You can almost imagine the operating room sequence: scalpel, suture, Schubert.
And when heart surgeon Dr. William DeVries performed the second implant of an artificial heart in a human Sunday, the operation on William J. Schroeder was accompanied by music, and lots of it.
Muzak can forget it. This was Vivaldi, Mendelssohn, baroque lute music and jazz saxophonist Grover Washington Jr.
George Atkins, spokesman for the Humana Heart Institute International in Louisville, remarked, "DeVries likes to have music in the operating room. It breaks the tension of the procedure."
He did not add, but might have, that DeVries listened to Ravel's "Bolero" when he performed the first mechanical heart implantation, in dentist Barney B. Clark, two years ago.
It turns out that his tastes are not so unusual in today's operating rooms.
"Such music is very common here," said spokeswoman Jeanne Parkes of Georgetown University Hospital yesterday. "It's up to the chiefs of surgery. You name it. They bring in their own cassettes, and you'll hear anything from Bob Seger and country-western to classical. Though you won't hear the really hard rock. After all, they've got to communicate with each other during the surgery."
OR repertoire has even spilled over into that socio-pop portrayal of Hospital America, NBC's "St. Elsewhere." There the music is fitted to the personality of the surgeon. "Dr. Ehrlich gets the Beach Boys," said Larry Blaustein of Mary Tyler Moore Enterprises. "But Dr. Craig has had the Bach B Minor Mass, Mozart's 'Exultate Jubilate' and Handel's 'Nightingale Chorus' from 'Solomon.' "
The idea is that music actually enhances concentration of the surgical team.
"What it really is is background music," said Georgetown's Parkes. "And it is most common in the lengthy operations, where the work is very tedious and takes such a long time.
"When this building was built, it was designed for Muzak in the operating rooms, but because the surgeons prefer their own music, the system has never been activated."
A spokeswoman for George Washington University Hospital quoted Dr. Benjamin L. Aaron, the chief of surgery, as saying that the musical range there "could stretch from modern swing to classical, whatever strikes the surgeon as right." At GW the music can be piped in through an AM/FM system.
But not all agree that concentration is helped. One local surgeon, who asked not to be identified, said he had ceased having music during operations. "I don't like to keep anybody's mind off what they are doing," he observed, "and Lord knows you have to keep the nurses' minds on what's going on."
No one knows how much an anesthetized patient actually hears. But there has been research to the effect that a patient may subliminally hear more than was once presumed, with possible subconscious effects on postoperative well-being.
Dr. Jerome W. Canter, a Washington general surgeon, said there have been a number of such studies. "I think everybody agrees," Canter said, "that patients hear conversations and remember things that are said under anesthesia, and we try to keep that in mind."
Spokesmen at the Washington Hospital Center and Baltimore's Johns Hopkins Hospital said that surgical music in those hospitals is usually of the easy-listening variety. According to Dr. Sylvan Shane, an assistant professor of anesthesiology at Johns Hopkins, "Many surgeons just bring in their radios, and turn them to station WLIF, which is instrumental music, like the '30s -- none of this crazy, rock 'n' roll, 'lova-lova' stuff."
In addition, Shane and others at Hopkins are using music on the patients as well, through earphones, in ambulatory surgery. These include eye surgery, dental surgery, hernia operations, urological procedures and others.
Shane said that this represents a new trend in which the anesthetized patient can talk during the procedure, but does not remember it afterward. "We put stereo earphones on the patient with music to blot out the noise that normally occurs in an operation. The patient doesn't hear the instruments clunk, hear the suction noises or hear the surgeon complain when somebody passes the wrong instrument, or who knows what else. Stereo music really takes up both ears, and when we need to talk to the patient, we can break in."
Shane added that such techniques -- as opposed to general anesthesia, which actually knocks a patient unconscious -- are increasingly popular because post-anesthesiological complications are reduced and the chances increased that a patient can go home on the same day.
"As is sometimes said in this profession," said Shane, " 'If the patient doesn't go to sleep, you don't have to wake him up.'"