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From Music Therapy – Intimate Notes – case studies compiled by Mercedes Pavlicevic

Based on an interview with Nicky O’Neill who works at Greenwich Healthcare, at a children’s hospital and at the Nordoff-Robbins Centre in London

Introduction

Nicky is at the keyboard in a hospital ward. Next to her is a small person with a large head, composed and intensely present in the moment. He resembles an old man - almost a Buddha figure - and uses his hands in a declamatory style as he sings. He sings with his entire body, with enormous pressure from his chest. There is no ambivalence about his presence in the music with Nicky. Every now and then he scratches his large, bald, blind head, takes a deep breath and enters into an expansive, sustained vocalization, accompanied by Nicky at the keyboard. As he sings, his hands move in a beautiful flow, drawing the music in the air, the music flooding out of him, into him.... Nicky's spontaneous playing at the piano opens the music for him, and he expands into it, like an opera singer, interweaving with her playing. This old old voice, in this old old soul. All of four years old. About to die………………………

Giorgos

Giorgos was born in Cyprus, with osteopetrosis, a disease which results in a thickening of the bones, especially in the skull. This results in pressure over the cortical nerve, which, in his case, is damaged. He is visually impaired, and although the disease can be arrested, it cannot be cured - the damage is irreversible. The next stage, if the disease were not arrested, could be for him to lose his hearing. He is not very mobile, and his legs are weak: in fact he is one of those visually impaired people who is very careful, who is not able to revel in his body. He is very static, and spends the day sitting on his chair upright in his hospital room, or lying on the bed. He is small for a four-year-old, with a very distended stomach, skinny little legs that are bowed due to lack of use and deformity. He has bulbous eyes because of his visual impairment, and a very, very large bald head. He is a Greek-Cypriot child of normal intelligence, speaks no English, and has come to Britain with his parents for treatment.

He has a tape recorder in his hospital room and tapes everything:     conversations, someone walking into his room, hospital noises, whatever there is to tape. He plays the recording back to himself and laughs at the top of his voice, commenting on it in Greek and laughing raucously. He has created this aural world which he can control, fuelling his imagination... but at the same time, this world accentuates his isolation. This is the only conversation that he can hold, and maybe he has done it out of his need to stimulate himself. Otherwise his verbal and emotional interactions, at the level at which he is able to function, are only with his parents.

He was referred to music therapy by the ward, as they knew prior to admission that he was responsive to music and had special needs that they couldn't meet. I went into his room to meet him, with my trolley.

He sat next to me at the keyboard and played bits here and there - I call it 'fluttering'. our musical contact was minimal: he would hang on to the edge of the keyboard and do bits of sounds here and there – and then chatter away in Greek, laughing. He seemed to enjoy the sessions- and asked his mum whether he could do this every day. Initially the sessions were difficult for me, and quite disconcerting. When he did his fluttering I would try to imitate a sound or pick up a rhythm, but he was like a butterfly just landing and then off again, he was so quick! And unpredictable! His rhythm constantly changed, his chattering was fast, his speaking was Greek. . .. I didn't have any words to hang on to, which in some ways was good, it really made me listen to his sounds, to his voice.

The mood of the music was very intense, at times almost hysterical: he laughed a lot, he shouted, the veins would stand out on his temples. Fleetingly I was able to catch the odd note out of his chatter…he would sometimes land on a note and I could sing it, or I could hear that his voice was occasionally influenced by what I was playing or singing. Most of what I was doing was to try and reflect his mood in my music, to reflect my experience of him. Whenever I managed to catch a tone or a mood, he would move off. Our contact was minimal, and frustrating for me. It was almost a defensive chatter, he would not let me into his world, he would not let me share his sounds, he kept me out. I didn't know what to make of him. He wouldn't play any of the other instruments at first. I had the interpreter in for the first session, to see if we could communicate in a basic way - for instance, tell me if he was in pain or needed to go to the toilet or finish, so she taught him those words. Because I wanted it to be safe in there. His mother would sit outside during our sessions, so it was just him and me.

The sessions with him lasted between forty and forty-five minutes. In my experience, the sessions with the children in the hospital are much longer than with non-hospitalized children, and very, very intense. The children are very focused: I don't know whether they are thirsty for that amount and level of contact. In music therapy, they are in control of the contact, the session, the space... the relationship, the music.

Then he went into isolation - medical isolation. In some ways it didn't seem to affect him as much as it does other children because he was so static, and had so little contact with the outside world anyway. I was asked to work with him in the isolation ward, which I mostly don't go into because of restrictions on the number of people who visit there - but nobody could communicate with him so directly. I had to wear an apron, make sure my instruments were well wiped. . . but my dirty shoes did not seem to matter!

His bone marrow transplant happened during his time in medical isolation. The child's marrow is eradicated and a new one is donated.

The new one hangs in a bag above their bed while they watch TV, eat, sleep... the image that I have is of the child's living self being replaced by someone else. They give over part of their livingness... and that can often cause problems for some children who might be receiving marrow from a forty-year-old woman, for instance, or they might be taking in something of the opposite sex.... I don't know how much was explained to him, how much he understood or whether he knew what was happening to him…………………

Anyway, he was in medical isolation, having his transplant, and in the second week there was a change in our music - this was our fourth session. He was chattering away as usual, sitting next to me at the keyboard, and then the speed of our music started slowing. I became more insistent musically about focusing on the notes that he was offering, and the speed came down even more. Maybe I was stronger, more confident, more assertive, more insistent: I held on for a longer time, I didn't let him just flutter here and there as he had been doing.

The whole quality of his voice began to change. It was as though he was becoming a fifty, a sixty-year-old man! There was a totally different level of interaction between us. The music became much more intimate I was supporting him with my playing, he was totally influenced by what I was doing. .. he was influencing me, we were creating music together.

It was extremely intense musically - a bit like East meets West: him this Greek Cypriot four-year-old, with no way of speaking to me, an English-speaking adult... and yet through our music-making we connected totally. I couldn't get my voice to match his quality and in fact I stopped trying. I find it astonishing that even when you cannot match somebody's vocal quality and you don't have to, you still remain connected as two separate individuals. Occasionally I would sing too- almost a Bach-like sequence of notes repeated, coming down, which somehow fitted to what he was doing. We were together. He had lost a lot of his vocal tone during this time in isolation - he'd had a very ringing tone to his voice before this. His voice had become almost more breath-like, although there were definite tones to it.

But this was like from another planet - extraordinary singing! Hardly the singing from a four-year-old! Almost like that of a religious singer, his voice had a lot of oscillations...

I could imagine him singing in a holy place……………….

We had one more session after this traumatic time. He became well after the transplant and was able to go and stay with an aunt, although he was still in and out of hospital. Somehow he just could not keep well enough to return to Cyprus. We didn't know it was going to be our last session, and he was much better. He was the most well he had been since before the trauma. I could hear that his voice had returned, and he had regained some of his confidence. We did some free singing together, his voice was triumphant. . ..

And then one night he died. About three weeks later.