Prologue

I turned the corner into the Surgical Intensive Care Unit and a
wave of sound hit me. It always did. Beeps from ventilator ma-
chines, infusion pumps, and cardiac monitors. The cacophony of
voices of doctors, nurses, patients, and visitors at every volume
and intensity. And the ever-present discordance of televisions
turned up way too high. It struck me again that this was the
worst environment for the critically ill to heal. Today there was
another noise, a sound I had never heard before, and I stopped
in my tracks, unsure. Strange words, very fast and loud, neither
happy nor angry, streamed from a bed at the far end of the hall.
A woman’s voice talking. But I couldn’t understand a word she
was saying or even make out the language she was speaking. It
was just a barrage of sound. I had no idea what was going on.
The voice flowed out from behind the curtain of Bed 5, tak-
ing over the whole ward. I saw nurse Richard Spatafora bolt out

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 2 • Wa k in g t he Sp irit

and dash to the Nurses’ Station, his face anxious. “We need the
music therapy tapes. Something. Quickly.”
“It’s okay,” said a nurse. “Andrew’s here.”
Richard whipped his head toward me. “Thank God,” he said.
“Andrew, get your guitar ready as fast as you can. We need you.”
I nodded, pulling my guitar from its case and grabbing my blue
music folder marked bach. I followed Richard behind the cur-
tain, not sure what to expect.
The patient, a woman I guessed to be in her sixties or seven-
ties, sat up in bed with a gauze bandage wrapped around her
head. Probably from brain surgery. She looked past me, brilliant
blue eyes sparkling, her smile radiant, talking, talking in this
loud, melodious tongue. It sounded like Russian. She looked Rus-
sian with her high cheekbones. She was beautiful.
There were two other nurses in this small space with Rich-
ard, and they all jangled with nerves. Exhausted. Richard shook
his head and looked at me. “She’s been like this for two hours
now.” His voice was flat. “She’s tied us all up. We can’t get her to
settle, can’t get to the other patients.”
I pulled a chair up to the end of the bed, set up my music
stand, and for a few moments just looked and listened. The
patient was talking still, her monologue seeming never to run
dry. What could she be saying? She laughed, looking around,
shifting constantly in the bed, fighting to get out. I noticed her
arms were restrained, tied to the side rails with white plastic
strips. But she didn’t seem scared or anxious. I realized she wasn’t
actually talking to the nurses, but seemed to be conversing with
people nearby that only she could see. She smiled the whole
time, her words pleading but never angry. It was hard to watch

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 Prologue • 3

but I couldn’t look away. She was so lost, as if she were stuck in
another place where we just couldn’t reach her.
I settled in, took a deep breath, and started to play my guitar
arrangement of the Prelude from Bach’s First Cello Suite. At the
sound of the first note she turned her head toward me, looking at
my face and then at my right hand as it plucked the strings of the
guitar. Gone was the scattered expression from her face as her eyes
gained focus. She stopped talking, her mouth half-open in sur-
prise, silent. Her face and shoulders relaxed, and she smiled. Not
the plastered grin of before but a real smile of pleasure. She was
here now, in this room, and not wherever she’d been for the past
few hours. Something was connecting. We were just ten seconds
into the music.
Richard let out a sigh of relief, smiled, and gave me a
thumbs-up. I grinned, wide. One by one, Richard and the
other nurses left, slipping through the curtain, able to tend to
other patients. It was just me and the patient now. The Russian
woman.
I played one piece after another for her without a break.
She was calm, settled in the bed. Listening. As I brought a
chorale melody to an end I paused, thinking about the next
piece to play. Immediately, she started to struggle, pulling at
her restraints as if she wanted to clamber out of bed. I moved
swiftly into a lively Bach minuet— a type of dance. As the
music started up, she calmed again. I noticed if I moved my
body, swaying to the rhythm of the music, it engaged her atten-
tion even more. I decided to spend my whole ninety minutes at
her bedside.
She talked to me as I played. I still had no idea what she was

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 4 • Wa k in g t he Sp irit

saying, but it wasn’t the senseless sounds of before. She was com-
municating with me now. Reaching out, as my music reached out
to her. Thirty minutes went by, then an hour, her attention never
flagging as long as I was playing. A doctor on rounds stopped by
for a minute to check on her. She leaned back when she saw him,
looked up, and in a small, childlike voice said, “Beautiful sounds.”
I was surprised and delighted. She had found her own voice again.
It was almost time for me to leave. I’d been playing short,
melodic pieces, and they were working well, keeping the pa-
tient calm, but I wanted to go a step further. To play one of Bach’s
most profound fugues, one of the most intricate forms of music
ever devised. I decided on the fugue from the Prelude, Fugue, and
Allegro written late in his life. As I started to play the deceptively
simple opening melody, she gazed at me, grateful, and settled back
into the pillows of her bed. Completely at peace. She closed her
eyes, and I played just for her. Somewhere at the edges of my mind
I remembered that we were in the Surgical Intensive Care Unit
(SICU) and that machines hummed and beeped all around us, but
then it was just the music, the patient, and me. For seven minutes I
watched her face. The fugue had worked. The word “fugue” comes
from the Latin fuga, which means “flight” or “fleeing.” And the
patient had done that. She slept peacefully now, far from this jar-
ring environment, partially healed by music. At the end of the
fugue, I packed my guitar and my trusty pages of Bach and
slipped away.

I left the SICU that day deep in thought, profoundly affected by

the patient in Bed 5. I still thought of her as the Russian woman,

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 Prologue • 5

although I’d found out from a nurse that she was American, from
a small town in upstate New York. The language she’d been
speaking at first was gibberish, although a very fluent form of it.
I’d learned she had undergone brain surgery the day before and
sometimes, after that kind of operation, the nerve synapses misfire
for a while and bring on bizarre behaviors. Several things really
struck some chords with me. The inability of the nurses, and I
knew how great these nurses are, to get through to the patient to
help her. The failure of all the modern medicine around her to heal
her. The amazing and rapid change that music effected on her, by
reaching some deep place in her brain. And the fact that Bach
was the agent of that change. I rushed home to my computer,
determined to find out everything I could about the power of music
to heal. Another leg of my journey had just begun.
I’m now in my sixth year as the resident musician in the SICU
at Mount Sinai Beth Israel hospital in New York City. Three
times a week I spend ninety minutes there playing my guitar at
the bedsides of the critically ill, patients like the woman in Bed 5.
Over the years, I’ve witnessed the most remarkable ways in which
music can help the healing process, the ways it can calm a patient
or lift their spirits, or reach them when they seem locked in a
place that no one else can access. It can soothe a staff member’s
exhaustion or anxiety and let them refocus on helping a patient,
and it can provide a connection for a patient’s family, perhaps
bring back old memories and open pleasant topics of conversa-
tion. I’ve also seen the beauty that music has brought when noth-
ing could save a patient’s life, as it eased the transition from life to
death, floating above the sounds of medical machines.
I’ve been forever changed by my interactions with the patients

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and medical staff here, by the bridge that music creates between
the healthy and the sick. But the event that was most life chang-
ing for me was one I didn’t witness. Because I was the patient. I
was wheeled into this very SICU, clinically dead. A Code Blue. I
wasn’t expected to live. I was the patient in Bed 11, hooked up to
machines and tubes, bloated beyond recognition and surrounded
by doctors and nurses. And my wife, Wendy, was the desperate
loved one, hoping against hope at my bedside, asking for answers,
for a miracle, emotionally raw. Somehow I made it through. I was
the sickest person in the SICU back then and music saved my life.
After that I decided to return to the SICU and give back, to
use my thirty-five years of experience as a professional musician
to bring about positive change in other people’s lives. I love it. I
love being part of a medical team and being able to say with
certainty— and with compelling evidence—that my guitar is
both a medical and a musical instrument. There is a clinical
research study under way at Mount Sinai Beth Israel on the
effects of live music in the SICU, begun in January 2011, exactly
a year after I began playing at the hospital, and my music has
been part of this study. The study aims to document the ef-
fect of live music on the sound environment of the patients,
family, and staff and determine whether it has an impact on
their level of stress, anxiety, and/or perception of pain, and
also—and this is especially interesting—whether it affects
the perception of noise in the SICU. I feel very honored to be
part of this study.
I’ve seen countless examples of the power of music to soothe
and heal from my position at hundreds of bedsides with my gui-
tar. But why does music have this power? In recent years, there

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 Prologue • 7

have been numerous studies addressing the impact of music and

medicine. The late Dr. Oliver Sacks, formerly a professor of neu-
rology at New York University School of Medicine and world-
renowned author, and Mark Jude Tramo, M.D., Ph.D., a professor
of neurology and ethnomusicology at UCLA—who founded the
world’s first Music and the Brain course at Harvard College in
1997—have shed enormous light on the topic. Dr. Sacks in his
best-selling book Musicophilia: Tales of Music and the Brain, and
Dr. Tramo in numerous professional journals including Science,
Journal of Neurophysiology, Journal of Cognitive Neuroscience,
Music and Medicine, and Contemporary Music Review.
Dr. Sacks, who along with Dr. Connie Tomaino founded the
Institute for Music and Neurologic Function in 1995, has said,
“Nothing activates the brain so extensively as music.” It goes
deeper than that, though. According to John Mondanaro, the
clinical director for the Louis and Lucille Armstrong Music
Therapy Program at Mount Sinai Beth Israel, the effects of music
on the physiological and psychoemotional components of the pa-
tient’s experience are central to current research efforts.
Compelling results are emerging from an abundance of this
new research. Dr. Joanne Loewy, founder and director of the
Louis Armstrong Center for Music and Medicine, led a landmark
study, published in the journal Pediatrics and reported in the New
York Times, that found that live music is beneficial to vital signs,
feeding, and sleep in premature babies, thereby relieving stress and
pain. The study also showed that when the babies’ parents sang
lullabies to them, stress was reduced—in the parents.
In Germany over the last thirty-five years, Dr. Ralph Spintge,
president of the International Society for Music in Medicine

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(ISMM), with Dr.  Loewy, editor in chief of the international

journal Music and Medicine, has conducted studies analyzing the
effects of music on anxiety and pain reduction before, during,
and after surgery.
Dr. Kamran Fallahpour, a clinical psychologist, neuroscien-
tist, and director of the Brain Resource Center in New York City,
is among a consortium of international neuroscientists who
helped develop one of the largest databases in the world of brain,
cognitive, and genomic data. As a clinician and researcher he
tries to translate the latest neuroscience research findings and
technology into clinical practice—including the use of music and
sound to help activate or deactivate certain brain areas and regu-
late the nervous system in order to manage pain, stress, and mood.
Dr. Connie Tomaino has undertaken pioneering research in
music therapy with patients suffering from the effects of brain
trauma including stroke, Parkinson’s, Alzheimer’s disease, and
other kinds of dementia.
On August 13, 2015, The Lancet published a new study that
confirmed that listening to music before, during, and after surgery
reduces patients’ anxiety, pain, and their need for painkillers.
The study team, led by Queen Mary University of London,
analyzed the results of seventy-three randomized controlled trials
that looked at the impact of music on postoperative recovery, and
their findings confirmed the positive link between music and
lower levels of pain, anxiety, and pain medications. This was true
even in cases of surgery performed under general anesthesia.
The study concludes, “Music is a noninvasive, safe, and inexpen-
sive intervention that can be delivered easily and successfully
in a hospital setting. We believe that sufficient research has

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 Prologue • 9

been done to show that music should be available to all patients

undergoing operative procedures.”
These studies—and others like them—provide the scientific
underpinning to explain why a guitarist playing for patients in a
SICU can have an important and positive role in such key areas
as anxiety reduction, pain management, and the prevention of
delirium.
Music used for healing is one of the oldest branches in the field
of medicine. Early records have been discovered from ancient
Egyptian medicine, Babylonian medicine, Ayurvedic (Indian sub-
continent) medicine, and classical Chinese medicine that incor-
porated musical healing. The ancient Greeks valued the relationship
between music and medicine in the god Apollo, whose gifts in-
cluded both the musical and healing arts, and the first use of the
term “musical medicine” began with Pythagoras, the fifth-century
philosopher-mathematician. The Romans are said to have used
musicians in their battlefield hospitals as a form of anesthesia.
Often, as I walk through the halls of the hospital, I see doctors
and nurses nod at my guitar and my ID badge and say, “Music, the
next big thing in medicine.” With the evidence of new research, it
just might be. I truly hope so. It would be wonderful to see music
being used in hospitals as a cost-effective and noninvasive medical
modality, to see hospitals as far better healing environments than,
in many cases, they are today. The hospitals that already include
music therapy departments understand how important it is to think
of what is best for the patients, not just the medical practitioners.
Playing for the patient in Bed 5 was a critical moment for
me on a journey that started when I woke up in the SICU.
Dr.  Marvin McMillen, the director of the SICU when I was a

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patient and the doctor who first gave permission for me to return
as a musician, has said that no one will ever know in medical terms
how I survived those first days in my coma, but he’s also said that
he’s sure that music was the turning point in my miraculous re-
covery. When I first returned to the hospital to play my guitar for
other patients I acted intuitively to decide what music to play, for
whom, and for how long. But the incredible transition I saw in the
so-called Russian woman was a “wow” moment for me that sent
me on a quest for knowledge. When I rushed home from the hos-
pital that day and turned on my computer I found this quote,
within seconds, from neuromusicologist Dr.  Arthur Harvey: “Of
all the music we tested in medical school with patients, colleagues
and others, Bach’s music consistently made the brain work in a bal-
anced way better than any other genre.” My brain lit up. I was
hooked.
I embarked upon hundreds of conversations with people who
shared their experiences and knowledge about music’s extraordi-
nary power to heal. Patients and their loved ones, doctors, nurses,
music therapists, musicians, professors, authors. And I began to
read, to study, to learn.
This abundance of material—from the informal and anec-
dotal hospital bedside story to cutting-edge scientific research—
has helped me understand why a guitarist playing in a SICU can
play such a positive role in patient care. It has helped me under-
stand why listening to music enabled the woman with the
sparkling blue eyes in Bed 5 to get through the neurological chaos
of her postsurgery brain. Music woke her spirit. And in those
minutes that I played for her, music helped her as much as any
other medicine available to her that day. Maybe more.

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 If I were not a physicist, I would probably be a musician. I
often think in music. I live my daydreams in music. I see my
life in terms of music. . . . I cannot tell if I would have done
any creative work of importance in music, but I do know that
I get most joy in life out of my violin.

—Albert Einstein

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