Instruments of healing

In the summer of 2024, Lacy Beane woke up in the ICU at Johns Hopkins Hospital. The 32-year-old had been in a coma for weeks, slowly recovering after a severe case of sepsis had led to multisystem organ failure. By the time she opened her eyes, Beane had weathered a crisis one of her nurses called unbelievable, and she was about to face another. An aggressive and excruciating fungal infection was spreading across her limbs, killing the skin and the tissue underneath. Doctors raced to contain the infection, performing more than a dozen surgeries to remove dead or damaged tissue. In the days after each procedure, Beane was subjected to agonizing, hourslong dressing changes.

"It was horrible," Beane remembers, wincing. "Very, very painful."

To get through the worst of the pain, Beane kept her eyes on Kerry Devlin, a member of her care team. But Devlin wasn't the one removing the bandages or the one controlling the delivery of intravenous pain medication. She was the one playing the guitar.

Donning scrubs and a surgical mask, Devlin played and sang the modern country music she knew Beane loved, songs by Chris Stapleton, Kacey Musgraves, and Lainey Wilson while Beane weakly mouthed the lyrics.

"It gave me something else to focus on, and I would forget what was happening for a little bit," says Beane, a phlebotomist from Frederick, Maryland.

But there was more at work than a simple distraction. Devlin watched Beane's monitors, adjusting the tempo of the songs to match—and then methodically bring down—the patient's heart and respiration rate. When it was time for the nurse to remove bandages from a particularly painful place, Devlin would speed up, adding tension (discordant notes) and volume to the music to help Beane breathe through the discomfort. "The music was helping to structure that experience," Devlin says.

As a music therapist in the hospital's neurology and critical care units, Devlin uses her training in both music and medicine to "support people through really hard moments," she says, the conviction evident in her well-honed voice. "It can be dehumanizing to be in the ICU and to have so much happening to your body, external to your control. Music is a way that we can bring a little autonomy into the environment."

When Beane eventually had to have her left leg amputated, a terrifying prospect for the mother of two (ages 12 and 14), she asked Devlin to sing Chris Stapleton's "Joy of My Life" in the moments before the surgery. As Devlin sang, "Some may have their riches/Some may have their worldly things/As long as I have you/I'll treasure each and every day," Beane closed her eyes and thought of her sons. Her reason to keep going.

"Having her play right before the surgery put me in a good headspace," she says.

While the idea that music can be a catalyst for healing is nothing new, there's a growing consensus among researchers and health care providers that music can play a pivotal role in a clinical setting, shepherding patients through the physical ordeal and emotional gauntlet of hospitalization. At Johns Hopkins Hospital, Devlin and her pediatric counterpart, Jamie Shegogue, have strummed, hummed, and harmonized during operations, psychiatric evaluations, and even end-of-life ceremonies.

"I've seen it have an impact across the entire spectrum of illness," says Sapna Kudchadkar, chief anesthesiologist at the Johns Hopkins Children's Center. "Those are the moments patients remember from the hospital. And those are the moments you want them to remember."

While Shegogue, who is the critical care music therapist at the Johns Hopkins Children's Center, has spent years studying how music affects different parts of the brain, she believes its medicinal power may lie in something an MRI scan can't capture.

"There's so much about the hospital environment that is sterile. You're surrounded by medical equipment, the boops and beeps of machines." A simple song and someone to sing it with, she says, "can provide a moment of humanity."

This kind of music therapy is a modern variation on a very old theme. The ancient Greeks worshipped Apollo, god of both music and healing, and used vibrations—created by sawing wood or plucking modified instruments—to aid in digestion, temper strong emotions, and treat sleep disorders. When an evil spirit tormented King Saul (with symptoms that sound to contemporary ears like anxiety and depression), it was David's harp that healed him; "Saul was refreshed, and was well, and the evil spirit departed from him," after David's recitals, the Book of Samuel tells us. In the Middle Ages, Arabic hospitals called bimaristans used music to treat mental illness, while in Europe, survivors turned to music as a way to cope with the existential terror and endless grief of the plague.

The earliest known reference to music therapy appeared in an unsigned 1789 article in Columbian Magazine titled "Music Physically Considered," around the same time that Benjamin Rush, known as the Father of American Psychiatry, asserted that music could be a powerful antidote for psychiatric diseases, and researchers around the world began investigating its effects on physiological responses, such as heart rate and blood pressure.

But a scientific basis for music therapy only emerged after the horror of both world wars, when, according to one music historian, "the healing powers of music were witnessed on an unparalleled scale." Community musicians, both amateur and professional, began visiting veterans hospitals around the country, producing such profound therapeutic benefits that doctors began requesting that hospitals hire musicians. In 1945, the U.S. War Department launched an official program for the use of music in its Army hospitals. Soon, it became evident that these musicians needed special training, and the first academic degree programs were established.

Today, there are approximately 10,000 board-certified music therapists practicing in the United States, and research into the connection between music and well-being has been funded by federal agencies such as the National Institutes of Health and the National Endowment for the Arts.

Since 2015, the Johns Hopkins Center for Music and Medicine has been investigating how music affects the brain and body, as well as its potential to help treat conditions like dementia, depression, Parkinson's, Alzheimer's, epilepsy, and stroke. According to Alex Pantelyat, the neurologist (and violinist) who co-founded the center, music activates multiple networks in the brain simultaneously. "Repeated activation leads to lasting, measurable brain changes, strengthening existing pathways and helping to form new pathways," a process known as neuroplasticity, he says. So far, research has shown that music can lead to improved executive function, memory, attention, and emotional processing.

While studies are ongoing to pin down how to employ these neurological responses for therapeutic gain, one thing that researchers do know is that a phenomenon called rhythmic entrainment has a lot to do with why music can make us feel better, both physically and emotionally.

"Think of the last time you were at a concert and the band asked the audience to clap along," Pantelyat says. "Whether there's 50 people in the audience or 50,000, the amount of time that it takes for people to get in sync is in the order of seconds." This is an example of rhythmic entrainment—the synchronization of a physiological response, like our motor system, with an external auditory stimulus, like a drumbeat.

When Devlin slowed down the tempo of a Kacey Musgraves song in order to harness Beane's runaway heart rate during those painful dressing changes, she was using rhythmic entrainment.

But entrainment goes beyond a physical reaction. "We now understand that there is an important emotional component to rhythmic entrainment," Pantelyat says. Ever find yourself in the so-called groove when your favorite song comes on: eyes closed, foot tapping, head bobbing? That groove has an association with dopamine release, Pantelyat says, particularly in areas ofbthe brain related to reward and pleasure.

"What we have found consistently in studies across populations is improvement in mood, depression ratings, and anxiety," Pantelyat says.

These findings have important implications for hospital settings where worry, sadness, and grief abound.

"Music is a powerful competing stimulus," Devlin says. She's provided soothing music to patients learning to breathe without their ventilators, a moment that can be fraught with fear. Shegogue, meanwhile, has leaned on Disney songs to guide pediatric patients through scary procedures like blood draws and IV insertions.

And both have accompanied patients in the final hours of their lives, during a time when their playing is as much for loved ones as it is for the person in the bed.

"People will be at opposite ends of the room in their grief, experiencing their own grief. But music can bring everybody to the bedside. Suddenly, they are touching the patient and talking to them, and they're holding each other and singing," Devlin says. "Music is like a magnet."

When a patient dies, Devlin and Shegogue sometimes perform honor walks, accompanying the body as it is wheeled out of the unit for the last time, while hospital staff line the hallway to pay respects and say goodbye.

"It's very striking to support people who are leaving the hospital and recovering and being a part of those journeys," Devlin says, "But we also support people in their transition to what's next, and that's a really sacred thing."

With their cheerful demeanors and carts full of instruments, Devlin and Shegogue say they are sometimes mistaken as a pair of traveling performers rather than the clinical professionals they are.

To earn their degrees, Devlin and Shegogue studied music theory and performance—honing their skills in piano, percussion, voice, and guitar—as well as physiology, anatomy, and behavioral sciences. They completed 1,200-hour clinical practicums and sat for broad certification exams. On the job, they are fully embedded in their units, attending daily huddles, updating medical charts, and creating care plans for patients.

"On the surface it looks like we're just musicians," says Devlin, one of the few clinicians in the country to earn a PhD in the young field, "but we're therapists. We're gowning up and going in."

As the sole pediatric critical care music therapist at Johns Hopkins Hospital, Shegogue says she is often present "during times in people's lives that are just unimaginable."

One of those people was 14-year-old Gabby Wenck, who suffered an arteriovenous malformation—otherwise known as a brain bleed—in the middle of science class in December 2024. When she arrived at the hospital, Gabby was quickly intubated and rushed into emergency surgery. Her prognosis, according to pediatric critical care fellow Billy Bennett, was uncertain.

"Gabby was very, very sick, and she was very unstable," he says. "I remember using medications that I hadn't used before in order to calm down her metabolic demand, which really is a marker of how severe her neurologic injury was."

Gabby was in a coma a few days after the surgery when Shegogue arrived in her room to help her extended family celebrate the teenager's birthday. Soon, spirited renditions of "Amazing Grace" were echoing through the halls of the PICU.

"Our whole family was in tears," remembers Gabby's mom Tiffany, who also happens to be a music therapist. "It was so magical even the hospital crew outside the room was like 'can we join you?'"

Days later, another magical moment: Shegogue was singing the family's favorite hymns for a still-unresponsive Gabby when "she took a deep breath, her heart rate went up, and we saw her eyes open," Shegogue says. "I was like, 'Hi! Nice to meet you! I'm Jamie!'"

According to Tiffany, music therapy played a "critical part" of her daughter's three-month recovery in the hospital, as she regained the ability to speak and move on her own. Stretching out the words of her favorite Billie Eilish song helped strengthen her lungs and practice her speech, while the bass line of a Sabrina Carpenter hit provided structure for Gabby's physical and occupational therapy sessions. Sometimes, she and Shegogue would simply discuss the lyrics of these songs, picking out words that resonated with the emotions the teenager was experiencing during her long hospitalization.

"Music helped me relax and feel calm," says Gabby, who is also a ballerina and a flutist. Six months after her medical crisis, she speaks softly but definitively: "It helped me a lot."

She's not the only one who thinks so. Sapna Kudchadkar, who was a part of Gabby's care team, says music "was such a key component of restoration and healing" for the teenager. The anesthesiologist laments that more doctors don't know about or embrace the tool.

"It wasn't introduced in medical school at all," she says. "I had to learn just by experiencing. Many physicians still don't truly appreciate the importance of nonpharmacologic interventions like music therapy."

Bennett agrees. "I didn't really understand how much it added until I started to see it clinically," he says. Watching Shegogue accompany a patient through a painful procedure and seeing "the really beautiful moments" she devotes to supporting a family after their loved one has died have made him a strong proponent of music therapy. "I wish every one of my patients could experience this."

But not every one of them can. Both Devlin and Shegogue receive far more referrals from doctors than they can take on, often triaging those with the most critical needs. Devlin, who sees about three to five patients per shift—meticulously sterilizing each instrument between appointments—says it's not unusual for her to have 15 requests for therapy a day. "We cry a lot," she says, about the psychic toll of saying no to desperate families.

While Devlin's position is funded by the Center for Music and Medicine, Shegogue's position is supported through donations.

"We truly need to invest in music therapy, not just in this hospital but across the country," Kudchadkar says. "If music is foundational in a healthy life, why wouldn't it be part of your life when you're in the hospital?"

After more than two months in the hospital, Lacy Beane was finally moved to the progressive care unit where she could continue her recovery—but where there is no music therapist on staff. When wound ostomy nurse specialist Amanda Owen read in her patient's chart that the treatment had been an integral component of Beane's time in the ICU, she reached out to Devlin.

"I had never seen music therapy for any of my patients," Owen says. So, Devlin sent her a Spotify playlist made up of all the songs she and Beane had shared in the ICU—featuring Jordan Davis, Jelly Roll, and of course, Chris Stapleton—and the nurse began playing it on her phone during dressing changes.

"Sometimes she would just lay the phone next to my head," Beane recalls. "And it really made a difference."

Pantelyat says this kind of collaborative improvisation could be especially effective in places where there is no funding for or access to music therapy. "The therapists should be at the forefront … whether we're talking about the creation of a playlist or some kind of algorithm, but it could be other health care professionals and even the patients who are healing themselves using music over time."

The delivery of the music is less important, he explains, than the music itself, which researchers are beginning to understand must be tailored to the patient's unique tastes and preferences to be effective. "One size does not fit all," the neurologist says, and not every melody is healing to every person. Twenty years later, how you respond to the song you danced to at your wedding, for instance, will depend on whether the marriage thrived—or didn't.

"To actually use the songs the patient likes seems sort of common sense," Pantelyat says. "But actually, much of the research has not looked at music therapy in terms of an individualized approach."

Devlin and Shegogue begin each clinical relationship by asking patients or their families that age-old question: What's your favorite music?

Because they treat patients across the spectrum of age, ethnicity, and culture, both have developed mental musical catalogs that would put a wedding DJ to shame.

Every once in a while, when a patient does stump them, Devlin and Shegogue use it as an opportunity for growth.

"Part of our commitment to this work is to always be a learner," says Devlin, who maintains an ever-expanding Spotify playlist of songs to study. "I might not know your favorite song or artist, but I'm going to make sure I take the time to sit down and listen to it and learn it."

Sometimes, the therapists learn by listening with the patients themselves.

"If somebody likes Kendrick Lamar, we're definitely going to listen to the recording because that's a more authentic way into that music together," Devlin says. "I've also had meaningful experiences with patients who love classical music, where we'll sit and listen to a movement from a symphony that is really resonant for the patient, and have this really profound experience of simply pausing and taking it in."

Shegogue recently treated a patient recovering from a brain injury, a woman who played guitar and loved '90s indie rock. "That's just not a genre that I'm familiar with. I didn't even know any of the bands; I wasn't even in the ballpark," the music therapist says. "So, we started by just listening to that music together."

Eventually, the pair made their own music, Shegogue creating a drumbeat on her iPad while the patient picked chords on the guitar. Not only did the jam session help the patient practice fine motor skills, it buoyed her emotionally, reintroducing joy and normalcy into a life interrupted by serious illness.

These encounters can be as poignant for the therapist as they are for her patients.

"No matter how much I understand about music and neuroscience, about all the neural mechanisms working behind the scenes, it still feels so magical to me," Shegogue says. "Being able to sit in a moment where we're just human-to-human making music? It's mind-blowingly beautiful."