Vital Sounds
SYNOPSIS
Illustration by Eva Vázquez
Medical student and classically-trained cellist Melanie Ambler describes her most memorable concert, which took place over Zoom with only one other person in attendance.
LISTEN
storyteller
Melanie Ambler is an aspiring physician-artist. She is a cellist and second-year medical student at Stanford School of Medicine and works as a musician “on call” for Project: Music Heals Us. She graduated from Brown University in 2019 and was then awarded a Fulbright Fellowship to study music and dementia in Caen, France.
CREDITS
Hosted by Emily Silverman
Produced by Emily Silverman, Jon Oliver, and Carly Besser
Edited and mixed by Jon Oliver
Melanie’s story was coached by Charlie Varon, with support from Head of Story Development, Molly Rose-Williams. It was performed live at The Nocturnists’ “Together Again” show in San Francisco in June 2022, and in Chicago in September 2022 at the Women in Medicine Summit.
J.S. Bach, “Suite for Cello Solo No. 1 in G Major, BWV 1007:1. Prélude”; Mark O’Connor, “Appalachia Waltz”; Antonín Dvořák, “Going Home” performed by Melanie Ambler.
The Nocturnists original theme music by Yosef Munro
Additional music by Blue Dot Sessions
Illustration by Eva Vázquez
This season of The Nocturnists is sponsored by The Physicians Foundation.
The Nocturnists is made possible by the California Medical Association, and people like you who have donated through our website and Patreon page.
TRANSCRIPT
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The Nocturnists: Stories from the World of Medicine
S5 E4: Vital Sounds Episode Transcript
Note: The Nocturnists is created primarily as a listening experience. The audio contains emotion, emphasis, and soundscapes that are not easily transcribed. We encourage you to listen to the episode if at all possible. Our transcripts are produced using both speech recognition software and human copy editors, and may not be 100% accurate. Thank you for consulting the audio before quoting in print.
Emily Silverman
You're listening to The Nocturnists’ “Stories from the World of Medicine.” I'm Emily Silverman. Today we speak with medical student Melanie Ambler, who is also a cellist, and shares a story about the most memorable cello concert she’s ever performed, which happened to be over Zoom with an audience of only one person. In addition to her medical studies at Stanford, Melanie works as a musician “on call” for Project: Music Heals Us, which you’ll hear more about in the conversation that follows her story. She graduated from Brown in 2019 and was awarded a Fulbright Fellowship to study music and dementia in France. Melanie told her story live at The Nocturnists show in San Francisco in June 2022, and then as you’ll hear in our conversation, again in Chicago in September 2022 at a special show we did at the Women in Medicine Summit. And it’s that second performance that you’ll hear in this episode today. In the conversation that follows, we’ll talk about Melanie’s love of her instrument, her experience working with The Nocturnists story coaches, and a bit more about the work she’s doing at the intersection of music and medicine. I know you’ll enjoy Melanie just as much as I did. Here is Melanie’s story.
Melanie Ambler
It's been a bad week. I've had this lingering cold for over three weeks, and I've been coughing so much. And every time I cough, people think I have COVID, so I've been holding in my cough. And because of that, my entire body hurts. My abs have literally never been this defined in my life. It's also my first week of exams in medical school. I've never been this stressed in my life. I have no idea what is going on. I don't know how to study, and I'm terrified. My crush is also fully leading me on. He's being incredibly problematic, saying, "Oh, I'm just not ready right now." I'm like, "When's now going to happen? Is it going to be sooner rather than later?" I have no idea. And in my one moment of joy, I'm sitting in class, my friend tells me a joke. I laugh and my rib pops. It quite literally pops out, goes back in. And in my very limited medical knowledge, I know that that's probably not supposed to happen. And so I've spent the past few days sitting on my couch, hugging a pillow, watching Zoom lectures, eating a lot more Ben and Jerry's than I care to admit, just trying to get by. But it's reached Wednesday of that week, and I have a virtual concert to give. I started playing virtual concerts for critically ill patients at the start of the pandemic. And every Wednesday, I sign on. I connect with the Veterans Affairs Hospital in Denver, Colorado, and I play one-on-one concerts for patients. Normally, it is the absolute highlight of my week. This week, I am dreading signing on. But I've made a commitment. So I get up off the couch, put my spoon in the sink, go grab my cello of 17 years--her name is Shelby, longest relationship I've ever been in--open, my door walk into my room, go into that familiar corner between my bed and my wall with just enough room for my bow to pass. I open up my computer, plug in my little USB microphone and click that familiar blue Zoom logo. And immediately Tim's face fills the screen. Tim is the pulmonary critical care doc that I've been working with for the past two years on this project and he is the most wonderful human being/mentor/role model in my life. And not even his smile can cheer me up that day. So instead, he goes into telling me a little bit about the patient that I will be playing for. He says, "Melanie, Mr. N is the first patient that we found for you today. He's been here for a while, but he's actually going home today and he would really love to hear some music." So I plaster on my best smile. And Tim takes me on the little iPad and on the rolly cart and he walks me through the hospital, through the halls. I see nurses stations and we walk in to Mr. N's room. And the first thing I hear is the heart rate monitor. And next the screen tilts down and Mr. N comes into view. He's just kind of sitting there in a chair right by the window, and he's ready for some music. So I introduce myself, fake smile, in pain. I say, "Hi, Mr. N. My name is Melanie. I'm a first year medical student calling in from sunny California. And I heard that you're going home today. I have the perfect piece for you."
Unlike y'all, Mr. N did not like that piece. He just kind of looks at me. He says, "Melanie, can you do something for me?" And I'm thinking, "Sure, I'll do something for you. I'm not in enough emotional, physical pain. Of course, what would you like?"
"Can you play me something from your heart?"
My fingers buzz with the warmth of just having played. I can see those familiar indents from the strings. And as those begin to fade, this familiar tightness forms in my right hand from holding the bow. I feel no pain
Mr. N has melted into his chair. His eyes are hazy, as if he's just woken from a long sleep. He says, "Melanie, a piece of your soul just entered my body."
I play this piece, "Appalachia Waltz," for almost every patient that I have the pleasure of meeting. "What does it do for you? Where do you feel it in your body? Where do you go? Where do I go?" I keep a journal of all of these interactions and these stories. And some patients have told me that it's as if they've lived through their whole childhood over the course of a single day. Another said that it was like going through a slow-moving roller coaster in a hallway and every door that opened, a new memory would swing into view--one was of his children, another was of his wife, and the last was of his mom who had just recently passed. But why do I keep that journal? Is it for my ego? Maybe a little bit. But I think more so it's to delve deeper into those moments, to stay in them a little bit longer, and to continue to suspend time. Growing up, my mom used to share this saying with me and my brother. She would say, "I'm the center of the universe. I'm a speck of dust." And when I'm playing these concerts, for an audience of one, they are the only universe that I see. I'm able to ask them questions, to meet them where they are, to see them as universes, not as specks of dust. Whereas when I'm here, I'm sitting on stage, I see more specks of dust than I see universes.
And on Zoom, of all places, I feel that magic. I feel big. And the patient is able to share part of their story with me. How does this even relate to medicine? As a second year medical student now, shit's getting real. I'm going to have to start going in the hospital soon. I have to interview patients. They're going to ask me questions. I'm not going to know the answer to them. And I feel, already, conscious incompetence. I know that I do not have the answers. And yet, playing these concerts in a medical setting, a patient can ask me a question like, "Play me something from your heart?" Or, "Can you do something for me?" And I can actually do what they ask and what they need. And as someone who's just starting, I get that feeling of fulfillment that I think a lot of you get every day with your patients. And that's something special. That's something healing for me, and hopefully, for those that are listening. So Mr. N and I, we talk for potentially longer than I play. He tells me about his life and I confide in him that I was having a pretty bad week. And he just goes, "I know. I could tell." We both needed that. And so I realize as we're wrapping up that the time is running low; I have another patient to play for, and that I have one last song for him, aptly named, "Going Home."
Emily Silverman
So, I am sitting here with Melanie Ambler. I almost said "Dr. Melanie Ambler". But you still have a little while till you get your MD; is that right?
Melanie Ambler
Yeah, I'm a second-year medical student at Stanford School of Medicine.
Emily Silverman
Do people say "student-doctor" Melanie Ambler"? Or is that phrase out of style?
Melanie Ambler
I've heard that that started being used more, recently, for doctors and preceptors to introduce their medical students as "student-doctors", but I've never been called that.
Emily Silverman
Okay. You just say that you're a med student?
Melanie Ambler
Yeah.
Emily Silverman
Okay, cool. Well, Melanie, I feel like I've actually had the pleasure of getting to know you a bit more than is usual for Nocturnist storytellers. I think, first because we live in the same geographic area. So, I'm in San Francisco; you're down in Palo Alto. I've also been down to Stanford a few times. So, we met there. And then, you told a story at our show in San Francisco, and then you told the story again in Chicago. And yeah, we've just been able to hang out a bunch. So, I'm so excited to share your story with The Nocturnists audience, and, also, just to hear a bit more from you about the amazing work that you're doing.
Melanie Ambler
Yes. Thank you so much for everything. It's been a wonderful experience, and also super special to be able to work on the story, twice actually, and have the experience of working with two coaches.
Emily Silverman
Yeah, so walk us back to the very beginning. So we put out the call for stories related to the theme of "together again", and you submitted this amazing audio clip, where you were talking and, I think you played cello. And you sent that in initially. So, did you know you wanted to do, like, a hybrid music/story? And what was it like to send in that clip?
Melanie Ambler
I honestly didn't really know what I was doing, when I was recording the first story. I had just recently had an incredibly powerful experience while playing a virtual concert for a patient, and thought that the theme of "together again", fit perfectly with it. And, that I was experiencing being together with someone, but not physically. And there's something about sharing a moment, virtually, that I didn't expect to feel that amount of togetherness, but I did. And so, my initial story recording was actually me essentially free associatively talking about this one particular piece: "Appalachia Waltz". And, it was a very rambling saga of all of the different times that I've played it. And, because I was talking about this piece so much, I decided to just do it with my cello as well and...and the recording, with that particular piece. And, I wasn't really expecting to hear back. I kind of did it as an exercise for myself, because I've really been wanting to explore storytelling more, and had considered writing about this particular experience. But there was something about the written word, that I felt couldn't capture what I wanted to capture. And so, having the opportunity, just within my own room, to speak out loud and recorded, helped me conceptualize what exactly these concerts are starting to mean to me. And I remember just saying, "this feels like therapy." Because there's something very intimate about sharing my music, and what that music does for me, with other people.
Emily Silverman
Yeah, I always like to joke that story development is half story development, and half therapy in a way. Because, in order to respond to the story, and let the story guide us to where it wants to guide us, we have to, like, kind of surrender, and also explore, and figure out what are our motivations for telling the story. And, I know that I've been really humbled by that process recently. But, before we get there, tell us a little bit more about your relationship to your instrument. So, when did you start playing the cello, and how did that weave its way into your medical journey?
Melanie Ambler
I grew up in a small town in Connecticut, called Redding, and my little public elementary school had an incredible music teacher... actually multiple. One was named Kathy Weiss and the other, Mary Jane Rogers. And they both had such enthusiasm for music. My grandmother was a harpist and music historian. My mom is a pianist and harpist. And so music had always been present within my life. But, in third grade, we had the opportunity to choose a stringed instrument. And there was this one day where four different instruments were represented at this class assembly, and they had older students come and play each of them, and show us what they sounded like. And then we could fill out a form if we wanted to play one of the instruments, with our top three choices. And so I listed: violin first, then cello, and then viola. And, I don't know what happened. But I got home that day, and I had my first of many existential crises. And realized, I actually want to play the cello. What am I doing? And so I called Dr. Rogers, and I said, "Can I please change to cello?" And she, of course, hadn't even looked at the forms yet. And she said, "Yeah, of course, no problem." And so, we went out and rented a little half-size cello. It really was something that I immediately fell in love with. I never once was asked to practice by my parents. I just wanted to play all the time. And every single night, I had this routine where I would have dinner, then I would play cello, then I would take a shower, and then watch a little show, and then go to bed. And that's just kind of what I did. And I then started working with a private teacher and playing in an orchestra. And that started an entire journey of cello and music really being inseparably tied to my identity and what I love in life.
Emily Silverman
When you got to college, and then med school, did you bring your cello? Were you playing the whole time? Or did you have, like, a period of years where it was sitting in the closet gathering dust? I feel like that happens with a lot of people. But, maybe for you, you were more engaged.
Melanie Ambler
I've never had a break. I almost feel that playing my instrument is required for my well-being, which I guess is a pretty healthy requirement. But, from age eight all the way up until now, I don't think there's been a longer span than a few weeks or months. I broke my thumb, so I couldn't play for a little bit. But it was usually an outside cause, not a decision that I made myself. I got the cello that I currently have (whose name is Shelby, after the Delta Airlines representative that helped me book a ticket for her one year), and I got that when I was sixteen, and since then, have kept her with me. And I brought her to college at Brown, which... I think you also went to Brown, which is exciting. And then, brought her out to Stanford with me, once I came here, I did have a brief stint where I had to rent a cello, because I was living in France, and I could not bring Shelby with me. But she's always been there. And, I think I'll likely have her for the rest of my life.
Emily Silverman
All right, well, let's get to your story. So, you're in med school, this pandemic arrives, and you start to volunteer to do these virtual concerts for patients. And you decide that that means something to you. Maybe you're not exactly sure what or why or how, but it feels important. You submit this story idea to The Nocturnists. And you get paired up with Charlie, your first coach. Tell us about working with Charlie on that story.
Melanie Ambler
Charlie is like a warm hug. He, first of all, loves the cello; has worked with a cellist before. So that was really nice. He also went to Brown. And, working with him required a lot of intention, when I signed on. He asked questions that I often didn't have the answer to. He also worked with me a lot on phrasing and pauses, and how the organization of the story could go from what I submitted (which was an absolute hot mess) to something that was digestible, understandable, moving, and still kept the core of what I wanted to get across. That was no easy task, because I had a lot of information in my first recording. And then, we really went through together, and created a skeleton of the progression of how I wanted to express the meaning of these concerts. And we started shying away from the importance of the specific piece that I had initially talked about, to this one specific interaction that I had with the patient. And by doing that, it grounded the story, and allowed me to explore a lot more of the emotion surrounding that, and going into the moment. So, he's all about putting yourself back into the exact second that you're experiencing something. And the fact that storytelling is kind of like chewing gum: You can either choose to compress it, and say two words about a moment that could span days, or you could spend minutes talking about a sensation you felt for five seconds. And, that's a really special part of storytelling that I hadn't really explored before, and he helped me discover that for the first time.
Emily Silverman
And what was it like to perform that story on the stage in San Francisco?
Melanie Ambler
It was so special. I'm smiling right now. I was lucky enough to be in a location where some of my loved ones were able to attend, as well. My mom was in the audience. And, I felt this sense of community, and peace on stage, that I honestly have never felt before playing cello for a live audience. And I think it was partly the fact that so many other storytellers were there, also opening up and sharing moments that are near and dear. And also this communal... again, sense of "together again", which was the theme of the show. The show started with you, Emily, leading everyone in this meditation and recognition of the fact that we were all together again. And we had these little light-up candles that were under each seat. And I remember looking around and just seeing little orbs of light, kind of floating, in the dark, in this theater. And, that set the stage for an evening that I really won't ever forget.
Emily Silverman
And then you get an email that says, "Come to Chicago." And I can't...Did you bring Shelby to Chicago? Or did you have a sub?
Melanie Ambler
I did not. I cheated on Shelby. I had a Belgian cello, named Thomas. Born in 1997, just like me. We had a little one-night stand in Chicago. And then I came back to Shelby. I mean, they say, "What happens at conferences, stays at conferences." So...
Emily Silverman
That's right, absolutely. And, you mentioned that you have harpist in your family, which I didn't know. Because at that event in Chicago, which (for the audience) was the "Women in Medicine Summit" at the Drake Hotel in Chicago. We had a, sort of, mini-show that was in this beautiful ballroom with crystal chandeliers and this really old-school space. And it was, again, a mini-show. There was three storytellers, and then we had an OB/GYN, from Chicago, come with her harp. So, it was so cool to see, like, this OB/GYN with her harp, and then to see you, with this cello. What was that like for you? Because, I'm smiling now. Because I just thought that was such a cool night.
Melanie Ambler
Audrey was incredible, the harpist. And, for me, it was so special, because I walked in and I saw this harp. And I said, "Wait." This is exactly the image that I associate with my family and music. My grandmother's harp... We have inherited it, since she passed away in 2019. And it sits in our living room, this majestic 100-year-old, gold-plated, ornate harp. And then to walk into this new event, and see the harp. It was again a sense of comfort that I felt, and excitement to hear Audrey play, and also share this passion for music with another medical provider a little bit further along in her training. So, that was just wonderful. And also, being at a conference for women in medicine, surrounded by the most badass women that I could imagine, just starting my career. And oftentimes, I think, at conferences, as a medical student, you don't necessarily feel like you're contributing much. There's more so a sense of, "Oh, who can I meet? Who might I be able to network with? What conversations are going to be meaningful?" And so, to have the opportunity to be someone that could contribute, gave me a feeling of belonging in the medical field, that, as a student, I think oftentimes, we don't feel like we're quite there yet.
Emily Silverman
And the Chicago version of the story was a bit different. And for this one, you worked with Molly. So, talk about working with Molly.
Melanie Ambler
So, Molly is a dancer. And, because of that, we discovered kind of this mutual understanding for what it feels like to reach a flow state within your art... more so than the structure or anything, that Charlie had kind of done the brunt work with me on developing. And so, Molly and I spent more time getting into those moments, and being present with them. And I remember two things from our coaching, which still were so powerful to me. The first was, she did an exercise with me that she'd never done before with anyone else. She had me say the end of my story as all questions. Once I did that, then she had me do it again. Ask questions again. But she would ask the same question back to me. And so for example, I would say, "Where do you feel the piece in your body?" And she would repeat, "Where do you feel it in your body?" And we did that, for the whole rest of the story. And I wanted to answer her questions, but that wasn't the exercise. But because of that, I started discovering the answers to those questions. And then, it changed the entire ending of the piece. The second thing that she had me do was, set an intention for the show in Chicago. And so my intention was, in the end of that story, when she had had me ask questions of myself, that I would be fully present in the thought process, and essentially improv it. I had a few parts of the skeleton that I knew I wanted to include, but then it was just, kind of, see where my mind goes in the moment and trust that. And I did, and the energy of the room changed. And that was really, really cool.
Emily Silverman
How did the energy of the room change?
Melanie Ambler
So, we were performing during a dinner, kind of dessert, reception. And, in the beginning of the story, people were eating. I could hear a lot of background noise and conversation. After I played the first part with my cello, I think there was slightly more engagement; I could feel more attention on me. And then once I started that end portion, there was absolute silence in the room. It was powerful, and I didn't honestly know that I was capable of doing that.
Emily Silverman
I was sitting at a table in the front. And, I think... Your story was the third story; it was the final story. And, I remember, you got up there, and you're right... Like, there was some commotion in the room, and you're sort of looking at me, and you were, like, "Should I begin?" And I was, like, "Just begin; just begin." And, yeah, over the course of the story, like molecules that were all scattered. And then, by the end, they were all just aligned and like pointing right at you. And yeah, what you said, "I didn't know that I was capable of that." I'm just wondering, like, how does that tie in with your journey as a med student, who is so early in the learning curve? It's so easy to feel scared, all the "imposter syndrome" things that we deal with as med students. So, how did those things settle out for you after the performance?
Melanie Ambler
They're still slightly at odds, I would say. But having that experience, as well as one other experience, performing here for a Stanford Medicine big-donors event, on a huge stage playing for pretty important people in medicine, and realizing that I have a contribution to make within this community. It's not the typical power we might associate with medicine, and with the hierarchy that's in place. And yet, through music or through art, I've received respect. And that helps me build my confidence, to realize that when I am interfacing with patients and speaking with them, that's also an art form.
Emily Silverman
You're continuing to do these virtual concerts for patients, and you said you have a journal where you take notes after each virtual concert. You also mentioned linking up with a program that organizes this. So talk a bit more about the virtual concerts that you do, and the framework under which you do them, and how that all works.
Melanie Ambler
When the pandemic first started, I received an email from one of my professors at Brown, of a New York Times article that was explaining a program called "Project: Music Heals Us", that was doing virtual concerts for critically ill patients. And, I read this article, watched the accompanying video, and knew that I had to do something similar. So I called up Tim Amass, who's the dad of two children that I used to nanny in Providence, actually, and is also a Critical Care physician now based in Denver, Colorado. I just said, "Tim, can I please play for your patients?" And he said, "Yes, anything. I need something to give them." Because visitation was totally limited. These patients were alone, often dying alone. And the healthcare providers, also, were just strapped for resources. And so, I started playing concerts for his patients, very much on-call. I was at my parents' house, not doing anything; basically applying to medical school. And he would just call me randomly and say, "Hey, can you hop on for 10 minutes, I have a patient. They would love to hear some music." And so that began this journey. And then I, serendipitously, was connected with the founder of Project: Music Heals Us, which was the nonprofit that had been featured in The New York Times, and began a partnership with them. We shared best practices, and decided that, as I was going to medical school, it would make the most sense for me to, kind of, just merge with them. And so, now I'm a part of their "Vital Sounds Initiative". And we're still playing concerts in Denver, Colorado with the hospital that Dr. Amass is associated with, and have also formed a partnership with Stanford recently. They just rolled out their first concert last week, actually, in a transfusion center and inpatient psychiatric unit. And, we're also starting the first research study on this virtual concert program at Stanford, as well. So, it's very exciting. Lots of new opportunities to actually study what we've already put into practice.
Emily Silverman
So, what do you see? Do you see yourself continuing to do this kind of research? Is there a particular domain of "Music and Medicine" research that especially interests you? For example, like music and critical illness, kinda like you were doing during COVID? Or music and dementia, like different diseases or different patient populations? Or just... Are you more interested, generally? Like, where is your heart leading you, in this "Music and Medicine" journey?
Melanie Ambler
Right now, my heart is leading me towards the practice of "Music and Medicine", more so than the research of "Music and Medicine". So, I've previously done work in music and surgery, music and dementia, music and pediatric anesthesia. And now, music and critical illness. And, for me, the most fulfilling things have been when I've been able to share my music, or when I've been able to witness other people benefiting from either listening to a playlist or getting a concert themselves from someone else. I think the research is important, and something that I love being a part of. But, the personal fulfillment is very much in the direct interface with patients.
Emily Silverman
Well, I cannot wait to see how things end up, where you end up, what you end up doing. You're not far, so I'll have my eye on you. And maybe, just to close, any final message or thought that you'd like to share with The Nocturnists audience?
Melanie Ambler
So, someone shared this with me earlier this week... I was having a little bit of a rough week, and they just told me, "Melanie, do something kind for yourself today." And so, whether that be listening to your favorite piece of music, drawing a picture, going outside... I think living by that philosophy is really important, and can do wonders.
Emily Silverman
I have been talking to student-doctor Melanie Ambler. Melanie, thank you so much for telling your story on The Nocturnists stage (twice), and for being here with me today.
Melanie Ambler
Thank you so much for having me.