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Friday Music With Paul.

As a neuropsychologist specializing in cognitive impairment in multiple sclerosis, I divide my time between research and clinical work with patients with multiple sclerosis. Four years ago, Paul Tunick, MD, came to me for a cognitive evaluation. Like so many people with multiple sclerosis, Paul struggled with severe depression, debilitating fatigue, and progressive physical disability that limited his ability to live the full, stimulating life he had known until recently. Paul made his career as an accomplished cardiologist at a major medical center in New York City, and he had an impressive life story. Accepted to Princeton University at the age of 15 years, he quickly proved himself to be a talented student and, without interruption, continued on to medical school where he graduated with distinction and began practicing medicine. Paul was a brilliant physician whose self-concept was deeply informed by a lifetime of academic achievement and professional skill. Beyond that, Paul can still describe patients he treated decades ago, recalling details of their care, their condition, and their personal lives. I never knew Paul the physician, which is unfortunate because if he were still in practice, Paul would be the person to whom I would send my mother, my sister, my husband, my best friend. My initial medical evaluation of Paul revealed severe cognitive impairment across multiple domains. He and his wife were highly motivated to explore all possible avenues of treatment, and I was eager to team with them. We tried a variety of empirically supported cognitive training exercises combined with aerobic exercise and met weekly to gauge our progress. We also tackled the concept of acceptance, which proved to be particularly intractable. How do you tell someone who used to be so accomplished, so adept, and so remarkably gifted to “accept” that he no longer is? As the months passed, it became increasingly clear that a major obstacle to progress was Paul’s depression, which came to represent an important treatment target. In a frustrated moment 1 week, I said, “Paul, you used to be an exceptionally talented guitarist. You haven’t played in 5 years because it pains you to hear yourself. I used to be a professional cellist. I haven’t played in years, and it pains me to hear myself. Next week I’m bringing my cello; I am going to play for you and you are going to play for me.” Thus began Friday music with Paul. Ours was an unconventional mix of bluegrass guitar and classical cello; as it turns out, at the intersection of these genres live the Beatles and George Gershwin, which quickly became our preferred repertoire. Each week we tackled a new tune, working out an arrangement that would accommodate our respective limitations. And week by week, little by little, from the ashes rose something approaching beauty. Paul and I have been meeting weekly for more than 3 years now, and our sessions continue to be one of the great joys of my life as a clinician, as a musician, as a human being. Paul still has cognitive impairment. He still struggles with depression and fatigue, and his physical limitations have increased. But through all of this, when I asked Paul what our music has given him, his 1-word answer was relief. He told me that when we first met, he was in mourning. Music had been a huge part of his life; for 50 years, he played 4 hours a day, creating complex jazz arrangements, studying with a private teacher to develop his technical skills, and eventually compiling and recording a solo album in the late 1990s. When multiple sclerosis developed in Paul, he could no longer play the elaborate and technically demanding chord-melody arrangements he loved, so he stopped playing altogether. With encouragement, we found a new way for Paul to play: simple, single-line melodies supported by a slow, low, walking cello line. Paul had never played duets; he was a solo player. But now, he is forced into a partnership, to listen and respond, to rely on another player to lay the foundation, and to trust someone else to support him. On his own, he can no longer generate the fullness and volume that sustained his solo playing of the past, but the simple arrangements we create accommodate his new abilities while revealing the possibility of finding beauty in simplicity. We recently performed for a small group of Paul’s friends gathered in his living room. It was hard to convince Paul to do it; although he frequently jokes about booking Carnegie Hall, he has no interest in performing. Yet when the day came, Paul was wearing a special shirt, bagels and lox had been laid out in the dining room, and the mood was festive. The music was mediocre, but nobody cared. Within the field of neuroscience, a rapidly burgeoning area of inquiry focuses on music: music as therapy to facilitate plasticity in stroke rehabilitation, rhythm training to facilitate sensorimotor synchronization in patients with Parkinson disease, and ensemble playing to enhance prosocial behavior in children with autism spectrum disorders, among other clinical applications. When we began Friday music, I had 1 primary goal: getting Paul back to something he loved. As medical practitioners who pride ourselves for being empiricists and skeptics, Paul and I continue playing together on the basis of a decidedly unscientific drive to fill a void we both felt in our lives when we lost music. In doing so, we stumbled upon something at the intersection of music and medicine and arrived at something beautiful.