Mr. Apron and I sat down at the kitchen table last night to enjoy our dinner of Exploding Pizza, the kind of crust that comes in a tube, and when you peel back the paper it kind of pops, and therefore contains a warning to point it away from your face. We call that Exploding Pizza. On the table was a brochure for Piffaro, a musical ensemble which performs renaissance and baroque music using period instruments, such as recorders, harps, shawms, and, my personal favorite, sackbuts. As I glanced at the various performance descriptions for 17th century Spanish music, I spied a familiar name in the November performance – the husband of a woman led my Early Music Ensemble in college. He came in a few times to support those of us brave enough to take on the shawms and dulcians, which are sort of proto-oboes and proto-bassoons, respectively. We obviously had to go.
“I love taking you to these performances, buddy,” said Mr. Apron as he made a mental note to take me to these performances, “but I hate that it always makes you so sad.”
My brain surgery left my body in less than optimal condition immediately after the surgery. While I’ve pretty much healed up in as much as spontaneous recovery and physical/occupation/speech therapy can do, there are subtle, sub-clinical deficits I still retain. When in the medical model, one refers to body function, whether it’s strength, range of motion, or activities you can do, in varying degrees of impairment, such as mildly, moderately, or severely impaired. In my case, I probably fit the description of WFL, three marvelous letters which stand for Within Functional Limits. This says, essentially, “This person or his body part is suited for all normal functions.” Not quite as gratifying as WNL, Within Normal Limits, WFL simply allows the medical professional to give a cursory assessment and determine that nothing significant is standing in the way of ADLs, (Activities of Daily Living): those happy life skills like dressing oneself; loading the dishwasher; using a spork; and running for/signaling at the SEPTA bus leaving the curb.
I am WFL. My body parts all work WFL. My once-paralyzed left arm, hand, and all five fingers are WFL. I can buckle my seat belt, cut up food with a knife, fasten a necklace, and open a door. My lips/mouth/tongue are WFL. I can chew food, move it around my mouth, form it into a swallow-able glob, and swallow it. I can find pesky pieces of lunch hidden in my cheeks, and I can use a napkin to locate detritus on my lower lip. I am WFL.
If you probe deeper, maybe compare pre- and post-surgery, you’ll see deficits. Maybe not in everyday function, but in measurable impairments. I have very little feeling in my lower lip, chin, and lower cheek on the left half of my face. My left fingertips perceive touch and temperature ever so slightly differently than those on my right hand. What this means for daily life is that sometimes I do miss a piece of food on my face, or drool if I’m sleeping on my left side (which I wouldn’t feel). My left hand might not be up to carrying a dresser long distances. All these differences would not matter for regular old ADLs, but they do matter for a musician.
Immediately after my surgery, my father, a psychiatrist who should have a good handle on brain function, approached my neurosurgeon with some concern regarding my “musical” ability. Now, in this century we’ve moved away from phrenology and believing concretely that lumps on the head/brain correspond to characteristics, strengths, and abilities, but there is emerging research into localization of some functions in the brain, made possible with fMRI, imaging which lights up in brighter colors which portions of the brain are active during certain tasks. I read an article once where the brain surgeons had to do surgery on a professional violinist while she was awake to make sure they had localized and avoided disturbing the “music center” while they operated. They stimulated portions of her brain and then asked her to play the violin to map out her brain during surgery. So my father, with his concerns about my “music center” was not completely out in left field. In fact, there’s a study at Harvard University which has discovered that certain parts of the auditory cortex are sensitive to aspects of music.
In the hospital I could do very little. I couldn’t sit up for any length of time without getting very dizzy and causing my already massive headache to throb even more. Finally, towards the end of the week I spent as an inpatient, I felt well enough to sit up. I tried to spend most of my days sitting up to prove to the nursing staff how much my constitution was improving so they’d let me go home.
My mother plays harp professionally. She plays a lot of weddings and church-related events such as midnight masses and Christmas concerts. She has also played for Mothers Day teas at yacht clubs, a Memorial Day event at a cemetery, and concerts for children. In addition to her concert-sized harp, she has a more portable version, which she brought with her to the hospital, to cheer me up, keep us all busy, and entertain the ward with strains of “If I only had a brain”. In an effort to appease my father’s worries, and for want of something to do that didn’t involve vision (I had double vision immediately after surgery which conveniently went away as soon as I made an appointment with an ophthalmologist 8 weeks later), I asked for the harp. Balancing it on the edge of the bed, cradling the harp between my knees, I propped myself up. My useless left arm lay at my side, but I was able to pluck out “Twinkle Twinkle Little Star” with my right.
Behold! They had spared my “music center”! Not only had the post-operative angiogram shown no residual AVM; they had successfully left intact my musical abilities. Or so it seemed. At least my father was relieved.
Unfortunately, I did not have so much success with my other instruments. When I had regained a little function in my left hand (I became strong enough to lift a spice bottle), I tried the clarinet and the bassoon. My embouchure, the shape of the mouth and lips when playing a wind instrument, was weakened not only by months of disuse, but also was significantly affected by my new deficits. I couldn’t keep a seal on the mouthpiece of my clarinet, and spittle flew out of the left side of my mouth. Bassoon was no better. Even as the months wore on, and my strength improved measurably in therapy, I had no more success. Every time I would pick up my bassoon, I would collapse in tears, wailing as I sat in the living room, apologizing repeatedly to the beautiful (some might argue) instrument. My left hand, as “functional” as it was for the physiatrist, was still too weak to even hold the heft of the 7 pound instrument, let alone support the instrument with my palm and move all five fingers in rapid precise movements. Websites will tell you that bassoonists don’t actually have to feel the weight of their instruments because they’re supported by seat straps. While it’s true they’re not lifting 7 pounds constantly, they do have to hold up the top-heavy instrument as it leans ever so slightly to the left.
I can do all of the range of movement exercises with my facial muscles, and my left hand strength is now pretty good for a non-dominant hand, but it is nowhere near agile enough to play a musical instrument. The rapid movements, the precision, the muscle memory needed for arpeggios, for reaching all of the 17 keys on a bassoon, for sealing the holes of the instrument…I just don’t have those abilities.
When we go to a concert, be it classical music, early music, Indonesian music, or any other genre or instrument I have played, I get sad. I think of how I used to play, used to be in ensembles and have concerts, and go out for Dairy Queen afterwards. I have been in marching bands of 100 pimply teenagers, chamber orchestras made up of physicians, school bands, wind ensembles, early music ensembles, quartets, and summer orchestras large enough to have 8 bassoonists and 40 flautists. With varying degrees of proficiency, I have played piano, recorder, harp, bassoon, clarinet, bari sax, dulcian, krumhorn, viola da gamba, cello, and gamelan (Indonesian percussion) instruments.
I wish I could pick an instrument back up. It’s been so long now that I’d have an uphill battle to relearn the instrument as well as reteach my hands how to play. I avoid even trying. I keep my bassoon locked up in the basement, where I don’t have to think about it. When I pluck out notes on a piano to help Mr. Apron learn his music for plays, I keep my left hand in my lap, ashamed to try to use it. It would be so hard now that I don’t even try. That if I did, it would be so difficult I would get frustrated and give up. The sadness also stems from the fact that, if you hadn’t gathered from my list of instruments and ensembles, music was a pretty big part of my life until my surgery. It’s also a pretty significant part of my family’s life.
My mother, as I mentioned, is a harpist. She is also a pianist. My brother dabbled in drums for a while before returning to piano, his first instrument. Last time I checked, he had completed his college majors in physics and music, ripping through sonatas and pop songs at the speed of lightning. My sister, too, started with piano, and branched off into brass, picking up the trumpet, mainly, but also trying out the euphonium. She also plays the shofar annually at my parents’ synagogue’s High Holy Days celebration, blasting the announcement of the holiday from the ram’s horn for all to hear. My father, though never quite reaching proficiency on the piano, stuck with woodwind instruments. He started with clarinet, as did I, and then moved to bassoon, as did I. I followed his path, waiting for my hands to grow even a smidge more so I could play the bassoon like my father. My first ensemble was a duet with my father. He had put down his clarinet since probably junior high, but dug it out of my grandmother’s closet to play when I started playing in 5th grade. And when I picked up the bassoon, he dusted his off from where it had lain, dormant under the piano, since I was born.
Though the years I’ve had many “clarinet buddies,” playing duets with me, or starting impromptu ensembles. We helped each other improve, and I may have actually done more practicing when playing with a friend. As I moved into high school, I found clarinet buddies in marching band or other low woodwind players in orchestra to be my bassoon buddies (I was always the lone bassoonist). In college, I never quite found any bassoon or clarinet buddies. I couldn’t figure out how to socialize during the breaks at orchestra rehearsal. I was just a shy freshman, the 3rd bassoonist in a section meant for 2. It didn’t seem like much of a loss when I quit orchestra, and, subsequently, bassoon lessons. I hadn’t been motivated to improve in a long time. Away at college, I missed the camaraderie of having music buddies. I didn’t have the motivation to play, or any of the benefits that had always come with music for me.
As Mr. Apron and discussed music last night, I started tearing up. I guess he thought I was again regretting that I have put down my instruments and am afraid to try again. It was all this talk about clarinet buddies. I was realizing that neither Hannah, nor Nadia, nor Jamie, nor Alison, nor Sandy were my first clarinet buddy. My father, who himself had put down his instruments when I was born, was my first clarinet buddy. Though we had built a pink dollhouse together for my 3rd birthday, and gone skiing together when I was 6, the most consistent and longest lasting activity we have shared is music. Music did not care if there was 24” of powder on the ski slope. Music did not care if we had wrist-guards while rollerblading. Music did not leave sawdust in our eyes or require Mickey Mouse ear protectors. Music is something my father supported me in for many years. I understand his fear of my losing my music because of my surgery. He hadn’t realized then that my deficits would not be in the region of the brain that is sensitive to rhythm, melody and harmony, but in my fingers and my discouragement.
We will go to that early music concert in November, and I know I’ll get sad. I’ll also enjoy seeing and hearing the beautiful instruments that I used to hold and play. I’m not sure where I’ll go with music, or if I’ll even persist with an instrument long enough to find out if it’s even possible to play again. I’m still fortunate to have grown up playing and listening to the tunes of my family, in the house where we referred to the living room as “the music room.” The music room was where I danced at age 4 to my mother’s harp practicing, where I set up a crude drum set for my brother made out of oatmeal drums and pie tins, and where my father and I played many hours of duets together.
More than physical impairments, and all the excuses I let my body and brain make for my failure to try again, is motivation. Maybe again I’ll find motivation in one of these concerts – an open call for a mediocre bassoonist, an invitation to come try out the bass recorder, a song I can’t let go of – or in another source. Maybe Mr. Apron will find a duet for banjo and something-I-used-to-play. Maybe I’ll meet someone who inspires me and wants to have jam sessions.
Or maybe we’ll have to grow me another clarinet buddy.
September 18, 2009 in Brain Surgery Tags: AVM, Brain Surgery, music, music cortex, phrenology, Piffaro, the father