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Of Orchestras and Brain Surgery

Nothing prepares you for what the doctor says:

“You have brain cancer. The tumor is large and growing. We need to remove approximately one third of your brain, and we need to remove it immediately. If we don’t, you will be dead in five years.”

You are stunned. This was just supposed to be a routine physical. You’ve always been a little bit nervous about medical visits, but your doctor has praised your excellent health in recent years, so you came in today with a bit of optimism. Nothing prepared you for this.

“Oh, don’t act so surprised,” says the doctor with a shrug. “I warned you about this last time.”

Your mind races to your last visit. You recall something about “we’ll need to keep an eye on those headaches.” Nothing about cancer. Nothing about losing one third of your brain. A third! Is it even possible to function with a third of your brain missing? Will you be able to work? To think? Will you be the same person? Even a whole person at all?

“It will be fine,” the doctor says impatiently. “Look, people have big chunks of their brain removed all the time. It’s happening all over these days, what with the rise of cancer. You should still be perfectly capable of performing your job with only two thirds of a brain. It’s not such a big deal. Trust me, I’m really good at this.”

His cavalier attitude is unnerving. No — it is enraging. This is a big deal. Both the diagnosis and the treatment sound like death sentences. If you have to choose, you’d rather live out the next five years with dignity than be reduced to an empty shell. You can hardly process this. How can it be so severe so suddenly? No, something is fishy. You don’t trust him. He doesn’t appreciate the danger. He doesn’t respect you at all! Why is he so eager to put you under the knife? He seems almost excited about the surgery.

You find yourself scared not of the cancer, but of the doctor. You want a second opinion.

Oh no! Certainly not. I am not about to release all your records. Shopping around for a different diagnosis is just a delay tactic, a way to avoid treatment. That will only decrease your chances of survival. The pamphlet I gave you is more than enough information.”

Furious, you storm for the door — only to be stopped by an armed guard.

“You’re not going anywhere,” the doctor says, suddenly menacing. “You are not going to work, you are not going to get a second opinion, and you are not going to get a new doctor. You are staying here until you agree to surgery. Unless you can explain to me your superior ideas about how to treat cancer, that is.” He slams the door behind him.

In the weeks that follow, you refuse the surgery, and remain the doctor’s prisoner. Desperate for information, you chat up the nurses, and learn several astonishing facts. Your cancer has been growing for four years. Your doctor avoided telling you about it until now, waiting until he could force you to accept the treatment he thinks you need. He even arranged routine tests in past years so as to hide your cancer — which incidentally helped improve his patient statistics with the state board — and then made it look extra large for this year’s tests so as to force you to accept treatment. You even hear vague rumors of experimental brain procedures that doctors are excited about, but completely change the patients’ personalities. Is that what he’s doing? Paranoia sets in.

You are furious, terrified, defiant and desperate. At best, your doctor has a disastrously bad bedside manner; at worst, you are a guinea pig in some mad scientist’s experiment. Everything is about the doctor now. You must defeat him. You must escape. Everything is about the doctor, and because of that, you cannot afford to even think about the grim possibility that you really may have cancer, that you really may soon be dead.

• • •

Although this allegory may provide good cheerleading fodder for those who support the musicians of the Minnesota Orchestra and SPCO, I am really speaking to the orchestras’ presidents and board members. You are hurt and frustrated. You are vilified. You are trying to do what you think is right, yet you’ve received nothing but anger and denigration from musicians, from the public — even from the legislature! You want to save the orchestras, and it seems like everyone else just wants to destroy you. Why? Why does everyone hate you? What did you do to deserve this?

Please try to put yourself in the position of the patient in my story. You may think it unfair, but that is how those of us who love the music feel right now. Please think about how that doctor behaved — and how he should have behaved. At best, you have a disastrously bad bedside manner. You’ve made an utter hash of these negotiations — not necessarily by being bad people, but by being bad doctors.

Yes, you are the doctor here, and it is the music who is the patient. Not the organization, not the building, not the endowment. The music. That is your mission. Remember that no matter how deeply you care about your patient, you are only recommending the treatment; it is the musicians who will truly live it. You hear the music; they inhabit it. This cannot possibly be as personal for you as it is for them.

As a doctor, your goal is get the patient the best treatment possible. What does that involve? Taking as much time as the patient needs to walk them through the diagnosis. Releasing all the medical records. Letting them seek out second opinions. Laying out the full range of treatment options. Working together choose the right course. No ultimatums. No secrecy. No playing god with the patient’s life. Would you take that from your doctor?

Think about how the patient in the story feels. By blindsiding everyone, by fudging numbers (Oh yes you did, so quit your bellyaching!), by being secretive, by exercising power plays, you’ve shaped these negotiations to be about power struggles, about the labor movement, about artistic direction, about who really loves music — about everything except the finances. You have the musicians and the public furious, terrified, defiant and desperate. That’s no starting point for tackling hard questions about money.

If you were that patient, what would you need to hear to regain any trust in that doctor? If you were the doctor, how would you say it?

Presidents, board members, you need to walk into the upcoming negotiations with a serious attitude adjustment. You are the doctor, and you need to start acting like one. You need to because the musicians need a good doctor. They need you to be that good doctor. We all do. The patient’s life depends on it.

(Excellent background on the all the events behind the MN Orchestra half of this story: Part 1 Part 2)