sound Connections
Hi! My name is Nicola Tagoe. I am a flautist (and singer), and I was one of five musicians shortlisted to participate in the rb&hArts and Sound Connections Musicians in Healthcare Mentoring Programme. As part of this initiative, funded by Youth Music, I was given the opportunity to shadow professional practitioners across a range of music projects at Royal Brompton & Harefield NHS Foundation Trust and local community settings.
My initial connection with hospitals stems from my own personal experience. In the summer of 1998, when out shopping with a friend in preparation to start secondary school, I was involved in a serious car accident. I was rushed to Great Ormond Street Hospital, where I spent two weeks in Intensive Care in an induced coma due to critical swelling of the brain, as well as a punctured lung. I was moved to the Parrot Ward when it was safe for me to be brought back to consciousness, and eventually transferred to Chelsea & Westminster Hospital, where I made a complete recovery. Fortunately, I have no recollection at all of the initial part of this experience. However, I’ve been told by my parents and older brother that every day when they visited, they would play music to me through headphones (with permission from the hospital staff), knowing that wherever I was, ‘waiting for my body to recover’ as my brother would say, I would be able to hear it. Perhaps it is this memory that has remained with me over the years in associating music as a powerful presence within hospitals, as well as fuelling my strong belief in the potential for music to aid recovery.
I have since had the opportunity to manage a number of Music in Healthcare projects in partnership with Chelsea & Westminster Hospital, West Middlesex Hospital, MacMillan Cancer Centre, Lewisham University Hospital and Queen Elizabeth Hospital, but this programme was my first experience as a musician on the wards.
Royal Brompton & Harefield NHS Foundation Trust is the largest specialist heart and lung centre in the UK. All of the music sessions delivered by rb&hArts are geared towards, a) teaching key vocal skills to support patients with cardiothoracic conditions and long-term conditions that make breathing difficult (such as Chronic Pulmonary Disease, COPD), and b) allowing patients to share positive experiences, particularly during challenging circumstances. During the course of the mentorship programme, I had the opportunity to shadow Heather Mclelland, Stac Dowdeswell, Ed Jeffery and Elisa Jeffery (vocals/ukulele), Adrian Garratt (violin), and MC Zani and Bellatrix (beatboxers). I visited seventeen sessions in total. Here is a summary of each one:
Vocal Beats on Rose Ward/PICU at Royal Brompton (0-16 year olds) – 5 sessions
The Vocal Beats sessions involved playing to and making music with young patients aged between 0-16 years on the Rose Ward at Royal Brompton Hospital. Vocal Beats took place on Wednesdays and Thursdays, usually with Heather and one of the beatboxers, MC Zani or Bellatrix. Each session lasted for three hours, during which time I sang and played the flute, as well as encouraging patients (and their families) to join in using small hand-held percussion instruments.
1-2-1 Vocal Coaching at Royal Brompton (17-25 year olds) – 2 sessions
The 1-2-1 Vocal Coaching sessions involved delivering vocal coaching to patients between the ages of 17 – 25 with Cystic Fibrosis. Heather was the lead musician for these sessions. The sessions were patient-led, but with vocal exercises geared to aid the symptoms of their condition. Patients chose which song they wanted to work on, with each session lasting around an hour. I joined in with the vocal warm ups and the songs, gauging when to drop out to give space for patients to work on specific parts of the song, or when they were being introduced to new vocal/breathing techniques.
Adult Inpatients at Royal Brompton/Adult Transplant at Harefield (ITU & HDU) – 4+3 sessions
I shadowed Stac during four sessions with Adult inpatients in the Victoria and Foulis Wards at Royal Brompton; and three sessions on the Adult Transplant wards, ITU (Intensive Therapy Units) and HDU (High Dependency Unit) at Harefield Hospital with Adrian. These sessions were 2.5 and 3 hours respectively, and were geared to bring respite to patients, many of whom had spent considerable periods of time as inpatients waiting for notification that there were organs available for transplant, or otherwise were at various stages of recovering from major transplant surgery. I sang with Stac during the sessions at Royal Brompton, and played the flute alongside Adrian on the violin at Harefield.
Singing for Breathing (all ages) – 3 sessions
The Singing for Breathing sessions were open to members of the community suffering from COPD and similar conditions, and involved warm ups and songs geared to strengthen lung capacity and breath control. I attended two sessions with Elisa at Harefield Library and a session with Ed at Royal Brompton. The number of attendees varied, ranging from around 16 to 30, with the majority being of older adult age. These sessions were relaxed and informal, with many being regular attendees who had been coming to the sessions for years and so knew each other well. I joined the attendees sitting in a semi-circle in front of the session leader, and participated fully in the vocal warm ups and songs. The groups were very friendly and I was always made to feel welcome during these sessions!
In his 2012 publication Music, Health & Wellbeing, Raymond McDonald highlights a number of ‘special reasons’ to consider music in contexts of wellbeing and health, and I have found these useful to frame some of my experiences during the mentorship programme.
MUSIC IS EMOTIONAL: Creating a Positive Environment
I witnessed the profound emotional impact that music can have on patients. Many commented that the music had ‘brightened up their day,’ and that it provided a much-needed break from the routine of medication/procedures and long days spent in the wards. To illustrate this, during a session at Royal Brompton, Stac and I had asked a particular patient if she wanted a song. She seemed somewhat indifferent but happy to hear something. After the first line however, she suddenly lifted her hands to her face and burst into tears! We stopped and gently asked if she would like a different song, assuming it had triggered a sad memory, but she simply said that she was crying because ‘it was just so beautiful’ that we were there, singing especially for her. Her visitors/family smiled and comforted her as we continued with the song, and when it came to an end, they clapped so joyfully and thanked us. Similar experiences happened on a number of other occasions, with patients becoming visibly moved by the experience of having live music played to them, and although some were clearly rather overwhelmed at first, they were (usually) smiling by the time we left! It’s not often that one gets such an immediate reaction as a musician, which made these moments all the more rewarding.
MUSIC IS DISTRACTING: Keeping Calm
I experienced music working to draw patient’s attention away from distressing procedures and situations. This was particularly apparent with younger patients, for example when a little baby was having his blood pressure taken, and a toddler was having a tube attached to a cannula in her arm, both visibly distressed. In both instances the lead musicians used techniques such as repeating the patient’s names, encouraging them to choose a song, or simply drawing their attention to the sounds and instruments being played, to distract them. The baby appeared to no longer feel the strange sensation on his arm, and the toddler had been noticeably calmer. There were a number of instances where adult patients had asked if they could record us while we were singing, so they could listen back to it at a later stage. One particular patient, who had been in an isolated bay for a long period of time and was feeling particularly low, mentioned that he would like to listen back to the recording when going to sleep, to allay stressful thoughts and make him feel calmer.
MUSIC IS AMBIGUOUS: Connecting with Memory
I witnessed patients interpreting music through the lens of their own personal experiences and memories. During a session with adult inpatients, Stac and I had just finished a song, and noticed a young female patient who had been moved to tears by the music. On speaking to her, it transpired that the song had taken her back to times with her late father, who had been musical and played in a band, but had sadly passed away. She proceeded to share happy memories of her father, showing us videos of him playing, and asked to record us as we sang another song so she could watch it and feel closer to him through the music. Another patient we met was non-verbal and spoke through an eye-operated speech device. She had allowed us to choose what we wanted to sing to her, and on coming to the end of the song, she began to dictate a message. When it came through, she shared with us that that particular song had been the first song that she had ever sang as a professional singer. Whilst being somewhat subdued when we arrived, she proceeded to really connect with us and the music, requesting another song and engaging in further conversation. To me, these profound experiences demonstrated the ability for music to encapsulate memory, as well as a person’s sense of identity, and that through music, we have the potential to help patients to reconnect with who they are deep down, separate from their illness or condition.
Music is Social: Patient Engagement
I was reminded of how music has the ability to connect people in a positive way. Through using techniques modelled by the lead musicians on the Rose Ward, I gradually learnt how to ensure that all patients were contributing in some way to a piece of music, whether singing along, playing a kalimba, shaking a drum or making sounds using an app on the hospital iPad. These were very touching moments, particularly one joyful session with a young patient and her family, which turned out to be her last music session before she sadly passed away just a few days later. I was extremely saddened by this news, but found some respite in the fact that we had been able to facilitate and be part of this special and intimate moment for her and her family during her final days. The Singing for Breathing sessions were a particularly prominent example of music as a social activity. Both Elisa and Ed led the sessions with such energy that motivated the attendees to really give their all, and it was difficult not to be swept away with the music making. So much so that on one occasion, when I was with Ed’s group at Royal Brompton, a passing nurse ran into the room and started singing and dancing along to Let’s Twist Again! The wonderful thing was however, that all the initial warm ups, breaths and phrasing in the song had been carefully worked out to support the attendees to strengthen their lungs and breathing, all whilst having a great time!
A key aspect of the programme was the opportunity to learn from the lead musicians, each of whom was a fountain of knowledge in their specialism. I found that in my early sessions, and even later on in the programme when entering contexts with which I was unfamiliar, I leaned heavily on the lead musicians. I would rely on them to ascertain what to do, where to stand, how close to stand, to stand or sit, as well as what was ‘appropriate’ when greeting and interact with patients. I found that all of the lead musicians were always willing to answer any questions or discuss, and as I gained more experience, I had a wider frame of reference to draw on which enabled me to respond to situations more appropriately, and eventually start to take initiative as my confidence increased.
By being part of this programme, I’ve had the opportunity to bring music to patients of all ages, many in critical conditions. In all honesty, this has not been easy, and I’ve been confronted with a range of challenging emotions, some of which have been difficult to process. Perhaps one can never be emotionally prepared to, for the first time, stand at the bedside of a two-week old baby who has just undergone a major heart transplant, and try to sing a song without welling up. Or accepting that a patient that had engaged consistently in sessions, who had responded to the music, and had even sang a song of their own despite barely being able to speak, had then passed away just a few days later.
Over time, I became aware that my discomfort and sadness in these circumstances, however extreme, could never come close to the lived experience of the patients or their families. My purpose was not simply to move from ward to ward, feeling sad for the patients. I found that as I became more emotionally resilient, I was able to focus on encouraging patients to take their minds away from their current circumstances, however traumatic. It was touching to see the relationships that had been built up between the lead musicians and some of the long-term patients as well, with many mentioning that they looked forward to the music sessions each week. It was clear that the impact of the work extended far beyond the duration of the music itself.
As a musician I have built up a range of new skills, particularly with my singing, which was somewhat dormant when I started the programme! It was fascinating to see the ways that standard vocal exercises could be manipulated to be particularly effective for those with COPD and Cystic Fibrosis. I’ve built up an awareness of the kinds of music that work well in different settings, vocal and instrumental, and have a growing repertoire that I can take with me as I progress in this line of work. I found it particularly rewarding to work with the babies, young children and families as part of Vocal Beats, and have been inspired to expand my music education work to include Early Years settings. I am delighted to have gained a new position within the Early Years team at The Conservatoire (Blackheath), and as a trainee musician on Wigmore Hall’s long-standing ‘Chamber Tots’ programme.
Participation in the Music in Healthcare mentoring programme has been a transformational experience for me. I am extremely grateful to the rb&hArts team, Sound Connections and Youth Music for having given me this wonderful opportunity, and to all the patients who were receptive to the music. Best of luck to the new cohort of mentees starting this year!
rb&hArts and Sound Connections are currently recruiting for the next cohort of music mentees with five spaces available.
Learn more and find out how to apply here.
DEADLINE EXTENDED to 23rd October 2019.