Musical and Medical Reflections

Aaron T. Gerds, MD, MS
Aaron Gerds, MD, is Deputy Director for Clinical Research at the Cleveland Clinic Taussig Cancer Institute and Associate Professor at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University in Cleveland, Ohio.

While updating my CV for an annual performance review, I noticed a considerable number of musical references popping up in the bibliography. Yes, Bruce Springsteen, Paul Simon, Johnny Cash, and even Salt-N-Pepa reside in my EndNote library.1-4 It could be that I’m just really into music – which is true – but I’m not the only one. A forthcoming Blood commentary features Mick Jagger in the references, and Bob Dylan has appeared in articles describing everything from chemotherapy-free treatments for lymphoid malignancies to the transcription factor role in hematopoiesis.5,6 Even last month’s Editor’s Corner by David Steensma borrowed its title from Jackson Browne’s “Running on Empty.”

On face value, referencing popular culture is a simple way to connect with the audience over a shared experience. We can instantaneously convey a feeling or emotion and set the tone for the piece. However, while listening to the Song Exploder podcast during my daily commute, I began to think that there is more to the relationship between music and medical writing. Not only do medical authors reference music in their writing, but songwriters often reference medicine. These range from the way Eddie Vedder uses blood as an analogy for his creative process being phlebotomized by record label executives in Pearl Jam’s “Blood,” to lighthearted takes such as Stephin Merritt’s description of disdain for an ex using the imagery of an appendectomy sans anesthesia in The Magnetic Fields’ “You Must Be Out of Your Mind.” The relationship between music and medicine is a two-way street.

Music that catches the ear often does so by the juxtaposition of different densities. For example, “The District Sleeps Alone Tonight” by The Postal Service features multiple layers of rich synthesizer-driven textures that abut raw and intimate vocals. This is analogous to the way an X-ray image works. There are only four radiologic densities in the body: air, fat, water, and bone. Well, five if you count metal. We only see the picture on the film because bone borders metal, or air resides next to water, providing contrast. With such comparisons available, it’s a wonder we don’t draw more inspiration from music in our medical writing.

Perhaps the compatibility between music and medicine goes even deeper, resulting from the layers in the story that peel away like the scales of an onion. As an impressionable trainee or a seasoned veteran, it is easy to get wrapped up in a mysterious case where the apparent diagnosis begins to fade away as a gut instinct compels you to dig further. Then, with a probing history and additional diagnostics, the covers of mystery are lifted revealing the true diagnosis underneath. On first listen, Semisonic’s “Closing Time” seems simply like a song about bars closing down at the end of a long night. However, lines like “Time for you to go out to the places you will be from” and “This room won’t be open till your brothers or your sisters come” really don’t quite fit that theme. After a careful read of each stanza, and a Google search or two, the layers lift. It turns out that the lead singer Dan Wilson was also writing this song in anticipation of the birth of his first child, adding a deeply sweet and meaningful twist on what could be perceived as an otherwise lighthearted song.

Does hematology have an anthem? Music has been immortalized in the pages of hematology literature, although this may only reflect the authors’ tastes. I can imagine a cardiologist holding up the krautrock anthem by Neu! as their chosen hymn, with its unswerving pacemaker-like beat driving a rhythm strip on a Holter monitor. I can picture the free and avant-garde jazz of John Coltrane flowing through the operating room as a surgeon adapts to an ever-changing situation.

Perhaps the compatibility between music and medicine goes even deeper, resulting from the layers in the story that peel away like the scales of an onion.

Thinking about hematology, I cannot put my finger on a sole piece, or even a style, of music that suits the field. I tend to think that this is what makes hematology so great. Walking through the convention center halls during an American Society of Hematology annual meeting, I see “A Little Bit Country, A Little Bit Rock ‘N Roll” reflected in the crowd. There is a place for everyone in hematology.

Like music, hematology allows us to share common bonds and celebrate our differences simultaneously. This year more than ever, as we emerge from a global pandemic and times of political unrest, we as a community can (taking liberties with a lyric from The Beatles) come together right now, over heme, and maybe over a few good tunes, too.

References

  1. Gerds AT. Beyond JAK-STAT: novel therapeutic targets in Ph-negative MPN. Hematology Am Soc Hematol Educ Program. 2019;1:407-414.
  2. Gerds AT, Sekeres MA. Albumin as a prognostic marker in myelodysplastic syndromes: still relevant after all these years. Leuk Lymphoma. 2015;56(9):2491-2492.
  3. Gerds AT, Sekeres MA. Initial transfusion frequency and survival in myelodysplastic syndromes: hopping onto a fast train to nowhere. Leuk Lymphoma. 2014;55(10):2221-2222.
  4. Gerds AT. Let’s talk about sex[uality]-related symptom burden in myeloproliferative neoplasms. Cancer. 2016;122(12):1804-1816.
  5. Cheson BD. CLL and NHL: the end of chemotherapy? Blood. 2014;123(22):3368-3370.
  6. Dzierzak E. Scl in the zebrafish: a simple (?) twist of fate. Blood. 2005;105(9):3391-3392.