Saturday, January 30, 2016

Music Heard on the Island, 2015 Edition

So my last couple of posts got pretty heavy, so let's change it up to something a bit more lighthearted.
2015 was a cool year in music. I liked a lot of what happened last year. Of course, there was some crap, but it seemed like I saw less of it then I did in 2014. Heck, 2015 was the year Justin Bieber finally became somewhat acceptable listening material. That in and of itself was enough to sit up and take notice of the musical year.

2015 saw a lot of great music, and sadly I missed a lot of it. I heard snatches here and there - Chris Stapleton's appearance on SNL left me wanting more, and the Chris Cornell and Sara Bareilles features on Zac Brown Band's new Jekyll+Hyde intrigued me. I still have yet to get to those albums.
2015 was also the year of the comeback. Shania Twain released a live album? Natalie Imbruglia finally stopped feeling "Torn"and released new music? Howie Day still exists and is making music? I didn't listen to any of them, but it's interesting that they came back (see below for more).
And there were a bunch of albums that I listened to in 2015 that, on looking them, actually came out in 2014, or even 2013. Son Little is an excellent modern blues album that caught my attention with the return of Spotify's "Discover Weekly" feature. Vance Joy's "Riptide" pulled me in (get it?), but that album came out last year, too. Whoops.

Anyway, onto albums that actually came out in 2015 and that I did listen to:

1. Kendrick Lamar - To Pimp A Butterfly: In March, the Billboard charts were swimming in the sludge that was Meghan Trainor's "Title", struggling to stay afloat with Fall Out Boy, Ne-Yo, and the remaining singles from Mark Ronson's "Uptown Special", none of which were making us dance in the street (RIP David Bowie) the way Uptown Funk did. Meanwhile, people who know more about rap than I do were abuzz with discussion of an impending new album from Kendrick Lamar. Then near the Ides of March, "King Kunta" threw open the pop-culture doors and drop-kicked Meghan Trainor across the room. I think Australian comedian Felicity Ward put it best when she Tweeted:

The rest of the album is amazing, but very differently so. It gets heavy. It's an intense 78 minutes that delves deep into racism in our country, and it takes a couple of listens before it can fully sink in. But it is a beautiful album. One of the coolest parts is that most of the album features live musicians creating the musical canvas on which Kendrick paints his words.  My friend Jon Lehning, a working jazz saxophonist, points out that TPAB is as much jazz as it is rap in some places. I fell in love with it instantly. Check out this video of a live performance.

2. Gavin Harrison - Cheating the Polygraph. I have been a longtime fan of the band Porcupine Tree. It started with, as many of my musical discoveries start, with an interview in Modern Drummer that introduced me to this master of making intricate drumming chops blend into the music so you barely notice. Harrison creates beats at times that I can often only begin to guess at, much less try to imitate. Here he takes Porcupine Tree songs and filters them through big band arrangements, molding them from progressive hard rock into a beautiful bop jazz, while maintaining their progressive sensibilities. The result is a mix of guess-the-PT-song as you enjoy the awesome layers of horns and woodwinds breathing new life into the tunes. The album goes by pretty quickly, but it's a fun ride for jazz fans and PT lovers alike. A Sampler Montage.

3. Chris Cornell - Higher Truth: Chris Cornell's new album pre-order emerged right as I was starting to get the itch for new music in October of last year. Soundgarden had put out a new album and tour the previous year, and Cornell had announced he was doing another solo project this year. His previous solo albums have seen mild success, with the melodic alt-rock of Euphoria Morning and Carry On, contrasted with the Timbaland-produced Scream, an album that fused Cornell's voice with hip-hop beats and made Cornell fans everywhere seriously question one of the greatest voices in rock. Higher Truth takes a more stripped-down approach and lays it all on the songwriting. And it absolutely does not disappoint. It balances an acoustic folk aesthetic with heartfelt rock-out moments (lead single Nearly Forgot My Broken Heart displays this perfectly). The songs on this album let Cornell's voice shine, as the pain, sorrow, or hope of the forlorn lyrics cuts into your soul. Definitely one of my favorites. Arguable best moment: "Murderer of Blue Skies" which starts as a quietly intense folk+electronica rhythm and suddenly bursts forth with an electric guitar and crashing drum beat, one of the album's best cathartic moments. 

4. Zella Day - Kicker: I actually forgot about this album until I went to make this list. Spotify brought back its "Discover Weekly" feature (I guess it used to be called something else, my sister was telling me - she was over the moon when it came back). One of my playlists featured the song "Ace of Hearts." I was immediately floored as Zella Day's forlorn voice cut into my soul over the slick slow 6/8 beat. I went to check the rest of the album out and Mustang Kids immediately had me dancing, having fun with the same theme that Halsey's "New Americana" tried to use later in the year (and not nearly as well). The album features a lot of emotion, but it's channeled through some beautiful lyrical imagery and fantastic layered beats and soundscapes.

The next one is not one I actually heard in 2015, but I was strapped for another selection that really captured my heart. On review of albums that came out last year in anticipation of this playlist, I came across this and was pretty much immediately sold:

5. The Corrs - White Light: I know what you're thinking. The most beloved Irish family band of the late '90s and early 2000s has returned? Okay, maybe you're not thinking that, because if you're like most of the population of the United States, the last (and possibly only) time you ever heard The Corrs was 2000's "Breathless," and that's only if you saw The Corrs Live in Dublin DVD, or heard it in that Debra Messing movie "The Wedding Date." Well, they made 2 albums after that, the last one in 2004, and then lead vocalist Andrea Corr struck out on her own for a bit. Apparently in recent years, drummer Caroline got the band back together, and they went into the studio under the radar. The result is an album that seems to pick up right where they left off in 2004. The first single, "Bring On The Night," features the same dance-pop vibe  that kept "Breathless" in your head for days, with a resilient hope that makes you want to sing along and then go fight a dragon. The rest of the album continues the Corrs' tradition of balancing pop sensibilities with traditional Irish songwriting and instrumentation - the tin whistle, bodhran, and violin blend so well with guitar, keyboards, and drums. They didn't necessarily break much new ground, but after 11 years, this is exactly what Corrs fans want. 

Honorable Mentions:
Kamasi Washington - The Epic. If you like the instruments and stylings you heard in TPAB above, check this out. Washington provides the saxophone flavor on the album. My closest musicophilic compadre Eric suggested it to me, and similar to TPAB, I was instantly hooked.
Brian Wilson - No Pier Pressure. I've been expecting this album since this video came out. And it does not disappoint. Wilson hearkens back to Pet Sounds with the same Beach Boy-style harmonies and sonic textures that we've loved for years.
Def Leppard - Def Leppard. Another comeback album, DL releases an album of new material that manages to cull together all the best parts of their music over the years. "Wings of an Angel" is one of my new belt-out-in-the-car anthems.
Toto - Toto XIV. This was a great album, but, while Joseph Williams may be a technically better singer, and the years have been good to him and his voice, I miss Bobby Kimball's over-the-top vocals, the desperate wails and angry growls of his mighty choruses.  On the whole, a good album...I just wasn't satisfied on a visceral level.

Monday, January 11, 2016

Happy New Year! Let's Talk About Death

I've been thinking a lot about death lately.

Admittedly, I do work in hospitals. Plenty of sick patients, and, as they say in Scrubs, sometimes it seems like Death is just another coworker. A coworker we fight against and do our best to foil every day, at every turn.
Recently on the floors, they called a rapid response when a patient displayed seizure activity. I arrived at the scene and heard the story from the witnesses, and got ready to turn the patient on his side in case he vomited. AK, one of my residents, arrived right on my heels, looked at the patient and asked me if the patient had a pulse.

He did not.

I turned him on to his back. She told me to start compressions, which I promptly did. My other resident arrived and he and AK ran the code. I did what I was told, helping to perform chest compressions while another team member breathed for him and another team member drew up medications. We performed CPR until the Zoll monitor told us it was time to shock him. After two shocks, we were able to successfully resuscitate the patient, took him straight to the ER, and from there he went to the cardiac catheterization lab. A couple of days later I saw him in a hospital room, recovering.
He looked awesome. He was relaxed, breathing easily, and did not look at all like the choking, gasping, swollen man I saw on the floor that day.
That's one of those times when it seems amazing, what we can do. We brought a man back to life. And he walked out of the hospital and will go on to live his life. Take that, Death. Checkmate (for this round).

On the other hand, I remember all too well the first time I watched someone die. It was in the emergency room. I was working a night shift during my last month as a third-year medical student. I had just done my tenth rectal exam that week, and was settling in for what I was hoping would be an interesting shift. Well, I got that and then some. She was 93 years old, African American, with several comorbidities. She came in with shortness of breath, and the rest was a blur. She could not maintain her oxygen saturations, but her pre-written advanced directive orders did not allow for transfer to higher level of care. We could not intubate her to give her more oxygen, and more importantly, she did not want us to do that. I don't remember what nursing home she came from, or even what her name was. I remember being told to take her blood pressure, and asking her how she felt. All she did was smile at me. A wan, accepting smile that was weighed down by pain, an inability to oxygenate, and 93 years of life experience. A wry, humble smile that was matched by the dim light in her eyes - a smile that will remain with me for a long, long time. She gave me that smile, and I had no idea what to say to her. All I could do was smile weakly back, and give my best reassuring grip of her hand. That grip of mine, while not the strongest or the largest of hands, usually serves to reassure patients that I'm doing my best for them and that I'm working hard to get them better. But in her be honest, I am not sure who was reassuring whom: The medical student who was doing his best to feign calm, or the elderly lady who was ready to face the next world. Soon her breathing became more labored, and the nurse came to tell us. My attending beckoned me along and we ordered a narcotic pain medication to ease her work of breathing. She got drowsier, and then we just stood there as she breathed her last. Her breathing stopped, her heart soon joined it, and that dim light in her eyes finally dimmed to nothing.
The hardest part was then, we had to just move on. There were other patients that required more immediate assistance, and we couldn't afford to dwell on it at the time.

I recently started listening to The House of God on audiobook. It's my second time with the book, the first time being a read-through in my third year of medical school (shortly before that ER shift), not to mention my repeated viewings of Scrubs, which is loosely based on some of the book's satirical concepts. An OB/GYN attending I once worked with told me I should read the book three times - as a medical student, again as an intern, and again after completing residency. In the first chapter of the book, the chief of medicine illustrates the hospital's mission statement of "doing everything always for everyone forever to keep the patient alive." A lot has changed since 1978, and that policy is not the end-all, be-all it used to be. Now, a part of nearly every History & Physical we interns write is a conversation about what the patient's end-of-life wishes are. Well, it's supposed to be a part of that H&P. Such conversations are uncomfortable for both the physician and the patient, and we often do not like having them. Or, as a palliative care attending I know will tell you, "too many doctors are afraid to have that conversation, or even say the word 'die.'"
Every palliative care specialist will tell you that having that conversation is not, as The House of God states so flippantly, "Getting the DNR." It's about knowing the patient and what they want. How they feel about the end of their life, whether it's coming soon or decades away. It's like getting consent for any other procedure - it's explaining the risks and benefits of cardiopulmonary resuscitation and intubation. And it's about respecting the patient's wishes once they make their informed decision. That doesn't make it any easier to talk about, though.

You know what I remember most about that code? The dull, sickening crunch of the patient's ribs breaking with that first compression. It's a sound I have heard multiple times in codes and, to break any illusion of eloquence, it freaking sucks. We may joke about it, but it's a terrible sound. And granted, sometimes it's a small sacrifice to make to restart the patient's heart. And in this case, he was a young enough guy that he recovered quickly. But sometimes...that's not the case. Sometimes those broken ribs just compound the fact that the patient's heart was only barely resuscitated, and he/she/they cannot be weaned off the ventilator. Sometimes it's that they required CPR and multiple shocks for so long that they suffered anoxic brain injury because we could not get the blood pumped to the brain in time, and for the rest of their lives, they will be unable to tell us anything about their thoughts or wishes.

When someone decides to become a physician, he/she usually does not consider this part. We become doctors "because we want to help people" but in our heads that is often synonymous with saving lives. With performing "heroic measures" to bring patients back from the dead, and watching them walk out of the hospital. Never once do we think about the other side of it. About what to do when people don't want those measures. About how to talk to a family about letting their relative go because he/she just cannot fight anymore, or how to accept that a patient wants to die with dignity and on their own terms rather than facing the possible adverse consequences of our so-called "heroic measures." Because we don't always want to think about that. We imagine the oft-used, "if it was my mother or father" scenario to help us counsel the patients...but in this case, that thought often terrifies us. We can bring ourselves to deal with patient deaths, and shrug those off, but when it comes to our own family, we often feel powerless. All of our medical insight and education becomes clouded as we find ourselves on the patient side. Even in our imaginations.
And that's when we question ourselves. We can't help but wonder if it is worth it (in these particular cases). Are our "heroic measures" there to protect the patient from death, or to protect us, the physicians, from having to deal with death?

The one-line answer is that there's a balance between the two sides of that sentence. 

But there is no easy way to find that balance, nor is there a universal way. But if we as doctors truly want to be the best physicians we can be (and, if that aforementioned palliative care attending has her druthers) - for the sake of the patients - we will never stop trying to find that balance.