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In Scales to Scalpels, Dr. Wong and Robert Viagas chronicle how the musical acumen of these physicians affects the way they administer healing and, in turn, how their work affects their music. What cognitive and emotional shifts occur when a surgeon transitions from the chaos of the ER to the discipline of the orchestra rehearsal studio? What’s it like to make a house call to a poor neighborhood in the morning and then play trumpet in a jazz group that night? Does music heal the doctors the way the doctors heal their patients? How does practicing the art of music transform the art of practicing medicine?
Overture to the Musician-Physician
Chances are, your doctor has a secret life.
As a musician.
When the patients all go home, the old magazines in the waiting room are stacked back into a neat pile, blood-pressure cuffs put away, and assorted medical instruments bathed in their disinfectant, many doctors then take out their other instruments—violins, violas, flutes, bassoons, cellos, contrabasses, tubas, French horns, oboes d'amore.... And they make joyful noise. Talk about a secret life! But the two sides of their personalities are more closely linked than you'd think. A burst of recent research is showing that music itself is a kind of medicine, a toning and a tonic for both the body and the mind.
I'm Dr. Lisa M. Wong, and I'd like to introduce you to an organization that has been a part of my life for over twenty years. As president of the remarkable Longwood Symphony orchestra, an all-volunteer ensemble consisting almost entirely of doctors and other health care professionals who, like me, are driven to play music. I'd like to take you by the hand and take you inside the lives of my colleagues who have two—and sometimes three or four—amazing skills. They use music to heal their patients, heal their community, and, often, heal themselves as well. They are part of the fascinating, growing awareness of the interplay between music and medicine. I'd like to take you backstage and show you the issues, people, research, and stories surrounding our orchestra and what we do.
Dr. Kimberly's Ride
When talking about the Longwood Symphony Orchestra, it all starts with our musicians. So let me introduce Dr. Heidi Harbison Kimberly, an emergency room doctor at Brigham and Women's Hospital here in Boston. Tall, slender, and muscular, with glasses magnifying her blue eyes, she has shoulder-length brown hair usually pinned up casually on the back of her head. She sits near me in the violin section where we meet every week.
Let's look over her shoulder as she is ending her shift late on the evening of a rehearsal.
She finishes stabilizing a trauma patient who barely survived a car accident. When she sees the patient is safely on the way to Intensive Care, Dr. Kimberly yanks her violin case from where she has stashed it under a desk. Colleagues used to ask her what it was—a 1930s Chicago mobster named Sebastiano Domingo apparently really did carry his machine gun in a violin case—but by now they're accustomed to her routine. She slings the violin case over her shoulders like a pack and dashes out to the rack where her bright red mountain bike stands waiting. She snaps off the u-lock, jams on her helmet, slips on ankle reflectors and switches on flashing safety lights, then leaps aboard and begins pedaling nimbly down the narrow street behind the hospital. Because of her position hunched over the handlebars, the violin rides up behind her head, pressing on her helmet and forcing her to crane her neck to see her way.
Her ride, a five-minute slalom through some of the top hospitals in the world, takes her backward through her career. Leaving the hospital where she works (and where she trained), she passes the hospital where she did her residency, then cuts through the quad of the Harvard Medical School, where she earned her medical degree. Ring-ringing the bell on her handlebars, she threads her way through the traffic and crowds on Longwood Avenue itself, then skids to a stop in front of the venerable Boston Latin School, where our orchestra rehearses. She's been riding this same route to rehearsal for the past eleven years. It's like the midnight ride of Paul Revere—which actually occurred only a few miles from Longwood Avenue with a much earlier Bostonian—except it's "the musicians are coming, the musicians are coming."
Parts of the Boston Latin School, founded in 1635, were already standing when Revere made his famous ride to warn of the British invasion. Dr. Kimberly patters up the steps into a hallway filled with her medical colleagues pulling their own musical instruments out of their cases and playing trills and arpeggios to warm up. It's very social. "How are things going? How was your vacation? Did you finish your surgical rotation? How were the Boards?"
"It's like a social parade into rehearsal," Kimberly said. "Finally someone starts clapping and yelling, 'C'mon everybody! Let's get going! Time for rehearsal!' And herding people in. I'm one of the ones who have to be herded."
However venerable its origins, the Boston Latin School band room looks pretty much the same as any high school band room. There's the same after-hours cleaning fluid smell, the same acoustic walls, the same lockers for instruments. Down the hall, the custodians are playing easy rock from their radios as they work, but over time have come to love our hearing our rehearsals so much that they have also become regulars at our concerts. Inside the band room, fresh young medical students alongside revered elder doctor specialists lend a shoulder to push aside pianos and drum sets to make room for their folding chairs and music stands. There's no air-conditioning, and the room becomes a sauna on summer days. Dr. Kimberly wipes her brow, swipes rosin on her bow, and arranges pages of music for herself and her stand partner.
Waiting on his podium is our conductor, Maestro Jonathan McPhee, erect and trim with grave blue eyes, swept-back dark hair, and salt-and-pepper beard. Put him in a commodore's hat and you'd think he could command a flotilla—which, in a way, he does. During his six years with the orchestra, he can be credited with raising the playing quality and diversifying the repertoire, and he commands respect from this band of perfectionists. Standing square-shouldered and calm, he waits for quiet.
Here before him is the Longwood Symphony Orchestra. They range from Type A personalities to Type AAA. Someone once compared McPhee's job to herding cats, but sometimes it seems more like herding pumas. Ambitious, driven, successful—and sometimes neurotic—pumas. McPhee makes an announcement or two, congratulates one member on a prestigious grant, another who is headed to Europe on a fellowship, yet another on a newly completed second or third doctorate, and announces the first piece to be rehearsed.
Dr. Kimberly, her odyssey from the ICU completed, tucks her violin under her chin and raises her bow. Without another wasted moment, the conductor raises his baton and begins.
I'm there too at every rehearsal, sitting in the violin or viola section. In my other life, I'm a pediatrician at Milton Pediatric Associates, a thriving practice south of Boston where I've worked for over twenty-five years. Helping children navigate through life in a healthy way is my passion, and I've been lucky enough to do it in association with talented colleagues at nearly every hospital on Longwood Avenue. Having heard about this unique medical orchestra through other musician-physicians, I joined the LSO in 1985, took a seat on the Board of Directors in 1987, and was elected president in 1991.
In my work as a doctor, I witness many miracles. In my work as a musician, I count the weekly music-making in the LSO to be equally miraculous. I've watched my musical colleagues, all remarkable people who do remarkable work and remarkable research—still find the time—still make the time—to create this remarkable music. By day, our musicians take their place in clinics, hospitals, and medical schools as internists, surgeons, oncologists, cardiologists, psychologists, pediatricians, and more. By night, they are serious, devoted musicians. They do it not for their own personal gain, but for the love of the music, the camaraderie and love of the symphonic art form, which brings more than a hundred disparate personalities and their instruments performing together in harmony. We're not alone. The Longwood Symphony Orchestra is just one of more than a dozen other medical orchestras in the U.S. And, to answer your first question, we do allow beepers to go off during rehearsals, but never during performances!
We play for an even more compelling reason—to raise awareness and support for medically-related charities in Boston. For twenty years, the Longwood Symphony Orchestra has its own unique way of collaborating and fundraising for these charities, which I'll discuss in more detail in future chapters. Over the years we have worked with organizations addressing such public health issues as domestic violence, homelessness, and hunger, supporting patients with cancer, hemophilia, and diabetes, to name just a few.
Why do we do it? Playing music is another way for us to heal. This book will break down the question into parts and, I hope, offer a few answers. But it's a tricky proposition. When you reach out your hand and try to touch the place between medicine and music, some place between the physical and the spiritual, you're coming close to one of the fundamental mysteries of life. It delves close to the core of what makes us human.
Medical Main Street
The Longwood Symphony Orchestra takes its name from Longwood Avenue—the main street of the Boston medical district where many of our players have their "day jobs": Beth Israel Deaconess Medical Center, Children's Hospital Boston, Brigham and Women's Hospital, the Dana-Farber Cancer Institute, and, as the street's centerpiece, the marble acropolis of the Harvard Medical School. Medical facilities of one kind or another have stood on this site since colonial days.
This street is the Broadway of Boston's medical community, and home turf to many of the musicians in the LSO. It's not a wide street, but, apart from a grassy mall where the Harvard buildings cluster, it's intensely developed in a jumble of old and new architectural styles. You can tell that some of these institutions have been here more than a century because there is often a classic-looking stone building with a newer concrete extension and then an even newer glass extension. And many building sport scaffolding and warning signs indicating that yet another expansion is underway. Longwood Avenue is a work perpetually in progress. New techniques, new technology, and new treatments mean new wings.
The hundreds of doctors who work on this street can't help but see themselves as part of a medical tradition that began long before they got here and is certain to continue long after they are gone. It's the same with the classical music we play. We are privileged to be a part of the ongoing musical tradition and do our part to keep it healthy and give it a long life. We are working and playing to ensure that both are here for future generations.
We combine two ancient archetypes: the healer and the troubadour. Perhaps at one point in the distant past they were the same thing: a traveling shaman who would play a rudimentary instrument, chant and use mysterious herbs and unguents to ease the suffering of our distant ancestors, or even to cure them. Perhaps that is why some of us are here today. The musicians of the LSO have found a way to bring both traditions into counterpoint.
Of the one hundred and twenty member musicians of the Longwood Symphony Orchestra, we use ninety in a typical concert. With our medical and scientific obligations, not everyone can make every concert and we have backups for each section. In this book you'll meet, among others, an occupational therapist who helped bring a patient back from a coma-like state with music, an emergency room physician who dashes from the ER to the concert hall, cancer patients who lessen pain and depression with melody, and a pediatric surgeon who shakes off tension by picking up her violin.
Many of us have "crossover" stories. One violinist's medical school professor shared a music stand with her in the second violin section. A cellist was appointed chief resident for the bassoonist's medical team. And it isn't unusual for sage advice to be shared by an old hand with the student cramming for a physiology exam during the rests. Or for curbside medical consults to happen during rehearsal breaks. Abdominal pain? Don't ask the violinist—he's a dermatologist. Better to seek the advice of the bassoonist, one of the best gastroenterologists in town.
These are people who touch your heart—in a few cases, literally.
"Plays" Well with Others
Both music and medicine engage the mind at its highest level. Performing with others and caring for patients in a team requires similar multi-sensory training. Ensemble musicians are making multiple high-level decisions at every moment—decisions about rhythm, pitch, harmony, tempo—constantly adjusting to who is playing and what is going on around them. Physicians, too, are making decisions about the intonation of the body, the rhythm of the heart, the pitch, harmony, and tempo of a patient's life. Both endeavors require emotional intelligence and close collaboration in order to achieve success. They demand focus, intent listening, and communication. When you're playing in a chamber ensemble or treating a patient, there can be no success without a key ingredient: empathy. Our hearts reach out for the feelings of others, whether we are trying to harmonize with a fellow musician or trying to understand the source of a patient's pain.
Dr. Kimberly is a case in point. Growing up in Springfield, Massachusetts, she reminisces about a home full of music. Her father is a cardiologist and violist and her mother is a violinist. One of her earliest memories is falling asleep to the sounds of her mother's chamber group practicing downstairs. Even today, whenever she gets together with her parents, they make time to play trios.
"My mother wanted to make music fun," she said. "And she believed that to do that, you had to play with others. Throughout my life I've seen again and again how right she was. Playing violin not only makes me a happier, more well-rounded person, I believe it makes me a better physician, better able to take care of people.
"I took a course in medical school called 'Living With Life-Threatening Illness.' They pair you with actual oncology patients who have terminal cancer and you're supposed to meet with them every week. I was paired with a woman named Judy who had ovarian cancer. We really hit it off and a big part of that was because she loved music. She told me she loved the music of Bohuslav Martinu, and I thought that was so amazing because Martinu is not a commonly known composer. She said she liked his music because it was so happy and joyful. Whenever she went to the hospital—which sadly became more and more frequently—she always brought music.
"At the end of the course, we were supposed to stop seeing the patients, but Judy and I kept in touch and even went to concerts together. They later asked me to speak at her memorial service. I wrote a letter to her family saying how she changed my life in medicine. I said I admired the way she confronted her illness. She wasn't sad or angry or bitter. She accepted that death was coming and decided to do things that made her happy. She liked to make ceramics, go to the beach—and listen to music. At the end of her life when she was confined to the hospital, she couldn't do those other things. But she was still listening to Martinu. It was so special and one more example of how music is such a deep-seated and emotional need. I can't listen to Martinu now without thinking of her."
We love our music and it is a constant struggle to keep our two loves in balance.
"Ultimately for me, the priority has to be the patients," Dr. Kimberly said. "There have been a lot of times when I'd be in the middle of something at work and trying to tie up loose ends so I could get to rehearsal on time. I try to hurry, but then I think, 'It's not fair to the patient.' If you have a sick patient, you can't really pass them off to the next doctor. So I finish it up and have that last chat with the patient's family, even though I know I will be late. At least with the LSO, everyone will understand.
"When you're a doctor, the intensity of it comes home to you, literally. When I don't have rehearsal, sometimes I go home and lie in bed and think about my patients all night. And I wonder, 'Did I do the right thing? How are they feeling? How tragic that accident was ...' I like to exercise a lot, but even as I'm running, I'm thinking about my patients. Even when I'm spending time with my kids, part of me is still thinking about my patients. It's a wheel that turns and turns constantly in your head. It's really hard to put aside.
"But when you're playing music, you can't have other thoughts in your mind. It's just the music. And you focus on that, and everything else goes away. In the end you can think back and put things in perspective a little bit.
Excerpted from Scales to Scalpels by Lisa Wong, Robert Viagas. Copyright © 2012 Lisa Wong. Excerpted by permission of PEGASUS BOOKS.
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Posted February 28, 2013
Posted February 5, 2013
You said youself that nothing would tear us apart... *his heart breaks* But fine...if you want to leave me i cant stop you... *leaves a box on the table* goodbye Rikki... *leaves*
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