The surgeon in Operating Room 7, Dr. Marc Bessler, jockeyed a patient's spleen to get to the kidney. "White Shadows" by Coldplay murmured in the background. A resident cut away tissue near the kidney. Abba's "Waterloo" came next in the shuffle.
Across the corridor on Thursday afternoon, Dr. William B. Inabnet, an endocrine surgeon, prepared to cut into a patient's neck. His iPod played Verdi's "Traviata."
"Madness! Madness!" sang the soprano Anna Moffo. A heart monitor beeped to a different rhythm, like a metronome run amok.
Scalpel, suture, iPod.It was a normal day at NewYork-Presbyterian Hospital in Washington Heights, where music fills the operating rooms much of the time, as it does in other hospitals. Like most of modern life, surgery has acquired a soundtrack, whether it be Sinatra or Vivaldi, Mozart or Bob Marley, "La Bohème" or the Beatles. Surgeons say it relaxes them, focuses their attention and helps pass the time.
Mention of the subject in medical journals goes back 50 years, and a growing body of recent research shows mild benefits for the patient going under the knife as well as for the surgeon holding it. The topic also figures in hospital television shows like "Chicago Hope" and "Grey's Anatomy."
Less examined are the rituals and protocols about how music is played and who decides the program.
Music can become a subtle bone of contention among the members of the surgical team or a practical aid. Loud rock 'n' roll is good for routine operations, they say, Mozart for trickier ones. There is even a genre called "closing music": raucous sounds to suture by.
Many operating rooms come equipped with music equipment, although iPods now appear to be the system of choice. Some patients are given headphones. (Surgeons generally do not use them, so they can hear what is going on.) Sophisticated teleconferencing equipment in some operating theaters is occasionally drafted to play music.
Given the large number of doctors who are amateur musicians, the presence of music at a surgeon's job site seems natural.
"The whole issue of performing in a finite period of time is very analogous between the two," said Dr. Eric Rose, chairman of the department of surgery at the Columbia University Medical Center, which is affiliated with NewYork-Presbyterian. Perhaps it is no coincidence that the operating room is called a theater, he said.
But there is no way to generalize about content. "As wide as musical tastes are, that's as broad as the listening habits of surgeons in the operating room," said Dr. Rose, whose tastes range from Vivaldi to Simon and Garfunkel. He said that Dr. Norman E. Shumway, the father of the heart transplant, who died in February, had often played Édith Piaf during surgery.
Dr. Paul Ruggieri, a general surgeon who practices in Fall River, Mass., said he was in a Sinatra and Diana Krall phase. Deep Purple's "Smoke on the Water" is another favorite. "That's a nice song if you're in a hyped mood," Dr. Ruggieri said.
Dr. Inabnet's first love is jazz: John Coltrane, Miles Davis, Ella Fitzgerald, Billie Holiday. When he has difficult operations, he prefers lively bands: the Red Hot Chili Peppers, for example. "That's good pancreas music," he said. "It's an organ I respect tremendously."
At St. Luke's-Roosevelt Hospital, Dr. Alan Benvenisty, a vascular and transplant surgeon, meticulously creates playlists for his two iPods, which he sets up with speakers. "I have the whole thing programmed ahead of time," he said. "If you spend many, many hours in the O.R. listening to music, you learn a lot about music. I'm pretty much an expert on classic rock." His nickname is Hyper Al.
Generally, the attending surgeon, the honcho in the hierarchical operating room, decides the playlist. Next in line is often the anesthesiologist. If no doctor brings music, it may come down to the CD collection of the head surgical nurse. Any member of the team has veto power if the music becomes distracting or interferes with dialogue. Music that requires concentration, like Mahler, is rare. When tensions rise, the music is often turned off.
Anesthesiologists have an important say because they must hear the beeps of their equipment. "There's a bunch of them who are always saying, 'Can you turn it down?' " said Dr. Bessler, the director of laparoscopic surgery at NewYork-Presbyterian. (He has 760 tunes on his iPod Mini. "For me, Abba is the thing," he said. "There's no gangsta rap in my O.R.")
In a survey of 200 anesthesiologists published in 1997 in the British journal Anaesthesia, 72 percent of respondents said music was played regularly in their operating rooms. About 26 percent felt that music "reduced their vigilance" and interfered with communication. Half felt that music was distracting when they encountered a problem.
In nonemergency situations, junior members of a surgical team are often at the mercy of the attending surgeons.
"I was brutalized for a number of years as a resident listening to Mantovani," Dr. Rose said. "The surgeon will go nameless. It was atrocious."
Another nameless surgeon at NewYork-Presbyterian would regularly play the same live concert recording of Vladimir Horowitz during a particular procedure, said Dr. Jonathan M. Chen, a pediatric heart surgeon. "He would always turn to the head nurse and say, 'Prof. Horowitz, please,' " said Dr. Chen, who works at Morgan Stanley Children's Hospital, part of NewYork-Presbyterian. "That got very old very quickly."
Other offenders are surgeons who like to sing along. "They get upset sometimes when I sing," an unabashed Dr. Benvenisty said. "I know all these songs by heart."
Surgeons often ask patients what they want to hear. Dr. Inabnet has to be especially sensitive, he said, because in most of his cases the patients receive local anesthesia and are awake. In Thursday's operation, to remove a pea-size parathyroid gland, the patient asked for opera. Dr. Inabnet's iPod happened to have a classic 1960 recording of "La Traviata," which played through a desktop computer with speakers surgically taped to the computer stand.
Sometimes patients come in with requests. Dr. Marc Dickstein, a NewYork-Presbyterian anesthesiologist, said a teenage girl facing a lung transplant had brought a CD of Seal, her favorite artist. "It was just kind of a powerful scene there," he said. "This was what she wanted to hear before what could have been her final moments." The girl made it. "She was unbelievably brave," Dr. Dickstein said.
Surgeons have adopted music into their practice.
Dr. Nas Eftekhar, a retired pioneer of hip and knee replacements, used Mozart's "Eine Kleine Nachtmusik" to mark the exact moments to apply cement to the femur and insert the artificial joint. "The timing is extremely critical," he said.
Dr. Chen, a blues lover, used to employ tracks to time the wait for bleeding to stop before closing up. "Everybody is impatient at that part of the operation," he said. But now there is no music in his operating room. He operates on the hearts of babies and children. Blood-oxygen monitors are crucial in such operations, and they emit beeps that change pitch with the slightest change in oxygen levels. So music is out.
Some physicians warn of excesses.
In a letter to the Medical Journal of Australia, Dr. Richard H. Riley of Perth raised two examples: a surgeon who had an opera videocassette playing during an operation, and a second who listened to music through earbuds despite having to be questioned by the anesthesiologist. While extreme, Dr. Riley said, the examples "do remind us that we should remain vigilant and not allow developments in entertainment technology to interfere with patient care."
But at least five studies published in the last dozen years show benefits to surgeons and patients from music, or at least no harm.
One showed that it made no difference in the results of psychomotor tests on anesthesiologist trainees. Another found that surgeons could block out music during complex tasks. Music made surgeons calmer, more accurate and speedier, according to a study published in The Journal of the American Medical Association in 1994. Music through headphones reduced the amount of sedation needed for urological patients and lowered the blood pressure of elderly eye-surgery patients, other studies found.
Dr. Brian Jacob, a general surgeon at Mount Sinai Hospital in New York who specializes in laparoscopic and stomach stapling surgery, said music helped everyone in the operating room.
"You're basically sending a message to the people around you that it's a cool place to be," he said. "I found I get a lot done when I have U2 in the background," he said. He does take care to lower the volume when the patient enters the room, and he sometimes asks for requests.
But the patient usually says that whatever is on is fine. "They want me happy," he said.
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