Music for a While – Blog 5

Music for a While BLOG
BSO Associate – Neil Valentine
Entry 5, 15/10/15

BSO Associate Neil Valentine is working acute older peoples wards in Poole, Portsmouth and Hampshire Hospitals. He will be visiting the each ward once a week for 6 months.This is a collection of his thoughts, feelings, impressions and experiences.

Music and Delirium

This post recounts the most intense experience of Music for a While so far.

I was in the day room working with a couple of patients, we had a nice time, some fun singing and exploring of instruments. Smiles were around and eyes brightening up.

They went back to their beds and I entered the ward to play to a few gentlemen who were unable to make the trip to our session. This was lots of fun, one patient was singing and clapping along, the others smiling and enjoying. I had been warned that one particular gentleman was a little unsettled and to be aware of this. My colleague from the BSO, who was there to observe, sat with him, and had a great time laughing and joking.

I was then asked to play from outside a side room to a particularly distressed patient. This lady had come in for a fall, but in hospital had developed some severe delusion and paranoia, probably related to an infection.

Her speech was full of fear and anxiety. Determined to tell us about a disaster that was happening for her. Words were repeated as she tried to convey her distress. She had flooded the room and all her bedding needed changing, but this was nigh on impossible due to her distress.

I decided that playing from outside the room made me (and probably her) feel like I was just watching her, peeking in rather than trying to be present and to engage. So I went in and for the next 45 minutes I played non-stop, her own private concert so to speak.

During this time she focused on me and whilst I played she tried to tell me about the disaster that was her reality. Whilst focused on me, the amazing nursing staff were able to change her bedding, clear up the water and get her into bed.

I played my full repertoire of relaxing and calming melodies and songs, all aimed at bringing the level of anxiety down. I brought the volume and intensity down, thinned out my tone but kept up the sense of emotion through vibrato and expressive phrasing.

The dementia specialist nurse sat with her, stroked her hair as I played. Occasionally she sat up, distressed, but then lay down again. She was made comfortable and began to speak with less distress, quieter and calmer.

It was quite an experience for me. Determined to play constantly, smoothly, beautifully, no shocks or sudden changes, just calm and sustained. A bed of sound that had the possibility to help her calm down and feel safe. It had the added bonus of masking sounds from the ward, many of which can be intrusive. Trolleys clashing, doctors and nurses talking about patients, drugs being administered, other patients talking or shouting. The music created a sound buffer for her in the room, allowing the room to be protected, door almost closed, light off and sounds not penetrating from outside.

There got to a point when the lights were off that she would open her eyes, look around and see me. When she saw me she had something to focus on and the distress increased. When this happened I realised that what she needed was to be able to sleep, not more music. It had reached the point where her delusion had been calmed and reduced, and a person standing in her room (playing beautifully or not) would now be a focus for this delusion and anxiety.

So I slipped out of the room.

Later I was told she had slept well and had a much calmer night.

This is the first time I have experienced someone with such a vivid expression of an alternate reality to my own. Yes we all see our own version of the world, and in the wards I have met many patients who are confused or unsure about their reality. But not to this level.

On my way out a Junior Doctor thanked me saying “that was magic”.

No hocus-pocus I’m afraid but it certainly put my recent whinging about a sore wisdom tooth in perspective.

Neil Valentine
BSO Associate

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