Doctor’s Orders: Sing This Song
Singing is a potent therapeutic tool—that’s why I started leading a weekly sing-along for cancer patients
I was a junior faculty member at a Philadelphia medical school many Septembers ago, racing to meet a research deadline, when my partner on the project announced that I’d have to finish the work myself because he intended to return home to Baltimore for the High Holidays. “I rarely attend synagogue services,” he explained, “but singing familiar holiday songs makes me feel like part of a community.” Up to that point, he’d done most of the work, so I couldn’t argue. Besides, his observation about the power in the music resonated for me.
Music can bring a community together; that’s something that many of us notice at this time of year, when Jews around the world gather for High Holiday services and share in the music we hear from cantors, choirs, and our fellow congregants. But music also has the power to elevate our souls and soothe our spirits, whether we’re sitting in synagogue or attending a concert. And as I’ve learned in my years as a doctor treating cancer patients, music is even a powerful medical tool, capable of healing our bodies, our hearts, and our minds. Music is so powerful, in fact, that I’ve made it a regular part of my therapeutic treatment.
It started when a young woman came to me for treatment of a tumor in the Broca’s area, a part of the brain that controls speech. Almost as devastating for her as her bleak prognosis was her inability to talk. As I finished planning her radiation therapy, by coincidence, my wife gave me a copy of Oliver Saks’ best-selling book Musicophelia. A New York neurologist, Saks describes the case of a patient who experiences a stroke as a result of a Broca’s area hemorrhage. Saks discovers that, although his patient has lost the ability to express himself in conversation, the man can still sing. I wondered: Would the same phenomenon hold true for my patient?
The next day, when I visited the woman, I started to hum a popular song. Her family was initially wary of this odd behavior, but they started to sing along during the second verse. By the time we reached the chorus, the patient chimed in—with the words. The latter verses of the song were more challenging to get through since we were all swallowing our tears.
Having been an “ear-witness” to that magical moment, I promptly invested in a guitar and hired a teacher. Two months later, I started leading a weekly singing group in my oncology department in Tel Aviv. Ground rules for our group singing sessions are simple. A “bad” voice doesn’t exist. (I’m hardly a virtuoso guitarist, so I don’t demand perfection from anyone singing along.) We place no religious restrictions (kol isha) on women vocalists. For anyone who doesn’t know the words or can’t read my song sheets, we prescribe “la-la-la.”
Our group singing sessions take place on Monday afternoons, usually on the periphery of our department’s waiting area or on the lawn outside the radiotherapy facility. Our group consists typically of a dozen patients and family members as well as two professional “medical clowns” who arrive 30 minutes before “show time” to set up. To disinhibit participants, they often inflate colored balloons and distribute percussion instruments. Ability to keep accurate time to a song is not a prerequisite for making use of our assortment of rattles, shakers, and clackers. In a previous life—say five years ago—I would have found the off-tempo sounds distracting, but today, I see people finding joy or even empowerment in the music, and this is grounding for me.
I learned quickly that it is foolish to arrive with an agenda and much wiser to let things evolve. The very first week, I tried to play Leonard Cohen’s majestic “Hallelujah” with plans to segue into a mellow Beatles song. But then something happened: One woman, who seemed rather withdrawn until this point, elected to make a free association and to belt out a different song also called “Hallelujah,” the bouncy, lighthearted melody that earned Israel a Eurovision title in 1979. It was a fingernails-on-the-chalkboard kind of musical transition. Worst of all, I felt helpless because I didn’t know the guitar chords. But she obviously had taken ownership. There was really only one possible response: I put my guitar down and lifted up my voice with hers.
Our singing sessions have also offered an outlet for patients to provide feedback. People don’t seem to be shy about venting once they’ve already overcome certain inhibitions. If someone has a concern about the waiting time or the side effects of radiation treatment, this is likely to be the forum for me to hear about it. Occasionally a compliment also leaks out; these morsels of positive reinforcement remind me why I entered a healing profession.
Now and then, patients passionately debate song selection or meaning of lyrics. When I introduced Simon and Garfunkel’s “The Boxer,” several objected to the melancholy feel, but the supporting camp prevailed after a 68-year-old man asserted that there is nothing sad about a poem that concludes, “I am leaving; I am leaving, but the fighter still remains.” After we finished the song, the man received high-fives all around as he was called into the cavernous treatment room full of imposing radiation equipment. Wouldn’t it be great if we all could have such supportive send-offs as we go to face our own life-challenges?
I could offer scientific rationale for the value of our song sessions. I have found evidence to proclaim that the release of adrenaline from singing activates patients’ immune systems. I’ve even heard it suggested that group singing releases endorphins in a pattern nearly identical to that observed during orgasm. I see no references for such an alluring hypothesis, but I confess to wanting to believe it.
Our reasons for singing, however, have nothing directly to do with science and everything to do with the emotional “high.” Two weeks ago, a Muslim couple from Jaffa asked hesitantly to join our circle as we swayed to a spiritual ballad by Rabbi Shlomo Carlebach. They seemed somewhat embarrassed as they waited for our approval. A curmudgeonly patient broke the tension when he quipped, “The admission ticket is that you bring us an Arabic folk song.” As a result, I’m frantically learning several compositions by the Lebanese singer Fairuz to play at a future session.
Even more to my surprise, a patient, after a total laryngectomy, wanted in. My face must have betrayed my shock as I stared at the tracheostomy of a gentleman who no longer possessed vocal cords. Sensing my discomfort, he pulled out a pad and scribbled a powerful declaration. “These people inspire me,” he wrote. “They give me voice.”
Music doesn’t have to be perfect to have power. At this time of year, many of us enter synagogues fearful of tripping over the words of the prayers or singing off-key. But perhaps this is a moment to forgo our cognitive discomfort and embrace the liturgy as an opportunity to immerse ourselves in the song and the spirit along with our neighbors (some of whom are surely contending with illness). Maybe we can look around and quietly decide that our fellow singers inspire us, and that they give us voice even as we give voice to them in return.
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