From Balcony to Bedside: Operatic Entrance Music in the Clinical Encounter

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FROM BALCONY TO BEDSIDE: OPERATIC ENTRANCE MUSIC IN THE CLINICAL ENCOUNTER CATHERINE V. CALDICOTT " As I open the door to the examining room, something about the quiet young woman seated there makes me introduce myself quickly and skip the usual pleasantries. Is it the look she gives me as our eyes meet? Or is it the way she curls back into the chair? Immediately I am reminded of the eerie arpeggio that accompanies the first entrance of Blanche, the main character in the French opera Dialogues of the Carmelites (excerpt I).1 Blanche is the impressionable and introspective young daughter of a French marquis who becomes a Carmelite nun against her family's expectations . Francis Poulenc (1899-1963) based this opera, written in 1957, on a true story about a Carmelite community martyred at the guillotine for upholding their faith during the French Revolution. Why does my meeting a new patient bring an operatic character to mind? I find that a device that enriches my understanding ofan operatic character also helps me understand a patient. This device makes use of entrance music, the music that accompanies or heralds a character's entrance in a scene. Frequently, a composer will provide musical clues to a character's personality or story in that character's entrance music. If I am observant and listen for those clues, my experience of that character will have greater meaning. But my patients also provide me with clues—not musical notes, but gestures, habits, affects. If I pay attention to these clues, I gain impor- *Department of Medicine, SUNY Health Science Center, 90 Presidential Plaza, Syracuse, NY 13202. The author would like to thank Rita Charon, Joel Howell, Clark Malcolm, and Susan McClary for their helpful suggestions during die preparation of this paper, Chris Chapman for setting up the web site, and Clare Weipert and Niki Sullivan for their assistance in preparing the manuscript. 1AIl operatic excerpts cited can be heard on the web site http://www.med.umich.edu/lrc/ em/.© 1998 by The University of Chicago. All rights reserved. 0031-5982/98/4104-1071$01.00 Perspectives in Biology and Medicine, 41, 4 ¦ Summer 1998 549 FÜRE p» -» tachez et tenez avec tes pr.da/es Excerpt 1.—Francis Poulenc, Dialogues of the Carmelites (1957). Blanche's entrance. tant insight into my patients' personalities, stories, and illnesses. My relationships with those patients will necessarily assume fuller meaning. The medical humanities in general, and literature and medicine in particular , inform and enrich our care of patients. Through the use of literary methods and texts, medical students and doctors learn how to listen more effectively, to diagnose more accurately, to comprehend the meaning of illness and treatment from their patients' points ofview, and to convey the inner world of the clinician [1, 2] . In this paper, I will describe the benefit of attention to entrance music in opera. I will then suggest how this skill can be applied to the practice of clinical medicine in order to achieve empathy with patients, self-knowledge, and deeper meaning in our professional lives.2 Entrance Music in Opera Let us return to the example of Blanche. Although brief, her entrance music is part of her character [3] . Using dissonance and a series of tritones, Poulenc produces a startling, haunting sound that captures Blanche's fragility , vulnerability, and torment, all of which we see later in the opera as she struggles with her commitment to religious life. Prepared by the arpeggio , we are not surprised by her inner conflicts. Aspects of an operatic character's entrance music include features such as melody, rhythm, tempo, dynamic (i.e., volume) changes, dissonance/ consonance, and type of orchestration, all of which are provided by the composer. Dutch musicologist Frits Noske observes that Mozart used orchestral tone color in his operas to "reveal, transmit, reinforce or clarify a dramatic element, such as a particular mood, attitude, situation, character or action" [4]. So, operatic entrance music shows us how the composer conceptualizes the character. The composer is responsible for communicating those ideas. 2Although I continually refer to the doctor-patient relationship, I do not mean to exclude other medical caregivers. Most of the points in...

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