My residency director, a not-at-all-old-but-definitely-wise man, used to compare the practice of medicine to jazz.

When people think of jazz, they think of improvisation, of unconventionality,   Maybe a little free-form, or rule-breaking.

Turns out, jazz is extremely structured.  And precise.  To be a great jazz musician, you’ve got to be cemented firmly in the basics, and from there, within the structure and precision, you solo.  You improvise.  You break the rules.  And it sounds fantastic.

And then the director tweaks things.  Interprets the music.  Each musician interprets, but they all have to be on the same page.  And then the solos!  They soar, they glide, they travel to the moon and back, but not at all randomly.  They follow over specific chord changes and progressions, overarching rhythms and key changes, and they crescendo and decrescendo, hang on one note or travel a chromatic scale, jump intervals in various tempos as the soloing artist sees, hears, and feels where the line of sound should go.

I think about music a lot.  I gave birth to three musicians (I seem to recall that each one came out playing an instrument).  Right now, I have the distinct pleasure of being with my oldest son in Grand Rapids, Michigan for a few days as he participates in the Michigan All-State High School Jazz Ensemble (third chair trumpet – yay, Zac!).  As I listened to these amazingly talented young musicians playing together for the first time on Thursday, I realized how fundamental the basics are to the output of the sound.  Were it not for the precision, the tightness, the structure of this language of music that these kids speak so well, it would sound cacophonous, rather than the delight it is even early in their first hour of rehearsal.

When my residency director compared the practice of medicine to jazz, he did it to hammer into our heads that we had to have a firm foundation, built on medical knowledge, able to speak the language, and then we could add the art, the gut feelings, the off-label prescriptions – in short, the solos.  As time has gone by, I’ve seen that the analogy goes deeper.  Music, and especially jazz, lives within its interpretations.    A doctor needs to speak the language of physiology, pathology, and statistics, and needs to then interpret the studies that come out, and apply them to the actual practice and decision making.  What is that study actually saying?  Does it fit with my patient?  It sounds ok now, but how would it work if I sped it up here, slowed it down there, and added a key change right here – would that make the difference between my patient’s stumbling along this rhythmically tricky path and her gliding gracefully through the measures to a finale of good health?

I plan one follow-up post to this jazz theme, and then I’ll return to the chapter 1 installments of Your Hospital Guide.