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Commentary on “The Needle and the Damage Done”

2015; Lippincott Williams & Wilkins; Volume: 90; Issue: 6 Linguagem: Inglês

10.1097/01.acm.0000466625.43215.9f

1938-808X

Jeffrey S. Farroni,

At its surface, “The Needle and the Damage Done” by Neil Young is about loss. The song conveys images of heroin craving and the desperation of addiction. It expresses a certain sense of hopelessness and an inevitability of self-destruction. There is an elegant beauty in the brevity and simplicity of the song. While I identify with its themes, the song represents something much more fundamental to me: the inspirational power of a medium that provides sustenance for empathy, compassion, and self-care. Marc and I were introduced to “The Needle and the Damage Done” through his stepfather’s record collection. The crackle and pop of the music through the speakers transported us to a piezoelectric paradise, infusing us with a visceral appreciation of the music as it was becoming an integral part of our lives. While not technically difficult with its variations of D–C–F–E chords, this song represented an embodiment of music’s transformative influence and provided a way for us to become closer to an artist we admired. At the age of 15, Marc began to experience bouts of refractory headaches, nausea, and vomiting; doctors discovered a tumor entwined around his brainstem. The cancer, and its surgical aftermath, transformed a spirited kid into a tortured prisoner. His body devastated; unable to move; unable to speak. The only parts of him that looked alive were his eyes—eyes that simultaneously pleaded for help and burned with defiance to beat this disease. Over the summer he slowly recovered the ability to speak, to walk with assistance, and he regained the dexterity to perform rudimentary tasks. However, the fine motor coordination to play guitar eluded him. Over the next few months, the sun began to set as Marc lost the small gains in function and started to decline. He transitioned to hospice care after treatment modalities were no longer effective. I cannot imagine what he or his family suffered, as I was merely a passenger on Marc’s journey through his illness. His recalcitrant disease mirrored the seasons, from the summer of his initial recovery, the autumn of cancer recurrence, and the winter of his death. Our enjoyment of music did provide comfort during this time. The immutable power of song touched all our lives in a profound way. The memories of listening to Neil Young with Marc carried me through his passing and have served as milk-blood for difficult times since. Witnessing Marc succumb to cancer at such an early age was an experience that parallels the lyrics of this song. The song does not proselytize but, rather, acknowledges the tragedy of substance abuse in a very personal way. The narrator “watche[d] the needle take another man,” and I was equally helpless witnessing my best friend waste away. Actually, the lyrics are irrelevant to me despite this congruence. The song’s meaning comes from the context of Marc’s illness and our shared, personal connection to Neil Young. Over time, this melancholy song has morphed into an uplifting source of inspiration. The damage was undone to some extent by someone who, through his art, was able to transform our lives in a very profound way. Although using this particular song would be too personal, I often try to incorporate a component of the arts into my teaching. We have all seen the needle and the damage done embodied in the demands of clinical practice. We can face such challenges as cynicism, burnout, and compassion fatigue by creating a space that fosters awareness of our own stress and mental status while encouraging self-care.1 The arts can serve as a bandage for the personal wounds we incur during the tensions of patient care. Engaging in creative endeavors nurtures professional practice.2 Therefore, I often encourage students to retain such means to decompress during their busy lives. Decompressing may be as simple as taking a deep, meditative breath between patients or following more ambitious pursuits such as dedicating oneself to a hobby that was sacrificed during medical school. The important point is that we must take time to nurture a healthy mind, body, and spirit. Music remains one of my instruments for reflection and rejuvenation, a way to keep grounded. We all need moments, nourished through art and music, to sustain us. Jeffrey S. Farroni, PhD, JD J.S. Farroni is assistant professor and clinical ethicist, Department of Critical Care, University of Texas MD Anderson Cancer Center, Houston, Texas; e-mail: [email protected]