Great performances, poor players

Medicine is a learned profession, but clinical practice is above all a matter of performance, in the best and deepest sense of the word. —Frank Davidoff, M.D.

Years ago I recall watching a television documentary on Arthur Fiedler, the conductor of the Boston Pops orchestra.

The camera caught Fiedler backstage, stooped and shuffling slowly about as he struggled with his tux in preparation for the evening performance at Symphony Hall. He looked like the old man he had become—tired, fatigued, worn out. But then, as he stepped out onto the stage, a miracle happened. Fiedler’s frame straightened, his head lifted squarely onto his shoulders, a big smile flashed across his face. Proudly, he assumed his position at the head of the orchestra, pumped up by the thunderous applause.

We are what we are; we become what circumstances require of us.

Fiedler’s transition occasionally flashes through my mind as I step across the threshold into an exam room to meet a patient. Almost always I offer a big smile and extend a hand in greeting. I attempt to hold my composure throughout the interview, adjusting my demeanor to reflect the emotional state of the patient. I become, as it were, a player on stage where the art of medicine is performed countless times in daily rounds.

I might move from an encounter with a new mother, freshly primed by a healthy, thriving infant to a silent teenager, subdued in the throes of a depression. In each case I’m cast as best supporting actor, called to muster my emotive repertoire at a moment’s notice.

Sometimes I don’t feel up to the task; I’m drained, exhausted, spent. Sometimes I want to turn tail and run as fast and as far as possible to distance myself from the suffering I witness daily. I want to cover my ears, shut out the woes, the aches and complaints, for I have more than enough of my own.

None of this is permissible, of course. The patient has come seeking expertise, care and compassion—what does it matter how I, the clinician, might feel?

Here Osler’s wise words of comfort seep into my mind:

Dealing as we do with poor suffering humanity, we see the man unmasked, exposed to all the frailties and weaknesses, and you have to keep your heart soft and tender lest you have too great a contempt for your fellow creatures…

Even I, a poor player who daily struts and frets his hours upon the stage of clinical medicine, am not one to wallow in self-pity. Ultimately, I can not run from the responsibility I have for those entrusted to my care.

I call to mind the image of Fiedler stepping out on stage. Once more I buck myself up, rap quickly on the exam room door and step into the limelight for my next performance.

It will be the best I have to offer.

Night and day with three musicians

"Three Musicians" by Pablo Picasso

“Expression was the need of their souls.” —E.B. White, Introduction, Onward and Upward in the Garden

No sooner had we arrived at the cottage secluded by the lake; no sooner had we unpacked the van, trucking in the duffle and the newly purchased provisions; no sooner had I slid open the screen door to step out onto the deck to peer down at the lake through the towering pines, than the musicians cracked open the latches on the cases of their guitars, tuned their instruments and began to play.

For an hour or more they strummed and sang. We put the kabobs and corn on the grill, and still they played. When the food was ready, we ate; and afterwards they picked up their instruments and played some more.

They played into the early evening and then into the twilight. A brother-in-law appeared, bearing a cache of blues harps and a drum and cymbals with sticks and brushes.

They began to jam, playing off one another’s riffs, improvising a tune, until some song burst into being. Three guitars, one bass, harp and drums: a litany of songs sung through the evening hours late into the night, notes strung together without pause, one rendition rolling into the next, and the next, and the next. Sonora’s Death Row, Sound as a Pound, Heart of Gold, The Night They Drove Old Dixie Down.

Like the band that played on while Casey waltzed with the strawberry blonde, they moved from one number to the next, without pause, without missing a beat.

Sometime after midnight the brother-in-law left, leaving the drum and cymbals behind. We bedded down beside a warm fire in the woodstove, drifting off into our own individual nocturnal reveries.

Hours later I awoke, threw back the blanket and made coffee. The musicians sat up, rubbed their eyes, retuned their instruments and jammed for another hour before breakfast. That’s how musicians talk, making morning conversation over coffee and finger-plucked guitar chords.

Base clefts in the rock, R & B, fish scales and folk, cowboy country ballads and bar songs, a few noteworthy bars; Joycean tunes, I say again, rejoice; play it again, Sam; you must remember this, a kiss is still a kiss, remember who wrote this? Improvise, resize, economize; Tommie and the Who, doo-whap, doo, jug band blues; crazy momma, crazy MoMA, art beat, the beat; beat-beat-beat-beat, brush and beat; freight train, freight train, going so fast, I don’t care what train I’m on, just as long as I’m moving, moving along.

Three Musicians on the Rocks, Big Clear Lake