No complaints this month. In many ways, I am lucky to be writing anything at all. But with the enforced vacation, due to a heart attack on November 1st, I have had some time to reflect about many matters, most having very little to do with music.
But here is what happened:
During my week of rehearsals and concerts in Rotterdam, I had started to feel a bit out of breath, especially walking over to the hall. Being somewhat overweight, this was not out of the ordinary, but once in a while, I actually had to stop. This should have told me something.
There were four concerts all together. During the first three, I got a bit winded and dizzy but got through the programs easily enough. At the first performance I felt I might actually fall forward off the podium and attributed this to simply not getting my balance. There were even moments when I knew I was losing concentration, but again, I ignored the signs, and attributed it to jet lag.
The final performance was on Sunday, at 2:30 in the afternoon. I had brought my luggage to the hall, as my flight to Prague for the next set of concerts was set to leave at 8:30 pm. It is about an hour’s drive from Rotterdam to Schipol airport in Amsterdam. Again, I got quite out of breath walking to the hall but this time the feeling did not dissipate, at least for a while.
When I got to my dressing room, I was already huffing and puffing. The first piece on the concert was the 3rd Piano Concerto of Beethoven, not a particularly physical work for the conductor. As it progressed, I started to feel much better. However, during intermission, I started to experience the out of breath symptoms that had occurred an hour earlier. Someone actually asked me if I was okay and I said yes.
Then things started to change.
The moment I got to the podium for the Rachmaninov 2nd Symphony, I began to feel a tightness in my chest, almost like someone was standing on it, trying to prevent me from breathing. I really did think that I should leave the stage for a few minutes and get some water. The reason I did not suspect a heart attack at that point was that there was no tingling in either the jaw or left arm, symptoms which I have always thought were the signals of a coronary event.
I am not sure what it was that made me believe I could get through the almost hour-long work, but somehow, I did. At that point I was perspiring profusely and the pain in my chest was unbearable. Collapsing on the couch in the dressing room, I asked for the door to be closed while I caught my breath. A few minutes later, Frans, the head of the stage department, and a very fine fellow, came back in and called the medical team. Each European house has such a group on stand-by and they rushed into the dressing room.
By this time, my shirt was off, I was desperately trying to find a comfortable position. Cold towels were pressed on my forehead. All that was on my mind was that the pain was increasing and I needed help. The medical assistants then uttered the magic words, “You are having a heart attack but will be okay. An ambulance is on the way.”
Much of the next hour is a blur. I remember being hoisted onto a stretcher, taken outside in the rain to the car and arriving at the hospital. We raced down a hallway and into an operating theater. I think there were only a few questions, like what I was allergic to, name, age, etc. Insurance never came up. The angioplasty progressed with me somewhat awake and able to see the wire going up my artery.
At some point I started to feel better and woke up in the hospital’s intensive care unit. There was much fussing and constant monitoring. A medical unit came in to tell me what had happened and what they had done. The angioplasty was successful and I now had three stents and a balloon pump in my body. Uncomfortable? Oh yes! But better than the alternative.
My job now was to just listen and follow instructions. So for the next ten days, I stayed put, with occasional forays into the hallways, attempting to get some motion back. This was not so easy and often I used a walker to get around. Eventually I managed on my own. It was even possible to survive the rigorously bland items that passed as food. Jello never looked so good.
It was initially thought that I might get back to the States in 6 or 7 days, but then the doctors decided that pushing it was not a good idea. So on the Monday, 9 days after the heart attack, I took a stress test on a stationary bicycle, passed, and went to Miami. Many years ago, in D.C., I had seen a cardiologist who would later move to Florida and become the dean of the University Medical Center. I decided to stick with a doctor I knew for the next phase of evaluation.
After three days, it was determined that my heart had not suffered very much damage, but that I needed a few more weeks of rest and recovery. At first, my own thoughts were that I could easily conduct one half of a program, probably doing just the concertos that were scheduled, maybe one rehearsal and then perform the concerts sitting down, not expending too much energy. But it became clear that even this was not possible, as I grew fairly tired as the day progressed. I also tried not to do very much paper work either, with just a little time spent moving program ideas around for next season.
But it was awfully good to get back to my home, where I could enjoy cooking in new and different ways, do a bit of low impact exercise, and catch up on DVDs that have been lingering on shelves for months on end. At one point I was surprised at how easy it was to let go for a bit. Not similar to a vacation but much needed after all I had been through. What did I learn from this?
Perhaps not quite as much in life changing experience as I thought. No major revelations, as almost everything I have thought about this past month was something that had been on my mind earlier. Slowing down? Probably a bit, with more time off. Obsessing about details? I am not sure that I am capable of letting go of the control issues that face almost every conductor. It is part of our being. But maybe more delegation of certain aspects of the job can take place. It truly was no problem letting substitutes fill in for me during the concert platform absence. After all, this was how I got my start, jumping in for indisposed conductors way back in 1974.
I was reminded of a trip to Milwaukee that I made almost 40 years ago. At the time, I was assistant conductor in St. Louis and spent a great deal of time flying up to Chicago to hear concerts there. This was during the period when Sir Georg Solti was music director and Carlo Maria Guilini was principal guest conductor. The orchestra used to play a series of concerts in Wisconsin, on Monday nights, and I would go in a car with whoever was conducting, giving me a wonderful opportunity to speak with the maestri in a calm environment.
Guilini very rarely spoke about the music itself. He was mostly concerned with the philosophy that underscored a piece or even a note. But he told me about a time in his life, when he was not quite 50 years old, when he had to undergo a serious operation. It was possible that he might not have survived the surgery. When he awoke from the procedure, he made a vow to himself, and these were words I would never forget.
“You must make music a part of your life and never make life a part of your music.”
Maybe one has to go through a life-threatening situation to fully comprehend this. That it took this long for me to act upon his wisdom is, in a way, unfortunate. Perhaps others can follow the advice sooner and not wait until it is almost too late.
It is not possible to underestimate the great job done at both hospitals. The Erasmus Medical Center in Rotterdam is renowned for its heart facility. How fortunate that if this was to happen, it was in this place. Everyone was very kind and helpful. Several members of the orchestra came to visit and the orchestra manager, Helga, showed up every day. Of course, she snuck in little snacks to off set the traditional Dutch hospital fare.
The Miami team could not have been more complimentary of their colleagues in Holland. The doctors said there was nothing different that they would have done. I was in the best of hands, literally. And to all of you who have sent notes and messages, I cannot thank you enough. One can never take kindness for granted.
At this point, I am not sure what December will bring. I know that I am not 100% yet, but feel quite good. Nevertheless, following the orders of the medical team is paramount. It is time to lose the excess weight, get the cholesterol numbers into a manageable range, and not push things.
Whenever I do return to the podium, there is one phrase that I do not want to hear in the middle of a concert:
“Is there a doctor in the house?”
On the other hand, perhaps that is exactly what I need to hear.
See you next month,