Healing Invisibly

It is a medical axiom that if a doctor doesn’t bring their humanity with them to work, they won’t find it on the way home. Where doctors find their particular brand of humanism—the kind that drives them toward suffering—is a mystery. But many have looked for it in music. Edward Jenner, discoverer of the smallpox vaccine, was a dedicated violinist; physician René Laennec’s appetite for carving his own flutes led him to invent the stethoscope; the surgeon Theodor Billroth was a talented pianist and violist, and sounding board of his friend Johannes Brahms. Dr. Albert Schweitzer funded the building of a clinic at Lambaréné, deep in the jungle of Gabon, by giving piano recitals, and then had an upright pedal-piano delivered to said clinic by canoe, so that he might unwind after treating bouts of yaws and dysentery.

The overlay of music and medicine goes both ways. Berlioz was expected to follow his father into medicine, and graduated from a Parisian medical school before abandoning the career for music. Borodin first worked as a military surgeon and didn’t begin his musical training until he was 29. “I should be sorry if I only entertained them,” said Handel of the audience following the London debut of his “Messiah.” “I wished to make them better.”

There is clearly a symmetry between these two practices. Both deal in transmission, restoration, emotion. It’s a coupling that goes back at least as far as the Ancient Greeks, who had in Apollo a god of both music and healing. Greek iatrikēs, and later Roman medici, used paeans—medical music—in the treatment of a variety of ailments, including melancholia and schizophrenia. Practitioners of traditional Chinese medicine, and the griots of western Africa, sing to their patients, while in India, some doctors perform religious chants to calm themselves before surgeries.

Healthcare professionals also have an organized, public performative presence, with numerous classical music orchestras across the globe—the World Doctors Orchestra and the European Doctors Orchestra, and similar regional groups in Los Angeles, Melbourne, Taiwan, Hong Kong, Montreal, and London, among others. 

The life of a medical professional, whether doctor, nurse, pharmacist, or technician, is a medley of prescriptions and surgeries, appointments and emergencies. It is a life of constrained schedules. For the vast majority of orchestral medics I spoke to, music was a childhood pursuit; they were musicians long before they were doctors. Some reached the level where a career as either a professional musician or a doctor lay before them, before choosing the unquestionably sounder career path. But the existence of these orchestras is proof that the constraints of a medical life do not preclude creating music, and may well benefit it.   

Tim Dornan, a retired internist and endocrinologist in Belfast, Northern Ireland, is a bassoonist with the European Doctors Orchestra. He finds the course of a doctor’s working day replicated in the arc of concert preparation. “You start rehearsing, and there is a crescendo where you enjoy the playing, then it begins to get difficult and you wonder if you’ll ever be able to play it well and you wonder what the concert will be like,” he says, “and then it begins to come together, you do the concert, and there’s a wonderful release of tension. And then you do the same thing all over again.”

The rhythm of preparing for a performance can mirror a doctor’s working conditions, but playing music can also be the antipode to the stress and pressure of the health worker. Clara Gaio Lima, an anesthesiologist from Porto, Portugal, played violin at a high level as a teenager, but stopped to focus on her medical studies. After ten years, the pressures of her work, multiplied during the Covid-19 pandemic, led her back to the violin. Knowing colleagues who desired the same creative outlet, in 2021 she co-founded, with fellow doctors and a professional musician, the Porto-based Orquestra Prescrição Musical (Prescription Music Orchestra).

“Music is a great way to release the emotions that doctors have but are forced to hide because of the nature of their work,” says Gaio Lima. “There is suffering in medicine, but in order to cope, you can’t think too much about it. You have to bottle it up. You have to be human and understand emotions, of course, and those emotions have to go somewhere.”

“All of us who are in the orchestra now are there because we want something else from life, not only medicine,” she adds. “Of course, I think I’m a better doctor if I play. Everything is easier if you’re happy.”

Further down the Portuguese coast, in Lisbon, is the Orquestra Médica Ibérica. Founded in 2022, its members come from across the Iberian Peninsula, as well as further afield—Britain, Ireland, Germany, and Canada. “People didn’t know that we had so many doctors and medical students playing at such a high level,” says Sebastião Martins, a psychiatry resident in Lisbon, and the orchestra’s conductor and artistic director. The group has played three concerts, each in a different Iberian city. “Even professional musicians were not expecting such a high level in an amateur orchestra,” he continues. “Our members show a passion and love for music that you rarely see, even in professional musicians.” 

The difference between professional musicians and medical amateurs, Martins says, is “the way they see the performance, the way they study their instrument, and in the playing itself. A physician might not play as much as a professional, so when they do, they give an energy and effort which is insane. And with that insanity comes a lot of passion and emotion. They leave it all on the stage. There’s a feeling that each time we play could be the last time.”

Martins also sees the relationship between conductor and orchestra as like that between doctor and patient: “The conductor must always look for what an orchestra needs and when, and then must decide what to say, and how to say it.” Speaking specifically to his specialty, he says, “As psychiatrists, we can only go by what the patients tell us. It’s like reading a conductor’s score—I don’t know what was in the composer’s head, but I have what they told me in the music. The rest is interpretation. Listening to a patient is a lot like listening to music. Their silences, their nuances, their anxieties and confidences.”

Whereas Martins finds conducting akin to psychiatric practice, Gaio Lima relates the orchestral setting to a surgical theater, with its requirement of clear communication, personal responsibility, an understanding of others’ roles, and a sense of the larger outcome. “With a medical team, like in an orchestra, you’re only as strong as the weakest player,” she tells me. 

It is an undeniably romantic notion for a medic to associate their particular specialty with the experience of playing music. But romanticism, or the application of romanticism, has its place in well-played music. “Medicine is probably the most humanistic and emotion-driven science,” says Martins. “Doctors deal with a lot of emotions every day, with the roller coaster of life and death, disease and cure, [which] creates an atmosphere where a refuge is needed. We can internalize it, or we can channel it into an art. Music is a very accessible outlet, and that’s probably why there are more medical orchestras than say for lawyers or engineers.” 

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The effect of music in the realm beyond entertainment has been well documented, with claims that listening to classical music in particular can boost IQ, spatial reasoning, and problem-solving. It’s known that in the brains of professional musicians, the corpus callosum (enabler of communication between the left and right hemispheres) and the planum temporale (important for language processing) are both enlarged. Several studies have focused on the relationship between music and medicine, including on music’s effect on surgical performance; one from the International Journal of Surgery found that classical music can increase both the accuracy and speed of surgeons. Whether the opposite may be true—whether one’s profession has some bearing on the quality of one’s musicianship—is a more complicated question. 

For a doctor inculcated into the seriousness of their work—of which treatment and remedy are a part, but also disease, suffering and bereavement— engaging in the “serious fun” of playing music can be a reprieve: a curative procedure, done to one’s best, with low stakes, and no threat of causing death. “Making music, you feel like you are making something better,” says Gaio Lima. “In music, you have to be methodic and focused, always thinking ahead, always listening.” There’s something medicinal about that—the desire to heal invisibly. The musician leaves only the memory of their work, as the surgeon aims to leave only the faintest scar.

Both medicine and music are oblique, difficult fields, without clear guidelines for success or triumph. For every mended patient, there is always another ailment to attend; for every finished concert, always another piece to learn. There are infinite technicalities to each field, but they share the central tenets of sensibility and empathy. Just as in music there is a difference between technical proficiency and musicality, there is in medicine a gap between knowing how to fix a corporeal problem and understanding a patient’s quality of life. While in each vocation, a certain level of technical skill may be a prerequisite of competency, it is sensibility in both cases—duende, or “soul,” in music, and bedside manner in medicine—that is the mark of a substantial performance. 

In his secondary role as Professor of Medical Education at Queen’s University Belfast, Dornan has found that “the social sensibility is something that drives people into medicine. Both medicine and music intrigue people who have some sense of uncertainty, some sensibility, some ability to engage with indeterminacy. Both only begin to make sense when they are treated as a humane discipline.” ¶