Sister Mitzie's piano: Music helps soothe Riverton woman's traumatic brain injury
By Kristy Bleizeffer Jul 6, 2021
If things had gone as planned, Rev. Michael and Mitzie Brumback would have been in Branson, Mo., on June 10. They would have left the day after Mother’s Day and drove to Illinois to see Mitzie’s 90-year-old dad and her brother who was recovering from heart bypass surgery. They would have spent time with their son and his family. Finally, they would have ended up at their sister-in-law’s timeshare in Branson, one of their favorite places on earth, to celebrate their 49th wedding anniversary.
Instead, on June 10, Michael walked Mitzie out of room 651 of Banner Wyoming Medical Center where she had spent the last 36 days. They rode down the Center Elevators and strolled past the cafeteria. He helped her to the bench in front of the baby grand piano on the second floor lobby and listened to her play as a crowd gathered and suggested church hymns.
“It was like a light switch, and she became Mitzie again,” Michael said. “I saw the real Sister Mitzie at the piano for the first time in a month. I saw her love of music.”
A terrible fall
The Brumbacks’ plans changed on Wednesday, May 5 – three days before Mother’s Day. It had already been a busy week. First Assembly of God Church in Riverton was planning a big Sunday celebration, and Mitzie had special gifts all laid out around the house for the congregation’s mothers. The Brumbacks had led the church for 10 years and Mitzie led the congregation in gospel songs and musical worship every Sunday, singing in front of an electric keyboard. Everyone called her Sister Mitzie.
Prior to moving to Riverton, the couple ministered in a Chicago suburb for 20 years. It’s where their children grew up and graduated from high school. Mitzie also grew up in Illinois where her mother owned a music store and she learned to play several instruments. At the time, Riverton, Wyo., felt like a world away.
“It was a big change for us, but we knew that God was leading us to Riverton. We know that we were called there,” Michael said.
On May 5, the couple prepared for Sunday’s service and made last-minute arrangements for their anniversary trip. At about 7 p.m., their son called. He stored a few boxes of his belongings above his parents’ garage, and he wondered if they could bring a couple to him on their swing through Illinois.
Mitzie and Michael went to their detached garage and Mitzie grabbed the ladder. Michael asked her to wait a minute so he could run back to the house and get the new, portable flood light he’d just bought at Home Depot. Mitzie didn’t wait.
“Well, you got to know Mitzie,” Michael said. “She never stops.”
He heard the ladder crash while he was still outside.
Traumatic Brain Injury
T.B.I., or Traumatic Brain Injury, is sudden damage to a part or some parts of the brain as a result of a blow, jolt, or bump of the head. It can both kill brain cells and cause little tears in neural pathways, disrupting connection between different regions of the brain. Symptoms vary depending on the area of the brain damaged as well as the mechanism and severity of the injury.
“That said, there are some common themes or symptoms we often see in TBI survivors: Irritability or short temperedness, changes in personality or behavior, poor judgement or insight, memory problems, fatigue,” said David B. Wheeler, MD, PhD, FAAN, FAES, FAHA, a neurologist at Banner Wyoming Medical Center.
Based on the severity of her injuries, doctors figured Mitzie was about 6 to 7 feet off the ground when the ladder kicked out from beneath her. The knot on her head swelled to the size of a grapefruit, which was actually a blessing because it relieved pressure on the brain. Her skull fractured in four places. She broke her tailbone and fractured the orbital bone around her eye. Blood trickled from her right ear and nostril, and they feared she would lose her hearing.
“Which would just be awful because of her gift of music,” Michael said. “She has perfect pitch. She plays not only piano but also guitar, bass, saxophone. She’s a very gifted musician.”
Mitzie was life flighted from Riverton at about 11 p.m. Michael and two friends from church watched as she was loaded onto the helicopter. At that time, Michael didn’t know if she would be flown to Salt Lake City, or Denver or Billings or where. “We just prayed together out there on the pad that she would be taken to the place she needed to be. And it was here, in Casper.”
Mitzie spent the first couple of days in the Banner Wyoming Medical Center ICU before she was transferred to room 651 of our Neuro Unit, which specializes in injuries and illness of the brain. Mitzie exhibited several of the symptoms common in T.B.I. She grew agitated when confused and paced around her room. She had a hard time remembering simple things and interjected conversations with anecdotes from years earlier. She wanted to go home and was frustrated that she couldn’t.
Typically, brain injuries require lots of quiet, rest and calm in order to avoid overstimulation. After a couple of weeks, however, Mitzie’s agitation hadn’t subsided.
“In Mitzie’s case, I think she was the type of person who is used to getting a lot done, so it was kind of like recognizing her for who she was before the brain injury,” said Tamara Thomson, R.N., Neuro Unit nurse manager. “Trying to shield her from stimulation, I think, frustrated her even more. Each brain injury is different, and we really try to see each patient as an individual. So I decided that we were going to try something different.”
Mitzie’s care plan started building in more walks around the halls and even supervised trips outside. It seemed to help and her moods evened out. Then, on June 9, speech therapist Rebecca Lewarchik approached Tamara with an idea: What if they took Mitzie to the piano in the hospital lobby?
The healing power of music
Banner Wyoming Medical Center believes that music promotes healing. At Christmas, you can often hear carolers serenading patients and visitors. The Wyoming Symphony Orchestra’s Music on the Move program brings performers into the hospital to play for anyone who’d like to listen. But we’d never had a structured, intentioned musical therapy program until March 2020. That’s when we partnered with VIBES Fine & Performing Arts to bring in a board-certified music therapist to work with longer term patients.
“The benefits of music are actually really dramatic on all sorts of brain injuries, particularly traumatic brain injuries,” Dr. Wheeler said. “There’s a whole emerging and rapidly growing field of science related to how music, and specifically music therapy, can help people recover from various types of brain injuries. Folks for whom music was a really important part of their lives, that kind of intervention seems to be even more effective.”
Music therapy is used in care settings around the world to help treat a variety of medical conditions: depression, heart disease, high blood pressure, Alzheimer's disease, brain injuries and more. By definition, it is the “clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional,” according to the American Music Therapy Association. The mechanisms of how it affects brain injuries is still largely unclear, but research suggests that by stimulating the parts of the brain that recognize, appreciate, read and/or perform music can create alternate pathways within the brain to get around the areas that were injured.
“Activities that activate large areas of our brains – like listening to or performing music, reading literature or moving our bodies in dance or athletics – are profoundly effective in helping the brain create new pathways for other functions. Not just for appreciating music, but for other things that we need to do every day,” Dr. Wheeler said.
“When a brain recovers from a traumatic injury, there is a little growth of new brain cells but not very much. There is, however, a lot of rewiring and remapping of the brain’s connections, which plays an incredibly important role in recovery. Therapies like music help to open these pathways and make them more supple and alive; they help wake them up, so to speak, so the pathways are open to learning other tasks other than just listening to music. They can be used to relearn how to move your body, or read a book or other tasks of daily life.”
Dr. Wheeler prescribes music therapy for his patients with dementia and Alzheimer’s, and music therapy would have been ideal for a patient like Mitzie. Unfortunately, the pandemic put a halt to our program just a few weeks after it had started. Dr. Wheeler wants to see it relaunched soon.
For most of her time in the hospital, Mitzie’s progress board in her room listed the same date for her anticipated discharge: “Unknown.” Her brain was still broken and she would need a lot of support and care when she was released. She required constant supervision because a fall and another bump to her head could be devastating.
On June 9, Mitzie made her first trip to the Samick baby grand piano on the second-floor lobby, donated by Dr. Mark and Caryn Dowell in 2019 to invite the community into the hospital and fill it with music. Mitzie played songs she and Michael learned in church in the 1950s. She could play upon request, with little to no hesitation, and her fingers remembered which notes to strike. Michael wished you could have seen Sister Mitzie play.
She went to the piano again on June 10, her 49th anniversary. Dr. Wheeler, Tamara and her care team were so impressed with her progress that Tamara pulled Mike aside and offered to buy him a cup of coffee.
“Mike, would you like to take Mitzie home?” she asked.
Mike started crying. “That’s the best anniversary present anyone could have given me,” he said.
The couple’s daughter arranged to come live with them in Riverton, and there were of course other plans to be make. But, the date on Mitzie’s discharge board was changed to Sunday, June 13.
“It was very healing to me to know that Mitzie was being cared for by loving people in this hospital,” Mike said. “Talking to them and hearing their stories and how they got into health care, they are a lot like me. It’s not a job, it’s calling. I look at them as ministers. Similar to how Mitzie and I minister to people, they minister to people in a different way.”
On the Friday before they left, Mitzie’s therapy team visited one last time to offer final discharge instructions and help Michael with the transition.
“Keep in mind that when you do get back to church, you’re going to have to be an advocate and help people understand,” the therapist told him. “Her communication is a little broken right now, she may become agitated more easily, and make sure she has the best support system ever.” As in life, Mitzie’s recovery would not be linear. She would have good days and bad, ups and downs. Don’t be discouraged by the setbacks, understand that they will come and move past them.
Michael nodded that he understood. He asked questions and took notes. He already had a slew of church volunteers lined up and ready to help, for as long as it took, until Sister Mitzie was in front of the church piano once again.