Washington University, St. Louis, Missouri, United StatesI had seen her name before. Her recitals were always well covered in the local press and reviews were littered with superlatives. “Sparkling Mozart,” they raved. “ A phenomenon.” “A vessel of tremendous power and virtuosity.” Yet it was always disguised beneath a most unlikely figure. She was barely five feet tall, an edentulous grandmotherly type who always seemed shocked to find such a large instrument awaiting her on stage. But seated before this familiar friend, she was utterly transformed. Hands that seemed more fit to fumble over pierogi would spring to life, imposing their will across eighty-eight keys, consumed by the song of another world. She would not know it then, but transformation was occurring within her as well. Her song was ending, and praise would soon turn to sympathy as a cluster of rogue cells quickly amassed into a lump, then spread throughout her body. Disease honors the dignity of none, and none are spared from its touch.
I had not looked forward to this. I had completed enough of my clinical training to be comfortable with the physical atrocities of disease. It was humanity that I feared. It was the recognition that this – this object of decay – was once full of life, love, and an unending stream of music. We are trained to face any of a thousand maladies. But it is the faces that bear these maladies that catch us off guard, that shake us from our calculated composure.
We entered her room, a processional of religious dimensions, complete with the priestly garb of long white coats. The pianist, once a lush fountain of Bach and Bartok, now lay like a discarded twig on a pyre of dried leaves, panting and groaning in her incessant nightmare. “Like a wounded animal,” I thought to myself, then immediately felt ashamed. For several minutes the entire medical ritual - the greetings, questions, physical exam - it all meant so little as I contemplated how a small bud in the right breast could devour someone so quickly.
“Ma’am - do you know where you are? Do you know your name?”
“August,” she replied, apparently unaware that fall had long given way to the driving lake-front snow of winter.
“August.” Her son shook his head gravely, and left the room, followed again by the long processional of doctors helpless to intercede. The attending physician was already outside, speaking with her son in a flurry of apologetic whispers, but spying a corner of her blanket falling to the floor, I quickly walked back to cover her. I had not been so close before. From afar, I could lament her inevitable passing without appreciating the full extent of her decay. But proximity offers no such graces.
For a second, our eyes met, and I thought I caught a glimpse of a flame somewhere behind that glassy window, flickering, but not quite gone. Her eyes, open now, were fixed just beneath my jaw, taking in the bell of my stethoscope, I presumed. Quite shocked, I peered out the door only to find that my team had left. She was awake now, perhaps rudely stolen from dreams of August and delivered back to the winter of her reality. “Ma’am - what is your name? Do you know where you are?” She said nothing, but shot me a look of mild offense, perhaps even mild amusement. Time passed painfully slowly in those few seconds, but sensing that I had perhaps mistaken discomfort for lucidity, I made my way towards the door. Fool! – I thought to myself. What would you have said if she spoke? I stepped back into the bright hallway, relieved to get away from the aura of death, only to hear her mutter as the door closed, “Tsk … violinists. Always in a rush …”
The next day, she was transferred to our palliative care unit. Over bagels and muffins we discussed her case and prognosis, and there was sad wagging of the heads and stroking of beards in a way that can only mean death is near. The case left everyone in a pensive state, such that even the gossip of weekend plans seemed less salacious than usual. Haunted by her rebuke, I gathered up courage and stopped by the palliative care unit to peek in on the pianist. For a moment, I believed her to be dead – she seemed more like a still-life than a living organism. I peered at her closely, watching for the rise and fall of her chest, and instead I heard her voice. “You’re back.”
It took me a few seconds to regain composure - sudden tachycardia does little to perfuse the brain.
“I’m back.” A slow smile crept across her face, those long and deep creases now resembling a grandmother’s wrinkles more than the etchings on a tombstone.
“You’re a violinist,” she declared.
“I am. How did you know?”
“The bruise on the left side of your neck. It was the first thing I saw when I woke up yesterday. I’ve seen that a thousand times.”
Summoning more confidence, I pulled a chair to her bedside. Medical instincts, so often critical, so often tactless, took over. “Do you know where you are?” She smiled, perhaps bearing with my good intentions, and replied, “Darling, I’m about to die. Why should I care where I am? Tell me something good.” And so I did. We talked about Debussy and Stravinsky, about del Gesus and Bosendorfer, about Barenboim breaking free of Solti’s shadow. I told her about my life in music before committing to a life of service to the sick. “Perhaps,” she said with a wry smile, “perhaps your life in music is part of your service to the sick.” Perhaps she was not so frail after all. A day ago she was an empty shell, washed up and nearly broken. Now, though her body was picked clean by cancer, her mind continued to spring forth wit and wisdom. She even laughed, an act which, I feared, would irreparably tear through her flesh. But if all ghosts possessed such mirth, I suspect none would fear them. “Now leave me alone,” she said finally. “Go care for the living. And tomorrow - bring your violin.”
The morning could not have come sooner. I had prepared a handful of movements from the Bach partitas, music that danced through serenity and joy in uncommon grace. But as I made my way to her room, I felt a hand on my shoulder. I turned, but a part of me knew what would come next. “She’s gone. She passed last night.” I set my violin down and walked into the room. Her body lay exactly as it had when we first met. Cold. Stiff. Still. Her family sat at her side, acknowledging my awkward expression of condolence. “Thank you for your care,” her son replied. “I suppose,” he muttered, “I suppose she’s been gone a while. It was only a matter of time before the music faded.” I left the room, burdened with guilt. I was the only one who enjoyed her final burst of lucidity. I was the sole audience of her last performance.
It’s been years since then, and now I too have a small processional that trails me through hospital halls. I have thought about the pianist often, those last words, that final encore to which I still feel unworthy. Curtain calls should be applauded by those who have stayed the whole concert, not stage hands who have come to move the piano. But perhaps Fate has a way of connecting souls, ever so briefly, for purposes beyond our understanding. In her grand finale, without so much as an instrument at her command, the pianist would muster one final encore, reminding me that even empty shells bear echoes of the ocean. And here, now, I cannot escape that faint whisper of music - ever present, gracing the bells and whistles of ventilators and the clicking of the dialysis machines – asking me to pay heed, to listen for the music as I – doctor, priest, musician, ferryman – honor the final songs of souls passing from one world to the next.
STEVEN CHENG, MD, completed medical school at the Northwestern University School of Medicine in 2001, and his short story, "The Pianist," recounts an experience during his residency at Northwestern Memorial Hospital in Chicago. He subsequently moved to Saint Louis to complete his fellowship in nephrology and is now an assistant professor at Washington University School of Medicine. An avid musician and writer, Dr. Cheng is also the co-concertmaster of the Saint Louis Philharmonic Orchestra.