Hippocratic Oath, circa. 21st Century?

A few weeks ago I got to play violin in this place: Duke Chapel

…because the Duke School of Medicine was having their graduation, and the organizers wanted a string quartet, and I still haven’t learned the art of saying No. Playing in the Duke Chapel was a pretty wicked experience though, so I can’t complain that much.

After the speech by the chosen graduate who characterized each year of med school with a work of literature, and compared choosing specialties to selecting a mate, the newly minted doctors were asked to join the veteran doctors in attendance to recite the Hippocratic Oath. The classic text invoked the witness of the ancient deities–Apollo et. al.–that each shall keep their fealty to the practice of medicine, and to accept due punishment for failure to carry out their duties. The modern version kept mostly to the ancient version, save for editing out the gods. It was kind of moving to see all of the doctors rise to their feet, men and women alike, some who have practiced longer than most of the graduating class has been alive, before our generation of electronic medical records and instantaneous vital monitoring and surgery performed with camera attached to a tube.

And together they said, the art of medicine.

I went in for a routine check-up with my primary care provider, and had to have a prescription filled. I was told that the order has been put in, and I should go to the designated pharmacy (located in the same hospital complex of my primary care provider) to pick it up. So up I go through the intestines of this massive building, getting sort of lost twice on the way, found the pharmacy, took a seat in the waiting area, waited for a while, then decided I should walk up to the counter and get my bearings, finally got to talk to someone, who then promptly directed me to go to a waiting kiosk to take a number. Said kiosk was placed behind a door. Number taken. Cue more waiting. When I was called to be serviced, the personnel informed me that the Rx was in fact not yet in the system, and I would have to wait for it to be ordered, then filled, since the item I was prescribed was not in stock. When I asked about the estimated timeline that the item would be available, and what I can expect for a co-pay, the personnel said that since “[the pharmacy] doesn’t have it, I can’t tell you when it’s going to get here. And I can’t tell you how much it’s going to cost until it gets here.” And when I asked whether I can get the prescription at another pharmacy that might have the item on-site, I was informed that I “need to talk to [my] doctor and see what they say”.

All before 9:30am.

There’s a reason that I dread going to the doctor’s. Not so much because I disregard my health, but I want to avoid the miscommunication and confusion and gigantic inefficiencies of a healthcare system. There’s a person who is supposed to tell you what options you have for tests and treatment, another for the amount of your co-pays and out-of-pocket fees, another for your schedule (and more options!) for medication, another for what to expect for when you go home. And it seems that rarely do people actually talk to you, and even rarer to each other. Even though I have a rudimentary understanding of what questions to ask, I still run into days where no one understands who’s saying what, and my words are put up against that five-to-ten-second window where someone actually has the time to listen.

We learn in school that patient education is the most crucial, because most people don’t know what to ask.

Maybe that’s the reason we don’t see medicine as an art, because we don’t have the time for art. An art requires its pupils to stay focused, to keep learning about it and re-learning about it, and being continuously open to new ideas. We try to understand an art from as many perspectives as possible, because we want to know the totality of an art for the love of knowing, because we are curious. Nowadays medicine is a trade, a war of strategies with the end goal of wringing out the most profit. We discharge ICU patients as soon as possible short of malpractice, because ICU patients cost the hospitals the most money. We prescribe an opiate to treat pain from trauma to return to work, then pop a stimulant to counter the drowsiness brought on by the narcotic. We run people through fancy machines made of giant magnets and run blood samples through gels to see if protein markers show up and run chemicals to drown a tumor and still run into the sentence of inconclusive, so we tell the patients that it’s all in their head. Refer to psychological counseling. And even though we crank out healthcare providers faster than Pepperidge Farm pops out Goldfishes, we have somehow run into the age of providing sick-care.

I know that there’s a wealth of dedicated healthcare professionals who take to heart their art of medicine, whether or not they have MD behind their names. And in the most dismal places we hear about the work of medical professionals who tend to the needs of the needy. And among my peers who are in training to become healthcare providers, I see this drive to do better, not for the sake of renown or prestige, but because we genuinely care about what we are learning, and want to know how to apply what we care about toward those we will care for.

And there’s a looming suspicion that I can at best call inefficiency. Or perhaps, indifference towards wellbeing. We expect doctors to tell us what we want to hear, for hospitals to be hotels, and to fix our problems with a prescription. Then we fight over who’s going to pay for the sick-care, the theoretical silver bullet that should alleviate all of our medical woes, because we’ve made medicine such an expensive trade to pay for, and the common man and woman doesn’t have the means to pay for the ideal of medicine, that grossly inflated trade with the down-payments of monstrous medical tuition, unexplainable procedures, and mysterious operating costs, that has replaced art with profit.

What have we missed? And when did it start?

For an art to exist and thrive you need both the artist and an audience, and both who want to sustain what they value. And perhaps because we’ve stopped viewing ourselves, our wellbeing, our health as something to be cultivated and respected, and we’ve placed the responsibility of living healthily into the hands of others–society, institutions, government–that we’ve lost the appreciation for the art of medicine. And when something loses its internal value, the exoskeleton is scoured for profit. And with ballooning amount of regulations, standards, reviews and performance feedback, it’s hard to keep medicine from becoming a trade. A very costly one, too. A lot of people are not going to the doctor’s because they can’t afford to, and they end up having their health deteriorate even further. There are people who have no other option–save for death or chronic disability–than to see the doctor and fall in the quicksand of bankruptcy from medical bills.

Perhaps we are all to blame for the loss of the art of medicine.

We have just wrapped up finals and now into our two weeks in the clinic. I have had some really slow days, but also some amazing days where I know in my heart of hearts that this is what I am supposed to be doing. There is no shortage of stress, and I tend to fall into the mindset that school is a reward-punishment model, and the end result is the quality of my grades, with the ultimate goal being my pruning into an efficient subunit in the mammoth machinery of healthcare. I have to remind myself that I am learning all of the things for the love of learning, for the love of my art-trade-vocation, and that grades and job security should not be the only goals of my efforts, but more as the outcomes from my striving toward something more, because I want to be part of something that is more than making profits and finding loopholes and wrangling compensation out of the tangle of sick-care business.

As I stand at the conclusion of my first year of PT school I feel excited and weird and surprised: excited for the second year and even more amazing things that we will learn, weird that I still don’t really know anything, and surprised because I somehow retained the majority of my sanity. I know I will not be very excited for 10-plus hours of lecture videos when we come back from our 1-week “summer break” and faceplant into musculoskeletal and neurological patient management courses. And it will be hard to remember that I keep plodding along because I am curious to learn more about the art and science that is the human body. But I will somehow remember, and herein keep my fealty. To this I solemnly swear.

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reblogged: The Juilliard School’s 109th Commencement Speech, Joyce DiDonato

Star mezzo-soprano Joyce DiDonato gave the 2014 commencement address at Juilliard Friday — and it’s a memorable one, both for her words and by DiDonato’s own example as someone whose own career began under low heat.

Chairman Kovner, President Polisi, most distinguished honorees, dedicated family, friends, faculty, and to EACH of the talented, ambitious, courageous, adventurous Juilliard graduates of the class of 2014 before us here today, thank you!

I stand before you this morning, duly humbled, and in awe of the distinguished and hard-earned accomplishment awarded to each and every single one of you on this unforgettable and long-awaited day of your graduation. Look at you! You are gowned and tassled and you’re ready to take on the world! Through that first nerve-racking audition, all those subsequent sleepless nights, the painstaking preparation for your recitals, the endless hours of reed-making and memorization, the blisters and the tears, and now here you walk side by side with the life-long friendships you have now forged, you are about to be Alumni of the acclaimed Juilliard School! I invite you to breathe that in. You, my friends, are living the dream! I wish I had had the foresight when invited to speak here today, to ask them to break with tradition and print my old biography from when I was your age instead of my current one!A great example of contrasts, it would have shown you that despite my “star turn” as the off-stage lover in Il Tabarro with my ONE, single, SOLITARY line (did I mention it was OFF-STAGE?), and that despite being the only young artist of my class to fail at securing management until the ripe age of 29, and DESPITE my evaluation sheet for the Houston Opera Studio which simply declared me to possess “not much talent” and that despite WAY more rejections and easy dismissals than actual “yeses”, despite ALL of that, I am somehow, miraculously standing before you all today, regaled in an admittedly different kind of designer gown, dispensing tidbits of “wisdom” before a group of artists who – and this is honestly no exaggeration – artists who I never could have been classmates with, because there truly is no way I could have gained admission to your school back in the day. I simply wasn’t ready back then. That is the truth. One never, EVER knows where their journey will lead them. But YOURS has led you here.

There are a few more hard-earned truths – as I have come to know them – that have arisen on my personal odyssey as a singer and at first glance, they may seem like harbingers of bad news, but I invite you to shift your thinking just a bit (or perhaps even radically) – you guys are artists, so thankfully you’re already brilliant at thinking outside the conventional box! I offer these four little observations as tools to perhaps help you as you go forward, enabling you to empower yourselves from the very core of your being, so that when the challenges of this artistic life catapult and hurl themselves directly and unapologetically into your heart and soul – which they will do, repeatedly – you will have some devices at your disposal to return to, to help you find your center again, so that your voice, your art and your SOUL will not be derailed, but you will instead find the strength to make yourself heard, and seen, and FELT. Then you will have the power to transform yourselves, to transform others, and, indeed, to transform the world.

My first observation:

You will never make it. That’s the bad news, but the “shift” I invite you to make is to see it as fabulous, outstanding news, for I don’t believe there is actually an “it”. “It” doesn’t exist for an Artist. One of the greatest gifts you can give yourself, right here, right now, in this single, solitary, monumental moment in your life– is to decide, without apology, to commit to the JOURNEY, and not to the outcome. The outcome will almost always fall short of your expectations, and if you’re chasing that elusive, often deceptive goal, you’re likely in for a very tough road, for there will always be that one note that could have soared more freely, the one line reading that could have been just that much more truthful, that third arabesque which could have been slightly more extended, that one adagio which could have been just a touch more magical. There will always be more freedom to acquire and more truth to uncover. As an artist, you will never arrive at a fixed destination. THIS is the glory and the reward of striving to master your craft and embarking on the path of curiosity and imagination, while being tireless in your pursuit of something greater than yourself.

A second truth:

The work will never end. This may sound dreadfully daunting – especially today when you are finally getting out of here!!!! But what I have found is that when things become overwhelming – which they will, repeatedly ~ whether it’s via unexpected, rapid success or as heart-wrenching, devastating failure ~ the way back to your center is simply to RETURN TO THE WORK. Often times it will be the only thing that makes sense. And it is there where you will find solace and truth. At the keyboard, at the barre, with your bow in hand, articulating your arpeggios ~ always return to your home base and trust that you will find your way again via the music, the pulse, the speech, the rhythm. Be patient, but know that it will always be there for you – even if in some moments you lack the will to be there for it. All it asks is that you show up, fully present as you did when you first discovered the magic of your own artistic world when you were young. Bring that innocent, childlike sense of wonder to your craft, and do whatever you need to find that truth again. It will continually teach you how to be present, how to be alive, and how to let go. Therein lies not only your artistic freedom, but your personal freedom as well!

Perhaps my favorite truth:

It’s not about you. This can be a particularly hard, and humbling lesson to face – and it’s one I’ve had to continue to learn at every stage of my own journey – but this is a freeing and empowering truth. You may not yet realize it, but you haven’t signed up for a life of glory and adulation (although that MAY well come, and I wish with every fiber of my being, that it WILL come in the right form for every single one of you – however, that is not your destination, for glory is always transitory and will surely disappear just as fleetingly and arbitrarily as it arrived.) The truth is, you have signed up for a life of service by going into the Arts. And the life-altering results of that service in other people’s lives will NEVER disappear as fame unquestionably will. You are here to serve the words, the director, the melody, the author, the chord progression, the choreographer ~ but above all and most importantly, with every breath, step, and stroke of the keyboard, you are here to serve humanity.

You, as alumni of the 109th graduating class of The Juilliard School are now servants to the ear that needs quiet solace, and the eye that needs the consolation of beauty, servants to the mind that needs desperate repose or pointed inquiry, to the heart that needs invitation to flight or silent understanding, and to the soul that needs safe landing, or fearless, relentless enlightenment. You are a servant to the sick one who needs healing through the beauty and peace of the symphony you will compose through blood-shot eyes and sleepless nights. You are an attendant to the lost one who needs saving through the comforting, probing words you will conjure up from the ether, as well as from your own heroic moments of strife and triumph. You are a steward to the closed and blocked one who needs to feel that vital, electric, joyful pulse of life that eludes them as they witness you stop time as you pirouette and jettè across the stage on your tired legs and bleeding toes. You are a vessel to the angry and confused one who needs a protected place to release their rage as they watch your eyes on the screen silently weep in pain as you relive your own private hell. You are a servant to the eager, naïve, optimistic ones who will come behind you with wide eyes and wild dreams, reminding you of yourself, as you teach and shape and mold them, even though you may be plagued with haunting doubts yourself, just as your teachers likely were – and you will reach out to them and generously invite them to soar and thrive, because we are called to share this thing called Art.

You are also serving one other person: yourself. You are serving the relentless, passionate, fevered force within you that longs to grow and expand and feel and connect and create; that part of you that craves a way to express raw elation and passion, and to make manifest hard-core blissful rapture and – PLEASE, I beg of you, never forget this – FUN! Don’t ever abandon that intoxicating sense of FUN in your ART. Thought that, you are serving your truth. My hope for you is that you will let that truth guide you in every moment of your journey. If you can find that, you have everything. That’s why “making it” is, in the end, utterly insignificant. LIVING it, BREATHING it, SERVING it … that’s where your joy will lie.

I want to share with you a quick email from a soldier on the front lines of our Arts: an elementary/middle school teacher from Salt Lake City, Ms. Audrey Hill, who is fighting the great fight! She brought her students to the recent HD telecast of “La Cenerentola”, and wrote the following note to me:

“One of my boys … a 5th grader… wrote in his review this morning that one of his favorite parts (besides the spaghetti food-fight scene) was where at the end you were singing about getting revenge, and how he really liked that your revenge was going to be forgiveness.   This boy was new to our school this year, has a beautiful singing voice, and has been teased a lot. I have seen him getting more and more angry as the year was coming to a close and today it seemed like all that had disappeared.  It was very moving for me to experience.”

* That’s exactly who you are serving as you now go out into the world. How lucky are you?!??!

Ah, so OK, I lied … I think this may be my favorite truth:

The world needs you. Now, the world may not exactly realize it, but wow, does it need you. It is yearning, starving, dying for you and your healing offer of service through your Art. We need you to help us understand that which is bigger than ourselves, so that we can stop feeling so small, so isolated, so helpless that, in our fear, we stop contributing that which is unique to us: that distinct, rare, individual quality which the world is desperately crying out for and eagerly awaiting. We need you to remind us what unbridled, unfiltered, childlike exuberance feels like, so we remember, without apology or disclaimer, to laugh, to play, to FLY and to stop taking EVERYTHING so damn seriously. We need you to remind us what empathy is by taking us deep into the hearts of those who are, God forbid, different than us – so that we can recapture the hope of not only living in peace with each other, but THRIVING together in a vibrant way where each of us grows in wonder and joy. We need you to make us feel an integral PART of a shared existence through the communal, universal, forgiving language of music, of dance, of poetry and Art – so that we never lose sight of the fact that we are all in this together and that we are all deserving of a life that overflows with immense possibility, improbable beauty and relentless truth.

What an honor it is to share in this day with you – savor every single moment of it – and then fly out of this building, armed with the knowledge that YOU make a difference, that your art is NECESSARY, and that the world is eagerly awaiting to hear what YOU have to say. Go on, make us laugh, cry, dance, FEEL, unite, and believe in the incredible power of humanity to overcome anything!

Mission II, Catherine Nelson, Courtesy of NPR.org

 

on being a storyteller

I’m a sucker for cellists. I wonder if I would have chosen to learn the cello instead of the violin if I had the option. Maybe I would have. But I think having that distance to breathe in the music made by another musician allows me to appreciate the artistic creation better; sometimes we see our lover in a different light when they are in their element, instead of in our consuming embrace.

Last spring I went to a concert featuring several soloists, one of them a cellist. I actually went because I knew the violinist that was part of a duet that was also featured in the concert. I remember randomly sitting next to a cluster of hipsters and feeling moderately out of place. I had been in orchestras in high school and undergrad, so I felt I should be on stage in the mass of black and white—the men donning tuxedos and looking like constipated penguins—instead of in the audience.

The auditorium darkened and the cellist entered, took his seat, tuned his cello. Then a pause. A silent prologue: the palpable awareness of being emotionally naked in front of one’s audience.  Inhale. The first few notes flowed from his hands, asking the audience for permission: the permission to share oneself. Trepidation. Bashful eagerness. May I share this with you? This part of me?

Then he took hold of my soul and took flight. Achingly, breathlessly. He and the cello and the music born from the two.

And I don’t remember breathing until the end.

I’m listening to Jacqueline du Pré while whittling away at my homework. Yes, we have school in summer. Yes, I agree, it’s no fun being a graduate student. As my brain meanders between skin pathogens and Dvorak, it makes me sad listening to the beautiful stories that this woman is telling through her fingers. Appendages that eventually failed and robbed her of her voice through her instrument. Jacqueline du Pré died in 1987 as complications from multiple sclerosis, after permanently retiring from performance in 1973.

When I heard of Gabriel García Márquez’s passing a few weeks ago there was a tinge of sorrow that the world is a bit poorer in losing a masterful storyteller. And I’m thankful that the stories of Jacqueline du Pré and Márquez remain, through decibels or text, and in a way, their stories continue, each time someone opens to the first lines of One Hundred Years of Solitude or inhale the first notes of Elgar’s Cello Concerto in E Minor seeping from du Pré’s hands and her Davydov Stradivarius. And I would like to believe that, in one way or another, we can still choose to be storytellers. At a recent lecture hosted by our program, a Duke PT alumna spoke of being a thoughtful practitioner, an active listener of our patients’ stories, and a mindful sharer of our own stories.

I think this is why, despite the gigantic imbalance of science-to-humanities ratio that is the existence of a physical therapist student, I still need music: I still need to be a storyteller. When I allow music to speak through me, I am reminded of the disclosed fibers of myself, all of the granules that I keep carefully wrapped up. Music seeks them out, and awakens that unspeakable joy and longing, because sometimes words are trite, and our nuclei of humanity need a wordless voice. Vocalise. 

marklambdance.org

marklambdance.org

technically speaking…

I played violin for (yet) a(nother) wedding this past weekend. A conversation between the photographer and I:

Photographer: “Hannah, can you move [the hand that’s holding the violin] closer to your…center…mass…?”
Me: “I believe it’s called the sternum, as the proper anatomical landmark.”
Photographer: “Well, I was trying to be subtle and as unoffensive as I can, because the only word I could think of was brisket.

Note to self: Modify job description: Violinist. Will travel. On-site trans-species mutation optional. Estimates available upon inquiry.

photo credit: tumblr. com

photo credit: tumblr. com