Variations on a theme

The facility was far uptown. We all dozed off during the long ride, and by the time the train lurched into the station, we were groggy. Though we were not native New Yorkers, three years in the city was enough to develop that uncanny ability to emerge from sleep just before missing your stop. We were a motley ensemble: myself (a pianist), two dancers, a violinist and a percussionist. As Juilliard students, we received a small stipend to give performances at health care facilities such as nursing homes, hospices or, in this case, a psychiatric hospital.

On this day, I had a new piece I had just memorized and wanted to try out. It was Robert Schumann’s Geistervariationen (Ghost Variations), a work built on a central melodic theme with subsequent variations presenting it in different guises. Schumann is best known for his piano compositions and collections of Lieder, German art song for voice and piano. Unfortunately, Schumann struggled with mental illness that began in his early twenties. He had periods of severe depression that alternated with phases of “exaltation,” consistent with what we now believe was bipolar disorder. His musical productivity mirrored his mood changes. Manic periods were marked by feverish output; in 1840, the so-called “Year of Song,” he composed 140 songs. In contrast, in the vice of a crippling depression, Schumann did not complete a single work in 1844. Over the next ten years, his mental health deteriorated, believed by some to be complicated by neurosyphilis or mercury poisoning.

According to the diary of his wife, Clara, Schumann awoke from sleep on the night of Feb. 17, 1854, and scribbled down a melody that was “dictated by the angels.”1 It was, in fact, a melody that Schumann himself had written and used in earlier works. The simple, hymn-like motif became the theme of the Geistervariationen. By the next morning, he was agitated, and the angelic voices turned into the “hideous music” of “tigers and hyenas.”2 In this space between lucidity and torment, Schumann composed five variations on the angelic theme. The work contains glimpses of Schumann’s brilliance, but at other points feels rudimentary in its construction. The theme, hardly reimagined, carries through each variation in a pervasive, almost obsessive manner. In the fourth variation, the only one in a minor key, a repeated figure is interposed over the theme like an ominous tolling bell. On Feb. 27, 1854, Schumann abruptly stopped working on the manuscript, left his home and attempted suicide by leaping from a bridge into the freezing Rhine.

Schumann was rescued by a fisherman and was brought home, where he continued to work on the Geistervariationen. The fifth variation was supposedly completed after this dark interruption, and is the only variation in which the theme is not more or less intact. Instead, it is obscured amidst a gauzy cloud of harmonies created by holding down the damper pedal. The piece disappears into an unceremonious, whispered close that surprises even the performer in its abruptness — feeling unfinished yet unequivocally final. Schumann sent the completed manuscript to Clara the day after his suicide attempt. Four days later, he voluntarily entered the asylum where he would spend the remaining two years of his life. The Geistervariationen is his last known composition.

I had never been in a psychiatric hospital and wasn’t sure what to expect. The performance space looked similar to what I had experienced at other health care facilities: an open space with light-coloured linoleum floors (easier to clean than carpet), a wooden upright piano in dubious tune. I ran my fingers along the yellowed keyboard. Its surface was slightly sticky.

Image copyright iStock.com/francis49. No standalone file use permitted.

The audience, younger than our typical crowd, had gathered in a semicircle facing a makeshift stage. Most were dressed in baggy, beige hospital-issue clothing. Some had the repetitive lips-macking, tongue-thrusting movements I now know as tardive dyskinesia. My eye was drawn to a woman with unkempt grey hair who looked to be in her sixties, sitting stone-like in a wheelchair, expressionless. Her eyes remained fixed straight ahead even as my group members performed a dance warm-up in front of her.

The significance of performing the Geistervariationen in such an institution was not lost on me. We had adopted the practice of giving a short introduction to the audience before each piece, with the aim of improving engagement in the performance. When I introduced the work, I explained that Schumann heard angels sing him the melody during a very difficult time in his life. I encouraged the audience to listen for the melody throughout the piece.

When I think of the Geistervariationen now, I still hear exactly how it sounded on that tinny upright piano. I feel the uneven weighting of the keys, remember how difficult it was to achieve the voicing — the balance of melody and harmony — I wanted. When the work drew to its anticlimactic conclusion, I let the E-flat major harmonies hang in the air a little longer than I usually do. I lifted my hands from the keys and swiveled slowly to face the audience.

That’s when I noticed the silver-haired woman again. She still sat motionless, but her eyes had a sheen. A trail of tears traced its way down her wrinkled cheeks and left dark stains on her tan hospital clothing. In my memory, her eyes found mine briefly, then returned to centre. I still don’t know whether that actually happened or whether it was a figment of my desire to believe we had made some sort of connection.

The rest of the performance passed uneventfully. As we gathered our belongings and the audience members were led back to their rooms, a staff member approached us and thanked us for our performance. The older woman still sat in her chair to the right of the stage. The staff gestured toward her and said that this was the first emotion the woman had displayed during her time at the facility. When I glanced back at her, her eyes were again dry and her face blank. She too was wheeled away.

On the subway ride home, as my group members chattered happily to each other and the express train rattled obliviously along the tracks, I couldn’t stop thinking about the silver-haired woman. I wanted to know more about her life story, her diagnoses. How did she come to be trapped inside herself, human yet unable or unwilling to express the things that made her so? Could it be just coincidence that the Geistervariationen had seemingly awakened something within her? Perhaps it was a purely physiologic response — the frequency of the music setting off a cascade of synaptic firing or triggering the release of some neurotransmitter. Or perhaps a young composer’s anguish, preserved in a set of theme and variations, had somehow traversed time and space to reach a woman oppressed by emotional suffering. I felt unsatisfied with my lack of answers. I found myself wishing that I had more time with her, that I was in a profession where I could learn how to help her.

In the nine years that have passed since that performance, I have found my way into medicine. I now identify as a pediatric resident who was once a pianist. Even so, this performance often comes back to me, most recently as I assessed a teenager who presented to the emergency department with nonepileptic seizures. During the neurological exam, the teen’s eyes were open and fixed forward, but he showed subtle response to stimuli and his hand stopped just short of striking his face in the “drop test.” I attempted to make eye contact. He stared right through me with an emptiness in his eyes that triggered a rush of fragmented memories — the sticky keyboard, the way the G key clattered and reverberated, the shimmering trail of tears on her papery skin.

The teen eventually exited his trancelike state and became increasingly agitated. Though he was now fully awake and responsive, I was still unable to establish rapport. He left against medical advice. Our encounter felt unfinished but terribly final. I went home and listened to the Geistervariationen. I needed to be reminded of a time when I was able to touch a soul that was beyond reach.