Medicine of the Tuba by Eli Newberger, M. D.
backed into medicine as an undergraduate at Yale. If I’d continued as a tuba player beyond the New Haven Symphony, I’d have ended up counting rests in an orchestra brass section. I never intended to leave music, but 1 could never have anticipated how my music major, and especially a music theory project on the evolution of jazz piano, would come to influence my choice of specialty and drive my medical career.
My transition from music to medical school in fall 1962 was eased by marriage to Carolyn Moore and by our summer work as aides in the children’s program of the Connecticut Valley Hospital. At the end of my first year at Yale medical school, the joint position of resident directors of the International House became open. The opportunity to help foreign graduate students adjust to the rigors of life in New Haven in return for a free apartment was irresistible. In our three years there, my wife and 1 enjoyed the company of these sophisticated individuals, who hardly needed our guidance. At the same time she and I developed a lively antipathy to the war in Vietnam.
In 1966, when 1 graduated from medical school, all male medical graduates were subject to the draft. The most palatable alternative to the military was the U.S. Public Health Service, specifically the Peace Corps. Feeling adventurous, and fascinated by the origins of jazz, 1 put in for a post in Africa. In 1967 Carolyn and 1 left for Ouagadougou, Upper Volta (now Burkina Faso), with our five-week’old daughter.
My assignment was to provide medical care for the volunteers – forty-two healthy young Americans – and technical support for a weakly conceived maternal- and child-health program. The aim was to have raw college graduates teach African mothers how to make better use of locally available foodstuffs to prevent protein malnutrition and reduce infectious disease. The general medical job turned out to be a piece of cake; the latter, however, was a Peace Corps folly that contradicted deep traditions regarding the role of women and the care and feeding of infants. On the other hand, my rounding at Ouagadougou Hospital with Ezra Elian, an eminent Israeli pediatric professor sent as part of an aid program, led me to apply for a pediatric residency, which 1 would begin on completion of my two years in Africa.
Africa also convinced me that jazz would be another, equally important calling in my life. I occasionally played with a high-life band called Volta Jazz, made up of upper Voltans from the city of Bobo Dioulasso. The rich, complex rhythms I discovered as part of this group were inspiring. I also struggled to learn the balafon, the African progenitor I of the marimba. Shortly before j our departure, 1 received a clipping from the New Haven Register, naming me as the I originator of the jazz band at the International House, begun four years earlier in an effort to liven up our Friday night coffeehouse. The group, originally called the International Feetwarmers, was by then known as the Galvanized Washboard Band and was holding forth with a guest clarinetist from Harvard, Tommy Sancton. On moving to Boston in June 1969,1 called Tommy, and with a British computer engineer, Tony Pringle, we started the Black Tagle Jazz Band, with Roy Smith on drums, Jim Klippert on trombone, Dave Duquette on banjo, and me on piano. When 1 switched to the tuba in 1971, we added “New” to the name. In the decades since then, we’ve played around the world; in 1996 we completed two European tours; our recordings, which now number about forty, continue to sell, if mostly to jazz cognoscenti. We manage about one hundred gigs a year. The joy and release of this musical life has enabled me to deal with the rigors of child abuse and family violence: my medical life connects to the sense of shared struggle and social protest that runs deep in the history and practice of jazz. Without music, I could not have pursued this specialty within pediatrics, for reasons having to do with creative inspiration and the dampening of it; the opposing emotional tug of joy and despair; and the clarity that music brings to the personal and professional ambiguities of medical work. I consider myself as much musician as physician. My life has been a constant balancing act, music sometimes serving as the counterweight to medicine, and sometimes the reverse.
In 1971 I was one year short of completing my pediatric training at Children’s Hospital in Boston. A newly opened pub in Hopkington, Massachusetts, hired our band for a trial on Sunday afternoon. The place sold out, and before long we were playing every Thursday night – in that Thursdays did not interfere with the weekend gigs that are a musician’s bread and butter. Soon we had a regular following and audience members from around the world.
That same year I was also taking a course at the Harva^ School of Public Health, which required students to write a mock grant proposal. I proposed an investigation that would reclassify the problem of child abuse among the social illnesses of childhood. I suggested a new theory to explain abuse, failure to thtive, accidents, and poisonings in preschoolers: that undetlying these “diseases” was a common causal matrix of social, family, and child-centered stresses, with varying combinations driving the expression of particular patterns.
We published an evaluation of how interdisciplinary coordination and case review reduced the monetary and human costs of child abuse and established one of the first out-patient clinics of abused and neglected children in the United States. We saw patients on Thursdays, because that was when space was available. So ever since 1972, my Thursdays have been entirely committed. In the morning, I usually consult on the management of one or two abused or neglected children on the inpatient floors, talking with doctors, nurses, and social workers about their findings. Does the evidence merit making a required report to the state child-protection agency? Should a legal action on behalf of the child be filed in the juvenile court? Are other siblings, and the children’s mother, also at risk of abuse? Or is it safe to send the child home?
Each year our hospital deals with five hundred cases of suspected child abuse or neglect, up from sixty-two in 1970. And the cases are complex, over half involving a mother who is also a victim of domestic violence. Defining how to help, without harming, is an ambiguous and confusing process. Fortunately, I work with committed, supportive colleagues in a hospital that has embraced the program. On Thursday afternoons, until five o’clock, we see children, parents, grandparents, and stepparents. “See” is perhaps an understatement: interview, examine, and evaluate are more accurate. But even more apt descriptions of our interactions would be “share the pain” and “deal with the terror and trauma” of the children and women, which involves heartrending conflicts over a child’s custody in the face of frightening allegations, few of which turn out to be false.
For all our professionalism, we cannot avoid getting drawn into family dramas. Inevitably, our findings displease someone, and we are subpoenaed to appear in court and subjected to the usual crossfire, during which our professed expertise is heal up to ridicule. It is always chastening to be abused for trying to protect the abused. The work is not for the faint of heart. If we conclude, for example, that a fouryear- old girl has been sexually abused by her mother’s brother, the judge will sometimes indicate in his rulings that he doesn’t believe such things actually happen. As chief of the clinic, I observe and supervise interviews through a one-way mirror. From the darkened observation room, my colleagues and I often feel that we are peering into the worst miseries of people’s lived. Few of us can imagine what it is like to be terrorized every day, to endure painful and humiliating assaults, and not to be believed. Of course I try my best to support my colleagues, who are also deeply affected by what they hear. As five o’clock draws near, it often seems as if we’ve all been through the wringer: eyes glisten, jaws clench, we slump in our chairs.
At five, I leave the clinic, and fortyfive minutes later I pull into the parking lot outside Coffee, Tea, and Melody, the pub the Black Eagles have been playing since 1995. I take off my tie, put the tuba out of the trunk, and enter a different world. Here, injustice does not prevail, there is a sadness but not misery, and every moment of improvisation carries with is a prospect of redemption. Indeed, “mistakes” in jazz improvisation become platforms for new ideas, not catastrophes that destroy lives.
Inside Tony’s already warming up his comet with the simple blues lines he loves, and the room is filling with jazz fans, at least half of whom I know. Some members of the audience have been following the band for more than two decades; they feel like family. After a few greetings, I take my seat on a bar stool and begin to warm up with an arpeggio or two. Stan Vincent, the trombone player, arrives and gets ready to play. Then Tony plays the little bugle call that for twentynine years has been the signal for everyone to get ready. Tony greets the crowd and calls the first tune (usually something straight-forward like “When I Grow Too Old to Dream” or “Moose March”; it’s comfortable to being with a nice New Orleans tune, though the band has a repertoire of some seven hundred numbers). Stan looks quizzical and asks what key it’s in. The crowd laughs, because they’ve seen this act before, but Tony tells him anyway that it’s in F and kicks off the tune by stamping his heel.
At this point my life is completely transformed. As we begin our first tune, everything else flows out of my mind. The ensemble is rich, thick, warm, and lively, with seven distinctive, familiar voices. I am always surprised by how wonderful it sounds. The beat is propulsive and swinging; and the tuba in my arms actually disappears from my consciousness. From some place within me comes a series of notes, not exactly a tune, but a low melodic line that both buttresses the ensemble and propels the rhythm. I “think” the notes – that is, I imagine a set of sounds – and they simply emerge from the horn. As I do this, I feel I am reading the people in the audience, both their ears and their hearts.
This is not, strictly speaking, a conscious process. As I play, I do not focus on what I am doing with the tuba to produce the sounds; it all happens spontaneously, and quickly. (If you stopped me and asked me at any moment, though, I could tell you exactly what I was doing and exactly what note each member of the band was playing.) In the middle of making music. I’m thinking colors, textures, and feelings, not notes and chords.
As the tune moves along, Tony distributes solos, mostly by his sense of who can best contribute as the piece evolves, sometimes in keeping with how the tune was treated by an artist or composer in the 1920s or 1930s. We pay homage to our musical forebears but avoid recapitulating note for note the original ; versions. The task in traditional jazz is to I make the tradition come alive. I Sometimes, the day’s events will impinge on my thoughts. This can actually displace the music to what I think of as another register in my mind.
I’ll weigh the thought in question and go on automatic pilot, tracing the bass line of the song. If Tony calls me to solo, I’ll instantly forget whatever was distracting me, walk forward with the tuba and, as we say, take my chorus. In jazz, this means making up your melody over the underlying chords, for twelve, sixteen, or thirtytwo measures. In traditional or New Orleans-style jazz, there are strict improvisational rules; one works within them to make an emotionally honest, interesting, and original statement. Inevitably, you make mistakes – that
is, you play notes that do not belong in the harmony. But you always recover, and even profit, from such moments, which add excitement and chance to the unfolding expression of musical ideas.
This is what I mean in referring to the promise of redemption. The improvisation is a kind of subversive play. One deliberately contorts the melody, creating something different and personal. A good chorus is intellectually engaging, a statement of the player’s view of the world. The solo should also resonate to the underlying feel of the tune. Not a few songs evoke the hardships and travails of the human experience, as well as the shared aspiration for overcoming them. Jazz is a music of protest and possibility. For me, it offers succor and relief from the oppressive aspects of my medical work. Without it, I might well become inured, hardened, and less able to feel for my patients and their families.
Our music elicits feelings that obviously relate to life experiences: joy, sadness, pride, love, lust, which are sometimes further evoked by the lyrics of a song. A happy tune, such as “Spreading Joy” or “Bogalusa Strut” can go far toward curing the blues. Some emotions, however, are almost impossible to name, and these can be expressed in strange convergences: the music can summon rage, shame, isolation, tenderness, aching, and painful contemplation of beauty.
I sense that my feelings are also felt by others, by band members as well as the audience. Mostly I play with my eyes closed, but sometimes when my feelings almost overwhelm me. I’ll open my eyes. Then I see that what I’m feeling is real. Before me are tears, rapt expressions, faces full of love. It’s not by chance that some of the best jazz recordings are the product of live setting, as opposed to a recording studio. Contact with the audience is vital to this music.
I should mention some of the more obvious points of convergence between fine medical work and accomplished musicianship. High-level performance in each domain requires motivation, technical mastery, disciplined scholarship, endless practice, personal honesty, professionalism, and the subordination of individual ambitions to the larger purposes of giving care or putting forth an effective performance.
But the most important gratification that derives from my life as both a physician and musician comes from the privileged access to profound aspects of the human experience that each profession provides. What makes me a more complete person and a better physician for being a tuba player is that the music keeps me in touch with the emotional underpinnings of life. It enables me to care. Reprinted by permission of Yale University Press from the book Doctors Afield, edited by Mary G.M. Cumen, Howard Spiro, and Deborah St. James, copyright 1999 by Yale University.
Newberger, E.H. The transition from ragtime to improvised piano style. Journal of Jazz Studies 3:3-18, 1976.
Newberger, E.H. Archetypes and antecedents of piano blues and boogie-woogie style. Journal of Jazz Studies 4:84-109, 1976.
Newberger, E.H. The development of New Orleans and stride piano style. Journal of Jazz Studies 4:43-71, 1977.
Newberger, E.H. Refinement of melody and accompaniment in the evolution of swing piano style. In: Morgenstern, D., Nanry, C., Gayer, D.A., editors. Annual Review of Jazz Studies I. New Brunswick: Transaction Books, 85-109, 1982.
About the Author
In high school, while raking private lessons with William, eli Newberger studied piano, organ, and theory at Juilliard. .At Yale, he majored in music theory, and began a lifelong interest in applying principles of musical analysis of the study of jazz improvising styles. His eight-year stint its tubist with the New 1 liiven Symphony was his last serious flirtation with a classical tuba career, althougb he has performed in recent years the David Baker Sonata for Tuba and String Quartet, and (twice), Tubby the Tuba. On the jazz side, in addition to the Black Hagle recordings mentioned in the article, he has recorded frequently with the banjo virtuosi and vocalist Jimmy Mazzy, most recently in 1999, when with Butch Thompson they recorded for Stomp Off Records “The Men They Will Become: Jazz Takes on Male Cdiaracter.” (On this recording. Eli plays piano on two cuts, and Butch switches to clarinet. Among his many acknowledgements and awards, Eli won the 1996 Mississippi Rag reader’s poll for best traditional jazz tuba player, and twice previously, the Jazzology Magazine poll. He posts a schedule of his upcoming appearances on his web site: http://www.elinewberger.com.
From “The Men They Will Become: The Nature and Nurture of Male Character” by Eli Newlierger (Perseus Books, 1999.) An excerpi from Chapter 8, “Sharing,” on William Bel^,^ generosity: “Rule.s may be very helpful in causing a certain amount of .sharing by the preschooler, bul I don’t think they will inspire sharing behavior as much as will hi.s .seeing the older members ot the hoiisehi’ld be very sharing with each other, with others outside the household, and with him. Sharing is contagious behavior. During my childhood, my father, even with two jobs, made bately enough income to pay for the essentials. By the time I was a pre.schooler, my parents were quarreling regularly about money; that is, my father frequently complaineil about what my mother spent. My mother had an old piano, on which she occasionally played Beethoven’s “Fur Elise.” When 1 begged for piano le.ssons at age live, anel a teacher told my mother 1 had enough talent to justify having a g(sod in.sirumenr at home, she, without consulting my father, upgraded the old piano to a Steinway, signing a contract to pay for it in installments. My father was predictably furious, bur after his outbursts he would eventually subside.
Looking back, 1 realize that my parents were playing our the normal middle-class division of labor of that time; a wife stayed home, took charge of the household, atid raised the children while her husbaml earited a living for the household. When such a conventional marriage w;ts nor a true partnership – as was the case with my parents – it was easy lor the breadwinner to slip into the resentment of thinking his wife was merely a consumer devouring his earnings, and an insatiable one at that. To me, as a pre.schooler and schoolboy, it often looked as though my mother was caring and giving, to the extent ot her ability, and th.it my father was ungenerous toward her and his children.
In my high school years, when I ww earning money playing gigs as a jazz pianist and giving it to my father to save for my college expenses, but also making the tuha my principal instrument, my renowned tuba teacher, William Bell of the Kew York Philharmonic, offered to sell me one of his favorite horns that he h.id already loaned me for three years – a Conn pirchetl in the Key of C – for the giveaway [trice itf two hundred dollars. My father refused to release atiy of my savings to buy the tuba; he said it was a foolish idea. 1 went off tit college wiihout my own instrument. Thi’ugh 1 now have four tubas at home and ha-e given several others from my collection to museums over the years, I yearn to this day for the one that belonged to a teacher with faith in me.
Fritm our hou.sehold’s struggle over finances, 1 grew up determined to be generous toward others. Yet the legacy of my childhood experience is that I do .Mtmetimes find myself calculating the cost of being generous: Wh;it is it going to take out of me.’ When I’m really tired or up.set or under pre,ssure, one of the things I do is get very uptight about money. My childhood comes back to haunt me, to remind me of the tremendous long-term power, for better or for worse, in the parent-child relationship.
The character strengths we treasure and foster in ourselves are in dynamic tension inside us with their very opposites – generosity and siingine.ss, courage and timidity. Under stress we risk becoming the very opposite of what we most aspire to. In the first century. Paul of Asia Minor de.scribed this struggle: “The good which 1 want to do, I fail to do; but what 1 do is the wrong which is again.st my will.” The qualities that we try to cultivate within ourselves do nor come from a textbook or from “character education.” Each one reflects a problem or challenge in our lives, against which we try to construct an inner strength to cope with it.” (pp. 106-108)