Finding Flow
While others revamp their musical skills for surgical purposes, Dr. Matthews, a Harvard-educated surgeon with a practice focused on the pancreas, uses music itself to aid his work in the OR. For 17 years, he has been the chair of surgery and Dallas B. Phemister Distinguished Service Professor of Surgery at The University of Chicago in Illinois.
Alongside his thriving career, Dr. Matthews is a self-described “drooling fanatic” for rock music. His background includes learning to play guitar as a teenager, becoming a punk rocker and radio disc jockey at Harvard in his undergraduate years, and transitioning into a blues and jazz fan later in life. As Dr. Shoskes did (and many other musically inclined surgeons do), he set music aside for years as his career advanced. “When I was in my 40s, I kind of decided, with the encouragement of my wife and kids, to get more seriously back into it again,” he said.
Gradually, he moved from intensive practice to writing his own songs, finally landing at recording albums with a team he described as a Grammy-winning producer, a drummer formerly employed by Paul McCartney, a guitarist who toured with David Bowie and played on John Lennon’s Double Fantasy, and other rockers with similarly illustrious CVs. The songs they record together are available on Spotify and elsewhere. “I don’t have any illusions about the talent level I bring to the table,” Dr. Matthews humbly noted, “but it’s a lot of fun to do.”
While he is impressed with the resumes of his musician colleagues, he said, they are impressed with his surgical achievements. And the connections between music and surgery don’t stop at mutual respect. For Dr. Matthews, music is important in the OR—where the purpose involves targeting attention. “Music helps with my flow,” he said.
Flow in the psychological sense is a term first defined by psychologist Mihaly Csikszentmihalyi, PhD. It is an intense state of concentration in which a person becomes so fully devoted to the task at hand that self-consciousness, awareness of time, and even a focus on one’s own physical needs temporarily vanish. The original impulse to study the phenomenon arose, Dr. Csikszentmihalyi once said, when he realized that artists, including musicians, often had the experience of becoming totally lost in their work.7
A mental state not fully under personal control, flow occurs when the amount of information a person receives is at or near, but not over, their maximum capacity. Through his research, Dr. Csikszentmihalyi eventually pinpointed this at 110 bits of information per second (in comparison, understanding a conversation takes approximately 60 bits per second).7
The Yerkes-Dodson law,8 first defined in 1908 by Robert Yerkes and John Dodson, captures an empirical relationship between physiological or psychological arousal and performance. To wit, increased stimulation improves performance up to a point, after which excessive arousal causes performance to decline. The key to sustaining a state of flow—and thereby maximizing performance—is to perfect the rate of input and the arousal it creates.
The goal of music in the OR, then, is to fine-tune arousal to the right level. In describing immersive operations as akin to an intensive experience of musical improvisation, Drs. Shoskes and Dearani are perhaps nodding to the concept of flow—in that case, flow achieved by maximal absorption in two different kinds of challenging situations.
For other, more routine operative experiences, Dr. Matthews described music itself as a topping-up of the information rate. He noted that it involved adding easily accommodated sound (“It’s sort of about filling in the spaces in the atmosphere”) and covering up extraneous noises (“I find it really distracting to hear people’s conversations around me. So, for me, having the music on allows that to go away”).
The Best Way to Play Music in the OR
Dr. Matthews’s approach is common; most surgeons, including Drs. Conrad and Shoskes, listen to music in the OR. Dr. Dearani noted that music can reduce tension in the surgical theater: “This feeling that making the room completely silent translates into people being more focused—I’m not sure that’s the case. That’s not the case for me, I know.”
But Dr. Matthews’s experience hints that the choice of songs playing in the surgical theater often needs to be precise. Getting it right is no small matter; all the interviewees, as well as the literature on music in surgery,9 agree that there is no guarantee music will aid an operation.
It is a finding that Dr. Conrad could verify through his own research. “I would say you should think about the role of music in the operating room like a drug. There are positive effects, but there can be side effects, and you have to be very strategic in the dosing of your music,” he said.
That includes the volume, which should be neither blasting loud nor whisper quiet; beat frequency, which should be slow to moderate; and shifts in tone and emotional intensity, which should be limited.
Dosage does not necessarily dictate genre, however. Here, tastes can vary. In the OR, Dr. Matthews tends to prefer the genre he plays himself, rock. Dr. Dearani said he has kept the same carefully curated mix of songs by James Taylor, Carole King, and Stan Getz for 25 years. Meanwhile, Dr. Conrad has examined the question of which genre of music is best and strongly favors classical music. As a result, he has created an entire album, Healing Hands, tailored for use in the OR and freely available online.
When referring to the lute music he plays, Dr. Shoskes noted, “My music is good background music,” but specified this was true for “only the people who have no connection with the music I perform,” an audience that of course excludes himself. Knowing the nuances of Renaissance and Baroque music means he taps into the music’s emotional depths, an experience too complex to handle mid-surgery.
“Pop music doesn’t engage me emotionally and intellectually the way this other stuff does,” he said, and this means the procedure itself can be his central focus. In the OR, where flow and the need to improvise can be essential, the only “best” music may be the kind that achieves this exact result.
A Long History
Whatever one’s involvement with music, it is clearly inextricable from the lives of many surgeons.
Indeed, surgeons’ inquiries into music in surgery go nearly as far back as surgery itself. In addition to the 19th-century inquiries of Dr. Billroth, a 1914 JAMA article, “Phonograph in Operating-Room,”10 raised the option of playing music “for calming and distracting patients.”
That early modern work added to a tradition already more than a millennium old. The medically trained Turco-Persian philosopher Al-Farabi (who, like Dr. Shoskes, played the lute), considered music a form of therapy in his treatise Meaning of the Intellect, written around AD 925, and compared learning music to learning medicine in his Kitab al-Musiqa al-Kabir (Grand Book on Music).1
The centrality of music to human lives is unlikely to abate, too. Dr. Matthews said his lifelong love of music has “deep, deep psychological roots,” a statement less particular to him than a description of nearly all of humanity.11
Music can be uniquely powerful for humans—whether surgeons or anyone else. Dr. Conrad mused, “People go to a concert and have this ecstatic or out-of-body experience that people rarely have from looking at a painting or listening to poetry. And what is it from? It’s nothing. It’s nothing we ingest. It’s just molecules in space that change their frequency. This is unbelievable, right?”
