Sitting in my practice room, I look in the mirror; the violin, held gently in my fingers, is an extension of my body. I recall the excitement of being admitted to the studio of the renowned pedagogue, Mauricio Fuks, believing that my musical challenges could be solved with technical exercises alone. It was quite a surprise when Mr. Fuks disagreed, insisting that the root of my difficulties was a disconnect between my emotions, artistic instincts and the dominating left side of my brain. As I stretch my fingers and see them turn white in the mirror, I can hear Mr. Fuks’ voice reminding me to spend at least half of my practice time liberating my inner voice to facilitate the transformation from a good student into a young artist. Letting my fingers go, I watch the blood rush back before raising my violin to begin yet another practice session.
Exhausted, I try to ward off the seduction of sleep. Throwing back another coffee while sitting at the nurses’ station, I am reminded of the hard work it took to become a surgical resident. The time spent in class, the dissection room, and on the wards did not touch the hours spent pouring through textbooks, memorizing every little nerve, muscle and bone. For practice, I used to close my eyes and imagine maneuvering my way all the way through the body beginning at the Circle of Willis. Just thinking about it makes me want to obsessively go through that routine again. I was driven to master anatomy, physiology and pathology in order to become an excellent general surgeon. Pinching my thigh, I stretch my eyes wide and stand up quickly to convince my body that it is awake.
I adjust my cap before entering the scrub-in area, prepared to assist Dr. Caverly in a Whipple procedure. My fatigue vanishes as I begin lathering my fingers, while reviewing the details of the patient and the procedure. As the operation begins, I try to take in Dr. Caverly’s every movement as he deftly gains access to the cancerous abdomen. He works with a quick, accurate rhythm that never feels rushed. Watching the surgeon connect the pancreas to the jejunum with elegance and precision, my personal goals begin to mature. Not only do I aspire to be a general surgeon, I also want to be able to take control of an operating room with the confidence, experience and instincts of a virtuoso surgeon. It is not enough to have an anatomical knowledge and technical experience derived from studying, watching and assisting; I want to tap into the intuitive flow that I see before me.
In my next lesson, I play Mozart’s Violin Concerto in D major for Mr. Fuks. Less than a minute into the piece, I can sense his frustration: he shakes his head. I try harder. The effort only serves to activate my brain, chasing away the spontaneity and emotional freedom I so desperately want. My memory begins to falter in places that have never been an issue before and Mr. Fuks stops me. Disappointment and frustration redden my face as I blame myself for not improving faster.
Leaning forward in his chair, Mr. Fuks poses a question he has asked me time and time again, “Honey, does worrying make you play better?” I shake my head. “Well okay, because if you said it did, I would start to do it too!” he says with a laugh. I force myself to smile, but I feel too discouraged for it to reach my eyes. “You know, the brain is the greatest killer of emotions.” He waits for me to nod before continuing. “If you let your head become too hot, your hands will become like an ice box! You need to keep your head cool as a cucumber.” I had also heard this before.
Then he adds something new. He asks me to choreograph and act out the Mozart concerto while playing, in order to liberate my right brain. Nodding, I immediately start planning how I will tackle this in my next practice session when I hear Mr. Fuks shout, “Close your eyes and move!” Shocked back into the moment, I have no choice but to pull my eyelids shut, and begin dancing. I move forward, backwards, crouch down and rise onto my toes as I bring Mozart’s music to life. It is as if emotional shackles fall away, freeing me from the ever-present rolling commentary filled with worries. There is no time to plan, no time to doubt. My goal has now shifted from endeavoring not to make mistakes to expressing every iota of music, using all the tools at my disposal. My memory flows effortlessly as my fingers flawlessly avoid the usual traps. I am enjoying the act of performing rather than simply making it through the piece. Mr. Fuks breaks into a wide smile telling me to hold on to this feeling and to demand it from myself in the future. I walk out of the lesson feeling confident and empowered by my abilities — for the first time looking forward to my next chance to perform.
Keeping in mind my new goal, I dedicate myself to finding more ease and flow with each procedure. At first I try emulating the motions of other surgeons, but it feels foreign and awkward: something is missing. Somehow they are able to get into a zone where I cannot seem to follow. I try concentrating harder, relaxing my body and playing music, but my mind continues to doubt, causing my fingers to slow down and at times falter.
The next procedure is the removal of a large lipoma from a patient’s back. As I drape the patient and apply the antiseptic, uncertainty seeps into my thoughts. Was my examination thorough enough? How big should the incision be? What if it is not possible to get around the whole thing without rupturing it? Taking a breath. I remind myself that I have the knowledge and training to do this. Unconsciously I begin to sing “Hey Jude” in my head. As the song continues, my breath becomes steady, my shoulders release tension and my focus becomes clearer. I cannot recall anything beyond the chorus, but even as my mind falls silent, the calm focus remains. While finishing the last stitch and washing off the area, it occurs to me that I just found my way into the zone; a place where my hands feel steady and confident, my body feels calm and my mind is ready to react to anything unforeseen.
With my graduation recital only a week away, I am fully engaged in preparations. One of my favourite tactics is to rehearse the piece at different speeds, sometimes at a blistering tempo where the brain cannot possibly keep up and at other times so slowly that the brain is capable of overthinking each step. In addition to liberating my instincts through dance, I practise keeping a cool head in less than ideal circumstances. By playing for those who intimidate me and doing run-throughs while I am cold, exhausted or hungry, I can test my ability to filter out distractions and strengthen my inner voice.
Backstage before the recital, I run through the piece in my head. Closing my eyes, I focus on my breathing as I do before every performance — it’s like a lock turns, granting me access to my performance mode. While scrubbing in, my colleague tells a joke he heard last night at a dinner party. The mood is light, but my mind is concentrated on the colectomy I am about to perform for the first time. Nervous excitement flows through my body as I try warming my ice-cold hands on the exposed length of my neck. I have to trust that my instincts, and the hours of preparations will not abandon me on stage. Putting my hand out to request the scalpel, I feel a calm come over me as I step into my zone. The transformation is immediate; my body relaxes and unhelpful thoughts fall away as if through a sieve, separated and kept for later. The moment the pianist plays the opening melody I feel the music swirl around me, dispersing thoughts of uncertainty. I open the abdomen and divide the peritoneal reflection, starting the process of mobilizing the descending colon from the sigmoid colon towards the spleen. I then turn my attention to the unnatural growth, hard and unyielding.
Lifting my bow off the string to do a whipped fouetté stroke, I pronate my arm, driving all the weight into my index finger. As the bow makes contact with the string, I anticipate an exciting articulation, but instead hear a crunch and feel the bow twist in my hand as it grinds to a stop. Suddenly blood rushes into the abdominal cavity. My mind races, did I nick one of the sacral arteries, what else could possibly cause this much blood? There is no time to analyze what happened. I quickly begin packing the abdomen and apply pressure, anxiously waiting to see if the bleeding will stop. My eyes widen as I take in the sight of the bow wedged between two strings. The pianist is unaware and keeps playing. I hear a gasp from the audience as I place a finger under the top string allowing me to wiggle the bow to safety. A quick check assures me that the bow is not broken. I know that with enough pressure the bleeding should stop, providing invaluable time. Adrenalin races through my body as I ask my colleague to take over the compression. My mind clamors to figure out what went wrong. The pianist is finishing the phrase without me and somehow my fingers are already in place to jump in for the next musical line. Although a disaster has been avoided, my brain is now fully engaged and with it the all too familiar state of hesitating and second-guessing.
Did I really cause this? The wash of emotions and thoughts trapped in my body threaten to burst out and flood the operating room. Can my team tell how nervous I am? I remind myself that a good surgeon is able to reassure a team with decisive actions and a calm demeanor. I take a deep breath. The performance will evolve into a game of survival unless I can access my inner voice and subdue the active side of my brain. I begin singing along with the music in my head to drown out the disruptive thoughts. It is working. I can do this. I begin to repeat those four words over and over like a mantra until they lose their meaning. Instead they serve a meditative function that sends me back into my zone. It is time to go back in and fix the bleeder. I notice the tension in my body and begin to physically move with the music. With an imperceptible step forward on stage, I feel released from the snare of my thoughts. As my inner voice grows stronger, I give myself fully to the performance with no fear.
A few minutes go by and I am faced with another fouetté bowing. My stomach twists at the thought of making the same error again. As the packs are sequentially removed, I trust my instincts to guide my hands, my body, even my breath. When the damaged artery is visible, I quickly place clamps on either side, transfixing and placing a double ligature for good measure. The music continues and I have no time to think. A moment later my bow is flying in the air before I throw it back to the string. As it lands with fiery passion, I know I am back in the performance. Holding my breath, I release the clamps and watch the artery fill without leaking. I exhale, smiling behind my mask. I did it. As I finish the procedure and close the abdomen, I feel myself truly enjoying the process. Paradoxically, the less I try to control every moment of the performance, the more accurate, enjoyable and convincing the performance becomes. Time does not feel like a factor anymore and my fingers move faster with more confidence. I take my final bow and walk off stage smiling. I finally understand what Mr. Fuks has been telling me all along.
Footnotes
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This story is a hybrid of fact and fiction. Maurico Fuks is a violin professor at Indiana University. He gave signed consent for his story to be told. The violin student is the author. The surgical resident and Dr. Caverly are fictional. The author acknowledges the valuable input of her grandfather Dr. David Albuquerque, a retired general surgeon.