Thursday, January 28, 2010

For J, her family, and her dad

Yesterday, I attended the funeral held for J's dad. J is of one of my dearest colleagues.

She's the physician's assistant who manages the day to day ICU care of neurosurgical patients, along with a nurse practitioner and first year resident. She's bright, capable, confident, and very caring. I include her among the clinicians who influence the way I think about my practice, who guide it, and who I most like to work with.

That's the way it is, isn't it? We look back on years spent in school, or anywhere, and count the best teachers we've had or friends we've known on the fingers of a single hand.

One of the ways that J and I work together is to extubate patients. In our unit, unless the patient is at very high risk for needing reintubation, or has a prior history of difficult intubation, the actual process of extubating them is pretty straightforward. It's done by a nurse and a respiratory therapist, and is over in a matter of seconds. Of course, those few seconds are the anticlimax to lots of careful assessment and preparation, which is where J comes in. The senior resident on the team, or maybe an attending, may note on rounds, "Let's try to get this person extubated." But the team quickly moves on to their next patient, so exploring that possibility, and making it happen when it's the right thing to do, is one of the ways J and I work together.

I've developed a mantra: "Breathe, or die."

It's not a threat, or a sign that either of us takes anything we do lightly. Far from it.

It's a simple statement of fact, and it keeps us keenly aware of the seriousness of it all. The mantra is a way to be sure that what we're going to do is something that should be done.

J's dad died suddenly and unexpectedly. It was an accident. He had two daughters, a wife, and several sisters. His brother died before him, as did his father and uncle who started the manufacturing business that he ran.

I read his online obituary, and looked at his picture there. J's father stands relaxed in a vested tuxedo. Perhaps the photo was taken at her wedding.

I've accepted the fact that I'm older than many of my colleagues, and that I'm even older than some of my colleagues' parents. Now I'm older than at least one colleague's deceased parent.

The funeral was held at a small catholic church tucked away in a pocket of rural New Hampshire. The place was filled. I was pleased to hear the priest who gave the eulogy. He spoke well, and he spoke well of J's dad. He knew him.

At the end of the service, a pianist and a singer in the choir loft began the tune, 'How Great Thou Art.' The musical arrangement was a simple one, and at first the singer's voice was soft, even a bit hoarse and almost bluesy. He slowly gained force with each line, and by the end he was firm, clear, and direct. It was moving. It fit the time and place. It fit our reason for being there.

Then, just a few short seconds after the last notes of the hymn faded from the piano, a man standing just outside the door began a dirge on his bagpipe, and continued playing as we all filed past.

I didn't go on to the cemetery, and returned home along the same quiet back roads I had taken earlier. I thought about the music I had just heard, and about the power music can have at a time like this.

I love listening to opera, though I often don't know the specifics of a particular story when I first hear it. What really grabs me is the sound of the singing, and its emotion. I've been told that, in Italy, opera goers are as passionately involved during a performance as the most rabid Red Sox fans at Fenway Park.

I was lucky to be in the stands for Clay Bucholtz's no-hitter. I understand how someone sitting up in a music hall balcony can be brought loudly to their feet upon hearing a performer really nail it.

There's an episode of 'Six Feet Under' that features a famous aria from Pucini's last opera, 'Turandot,' as part of a man's memorial service. It's a quieter than usual performance of the well-known piece, 'Nessun Dorma.'

The priest who spoke at the funeral talked about the catholic faith in everlasting life, though he presented it as a certainty, as something that catholics know to be a fact.

I have to admit that I'm not nearly as sure about all of that.

I'm going to send a note to J in one of my daughter's cards. I don't know when I'll next see and work with her, or even if. I think I'm also going to include a CD that my son's band recorded. He's the drummer, and he calls their sound a mix of rock, funk, raggae, and rap. They write most of their own stuff, including a tune called 'Life Goes On.' Maybe it will fit a time and mood for J at some point.

For now, here's a 1980 performance of 'Nessun Dorma' by Luciano Pavarotti, with Zubin Mehta conducting the New York Philharmonic. I'm told that this clip shows Pavarotti in his absolute prime. I found another by him here, in a 2006 performance that's listed as his last one ever. He died the following year. I also enjoy watching this version by Roy Cornelius Smith, which has the added benefit of featuring the song in the context of the staged opera.

Maybe the priest is right, and everlasting life is a lead pipe cinch. If that's the case, I hope it unfolds like Pavarotti's singing.

Nessun dorma! Nessun dorma!
Tu pure, o, Principessa,
nella tua fredda stanza,
guardi le stelle
che tremano d'amore
e di speranza.
Ma il mio mistero è chiuso in me,
il nome mio nessun saprà!
No, no, sulla tua bocca lo dirò
quando la luce splenderà!
Ed il mio bacio scioglierà il silenzio
che ti fa mia!
(Il nome suo nessun saprà!...
e noi dovrem, ahime, morir!)
Dilegua, o notte!
Tramontate, stelle!
Tramontate, stelle!
All'alba vincerò!
vincerò, vincerò!

Nobody shall sleep!...
Nobody shall sleep!
Even you, o Princess,
in your cold room,
watch the stars,
that tremble with love and with hope.
But my secret is hidden within me,
my name no one shall know...
On your mouth I will tell it when the light shines.
And my kiss will dissolve the silence that makes you mine!...
(No one will know his name and we must, alas, die.)
Vanish, o night!
Set, stars! Set, stars!
At dawn, I will win! I will win! I will win!


  1. Thought you might be interested in what Amber Wollesen at Pallimed Arts had to write about Nessun Dorma.

    Opera is not my bag, but since you like it I thought you would find it interesting. Thanks for sharing your story.

  2. Thanks for the link to Amy's piece, though the YouTube she included is no longer available.

    But seriously, Christian, you're not into opera? If you dig music, ya gotta dig opera.

    I admit, I couldn't tell you the first thing about most operas, even the really popular ones. But there are pieces, or parts of pieces, that just melt my heart.

    Frankly, what really turned me on to opera in the first place were the performance scenes from the movie Amadeus. Purists probably scoffed at those stagings, but I thought they were magnificent.