You're wheeled into the operating room on a gurney, staring at the ceiling through a haze of sun-bright lights, and a mask-shrouded anesthesiologist suddenly looms over you and hollers, "Count backwards from 100 — if you can hear yourself over that Korn CD we're blasting at arena volume ..."

Actually, that's probably never happened at any point in the history of invasive medical procedures — and not just because most folks with an IQ sufficient to earn board certification as surgeons are intellectually beyond Korn.

No, by and large, you'll descend into chemically-induced sleep with no music but, rather, a hushed and comforting ambience that implies complete professionalism, confidence, routine and focus. Similarly, when it's over, you'll emerge from the general anesthesia in a quiet and peaceful — if perceptually foggy — environment.

While you're unconscious, though? And your gallbladder is being removed or a spinal fusion is being delicately negotiated? Well, that's a different story — or perhaps a different soundtrack.

It's a fact that many surgeons and operating teams perform their procedures to musical accompaniment; the familiar rhythms and melodies provide soothing textures in a very high-stress environment. As Dr. Patrick Doherty, assistant professor of clinical neurosurgery at Yale Medical School and the chief of neurosurgery at Lawrence + Memorial Hospital in New London, says, "Music really is a relaxant to me ... and the reality is that typically people are happier and do better and are more efficient if there's music playing."

Doherty is one of a group of physicians who recently spoke to The Day or answered email questions about the dynamics of playing music during surgeries. Comments ranged from the complex and thoughtful to lighthearted and surprising.

"The idea of music in the OR could at first be baffling (to the patient or outsider) because the image is that of a dead-silent cathedral, and it's not," Doherty says. "The reality is there's a lot of activity during every case. You've got machines monitoring the patient's pulse, blood pressure, respirations — and they all make noise. There's a hum of conversation — whether 'Hand me that instrument' or 'What's going on with that patient?!' — and alarms that can go off. And, for me, in a positive way, music has always been part of that environment."

Dr. David Reisfeld, a general surgeon at L+M whose cases vary widely from abdominal procedures to breast cancer and bladder cancer operations, echoes those concepts. "I find music relaxing and stress-reducing during surgery. I have to say my taste in music isn't the same as everybody else." He laughs and jokes, "Because I'm cultured. But, really, I have a pretty divergent playlist. Music is subjective, and the idea is to be sensitive at all times to the members of the (surgical) team when selecting the music played during an operation."

Each source for this story also emphasized that, although the interviews often veered in whimsical or even comical directions, the serious point to it all is that the music has a purpose and a place in the OR.

"It's important to note that the music is there as background," says Doherty, a New Jersey native who grew up in a music-centric household, absorbing everything from classical to Springsteen to '70s and '80s pop. He listens to a wide variety of music almost constantly, including reggae and Latin. But there's a certain criteria for music in the OR. "If it has a certain tonal quality and it's relaxing and lifts the mood, then it's OK. Otherwise? No, because the patient's safety is of the utmost importance and the music, if it's there at all, has to serve that."

Who's the DJ?

In that context, it might be reasonable to assume the surgeon might call the musical shots during any procedure. It's his or her hand holding the scalpel, after all. And it does happen. Doherty remembers a now-retired surgeon who insisted on listening to Elvis Presley and only Elvis Presley while he was operating. Doherty says, "Now, most people can listen to Elvis for a while. But there comes a point when Elvis has to go." He laughs. "Elvis needs to leave the building. And (the doctor) was a great guy and people loved him, but he had to have Elvis. So there are people like that but probably not so much anymore."

Dr. Jon Gaudio, a cardiologist at L+M who writes a monthly column for The Day (and also treats this journalist), says he has a colleague who operates to the Grateful Dead. Gaudio also refers to his father, an eye surgeon who's still practicing, saying, "Dad listens only to Frank Sinatra (in the OR), so much so his repeat patients get nervous if they don't hear Frank when they get rolled into the room."

Reisfeld loved classic rock as a kid — "the stuff everybody likes, for the most part" — but is a huge fan of '50s jazz vocalists including Billie Holiday, Ella Fitzgerald, Blossom Dearie and Beverly Kenney, and his surgical playlists reflect that.

"A lot of that stuff resonates pretty well in the OR," Reisfeld says. "There are a lot of complaints (from the surgical team) about it — not that it's a distraction but it's just not their thing. A lot of music in the OR can be a generational thing." He smiles. "Deep down, I think they really like it but they won't admit it. I like to think they don't appreciate it so much now but some day they will."

Dr. Ricardo Young, director of bariatric surgery at Backus Hospital in Norwich and a former U.S. Army surgeon who has operated in tents and on mountaintops during deployments in Afghanistan, can listen to a blues artist like Big Al Carson but says his OR playlists are weighted toward a club genre called "trance," which is a form of electronic dance music propelled by galloping, synthesized beats and washes of ambient soundscapes. If that sounds distracting, it's actually not: the form is very hypnotic and, well, as the name suggests, trance-inducing.

"I tend to think of the operating room as a fairly complex interaction with a certain rhythm following physical movements," Young explains. "(There are) cardiac rhythms, breathing circadian cycles, and so on. It's almost like a dance. Trance is fairly benign and provides a nice, smooth, perhaps subconscious stimulation — at least to me."

But plenty of doctors are happy to let team members provide playlists, including all the doctors spoken to for this story. After all, in any surgical procedure, there might be as many as nine professionals including nurses, technicians, anesthesiologists, and the physician's assistant. The surgeons all say it's not unusual to rotate amongst surgical team members in terms of whose music might be playing.

"It's good for morale," Young says, "and exposes me to musical genres I wouldn't have chosen myself."

The common denominators seem to be minimal distractions and nothing offensive to any team member. Gaudio says, "I don't really care what's playing, so the nurses usually put on bubblegum pop. We have one tech who likes '80s rock, so we let him play that, and there's a newer nurse with really eclectic tastes who cranks up Muddy Waters or Susan Tedeschi. Occasionally, someone will play metal, but I ask that they turn that off. I don't dislike metal, but it disturbs my concentration."

"There's no metal or rap in the OR," Young says, but that wasn't the case in his time as an Army surgeon. "When deployed, the adrenaline junkies congregated in the medical areas, and they loved metal. There was a lot of life and death stuff going on, so I could listen to metal (in that situation), but not stateside."

Perhaps surprisingly, the music Doherty can't listen to during surgery is classical.

"The harmonics and structures are too much," he says. "I find myself listening for the key changes and tonal elements, and it's all too much. I can't relax, so it doesn't work in my room."

Delivery system

The idea of doctors listening to music during surgery goes back to the early 1900s when, apocryphally, a physician lugged a phonograph into the OR — a concept considered not remotely sanitary by today's standards. Radios certainly found their way into the process, to be replaced by 8-track players, early cassette decks and boom/jam boxes, through CDs, and increasingly sophisticated digital MP3s that activate custom-made playlists or stream from music services like Spotify and Pandora that are incredibly easy to program to specific tastes.

Given the sophistication of MP3 players, the typical "soundtrack" to an operation is predictably smooth. Except ... Reisfeld says he's always asking his own kids what they're listening to so that he can further his own musical horizons. He'll make playlists based on what they recommend, some of which include hip hop.

"I thought some of it was pretty good," he says, "but the lyrics can be pretty bad. I'm also not technically savvy, so sometimes we'll be in the OR and one of those rap songs will pop up that I, ah, didn't intend to be there. The young people in the room don't seem to mind — they usually recognize the artist — but it's certainly a surprise when it happens."

What about the patient?

Since the patient is the focus in all this, do they have a say in what's played during their own surgery? Obviously, they're unconscious, but sometimes the physicians will field requests for specific songs the patient can hear as the anesthesia takes effect or wears off.

"Typically, I won't put music on before the patient is asleep," Doherty says, "because I normally have no way of knowing what music the patient might find objectionable and, again, our only priority is to treat the patient. Now, I guess if you're the one going into surgery and you want to hear something as you go to sleep, well, you should certainly hear the music you like."

On rare instances, the patient's requests go beyond that. Doherty says, "We once had a patient who was a musician who handed us five CDs of his personally recorded music to listen to because he wanted us to operate on him to HIS music." He laughs. "And, ah, we listened to it while he was going to sleep and we listened to it while he was waking up. And he was happy."