Nicole Steele, clad in a face mask and thin plastic protective cover over her shirt, strung a ukulele while 14-year-old Yaheim Young played alongside her. The two had a jam session on the ninth floor of the UPMC Children's Hospital in Lawrenceville.
They practiced a simple, three-chord progression that Steele taught to Young during an earlier session: Young set the basic rhythm with his strums—one, two, three four—as Steele filled the space in between with a more complex pattern.
Young has been in and out of Children's Hospital over the years, most recently since being diagnosed with diabetes.
In her job a music therapist at the hospital, Steele works with a handful of patients like Young each day.
"On top of having that therapeutic training and the counseling training, we are trained musicians, as well. So we have tools that we can use, be it guitar or piano or drumming, that we can connect to kids on a non-verbal and or verbal level," said Steele.
According to Noah Potvin, a professor at Duquesne University, music therapy saw rapid development as a field after World War II. When music was played for veterans, it seemed help them manage "shell-shock," or what we would today consider post-traumatic stress disorder.
Potvin said there’s research-based evidence in his field to suggest that music therapy is effective at reducing pain and anxiety, although the exact mechanisms are still a bit of a mystery.
"We’re now in this position where we’re trying to understand the how," Potvin said. "How does music impact the individual on this level? How do we get from somebody who experiences an eight out of 10 pain everyday of their life, but experiences a six out of 10 pain within a music therapy session?"
Modern music therapists are academically trained and practice in a variety of settings, such as in nursing homes, with outpatients and of course, at hospitals.
Steele is one of two music therapists at Children's -- Kory Antonacci is the second one. They spend most of their time moving throughout the hospital, hitting all the different units for sessions with patients of all ages.
Sometimes, they may just play while the patient listens. Other times, like with Young, they might actually teach them to use a certain instrument and play along.
"But the goals that we’re really working on inside that session don’t have anything to do with being a ukulele player," said Steele.
Those goals can vary depending on the patient and the situation. For example, Jaycee Park, a 14-year-old recovering from a multi-organ transplant, said she'll often have sessions with Antonacci in anticipation of an unpleasant procedure.
"[When] Kory comes before and cheers me up, it's always a nice distraction, especially if I'm having a bad day," Park said.
Antonacci also recalled another patient she had worked with in the past, who was a singer.
"She had to regain her breath support ... so [we worked on] that, retraining her body to be able to provide the lung capacity to be able to sing again," said Antonacci.
But the music can also serve as a bridge to a conversation.
"'What is it like to have to stay with us for 30 days here?' If I know they have they got some really hard information: 'what was that like for you to to hear that?'" said Steele. "[It's] processing that information, processing their emotions.”
Chronic illness and extended hospital stays can have a profound affect on children. They often miss their friends at school and the routines of normal life. Losing their hair to cancer may cause damage to their self-esteem. They may even be afraid of dying from their condition.
Scott Maurer, a pediatric oncologist at Children’s, said many patients won’t normally open up about these things to their doctor or nurse, but it’s important information for the medical staff to have.
"If we can better learn how to care for someone’s emotional health, we’re better able to take care of the whole patient," said Maurer.
He said sometimes it’s necessary to prescribe powerful drugs like opioids or benzodiazepines to treat pain or anxiety in his patients. These can be effective, but are also highly addictive.
So whenever possible, he prefers to avoid prescribing them and said one way to do that is collaborating with a music therapist to identify the root causes of these problems in the patient.
There’s a certain weight to that kind of work. Antonacci has been doing it at Children's for three years, and Steele for 12.
Steel said there have been plenty of rough days, but there are a lot of good ones too. And she doesn’t regret it.
“To be able to work with the patients and families and staff like this, it’s truly, truly extraordinary," she said. "I feel very, very lucky to do this work.”
WESA’s Bridges to Health series covers the well-being of Pennsylvanians and is funded by the Jewish Healthcare Foundation. WESA also receives funding from UPMC.