If you were coming down with a cold, you might not think much of it. You might even welcome it as an excuse to miss work. But not if you're one of 103 world-class musicians touring Europe as part of the National Symphony Orchestra.
For symphony musicians, even the threat of a sore throat, nagging cough or plugged ear is enough to send anxiety levels soaring. They can't afford not to be at peak performance, to play night after night for sell-out crowds in Brussels, Paris and Zurich.
As the symphony's physician for this tour, my job was to keep them in good shape and keep them playing during a two-week tour of Northern Europe that began October 8.
I'm a family physician on the faculty of Georgetown University's School of Medicine. My wife Linda is a registered nurse at Columbia Hospital for Women. When I was invited to serve as the symphony's tour physician, we jumped at the opportunity. The two institutions where I work -- Georgetown University and Providence Hospital -- extended my medical malpractice insurance to cover the European tour, and we were off.
First, however, I realized I'd better know a few things about musicians and the ailments that might plague them during a foreign tour. I compared notes with two physicians who had accompanied the orchestra on previous tours, Gene Miknowski, a rheumatologist, and Phil Pierce, an infectious disease specialist at Georgetown Medical Center.
I also read medical articles about health problems unique to musicians, such as flutist's chin, an acne-like rash triggered by constant moisture and friction; fiddler's neck, a darkened patch of skin brought on by steady pressure, and clarinettist's cheilitis, a sore, red lower lip from excessive playing.
Because we were traveling to modern, industrialized cities, I didn't worry much about diseases such as malaria, travelers' diarrhea or typhoid fever. I had a brief medical history for each member of the orchestra. I also knew that the few musicians with chronic medical problems would bring their own medicines. I wound up taking a suitcase full of medications, along with an emergency kit to carry on planes, buses and trains and have in the concert hall for use before the performance and during intermission.
As it turns out, most of the medicines I wound up using were common, everyday remedies. I never had to use emergency drugs or intravenous fluids. In fact, the chief complaint was the common cold. What surprised me, though, was how busy I was.
Over all, I had 125 visits. I saw my first patient, who had a severe cluster headache, even before leaving for the trip. Two consultations -- one for back pain caused by a ruptured disc, the other for a capillary hemorrhage on the eye (not at all serious) -- took place at Dulles Airport before boarding.
The pace picked up as the trip progressed and as more and more musicians fell victim to the "tour bug," a respiratory virus that swept through most of the orchestra. In fact, violinist William Steck, the concertmaster, was forced to miss a performance with this flu-like syndrome but was back on his feet after a day in bed. Conductor Mstislav Rostropovich expressed fatherly concern and checked with me about the health of his orchestra. But the famous maestro -- known for his stamina and vigor -- never showed signs of being under the weather. Most problems were, thankfully, minor: scratchy throats, ear problems, aches and pains -- some from years of playing an instrument, others from arthritis, bursitis and the like. I only had two patients whom I worried I might have to send to the hospital. One had a deep skin abscess and the other an unusually severe headache. Fortunately, both responded to treatment.
My last orchestra patients were treated on the plane back to the U.S., with a final case at Dulles Airport where I handed out an inhaler for an asthma attack.
The tour covered six cities -- Brussels, Paris, Strasbourg, Zurich, Cologne and Hannover -- in 14 days, with one performance in each as well as three "run-out" concerts in nearby towns -- Leuven, Bonn and Dusseldorf. Two afternoons included a rehearsal before the concert.
A typical schedule called for having office hours -- or, more accurately, one hour -- first thing in the morning. Our days were usually free until the afternoon rehearsal or evening performance. I had a "doctor's office" somewhere backstage, ranging from a makeshift setup of dressing screen or quiet corner to private room with bed, bathroom, desk and chairs. About half of the visits took place at the concert hall; the rest were at the hotel. A few, however, were conducted in transit -- in the airport or train and even on the street. Convenience was key, because the musicians didn't have the time to spare trying to treat their symptoms at local pharmacies. They would not only have to speak a foreign language, but they would also have to know the foreign names of familiar drugs.
What if someone had needed hospitalization? I made it a point to know the telephone number of the local American Embassy or the names of English-speaking physicians affiliated with the hotel we were staying at. In Brussels, for example, I saw a 2 1/2-year-old boy, the son of cellist Janet Frank, for an ear infection. Although armed with enough antibiotics for a small epidemic, I didn't have any liquid kinds for children. She had to go to the NATO health clinic and pay a registration fee of $75 to get some.
As for medications, I used more over-the-counter remedies than I had expected. I handed out so many cough drops, sore throat lozenges and decongestants that I took to rationing them. During intermission at the final concert, I faced a line of six or seven weary musicians with various degrees of "the bug" that was going around. Trying to cheer them up, I joked that all I had left were some little red pills and I wasn't sure if they were decongestants or laxatives.
I had thought there'd be more of a demand for Inderal, a heart medicine that some performers use to block the symptoms of stage fright. I had read that even among seasoned musicians, as many as one in four have performance anxiety, with about 4 percent overall being nearly incapacitated by it. But no one asked for Inderal. Either the NSO is a group of very easy-going individuals, or they carried their own supply.
As you might expect, orchestra members are a fairly healthy group. They have to be to keep up with the demands of their schedule. Different members, however, had different ways of staying fit on tour. At present count, the NSO boasts five members who are marathoners. Upon arrival in a new city, a few speed demons would take off for the streets, while the rest of us hit the sack, the nearest golf course or the museums. In fact, Desi Alston, a violinist, caught up with the tour just before it left Washington after completing the Ironman Triathlon in Hawaii hours before.
We also learned that certain instruments seemed to attract certain personalities. For example, energetic Tony Ames, principal percussionist, always seemed to be tapping his fingers. Fred Begun, principal timpani player, had a flair for being vibrant. In some cases, playing a certain instrument had decided health benefits. I remember telling Keith Jones, a trumpet player, that one of the side effects of codeine cough medicine was constipation. "Don't worry, Doc," he reassured me, "I play the trumpet, and trumpet players don't get constipated."
Jay Siwek, a family physician, practices at the Fort Lincoln Family Medicine Center and Providence Hospital in Northeast Washington.