He seemed a little uncomfortable. Not nervous, but he just did not seem to feel quite at home. "No offense," he said, "but I don't like doctors."
"None taken." I meant that sincerely. Some of the best patients are the ones that need me, but not too much.
Sam was one of those, I could tell. Mid-sixties, fit, grandfatherly, only lightly concerned about his health. He had a wife who cared more, though, which is why he was seeing me.
"Yeah, my wife bought this new blood pressure cuff at Wal-mart last week. She tried it out on me, and my pressure was 162 over something. She made me come in."
"Well, I'm glad you did. High blood pressure is a serious thing."
"Not for me. My pressure has been like this for years. Never bothered me."
This was going to be a little harder than I would have liked. I like a patient who does not worry excessively about his medical problems. But if the patient is relaxed to the point of indifference, that is another problem altogether.
"Blood pressure rarely bothers you before you have a heart attack or stroke," I offered. Unfortunately, Sam was old-school, with Southern manners. The problem with old fashioned Southerners is that you can never tell if you are getting through to them. They look at you and smile, and they say "Yes, sir" and "No, sir" right on cue, because their mamas taught them always to be respectful even when they didn't give a hang what they were being told.
Usually the way to get unstuck with fellows like this is to change the subject. I took a little social history.
"Where do you live?"
"Been here in St. Bernard all my life."
"Ever considered moving?"
"No, never. In my profession New Orleans is the place to be. Always has been."
That narrowed his career possibilities down quite a bit. He was too cleancut to be a fisherman or a longshoreman. I guessed he was in the entertainment business.
"I thought you were retired," I said.
"Semi-retired. I am a jazz musician. I have played the trumpet professionally for 36 years."
Now I was interested. I got my first guitar when I was 10 years old. Though I have never been exceptionally good, I can read sheet music and know a E-flat 9 chord when I hear one. And I know enough to know how technically difficult jazz is to play. I'll put Duke Ellington up against a Bach fugue any day of the week. An accomplished jazz musician is a true marvel in the intellectual world.
"So you still play gigs?"
"Oh yeah. A few festivals a year. Not every week. But every once in a while I get the my old band together and we jam out. It's one of those things you can never put down."
I know the feeling. Lousy though I may be, I have never considered living life without my guitar. Playing is an experience that sticks with you; the pleasure of holding a sacred instrument in your hands, making sounds that are your sole creation, is one of life's great spiritual mysteries.
I could have talked to this cat all day. But I reminded myself of my duty. I am a doctor, and my responsibility was his health. Cue theme music from "Marcus Welby, MD."
We dug back into the blood pressure thing. As I completed my history, then went through the physical exam, a thought rose slowly in my mind. Though I have always stuck with the guitar, my joy with it never developed into a passion. The kind of passion that results in long hours of practice and study, of growth in skill and perfect performance.
What drove Sam to hang with it all these years? To endure the grueling road schedule and poor pay of a jazz trumpeter for all of 36 years? Anyone who could absorb the techniques of Dizzy Gillespie and Miles Davis was smart enough to succeed in something much more boring and financially rewarding. With his mind, he could have even stooped as low as to become a doctor, had he chosen to do so.
I started to ask, but each time I thought to, I was distracted by a medical issue. Duty first. I finished my exam, wrote up a prescription for an antihypertensive, and carefully explained to Sam that he needed to take it without fail. I loved that carefree jazz spirit in him, but hypertension is a problem that answers to method and plain logic, rather than freethinking improvisation.
Sam's keen technical mind must have read mine, though, because he asked my forgotten question for me just as I was ready to head for the door.
"Do you know who taught me how to play the trumpet?"
I told him I had no idea.
He reached into his pocket and pulled out his wallet. After a brief search, he found what he was looking for, and handed me an old photograph.
"This was taken in Chicago," was all he said.
The photo was a little washed out with the years, but I could see several men seated in a booth in a bar. On the left side was a skinny, black-haired man. I looked harder. It was a younger Sam, no question. A beer bottle stood at Young Sam's right elbow, and to the right of that was a somewhat obese black man, late middle-aged. He looked familiar to me. Then I got it.
"Oh my God," I said, stupefied. "Louis Armstrong."
Yes, it was. I have talked to many people in my day, and heard many a name dropped. Rarely am I impressed. This time I was completely numb.
Turns out in the early 60s Sam was the lead trumpet in Lil Armstrong's jazz band. Lil Hardin Armstong was the second Mrs. Louis Armstrong and a creditable pianist in her own right. Through Lil, Sam got to know Louis. And apparently, Louis taught him a thing or two.
I knew even at that moment that it was unlikely Louis Armstrong had been Sam's teacher for very long. They were probably acquaintances, maybe even friends, and Louis may have coached him a little. But who cares? The man knew and played with the immortal Satchmo!
Louis Armstrong is one of the most towering intellectual figures in American history. Armstrong invented swing. Literally. He is one of the first, if not the very first, recorded jazz artist who consciously accented his notes using the back beat. Most music before Armstrong was written in a four-beat time signature in which the rhythmic emphasis was placed on the first and third beats. As in ONE two THREE four ONE two THREE four. Armstrong started off this way, but thought it would be interesting if he reversed the emphasis, creating a one TWO three FOUR rhythm. This two-four emphasis is called the back beat.
This emphasis on the back beat is the essence of what jazz musicians call swing. Inventing swing for a musician is something like inventing calculus is for a mathematician. It is so essential, so central to modern music that jazz (and rock music) as we know it wouldn't exist if Armstrong hadn't done what he did.
If Sam had told me he knew Shakespeare, and then produced a heretofore unknown 38th play, I would not have been less impressed.
Nor I have never been so jealous of a patient. Perhaps if I had met William Osler, or Jonas Salk, or had dinner with Watson and Crick, I could have had the kind of passion for my own work that Sam undoubtedly had for his. It takes more than just personal inspiration to drive a person to excellence in his profession, but nonetheless to have had the opportunity to learn at the knee of one of the divine in one's own field must be an exceeding and sustaining joy.
No wonder monks carry around the very bones of the sainted.
My all time favorite recording is Louis Armstrong's "West End Blues." (West End is a part of New Orleans. Today it is rubble after Hurricane Katrina, but in Armstrong's day it was a strip of bars and honky-tonks on the outskirts of New Orleans, frequented by gamblers and people of color.) The song opens with a thrilling trumpet solo by Satchmo, unquestionably the most famous blast of notes in jazz history. It progresses to a haphazard, lugubrious chorus that is both lazy, sad, and uplifting at the same time. It lumbers into a passionate, bluesy Armstrong solo that mixes all the jazz, blues, and pain New Orleans ever had to offer, then ends with the call and response between Armstrong and his remarkable pianist, Earl Hines. There is nothing in music like it.
A guy who knows the guy who recorded that record was once my patient. That alone may be enough to keep me doctoring.
Sam fled to Denver after Katrina, but he and his band were back in New Orleans in April for the French Quarter Festival. The passion and love instilled by a great master burns on after the storm.
Swing on, Sam!