The Unexpected Miracle

It’s the usual Friday night scene in the Emergency Department. All that remains of another drive-by shooting victim is splotches of blood on my shoes. A swearing, spitting drug abuser is held down by security guards while being placed in four-point restraint. Quiet crying comes from behind the curtain hiding a woman who has painful gallstones. A young AIDS patients stares hauntingly from sunken eyes, his gaunt face distorted by the purple blotches of Kaposi’s sarcoma. All around the room are the sullen, resigned faces of those who have waited up to twenty-four hours to be seen for their sore throats or sprained ankles. The stench of an unwashed homeless man in the corner, ravenously consuming a brown-bag hospital-issue lunch, permeates the atmosphere. Walls display reminders of the season; cardboard candy canes, blinking minilights, and grinning Santas bearing sacks of gifts, the likes of which no patient in this department will see. In the midst of the chaos, I hear the manic chatter of a giddily cheerful middle-aged woman. She greets everyone in passing with a jolly ‘Merry Christmas’ and an endless stream of meandering conversation. She is in the Emergency Department for a chronic infection in her lower legs. While I examine her, she talks on about living on the streets, peppering her narrative with references to life before homelessness. Her eyes take on a sparkle as she describes her prior home; two stories, five bedrooms, three-car garage. Her unwashed hair falls in clumps across her forehead as she proudly speaks of three successful sons. She describes her husband, a prosperous banker, handsome as a movie star. A shadow crosses her face when the nurse asks where her husband and sons are now. After a pause, she ignores the question and continues her chronicle. Her lofty tales extend to her own life. She boasts of being a Julliard scholar, of playing violin in New York City’s philharmonic. Her hands wave grandly as she describes standing ovations, velvet curtains, black satin dresses, and post performance parties. We humor her with tolerant smiles and give one another knowing glances. As she is wheeled from the room, she beams magnificently and promises to come back to play her violin for us. We nod patronizingly, then forget as we turn to yet another patient in need. A week later, the scene is the same. More sullen faces, another psychotic patient screaming incessantly, more shooting victims, more pain, more endless need. Patients and staff alike are stretched to the limits of tolerance. Doctors snap at clerks, patients swear at nurses. A general murmur of discontent pervades. I feel pulled in all directions at once, working as fast as I can while falling more and more behind. No one notices her come into the room. No one notices her take the rolling stool and position herself in a doorway. No one notices her take out the violin, place the cloth to her chin, and rest her cheek gently against the instrument. No on notices her raise her right arm and carefully place the bow to the strings. The first pure, sweet notes drift softly into the confusion, taking everyone by surprise. Out of her violin flows phrase after phrase of perfect sound. Her musical repertoire is as disjointed as her conversation; a bit of Bach, a few show tunes, a little Gershwin, Mozart interspersed with carols of the season. Her technique reflects the Julliard years. Her face is composed, peaceful, almost beautiful. I wonder if her mind is in another time, a time of black satin dresses, handsome husbands, and loving sons. Her concert lasts four continuous hours, no musical phrase ever repeating itself. The first person affected is the psychotic man. He becomes quiet, pauses to hear her music. Patients waiting in chairs listen intently. When their conversations resume, frowns are eased and they chat amiably in hushed voices. Two patients stop weeping, their attention drawn to the music. The staff members slow their pace a fraction, and smiles replace the angry tension in their faces. I find myself humming snatches of music I recognize. A calmness settles on the Emergency Department, muting the continuing bustle. Peaceful feelings of the holiday blossom and, for four hours, tranquility reigns. The last note hangs in the air as she lowers her arms and looks around the room. She blushes, startled out of her reverie, by the faces focused on her, and carefully places the violin back in its case. She stands slowly, shuffles over to me on her painful, swollen legs, and murmurs, ‘I just wanted to thank you’. Having worked her magic, she departs quietly, leaving me in awe of the unexpected beauty and dignity of life. originally written by Diane Birnbaumer, M.D. (transcribed from book borrowed from library)