The Beginning of Everything

by Andrea J. Buchanan

  Then how you must put it together again. Right and left, with this new understanding.

  And take it apart.

  And put it together.

  And take it apart.

  How you must perform it as though you are discovering it all as you go, inventing it right at this very moment as the perfect expression of what you might say if you only had words to express it.

  And how later, when you have truly forgotten, when the piece has fallen out of your hands and ears and mind from lack of practice, you go back to the beginning and start again.

  36

  I don’t start with one note, like the one my teacher had relegated me to in my first weeks at the conservatory, but I do start at the beginning, with the most basic part of being at the piano: sitting.

  Although my dura is no longer as sensitive as it was in the early weeks after my procedure, when slumping or having my chin down even slightly provided immediate, painful feedback that my posture should be corrected, at four months out, it is still sensitive enough that sitting for any length of time gives me a near immediate headache. The dural sac extends past the end of the spinal cord, and sitting creates a kind of compression of this sac and the fluid within it. Normally this would have no effect at all, and yet now, with my brain so sensitized to changes in pressure, with the nociceptive fibers innervating my dura so alert for potentially damaging stimuli, and ever at the ready to translate that information to my spinal cord and brain as pain, as danger, I feel the consequences of sitting almost as instantaneously as I would the stubbing of a toe. My intracranial pressure increases, and the headache begins, bringing with it the attendant brain fog and nausea. Unlike the pain of a toe stub, however, this high-pressure headache and brain fog can take hours to subside. My hope is that sitting at the piano, which requires the kind of posture most favorable to the dura and spine, will help me tolerate the side effects of sitting down, and that any playing I will do will function as both a distraction from the pain and, not incidentally, as a kind of occupational therapy for my brain.

  Sitting at the piano is its own exercise, as it is the base for proper technique. You must sit with your weight distributed evenly, neither to the left nor the right, your feet resting, also equally weighted, on the floor. Your spine should be elongated, as though there is a string attached to the very top of your head, toward the back of your skull, pulling you slightly upward. Your shoulders are down, relaxed. Your arms are at your sides, relaxed. When you bring your arms up, when you bring your hands to the keys, your shoulders should remain down and relaxed, which is the tricky part. But a relaxed shoulder is crucial: Your relaxed, elongated spine and your relaxed shoulders and arms are the conduits for all the energy and tension that should end up in your fingertips, not stuck in a slumped back or hunched shoulders or tense wrists. Your arms are like wings, joined at the center point between your shoulder blades, emanating outward, your fingertips light as feathers.

  The center point between my shoulder blades is, of course, where my leak was. And so sitting in a way most beneficial to my dura is especially crucial as I bring my arms to the keys and attempt to play. Every sound I make at the piano has its physical starting place in the muscles and nerves around the site where I was torn, and though there is something satisfying, even poetic about the thought of this, the thought of music emanating from a broken place, there is also an element of danger: I don’t want to stress the still-healing area too much, I don’t want to strain the sensitive spot. And so I sit, upright yet relaxed, and bring my hands to the keyboard imagining a line of energy that flows from the leak spot, energy leaking out toward my shoulders, down my upper arms, past the potential stopping places of my elbows, of my wrists, and all the way to my fingertips, unimpeded.

  I don’t start with one note, but I do start small. I think about what I learned in my reading about patients recovering from traumatic brain injury, the importance of those small, focused, repetitive practical-life tasks in their healing process. It was the smallness of them, the level of concentration required, the repetition of them, that seemed to help the brain find new ways of thinking, of rewiring itself, of making new connections in places where the old connections were broken seemingly beyond repair.

  And so I start with a book of Pischna technique drills, a set of sixty progressive exercises that are purported to help with finger independence—the ability to control each finger independently, without tension or interference from nearby fingers. (This sounds like an easy task, fingers working independently; but place your hand on a flat surface in front of you and try to lift each finger one by one, without the other fingers moving. The thumb and index finger should be relatively easy, perhaps even the third and pinkie fingers, too. But that fourth finger: lifting it up without your other fingers joining in for moral support is tricky, and even if you can do it a little bit, it’s almost impossible to lift it as high as you did your index finger, for example. This is due to the ways in which the muscles tangle in the back of your hand, and depend upon each other. As a pianist, it’s important to work against that codependence and try, as much as possible, to untangle that knot.) These exercises require concentration, relaxation, coordination, and repetition. In other words, they seem to be a perfect fit for what I’m hoping to accomplish with this homegrown brain-rehab therapy.

  Even something small, like this, is a challenge for the brain. Playing these exercises requires the use of both hands, which involves coordination between and cooperation by both hemispheres of the brain. Looking at the score while playing the music requires eye-hand coordination, and also involves the mental task of translating marks on a page representing tones into their proper embodiment of sound via the correct keys on the keyboard. To know whether or not I have succeeded in the effective translation of these printed notes into their corresponding audible notes, I have to be able to listen and hear and evaluate and, if necessary, correct and respond. There is auditory feedback, visual feedback, physical, muscular feedback, left-brain/right-brain feedback: so many levels of engagement required of the brain, just to perform the simplest, most basic exercise in the book.

  I begin with just ten or fifteen minutes per day, starting with these Pischna exercises. The early ones are basically short phrases built off a pattern of one or two notes of a chord being sustained while an upper melody vacillates between two notes, first moving back and forth from one note to the note above it, then between the top note and a note just a half-step above that. Then the pattern is repeated a half-step higher, and so on and so on, until you have repeated the full pattern on every note of the chromatic scale. I remember doing these exercises in my early days at the conservatory and becoming quickly bored by them—Yes, okay, I get it, it’s a pattern, whatever; I much preferred my teacher’s main technique of making technical exercises out of tricky passages in whatever repertoire I was trying to learn. But now, focusing on trying to sit in such a way as to align my spine and not aggravate my dura, focusing on getting these small, precise finger movements right, it feels like a challenge, and my brain feels soothed by the melodic pattern rather than bored by it. It provokes a feeling in my brain like the tranquil puzzle games I played while stuck in bed, leaking, the same games I play now, while listening to podcasts, recovering. It’s the feeling of things fitting into place, the satisfaction of patterns fulfilling expectations. It makes my brain feel full, nourished.

  When I was leaking, and enveloped in brain fog, playing piano was both a reassurance and an exercise in implicit memory. Explicit memory is the kind of memory you use when you recall an anecdote, or remember an event that happened to you, or do anything that requires a conscious effort in retrieving information. Implicit memory is the kind of memory you use when you don’t have to think about anything at all: brushing your teeth, washing your face, tying your shoes. Implicit memory doesn’t require conscious, executive control. Implicit memory is what enabled me to walk to the store to run an errand; my CSF leak–induced problems with explicit memory wer
e what prevented me from remembering what I was supposed to buy when I got there. Sitting at the piano and playing through old repertoire when I was leaking involved implicit memory, the muscle memory of years of practice from years before, and it was soothing to be able to play, to know that a part of me was still there, remembering things, able to do some things, even if my executive functioning brain was not explicit enough in its instructions to follow through on others. This new piano therapy I’ve devised is forcing the use of both implicit and explicit memory: the implicit muscle memory of having done these exercises, however haphazardly, at some point in my past studies; and the explicit memory of doing them now, remembering what I discover and learn as I go through the process of doing them now, and applying that knowledge moving forward, whether in the next moment or the next measure, or on the next page or the next day.

  I begin to gradually increase my practice time, from ten or fifteen minutes to a full half hour, as my tolerance for sitting increases, and soon I begin to increase my musical scope as well, moving from technique exercises to scales and arpeggios, to the comfortable muscle memory of old repertoire. I find my music books from when I was in high school, and begin to read through pieces I learned when I was thirteen, fourteen, fifteen. I recognize my old teacher’s handwriting on the page, indicating tempo, cautioning about problem areas, underlining tricky passages. And more than that, I recognize memories, as I play through these pieces. Most practice sessions over the course of a musician’s life do not involve the kind of high-level focused concentration I’m attempting now—sure, there is focus, and sure, there is concentration, but when you’re practicing six to eight hours per day, it’s just not practical or even possible to be on high alert the entire time. I spent many hours in practice rooms thinking about breakfast while playing Brahms, or letting my mind wander as I meandered through some Mendelssohn, supplying my own off-topic narrative to his Songs Without Words. Playing through this old repertoire from high school—Debussy’s First Arabesque, Scarlatti sonatas, the third movement of the Beethoven Pathetique, which I learned one year for the annual Sonata Competition—I not only remembered the pieces themselves and how they felt in my fingers, I remembered the feeling of practicing them, in some cases, specific thoughts I had working on specific measures on a specific day at a specific moment in my practice time. It was as though in awakening those neural pathways, I gained access to memories that had been long buried there, and were now able to be uncovered, like the snow melting away after months of winter and revealing the sidewalk underneath, along with everything that had been there when the snow first fell. This happened as I moved on through my old repertoire, too: playing through one of the middle-years Beethoven sonatas I’d learned during my first year of music school, I remembered not only the slightly terrifying memory that had always stayed with me, of Mrs. Kim standing behind me in the third-floor practice room where we were, for some reason, having a lesson that day, and physically provoking me, prodding me, pushing my back, poking me with her strong fingers to startle me into a forte sound during an octave passage that was difficult for me to reach; but I also remembered the memory of practicing the page before that passage, and being able to hear the person in the practice room next door practicing the Chopin Fourth Ballade, and thinking about the way the light was coming in through the window to my right, and the way the trees were starting to regain their leaves again, and about how soon I would be able to take a break and knock on the door next door, and wondering if he could hear me as clearly as I could hear him, and whether or not my small hands would be ultimately too small for this piece, wondering whether in the end it would defeat me, but also wondering what I might have for lunch, and whether I might go over to his house later, and whether he still loved me. All of this came back to me, all at once, a full paragraph of memory, as I played past that measure, and I marveled at all of this information stored somewhere deep in my brain, and wondered how much else was there, buried and otherwise inaccessible, waiting for the snow to thaw.

  Within a month of starting this practice, I begin to experience the feeling of my brain reconnecting itself, like going from dim Fourth of July sparklers of ideas to full-on fireworks. It reminds me of the way I felt on the table during my blood patch, or during the CT myelogram at Duke, when after being injected with fluid, I felt the fog lift and my mind become clear, when I felt myself become Me again. I’m still struggling with regaining my explicit memory, with things like executive function and organization; I still lose words and find myself overwhelmed by situations which previous to all of this would have been trivial for me to handle. But a month into this piano therapy, I am able to hold ideas in my head, to remember numbers and dates, to have moments of insight. I can make connections between concepts, I can remember things better from one moment to the next, complete tasks more efficiently, have wide-ranging conversations and not lose my train of thought. Is this happening because of this piano practicing? Is it because I have more than twenty-five years of music training already in my brain, ready to be reactivated? Would other people without previous training have similar results?

  It makes me curious: Is there a difference between learning new music I haven’t studied before now versus revisiting repertoire I learned and spent hours practicing as a teen, a time when the brain undergoes remarkable and significant development? Is there a difference between reactivating old pathways versus creating new ones? Or is my brain different now, after this leak, so that even those old pathways, from those decades-old years of practicing, when reactivated, become like new?

  It also makes me curious about the idea of the self, about how the self that is me now recognizes the thoughts and memories of the self that was me when I first learned the piece of music I’m now revisiting. About how the self that was me when I was leaking felt cut off from the self that was there, lost in the fog, the “real me” that emerged when I had a bolus of fluid injected into me, raising my intracranial pressure, and—somehow—allowing my mind to once again resurface from the depths of my brain.

  I think, too, about my experience of illness during those years in music school, when I battled with some of these same questions: the questions of pain, of being believed, of the value of my own narrative, of who I was. When I was sick then, with what I called Mystery Disease, and in the years afterward, when I recovered, I’d thought of that time as partitioned off, compartmentalized from the rest of my life. That was not the Real Me; that time I spent being sick was some kind of strange exception to the rule, some kind of secret side-quest, some deviation from the norm, not the Real Me, the me who was ordinarily healthy and productive. That compartmentalizing, I came to understand, was a choice I made to protect myself. My experience of myself as a sick person didn’t make sense with my experience of myself as a well person; it didn’t cohere. So thus it couldn’t be truly me. It was an aberration, a time in my life that was the exception, not the rule.

  But before the leak happened, back when I was reading through my journals from music school while working on a book idea about conservatory life, I was suddenly able to see the continuity. That sick, struggling self in those journals, writing about being sick and not wanting to be sick—that self was still me. I recognized it. I saw it in the attempts at narrative, at understanding. In the stitching up of story, in the denial of story. I saw it in the comments written in the margins from Future Me’s at later times in my life, now all of them Past Me’s, evaluating what I’d written, taking issue with things, revising, correcting, reevaluating, clarifying, discounting, admitting. Reading through these diaries, this writing from a me who was at the time only slightly older than my daughter is now, I was able to accept and genuinely embrace, for possibly the first time in my life, a coherence of self. I was still me, even then. That sick me, that lost me, that ashamed me: It was still me. I was able to recognize it now. It was me, even when I thought it wasn’t, even when I didn’t want it to be. Sick me was actual me, is present me.

  It was fitting, in
a way, to have stumbled upon that self-acceptance, this understanding of continuity and coherence of self, before the CSF leak happened. Because although my experience of the leak was in many ways an experience of dissociation, of a splitting off of implicit me and explicit me, a distance between brain and mind, a sense of selflessness, I’m able to understand that I don’t have to understand this illness and recovery as a period of being Not-Me. I don’t have to decide now, the way I decided as a teen, as a young person in my twenties, to discard the time I spent lost and sick as Not-Me Time, some kind of distraction from Actual Me, all of it a Me that didn’t count. This CSF leak took my sense of Me-ness away for a time, and now, as I recover, I’m reintegrating, relearning what it’s like to be me, right now, in the midst of a process. Recovery is putting the pieces back together. Just like in piano practice. The part after you take everything apart, and do the slow, careful practice of putting it back together; the part after the deconstruction.

  The entire self is a story we tell ourselves without even realizing it. Like music, the self assembles in real time. Moments are stitched together to make a seamless whole. Reactions moment to moment assemble a personality, a behavior, a summary of self. We think of a melody or a symphony or a song or a self as one solid thing, when it’s just this and this and this and this, finite moments pretending to be infinite.

  The more I practice piano, the more I invoke the coordination of sight and sound and concentration and memory and physical motion and intellectual analysis, the more I feel my brain return to itself. The more I am able to understand that perception is a fiction the brain is constantly creating. That our seemingly intact, seamless experience of consciousness is actually a series of discrete moments we stitch together so quickly we’re not even aware we’re doing it, creating movies out of still pictures, solid substance out of fluid particles, progression out of stasis, cohesive self out of individual, unconnected moments. That I assemble myself as surely as the way a series of notes tricks a listener into hearing what sounds like a song.