My eyes went to the mass on the chest film: big, dense, and ugly, surely a lung cancer. I looked at my former piano teacher, my friend, sallow, emaciated, and withered. I felt as if a lump of lead had dropped into the pit of my stomach. Earl (not his real name) said, “My family doctor wanted me to see a lung specialist, and I told him I wanted you.” I faked a smile. “I appreciate the compliment. It's been what, eight years?” He shifted in his chair. “Sorry. It hurts if I sit still very long. You still playing the piano?” “Not as much as when I took lessons from you. Maybe a few minutes a couple of times a week.” He brushed tobacco-stained fingers over his thick, yellow-brown mustache. “Still busy with your practice, eh?” “Yeah. Keeps growing. No shortage of patients. Something had to give. You remember.” “Too bad. The piano was good for you.” I chuckled. “Made me humble, that's for sure. Learning chords didn't come easy.” He managed a little laugh. “I still remember when you came to me. You thought the music came from the piano. I couldn't believe someone intelligent enough to get through medical school would think music came from a box of wires and hammers.” “Like it was magical,” I smiled, then looked at him. “You taught me a lot.” “I was always trying to get you to loosen up, to feel the music.” “You had that newspaper clipping taped to the wall. The one quoting Artur Rubinstein that if he didn't have a couple of slips in a performance, he hadn't given his best effort. That was an important lesson for me: trying to be perfect leads to being mechanical.” I leaned forward and put my hands on my knees. I said, “I remember you teaching me to feel triplets. You’d say, ‘Put your hands on your knees. Now pat each kneecap while you count: one, two; one two three, one, two, one two three.’ ” “It wasn't hard, was it?” Earl extended his hands, palms up. “They're so weak I can't even play anymore. I don't know what's causing that.” I whispered, “I’m not sure either. For a professional pianist, that must be a problem.” As if the thought was too painful to discuss, he continued. “You were a challenge. You had been told you had no ear and I knew that was wrong. I wanted to prove that you could hear music and could carry a tune.” “I had been told since I was a little boy that I had no talent.” “I felt that if you could learn to play the piano, it would help you as a doctor.” “Oh? Why so?” Earl looked at me. “Music is the universal language. But you can't create music by analyzing. You have to feel it.” He shrugged. “Doesn't a doctor have to be in tune with his patients?” “Music did make me use my right brain.” I crossed my leg and sat back, laughing. “When I discovered I could play ‘Happy Birthday’ in any key without sheet music, I felt like I had climbed Mount Everest.” “Sure you did. That was why I kept you as a student.” “I thought it was because you expected I would become another Hoagy Carmichael.” He snorted. “I just wanted you to enjoy music.” I nodded and said, “And I did. And I still do. I’m grateful to you.” I paused a couple of seconds. “So, let's talk medicine. When did you get sick?” He shrugged. “I haven't felt like eating for the last couple of months. Then I started coughing, and last week when the bleeding began I knew it had to be serious.” I felt that lead lump again but quickly regained my professional poise. “We should do some more x-rays, take a look down there, and figure out what's going on.” “Whatever you think.” A biopsy showed the mass was lung cancer. Radiation therapy didn't work, and he went downhill fast. Earl said he didn't want to go back to the hospital and so I connected him with hospice. Two days before he died I made a house call and could hardly face him. His legs were so swollen he couldn't put on pants. He sat in an easy chair, naked from the waist down, unable to stand without help. His wife hovered in the corner, her eyes telling me she didn't know what to do. I said, “Earl, time is short. I want to say thanks again for your patience with me during those Fridays when I used to dash in, late for my lesson, and not having practiced.” “I understood you were busy.” He looked up at me beneath eyelids drooping from morphine and mumbled, “Young doctor, starting out in practice.” I turned to his wife. “He's as comfortable as can be. Hospice is doing a good job. You're doing a good job. Just keep it up. Call me anytime.” I put my hand on her shoulder and said, “I’ll come back again in a few days.” To myself I said, If he doesn't die sooner. Earl and I shook hands; his bony grip dug into my palm, and I remembered his thumbnails had always been long, which I figured was to help reach octaves and tenths on the keyboard. Earl died nearly 20 years ago, but his gift to me endures. Many of life's experiences have to be felt, not analyzed. Understanding this has made me a better husband, father, and physician. Sometimes late in the evening, when it's quiet and I want to relax, I go to the piano and play melodies from those old Broadway shows, Oklahoma, South Pacific,The Sound of Music, and My Fair Lady. I see notations on the score scribbled by Earl with a felt pen to help me choose the accompanying chords. The sheet music is stained and dog-eared from turning, but the pages are treasures to me. They remind me of a time when I was learning about myself and medicine and the world, a time when I realized that with a little help I could do it. I could make music. Back to top Article Information Conflict of Interest Disclosures: The author has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
JAMA – American Medical Association
Published: Sep 14, 2011