She does not start IV's or check vital signs, but she is a new key member of the Infusion Room staff at Creticos Cancer Center in Chicago. And for a stethoscope slung over her shoulders, she has substituted a guitar. Louise Dimicelli-Mitran is the Infusion Room's first minstrel.
Ms. Dimicelli-Mitran is one of 3,327 certified music therapists nationwide. "I bring music to sick people," she says. "Music is medicine." And a dose of this kind of medicine is now being administered more often to treat patients with cancer. It was not too long ago that music therapy was considered little more than a balm.
All that changed after scientists discovered that Muzak piped into a New York City intensive care unit seemed to help lower the mortality rate 8 percent below the national average. Or that lullabies played in a neonatal nursery might have helped premature infants gain weight and speed their discharge home. Music therapy is on the books as hard science. And hard science is what Ms. Dimicelli- Mitran exploits to ease the anxiety and pain of cancer patients.
The cancer center's Infusion Room is on the campus of the Advocate Illinois Masonic Medical Center, and patients go there for intravenous chemotherapy or transfusions. Their anxiety is often more debilitating than the procedure itself. One tool Ms. Dimicelli-Mitran uses to help cancer patients subdue their anxiety is music-guided imagery.
"She was a bag of nerves," Ms. Dimicelli- Mitran says of a woman who came in for the first time. "She was very afraid of needles, and I could see the electricity bouncing off her skin. I found out she had fond childhood memories of citrus groves. So I told her to imagine the air smells of oranges. And we built an entire mental scene around oranges." "I play the guitar while I'm speaking," she went on. "I believe you need the music. When you get really involved in the music, it takes over both sides of your brain."
There is more to this than Ms. Dimicelli- Mitran lets on. Some psychologists think the sound of music evokes conditioned relaxation — just as the sound of a dentist's drill evokes conditioned nervousness. And other scientists have discovered that levels of stress hormones can drop while listening to music. Moving the patient out of the present with music and imagery can relieve pain, too.
Joe Eschbach is a 31-year-old engineer from Chicago's Southwest Side who comes to the Infusion Room now that his colon cancer has spread to his liver. "It definitely helps the pain," he said. "It's easier to sit there with a big bag of chemo drugs dripping into you that you know are toxic. I dread sitting there. "I ask Louise to play Beatles songs or `I Can See Clearly Now.' It's uplifting and inspires me. It pushes me to move around after a cycle of chemo. Louise is a light in the chemo tunnel. That's what some of us there call it."
Skeptics say music therapy is a mere distraction technique. But scientists cite the "gate control" theory of pain. Only a limited number of neural pathways can transmit pain impulses. Clog these pathways with music, and there will be fewer left to respond to pain. Some physiologists believe that focusing on music coaxes the body to release its own endorphins. These molecules provide a measure of built-in pain relief and are the same molecules that give runners their "high" after a race.
But Dr. Charles Furman, a professor of music therapy at the University of Minnesota, said: "There hasn't been enough research yet to make responsible conclusions. We can't feel we're so right that we don't need to prove what it's all about." Music therapy is not alternative medicine. It does not replace conventional types of care. Instead music therapists consider their specialty collaborative medicine. Music therapy is intended to enhance a patient's predisposition toward progress with conventional cancer treatments.
"I ask patients if they want to sing," Ms. Dimicelli-Mitran said. "For those who can't, I bring along percussion instruments like paddle drums or egg shakers. "Since many of these patients have IV's running, they don't have a second arm free for a drum. I found that finger drums get around this problem."
Some cancer patients want to compose their own lyrics for well-known songs with the therapist. The lyrics often come out sounding like, "I'm so afraid," or "Just don't give up." And some will want only to listen to music. Dr. Furman recommends New Age music — it is free of the associations that popular songs may have because they were heard on a special occasion. "There are a number of patients who aren't comfortable being pulled into a deeply reflective or emotional place while in a hospital setting," Ms. Dimicelli-Mitran said, noting that those people refused her services. "Patients know their own boundaries and may not be ready to go beyond them. They don't want to appear vulnerable."
Now, some music therapists are visiting cancer patients in hospital rooms and even at their homes. "Music therapy for at-home hospice patients is one of the best services we provide," Dr. Furman says. It is not just the effectiveness. Music therapy saves money. "Music therapy promotes relaxation and sleep," said Al Bumanis, director of communications for the American Music Therapy Association. "It can substitute for medication and therefore translate into a decrease in the cost of medical care."
When she was 17, Ms. Dimicelli-Mitran's 22-year-old brother died of a cancerous brain tumor. "I know when you're put in a cancer situation, you don't show your emotions," she said. "A lot of my patients stuff their feelings down," she added. "Music brings them out. When you get into this profession, compassion is part of your gig. Until someone has an experience with music therapy, they don't believe. A quite elderly patient once told me she didn't like music. I said I hoped it wouldn't bother her if I played for the other patients, and she heard the music from another part of the Infusion Room."
Ms. Dimicelli-Mitran said that after a while the woman yelled across the room, "Hey, do you know . . .?" And she played the song the woman requested.
MORE INFORMATION
This article first appeared in The New York Times on the Web on February 13, 2001. Their website is www.nytimes.com
Music without words means leaving behind the mind. And leaving behind the mind is meditation.
Meditation returns you to the source. And the source of all is sound. — Kabir
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