An Oliver Sacks Foundation Best Book of the Year Selection, Finalist for the Books for a Better Life "Best First Book” Award, and a People Magazine Pick in nonfiction.
The astounding story of a critically ill musician who is saved by music and returns to the same hospital to help heal others
Andrew Schulman, a fifty-seven-year-old professional guitarist, had a close brush with death on the night of July 16, 2009. Against the odds—and with the help of music—he survived: a medical miracle.
Once fully recovered, Andrew resolved to use his musical gifts to help critically ill patients at Mount Sinai Beth Israel’s ICU. In Waking the Spirit, you’ll learn the astonishing stories of the people he’s met along the way—both patients and doctors—and see the incredible role music can play in a modern hospital setting.
Schulman expertly weaves cutting-edge research on neuroscience and medicine, as well as what he’s learned as a professional musician, to explore the power of music to heal the body and awaken the spirit.
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Waking the Spirit
A Musician's Journey Healing Body, Mind, And Soul
By Andrew Schulman
PicadorCopyright © 2016 Andrew Schulman
All rights reserved.
The Ultimate Reality
The telephone rang.
It was midafternoon, late June 2009. The caller ID showed the name of a doctor I'd seen for the first time a week before. I instantly realized that if my doctor was calling the day after a pancreas scan there was a very good chance I was about to get some very bad news. We'd known for ten months since the first scan revealed two suspicious cysts that things might get serious. I stared at the phone for another second before answering. My wife, Wendy, must have seen my expression. She hurried over, fear in her eyes.
"I just got the results of the scan, and the two cysts from last year are still there but they haven't changed in size, which is a good thing." He paused, and when the next words came his voice had lowered in pitch and darkened in timbre. "But there is something there now that wasn't there ten months ago — a mass the size of a walnut with irregular borders."
Another pause. "Look, I'm going to tell it to you straight. I showed everything to an oncologist who shares my office suite, and I called the radiologist. We all concur — you have pancreatic cancer."
When I'd met with him in his office I'd found his manner off-putting. Now, though, there was a sound of compassion in his voice.
"If it hasn't spread, you may survive this. But the only way to really know what's going on inside is to look with a laparoscope. You need to find a pancreatic surgeon immediately."
"Pancreatic cancer," I said, my voice a whisper. Wendy began to tremble, and I could see she was going to cry. I pulled her in close. Like me, she was a professional musician. She'd barely finished a year of breast cancer treatments — surgery followed by chemo and radiation — and the extra singing she'd been doing to make more money had caused a polyp to grow on her vocal cords. She'd just had another surgery to remove the polyp and was on total vocal rest. She wouldn't be able to talk for another two weeks. There weren't any words to express how we were feeling anyway.
As I listened to the doctor, I wondered if my time might be up. I was fifty-seven years old but I still felt young. At least I did until this moment. Now I felt cold, and numb.
* * *
Less than a week later, Wendy and I were sitting in an examination room at Beth Israel waiting for Dr. Martin Karpeh, Jr., the chairman of the hospital's surgery department. When he entered the room we liked him immediately. In his early fifties, handsome, about six feet tall with broad shoulders, he had a quiet charisma and a smile that put us at ease. He exuded professional competence and personal warmth.
We watched him while he read the radiologist's report. When he finished, he looked up and said, "I'm not convinced. I need to look at the pictures. I'll be back in five minutes."
As with many couples that have been together a long time, Wendy and I didn't need to speak. We looked at each other, hoping that maybe this whole thing was nothing more than a terrible nightmare from which we would soon awaken.
Five minutes can seem like an eternity. When Dr. Karpeh finally returned, the ashen expression on his face told me everything. He sat down, looked at me, then Wendy, then back at me, and said, "It's a 98 percent probability of pancreatic cancer. We need to schedule surgery right away." The other doctors had said 100 percent. It was oddly reassuring to get another 2 percent back in my favor.
Over the next fifteen minutes, I learned more than I ever thought I would about pancreatic cancer. I learned that of the approximately forty-nine thousand pancreatic cancer diagnoses every year, 75 percent are discovered too late. There are no symptoms until the cancer has spread to the point when the patient is inoperable and has only months, maybe weeks, to live. I had no symptoms. The 25 percent of cases found early enough to be operable are almost always discovered from a scan that's done while looking for something else, as was the case with me. My father died from a burst aorta, and a year earlier a cardiologist had ordered a CT scan to see if I'd inherited that condition. My aorta was fine; however, that was when the two cysts on my pancreas were seen. Dr. Karpeh explained that as far as he could see in the scans, the cancer had not yet spread. The only way to know with certainty would be through a laparoscopy, the insertion of a thin plastic tube with a tiny video camera attached. He couldn't biopsy — that procedure ran the risk of spreading the cancer. If the laparoscopy showed that the cancer had already spread, he would simply close the incision, and I would be made as comfortable as possible for the short amount of time I had remaining. If there were no signs of cancer beyond the pancreas, then Dr. Karpeh would proceed with surgery and remove the mass.
The last thing I remember from that meeting was that I had a 3.9 percent chance of living another two years. It's hard to be hopeful with those odds. The math told me I had a 96.1 percent chance of joining my ancestors in the near future and during the forty-minute cab ride home that was all I could think of.
A friend who'd been diagnosed with Stage 4 melanoma and survived once told me about Plotinus, a disciple of Plato, who spoke about an "ultimate reality" that transcends the physical world and is beyond all rational knowledge. I lived mostly in this ultimate reality for the two and a half weeks before the operation.
One of the things I remember from that time was a gift of nature. Every day was sunny and mild. It felt like the management upstairs was watching out for me. I shared much of those presurgery days with Dolly, then seven years old, and Paco, five, our furry, four-legged children — two beautiful and exuberant yellow Labrador retrievers. We took long walks every day in Riverside Park along the Hudson River and spent part of each afternoon in the dog run at 105th Street. There was a bench at the south end of the run that I liked in particular. Each day I looked up and saw a rectangular shape formed by the branches of two trees. It seemed to me like a huge TV screen revealing clear blue skies opening up to heaven.
I'd never thought much about heaven, but seeing my own little glimpse of what might be awaiting me, if I qualified, calmed me. Over those two weeks, with my dogs settled at my feet, looking through that gateway to the eternal sky above, I was grateful for fifty-seven very good years. At the heart of it was a happy marriage with Wendy, the joy of time spent with our beautiful dogs, and a lifetime in music — playing the guitar — doing what I loved.
Memories came, like home movies. I saw a perfect Sunday morning in August 1960 — sunny, breezy, and warm. I was eight years old. We were in the car on the way to the beach, my parents in the front and my two sisters and me in the back. As the car stopped for a red light, my mother turned to me and said, "Your father and I have decided it's time for you to learn to play a musical instrument." It was the Age of Elvis, and an imaginary cartoon bubble with a guitar in it appeared over my head. Though she didn't know it at the time, my mother's dream, that one day I'd be a doctor, vanished into the ether. I became a guitarist in that moment.
A few weeks later, my first guitar teacher, Jane, a tall, blond, leggy nineteen-year-old beatnik, rang our doorbell and my love affair with the guitar began. After nine months, Jane said to my parents, "I've taught him everything I know," and suggested I take classical lessons with Mr. Goldstein, a retired music teacher who lived nearby.
The following week, my father drove me to my first lesson. Hanging on a wall in Mr. Goldstein's house was a photograph of an old man with gray hair, a round face, and thick black-framed eyeglasses, playing a guitar and looking rather stern.
"That's Andrés Segovia, the greatest guitarist of all time," said Mr. Goldstein in a reverent tone.
I nodded. Next to the photograph was a painting of another old man, this one wearing an elaborate white wig and a jacket with silver buttons. He was holding a sheet of music, and had what looked to me like a mischievous smile on his face. I was instantly drawn to him.
"And that's the greatest musician of all time, Johann Sebastian Bach. Sit. Listen." Mr. Goldstein began playing Bach's Little Prelude in D minor. The notes started spinning through the air.
Gazing at that piece of sky, the years flowed by. I saw myself walking out onto the scuffed stage of Carnegie Recital Hall to make my New York concert debut. As I got seated, it seemed to me as if the floorboards looked up and said, "We're not impressed, we've seen it all." I knew I was just one of many who'd sat there. But, oh, how I loved being on that stage.
And Wendy. My mind flashed to our first date. The doorbell rang. There she stood, a petite five foot four with wavy red hair, big blue eyes, a pink sleeveless blouse, and a diffident smile. She walked past me with a nod and took a slow look around the apartment. Clearly unimpressed.
We chatted awkwardly in the kitchen while I made my favorite dinner, garlic spaghetti. I was stoned, and sipping on a big can of Australian beer. I opened another. Halfway through that second can, Wendy fell silent. She gave me a hard look and said, "You're stoned, and getting drunk, and I'm not comfortable with that." She stalked into the living room, grabbed her bag, and headed for the door. I hurried after her and, turning on the charm, persuaded her to stay, to sit with me on the couch. She started crying so I put my arm around her. To my surprise, she laid her head on my shoulder and confessed she was heartbroken because a guy she liked had broken up with her the day before.
Seven years, and quite a few garlic spaghetti dinners later, we got married.
Two nights before the surgery Dolly jumped up on the bed, circled a few times, and lay down at my feet. I'd always known that the day would come when her life would end and that we would all grieve terribly. Suddenly, it hit me that almost certainly I — her daddy and pack leader — would be leaving her. No more joyous reunions every time I came home. She and Paco would wait at that front door for someone who would never walk through it again. I couldn't even explain it to them. I had no way of saying goodbye or thanking them for all they had given to me. I cried for all of us.
Finally, it was the night before the big day. Last-minute packing; time to figure out what to take with me. The two most important items: my iPod, and the choice of a book.
My iPod playlist always varied, but now I filled it with my favorite music. I'd been listening to the St. Matthew Passion by Bach a lot in the past two weeks, especially when using the rowing machine in the gym. My favorite piece in the world, and my favorite version of it, recorded in 1962 at Carnegie Hall, conducted by Leonard Bernstein with the New York Philharmonic and great singers, sung not in the original German but in English. The opening movement — one of the most dramatic pieces of music ever written — begins with the sound of a heartbeat in the basses and a mesmerizing ascending melody played by the flutes and oboes. When the voices of the choir enter, the effect is heavenly. From that point on, the choir and orchestra, actually a double choir and double orchestra, which is part of the enormous power of this music, move to a climax that is both resolute yet pulls forward into an unfolding mystery. You are completely hooked. The first voice that follows, the tenor soloist, the Evangelist, appears suddenly without accompaniment. The contrast to the huge sound of the opening is startling yet so centered and strong. It is riveting. It had got me through to the end of many a rowing session. And, whenever I found myself dwelling on that 3.9 percent chance of living another two years, the St. Matthew Passion would lift me to a better place.
I loaded in the other music that I loved: more Bach, the Beatles, Brahms, Ellington, Debussy, Jobim. All the music that moved my heart.
The final choice to be made was, what book to bring? An important decision, as I've been a voracious reader from the same age I started playing the guitar. At the time, I was making my way through Rex Stout's crime series featuring genius detective, Nero Wolfe. My first choice went in the bag, but I reconsidered. The title might have been unsettling to another patient — Might As Well Be Dead. I took it out and reached for another that I thought was a better choice:
Not Quite Dead Enough.CHAPTER 2
Wendy glanced up once again at the big white clock on the wall of the main waiting room of Beth Israel Medical Center. She was curled up in a chair, her head resting on a pillow, shoes off, and thoroughly exhausted. Her stomach had been in knots all day. Now it was nearly nine P.M., Thursday night, July 16, 2009. I'd been in surgery since two P.M.
Soon after the anesthesiologist put me under, Dr. Karpeh had begun the laparoscopic examination. At around 2:45 P.M., Wendy received a call. The coast was clear. There was no sign the cancer had spread and the operation would proceed. A huge relief, but for the rest of the day, with me still in surgery, Wendy struggled to keep calm.
She heard a sound first before she saw him; someone was walking over to her. Looking up, she saw Dr. Karpeh in purple surgical scrubs and cap, and her first thought was that, although he looked tired, it didn't seem as if he was about to tell her bad news. He wasn't.
He broke into a big smile and said, "You're not going to believe this. The tumor was benign!"
Wendy gets extremely excited when she hears great news. For a split second she almost couldn't believe it, and when she did, she screamed, jumped up, and threw her arms around Karpeh's neck. He looked slightly embarrassed but laughed. He also knew that many of the people sitting nearby were terribly on edge, and so he told Wendy to follow him to one of the small rooms nearby where he could give her a brief report of what had happened.
Wendy's first question was, "How could this be?"
"Every once in a while," Karpeh said, "even when every sign says cancer, it isn't." He explained that the area with the mass in the tail of the pancreas was in necrosis — meaning that it was dying tissue — and showed exactly like malignant mass. That even though the mass was benign, the surgery had been necessary because the necrotic tissue would eventually have destroyed my entire pancreas.
"We still need to do a full pathology test to confirm," he added. "But I'm confident about a good outcome." He grinned and headed toward the door. "Meet me in the SICU. He'll be in Bed 5, all the way at the end of the hall. He'll still be sedated but by the time you get there he'll be coming out of it."
Wendy, deliriously happy, picked up her cell phone and speed dialed my mother, Sylvia. "It's not cancer!" she yelled.
Karpeh, still there, paused briefly to enjoy that moment. Then his beeper went off. Wendy noticed his sudden change of expression.
He looked at her and said with some urgency, "I have to get up there immediately."
She began to follow him. "I'm coming with you."
"Sorry, you can't, you have to take another elevator. Go to the SICU waiting room on the third floor. I'll be with you as soon as I can." He turned and hurried away.
It took her a while to reach the SICU — Beth Israel is a big hospital with many sections and departments, and she got lost several times in the maze. I'm glad she was late to meet me, especially since she didn't go to the waiting room as Karpeh had told her, but instead followed the signs into the SICU itself and rushed past the double doors. What she saw next, as she would say many times afterward, was the most terrifying sight of her life. It would have been even more traumatic had she walked in just a few minutes sooner.
Dr. Mason Mandy, Karpeh's chief resident, had prepared me for the trip to the SICU; the final sentence in my operative report was, "The patient left the OR in stable condition." The report showed that the surgery was perfectly executed. Wheeled on a gurney into the elevator, I was a very lucky postsurgery patient on my way to recovery.
Then, seconds later, I began to do everything I possibly could to die. Inexplicably, my blood pressure started to plummet and my face turned gray. As soon as the elevator doors opened, the race was on.
Under normal circumstances, it's about a five-minute trip to the SICU, but this time it needed to be a lot faster. Dr. Mandy and the anesthesiologist sped me through hospital corridors. Within another minute, my blood pressure was undetectable — and, without it, my heart stopped. I was in cardiac arrest, a term synonymous with clinical death. No heartbeat, no blood circulation, no respiration — a complete cardiovascular collapse. I was a Code Blue, requiring immediate resuscitation.
As we dashed through the double doors into the SICU, Dr. Mandy was pumping my chest, one hundred compressions a minute, in a desperate attempt to preserve my brain function. He saw that Bed 11 right next to the entrance was empty and available, and he directed the gurney transporter to turn hard left. If he'd taken me to my scheduled bed, at the far end of the unit, it would have been the end for me. Barbara Gerbier, a physician's assistant and first member of the SICU staff to arrive at my bedside, thought I was already gone. So did the rest of the team.
Excerpted from Waking the Spirit by Andrew Schulman. Copyright © 2016 Andrew Schulman. Excerpted by permission of Picador.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Table of Contents
1. The Ultimate Reality
2. Code Blue
3. The Passion of Wendy and Bach
6. Goin’ Home
7. Every thing Vibrates
8. Alice Blue Gown
9. Better Than a Standing Ovation
10. Getting to the Other Side of the Rainbow
11. Through the Gate
12. Just Don’t Kill the Patient
13. The Music of Poetry, the Poetry of Music
14. Steppin’ Out with My Baby
15. The Memory of All That
16. Wild Horses
Afterword by Marvin A. McMillen, M.D., FACS, MACP
Resources I. Music and Medicine Resources by Barbara L. Wheeler, Ph.D., MT-BC
Resources II. More Resources by Andrew Schulman, Guitarist
A Note on the Music
Sarabande by Johann Sebastian Bach arrangement by Andrew Schulman
Most Helpful Customer Reviews
If you read no other book about the power of music to heal, READ THIS ONE. It is beautiful, touching, and profoundly amazing. In combining his own story of how his favorite music was the catalyst for his miraculous recovery, and how he is "paying it forward" by playing his guitar to help others heal, Andrew Schulman succeeds brilliantly in meeting several challenges. He brings out the drama in his own story, making the reader feel as though she or he is right in the situation and experiencing the very emotions he and his wife, Wendy, and the SICU doctors were feeling -- but without being melodramatic. He writes in a way that helps the reader identify and connect with all of the other patients and family members we meet throughout the book -- although Andrew is telling their stories here, we can clearly hear their voices. And he brings in the brain science explaining why music is such a potent, transcendent healing force, in highly intelligent but easily accessible language. Each chapter of Waking the Spirit will make you grin, weep, say "WOW!", hum or sing along with the tunes Andrew mentions that you recognize...or all of the above! It will also inspire you to consider what music might help you heal, should you ever need that. And the lovely, small-world coincidence with which he brings the narrative full-circle will give you goosebumps. Best book about music's healing power to date!