Death, suffering, and the after life – what a way to finish a geriatric medicine congress!  I had at first viewed the invitation to the Vienna Philharmonic Orchestra concert as an unexpected bonus to an extremely stimulating and hospitable Austrian and German Geriatric Medicine Congress the week before last. Yet when viewed through the lens of this extraordinary orchestra fronted by a crack UK team – Daniel Harding conducting, and the Scottish soprano Lisa Milne as soloist – a certain continuity of spirit and logic between an unusual programme pairing Bach with Mahler and the everyday life of a geriatrician became inescapable. 

The juxtaposition of baroque and late romantic music worked extraordinarily well, a sign that Daniel Harding shares a gift for unusual but apt programming with his Berlin based compatriot, Sir Simon Rattle. Mahler, the centenary of whose death is the focus of this year’s Wiener Festwochen, was an inveterate tinkerer with other composers’ works, producing adapted editions of the Schumann symphonies and Beethoven’s Ninth. However, Bach prompted him to become one of the first pioneers of historically informed performance, writing with enthusiasm about restoring the basso continuo and substituting the newly rediscovered harpsichord for the piano.

In addition to recognising this deep-seated admiration, there was an emotional and spiritual congruence in the concert between the deep suffering outlined in Bach’s cantata Ich Habe Genug, ending with the serene I rejoice in my death, and the crystalline child’s vision of heaven in the final movement of Mahler’s Fourth Symphony. An added foundation of deep meaning and authenticity in this music comes from the awareness that death and trauma had been close to both composers in a way unimaginable in 21st century Europe. Bach lost both parents at the age of nine and watched 10 of his children die in infancy, while Mahler experienced the death of six of his twelve siblings, most traumatically his beloved younger brother Ernst.

Both composers encapsulate our vulnerability without in any way lessening our integrity, and a hard fought consolation shines through the music. The magic lies in how the music lifts, illuminates, and enobles texts which otherwise may appear rough hewn, veering between the banal, and the sentimental on the printed page. In performance, the marriage is complete, and neither is thinkable without the other.

This sense of wider, greater, and deeper currents underlying what at first sight looks like the ravages and vulnerabilities of life is a potent metaphor for the assertion of vitality, expression of personality, and serenity in the face of death, suffering, and the unknown that illuminates the practice of medicine with older people. This experience may underpin the fact, counter-intuitive to the lay public and indeed even to medical colleagues, that geriatricians are generally such a even-tempered and optimistic group of people in the face of what seems to be suffering and loss. This great music truly encapsulates what is remarkable about humans faced with catastrophic losses in a way that the spoken word can only stumble over at best.

Intimations of the after life are also generally out of bounds in the discourse of medical practice, other than a growing literature on near death experiences. Yet what lies beyond, and the accompanying beliefs, awe, and fears are clearly important to huge numbers of our patients and many of us, whether religious or not. The universality of our need for grace and consolation in the face of the “awfully big adventure” is beautifully addressed by Bach the Lutheran, and a Mahler whose belief system – born Jewish, a pragmatic convert to Catholicism and almost certainly an agnostic – is considerably more in step with modern times.

This great music allows us to rise above these labels, and in the hands of Mahler’s old orchestra, the performances were luminous. The players responded with aching sensitivity and an unerring accuracy and unity of ensemble to Harding’s direction which combined clarity and warmth with a firm grasp of the underlying narrative structure.

The prolonged silence at the end of the symphony was breathtaking, a shared realization of expanded emotional and spiritual horizons. Mahler famously said to Sibelius that the symphony must be like the world, it must embrace everything: but perhaps in the final analysis it is the other wordly that truly draws us in.

Desmond O’Neill is a consultant physician in geriatric and stroke medicine, Dublin.