As a young medical student trying to figure out the inner workings of life at a busy hospital-

how to think like a clinician...

how to be helpful to patients, to families, to nurses, to anyone...

how and when to stay out of the way...

and where did you say the cafeteria was again?...

your initiation into the liturgy of the operating room is intense. The seasoned staff watches you like hawks, certain that you will make a misstep, as they have already seen it all-

don’t cross that line of red tape...

where is your mask, and tuck that hair back into that cap...

do NOT touch anything not blue, and keep your hands above your waist!

Because you are a newbie, you are assigned a minder, and you are both terrified and grateful for this person, generally a veteran surgical nurse with a stern face and a voice like a drill sergeant who has guided decades of baby-faced students just like you through the labyrinth of sterile corridors. You practice, again and again, the five minute scrub at the stainless steel sinks, thrusting your freshly washed arms into your gown (always too big, billowing around you), and trying over and over to get each finger into the proper part of the glove (so much harder than it looks).

Once you pass muster, the operating theater lives up to its billing, unfolding like a stage colored with drama and tinged with steampunk romance.

It is just like what you have seen on TV and envisioned in your syllabus-induced daydreams (or nightmares…). Bright lights, gleaming floors, a medieval assortment of equipment, the odd aseptic smell of dried betadine, alarms and signals, the oddly comforting bwip bwip bwip of a tech-interpreted steady heartbeat, and wait, what’s that?

Music.

As a novice surgical student/intern/resident, you quickly appreciate that the person in charge of that operating room wields the power to choose the tunes. Surgeons are an eclectic bunch, to be sure. Some prefer the soothing calm of a wordless symphony. Others will only listen to West Coast late ‘90s hard core rap, preferably at anesthesiologist-annoying loud volume levels. Some are magnanimous, deferring the choice to the consensus of the team. But just about no one chooses silence in their OR.

As I have done my education and training in this wildly evolving epoch of musical technology, I have witnessed the change of how we bring music into the operating room. As a student, you would be lucky if the surgeon had invested in a boombox and hauled it every morning into the room with a stack of CDs (“You brought the latest Smashing Pumpkins, yes!”).

As a surgical intern, it was A BIG DEAL when radios with good reception were installed in each operating suite (“Should we listen to Alice or KFOG today?”). Then came the barrage of iPods and the scramble to find the right connecting cable (“I made this amazing playlist for the OR, hope you are into the White Stripes!”). And now we have streaming services where you can listen to just about anything you want (sun-soaked tropical house beats for the afternoon, anyone?) Spotify recently made public the top ten songs played in the OR, and apparently a lot of us are really into classic rock.

Although it might be cool to imagine your surgeon rocking out to power ballads from late-80s hair bands, is there more to it than just background noise and air guitar solos with a scalpel in hand?

It would seem that there may be some science to back up the implied chain of happy surgeon = happy team = happy patient.

For surgeons, listening to music in the operating room seems to make them faster and more accurate (1). For the team, music helps them feel calmer and work more efficiently (2). (Although back to those poor anesthesiologists - if the volume is too loud, music can actually impair their ability to hear the crucial tones of heartbeats x oxygenation) (3). For patients, music truly seems to be a panacea - reducing preoperative anxiety (4), even lowering postoperative pain and distress (5).

Sounds like as long as we keep the volume down, it becomes a win-win-win.

References
1. Moris DN and Linos D. Music meets surgery: two sides to the art of “healing”. Surg Endosc 2013 Mar; 27(3): 719-23.
2. Ullmann Y, et al. The sounds of music in the operating room. Injury Int J Care Injured 2008; 39: 592-597.
3. Katz JD. Noise in the operating room. Anesthesiology 10 2014; (121) 894-898.
4. Bradt J, Dileo C, Shim M. Music interventions for preoperative anxiety. Cochrane Database Syst Rev 2013 Jun 6 (6).
5. Van der Heijden MJE, Araghi SD, van Dijk M, Jeekel J, Hunink MGM. The effects of perioperative music interventions in pediatric surgery: a systematic review and meta-analysis of randomized controlled trials. PLoS One 2015; 10 (8).

By Dr. Angeline Lim of Duet Plastic Surgery - Expert Plastic Surgeons

Angeline Lim, M.D. and Jennifer Weintraub, M.D. are the board-certified plastic surgeons of Duet Plastic Surgery, a boutique-style practice in Palo Alto, California. When not guiding her patients through their health and beauty journeys in the operating room, Dr. Lim remains a devoted fan of live music. Some of her favorite places to catch a show: Blossom Music Center (particularly concerts by the renowned Cleveland Orchestra), the Santa Barbara Bowl, and the Fillmore in San Francisco.