Tuesday, 1 May 2012

Death and the Piano, Unfinished

Only looking back can one see the old folks or rather as they were then the young folks of 33 and 36 respectively having taken over the pavilions as their new home, only now can one begin to pin down the family dynamic and get to grips with the misunderstandings, the difficulties, the irritations and frustrations which then were to me either obscure or frighteningly intense, the harbinger perhaps of an unknown fate, stressful anxiety oozing up out of those past layers, only now can I meet it with equanimity.  There was love there.  My parents did get on well together at that time.  And their time was short – 1942 to 1976, thirty-four years.  Hardly enough, not enough time to get to know each other well.

The photographs are always of women and children, families and children.  At the beach, on the farm, at the harbour and on Sunday school picnics.  Kids everywhere, having fun.

By bus to Fraserburgh.  Smell of diesel, engine-sounds.  Dad’s pulmonary TB, cystitis, dermatitis – I seem to know them like the back of my hand.  Before I was born.

The power and the glory of electronic music or music sounding like classical music only generated through notes written in standard fashion on a computer, going somewhere.

With tertiary neurosyphilis, aka general paralysis of the insane, the old guy was an absolute treasure trove of clinical signs.  I didn’t have a lot of spare time as a junior doc, but whenever I could I would go to Mr. Spottiswood’s bedside, lean on the patient-retaining bars and gaze at his unequal pupils, listen to his jagged, paranoid conversation, test his slow tendon reflexes and examine his cranial nerves.   An enormous tuning fork forms part of the toolkit when examining the central nervous system.  Give it a bong and plonk the end on someone’s shin, and mostly people will feel the vibration;  not Mr. Spottiswood, though.  Meanwhile he would be muttering on about the Kenyan Indians who had escaped from persecution to persecute himself;  this was quite amusing for me at the time, since my senior-doctor-in-a-striped-suit was a Kenyan Indian.  Syphilis, the great imitator:  lurking behind all the scenarios of potential diagnoses, the pale-as-death treponema pallidum strikes again and again, constantly changing, presenting new and confusing symptoms and signs for both doctor and patient.  The latter, of course, is utterly fucked.  The wages of sin, God’s answer to three minutes in the garden of earthly delights, take that, Schubert!  And the hundreds of thousands of you others we’ve never heard of, consigned by the wrath of God to a lingering necrotic gummatous decline which only Hieronymus Bosch comes close to adumbrating…

Playing through the first page of the Ravel piece, Pavane pour une infante defunte, it became apparent that each line, each phrase, could be perfected to a much higher degree through attending to expression, aftertouch, emphasis, volume, timing, phrasing.  Each bar would need to be practiced over and over again until the fullest possible potential from the music can be extracted.  But then, within each bar, all the notes, the individual little passages linking from one to another, these also need practicing.  Soon, I find weeks are passing while I work on the first note of the Pavane.

And so, Schubert.  The signs of neurosyphilis, in order of decreasing frequency, include:
                Hyporeflexia - 50%
                Sensory impairment (eg, decreased proprioception, loss of vibratory sense) - 48%
                Pupillary changes (anisocoria, Argyll Robertson pupils) - 43%
                Cranial neuropathy - 36%
                Dementia, mania, or paranoia - 35%
                Romberg sign - 24%
                Charcot joint - 13%
                Hypotonia - 10%
                Optic atrophy 7%
Neurosyphilis is divided into 2 general categories: (1) early involvement of the CNS limited to the meninges and (2) parenchymal involvement. The 6 groups comprise:
                Acute syphilitic meningitis
                Meningovascular (arteritic) syphilis
                Tabes dorsalis (parenchymal)
                General paresis of the insane
                Optic atrophy
These syndromes overlap into combined forms. Early neurosyphilis affects mesodermal structures, whereas late neurosyphilis affects the brain and spinal cord parenchyma.
I close up the piano and head for the refrigerator.
© Donnie Ross 2012