Listening In
Listening In on the OR
Gideon D'Arcangelo
MARCH 8, 2008
- Dr. Atul Gawande scrubs up.
- (Laura Hanafin)
- View the Slideshow
Web Resources
- Gawande.com
- "Better: A Surgeon's Notes on Performance," by Atul Gawande
- Gawande's Articles for the New Yorker
Related Stories
- The Schooner Anne
- Focus Music for Power Lifting
- Your Morning Music Hit List
- An Architect's Morning Music
More From Gideon D'Arcangelo
Indie rocker Kim Deal from the Breeders croons from the iPod docked in the operating room where Dr. Atul Gawande and his team are performing a thyroidectomy. He is working closely with Kim Leavitt, the circulating nurse.
Wearing something that looks like a shower cap, and booties over my shoes, I feel like another member of Dr. Gawande's team, which is made up of several people: the senior resident, the anesthesiologist, the circulating nurse, a medical student and the scrub.
"Something of a myth about the way people understand the operating room is that it's not all about the surgeon," Dr. Gawande laughs, "or about whether my hands are shaking. Absolutely I have to be able to concentrate and know what I'm doing, but so does everybody else. And having a good operation for each of the patients I take care of in a day means making sure that we can all function as a team. And I find that having music helps us all perform well, as a team."
To the strains of Gnarls Barkley's "Crazy," Dr. Gawande's team busily prepares the area on the patient's neck for the operation.
"So, if you were trained in an era where this is a silent cathedral, that's how you practice surgery. Technologically, in my training, it was an era where we suddenly had iPods."
Dr. Gawande flips through the playlists on his iPod.
"My OR playlists are called 'The safe mix 1, 2, 3,'and I just keep adding to them over time, meaning that they're safe enough for the OR," explains Dr. Gawande, chuckling again. "For it to be safe for the OR, I have to know that there aren't going to be any themes that will be incredibly embarrassing; not an excess of foul language. Something like this song, 'Crazy' is perfect. I try to have a mix of things, that have some quiet songs, and then some danceable songs, just enough to kind of keep the energy going."
Dr. Gawande makes an incision at the base of the patient's neck while the senior resident cauterizes the small blood vessels beneath the skin, anticipating his every move.
"If the music is working well, every three or four songs, there's something that somebody in the room likes, and that's enough that it makes it so that good people want to be in my room, and they aren't making requests to be in some other room."
It's a strategy for retaining a top-notch team. "As you get to talk to the nurses, you'll find out that there are some people who will, given a choice that day, they'll try to choose my room just because they know it'll be low stress, nobody yelling and music on."
The critical moment in the procedure has arrived. Now they are ready to remove the thyroid. Nurse Leavitt instinctively turns down the music. Dr. Gawande deftly works to extricate the enlarged, golf-ball-size gland. He tussles with it a bit, makes a few more snips and it's out. He hands the thyroid to Shawn Scandrick, a scrub, who stores it away in a glass vial. Now that the hard part is over, the music's back on and tone in the room lightens up.
"It's a delight to work with some physicians who do have the music going on in the background," Scandrick says while cleaning and organizing the forceps, scalpels and other instruments used in the procedure. "It makes the environment, I feel, a little more calmer. It's so much better than silence. For some odd reason, the music does kind of mellow out the whole crew. No matter if it's country, pop, alternative, hip hop, I love music, cross the board, so it's always nice to see what the physicians and the surgeons are listening to at home"
Dr. Gawande and his team have been in surgery since 7:30 this morning, and they'll be in surgery until 7:30 tonight. They have to keep their energy up and their minds focused. As the team gets ready for the next patient to come into the operating room, Radiohead's "Fake Plastic Trees" blares in the background.
"You have to make dozens of steps go right, a lot of them taken for granted, like, has everybody washed their hands? Does everyone on the team even know each other's names? Is everybody in the right mood for being able to do a complex operation today? All of those things have turned out to make a difference."
The next patient is wheeled into the room as Dr. Gawande scrubs his hands and dons his gloves. "Music is not the most important thing on that list, by any means, but it has turned out to be something that I find helps our performance. It keeps people engaged and makes them feel good about being in the room. Some of performance can be boiled down to a checklist, but there are other parts of the performance that can't be boiled down to something as simple as a checklist, and that's the human element of how a team works, and how a team works well."
Weekend America "Songs for the Doctor's Office" Listener Playlist
Nowadays, some doctors are set up to play your music -- the music that makes you feel most calm and comfortable-- when you come in for an appointment. What music would you want playing the next time you're in the doctor's office? We asked you to let us know, and here's what we heard back from you.
"Wagon Wheel," Old Crow Medicine Show
This song works for me because it talks about the future and not turning back. When I am waiting in the doctor's office I am pretty nervous and just hope everything goes well. It allows me to drift off into a world of hope and the music is very soothing.
Michael Mellon,
Lincoln, Neb.
"Goldberg Variations for String Orchestra," arranged by Dmitri Sitkovetsky
I think asking for a "song" is unnecessarily limiting. When I go in for acupuncture, my doctor puts on our local classical music station, because that's what I most enjoy. I chose the CD mentioned because it's an endlessly beautiful and interesting repetition of variations on a basic theme. So, in a funny way, time doesn't seem to pass while listening to it.
Sheila Quinn,
Gig Harbor, Wash.
"Tommy Gets His Tonsils Out," The Replacements
It brings back fond memories of my first surgical procedure at the tender age of five.
Eric Iverson,
St. Paul, Minn.
"Three Little Birds," Bob Marley
For me, this song simplifies life and reminds me to live in the moment. I find it reassuring, comforting and full of joy. When going through treatment for cancer, I took a dose of this song daily.
Debrajo Erickson,
Pasco, Wash.
An easy hands-down choice is Bob Marley's "Three Little Birds." Lyrics include "Don't worry 'bout a thing cause every little thing gonna be alright" Anyway, that's what I'd listen to at the doctor's office.
LeRoy C. Pressley III
Clinton, Iowa
It's simple, it's soothing and the song says it all! "No, don't worry 'bout a thing... 'cause every little thing's gonna be alright..."
Roz Bertone,
Huntersville, NC..
"Comfortably Numb," Pink Floyd
I can't think of another song that would ease the transition to unconsciousness. "Relax! It's just a little pin prick." Images like "a distant ship sails on the horizon" are perfect lullabies for sedative sleep. "You are only coming through in waves."
Niall Kingston,
Waynesville, Ohio
"Beautiful Tomorrow," Blue Six
It's a calming tune and it has a positive message. Of all the information that people get from doctors, thinking about a beautiful tomorrow would seem to be a cool thought to have. So whatever they tell you, you can look forward to the future.
Michelle Rogers,
Cincinnati, Ohio
"Photograph," Jamie Cullum or
"Boogie On Reggae Woman, Stevie Wonder
I have to go to the hospital in three months to give birth. The brochure from the hospital encourages you to bring your own music to the room to comfort you during the experience. I've picked two because I've never had a baby. Will I want to get pumped-up (Stevie)? Or should I attempt to remain as calm and tranquil as possible (Jamie Cullum)? Not sure. So, I'll bring both. My suspicion is that, at the time, I will not care what is playing.
Emily Deedler,
Ann Arbor, Mich
"Fields of Gold," Sting
It is a very peaceful, serene tune and is as timeless now as it was when I first heard it, 15 years ago. It immediately puts me in a very relaxed mood -- a good mood to be in before seeing the doctor!
Barbara Bergan,
Boise, Idaho
Comments
Comment | Refresh
From Boise, ID, 03/31/2008
It was a bustling evening the emergency department and five minutes prior to the start of our shift we get called into an exam room for a patient brought in via EMS. A 55-year-old gentleman complaining of acute substernal chest pain, although anxious and diaphoretic, appears relieved to see the physician enter the room. As a scribe, I scramble to place the orders while at the same time I try to listen and record the history and exam, relay to the nursing staff what orders were just made; in addition to paging the interventionalist for what’s said to be 5mm ST elevations in the inferior leads. Quickly, a stressful day at school and the thought of my biochemistry exam less than 14 hours away rapidly escapes my mind. Like the OR, the ER can often flow like a musical or a symphony—if all goes right. That is why I enjoy ‘Bittersweet Symphony’ by The Verve. I imagine the OR can be like the ER in that the time course of events are often bittersweet.
From Boise, ID, 03/14/2008
As a paramedic student I was in the OR to get my required intubations. A man in his late thirties is wheeled in and requests to hear some classic rock instead of the county that was playing. I successfully intubated this guy to the strains of Black Sabbath's "War Pigs", a surreal experience that has never been matched.
From Baltimore, MD, 03/10/2008
I recommend Andrew Bird's (especailly, the appropop "Darkmatter"), a smattering of Rodrigo y Gabriella and New Pornographers. I personally have included these in every one of my operating room playlists.
From Seattle, WA, 03/08/2008
In 1995 I woke up mid knee surgery to Bowie's "Little China Girl." Three weeks ago I had hand surgery, and woke up mid-surgery to Mark Knopfler. The first time I was blown away and excited, and people I told later thought I'd been hallucinating. This surgery I was just happy to hear it, and didn't even think to mention the music to anyone.
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