Music for the Dying

An interview with cellist and physician Melanie Ambler of Musical Rounds

Recently I had the great luck to meet Melanie Ambler at a social dinner hosted by Alex’s parents in Palo Alto. Melanie is a professional cellist as well as a physician in med school, who brings her cello to the hospital to improvise for people with terminal illness as they talk to her about their life. Her initiative, Musical Rounds, has two goals. To teach other musicians to perform in a medical setting, and to produce recordings with patients with the intention of leaving them behind to their friends and family, as a way to build their legacy.

You can listen to a recording here: Musical Rounds Sessions – Melanie Ambler. In the first recording a patient is talking about one of her favorite places her cabin in the Sierras, and what it makes me feel is dignity. Majesty. I can hear the mountains, despite the patient never describing them either in voice or tone. Music does something that we’re rarely capable of doing. It accesses the deep, expansive, liquid realm of pure emotion. And for a person who is trapped in bed and dying – I listen to this first recording and think (a) this person wouldn’t have described this story unless someone was listening and (b) this person wouldn’t have enjoyed describing this story unless someone was really listening. At the end of the recording there is a hush, likely a muffled “How do you feel?” and the single word response “Overwhelmed.”

I came up to her after the dinner and told her about how sometimes my musical friends will improvise on the piano or the guitar for me when I’m having a bad day, and how relaxing and sweet it can feel. She was open to talking about her process, so I got on a call with her a few days later.

I was curious to understand the power of improvisation. What is it that makes this improvisation healing? What is it about structurelessness combined with listening and emotionally attuned music? It’s quite different from background music, or performance music, and much more like a long conversation. It’s really cool that people are doing this kind of work, and also unusual for it to be free, high quality and reactive to the moment – improvised.

Transcript edited for concision.

[Melanie joins the call on a summery patio with a lawn behind her].

ANVITA: Where are you? That looks really nice.

MELANIE: I'm on Stanford’s campus. I'm a music program this week so I just stepped outside. Basically, I'm doing chamber music coaching and rehearsals with a couple of groups. There's a week-long chamber music seminar on campus, so it's like an all day, every day, music adventure kind of thing.

Anvita: I do a lot of improvised dancing as a contact improviser. I'm curious about how improvisation works across fields or in different areas. You’re improvising to someone’s voice but also to their life story. How do you know where to start?

Yeah, I actually had a chance right before we met last week to do a contact in class for the first time. And I found a lot of similarities. Most of our lives are improvised. The way that I approach the music sessions is that I've been training for so long in music that I have a vocabulary and a toolbox to pull from just as if I were naturally responding to the person in conversation. Different textures, rhythms, tempos, keys. The music feels like a continuation or a reflection back, of what a person has just told me, based on their body language, on the energy that's involved, or what I can picture in my mind. It might be a story about them and their grandchildren at the beach, their love of the ocean and its vastness. I usually already have an idea in mind as someone is speaking. Like I’ll be humming to myself with the cadence with which they’re telling a story. I try to tether onto these as I explore what happens musically afterwards.

I think the fact that whoever was listening knew that this music was being created on the spot for them made that connection much stronger than if I were playing Bach or Beethoven or Somewhere Over The Rainbow, that kind of thing. And as a result, what was quite interesting is a lot of the time we would sit for a while after the music in silence. And I learned to be comfortable with that.

I think because they knew the music was a description of something that they had already described, it often brought up more memories that were related. Then afterwards they would be like, ah, you know, I was just picturing this one time I was with my grandchildren and we were all like, running around in the sand. That was during the more energetic part and then during the more calming part everyone was relaxing in the sun and just enjoying it. It works in both directions. Someone tells me their story, I improvise, and then they tell me more of their story based on what came out of the music.

Reverberation and amplification.

Yeah, exactly. And retrieval, like memory retrieval. Because it's quite rare in a clinical setting, that there's enough time outside of the time speaking to each other, to just think and be in the moment together. And when there's music, when there's art, where there's some other kind of flow state happening, that allows for things to just kind of like rest and settle, and continue afterwards in a direction that may not have happened if there was like a requirement of an immediate response.

I did a little experiment with a few of the patient recordings that I have. I took excerpts of them, just the voice speaking, not the cello, and I brought it to a week-long recording session that I did with a lot of other musicians in Indiana. We were five musicians, and they had not heard the excerpts before, and we did a group improvisation inspired by this. We did two formats. We did a direct response, where we were listening to the recording in our headsets as we were playing. Then we did one where we listened to the whole thing and then we turned it off and played. And when we played the whole thing after we listened to the entire story... There was such a cool, clear arc and consensus of where we wanted the music to go, even though we hadn't talked about it. We were still improvising. It gave us scaffolds. The timing actually worked perfectly. When you overlay it, it was the exact length of the story. We didn't plan that.

Anvita: Do you remember the first time you tried improvising in a healing setting? I'm imagining the first time wasn't for a stranger at the hospital, there must have been a gradual lead up involving playing for friends, playing for family and realizing the impact that it has. There’s a key jump between “I'm going to be a professional musician playing concerts”, to “I'm gonna play music to build a really strong connection to one person who needs it.”

MELANIE: Yeah totally. It's a completely different feeling. Completely different skill set even. The thing that actually pushed me the most… I gave virtual concerts for patients during the pandemic, sometimes to 200 patients. It was music that I knew and felt comfortable with. I would improvise on the spot with which pieces I chose, I didn't have a set repertoire. But I found that the conversations that came out when I found a piece that matched the energy they wanted would be so much more interesting and fun than the times where I came in with a set list and knew what I was going to play.

That inspired doing this week-long program called Resonance at the Honeywell Arts Academy. It's run by this Grammy award-winning trio called Time for Three. They’re classically trained. Went to Curtis, Julliard, the two best music schools in the country, and they've turned classical music on its head because their instrumentation is two violins and a bass. Nobody's written a repertoire for that. A huge part of their vibe is improvising. They run this week-long session where you basically just …like, I don't think I looked at a single piece of sheet music that entire week, which is very different from training classically, you know.

When I got back from that, truly the day after I got back, I started my clinical rotations on trauma surgery. A week later, I met a patient who was a bassist and a pianist. He had crushed his left hand in a car accident. It was super devastating for him as a musician. He asked me if I would bring my cello in. I’m like, I’m probably not supposed to do that. He kept asking me. I finally brought my cello in and his IV pole monitor started alarming in the middle of the first piece that I was playing for him. I knew it was going to do it, and I sat there, and I got up to turn the alarm off, and I started to listen, which I wouldn't have done otherwise, and I was like...that's a beat, and it's giving me a beat, and so I sat back down. I didn't mute the alarm, I just started improvising and jamming along to my beat. And he immediately just relaxed and then he started to cry. We knew it was malfunctioning, nothing was wrong with it but it had just been alarming constantly all day. Afterwards, he was like, Mel, you just made something so ugly, sounds so beautiful. And I said, well, you're a composer, just listen to it, if you hear the beeping, sing along to it, you know, improvise along to it. See what you can make.

And that was actually the first time that I had improvised, I guess, in a non-structured way. It was for a patient.

Anvita: Wow. That's really special. There’s so much spontaneity there. So much luck of the moment.

Yes, absolutely.

I guess everyone needs to go to the hospital, like eventually you will meet a composer in the hospital, but just the confluence of these things happening.

Yes, and that when he said he was a musician, I kind of unabashedly, in the mix of my entire trauma surgery team, piped up from the back and was like, oh, I play the cello! Even though I probably shouldn't have said that.

<laughter>

But you know, it's crazy how much, like...this will make sense in a second, but I was talking to my friend about the difference between fortune and luck, and that fortune is something that's completely out of your control. You have good fortune to be born in a place that has resources, you win the lottery, those kinds of things. But luck has a level of intention. So I would say that was a super lucky encounter, but I also asked questions and piped up and shared about myself so that meeting could happen. I don’t think I would have brought my cello in unless the patient kept badgering me to bring my cello. Then the team was like, Mel, you should bring your cello. Then that kick-started me not asking permission and bringing my instrument to work. And if I had a free moment, I would go and play.

So luck is interesting. I’ve been thinking a lot about it lately.

What else have you been thinking about luck?

How sometimes, experiences and interactions with people can feel so deeply out of your control, like, how did I possibly cross paths with this person and find this common thing and that kind of thing? Then teasing that apart, putting a microscope to it and asking – how did I get in this situation where I would have learned this information? What question did this person ask me that then revealed what I did next? How many connections are there to people that we don't know because we don't ask?

That’s a deep idea. It's the kind of thing that can constantly be unfolded to reveal more and more about the world. I’ve been thinking about something similar, except I’ve been calling it the timeline. It's like when you meet someone, your timelines converge and entangle each other briefly, and then that moment opens up and something else tumbles into another, a sequence of events cascades as a result. Then you break away and the timelines diverge.

And I don't know, it's just a very precious thought at the moment. Of how the choices we make every day lead to the events in the next day unfolding.

Yes. Absolutely. Even the events that unfold years from now. That also just gets at the idea that time is limited. And speaking to a lot of individuals that are close to the end of their timeline is also such a different perspective on meaning and importance, to see what people want to talk about and share. I'm actually processing a lot of this for this year because, you know, it's quite heavy, but also quite light at the same time.

<laughter>

You seem remarkably well suited for palliative care. Kind of untouchable, in a way.

<laughter>

Thanks.

Anvita: When you play to patients, it’s almost like you’re setting up a spoken word performance for them, where they’re the performer and you’re their musician. Which makes me wonder if you’ve ever performed spoken word.

Yes. Well, actually no, sorry. I've done it as a musician where I've listened to spoken word and accompanied someone live as they speak, which is a much different experience because you don't know where the other person is going. It might be more like contact dance. What's interesting about the call and response for the patient is that the improvisation already has an arc and a structure defined based on what the person told you before. And so maybe it's less of a pure improvisation.

So you've not been accompanied.

I have not been accompanied.

I’d be curious to know how you’d feel with you as the speaker and a musician as the attuned listener. I think the reflection of the role would be an interesting experience. Because speaking to music is quite intense. It's a lot of attention. With your cello, you kind of create a stage for people to replay and process their feelings.

Yeah. I haven't thought about it that way. I love that. And also why it makes people a little bit nervous, too.

Yeah.

I'll ask! I mean, I'm in a music program, I’m sure someone would want to.

II.

IN SUM – I think this kind of improvisation is about connection. For both the patient and the musician, the source for their voice, for their playing, is the other person. It is a kind of entwinement, a partner improv. They amplify each other. Provide a mix of freedom and structure.

I showed this post to a friend of mine, and she said, on the seeming untouchability – “People who have done palliative care are just like this i think … But I don't think it's untouchable as much as comfort with death, which feels like untouchability to people not comfortable with death. It can't be untouchability because they are emotionally available - touchable.” Though I think it’s not just the comfort with death that makes such people untouchable. It’s that death, like birth, has gravitas, and that gravitas settles into the death workers.

I wonder – Is there something about being near to death that makes its way into this music? It’s solemn, but also rich and complicated and it has a sense of humor…

And I had this unsorted thought:

Nobody knows what to do with their feelings. Their thoughts are all in a jumble on top of one another, and their emotions are keening loud screeching and too soft to hear at the same time. They don’t have enough space in their heads to lay out all their separate feelings one by one and sort them and pack them all away. You construct that space for them, with music.