Nancy N. Futrell, MD, readily admits that she is not the only neurologist with a passion for music. In an interview, Dr. Futrell rattled off the names of five other neurologists who also happen to be serious musicians. But Dr. Futrell, who founded and directs the Intermountain Stroke Center in Salt Lake City, might be the only neurologist to request a piano in her hotel room when she travels to professional conferences – as she did when she attended the AAN Annual Meeting in Denver in April.
In between business meetings of the AAN Section on Stroke and Vascular Neurology – which she chairs – and attending meeting sessions, Dr. Futrell performed compositions, ranging from Liszt's Mephis to Waltz to Ravel's Sonatine, for a small rapt audience. She needed the piano to practice at least two hours every day, she explained, in preparation for the Van Cliburn International Piano Competition for Outstanding Amateurs. Dr. Futrell was one of 75 pianists chosen from a pool of 130 applicants to compete in the annual event in Fort Worth, TX.
In a conversation with Neurology Today before the competition on June 2nd, Dr. Futrell discussed the influences that have melded her career in neurology with her passion for music.
WHAT CAME FIRST FOR YOU – YOUR LOVE OF MUSIC OR MEDICINE?
I was always interested in both science and music. I played piano from an early age, and I was intrigued by science. I can remember my fourth grade teacher telling my parents that my best skills were research, logic, and problem solving. But it wasn't until my senior year in college – when I saw that two women got into the medical school at the University of Utah – that I thought about going myself. Until then, I didn't feel confident that I could get into medical school. I pursued a different career track, performing and teaching piano, and earned an undergraduate degree in music from the University of Utah [in 1971]. When I graduated, I was granted a Fullbright scholarship to study piano at the Hochschule für Musik School in Frankfurt, Germany.
WHAT MADE YOU CHANGE CAREER PATHS?
I had health issues. While I was doing my Fullbright, I was diagnosed with myasthenia gravis, which made it difficult, virtually impossible, for me to practice – let alone play – the piano. I had to leave the Fullbright program two months early and was hospitalized for five weeks. I had a tracheotomy done, and within six months, the disease spontaneously remitted. I decided to go back to school to take pre-med courses. A few years later, I applied to medical school at the University of Utah. I was initially concerned that someone with my medical history would have a tough time getting admitted, but the medical school encouraged me to apply. In 1977, I started medical school at the age of 30; one year later, my disease relapsed.
HOW DID THE DISEASE AFFECT YOUR MEDICAL STUDIES?
I was very weak and there were times when I had to ask classmates to get me a drink of water so I could continue to sit and listen to lectures. I had my thymus out and was on steroids for a year, and I had bouts of double vision. But the medical school was very accommodating. They let me take some tests late and told me that I didn't have to be on call overnight. But I actually ended up doing all of the night call duty, and I graduated on schedule in 1981. There is no sign of the disease anymore.
WHAT DREW YOU TO NEUROLOGY?
I actually resisted it at first. I thought it was a hopelessly complex, unfathomable body of knowledge. But one of my instructors, Clark H. Millikan, MD, was convinced that I should pursue this specialty. His systematic approach to neurology showed me it could be comprehended. He persuaded me to do a rotation in neurology with him, and I got hooked on it. Dr. Millikan later became my husband.
I remember a specific case that really pulled me in. I had a 19-year-old patient who came into the hospital with syringomy-elia, and he was drunk. I did a neurological exam, because he had upper and lower motor neuron problems. When Dr. Millikan saw the exam, he said: ‘I don't know how you could do this exam with his alcohol level. The exam was perfect.’ It got me very excited to know that just by looking at a patient this carefully, you could find these things. I realized how interesting and logical the diagnostic issues in neurology are.
WAS IT HARD FOR YOU TO GIVE UP YOUR MUSIC?
It was difficult not being able to play, but I was then also very engaged in my academic career in stroke research and care. I went to Creighton University School of Medicine, where I was Medical Director of a stroke unit [from 1992 to 1994]. I then moved to the Medical College of Ohio, where I directed the stroke center, oversaw the neurology residency program, and served as Chief of the Neurology division from 1995 to 1997. During that time, I was the principal investigator on a number of NIH-supported trials on animal models of stroke.
WHY DID YOU LEAVE YOUR ACADEMIC PRACTICE?
I moved back to Salt Lake City, my hometown, for various personal reasons. My dad had been sick with colon cancer and I had a large extended family there that I missed. I also realized that I wanted to make more time in my life for piano again. I knew so many people in the music community in Salt Lake City; I felt that would make it easier for me to re-enter that world. Also, there was no stroke program in Salt Lake City, when I moved back here five years ago, so I started one – the Intermountain Stroke Center. I felt that once my practice got established, I could start playing piano again.
WHAT INSPIRED YOU TO ENTER PIANO COMPETITIONS AGAIN?
My former piano partner, who is Chair of piano at the University of Utah, asked me to play at a recital to honor Lowell Farr, a well-known and accomplished accompanist and soloist who had moved from Salt Lake City to Atlanta. The concert was a fundraiser for a music scholarship in his name. Lowell came in from Atlanta to attend the recital. He was so excited to hear me playing again. He encouraged me to compete again in piano competitions. Last November, I was one of six finalists in a piano competition in Litchfield, CT, named for a woman patron of the arts, Simone Belsky. At the Belsky competition, I had an opportunity to play and talk about the composers I was studying and how each composer's mode of composing reflects their musical style.
WHAT DID YOU SHARE ABOUT THE COMPOSERS AND THEIR MUSICAL STYLES?
I discussed Bach, Ravel, and others. For example, Bach thought of music as a craft, and that was apparent in his compositions. He would create an outline of musical notes and figures, intertwining them throughout a harmonic structure until it all worked. This is how he applied his craft to his compositions. Ravel, on the other hand, conceived of music as inspiration. He would walk through the forest and listen to the ambient sounds of bird songs and write them down. His father owned a factory and he would listen to the background noises there and transcribe those sounds as music for his pieces. You can hear this approach in his music.
HOW DO YOU PREPARE FOR PIANO COMPETITIONS?
It takes months to learn a new piece in general and I have to practice at least two hours every day. I also have been studying with Lowell Farr. Once a month, I fly to Atlanta and work intensively with him for two to three days. He is such a wonderful teacher that he's worth all the travel. To apply for the Van Cliburn program, I had to send in a 15-minute audiotape of me playing pieces of my choice. They wanted to hear varying playing styles. Interesting enough, 14 physicians were accepted to play in the competition.
WHAT DO YOU HAVE TO DO DURING THE COMPETITION?
There are three rounds of competition. During the first round, I will play Liszt's Mephisto Waltz #1; during the second round, I'll play selections from Beethoven and Chopin; and for the final round, I'll play selections by Bach, Schumann, Ravel, and Prokofieff.
WHAT DOES MUSIC GIVE YOU THAT NEUROLOGY DOES NOT?
They really meet different needs and challenges. Music is obviously my forum for artistic expression. It allows me to communicate something of great beauty and provides tremendous challenges technically – to have to learn pieces, study harmonic progression and the lines of notes, to bring out the enormous emotion of music.
Of course, medicine presents different intellectual challenges, which involve problem solving. I get a tremendous satisfaction from figuring out a way to diagnose and treat people. When I give tPA [tissue plasminogen activator] to patients and see them move afterwards – and watch the stroke actually disappear – it's chilling. Music satisfies my artistic needs, while medicine takes care of the intellectual parts of me.
HAVE YOU USED MUSIC IN YOUR NEUROLOGY PRACTICE?
No, but my own experience with learning to play pieces has inspired some thoughts about possible strategies for stroke rehabilitation. One of my goals is to develop a piano course for stroke patients who have lost the use of their right hands. If people have their right hand damaged from stroke – and their left hand is intact – chances are they will have their music side of the brain intact too. It would be interesting to see if they have enough speech to understand music instruction.
IF YOU HAD TO MAKE A CAREER CHOICE, WOULD YOU CHOOSE MUSIC OR NEUROLOGY?
Neurology is my real love and I would choose it any day. But I still want to have music in my life. To be a well-balanced person, I need both the artistic and intellectual challenges of music, as well.
DO YOU HAVE ANY LONG-TERM GOALS AS A MUSICIAN?
I'm working toward participating in a piano recital at Carnegie Hall's Weill Hall in New York City. With lots of practice and commitment, I'll be ready for it in a few years.