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Editor's Comments on 'Fugue in C Minor'

 , June 30, 2017

The concept of a musical fugue carries with it an element of separation: a feeling of otherness or removal from the world as a mere observer. Its transcendent, haunting, yet alluring polyphonic nature was appreciated by many historic composers dating back to the Middle Ages; however, this canonical styling has perhaps been most readily memorialized by well-known Baroque mastermind Johann Sebastian Bach. As a primary subject plays through the measures of the music, additional voices chime with some relation to the subject – perhaps in a slightly different key or with specific accentuations. The effect is a surprisingly connected disconnection or euphonic cacophony which invites the listener, who in vain attempts to appreciate all elements at once, to experience the totality of the composition in the moment. The audience simply exists within the story told by the fugue.
Such an introduction must precede what, only on its very surface, seems like a very modest piece. Indeed, far from simple, “Fugue in C Minor” is one of those truly magical pieces in which you find something new upon each re-read. Ivana Viani has embodied the essence of fugue in written form by allowing the rawness of each “voice” (pregnancy, womanhood, domestic abuse, medical training, life itself) to simply be – unabashedly unedited or unfiltered. No doubt, the poet is the intended observer of this piece, but how easily she allows her readers to place themselves in that precise moment, rich with intersections in space and time. Do not miss a single word, as each one represents the accentuations of the many voices of this fugue. Take a moment to mull over this piece, wander through the lines as the sudden yet intertwined subjects shift your attention, read it again … and then, again. Find each subject buried in the overarching story. But, just as one does with fugues of centuries past, remember to appreciate this piece’s greater composition as experienced in but a single point in time.
Within the perspective of medical training, “Fugue in C Minor” so greatly highlights the importance of understanding the social determinants of health underlying the foundation of medicine and our care. Try as we might to understand our patients to the best of our abilities, we will always be observers in the lives of our patients – fellow humans each with lives as exciting and complex as the next. Healthcare providers indeed live metaphorically in a constant fugue: listening to the intersection of various symptoms, signs, and stories that shape our perspectives and recommendations as certain elements catch our attention among the greater landscape of a patient’s life. Our job, ultimately, is to unravel the fugue, study its parts, and make sense of the composition to recreate harmony.
Herbert Rosenbaum