Horowitz, 26.2 and Palliative Care

One evening when I was 5 years old, I was thumbing through my parent's records. After passing by Peter, Paul and Mary and the soundtrack to West Side Story (which I loved, I used to do reenactments of the entire musical for my probably bored-to-death mother in our living room), I came across this album with a a candelabra and a piano and Beethoven. It was Vladimir Horowitz, who, truth be told, is not the world's best Beethoven player by a long shot, but it stopped me from further seeking and I took that LP out of the cardboard cover and placed it on my parent's record player.

Now let me explain for a minute. A record is this thing that we used to use to listen to music. It is round, and has grooves in it and the needle of the record player contacts the grooves and magically produces music. Records look like this.

So anyway, it was a winter evening when I found this Horowitz album. It was dark outside. We had a very small house but the rest of my family was doing their own thing. My Dad was probably at a meeting. My Mom was watching TV after a very long day at work. My sister was probably at work or in our shared room listening to ELO or the Beach Boys. My brother was probably in his room plotting his next terrorist attack on me. I put this album on and laid on the couch which my parents had for approximately one thousand years, and I closed my eyes, and I listened to Vladimir Horowitz play the Moonlight Sonata by Ludwig Van Beethoven and I decided, then and there, that I was going to do that too.

This is a true story.

My husband wrote this song once with the lines: "when I was born I was gifted, now I'm just about average. So somewhere I drifted…"

Fast forward seven hundred years to the present time. Parents: dead. Sister and brother still tolerate me. Brother no longer with terrorist tendencies toward me. I am a music major gone astray, now a medical doctor and a mother of teenagers who don't know Horowitz from their very cute behinds.

I spend my days now largely caring for people either at the end of their lives or at the frail end of the aging spectrum. I ran this marathon last weekend, and at the awards, there were not one, but TWO guys in the 85-89 age group. They ran the half marathon. They are not frail, though they are aged.

What is frailty? Scientists really cannot come to an exact consensus on this. You can measure grip strength. You can do the "get up and go" test (how easy is it for you to get out of a chair and start walking). Usually it is more vague. Frequent falls. A lot of trips to the ER or hospital. Choking on food.  Episodes of forgetfulness. Your kids or loved ones start to wonder if you can manage anymore, and if you need to be "placed" somewhere to keep you safe.

Vladimir Horowitz did his last concert at age 86. This was in Moscow, and was the first time he went back to Russia since his exile 61 years prior. He reported continued stage fright even at 86, puking prior to performances. I find this oddly reassuring. He also owned over 600 bow ties.

My friend and colleague Dr. Michael Fratkin is doing some interesting work. People, it turns out, are more than their disease, more than their age, more than their cancer stage, more than their frailty index, more than their fall risk, more than their ability to run half marathons or do internationally televised performances at age 86. I think Michael's work is worth supporting. He is touching on something vital and true, and though I am a boot-straps-pulling midwesterner at heart, I can see that palliative medicine is what we all need: even if at the prime of our health. It is about health in the context of being a real, live human being, whether you are about to fall and break your hip, or on your way to radiation therapy for recurrent cancer. Cure may be sexy, but palliation is the very core of healing.  What does it mean to be mortal? And what is it you plan to do with your one precious life?

I ran my 6th marathon in 6 years this past Sunday. I am a Master (aka "older American"). I am not as fast as I used to be. I am not as sore as I was for the prior 6 marathons. In fact, after one day post 26.2 miles of dreading stairs, I am not sore at all. This makes no sense whatsoever. I can only think the following:
This run was palliation for what ails me.
I am meant to run, until I can no longer run, at which point I will call Dr Fratkin.

My next goal is to tap into my 5 year old self. The one that snuggled into the well worn couch of my Mom and Dad, and listened to a miraculous bow-tied gentleman play Beethoven, and knew this was my calling.

I do love Beethoven.