Old and New Music, on Dying to Give Birth

By |January 5th, 2014

Recently I saw Inside Llewyn Davis, the new Coen brothers’ film about a folksinger in Greenwich Village. The moving, fictional story takes place in the early 1960s. The protagonist, handsomely portrayed by Oscar Isaac, can’t quite make it as a musician. He roams from one friend’s apartment to another, never quite sure where he’ll go next. There’s a lot you might explore, intellectually, about his journey, a cat named Ulysses and a trip to a Chicago club called the Gate of Horn.

I liked this sad movie, a lot.

What I nearly missed, though, was the significance of one of the songs, “The Death of Queen Jane.” Fortunately an obstetrician-gynecologist and neighbor, Dr. Peggy Polaneczky, reminded me by her post on its relevance to women’s health. The English ballad tells of Jane Seymour, a wife of Henry VIII. She died in October 1537, at less than 30 years of age, days after delivering a male heir. Queen Jane’s labor was prolonged, her death attributed to complications of childbirth.

Image of the actress Carey Mulligan, Inside Llewin Davis

The actress Carey Mulligan, Inside Llewin Davis

Fast-forward 475 years and a bit more…

In 2012, the WHO reported that approximately 800 women die each day from preventable causes related to pregnancy. That figure translates to over 300,000 unnecessary deaths each year, worldwide. Pregnancy-related deaths declined sharply in the United States and most of the world in the 20th Century. The CDC indicates that U.S. maternal death rates have been on the up since 1987. The reasons for this trend are not established. That some are having children at an older age may be a factor. But most pregnancy-related deaths in occur in young women. The problem is particularly grave among African Americans. Likely contributing risks, from 1987 to 2009, include lacking of access to health care, and having chronic medical conditions like diabetes, hypertension and obesity.

Shifting notes –

The music Inside Llewyn Davis is lovely, haunting. Seeking details on the traditional English folksong, “The Death of Queen Jane,” led me through a different sort of journey. Here’s a link to some information on it from the Mainly Norfolk English Folk and Other Good Music ProjectOn YouTube you can find versions performed by Joan Baez, among others. Wouldn’t you know it, the music of her sometimes lover, Bob Dylan, plays toward the closing of the Coen brothers’ film? Dylan has a song, “Queen Jane Approximately,” that was picked up by the Grateful Dead. The consensus on Wikipedia, though, would suggest that Dylan’s lyrics have nothing to do with the Tudor Queen.

At that point I stopped searching for answers about Jane Seymour’s cut life, whether she was in labor for two or nine days, and the meaning of the song. And I’ll close with this sound clip of “The Death of Queen Jane” from Inside Llewyn Davis, performed by Oscar Isaac. You can catch a fragment of the desperate woman’s plea.

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Reading and Hearing ‘Bang the Drum Slowly’

By |February 28th, 2013

image from the 1973 film

Recently I read Bang the Drum Slowly, a 1956 novel by Mark Harris about players on a fictional baseball team. According to the University of Nebraska Press website, this book was once ranked among the top 100 sports books of all time by Sports Illustrated.

This is a rare cancer narrative. I’d give it 4 stars, or maybe even 5 – depending on my mood and your scale. The story’s told from the perspective of the New York Mammoths’ reliable and usually-winning pitcher, Henry Wiggen. With reason, his teammates call him “Author.” Early on, Author learns his team’s less verbal catcher, Bruce Pearson, had traveled, covertly, to Rochester Minnesota for treatment of Hodgkin’s disease.

In the patient’s words, he’s “doomeded.” Author’s immediate response reveals a clear sense of obligation to his teammate: “I will come,” he says, despite that it’s far away and his wife is pregnant. When he gets to the medical center in Minnesota, he finds Bruce looking deceptively well:

“…and in he come, all dressed, all fit as a fiddle, looking as tip-top as I ever seen him, and I said, ‘This is sick? This is why I dropped everything back home and risked my life in a snowstorm and went to the expense of a new wardrobe in Minneapolis?’   (p. 11)

Harris’s insights and skepticism about physicians in white coats and research funding are familiar now. As his protagonist (Author) remarks:

“’…You are the boys that send me 50 letters a day looking for contributions for your rotten hospitals. What do you do with the contributions I send?’

‘We done many great things,’ said the first doctor. ‘We are only human and cannot do everything.’ (p. 13)

This slim work, oddly elegant in its tenderness and guyish language, resonates today. Some of the pertinent issues include Author’s difficulty in keeping the knowledge of his friend’s illness to himself, the others’ varied responses to the catcher’s disease and cope with his looming death, some acquaintances trying to take advantage of the situation while others reach out and help, fear of the disease…It’s loaded!

An unmissable medical message – apart from the work’s cultural aspects – is that the young player with Hodgkin’s lymphoma had what was accepted as an incurable illness back then. Today, approximately 90 percent of young people with that cancer type survive for decades after the illness and may have a full life after treatment. With so much talk about the costs of care, and research, it’s easy to forget that this was a usually-lethal disease, even at the best of medical centers six decades ago.

I plan to see the two cinematic versions of this story. The first appeared on TV in a 1956 episode of the United States Steel Hour, with Paul Newman as Author and Albert Salmi playing the infirm catcher, among others. More of you may be familiar with the 1973 movie, called Bang the Drum Slowly, starring Michael Moriarty and Robert DeNiro.

Toward the end of the book, a character nick-named Piney sings an old tune about a dying cowboy with this verse: “O bang the drum slowly and play the fife lowly, Play the dead march as they carry me on, Put bunches of roses all over my coffin, “Roses to deaden the clods as they fall.” Some of the players mind the music more than others. The author admits feeling sad.

Though I didn’t find much on the original music behind those verses, which probably exists and has a long history, I did find a clip of Emmylou Harris singing a newer song of the same name.

Emmylou Harris sings another version of "Bang the Drum Slowly" (YouTube)

Emmylou Harris sings another version of “Bang the Drum Slowly” (YouTube)

All these “lessons” – stories of patients, from patients, about patients, form a trail.

ES

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On Sheryl Crow’s Report that She Has a Meningioma, and Singing Loud

By |June 6th, 2012

This morning CNN fed a headline: Sheryl Crow: ‘Brain Tumor is a Bump in the Road.’ This concerned me, not only because I’m a huge fan, but because in 2006, she began treatment for breast cancer at age 43. “Singer-songwriter Sheryl Crow says she has a brain tumor,” says the first line of the CNN story. I was concerned. It seemed liked she’d been getting a little bit closer…to feeling fine.

Fortunately, the LATimes and People magazine got Crow’s story right. Their headlines, and text, emphasize the benign nature of Crow’s newly-diagnosed condition, a meningioma. Most meningiomas are benign, local expansions of the cells that line the brain and spinal cord. These growths occasionally cause neurological symptoms. Some patients have surgery to relieve or avoid complications of these non-malignant growths, but many don’t need intervention. When I was an oncology fellow I learned that meningiomas were relatively frequent in women with breast cancer, but that association turned out to be untrue. The “lesson” back then was that if a scan shows a brain mass in a woman with breast cancer, you shouldn’t assume it’s a brain met, because meningiomas were not rare in women with a history of breast cancer. According to the NCI website today, meningiomas are more common in women than in men.

Singing ‘Rock and Roll,” on top of a piano

Cancer scares aside – I’m glad that Sheryl Crow’s brain mass is benign, and that she can keep on singing if she chooses. I’ve seen her twice in concert, and she’s amazing. I have several favorite songs of hers, but the most memorable moment from a performance I’ve seen was when she got up on top of the piano at Radio City and sang Led Zeppelin’s Rock and Roll. I wish I could do that! She’s a powerful woman, for sure.

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New Music from an Orchestra of Radioactive Isotopes

By |December 2nd, 2011

For the weekend –

A tweet led me to a fantastically inventive kind of music. The Radioactive Orchestra comprises 3175 radioisotopes. From the website: “Melodies are created by simulating what happens in the atomic nucleus when it decays from its excited nuclear state…Every isotope has a unique set of possible excited states and decay patterns…”

image from the Radioactive Orchestra project

The project, sponsored by a Swedish nuclear safety organization, KSU, encourages visitors to select among the graphed isotopes, listen and learn. You can try composing music on your own, or you can check out a production by DJ Alex Boman on YouTube:

Super-cool.

h/t: Maria Popova, @brainpicker, who picked up on this last August at Brainpickings. And to @JohnNosta, who sent yesterday’s tweet.

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iPod Therapy – Why Not Prescribe It?

By |November 16th, 2011

Yours truly, the author of Medical Lessons, is listening to music while she writes. A live version of the Stones’ “Silver Train” has just come on, and she’s happily reminded of something that happened 30 years ago. Distracting? Yes. Calming? Yes. Paradoxically helps to keep me on track? Yes.

My iPod keeps my mind from wandering further. And it lifts my mood.

And so here, on my blog, which is not peer-reviewed or anything like that, I put forth the medical concept of “iPod therapy.”

“When you’re weary, feeling small…” Music can help.

Today’s news reports that 1 in 5 Americans take drugs for psychiatric conditions. That sounds like a lot to me, but I’m no pharmaceutical surveyor. Of course many people need and benefit from medical help for depression and other mental illnesses.

But, in all seriousness, I wonder how many people might use music like a drug to keep them relaxed, happy, alert…

Why not prescribe music? It works for me, n=1.

Maybe doctors should be recommending iPods, or radios, or Pandora to some of their patients who are feeling down. I hope an academic psychiatrist somewhere, without ties to Apple or Pandora or Bose or other relevant party is coordinating a careful, prospective study of this promising and relatively inexpensive intervention.

As best I can tell, music is non-addictive. Except that if I had to live without it, I’d start humming, or maybe singing, which might be detrimental to those who live near.

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Thoughts on the Death of Amy Winehouse

By |July 28th, 2011

I feel compelled to write at least a short note on Amy Winehouse, a young woman who was found dead in her London apartment a few days ago. I don’t like to speak ill of the dead, but the truth is I was never a big fan of her music. I wasn’t fond of her highly-stylized hair or her weirdly-curved eyebrows.

Once, when I was 17, a friend told me he always tries to see the good in people, no matter how much they behaved disagreeably. Ever since he said that, it’s stuck. Today his words come through, in contemplating Amy Winehouse’s personality and short life.

I like her for her willfulness, even though it was so destructive.

Amy Winehouse, in 'Rehab' Video

Not a good medical lesson, for sure – or the message most people are telling their kids upon this “teaching moment,” but not everything I care for is just how it should be.

Yes, she should have gotten more help for her addictions. She needed it, that’s obvious. Family and friends, take note!… You can intervene and make a difference in a troubled person’s life.

But sometimes this happens in medicine, when you’re caring for a patient who smokes or drinks or smokes and drinks or does something else unhealthy, or in a family, or among friends – it’s not always so helpful to simply criticize and judge or lecture and point the person to the door.

So here’s another take: to identify something good in the person, and focus on that, and remember that.

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Gregg Allman Stars in Hepatitis C Awareness Campaign, with Merck

By |June 27th, 2011

This weekend I learned that Gregg Allman, of the Allman Brothers, has hepatitis C. Not just that; he underwent a liver transplant last year for treatment of liver cancer. This information came my way via CNN, in a clip narrated by Dr. Sanjay Gupta. The cable TV crew filmed the old rocker in Macon, Georgia, at the band’s Big House.

Gregg Allman, performing in 2010 (Wikimedia Commons)

“He’s taping a public service announcement for the drug company Merck, about hepatitis C,” Gupta says 40 seconds or so into the clip (italics added, ES).

Hepatitis C stays silent in many carriers, meaning that most people with the virus are unaware of their infected state. The liver-infecting virus spreads most often by contaminated needles, sexual relations or transfusion of infected blood. Over time, the virus tends to cause liver damage and blood problems including anemia and, rarely, a condition called mixed cryoglobulinemia. In patients with long-standing hepatitis C, there’s a significantly elevated risk of developing liver cancer.

For two decades there have been a few, fairly effective anti-viral drugs available for hepatitis C. Treatment generally reduces patients’ anemia and liver disease, which leads them to feel better, and also reduces the risk of the long-term effects of infection, including liver cancer. Last month the FDA approved two new drugs for hep C: Victrelis (boceprevir), manufactured by Merck, and Incivek (telaprevir), by Vertex Pharmaceuticals.

While I have no formed opinion as to which of these new drugs is most effective or less toxic or more affordable in the long term for patients with hepatitis C, I do find it strange that Gregg Allman will be singing for Merck.

Eat a Peach (album cover)

The ethics of this are complicated: On the one hand, it might be a good thing for a music icon to raise public awareness about hepatitis C, so that more people at risk might get tested and then treated early before they develop severe liver disease and cancer, and would feel better. Gregg Allman is in a position to spread that message effectively: “If I have hep C, you might have hep C. Let me tell you about it…” (somewhat in the style of Magic Johnson, on HIV).

On the other hand, the notion of a post-transplant musician serving as the public’s primary source for information on hepatitis C seems preposterous, especially if he’s tied in with a pharmaceutical company with a stake in the matter. The situation is reminiscent of Sally Fields starring in commercials for Boniva, an osteoporosis drug.

You might ask yourself – and it’s not a trivial exercise – who can best, and objectively, inform the public about viral liver infections and the potential benefits of treatment: doctors? (we harbor biases; many have industry ties); patient peers? (Allman is a heightened example, but he’s hardly objective about this, either); newspapers? (or radio…

Will Allman’s be wasted words? (Hard to resist.) Really I’m not sure.

But I might go to Allman’s concert for the American Liver Foundation, at the Beacon Theater, scheduled for July 27.

All for now.

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A Trans-Cultural Time-Crossing Take on Long Words, and Medical Jargon

By |April 26th, 2011

Today Scientific American shared this bit from its 50-year archive, by the mathematician Sherman K. Stein, recounting an interview with the composer George Perle on a theory of rhythm developed in India over 1000 years ago:

While reading about this theory,’ he said, ‘I learned my one and only Sanskrit word: yamátárájabhánasalagám.’ I asked him what it meant. ‘It’s just a nonsense word invented as a memory aid for Indian drummers…. As you pronounce the word you sweep out all possible triplets of short and long beats.’

Sounds like onomatopoeia, or something similar in ancient Indian music parlance. But I’m no drummer, and I don’t know Sanskrit.

It’s got me wondering about the thousands of ancient, hard-to-spell-or-say terms, not rooted in Greek or Latin, for complex medical conditions doctors use today, about which we have so little knowledge.

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Listening to Aretha

By |December 10th, 2010


We learned this week that singer Aretha Franklin has pancreatic cancer. The 68 year old, Memphis-born Queen of Soul was hospitalized and underwent surgery last week, according to several reports.

It’s sad news, in a week that was already sufficient in that dimension. According to the American Cancer Society, there are 43,000 new cases of pancreatic cancer per year in the U.S. Pancreatic cancer tends to occur in the elderly and is slightly more common in men than in women. Cigarette smoking is one of the few certain disposing factors; the causes are largely unknown.

There’s a cardinal triad* I once learned for this disease: weight loss, abdominal pain and jaundice. These symptoms arise due to local effects of having a mass in the pancreas, which rests in the upper, back part of the abdominal cavity. The pancreas sits roughly between, and slightly behind, the stomach and liver, near to the bile duct. Jaundice can result from bile duct obstruction by the tumor mass and is painless in some cases. It’s said that many patients experience depression in the period preceding the diagnosis, although the reason for that, if it’s true, is enigmatic.

You can read up on pancreatic cancer on the NCI website, if you’d like. The American Society of Clinical Oncology offers information, too, as does the American Cancer Society.

As for me, I’m just listening, with due RESPECT. Say a little prayer. Rock steady –

Great stuff!

addendum: One of the most interesting open-text references I found on symptoms of pancreatic cancer is a 1968 paper in the British Medical Journal by Dr. Ian Bouchier. The document, a .pdf, doesn’t open as a link in some readers’ browsers, so I’m including it here:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1986109/pdf/brmedj02093-0053.pdf


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No Quick Fix

By |November 1st, 2010

On History and Health Riffs in the musical, Bloody Bloody Andrew Jackson:

“If it’s chafed, put some lotion on it.”

– some practical advice, offered by the character portraying Andrew Jackson, speaking toward the audience in the last scene of Bloody Bloody Andrew Jackson, a play written and directed by Alex Timbers

Yesterday I had occasion to see the outrageous politico-emo-rock musical, Bloody Bloody Andrew Jackson, which recently moved to Broadway’s Bernard B. Jacobs Theatre. The production focuses on the life and times of the 7th President of the United States.

Now, Old Hickory comes on like a rock star. The story is narrated, in part, by an excitable, graying Jackson groupie who bumps around the stage in a motorized wheelchair. A wild and rattling cast sets the thing’s tone in a startling first number, “Populism, Yea, Yea!” An early review of this musical, toward the end of its early 2008 LA run, cites these lyrics:

Sometimes you have to take the initiative.
Sometimes your whole family dies of cholera.
Sometimes you have to make your own story.
Sometimes you have to shoot the storyteller in the neck.
Sometimes you have to take back the country…

(These words antedate the Tea Party, to which the play vigorously alludes in its current form.)

You get the idea: it’s lively, a bit disjointed and politically relevant. And fun. It messes with the facts, and is tangentially rife with medical topics:

In the play, Jackson’s father, upon witnessing the whoosh and arrow-in-her-back slaying of Jackson’s mother in a backwoods cabin somewhere in South Carolina or Tennessee, immediately and without hesitation attributes her death to cholera. A moment later, he and a cheery cobbler are felled by similar instruments. The future President Andrew Junior, who’s playing with toy cowboys and Indians while both of his parents are shot dead in this life-motivating scene of pseudo-history, refers later to his parents’ deaths from cholera.

Most historical sources and Jackson’s Tennessee home’s current website, attribute the mother’s death to cholera. According to a scholarly review of cholera epidemics in the 19th Century, the disease didn’t appear in North America until after 1831 or so. A fascinating, original New York Times story details the ravaging effects of this illness in Tennessee in 1873, but that would be long after Jackson’s death in 1837.

An unexpected medical writer’s gem of a song, “Illness As Metaphor,” cuts to the heart with a message about blood, symbolism, love and Susan Sontag’s classic essays on the meaning of tuberculosis and cancer in literature and in life. The lyrics of the song from Bloody, Bloody Andrew Jackson are hard-to-find on-line, but you can get it through iTunes, by which I found these words:

A wise woman once wrote that illness is not metaphor.
So why do I feel sick when I look at you?
There is this illness in me and I need to get it out, so when I bleed
It’s not blood, it’s a metaphor for love.
These aren’t veins just the beating of my heart.
This fever isn’t real it represents how I feel…

You can see a Spanish-sung, sickly romantic version on a YouTube video:

I’m not sure how Susan Sontag would feel about emo-rock in general and about this song in particular, but I should save that subject for some intense, future writing project –

A few other medical digs include mention of Jackson’s hepatitis – acquired on “the battlefield,” as he explains to his admirers, syphilis – a killer of Indians and, consistent with the play’s hemi-modern approach, Valtrex – which some of the prostitute-turned government advisees run to get when it’s given for free.

All in all, it’s a terrific play about Americans, Manifest Destiny, populism, anti-elitism, economic frustration, anger toward foreigners, fear of terrorism, emotions and the founding of the Democratic Party.

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Tomorrow is Election Day. Remember to vote!

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The Music of H.I.V.

By |October 6th, 2010

Yesterday I came upon something I’d never heard before: Alexandra Pajak, a graduate student at the University of Georgia, merges art and science in a novel way. She composed a new work, the Sounds of HIV, based on the virus’s genetic sequence.

A CD, produced by Azica records, will be available later this month. A ScienceRoll post, by Bertalan Meskó, clued me into this fascinating project. He shared the artist’s explanation of her work:

Sounds of HIV is a musical translation of the genetic code of HIV, the Human Immunodeficiency Virus.  Every segment of the virus is assigned music pitches that correspond to the segment’s scientific properties.  In this way, the sounds reflect the true nature of the virus.  When listening from beginning to end, the listener hears the entire genome of HIV.

In English, the nucleotides Adenine, Cytosine, Uracil/Thymine, and Guanine are abbreviated with the letters A, C, T, and G.  Since A, C, and G are also musical pitches in the Western melodic scale, these pitches were assigned to the matching nucleotides.  To form two perfect fifths (C-G and D-A), “D” was arbitrarily assigned to musically represent Uracil.  I assigned the pitches of the A minor scale to the amino acids based on their level of attraction to water…

According to a May, 2010 post in the Daily Scan, the artist has assigned pitches to each viral segment’s properties:

…The composition’s Prelude and Postlude correspond to the first and last 100 nucleotides, and the sections named after the proteins (Proteins 1-9) represent translations of the amino acid sequences…

Upon searching further, I tracked down some partial HIV music clips, available now, at ClassicsOnline. The start of the prelude sounds calm and lovely to my rock-trained ears; other portions are distinct and lively.

I look forward to more listening!

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