COVER STORY

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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Ripley hired Means on the spot. During Means’s four years between college and P&S, she and Ripley created two solo shows, which they took on the road. Around that time, Means met a neurosurgeon who, in exchange for piano lessons, agreed to let Means shadow her in the operating room.

Jessica Means“The second I got into the OR I knew: I have to be a surgeon,” says Means. “I had never been in an OR. Had never met a female surgeon. I had no idea what to expect. I’d imagined very delicate, tiny movements, and was stunned by some of the almost brutality of the surgery. What she did with her hands was so beautiful. The idea that you can use your hands to heal — I watched her take out a massive tumor right in front of me. I had never felt electric about anything in my life besides music. I felt that way about this.”

As with other musical students, Means’s interview at Columbia, which was conducted by psychiatrist Donald Kornfield, was less medicine than Mendelssohn, less pleurisy than Debussy. “In my entire interview with Dr. Kornfield,” she says, “we didn’t talk about medicine at all. He wanted to know everything about music. He thought it was wonderful.”

Now Means is about to start her rotations. So far, she has pulled off a kind of double life. “It’s amazing, because I can go downtown, play a show, come back up, and go to class the next morning. I bring my notes and study backstage. It works.” She also plays events like Musical Monday and its shaggy cousin, the pop-­centric beer­-and­-music-­filled evening known as Coffee House.

“It blows my mind how talented these people are,” Means says of her schoolmates. “Musical Monday is conservatory­-level.”


So how did all these musicians end up here?

The trail leads straight to Stephen Nicholas. If anyone can enlighten us, it’s Nicholas, who has been on the P&S admissions committee since 2001, and who became admissions dean in 2010.

Nicholas is a tall, kindly Wyomingite who loves photography. His walls are covered with decades­old photographs of pediatric AIDS patients. His patients.

“We have one highest desire: to find people who will make great doctors,” Nicholas says. “The question facing all medical schools is, ‘How do you find those individuals?’ Some schools use metrics; some look at undergraduate majors. Those things are important, but they’re not what make this place tick. We think there are a lot of surrogate measures that can help students become the sort of doctors who will be passionate, who will be listeners. Music is one of them.

“Let’s start with listening: the trouble with physicians is that we go through a process that tells us we’re experts. I’m a pediatric AIDS expert.” (Nicholas came to Columbia in 1981 for his pediatrics residency and later started the pediatric AIDS project at Harlem Hospital.) “One of the great pediatricians of our time, T. Berry Brazelton [’43PS], stumbled onto this idea of questioning expertise. It took him a long time to understand that while we have expertise, we are not the expert on a baby. The mother is. The father is. In time, the child grows up and becomes an expert on herself. One thing Brazelton taught me was this importance of shutting up and listening. If you’re a musician, you’ve got to listen, you’ve got to watch, you’ve got to be very involved and observant. These traits matter. If you’re attuned to what other people are doing, you’re probably going to be a better doctor.

“It’s amazing, because I can go downtown, play a show, come back up, and go to class the next morning.”

“Then there are traits like compassion and selflessness. We have a sacred relationship with patients: we hear their secrets, we invade their bodies to make them better. It’s all part of an agreement. So we certainly want people who have an ability to feel.”

This depth of emotion resonates from the strings and brass tubing and ringing voices of the students: one hears it in the glass-­bell clarity of the CUMC Choir’s first note, as the conductor, Jessica Buesing ’13GS, who founded the group, threads a needle in the air; one feels it in the velvet lushness of the CUMC Symphony Orchestra performing Mozart’s Symphony no. 40 and Tchaikovsky’s violin concerto, featuring soloist Elliott Huang ’11CC, under the baton of Hanjay Wang, who is also a pianist; and one sees it in the power of Artreach, as on a recent evening, when five people in wheelchairs were parked a few feet from an upright piano in the Milstein Building, listening as Juilliard graduate Devon Joiner, a first­-year, knuckled down on Beethoven’s 32 Variations in C Minor. Joiner’s rendition elicited particular delight from an eighty­-four-­year-­old cinnamon­-skinned woman with bobby pins in her sea-­salt hair. “This is my fourth concert,” she said. “They’re just wonderful.” A pianist herself, she’d had a stroke that affected her arm and leg. “Now look,” she said, waggling her limbs. “Piano is part of my therapy here. I’m so happy to move my fingers. I cried and said, ‘Thank God.’ All my doctors play instruments. I said, ‘I’m in the right hospital.’”

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Comments

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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