This is a follow-up to the musical analogy from my last post.  A hospital functions like a jazz ensemble.  Intricate, intertwining, indispensable parts come together to form a unified, breathing, well-oiled whole.

The nurses play the role of the bass.  The bass is the heartbeat of the ensemble.  You don’t necessarily notice or think about the bass, but you feel it deep inside.  It’s actually what you dance to, what you tap your foot to, and what you bounce your head to as you listen to the music.  The bassist sets the overall rhythm, stepping out at times to solo and demonstrate the profound foundation the instrument provides along its range of deep beauty, and then brings back steadiness to the piece.  You cannot do without a bassist.  You cannot do without the nurses.

The internists, pediatricians and family practitioners are like the trombones.  Trombones are in the middle of everything.  They slide from high to low and back as they maintain the steady middle ground of each piece.  They harmonize, and tie together the sounds of the other instruments.  The trombonists provide the backbone for the other brass and the woodwinds.  Their range is wide, and they function across their range to blend the treble and bass sounds to coordinate the overall flow and sound of the music.

Saxophonists are sexy, and a little bit cocky.  Kind of like surgeons and obstetricians.  They solo frequently, and have incredible manual dexterity.  They’re a little showy, and with good reason – they’re really good.  They open the piece, close the piece, and take the piece on fantastic rides throughout.  Have you ever watched a saxophonist solo?  They tend to move with their instrument, leaning and thrusting their bodies into the sound almost in a “Dirty Dancing” kind of way.  It’s very physical.  They are fully immersed and sure of what they’re doing.  Like you have to be when you’re gowned, gloved, masked, and cutting into a person.

The specialists come in like the trumpets: loud, sure, and precise.  They can make a statement playing the same note repeatedly, and then when you think you can anticipate their next sound, they jump pitch, leap back and forth, and add a brilliant flourish as they bring the narrative of the musical story to another level.  You want them to weigh in on a subject.  When they speak, you listen.  And they know what they’re talking about.

The social workers and the respiratory, speech, physical, and occupational therapists fit the role of the electric guitar player in the jazz ensemble.  The guitarist has unique style and technique, filling in and enhancing the melodies and rhythm.  The guitar licks punctuate the storyline, adding layers that before you heard them, you might not have realized were missing, but once they’re there, you realize how important they are.

A drum set encompasses the behind-the-scenes people within the hospital.  The snare, like the clerks and secretaries, takes the lead in moving things along at a reasonable pace.  Each drum in the set has to beat in exquisite coordination with the others, fulfilling basic roles and ensuring that the rhythm and tempo proceed as they should.  The scurry of activity within each drum fill takes the musical piece to the next spot.  You’re not sure what just happened, but you liked how it sounded and you know you’ve shifted.  There’s a lot of complicated action.

The pianist sets the tone of the piece, like the administration of the hospital.  The tone can be soft or harsh, bright or dark.  You hear it louder at some times than others, but it is always there, affecting the overall mood.

The individual musicians in the jazz ensemble need to practice and hone their skills.  Each section needs to function together, and while each section speaks out and sounds great, you can’t listen to any one subgroup by itself for too long without its getting a little annoying.  You need the balance of the different facets of the ensemble playing off one another.  The entire group needs to practice together, listening to one another and adjusting as necessary to achieve an overall sound that is mind-blowing in its complexity, flawless in its integration, and simply beautiful.

And with that, we will return in the next post (on Monday) to your regularly scheduled installment of Your Hospital Guide.  I hope you’ve enjoyed this brief musical interlude!

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. 

Because I have transitioned from taking care of patients to taking care of clients (please click link at the top of this page to check out my company’s website, if this is news to you), I no longer wear a white coat.  I generally wear standard business attire when I give talks and when I meet with clients or business associates.  On days when I have no meetings and I’m focusing on writing, I dress pretty casually – current outfit of choice is jeans and a sweater.

On writing days, I’m frequently the only one home.  And when I am the only one home, I will not, as a matter of principle, turn up the heat.  Today is such a day.  And it’s cold in my house.

The only clean pair of jeans this morning was the black pair.  So I put on the black jeans and a grey and black striped cowl neck sweater.  I worked on my book (happily near completion) for a bit, and got tired of shivering, so I threw on my black cardigan, which was near the front of my closet and easily reachable.  I made a second cup of coffee.  I wrote some more.  And I was still cold.

So I walked to the front hall closet to see what I could find to help the situation.  I wanted to put on a hat, but didn’t want to end up with “hat head,” so I put on a loose, floppy beret that I’ve had since high school, which rests comfortably on top of my head, keeping in the heat and leaving my hair only minimally squished.  And I grabbed a scarf, since my neck was feeling a bit of a draft.

A bit more typing at my computer, and then a quick trip to “return” some of that coffee.  I glanced in the mirror as I walked into the bathroom – there I was, in layers of black and grey, wearing a beret and scarf, looking like I was about to audition for a character role as a writer in a movie.  So apparently there’s reason behind the stereotypical writer’s outfit – a slow laundry system, a chilly climate, and a stubborn unwillingness to turn up the heat.  Who knew?