Reflections: Neurology and the Humanities

On call . . . Carl Ellenberger, Jr.

I knew what to expect as soon as I noticed the usherwalking deliberately into the audience during achamber music concert. He entered from the side,walked purposefully across the front of the hall, andheaded up the aisle toward my seat. “Please comewith me,” he whispered. I followed him as he re-traced his steps, all heads in the audience turning,momentarily distracted from a Haydn string quartet.

Although there were other physicians in the audi-ence, not a few of them my friends or acquaintances,I was the one the ushers always headed for. As“Founder” of the music festival, everyone knew thatusually “the doctor is in.” Over 30 years of summerconcerts, I had come to recognize, and dread, thedeliberate somber approach the usher made tonight.

Three sides of our hall are open to the summercottages arrayed along narrow tree-lined lanes thatwind around the back of the theater. Some porchesare so close they can serve as box seats—the exactintention of their 19th century builders. But modernsounds travel both ways; motorbikes, barking dogs,and even baby strollers often disrupt the music. Theemergency siren is by far the worst distraction; itwails three times whenever someone dials 911, eachblast seeming interminable during a quiet slowmovement. The siren sounded that night as I crossedthe adjacent park toward the steps of the old woodenChautauqua Hall of Philosophy, where I was told tofind the victim.

The audience for classic music is graying, somesay, and, theoretically, at least, bring to concerts agreater risk of medical events. Some need assistanceto transfer into wheelchairs or walkers from carsdriven right to the entrance. Others arrive with evenmore elaborate medical equipment. Most walkslowly, arm in arm, up the slight incline to the en-trance in the back. As I watch them pass by, I won-der who will be next. They like older classicalmusic—from the 18th and 19th centuries—even ifplayed by very young musicians. But these older gen-erations prefer jazz by older artists, like the tradi-tional jazz band that has aged 30 years since theirfirst appearance in our concerts.

Fortunately, all of these performers, includingdozens of septuagenarians and octogenarians, havecome and gone over the years without incident. I didhave to repair Lionel Hampton’s vibraphone when apedal fell off, but never had to resuscitate LionelHampton. Stephane Grappelli (“Hot Club deFrance”) brilliantly made it through his concert atage 77 with the help of the better part of a bottle of

Chivas Regal—stipulated in his contract—and leftthe stage unassisted to raucous cheers and standingapplause. Skitch Henderson’s stories of working withmost of the famous musicians of the past centuryproved as prodigious as his ability at the piano. I amalways amazed by how music, hardwired into thebrain during the first three decades of life, staysthere until the end. Onstage, in their universe, allgreat performers can seem ageless. The singer JoeWilliams (“Every Day I Have the Blues”) died at age80 while walking home from a hospital room thatgave him the blues, but not until 3 years after a verylively performance on our stage.

Our audience has been less fortunate. As I headedfor the Hall of Philosophy, memories of earlier ur-gent summons ran through my head. One Augustevening, heeding the call, I stepped from the dimlylighted hall into total darkness. In my haste to reacha woman who had fallen outside, I forgot about thestone culvert that for over 100 years had directedwater around the hall rather than into it as it floweddown the side of our modest mountain. My first stepwas not the 9 inches I expected, but about 4 feet tothe bottom of the ditch. As my extended right footfinally struck stone, a loud crack accompanied myastonishment. As I continued my fall, my rightshoulder struck the side of the culvert. I diagnosedthe comminuted fracture of my right humerus beforepainfully arising, but only after my first step de-tected the ruptured Achilles tendon. The fallenwoman went home; I went to the hospital.

Another time an elderly woman fainted in thethird row and the musicians stopped playing. I posi-tioned her flat in the aisle. As she slowly awakened,I learned from her husband that she had “fainted atconcerts before.” The siren sounded as I helped herwalk up the aisle to the back entrance of the hall.The first emergency vehicles arrived, sirens scream-ing and lights flashing. The rescuers brusquely el-bowed me aside, announcing, “Stand back! EMT!” Allfive vehicles remained, motors running and lightsflashing under the overhanging roof of the hall, asthe embarrassed victim, fully recovered and sittingon the steps of the ambulance, completed the neces-sary reimbursement forms. Exhaust from the vehi-cles slowly filled the hall. My request to move themwas “interference with a rescue,” a charge dismissedonly after a thorough investigation and a warning bythe local police.

I usually did not have the chance to summon thewit of a friend, paged during a concert by the Phila-

Address correspondence and reprint requests to Dr. Carl Ellenberger Jr., Lebanon Magnetic Imaging, Box 70, Mt. Gretna, PA 17064; e-mail:magnetic1@comcast.net

Copyright © 2006 by AAN Enterprises, Inc. 541

delphia Orchestra. “What time is my appointmenttomorrow, doc?” “You’ll have to find another neurolo-gist,” he replied, “I just retired.” And then he retired.

A crowd was gathering in the twilight as I ap-proached tonight’s victim. He was a robust middle-aged man dressed in shorts and a T-shirt. Heappeared dusky and apneic, his mouth and sightlesseyes slightly open. I noticed a knee brace on his rightleg. Again I was asked by an EMT to stand backfrom a fruitless resuscitation effort in progress. Thechest pumping was far too gentle, but I knew he hadbeen asystolic for more than 5 minutes. One afteranother screaming and flashing vehicles arrived,their occupants bursting out carrying cases of equip-ment in both hands. “Anyone know who he is?” theyasked. No one responded. I felt helpless, sad, andeven a little guilty because I was too late, not partic-ipating, or even wanted.

My guilt increased as I deserted the scene andwalked back to the theater and the warm elegantsounds of Haydn, punctuated by still more sirensarriving. After the end of the allegro I asked themusicians to pause until the sirens stopped. A violin-

ist took the opportunity to talk to the audience, allstill oblivious to the drama outside, about the F Ma-jor Quartet and why it had begun so loudly andabruptly: it was to command the attention ofHaydn’s chattering aristocratic audience, he re-vealed. Our audience, who had tittered as each sirenjoined the music, didn’t grasp the meaning of theultimate eerie silence: rescue efforts had failed andnone of the ambulances raced for the hospital. Whenthe music began again, I couldn’t enjoy Haydn’s styl-ish, graceful humor, usually still vital after 200years. The Charles Ives quartet was more unsettlingto me than the composer, as always, deliberatelyintended it to be. The lyrical melodic strains of thefinal Dvorak quartet, although warm and soothing,didn’t fit at all as an impromptu requiem.

The next day’s paper told that the victim was amathematics professor at a nearby college and fatherof three young children who had just finished hisweekly pick-up basketball game. His wife and chil-dren had watched the game, but were already on theroad home when, after visiting the local ice creamparlor, their husband and father collapsed and died.

Figure. Mt. Gretna Theater by Bruce Johnson. (Property of Carl Ellenberger.)

542 NEUROLOGY 67 August (1 of 2) 2006

DOI 10.1212/01.wnl.0000232739.09299.182006;67;541-542 Neurology 

Carl Ellenberger, Jr…On call

This information is current as of August 7, 2006

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