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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As the woman notes, the musical spirit is not confined to the students. On any given Musical Monday you’re liable to find, in the audience, faculty members like neurological-­surgery professor/trombonist Donald Quest ’70PS, or retired professor of medicine/composer Kenneth Altman ’54PS. There are musical administrators, too: CUMC’s vice dean of academic affairs, Anne L. Taylor, studied cello at the Manhattan School of Music. Artists are found here in proportions that bespeak a tradition stretching back to 1894, when John Mott, a young YMCA leader and future winner of the Nobel Peace Prize, founded the “YMCA at P&S,” later renamed the P&S Club.

Jessica Buesing '13GS, a student at the College of Physicians & Surgeons, conducts Chorda Tympani (the CUMC Choir) in a Musical Monday performance of "Locus iste" by Anton Bruckner. Buesing, who grew up in Palos Verdes, California, founded the choir in the fall of 2014.

“The P&S Club was founded during a period when there was a lot of discussion about professionalism,” Nicholas says. “Mott was aware of a narrowing process that you go through. He thought that if you’re not careful, you could lose balance as a person. If we don’t encourage students, as they’re going through professionalization, to hold onto balance, they’re going to be narrow individuals, and not the doctors they want to be.”

This ethos of extracurriculars holds the key to the musical bounty at P&S: the arts culture has become, over time, self­-perpetuating.

“Like attracts like,” says Nicholas. “The secret is that these wonderful musicians attract other wonderful musicians, year after year.”

But if Mott provided the music scene at P&S with its origin story, it was another figure that bestowed it with something like mystique.

“You’ve heard about the Rachmaninoff piano,” Nicholas says, and holds up a printout of a 2006 Times article that probed the piano’s link to Rachmaninoff, and found no paper trail to support or refute it. In the petri dish of inconclusiveness, then, the story flourishes: Columbia pathologist Jay Lefkowitch ’76PS, a music lover who gave his own piano to the med school, tells a version in which Rachmaninoff, afflicted with problems in his hands, is treated at the Neurological Institute and has a Steinway brought up to his floor so that he could compose. “When he went home, he wasn’t going to take the Steinway with him,” says Lefkowitch, “and it was consigned to the medical students. The whole question in the Times was, is the story apocryphal or aggrandized?” Lefkowitch answers lawyerlike. “I think that’s not an impossibility.”

Stephen Nicholas, in any case, can vouch for the piano’s sound. “When you hear Aidin Ashoori playing that thing,” he says, “it’s just incredible.”


 

Spring 2015, and some of our students have entered MCY. These months hold a test for people so used to practicing and performing. It’s true that they have chosen to become doctors and not professional musicians. Covenants of the soul have already been made. But what will happen to their fingers, their lips, their vocal cords, their technique, their psyches, their hearts? Will they be too busy to even think about music?


Internal medicine is one of the most intense and difficult rotations, and it’s the first for Jessica Means. She wakes up at 5:00 a.m.; walks her dogs, Phantom and Cosette; and goes to the hospital. “I am loving internal medicine,” she says. “I did three weeks on oncology.


It was incredible. I saw such a wide range of cancers. And the strength of family — how cancer affects whole families. The love is so tangible. Cancer is so brutal, and you really feel like you’re part of the fight, right there. Even as a student, I felt I was doing a lot.”

There’s a piano on the ninth floor of the hospital, and sometimes Means goes up there and plays a song or two. Then, later, at home, she plays her keyboard. “That keeps me totally happy,” she says. “I don’t feel like I’m missing out on music at all.”


Aidin Ashoori’s first rotation is surgery.

“I’ve never learned so much in such a short time,” he says. “I helped guide the scope for laparoscopic surgery. I was in a five-­hour operation for pancreatic cancer and helped suture some of the guts together. I’d never sutured on a human before.”

If his fingers have been busier lately on patients than on the piano, Ashoori doesn’t mind. He’s in a composing phase now (he’s been writing music for video games since high school), which he can do in his room.

Nor is he worried about a diminution of his technique: as all the students point out, once you reach a high level, your chops don’t fade so easily. The anatomy remembers.


For Jeremy Ying, MCY has been “stressful, but in a good way. I feel like I’m growing in leaps and bounds.”

One evening, in the midst of his neurology rotation, we spot the violinist Ying in a Bard Hall practice room, behind a Steinway. Lately, when he can, he has been teaching himself piano, and he can plink­-plunk his way through some short pieces that he enjoys.

For Ying, the work-life balance isn’t brain surgery.

“If you set time aside for something you love,” he says, “it will never go away.”

 

Read the related article Quartets on the Cortex: Neuroscience at Play
http://magazine.columbia.edu/features/spring-2015/quartets-cortex-neuroscience-play

 

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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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