February 1, 2015


Madge Kaplan, Director of Communications, Institute for Healthcare Improvement (IHI), is responsible for developing new and innovative means for IHI to communicate the stories, leading examples of change, and policy implications emerging from the world of quality improvement in health care. Madge is also the host and producer of IHI's online audio "talk show" called WIHI, a program she conceived of and founded in 2009.  Madge came to IHI after a 20-year career in broadcast journalism for public radio. She began exploring non-fiction and playwriting more than a decade ago. Many of her essays have aired on radio or been published in print.  Her first play, The Last Appointment, was produced on Martha’s Vineyard in October 2011. 

Vocal Exercise

We approach the studio in the heat of the day, from the top of a small hill that nestles the locanda. We follow a narrow path downward bordered by open-ended views of Umbrian hillsides so breathtaking it’s easy to lose one’s footing and slam into the person walking just ahead of you. At the studio, we slip off our shoes and enter the cool, single room. Ten of us have enough space to each claim a piece of the warm, varnished floor, plop down a mat, and stretch out for some meditative five minutes. I squint at all the wood and glass and light, mingled with colorful shirts and shorts and human limbs. It’s quiet. Only the sounds of bees in the abundant rosemary and the occasional dog barking float through the open windows. No one wants to be the first to stir and sit up.
But, then we are asked to open our eyes, focus on our surroundings, and scooch back against the walls. While others are receiving one on one coaching in a building back up the hill - I can now hear faint piano accompaniment - we are getting ready for the psychodrama exercise. It’s designed, we are told, to help each of us appreciate and then reject the ‘no’ voices we carry around that keep us from singing full out.
The studio starts to feel quite warm, and sitting up against the wall, my legs begin to ache and I struggle to find a comfortable position. I stare at the clock wondering how I might manage to go last, or maybe not have to go at all if the hour runs out. I try to make myself small and unnoticeable.   
Someone volunteers to go first and is asked to stand up and approach the center of the room. She tells a brief story of being dismissed as having any vocal talent. Then, while the rest of us watch, the two teachers take turns giving the student a bit of a shove, quickly followed by more forceful pushes, until, provoked, the student starts to shove back and gains the upper hand and her right to sing. The hell with what other people think, especially unsupportive teachers and members of one’s own family.  
Amazingly, as the hour ticks by, everyone appears to have a tale of being told that singing was not his or her calling. In contrast to the very talented and encouraged, many of the students tell of being asked to mouth the words in their school (or church or community) choir and not to draw attention to themselves. The stories are heart breaking. Some people, including parents, were downright cruel.
Gradually, with the help of the group’s encouragement, all the negatives and the NOs are purged, drowned out by the chorus of the rest of us who are asked to yell, Yes, Yes, YES, repeatedly to the person in the center of the room. Then, each student reasserts her rightful place amongst the rest of us. We are legitimate singers. Forget what you’ve been told; stop comparing yourself to pop stars and anyone else you’re sure deserves to stand up and sing in front of others more than you.
Some students are literally sobbing over the experience and say they’re grateful for the exercise, even if draining. It’s cathartic I hear over and over again. One woman sits down next to me and whispers, “I could sing an aria, right now!” When it’s my turn, I’m at a loss for a tragic story. I wind up saying that my vocally talented older sister got the thumbs up for singing and that I never did. No one seemed to notice that I also had a strong voice. Maybe because it was deep and low as opposed to my sister’s soprano quality.  I must have suffered as a result. The teachers like this narrative, even though it’s not really true. The shoving begins; I shove back, harder than I imagined I would, perhaps in anger over having to pretend so hard in order to participate. I don’t cry. I can’t quite fathom why everyone is yelling YES at me, and then pulling me into a group hug. When I finally get to sit down, I wonder if anyone else in the room had grasped at straws rather than risk being outside the circle of pain. I have no idea because once the exercise is over, we’re dismissed and no one speaks of that afternoon’s experience again. 
~Madge Kaplan~

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