Even as he approaches age 80, Leon Fleisher is an imposing figure, with piercing eyes behind thick-rimmed glasses. He has a large head and body and, unlike most men his age, he looks stocky. He has a mass of gray-black hair that appears spared the thinning that age usually inflicts on men. If I were describing Fleisher as a patient, I would say he looks much younger than his stated age. The only hint that he is almost an octogenarian is a slightly stooped posture.
Fleisher’s body is not intact, however, because his right hand is damaged. The hand that hangs uneasily at Fleisher’s side is pearl white in color and has a waxy appearance. While the left hand is thick and muscled from decades of practice and performance, the right hand looks frail and dystrophic, as if it had been reattached to his body after severing and lacked an adequate blood supply.
For many years after the onset of his focal dystonia, Fleisher struggled mightily against what must have been a devastating loss that imperiled not only his livelihood but also the very fulcrum of his being. At what should have been the peak of his career, at age 37, Fleisher had to retire from the concert stage. His biography indicates that, as the condition of his right hand deteriorated, he became depressed and considered suicide. His personal life suffered as his family life disintegrated.
Despite the tragedies in life worthy of Job, Fleisher did not succumb. He realized that, while he could not be a soloist for the complete repertoire, he could nevertheless enjoy a life of music, and he became a renowned teacher, conductor, and composer. He also resumed a career as a performer, playing—among others—important pieces by Ravel and Prokofiev that were commissioned by an Austrian pianist who had lost his right arm in World War I.
While Fleisher had a wonderful career on the faculty of the Peabody Conservatory of Music in Baltimore, he never gave up the dream of playing with both hands again. He tried a multitude of treatments—some conventional and some not very conventional. He eventually found relief with injections of Botox and rolfing, a form of message to soften the connective issue and realign damaged ligaments and tendons. Most rheumatologists would roll their eyes at the idea of rolfing, but it worked for Fleisher and he was able to gain enough function to resume his solo career with pieces for two hands.
A Masterful Recital
Having read about Fleisher and heard an interview with him on National Public Radio, I immediately bought tickets to a solo recital that he gave at Duke. I am a fan of live events—I like the spectacle and excitement—and I relish seeing great performers of any kind—whether a pitcher, pugilist, or percussionist. I bought seats as close to the front as I could, but unfortunately they were at the side.
At the beginning of the concert, Fleisher walked out wearing a black tuxedo and a shiny black shirt. As I watched him walk across the stage, I could not believe that Fleisher was about to perform a difficult solo concert in which he would play pieces written for two hands and not just the left hand. I wondered by what power Fleisher could instill life into his right hand and allow it move across the keyboard.
From the very first notes of the concert, Fleisher’s performance was magical. The delicacy of his playing belied his large size. He opened with “Sheep May Safely Graze” by Bach, which he rendered with an exquisite touch, a piece of modulated softness and great feeling. I could not see his right hand, but I would have been intrigued to see how he got that almost lifeless-looking appendage to strike the keys with such precision.
The whole performance was a marvel of virtuosity, although no doubt Fleisher had selected pieces that played to his mastery of technique and control. Whether because of his age, limitations of his hand, or a love of more tempered composition, there was no banging in the concert, and no bombast, great flourishes, or dazzling arpeggios that would have demanded his hands to fly along the keys.
Near the end of the performance, I thought I could detect a faltering of Fleisher’s right hand during a Chopin nocturne. It was trivial at most, but at the end of the piece (which was next to the last on the program) Fleisher lowered his lion-like head and, in a sad but ironic voice, said to the audience, “I have become fatigued by dealing with a recalcitrant piano.”
I anticipated that Fleisher was going to end the performance right at that moment but instead he added, “I will substitute another piece, but I want to inform you that it is six minutes longer than the scherzo that I was going to play.”
The audience laughed warmly as Fleisher repositioned himself on the piano bench. He moved his right hand to his side, almost tucking it away. The hand looked almost dead and without movement. Could this be the hand that created the lush, melodic sound of Debussy and Albeniz?
For his last piece, Fleisher played something from the left-handed repertoire. This was a stirring moment as an 80-year-old man with, yes, a serious disability would not let his audience or himself down and would finish his performance on a note of triumph and bravado.
My Musical Epiphany
I had never witnessed a moment in classical music like this, and the only analogy I could find in my mind was sports. In real life, this was the great Willis Reed of the Knicks fighting through injury in the final against the Lakers in the 1970 NBA championship. In the movies, this was Rocky Balboa, with blood streaming from his eyes, rising from the corner to knock out Apollo Creed.
The left-handed piece was lovely and, at its completion, Fleisher looked exhausted. He paused for a moment, took a deep breath, and then received one of the most admiring and rousing standing ovations that I have ever heard.
It was at that moment that I realized how disability can lead to secondary gain. Fleisher did not simply cope with disability. He transcended and negated it and, when one path in music seemed to close down, he took another. For Fleisher, disability was a long detour but not a dead end. Fleisher enriched his career by teaching, composing, and conducting. He gained the love and approbation of students who have called him the Obi-Wan Kenobi of piano teachers. When he holds a rare solo recital, he gains by enthralling and inspiring an audience with courage and heroism in a calling that is not often thought to require such attributes.
I do not know whether I have a Fleisher in my practice, but I think I know a way to find out. When I see a patient with disability, I will not ask my usual question about loss. Instead, I will take another direction and inquire, “What are things that you can now do that you could not do before you had arthritis?”
I await the answers.
It is time for providers like me to discover the real meaning of secondary gain.
Dr. Pisetsky is physician editor of The Rheumatologist and professor of medicine and immunology at Duke University Medical Center in Durham, N.C.