A Breath of Fresh Air

Last week SOUND paid a visit to Royal Brompton Hospital to sing for patients on the Adult Surgical wards.

Phoene Cave, one of our star altos, was able to arrange this for us thanks to her inspiring work with Singing for Breathing at the hospital. Here, she explains how she first became involved with this unique and powerful initiative.

In 2008 I answered an advertisement from rb&hArts, based at Royal Brompton Hospital in London. They were looking for a singing teacher to lead groups for some research. The participants all had COPD, or Chronic Obstructive Pulmonary Disorder.

According to the British Lung Foundation website, 1.2 million people in the UK were diagnosed with the disease in 2012. The true figure is thought to be higher as there are many who remain undiagnosed. The symptoms include wheezing, breathlessness, tightness across the chest and coughing. Some people can walk only a very short way without pausing to find breath and everyday activities can be tiring.

I was pleased to get the role, but very nervous. The Sister on one of the hospital wards, gently giggled and reminded me that “no-one has died from singing” (I have not verified this!)

The wards were full of frail people in nightwear, many curled up in bed with large full face masks billowing steam. It was such an altered universe for me. As one woman said to me incredulously, “I can’t even speak, let alone sing”. She came and she did sing and told me how much better she felt afterwards. It took her back in body, mind and heart to a time when she danced and felt alive. Music has the power to do that.

On the odd occasion we sang on the wards it was an opportunity to connect with others. Singing together brought a sense of connection and communication with other patients, as well as staff. Nurses, porters, physios would join in a chorus as they were passing through and consultants would smile. On many occasions the singing could heal the strain of visiting sick relatives in a way that words never could. One aunt, seeing her niece sing for the first time in years, wept with joy; one brother pulled out his mobile phone and found the words to a song so he could join his wheezing sister as he watched the breath soften and the colour lift in her cheeks with every verse.

In two years, I worked with hundreds of patients at Royal Brompton Hospital, old and young from a variety of backgrounds and with a variety of lung diseases. Some of my most treasured work was with younger patients with cystic fibrosis. This is such a cruel disease. Cystic fibrosis is caused by a fault in the gene that controls the movement of salt and water in and out of your cells. The lungs and digestive system become clogged with mucus, making it hard to breathe and digest food.

The work was as varied as the patient population – typical exercises included gentle guided relaxation and breath awareness, postural re-integration for better breathing, singing known songs, working on vocal technique, focusing on the emotional expression & release singing provides or even improvising and composing new songs.

Singing for Breathing may include therapeutic, practical and creative elements to help better breath management. Many patients hid their troubles behind a cheerful face and the singing gave them a place to express the truth of their stories in song. Some very dark songs were sung, providing emotional release and a safe place to connect to those feelings.

One patient, awaiting a lung transplant, chose to sing a song she was going to sing on her wedding day – the wedding that had to be postponed as she was too unwell. Patients generally chose songs with lyrics that moved them. From my notes I commented: “She looks weary, oxygen piped in through a tube, her shoulders up by her ears and her body contracted. She finds it hard to relax and to connect to the ground. Her toes are curled up. I put my hands onto her shoulders to help her to release unnecessary muscular tension.

She sings low pitched “ssssshhhhheeeees” over long exhalations, keeping a low breath – there is lateral movement beginning to appear and her belly is releasing. Her shoulders stop moving with every inhale. As she starts to sing a song her voice is light and ethereal & yet heartful and warm. She looks very different after singing. Open, relaxed and radiant.”

For so many patients, the Singing for Breathing sessions helped them overcome a fear about singing and expressing themselves this way, opening their upper bodies to feel the breath moving them through the song and releasing unnecessary muscular tension. Time and time again, I introduced myself to patients scared to even contemplate vocalising. They were low in energy and mood, curled up in their beds in the dark. After the session they had shining eyes, colour on their cheeks and smiles on their faces.
We have come a long way since 2009.

The British Lung Foundation no longer find the idea of Singing for Breathing too controversial and “outside the box” – in fact, they embrace it wholeheartedly. I am training 32 singing leaders funded by the BLF to take the work to people with COPD into the community. There is now a dedicated page on their website and more groups will be set up this year.

SOUND in ShakespeareMarch 19th: SOUND @ Chorus Festival 2016