Thirteen-year-old Raphael is focused intently on the musical instrument he has cradled to his chest, studying his finger placement.
He hesitates — and then strums.
“That is a ‘G’ chord,” music therapist Kelly Morris, M.T., says. “If you need a break for your fingers, go back to ‘C.’”
Raphael is learning the unique charms of the ukulele. But he’s not in a music studio. He’s in a hospital room on the Cancer & Blood Disorders unit of Johns Hopkins All Children’s Hospital in St. Petersburg, Florida.
Last July, Raphael was diagnosed with a high-risk form of acute lymphoblastic leukemia (ALL). Since then, he and his dad have spent more days and weeks and months here than either would like to think about.
Music is a welcome respite.
“We come from a musical family,” says his dad, Rafael, who spells his name differently from his son. “I know this really helps him.”
Within a few minutes, almost magically, Raphael has relaxed into the music session. He and Morris play songs together, sing and laugh.
It’s no surprise to Morris. Closing in on a decade of service as a music therapist at Johns Hopkins All Children’s Hospital, she is intimately familiar with how music can be so many powerful things to the young patients with whom she works — music as a balm to soothe anxiety, a tool for therapeutic progress, or just a blessed distraction to allow for healing to take place.
“It’s not easy work,” Morris says. “We see some hard things. But it is meaningful work. We try to hold space for these kids with the understanding that it’s OK not to be OK.”
Music therapists come with an impressive educational background. They must have a bachelors or master’s degree in music therapy. They go through much of the same coursework that music educators and performers do, along with a heavy psychology curriculum. Beyond that, a knowledge of biology and anatomy is key. Ultimately, a deep understanding of how the mind works, how the body works, and how music works is required learning for music therapists.
Each must know how to play the guitar, the piano, at least one percussive instrument, and he or she needs to be able to sing. But in a children’s hospital, the tools of the trade can go well beyond that. On any given day, Morris may pull from her musical bag of tricks a recorder, a xylophone, a tambourine, or egg shakers.
She may employ the use of something called a Hapi drum, a steel tongue drum with a relaxing, flowing sound.
When the situation calls for something strictly silly, she may reach for a “quack stick” (which actually sounds more like a gobble than a quack).
Sometimes with a patient, the key in which a song is played can make a difference in the environment. The key of “F” may be used to energize, or the key of “E flat” to help someone wind down, as examples.
Reading the room is always important. Morris does a lot of guided imagery and relaxation with children, but it doesn’t always start there.
“If a child is yelling and throwing things and attempting to pull out their IV, me going in singing Twinkle, Twinkle Little Star in hushed tones isn’t going to be effective,” Morris says.
Instead, she’ll choose a song that meets the intensity of the patient’s emotion in the moment and work from there.
For a toddler, it may be the high energy theme song to the animated children’s series, Paw Patrol. For a child who’s a few years older, a song from the Disney movie Encanto may meet the moment. Or, if the patient is a teenager who likes country music, a Luke Bryan song might fit the bill.
Morris can often bring a patient around to achieve the desired goal, perhaps helping to lower cortisol levels, to bring blood pressure down or to assist in physical therapy milestones.
A music therapist can calm an infant who is struggling through withdrawal symptoms. Or she can motivate a young child with no appetite to eat by writing songs with him about mac-n-cheese.
Most people have, in some way throughout their lives, experienced the very personal and almost mystical impact of music — by way of its sheer power to uplift or evoke some other strong emotion. It may have been through songs we learned as children, or from a favorite band, or upon hearing a tune that transports us back to a special moment we experienced.
While it possesses qualities that can feel magical, Morris is deeply rooted in the science of how and why patients can be made better with music.
“Music is sound, and sound is made up of waves of energy,” Morris says. “It absolutely influences our bodies, our brains, our moods.”
In Raphael’s hospital room, the mood has continued to lighten. He and his music therapist have been jamming for about 20 minutes with their guitar and ukulele.
Raphael is not thinking about cancer.
An easy smile spreads across his face as the two break into a classic Taylor Swift favorite, Shake It Off.
I’ve got this music in my mind sayin’ it’s gonna be alright…