Life / Health

These are the songs playing in your hospital’s operating room — doctor’s orders

Playlists are becoming a crucial part of doctors’ surgical routines, with many surgeons saying music boosts morale and concentration in the operating room.

Dr. Sunit Das says music gets him in the “right frame of mind” for the operating room, but he refuses to operate to any song he doesn’t know.

Randy Risling / Torstar News Service Order this photo

Dr. Sunit Das says music gets him in the “right frame of mind” for the operating room, but he refuses to operate to any song he doesn’t know.

Dr. Sunit Das is prepping for surgery.

He ties on his mask, studies images of his patient’s brain and, just as crucially, sets his playlist.

Like a rock band crafting a concert set, the neurosurgeon at Toronto’s St. Michael’s Hospital has carefully chosen today’s music to suit the surgery.

It’s an awake craniotomy, a tricky procedure that Das, 43, undertakes while the patient is primarily asleep, but at times aware, to extract a tumour from deep within the brain.

While nurses ready the sterile space, the cheery strains of a piano sonata mingle with the clink of surgical instruments. Soon, the sonata gives way to a George Gershwin tune, followed by Brazilian jazz and early Leonard Cohen.

Then the whir of a surgical saw slicing into the patient’s skull momentarily drowns out music streaming from Das’ nearby iPhone and small speaker.

Instead of Beck and his melancholic coos, all that can be heard is metal zinging on bone.

These days, most surgeons bring their iPhones into the operating room. More than just background noise, music sets the mood and focuses their concentration, becoming a crucial part of a surgeon’s surgical routine.

Dr. Ike Ahmed, head of ophthalmology at Trillium Health Partners in Mississauga, loves his custom-built operating room with its subwoofer speaker system.

For Ahmed, music helps pass the time during back-to-back procedures and unifies his team of nurses, surgeons and anesthesiologists who, no matter their age or background, can usually hum along to Pink Floyd. At their request, he won’t play Justin Bieber.

An expert in surgically treating cataracts and glaucoma, Ahmed also uses classic rock as an adrenalin boost before making these incisions — one-one hundredths of a millimetre deep — into a patient’s eye.

On his drive into work, he’ll often sing “Where the Streets Have No Name,” matching Bono’s passionate crescendos.

“It’s like an athlete listening to music in the locker room before heading out onto the field; it gets me psyched up. I can’t tell you how important that is, to get me in the right frame of mind.”

Before the widespread use of anesthesia 150 years ago, a patient’s screams would surely have drowned out any peaceful melody.

But by the early 1900s, after anesthesia and antisepsis made survival more routine, some surgeons looked for ways to make surgeries less frightening.

Dr. Sunit Das, a neurosurgeon at St. Michael's Hospital, docks his iPhone and sets a playlist before doing a craniotomy in the operating room.

Torstar News Service

Dr. Sunit Das, a neurosurgeon at St. Michael's Hospital, docks his iPhone and sets a playlist before doing a craniotomy in the operating room.

In 1914, Dr. Evan O’Neill Kane of Pennsylvania was pushing a phonograph into his surgical suite, hoping music might calm his patients. (An intrepid surgeon, Kane once extracted his own appendix under local anesthetic in part to experience surgery from his patient’s perspective.)

His phonograph idea seemed to work. In a letter published June 6, 1914, in JAMA, Kane writes “The phonograph talks, sings, or plays on . . . and fills the ears of the perturbed patient with agreeable sounds and his mind with other thoughts than that of his present danger.”

Fast forward a century and music is now common in most operating theatres.

A 2014 editorial in the BMJ estimated music is played in the operating room about two-thirds of the time. Earlier this year, Spotify and the medical app Figure 1 surveyed 700 surgeons about their music habits and found 90 per cent have surgical playlists, many dominated by pop and classic rock.

Most of the time, the head surgeon chooses the music. In Toronto, that usually means no country music, no opera, not too much heavy metal and no songs that hint at death.

Often, anesthesiologists get a say during the critical minutes when a patient is put to sleep. Always, music is turned down or switched off if something goes wrong.

Jessica Grahn, a neuroscientist at Western University, studies the relationship between music and the brain and says people in good moods perform better on all sorts of cognitive tests. And like sex, drugs and food, music is known to boost mood.

“Silence can be better for certain tasks, like those that involve language and complex logical thinking. But for surgeons, who are executing this well-practised manoeuvre over and over, staying vigilant is crucial and music would absolutely help. Especially music that they like.”

Some studies show the benefits of music in the operating room, including one that found plastic surgeon residents stitched more efficiently while listening to their favourite music. Others suggest it’s a distraction.

For Das, music is his constant during the controlled chaos of brain surgery. The melodies simultaneously quell his nerves and keep him on the alert.

But whether Beck or Brazilian jazz, Das will not operate to unfamiliar songs. It’s his one musical rule.

Not long ago, one of his patients, a young mother of three, asked to listen to the Tragically Hip during the awake portion of her craniotomy. She believed Gord Downie singing about Bobcaygeon could help ease her terror. 

An American, Das hadn’t grown up with the Hip on repeat. So he spent hours learning their signature rhythms and lyrics before adding the band to his surgical playlist.  

On the day of the surgery, at one of the most critical moments, Das recalls the Hip’s familiar songs — “Ahead By A Century,” “Courage,” “Fiddlers Green” — streaming into the operating room.

His patient, now awake from her artificial sleep and aware that Das was cutting into her brain, could hear the music that made her think of family and friends and good times, those in the past and those to come.

The Hip will remain on Das’ surgical playlist.

“There’s a history now to these songs, an emotional resonance.”

He considers them a gift from his patient.

Dr. Jacqueline Auguste, orthopedic surgeon at Humber River Hospital (and lead singer in her rock band, Across The Board)

What’s playing in her OR: “For me, it’s mostly classic rock, the music my dad taught me about — The Doors, Pink Floyd, CCR, Neil Young. More recently, I’ve added some pop rock to the mix, so Lorde, Lady Antebellum, the Chainsmokers, The Weeknd, OneRepublic — I just love their sound.”

What never plays: “Scream rock. Forget it, man. I can handle heavy metal, but no screaming. I love opera, but I can’t have it in the OR.”

Why she plays music: “It calms me. The operating room is my workplace, and it can be a stressful one. I know that I’ve hit the nail on the head with my song choices when the nurses are singing along, too.”

Her top singalong songs

“Something Just Like This,” The Chainsmokers & Coldplay

“Lift Me Up,” OneRepublic

“Shape Of You,” Ed Sheeran

“Don’t Drag Me Down,” Across The Board (Auguste’s band)

“Rocket Man,” Elton John

Dr. Ike Ahmed, division head of ophthalmology at Trillium Health Partners

What’s playing in his OR: “Usually, classic rock. I mix in a lot of ’80s music. Often, I let my 7,000 songs play randomly, skipping from Led Zeppelin to Katy Perry to U2 to The Weeknd.”

What never plays: “Country music is not very popular. We ban that. And the Biebs; we don’t have any Beliebers in the OR. And no Swedish death metal.”

Why he plays music: “The energy in the room and the focus in the room and the mood in the room and the teamwork is so critical to success. Music makes the day go smoothly, it makes difficult surgeries smoother and it allows everybody to work under a positive atmosphere.”

His top singalong songs

“Where The Streets Have No Name,” U2

“Learning To Fly,” Pink Floyd

“Radio Ga Ga,” Queen

“Good Times Bad Times,” Led Zeppelin

Any song by The Who

Dr. Herb Wong, obstetrician and gynecologist at Sunnybrook Health Sciences Centre

What’s playing in his OR: “I tend to play a lot of pop, a mix of music that most people will recognize.”

What never plays: “I won’t play country music and I won’t play opera. And I’m careful about the lyrics. There are certain songs people don’t want to hear as they’re drifting off to sleep.”

Why he plays music: “It sets the overall tone. Good music helps to brighten everybody’s attitude, it makes long cases more endurable, it helps with the overall surgical flow. It makes the whole process seem less sterile and institutionalized.”

His top singalong songs

“Lovers in a Dangerous Time,” Barenaked Ladies

“Lost Together,” Blue Rodeo

“Take Me To Church,” Hozier

“Little Talks,” Of Monsters and Men

“Wheat Kings,” The Tragically Hip

Dr. Dean Elterman, urologist at Toronto Western Hospital, a part of University Health Network

What’s playing in his OR: “For surgeries that require focus, I tend to play jazz for background music, like Miles Davis and Chet Baker. For easier cases, I play things with high energy. So maybe Major Lazer, Gorillaz or 1960s Rolling Stones.”

What never plays: “I’m not a big fan of country music. No offence to it, I’m just not that into it.”

Why he plays music: “We go hours and hours without eating or drinking or going to the bathroom. Even a little thing, by making your day happier, by listening to a song you like, makes a difference in the workflow and pace of the day.”

His top singalong songs

“Life On Mars,” David Bowie

“Young Folks,” Peter Bjorn and John

“New Feeling,” Talking Heads

“A-Punk,” Vampire Weekend

“Feels,” Calvin Harris

Dr. Sunit Das, neurosurgeon at St. Michael’s Hospital

What’s playing in his OR: “It can vary pretty remarkably from classical to jazz to popular music, so depending on when you walk in you might hear a late piano sonata of Beethoven’s, you might hear a Leonard Cohen ballad, you may hear something by Stevie Wonder. It follows my own mood and tastes in music.”

What never plays: “Not to upset anyone in saying so, but I’m not a big fan of contemporary country music. I do have some Merle Haggard and Johnny Cash on my playlist, but my taste in country doesn’t sway beyond that. There’s not a lot of death metal, though I do have colleagues who find a way to get it into the operating room.”

Why he plays music: “If you think about what surgery requires, it often demands attention and constant decision-making in a setting that is often stressful and heavy with the weight of what it involves and the consequences of what those decisions are. I think there is a way that music allows me to escape some of the weight of that emotion and stay within the moment of surgery itself.”

His top singalong songs

“One Tree Hill,” U2

“Beg Steal Or Borrow,” Ray LaMontagne

“Lush Life,” Johnny Hartman

“Diamonds On The Soles Of Her Shoes,” Paul Simon

Any song by Stevie Wonder

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