Unfinished Symphony

By Danielle Ofri
The Lancet

“When in doubt, mime,” a musician once confided to me. “Just saw your bow along with everyone else and no one will notice. That’s the beauty of an orchestra!” Miming was my planned strategy for my current conundrum. 7 years of cello lessons put me at only an intermediate level, but I was on sabbatical from my hospital in New York City to spend time as a visiting professor in Israel, and the neighborhood orchestra was desperate for cellists.

“It’s easy,” the conductor of this orchestra assured me, emailing the cello section for Schubert’s eighth symphony on a Tuesday. The rehearsal was on Sunday. Thankfully for me—although tragically for Franz Schubert—this was his “unfinished” symphony, cut off after only two movements due his syphilitic demise in 1828 at the young age of 31 years.

I decided to ignore the second movement and use my few days to cram the first movement, so at least I might have the beginning of the piece in semi-workable form. It was winter in Israel; flowers and bees were in feverish action. The landscape was in full bloom, making it easy for me to push aside the book I was supposed to be writing while on sabbatical. Citrus, loquat, and olive trees surrounding our rental were stirring restively as I labored through Schubert’s first movement.

I arrived at the library of the local elementary school that Sunday for my first rehearsal. The orchestra members hailed from all walks of life. There was a skinny young Sephardic man with a black velvet kippa sandwiched in the first violin section between two professorial Ashkenazim wearing socks with sandals. The violist wore flip-flops. The Russian music teacher who led the second violin section sported prim pumps and flawless technique. The bassoonist was a gregarious tech executive.

The cello section, I learned to my dismay, consisted of only two other cellists, one of whom was absent that night. The conductor brought the group to order. “Tonight,” she said, “let’s start with the second movement.”

My heart swung into a bout of supraventricular tachycardia as I hadn’t even peeked at the second movement. But the baton came down and everyone was off. I tried to catch a few notes but was immediately flailing and thoroughly lost. It went downhill from there, for a solid hour, an experience that could comfortably be compared to extended root canal, although dentists generally provide anesthesia.

As we readied ourselves for the second half of rehearsal, my fellow cellist zipped up his case. “I’m really sorry,” he said to me, tucking the score into a folder, “but I can’t stay for the rest.” I stared at him in disbelief, unable to articulate a response, as he collapsed his music stand and disappeared into the night, leaving me as the entirety of the cello section.

When I was a medical student, a sage intern had whispered to me, “when in doubt, pretend.” But anyone familiar with Schubert’s famous symphony knows that it opens with just the cellos. Well, it opens with the cellos and the double-basses, but we did not have any basses, and right now we had only one single cello, whose wooden seams were threatening to split open from the sweat streaming out of my palms.

The rest of the orchestra placed their instruments at rest, and turned toward me. The conductor raised her baton, then brought it down squarely in my direction as I leaned into my five flimsy days of practice and the ineffable belief that my misery could not sink any lower. Faced with the vast open ocean of the solo music before me, and no one else to hide behind, my fingerboard dissolved into an anonymous ebony. I stabbed at what I hoped were the notes, my bow scraping like galvanized steel. Tears squeezed out from the corners of my eyes as I suffered through eight wretched measures of musical nakedness. The band—out of pity or out of practical necessity—played on.

When I finally escaped the rehearsal, I was firmly ready to quit. The smart doctor knows when she is in over her head, and steps aside to spare the patient. It is the right thing to do to transfer care to someone better equipped—more knowledgeable, better trained, more clinically appropriate. The smart cellist should do the same.

But I found that I wasn’t able to. The music turned out to be toxically addictive. Although I have listened to symphonic music for years, I had never before sat inside the music. Even though I had been distraught and irretrievably lost during this rehearsal, the experience of being inside the symphony was like being cradled in the curvature of a conch shell, the music unfurling from the deepest recesses, thrumming through your very cytoplasm and then exploding out to saturate the air around you. That opening—botched though it was in my hands—was a sensuous elegiac whisper that swelled into a sonorous F-sharp, exhaling its melodic breath over three impossibly long, lush measures. Those tears were not just tears of mortification—they were tears of revelation.

Night after night I practiced the symphony, often relying on the same brute force approach we’d been taught in medical school. The hem of cellist Mstislav Rostropovich’s trousers might remain light-years away, but that did not mean I couldn’t slog at it the same way I’d tackled the Krebs cycle. Within weeks, all three of my children were grumbling Schubert in the bath.

Winter had given way to a fragrant spring. A low-slung vine sprouted unexpected handfuls of grapes. Bird-of-paradise flowers muscled into bloom. By this point, my book had made progress and my seminar with medical students was starting to wind down. As the first tentacles of summer heat slithered in, our plans to return home took shape. The year was drawing to a close. But first, the conductor insisted, we must have the concert!

At this, I blanched. Mucking it out in an elementary-school library was one thing, performing on a stage was something else entirely. Playing in this community orchestra had been exactly that—playing. I was playing at being a musician, larking it up in the gentle fantasy of a world that was not mine. But coming clean in public? I was not ready for that. However, a hall already had been rented. Family and friends were invited. A pot-luck reception was organized. As we readied our instruments backstage on the day of the concert, all I could think was: “Dr Ofri, how did you ever get yourself into this mess?”

Many have made comparisons between music and medicine—and I’m equally guilty here. There are the critical listening skills they have in common, and the keen observation of detail. There is the parallel of all-consuming training in service of your field. There is even a similar sense of performance—physicians being “on stage” with each patient encounter. But what struck now me was the powerful sense of being part of something greater than the self.

When I was younger, I had never understood why any musician would want to be buried in a sea of anonymous players in an orchestra. Why wouldn’t they want to be the soloist, standing out far from the madding crowd, soaking up the accolades? But now I got it. In fact, the very last place I’d want to be was out there solo. I was desperately grateful for the presence of musical colleagues. And it wasn’t just that they provided cover for when I messed up—which they did heroically. It was that they provided a scaffolding for me to be better than I ever could have on my own. That was the miraculous essence of the experience.

I think about this a lot in my medical practice. Without a doubt, I am a far better doctor than I ever could have been because of the presence of my colleagues. True, it is partly because my colleagues have rescued me —well, really my patients—when I have erred or fallen short. But mostly it is because of the infectious nature of the group endeavour that perpetually pushes me forward, pushes us all forward. The collective fund of knowledge and clinical skills is a propulsive force—much like orchestral music—that not only insists on betterment but is also a defiant reminder that there is a good greater than our individual enterprise.

This was most vividly on display during the COVID-19 pandemic, but I feel it even during the quotidian routine of daily clinical life. Not a day goes by when my patients’ medical care has not been bolstered by my colleagues—sometimes in ways that are subtle and sometimes in ways that astonish. Which is why, despite all the very real heartache and moral distress that is ever more prevalent in medicine these days, I still feel like it is the best job out there.

Our final performance of Schubert’s unfinished symphony was not exactly virtuoso material, but we three cellos managed to coax out that haunting opening and hand it off to the violins for the pulsing cadences that upped the emotional ante. Once the oboe and clarinet sailed in on top with that floating melodic line, my pulse eased down a notch and I was able to breathe. My nerves were still rattling like buckshot, but there was something encouraging about the ballet of bows around me. They both pulled me along and pushed me forward.

When we finally rallied our way up the arpeggio of that last chord, we had produced an actual symphony. The Israel Philharmonic Orchestra was in no danger of losing its job, to be sure, but that hardly mattered. We had made it!

So many aspects of our lives are complex orchestrations: our families, our communities, our medical practices, our book clubs, our sports teams. Occasionally it’s even an actual orchestra. The common thread is that they are simultaneously intimate and exhilarating, even as they may also be rife with turmoil and frustration. Our chances of success, however, would be infinitely lower if we were going it alone.

I am grateful to be part of the minions—at work and in life. Practicing cello on my own, like practicing medicine on my own, often has a tinge of loneliness about it. Yes, I get to mess up without anyone hearing, and there are days that I embrace the solitude. But I often find myself needing to recreate the orchestral experience in my head. I close my eyes into the Mediterranean evening and can conjure up the orchestra in the tiny library. I can feel them bac king me up, urging me forward.

And if I get stuck, I can always mime. They’ve got my back.