A Defining Moment of Harmony

Elliana Kirsch finds magic in the integration of medicine and music

Elliana Kirsch

This essay was written for the 2018-2019 HMS Dean's Report in answer to the question "What was your most formative or memorable experience in your medical education at HMS?"

Early in my medical training, I observed a laryngologist perform a type 1 thyroplasty on a singer who suffered from vocal fold paralysis.

He made a small incision in the skin near the larynx, drilled through the cartilage and then hand-carved a small block of Silastic, securing it inside the vocal fold.

I vaguely understood that this block would push the vocal fold to midline, improving vocal closure. I also knew the physician was applying his research in physiology and laryngeal mechanics to optimally place the implant.

To my amazement, the surgeon aroused the patient in the midst of the procedure and asked her to speak so that he could observe the movement of the vocal folds.

 To my amazement, the surgeon aroused the patient in the midst of the procedure, asked her to speak so that he could observe the movement of the vocal folds, and then fine-tuned her voice by making modifications to the implant. I was even more astonished when he asked me to use my knowledge of opera and vocal acoustics to assess whether the implant was adequately placed.

As we made preparations for closure at the end of the case, the patient used her new voice to thank the team for giving her voice back. This was the first time she had a clear voice quality in years.

Before medical school I was a professional opera singer. I thought I would have to leave that part of my life behind when I began medical school, however, when I walked out of that operating room, I knew that the sense of personal fulfillment I felt helping that patient regain her voice on the operating table was something I could commit my life to pursuing. I had found a way to integrate my love for medicine with my love of singing. I knew then that I had made the right career choice to become a physician.

I have been a musician ever since I can remember. I began violin instruction at age 4, singing lessons at age 9, and I performed in a symphony youth orchestra as well as musical theater and opera scene productions throughout high school. I then decided to pursue a career in vocal performance in college.

I was fortunate to be accepted as an opera performance major at the University of Cincinnati College-Conservatory of Music. In the course of completing the rigorous requirements for a Bachelor of Music in Vocal Performance, I performed in several professional operas, concerts and international music festivals.

During the last years of my music career, however, my desire to understand the physiologic processes underlying the voice began to slowly transform my passion from performance to science. I became fascinated with both the mechanical function of the voice, and I began engaging in research with local otolaryngologists and voice pathologists. It was shortly thereafter that I started to seriously pursue a career in medicine.

In medical school, I have made it a priority to act as a champion for the integration of music and medicine at HMS. I served as a student coordinator for the HMS Arts and Humanities Initiative, helping establish new traditions of music-making in the Harvard medical community.

As co-president of the HMS Chamber Music Society, I collaborated with colleagues to organize a network of musicians within Harvard Medical School and the Harvard-Longwood community for reducing burnout and promoting creativity through music.

Our organization created opportunities for students and health professionals to maintain their musical interests amidst the rigors of science and medicine through triannual multidisciplinary concert events in the Longwood medical area. I also serve as a music instructor and teen mentor to underserved youth in the greater Boston community.

During the course of my medical training, my academic interests have expanded beyond care of the professional voice, to developing pathways that can enhance communication and quality of life for patients with no voice at all.

I am currently leading a quality improvement and educational project aimed at increasing the incidence of early speaking valve use for tracheostomy patients in the ICU. I have presented this and related research at both national and international meetings.

I have also engaged in work with the Global Tracheostomy Collaborative, an international quality improvement initiative aimed at improving the care, safety and quality of life of every individual with a tracheostomy. At a recent collaborative symposium, I had the joy of singing a duet with a longtime tracheostomy patient. It was a magical moment encompassing both my personal and professional passions.

In a letter to a friend, the American writer Willa Cather once mused, “Novelists, opera singers, even doctors, have in common the unique and marvelous experience of entering into the very skin of another human being.”

I have experienced the magnificent intimacy of connecting with another person as a musician and opera singer. Now, I have had the privilege to experience this intimacy and connectivity with others as a student doctor.

I know I have made the right personal and career choice to become a physician. I have committed my life to helping people find their voice.