The ER physician had just finished making the rounds. He had just seen a patient on the floor that he put on a ventilator, and he had written a prescription for an antibiotic for a patient with a skin infection that he had to drain. The waiting room was otherwise clear of patients. He proceeded to take a nap and had barely done so for twenty minutes when the red phone in the room awoke him. “MVA, one victim with numerous bruises. ETA 12 minutes.” Shortly hereafter, the still of the night in the wee hour experienced a jolt by the blaring of the ambulance siren. This sound, as grating as it can get, choking off one’s sleep, still represented a bliss for the afflicted, a stark reminder that the safeguarding of citizens’ lives is a serious endeavor that knows no respite.

The scene was pathetic in the ER of this sleepy town in southern NJ near Philadelphia. A lithe young man, in his twenties, unconscious, nattily dressed, with neat dreads, gasping for air in this early morning on a Sunday. The young man had his clothes soaked in blood, his face swollen. A large gash on his forehead was the source of bleeding. His breath was reeking of alcohol. “Very likely he fell asleep behind the steering wheel, and he hit the divider and the car careened out of control and collided with another. It’s a miracle he is alive. I was just a few yards away and I saw the whole thing,” an avuncular state trooper reported to the ER physician, a young male wearing the usual scrubs but whose face obviously bore the markings of a recent catnap.

Because of the proximity of this small hospital to the highway, it regularly saw its fair share of trauma cases. The routine of the response of the staff had become a science unto itself. The ICU, x-ray department were all prepared to handle the patient. In short order, diagnosis of extent of trauma and of shortness of breath became evident. Air was leaking outside of the right lung and filling the space as well as squeezing the lung itself; in addition, several ribs were broken. Scan of the brain revealed no fracture or soft tissue damage. Alerted of the lung finding, the surgeon working in the ICU came down for an evaluation. “Holy cow! I know this dude. He is Mathew Genster, a local jazz celebrity. I went to a club two nights ago to dig his music in Philly. My oh my!” He was in an akimbo position, part in awe of an artist he admired, part disturbed by the enormity of the injuries the artist sustained. As expected, his blood alcohol level was elevated, and he tested positive for valium. The young surgeon’s hands were slightly shaking as he proceeded to insert a chest tube to drain the air that had accumulated outside of the patient’s right lung. The ER physician sutured his forehead feverishly to stem the bleeding.  The patient remained unconscious for the next 24 hours.

“Where am I?” the patient asked a day later. The whirring sound of ventilators, the constant beeping of IV pumps clogged, the screaming of a patient in full-blown delirium, the pitter-patter of staff and visitors, added to the confusion, unnerving and fear all combined into one brew of consternation. “You are at the hospital, bud,” his nurse answered as she swiped the saliva off his lips. Some tears fell off his eyes as he surveyed the surroundings. Indeed, it looked like he was in a room filled with other sick patients. “What happened to me? Last thing I remember is driving home from a gig at the club. Everything else is a blur.” “A state trooper who saw the whole thing said you lost control and strongly felt you fell asleep. You should know you were impaired as your alcohol level was high. You also had valium on board; this is not a good combination.”

“Not a good combination at all, my man,” the young surgeon, clad in scrubs, reinforced, while scratching his head. “I don’t get it. You are so talented, man. How do we square the two?” he asked as a rhetorical exercise and turning to the nurse, “This cat can blow that horn like there’s no tomorrow. He goes from high to low notes and his fingering is so rapid that he leaves one breathless. I would pay gold to be able to do what comes so easily to him.”

Mathew wanted to answer but he was in too much pain. He wanted to submit a written reply, but his mind was still somewhat foggy and between the anguish of dolor on one hand and the impairment of incoherent thinking on the other, he gave up fighting. “I am in pain,” he murmured to the nurse. Once he received a pain killer, he fell asleep. He had a dream, a flashback of his love affair with the trumpet. It was very vivid. It started with his first encounter when he was eight years of age and his father had brought home Clifford Brown and Max Roach’s album. He was simply mesmerized by Brown’s solo on the tune Joy Spring, incidentally, considered one of the best all-time improvisations on the trumpet. His dad played the tune first and several times thereafter. From then on, he was hooked on the instrument. The look on the face of the canons of the genre such as Dizzy, Miles, Armstrong, when they were blowing the instrument with cheeks all puffed up simply had him riveted. He later on learned that a muscle called the buccinator tends to hypertrophy with trumpet players. The word buccinator added to the charm of his enrapture of the instrument. Buccinator sounded aurally pleasing, had a mythic cachet as if it conveyed some special force to the beholder and parlayed into the imaginary center of his young mind and remained forever stuck there like cement mixed with glue that can’t be pried apart.

The flashback in the dream took him through his different stages toward mastering the instrument.  “He is a natural,” his music teacher kept telling his father who himself dabbled with the instrument as well as the sax in the reverse order of preference. He became a prodigy, spending more time with the instrument and less with his friends, foregoing games for practice or rehearsal sessions. Starting at the age of fifteen, he was jamming with older professional fellows, and he accumulated a cult following. The dream ended when a searing pain from the broken ribs hit hard. He looked at the clock and it read 4:15 and the room was dark. He didn’t know if it was day or night. All he wanted was relief from the pain. He was not aware of the existence of a call bell to reach a nurse and for this ignorance, he paid a dear price of intense suffering. Due to the discomfort, he started panting, “Are you alright?” the inquiring nurse asked. “I am in misery from pain,” he replied, with a barely audible voice. She obliged and gave him an injection of a pain killer.

He fell asleep but only for a few hours. When he awoke, the clock read 6:50. “Mr. Genster, the MVA victim, slept for much of the night. When he awoke a few hours ago, he received an intravenous analgesic and he fell right back to sleep. His vitals remain stable. Hopefully he can be fed by mouth today,” he overheard one nurse tell another. It didn’t occur to him he had not eaten by mouth for more than 24 hours. His stay at the hospital has been nothing but a time warp. He didn’t know the time of day, the day of the week, the exact circumstances of his arrival. The only companion that has been by his side constantly and without his request has been a villain called pain that came spontaneously with an unmatched ferocity, a debilitating accompaniment, like the blues writ large, or simply misery poster child. Another sensation in his belly, familiar, reminded him he was still able to experience the discomfort of hunger.

He was in the midst of his breakfast when the young surgeon came again, “Your style reminds one of Clifford.” “My… man. He is the…. one that turned me… on to this instrument,” he responded with a halting voice indicating he was having difficulty speaking due to the pain from the broken ribs. He motioned to the doctor to give him a piece of paper and a pen. This time he was very lucid and in full control of all his senses.

“Yesterday you said you would pay gold to be able to do what comes easily to me. You also asked how come I use alcohol and a sedative. The answer is simple and complex. The truth is that one ought to be careful and not think the grass is greener on the other side. I love playing music, don’t get me wrong, but the life of an entertainer is not so pleasant. It can be lonely at times. This comes on top of the stress of the financial uncertainty that’s part and parcel of the trade. Once one masters an instrument, there are few options and few of them are financially rewarding: play professionally and despite any artistic success, financial reward is iffy; the other one is teaching. The best players prefer performance over teaching. The yardstick, the gold standard, remains one’s virtuosity in performance in front of a live audience. Its pursuit becomes an obsession and anything short of it becomes reason for depression. One pursues the top spot and staying at the top is difficult; the notion of any position less than the peak is aggravating.

The acclaim on the set takes one on a high made all the more desultory in the face of the low of the afterglow. As a human, loneliness is the enemy, to be avoided or to be remedied as best as one knows. Alcohol transports one into that zone that allows an effacement of an uncomfortable reality. The only certainty of this lifestyle is its uncertainty, the fickleness of success, the drabness of long road trips, the monotony of playing in front of strangers and the constant pressure for spontaneous creativity and improvisation. Ergo life on the road for an entertainer’s not a piece of cake. Pedestrian issues such as health insurance, pension plan, disability benefits are added costs, cutting deeply into one’s income and that’s no joke. One ends up taking from Peter to pay Paul.

The life of a performer is complex. It’s not as pleasant as it appears. Its peaks and valleys are wide apart.

Thus began a conversation between two artists if you will, one wowing aurally using the medium of an instrument and the other curing physically via the deft manipulation of a scalpel. Both had the same mastering of dexterity to achieve their aim. “How do you handle the constant stress of making life and death decisions?” the musician would ask. “Dealing with stress is ingrained. Each decision is made based on the degree of certainty about the risk versus benefit ratio, taking into consideration that we are fallible.  One can’t eliminate stress. The best one can do is to manage it by keeping it at bay and move on.”  This could be a response or a variation thereof. The curious surgeon would then ask, “How do you handle fame?” “Fame is a double-edged sword. It reeks of the famous saying, ‘be careful what you hope for.’ It’s flattering but is fleeting, here today and gone tomorrow. It also carries a burden that makes one question its very existence. With fame, one loses privacy. It’s hard to have both at the same time.”

To the most important question that the surgeon would ask, “How do you prevent a similar accident in the future?” The answer would be remarkable for the stated as well as the unstated.    “The obvious answer is avoidance of alcohol altogether. That’s a nonstarter. The entertainment industry would not survive without the sale of alcohol. I can curtail it, but I won’t quit altogether, if I am honest with myself. I will quit using a sedative before I quit alcohol. The love affair between alcohol and society needs to be acknowledged. At a club, patrons are expected to consume alcohol. Among musicians, conversations are held over drinks. Turning down an offer to share a drink is at least rude and even professional suicide. The best I can do is find a dedicated driver who should be the most sober person for the evening or avoid driving altogether. This is an adjustment I need to make, I reckon.” An answer brutally honest, without any shading of the truth from the perspective of an active participant, delivered in a matter-of-fact manner jousting diplomacy.

The young musician’s recuperation from the accident was arduous, one he wasn’t prepared for.  It was a period that road-tested his physical and mental makeup. On the physical side, even after removal of the chest tube during home convalescence, he still had the festering pain from the broken ribs. That got in the way of laughing, was the outcome of simple acts like coughing, and it became ensconced as a major handicap against practicing on the trumpet. Any movement that entailed the rib cage was plain torture. Instead of blowing the horn, he mimicked playing it by repeated fingering exercising, dreaming what the sound was like.

On the mental side, it also meant weeks without income. “Get in line after filling out the form,” the clerk at the unemployment office rudely told him and without missing a beat, she proceeded to chat with a coworker instead of helping a fellow brethren in need and in pain. Instead of star treatment, he received the cold shoulder slated for a minion. His checking account balance was less than five hundred and his savings account held only fifteen hundred dollars. Generous with others and spendthrift overall, he never developed the habit of saving for a rainy day. He had to find a way to survive on this meager asset while waiting for a state disability check that was crawling at a snail’s pace to reach him. Obviously, it was a time of introspection, to find out about his real friends when in dire need.  “Hey bro, how are you surviving, mind if I bring you some home-made food?”, “We were thinking about you. Can we stop by to see our buddy?” These would serve as counterweight to the above rudeness and would mean the world to him. The moral support came from unexpected sources. Folks he had been kind to were not exactly lining up to come and help. This extant awakening, abrupt and somewhat disruptive, stretched the limit of the present challenge.

It was as if he were in purgatory and hauling a heavy cross with an ill-defined finish line. This calvary that tested his mettle, lasted three whole months, an eternity, before full recovery. That allowed him to count his blessings despite this calamity. It was also a period of sobriety by necessity, as penny pinching was de rigueur and the learning process to make do with the minimum, however heart rending and humbling a proposition, but all the same shone with the silver lining of character building. A rite of passage that blindsides acutely but rewards on the long run.

Taking stock of his life after this teaching and trying episode, he set out to extract a victorious lap from the wand of defeat. His creative juices went into high gear and fiddled with several ideas until he came up with the notion of a celebration as a finale for each performance, a coda fusing his latest deed with his creed. This led to the birthing of his anthem, his first foray at writing both lyrics and music for a tune. It would be interactive with the audience and would become his signature song. It was influenced by the name of the composition that captivated him as a lad and turned him into a trumpet afficionado. He dubbed the tune, Jump for Joy. At the premiere of the song, he invited the surgeon.


Jump for Joy.

When one feels down, and things don’t seem to go right

When the blues seems to get a hold of your soul,

And sorrow fills your being and knots your day and morrow.

It makes sense to remind oneself that things can always be worse.

(Audience is meant to respond in chorus:)

This is the time to beat your chest, raise your fist,

Be grateful for what you have and jump for joy!

If and when the weather takes you from gloom to doom,

When a love affair takes you from swoon to frown,

And causes your heart’s cockles to feel burnt

And life seems like it’s not worth fighting for.

This is the time to beat your chest, raise your fist,

Be grateful for what you have and jump for joy!

At the end of this jam session

Ask yourself this simple question

Was it worth your while?

And if so, say it loud and clear by clapping.

This is the time to beat your chest, raise your fist,

Be grateful for what you have and jump for joy!


Reynald Altéma, MD


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