Layers

As time passes, certain events are encoded into memory.  The slightest stimuli unleashes a flood.   A waft of fresh-baked cookies triggers fond remembrances of home; the sound of rain on canvas, camping trips.

It is our collected memories, and our perceptions that stem from them, that are the core of ourselves.

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Classical music is an obsession of mine.  I have played the piano as long as I can remember and I do not go a day without listening to it.  While studying I prefer Glenn Gould's Bach - the Goldberg Variations are a particular favorite - but while taking a long drive I prefer Rachmaninoff preludes.  I made the mistake of listening to Violin Partitas almost exclusively while studying for Step 1 and I fear I may have ruined listening to them for ten years, at a minimum. There is a reason that people still listen to classical music even though the composers are long dead:  classical music taps into the depths of human experience.  (What was the top song of 2006, again?)  I listen to the same works over and over again.  When I hear the Beethoven symphonies I can tell what's happening next; with his piano sonatas, I hum along. 

As a consequence of listening to the same things over and over again, they have acquired layers of meaning.  I reserve the 4th movement of Beethoven 5 for moments of triumph.  Walking out of an exam I listen to it nearly every single time.  Brahm's Intermezzo in A is saved for decompression - when I want to sit back and relax after a long day of work I close my eyes and let the sound wash over me.

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Today I discharged a man to palliative care.  It was the first time I've done this.  He had a long and complicated stay in the hospital - over the fifteen days of his stay he was cardioverted, delirious, and sent in for an embolectomy secondary to critical limb ischemia.  Delirium imposed on his history of paranoia and dementia made him what the interns call a "rock" - someone who is staying on our service for a while due to the fact that no other place will take him.  Late in his course his oxygenation started to fail and he developed a wet cough, secondary to his failing heart and a month and a half of not eating.

As I went in his room to say goodbye he had a rare moment of lucidity.  I took his hand and started to say goodbye.  He looked at me, in between coughs with naked fear in his eyes, and said "Am I going to go?"  Not "go" in the sense of leave the VA, go permanently, as in die.  I did not know what to say.  I had no comfort to offer him, save that he was going to a place where they were able to take care of him.  How utterly inadequate I felt.

While I was sitting in the room blaring in my head was the opening to Mozart's Requiem; the ponderous d minor opening was playing as I was holding his hand.  The crescendo to the haunting entry of the baritones sounded as I left the room.

Requiem aeternam dona eis, Domine. Grant him eternal rest, Lord.

A new layer has been added to the work: the sight of an 86 yoM with a pmhx of dementia, paranoia, Parkinson's, and CHF being put on a stretcher to go and die.