Acad Psychiatry 30:80-82, February 2006
doi: 10.1176/appi.ap.30.1.80
© 2006 Academic Psychiatry
Acoustics
Veronica Hackethal, MSc.
Received September 14, 2005; accepted September 20, 2005. Veronica Hackethal is a fourth-year medical student at Columbia College of Physicians and Surgeons, New York, New York. Address correspondence to Veronica Hackethal, vh2008{at}columbia.edu (E-mail). Copyright © 2006 Academic Psychiatry.
Cecilia stared into her morning coffee. The steam rose in a lazy spiral from the murky liquid. Cafeteria coffee, she sighed, gazing languidly from her balcony seat to the hospital entrance below. She sat in early spring sunlight filtered through half-washed windows and ruminated on the past year, her third of medical school. It hadn’t been easy. She had a sensitive soul, and it seemed that the faculty had tried to pound it out of her. "You’re too quiet," her attendings had scolded, "too gentle. You need to be more aggressive, faster-talking." More like us is what they meant to say. It left her feeling like her character had been attacked, and she’d grown monumentally discouraged. Usually Cecilia censored herself from these thoughts—they made her throat knot in anger. She took another sip of coffee, tried to ignore its acidic bite, and allowed her mind to wander onto the story of a patient she’d just met.
The girl’s name was Mona, a 10-year-old with autism. Cecilia, exhausted this morning, had reluctantly walked into Mona’s world. "Hi, my name’s Cecilia," she’d begun, "what’s your name?" It was a half-hearted gesture to get the girl to respond. Mona seemed oblivious. She sat in the center of her bed, curled into a ball, rocking slowly back and forth and humming a jumble of barely audible notes. There was no melody, only a random assortment of varying pitches sung in a child’s uncertain treble.
"I see you like to sing," Cecilia continued. No response, only humming and rocking. "I like to sing, too. Do you know that my name’s a song?" Still no response. "Want to hear it?" Cecilia continued, feeling like she was talking to herself. Mona continued rocking, wrapped up in her own musical hodgepodge. "It goes like this," Cecilia continued. Bashfully she ventured a few lines: "Ceceeeeelia, you’re breakin’ my heart. You’re shakin’ my confidence, Lately-y-y. Oh, Ceceeeelia, I’m down on my knees. I’m beggin you please to come home!"
That was as much as Cecilia could remember. But it didn’t seem to matter to Mona, who continued to rock back and forth. "You have a nice voice, Mona," Cecilia said, trying to sound upbeat. "I bet you could carry a mean tune." But the girl still took no notice, and finally Cecilia ran out of things to say. For ten minutes, Cecilia didn’t speak. She listened to Mona’s humming and stared morosely out the hospital window at the golden sunlight shimmering off the waves in the Hudson below.
What a beautiful child, Cecilia thought. Mona had raven hair and velvety black eyes that looked off into the distance (but never into anyone else’s) from beneath long curling lashes. Her skin, smooth and olive toned, was sallow from lack of sunlight, devoid of the rosy cheeks of childhood.
Mona did not look unhappy. She simply didn’t care about the outside world. But when that noisy world broke into her isolation, she exploded in torrents of sound. A thunderclap could make her shriek and roll with pain, a car alarm could precipitate a temper tantrum. She would clap her hands over her ears trying in vain to expel the intruder. Her parents, defeated by her outbursts, had come to the hospital desperately searching for solutions. "Please help us," they’d pleaded, their faces branded with the guilt of parents stretched beyond endurance, "we can’t live like this any longer." So Mona had been admitted for "observation." All day she sat in bed, rocking back and forth to her own melody.
As Cecilia sat thinking, Mona’s humming began to invade her thoughts. Gradually, she realized that the little girl’s melody was not completely random. It was a scale of half-steps: three steps forward, two back, four forward, three back, in perfect tune. Mona had suffered from autism since infancy, Cecilia thought. She’d begun talking around age two—had learned a rudimentary vocabulary. Then she’d quickly regressed, had lost all verbal ability, and shut out everyone. Mona hadn’t spoken a word since age three. All she did, day in and day out, was hum incessantly. She’d never been capable of taking music lessons, so how could she hum scales?
Mona’s peculiarities were not entirely foreign to Cecilia, herself highly musical. Her father had said, in the German accent he found impossible to lose, "You haf ze privilege of being named after Saint Sheesheelia, so of course you vill haf ze geeft of music." But Cecilia had never liked her name. She thought it sounded old-fashioned. "Be proud of your name," her father had continued unconvincingly, his nasal Rs stuck in the bridge of his nose, "Saint Sheesheelia was one of ze greatest vomen in heestory." That was another thing. Cecilia never liked the way her father pronounced her name. He tried to imitate an Italian accent, out of deference to his Italian wife who’d always seemed to him the height of style. Even after she’d gained thirty permanent pounds of pregnancy and her feet had widened so that she could no longer wear heels, he still adored her.
Cecilia’s father had escaped from behind the Iron Curtain—had "vaulted" (his term) the Berlin Wall in the 1960s. "Eez not a vall," he insisted, "eez a goddamn fuckin’ preeson." He’d sought refuge in Italy, where he’d met Cecilia’s mother. The two had worked their way to America, where her father promptly fell in love with all things American, especially the little known (and rarely eaten) Uncle Sam cereal. He’d stocked their kitchen with hundreds of boxes of the stuff: patriotic insurance against "it" happening again. At bedtime, Cecilia’s father taught her to end her prayers with "and please don’t let the communists take over America. Haymen."
Aside from his accent, his love of music was the only other vestige remaining from the Old Country, "Your grandfather played veeolin. I played veeolin. Now you, dear sweet Sheesheelia, vill also play veeolin," he’d said, absentmindedly tapping his lame left arm. The triceps had been shot off in his youth, leaving him unable to play his beloved violin. Cecilia rarely asked about these matters. Occasionally glimpses of the past emerged when her father fell into a rare fit of sadness, but mostly the past stayed just there, bubbling under the surface. Cecilia would have liked to have known more about her heritage, but her father’s melancholy moods scared her.
So Cecilia had learned the violin, and her playing resonated with exuberance and love of life. Her teachers boasted that she had an uncanny ear, an other-worldly tone and a soulful vibrato. She performed through high school and college, but upon reaching medical school, she laid down her violin for a "break" that had grown into three long years of arduous study. She longed to play the violin again, but she feared that her passion for music would control her life.
Yet it was this very adoration of sound that drew Cecilia to Mona. As she sat daydreaming over her coffee, the harsh sounds of the hospital—the rushed, urgent voices bouncing off stark linoleum—swirled around Cecilia’s head. She tried to shut out the sensory stimulation, concentrating instead on the sugary coffee in her mouth, the changing cloud patterns outside the window. Cecilia felt afraid of Mona. If she identified with Mona’s sound sensitivities, what did that say about herself? Cecilia could sympathize with Mona’s rejection of the world. There were times in the last year when she’d wanted to do the same. Cecilia was tired of feeling. She had turned off her emotions and now wondered whether she dared turn them on again. It was unconscious, a gradual slide into not caring.
She had started the year feeling for her patients, but this identification had subsided into trying to survive the angry frustrations of the residents. She remembered one resident who, when she could not remember the answer to a question, had hissed full of venom, "Do you even want to do patient care?" Another who’d called her a deer in headlights. Another who’d clapped her hands at Cecilia and called to her as to a puppy dog. She’d been ignored, demeaned, her hands slapped by an imperious surgeon. It made Cecilia wonder, "How can I treat patients with dignity and respect when I’m not treated that way myself?"
That evening, Cecilia took a walk in Central Park. The evening was sunny, the kind that makes a person yearn to linger outside until the last ray of light has faded from the west, and Cecilia completely forgot about Mona. She rejoiced in the gentle spring breeze, the soft splash of water in the Bethesda Fountain. She sat on a cement bench warmed by the early evening sun and gazed up at the angel crowning the top of the fountain. The angel stood with mighty wings outstretched, as if alighting from flight. She extended her right hand gracefully downward, offering solace to those below. Two sisters, their faces framed by halos of long curls, played in the fountain. They splashed and squealed with delight, their laughter bouncing off the stone pavement. Cecilia absorbed their joy felt relief to be in the presence of children blooming with health.
Back at her apartment that evening, Cecilia’s eyes fell on her dusty violin case lying unused in a corner. She picked up the case—unlatched it. She let her fingers slide over the smooth, shining beauty of the violin’s varnish. She caressed its curves longingly, her fingers curling around it. She lifted the instrument and let it come to rest against her left shoulder, then hesitantly picked up the bow and played a few shaky notes. An electricity spread through her body, coming to rest in her fingertips. She shuffled through the old scores in her violin case and drew out Beethoven’s Ninth Symphony, long her favorite. She loved the galloping exuberance of the orchestra and chorus singing as one in the final movement. That night, Cecilia played until her fingers were too tender to continue. The calluses she’d had all her life, hardened through hours of expressing herself in music, had disappeared from lack of use, leaving her vulnerable.
The next day, Cecilia felt less reluctant to visit Mona. The little girl still sat rocking to and fro, still humming the same scales. "Good morning, Mona," Cecilia said. "Do you remember me?" No response, only rocking and humming. "I remember you. You’re the girl with the golden voice," Cecilia continued. No reaction. And then Cecilia had an idea: if Mona won’t answer me, I will answer her. Softly, Cecilia began to hum along with Mona. Still the girl took no notice. Once in a while, Cecilia threw in a note of her own, and after a few dissonant clashes, Mona started mimicking Cecilia. It began hesitantly and with many mistakes, but gradually they started to sing together. And ever so gradually, Cecilia made a song out of their mutual notes. Without thinking, Cecilia fell into the Ode to Joy and Mona fell along with her. And then, a miracle. Mona stopped rocking and instead swung both hands back and forth in time to the music, a smile of pure ecstasy lighting up her face. They sang the melody over and over, until Cecilia realized that she was nearly late for class. "I’d like to sing with you longer, Mona, but I have to go to a lecture now." No response from Mona, who remained singing, arms moving to the rhythm.
As Cecilia turned to go, she heard, intermingled with Beethoven, "Ceceeeelia, you’re breakin’ my heart. Oh Ceceeelia!" Cecilia, electrified, turned to look at Mona. The words had sounded eerily normal, like those of any ordinary 10-year-old. But the little girl still sat staring into space, still flapping her hands to the music. Cecilia stood transfixed. She waited for more of Mona’s words until, with sinking heart, she realized that the little girl had begun to rock to and fro.
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