Desmond O’Neill: Four helicopters and a string quartet

Desmond O'NeillUnlike last year, there was not a formal cultural event at this year’s European geriatric medicine congress. The organising committee may rightly have considered this superfluous with the glories of Venice at our doorstep. Indeed, large numbers of geriatricians were observed garnering informal extra-mural CPD at the many locations across the island displaying the wonderful late-life creativity of Titian,Tintoretto, and Bellini.

But culture takes many forms, and in a delightful expression of the Italian phrase “a tavola non si invecchia” (one doesn’t age at the table) there was a droll and insightful presentation at the opening session on “luxury ageing” by Arrigo Cipriani, the doyen of the celebrated Harry’s Bar, home of the other Bellini (prosecco and peach purée) and carpaccio.

This brio was reflected in the presentations at a conference that continues to grow in size and quality from year to year. As the practice of geriatric medicine can vary significantly from one country to another, this provides opportunities for contrast and comparison, as well as fresh thinking on old problems.

The UK and Ireland were well represented, with particular mention due (from presentations from many centres) to Simon Conroy (Leicester) for emergency care of older people, Finbarr Martin (London) for care home medicine, Peter Crome and the team for the National Audit of Dementia Care, Denis O’Mahony (Cork) for polypharmacy, and Lorraine Kyne (Dublin) on Clostridium Difficile.

However, just as John Cage’s 4’33” alerts us to the ambient noises and social conventions in the concert hall, one of the fascinating peripheral experiences as we sat in our various lecture halls in the fascist-era Palazzo del Casino was the insistent thrumming in the background of multiple helicopter engines.

Little by little it dawned on delegates that we were immediate neighbours to the rehearsals and performance of a once in a lifetime musical experience, Karl-Heinz Stockhausen’s Helicopter String Quartet for four helicopters, a string quartet, and an ungodly assemblage of technology.

One of the most Gothic flowerings of his interest in spatial effects—as seen in his earlier orchestral works Gruppen and Carré—the enterprise also attempts to match the tones and timbres of the helicopters with tremolo effects of the string instruments, all relayed to the live audience in the theatre below.

Tolerance from the delegates towards the acoustic burden was merited for several reasons. As gerontologists, we should celebrate this output from Stockhausen’s later years, completed when he was 65, which neatly breaks the myth that we become more conservative as we age: in fact, most great artists become increasingly radical as they age.

As geriatricians, this somewhat crazed musical endeavor has resonances with our own goal of alerting physicians and the health system of the importance of stepping back from the mechanics of organ-specific illness and viewing a broader holistic view of this most complex of life stages, uniting the biological in appropriate relationship with the social and the psychological.

But perhaps it advocates for radically re-thinking how we deal with older people in a wide range of clinical settings that we can learn from the confidence and self-belief of a great, if radical and controversial, artist.

Although significant progress has been made in the introduction of some of the principles and practice of geriatric medicine in wider arenas of healthcare, the Sisyphus of gerontological indifference shadows much of older peoples’ journeys of care. Some of this is a resistance to the increased time and skills required to provide care, yet the process and outcome of a well-executed intervention can be so much more enriching for both patient and clinician than traditional care.

If Karl-Heinz Stockhausen can compose a work requiring such an extraordinarily demanding ensemble for execution, on the assumption that the integrity of the project will attract performances, as we saw with the Venice Biennale and the Arditti string quartet, then we too should not shy away from our more modest goal of continuing to present appropriately complex assessment and care for older people as a desirable outcome on the basis that in time it too will be universally recognised as eminently worth doing.

Desmond O’Neill is a consultant physician in geriatric and stroke medicine and immediate past president of the European Union Geriatric Medicine Society