Finding a common chord with a patient

”I long, as does every human being, to be at home wherever I find myself.”
— Maya Angelou

Before starting my dive into medicine, almost four years ago, I was an avid violinist, pianist, disc golfer, and novice chef. Each of these activities felt comfortable and familiar–like “home.” But when I began medical school, I somewhat wistfully set them aside to focus on becoming a doctor.

If I can get through this grueling stage of my life, maybe things will get better, I told myself.

As my medical studies progressed, my violin collected dust in the corner of my living room. Then, during one of my third-year clinical clerkships, I met Ms. Winston.

A frail, older woman with advanced dementia, she’d been hospitalized after her caregiver, a nurse named Shirley, brought her in with fever and confusion.

As Shirley recounted Ms. Winston’s medical history, Ms. Winston sat there barely moving, a glassy look in her eyes. She only spoke once, when asked how she was doing: “I’m fine.”

By contrast, Shirley was relentlessly energetic: She asked if the antibiotics we’d prescribed were appropriate, and after Ms. Winston suffered a choking episode she wanted to review Ms. Winston’s chest X-rays herself.

As challenging as I found it to respond to Shirley’s concerns, I found it even more frustrating to build a relationship with Ms. Winston. When I tried to talk with her, she would simply give me that silent, glassy stare. My most vociferous questions elicited only an occasional soft “yes” or “no.” I wanted to be a good provider and check in on her throughout the day, but the thought of yet another failed conversation brought up dread and apprehension.

After two days of this, I was desperate for some way to connect with Ms. Winston. Then things took an unexpected turn.

Approaching her room the next morning, I heard Bach’s Double Violin Concerto wafting from her radio. I know this piece well, having played it several times in my previous life.

As I walked in, I mentally scrapped my medical-student playbook.
“Do you like classical music?” I asked Ms. Winston.

Her eyes lit up.

“Yes!” she said with a smile, looking straight at me.

“She loves the radio,” Shirley chimed in. “She was a violinist and pianist for 40 years.”

“What a coincidence!” I said. “I play those instruments too!”

We talked about her favorite composers and pieces. She reminisced about playing piano for church and was excited to hear that I’d started violin at age four.

If this had been our first encounter, I’d never have guessed that she had dementia. In my mind, she shifted from being a patient to being a musician, an artist, and a peer. I was enjoying the conversation so much, I almost forgot to do her exam.

Later on, when I reported this to my medical team during rounds, they expressed surprise at my being a violinist and even more surprise at Ms. Winston’s transformation.

“Wouldn’t it be cool if you brought your violin and played for her?” my attending exclaimed. We all chuckled.

Rounds went by without any further mention of music. But before I left the wards, my intern stopped me.

“The attending texted me to ask if you can bring in your violin tomorrow,” she said.

I was shocked, even terrified: Are we allowed to do that?

I’d never seen a provider play music for a patient. Questions flooded my mind: Was it a mistake to mention my conversation with Ms. Winston? Will I embarrass myself in front of everyone?

I hadn’t played the violin for almost two years. My evening plans had involved writing up a history and physical note, not revisiting my former pastimes. Still, I went ahead and dusted off my violin.

After playing through a few scales, arpeggios, and pieces, I realized that I’d retained some of the easier pieces in my muscle memory. Sure, my fingers slipped a bit on the higher pitches; but I felt confident that I could play the music. More importantly, I didn’t want to miss a chance to do something meaningful for Ms. Winston.

Supposedly, dementia patients store music in their long-term memory, I thought. Wouldn’t it be great if I could help her add some new musical memories?

The next morning, my team gathered expectantly at Ms. Winston’s bed. Tuning the violin, I felt hopeful that she would enjoy the music that I’d planned.

“Do you want to hear something fast and lively, or slow and beautiful?” I asked her.

She chose the latter. I began playing “Méditation” from the opera Thaïs by Massenet–a lyrical, romantic piece that expresses a courtesan’s emotions at leaving her lavish life for one of humility.

As I played the first notes, Ms. Winston closed her eyes and smiled. The warm, tranquil tones flowed on, and she gently swayed in time, enjoying the music. She looked like Ms. Winston, not just another patient with dementia.

For me, hearing the strings of my violin again brought back nostalgic memories: feeling chills down my spine while playing Beethoven’s Ninth Symphony, and my brother’s and my playful duels with our bows. Playing violin for Ms. Winston reminded me of an identity— a home — I hadn’t visited in a very long time. It was humbling to realize how much of myself I’d set aside in committing myself to medicine.

I’ll never forget Ms. Winston’s simple “thank you” and smile. Seeing my team’s tears of joy and hearing the applause of friends and staff who’d snuck in mid-performance, I felt touched and grateful.

I hope Ms. Winston found home in that performance because I definitely did. If I hadn’t shared the music with her, I don’t think I’d ever have seen through her diagnoses to the person–the artist–that she is.

Ironically, playing music worked the same alchemy in me: I reconnected with a vital part of myself and realized how important it is that I hold onto it amid this arduous professional training.

Although some facets of my identity have receded, for now, I still cherish them. Now, thanks to Ms. Winston, I know that they’re still there — waiting for me to reclaim them when the time is right.

Jimmy Chen is a medical student. This piece was originally published in Pulse — voices from the heart of medicine.

Image credit: Shutterstock.com

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