Q J Med 2002; 95: 63
© 2002 Association of Physicians
Coda |
The condition of music
What do you call a regular column in a medical journal? You need something bold but not grandiose, memorable but not egotistical. A few weeks ago, the Executive Editor sent a list of suggestions for a title. These included ‘Jouissance’ and ‘Scorpion’, but I wondered what would happen if my mood didn't always fit my sobriquet. It could be embarrassing to be a jaded Jouissance or a sweet Scorpion, so I said no to both.
He also suggested ‘Parthian Shot’, which he thought might appeal to the erudite readers of the QJM. I vaguely remembered that the Parthians liked to have the last word, but otherwise I wasn't quite sure who they were. (Apparently, they were ancient Persians who liked to fire arrows over their shoulders, while they pretended to retreat. I don't think I would have liked them.)
In the end, as you can see, we settled on ‘Coda’. It's a nice mixture of the medical and the musical. Coda means ‘tail’ in Italian, and hence is related to ‘cauda’. In musical terms, the Oxford English Dictionary defines it as ‘a passage added after the natural completion of a movement, so as to form a more definite and satisfactory conclusion’. I will try to hold this definition in mind each month, as a job description.
Medicine and music are always jostling up against each other. Many medics are also keen amateur musicians. No doubt a sizeable proportion of the readers of QJM are flautists, fiddlers or fine singers, although I have to confess that I gave up the French horn after Grade Six following a family ultimatum. You may be aware of a number of notable musicians who first trained as doctors. The conductor Jeffrey Tate and the opera singer Emer McGilloway are current British examples.
It may be no coincidence that these two interests are so commonly shared. The worlds of music and of medicine may be very close together, for reasons that we recognize intuitively but are hard put to describe in words. I came closer to understanding this at a recent conference in Cambridge on ‘Narrative Based Medicine’. It was the end of the first morning, the presentations had overrun, and I badly wanted my lunch. I probably would have slipped out, but this meant walking directly past Professor Trisha Greenhalgh in the chair, and I was scared that she would glare at me disapprovingly. Because of this I stayed on for the final speaker, a philosopher from Swansea University called Martyn Evans. His topic, as it happened, was medicine as music.
Instead of starting his presentation immediately, he first played a recording of Bach—a piece from ‘The Well Tempered Klavier’. The moment was spellbinding. I forgot my rumbling stomach. I would happily have missed my lunch—and indeed the whole afternoon—to hear all the 48 preludes and fugues in the book. I looked round at the hundreds of assembled doctors, researchers, teachers and social scientists, and they all seemed transported to a place that none of the preceding lectures (excellent as they all were) could possibly have taken them. When the music came to an end, it seemed hardly necessary for Dr Evans to say a word. However, he somehow managed to articulate what the piece itself had conveyed subliminally.
He spoke of how music creates narrative without representation. He suggested that music provides an organizing metaphor for medical practice. He argued that ‘medicine belongs to music’ as the imaginative creation of order amid chaos.
This claim rings true. Yet it also challenges us profoundly as doctors. On the one hand, we regard such models of medicine as entertaining, but cannot believe that they might be seen as a serious alternative to the application of reason. On the other hand, we recall our real-life encounters with patients, and we have to acknowledge that there are nearly always some processes going on that cannot be understood at all through reason. They are processes that remind us inescapably of rhythm, cadence, and the elaboration of themes towards a resolution.
The nineteenth century critic Walter Pater claimed that all art aspired to the condition of music. If medicine is an art, then it shares with its fellow arts that same yearning towards wordlessness, and towards communication through abstract aerial vibration alone. If you try to analyse why you took a medical history from a particular person in a particular way, or why you offered information with the exact nuance that you did, or why the patient ended up pursuing one treatment option rather than another, it may be impossible to understand these except in terms of an instinctive human capacity for composition. Unsettling as it is, it may be hard to resist the notion that science pays tribute to harmony, and not the other way round.
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