The Hippocratic Overture

Students at Columbia’s College of Physicians and Surgeons are getting ready to practice. Will it make them better doctors?

by Paul Hond Published Spring 2015
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Inspired, Ashoori sent e-­mails to top neurologists and neuroscientists saying he was a musician interested in collaborative research. He heard back from Joseph Jankovic, a Parkinson’s researcher at Baylor College of Medicine. Jankovic, who did his residency at the Neurological Institute of New York — an affiliate of Columbia University Medical Center — was a former conservatory pianist. He asked Ashoori to help him investigate if Mozart had Tourette’s syndrome (which is thought to involve an excess of the neurotransmitter dopamine), and whether this had any connection to his creativity.

Ashoori studied the composer’s life.  The result was a paper by Jankovic and Ashoori titled “Mozart’s Movements and Behaviour: A Case of Tourette’s Syndrome?,” published in the Journal of Neurology, Neurosurgery & Psychiatry in November 2007. Ashoori was seventeen.

Meanwhile, Ashoori was playing in piano competitions, where a name kept popping up. “Who’s this Stephanie Chen?” he wondered. He knew she was one of the best young pianists in Texas, but they had never competed head­-to-­head, and he had never met her.

In 2009, Ashoori, by then a junior at Rice University, won a piano competition that put him on a Carnegie Hall stage for the first time. But he had no illusions about a career. “There’s very little demand for classical performers,” he says. “It’s sad, but that tradition is dying.”

He wanted to study medicine after college, preferably in Texas. But he applied to Columbia anyway, and was interviewed by John Truman, who is professor emeritus of clinical pediatrics and also a harpsichordist. The conversation, to Ashoori’s surprise, focused on music. One detail in particular leaped out.

“When they told me they had the Rachmaninoff piano,” he says, “I knew I wanted to come here.”

“Surgery is an ensemble: nurses, surgeons, everyone has a role, and they need to interact with each other.”

For the past two summers at CUMC, Ashoori has worked in the neuroscience lab of Nobel laureate Eric Kandel. There, as the only med student in a pool of postdocs, he studies things like the neurobiological processes of posttraumatic stress disorder. “We’re finding all these neurobiological correlations with the behaviors we see in psychiatric illnesses,” he says.

It’s been a time of connections for Ashoori — in the lab, in the classroom, and in Bard Hall Lounge, performing Gershwin with Stephanie Chen.

“It was funny,” Ashoori says. “Stephanie and I finally met at med school, and the next thing we know, we’re playing Musical Monday together.”

Portia SirinekAccording to The Guinness Book of World Records, one of the two most difficult instruments to play is the French horn. Portia Sirinek’s parents probably realized that when they chose it for her.

“The French horn is perfect, and I love it,” says Sirinek, who seems exactly the sort of self­-assured, proficient person the French horn would produce. “I wouldn’t pick anything else.”

Sirinek’s parents both work at the Metropolitan Opera. Her mother plays the oboe (the other most difficult instrument, says Guinness). Her father, who is now the orchestra manager, played the trumpet. They started Sirinek on the French horn in the fifth grade.

Growing up, Sirinek played in youth orchestras in New Jersey and New York. She also saw many fine musicians — her mother’s private students — struggle to get jobs. “My mother said, ‘You shouldn’t be a musician unless you can’t see yourself doing anything else,’” Sirinek says. “I could always see myself doing other things, and I did do other things.”

She studied chemistry at Yale, and after applying to P&S, she heard from the dean of admissions, Stephen Nicholas. “Dr. Nicholas called me to tell me I got in. ‘If you’re a musician,’ he said, ‘you really can’t go anywhere else besides P&S.’” Sirinek would soon understand what he meant. Shortly after arriving at P&S in 2012, she was playing in the pit orchestra for the Bard Hall Players’ production of My Favorite Year.

Now she toots her horn off­-campus with the Park Avenue Chamber Symphony and is leaning toward becoming an eye surgeon.

“Surgery seems like performance: you prepare, then you go in and do it,” she says. “The performance comes, and everyone is focused on the same thing. Surgery is an ensemble: nurses, surgeons, everyone has a role, and they need to interact with each other. Everyone has a common goal.”

Last fall, at a Musical Monday, Sirinek played a piece for solo horn by the twentieth-­century composer Bernhard Krol. From her instrument’s flared bell came a soft, warm tone, a five­-minute plainsong that the hornist embodied.

“When you play a piece by a composer, you end up understanding something about their experience or what they’re trying to convey,” Sirinek says. “You develop a certain empathy. Just thinking in that way may influence how you approach things as a doctor.”

To witness Stephanie Chen play Beethoven is to feel someone feeling. Her fingers hop, her head keeps low, absorbed in the notes, bouncing to the scampering frolic, the thundering crash.

“Beethoven speaks to me,” Chen says. “He seems to have this deep understanding not only of beauty but of struggle and conflict. He makes you feel emotions in a very raw way.”

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I am a P&S alumnus, class of ’81. While at MIT, prior to coming to Columbia P&S, I was privileged to play the trumpet in our Concert Jazz Band and also in the Festival Jazz Band. Once I embarked on my medical education, I was unable to maintain my “chops” on the trumpet.

After completion of my residency, I picked up the saxophone, in that the chops required of the woodwind player was far less than that of a brass horn player. I was fortunate to have been able play as the lead alto in our local community big band, the Swing Shift Orchestra, for about 10 years up until a couple of years ago. I was also fortunate to play a number of gigs in small combo bands over the years in various local venues.

As I read this very well written article exploring the connection between music and medicine, I was very moved by some of the insights that were shared.

Musicians, by nature and by training, are better listeners. Musicians also tend to be more passionate and compassionate, striving for perfection while attempting to connect with all of humanity through a universal language. This is by no means to say that non-musicians are less proficient, passionate or compassionate, in defense of many colleagues that are not musicians, yet practice surgery with virtuosity and technical excellence or practice medicine with similar clinical excellence.

I remember when I was an attending at Cedars Sinai Medical Center, I would try to encourage the surgical residents to strive for technical excellence using the analogy of musicians striving to be able to perform at Carnegie Hall. Virtuosity in the operating room should be no different that virtuosity in Carnegie Hall.

There is no doubt that my love of music and my pursuit of virtuosity with my instruments has greatly helped me in becoming a better doctor overall, in becoming a better general and laparoscopic surgeon with the manual and physical dexterity skills required of any horn, string, or keyboard player, and also in becoming a “conductor” in the operating room with many key players all working harmoniously to achieve the best outcome for our patients.

I would like to add an additional insight that was not brought up in the article.
Jazz, which can justifiably claim its rightful birth and maturation in America, has contributed significantly to my development as a surgeon. In Jazz, there is much emphasis on improvisation, which requires not only listening to what is going on, but requires one to then create extemporaneously music that works both in rhythm and in harmony. In surgery, while most straight-forward cases proceed in the classical mode, there are situations that require a quick shift into the jazz mode, requiring the surgeon to improvise and go quickly with different keys, tempos, meters, and unconventional chord changes.

This cross training, without a doubt, has helped me to quickly and effectively navigate difficult situations in the operating room which I believe has resulted in better patient outcomes.

I applaud Stephen Nicholas, the Dean of Admissions, for his insightful recognition of attributes other than test scores and grades, in his mission of selecting new future doctors that will excel and contribute greatly to society as physicians and surgeons of great ability both in regards to technical skills and intellectual skills, but also in regards to passion, and compassion.

Thank you so much for your thoughtful and interesting comment and for your additional insights. With your permission we would love to publish a portion of this comment in the next issue of our magazine.

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