AAP Contest Winner
Acoustics
Veronica Hackethal, MSc.
C ecilia stared into her morning coffee. The steam rose
in a lazy spiral from the murky liquid. Cafeteria cof-
fee, she sighed, gazing languidly from her balcony seat to
the hospital entrance below. She sat in early spring sunlight
filtered through half-washed windows and ruminated on
the past year, her third of medical school. It hadn’t been
easy. She had a sensitive soul, and it seemed that the fac-
ulty had tried to pound it out of her. “You’re too quiet,”
her attendings had scolded, “too gentle. You need to be
more aggressive, faster-talking.” More like us is what they
meant to say. It left her feeling like her character had been
attacked, and she’d grown monumentally discouraged.
Usually Cecilia censored herself from these thoughts—
they made her throat knot in anger. She took another sip
of coffee, tried to ignore its acidic bite, and allowed her
mind to wander onto the story of a patient she’d just met.
The girl’s name was Mona, a 10-year-old with autism.
Cecilia, exhausted this morning, had reluctantly walked
into Mona’s world. “Hi, my name’s Cecilia,” she’d begun,
“what’s your name?” It was a half-hearted gesture to get
the girl to respond. Mona seemed oblivious. She sat in the
center of her bed, curled into a ball, rocking slowly back
and forth and humming a jumble of barely audible notes.
There was no melody, only a random assortment of varying
pitches sung in a child’s uncertain treble.
“I see you like to sing,” Cecilia continued. No response,
only humming and rocking. “I like to sing, too. Do you
know that my name’s a song?” Still no response. “Want to
hear it?” Cecilia continued, feeling like she was talking to
herself. Mona continued rocking, wrapped up in her own
musical hodgepodge. “It goes like this,” Cecilia continued.
Bashfully she ventured a few lines: “Ceceeeeelia, you’re
breakin’ my heart. You’re shakin’ my confidence, Lately-
y-y. Oh, Ceceeeelia, I’m down on my knees. I’m beggin
you please to come home!”
Received September 14, 2005; accepted September 20, 2005. Veron-
ica Hackethal is a fourth-year medical student at Columbia College
of Physicians and Surgeons, New York, New York. Address corre-
spondence to Veronica Hackethal, vh2008@columbia.edu (E-mail).
Copyright 䊚 2006 Academic Psychiatry.
80 http://ap.psychiatryonline.org
That was as much as Cecilia could remember. But it
didn’t seem to matter to Mona, who continued to rock
back and forth. “You have a nice voice, Mona,” Cecilia
said, trying to sound upbeat. “I bet you could carry a mean
tune.” But the girl still took no notice, and finally Cecilia
ran out of things to say. For ten minutes, Cecilia didn’t
speak. She listened to Mona’s humming and stared mo-
rosely out the hospital window at the golden sunlight shim-
mering off the waves in the Hudson below.
What a beautiful child, Cecilia thought. Mona had raven
hair and velvety black eyes that looked off into the distance
(but never into anyone else’s) from beneath long curling
lashes. Her skin, smooth and olive toned, was sallow from
lack of sunlight, devoid of the rosy cheeks of childhood.
Mona did not look unhappy. She simply didn’t care
about the outside world. But when that noisy world broke
into her isolation, she exploded in torrents of sound. A
thunderclap could make her shriek and roll with pain, a
car alarm could precipitate a temper tantrum. She would
clap her hands over her ears trying in vain to expel the
intruder. Her parents, defeated by her outbursts, had come
to the hospital desperately searching for solutions. “Please
help us,” they’d pleaded, their faces branded with the guilt
of parents stretched beyond endurance, “we can’t live like
this any longer.” So Mona had been admitted for “obser-
vation.” All day she sat in bed, rocking back and forth to
her own melody.
As Cecilia sat thinking, Mona’s humming began to in-
vade her thoughts. Gradually, she realized that the little
girl’s melody was not completely random. It was a scale of
half-steps: three steps forward, two back, four forward,
three back, in perfect tune. Mona had suffered from au-
tism since infancy, Cecilia thought. She’d begun talking
around age two—had learned a rudimentary vocabulary.
Then she’d quickly regressed, had lost all verbal ability,
and shut out everyone. Mona hadn’t spoken a word since
age three. All she did, day in and day out, was hum inces-
santly. She’d never been capable of taking music lessons,
so how could she hum scales?
Mona’s peculiarities were not entirely foreign to Cecilia,
Academic Psychiatry, 30:1, January-February 2006

herself highly musical. Her father had said, in the German
accent he found impossible to lose, “You haf ze privilege
of being named after Saint Sheesheelia, so of course you
vill haf ze geeft of music.” But Cecilia had never liked her
name. She thought it sounded old-fashioned. “Be proud
of your name,” her father had continued unconvincingly,
his nasal Rs stuck in the bridge of his nose, “Saint Shee-
sheelia was one of ze greatest vomen in heestory.” That
was another thing. Cecilia never liked the way her father
pronounced her name. He tried to imitate an Italian ac-
cent, out of deference to his Italian wife who’d always
seemed to him the height of style. Even after she’d gained
thirty permanent pounds of pregnancy and her feet had
widened so that she could no longer wear heels, he still
adored her.
Cecilia’s father had escaped from behind the Iron Cur-
tain—had “vaulted” (his term) the Berlin Wall in the
1960s. “Eez not a vall,” he insisted, “eez a goddamn fuckin’
preeson.” He’d sought refuge in Italy, where he’d met Ce-
cilia’s mother. The two had worked their way to America,
where her father promptly fell in love with all things Amer-
ican, especially the little known (and rarely eaten) Uncle
Sam cereal. He’d stocked their kitchen with hundreds of
boxes of the stuff: patriotic insurance against “it” happen-
ing again. At bedtime, Cecilia’s father taught her to end
her prayers with “and please don’t let the communists take
over America. Haymen.”
Aside from his accent, his love of music was the only
other vestige remaining from the Old Country, “Your
grandfather played veeolin. I played veeolin. Now you,
dear sweet Sheesheelia, vill also play veeolin,” he’d said,
absentmindedly tapping his lame left arm. The triceps had
been shot off in his youth, leaving him unable to play his
beloved violin. Cecilia rarely asked about these matters.
Occasionally glimpses of the past emerged when her father
fell into a rare fit of sadness, but mostly the past stayed
just there, bubbling under the surface. Cecilia would have
liked to have known more about her heritage, but her fa-
ther’s melancholy moods scared her.
So Cecilia had learned the violin, and her playing res-
onated with exuberance and love of life. Her teachers
boasted that she had an uncanny ear, an other-worldly tone
and a soulful vibrato. She performed through high school
and college, but upon reaching medical school, she laid
down her violin for a “break” that had grown into three
long years of arduous study. She longed to play the violin
again, but she feared that her passion for music would con-
trol her life.
Yet it was this very adoration of sound that drew Cecilia
Academic Psychiatry, 30:1, January-February 2006
VERONICA HACKETHAL, MSC.
to Mona. As she sat daydreaming over her coffee, the
harsh sounds of the hospital—the rushed, urgent voices
bouncing off stark linoleum—swirled around Cecilia’s
head. She tried to shut out the sensory stimulation, con-
centrating instead on the sugary coffee in her mouth, the
changing cloud patterns outside the window. Cecilia felt
afraid of Mona. If she identified with Mona’s sound sen-
sitivities, what did that say about herself? Cecilia could
sympathize with Mona’s rejection of the world. There were
times in the last year when she’d wanted to do the same.
Cecilia was tired of feeling. She had turned off her emo-
tions and now wondered whether she dared turn them on
again. It was unconscious, a gradual slide into not caring.
She had started the year feeling for her patients, but this
identification had subsided into trying to survive the angry
frustrations of the residents. She remembered one resident
who, when she could not remember the answer to a ques-
tion, had hissed full of venom, “Do you even want to do
patient care?” Another who’d called her a deer in head-
lights. Another who’d clapped her hands at Cecilia and
called to her as to a puppy dog. She’d been ignored, de-
meaned, her hands slapped by an imperious surgeon. It
made Cecilia wonder, “How can I treat patients with dig-
nity and respect when I’m not treated that way myself?”
That evening, Cecilia took a walk in Central Park. The
evening was sunny, the kind that makes a person yearn to
linger outside until the last ray of light has faded from the
west, and Cecilia completely forgot about Mona. She re-
joiced in the gentle spring breeze, the soft splash of water
in the Bethesda Fountain. She sat on a cement bench
warmed by the early evening sun and gazed up at the angel
crowning the top of the fountain. The angel stood with
mighty wings outstretched, as if alighting from flight. She
extended her right hand gracefully downward, offering sol-
ace to those below. Two sisters, their faces framed by halos
of long curls, played in the fountain. They splashed and
squealed with delight, their laughter bouncing off the stone
pavement. Cecilia absorbed their joy felt relief to be in the
presence of children blooming with health.
Back at her apartment that evening, Cecilia’s eyes fell
on her dusty violin case lying unused in a corner. She
picked up the case—unlatched it. She let her fingers slide
over the smooth, shining beauty of the violin’s varnish. She
caressed its curves longingly, her fingers curling around it.
She lifted the instrument and let it come to rest against
her left shoulder, then hesitantly picked up the bow and
played a few shaky notes. An electricity spread through
her body, coming to rest in her fingertips. She shuffled
through the old scores in her violin case and drew out Bee-
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ACOUSTICS
thoven’s Ninth Symphony, long her favorite. She loved the
galloping exuberance of the orchestra and chorus singing
as one in the final movement. That night, Cecilia played
until her fingers were too tender to continue. The calluses
she’d had all her life, hardened through hours of express-
ing herself in music, had disappeared from lack of use,
leaving her vulnerable.
The next day, Cecilia felt less reluctant to visit Mona.
The little girl still sat rocking to and fro, still humming the
same scales. “Good morning, Mona,” Cecilia said. “Do
you remember me?” No response, only rocking and hum-
ming. “I remember you. You’re the girl with the golden
voice,” Cecilia continued. No reaction. And then Cecilia
had an idea: if Mona won’t answer me, I will answer her.
Softly, Cecilia began to hum along with Mona. Still the girl
took no notice. Once in a while, Cecilia threw in a note of
her own, and after a few dissonant clashes, Mona started
mimicking Cecilia. It began hesitantly and with many mis-
takes, but gradually they started to sing together. And ever
82 http://ap.psychiatryonline.org
so gradually, Cecilia made a song out of their mutual notes.
Without thinking, Cecilia fell into the Ode to Joy and
Mona fell along with her. And then, a miracle. Mona
stopped rocking and instead swung both hands back and
forth in time to the music, a smile of pure ecstasy lighting
up her face. They sang the melody over and over, until
Cecilia realized that she was nearly late for class. “I’d like
to sing with you longer, Mona, but I have to go to a lecture
now.” No response from Mona, who remained singing,
arms moving to the rhythm.
As Cecilia turned to go, she heard, intermingled with
Beethoven, “Ceceeeelia, you’re breakin’ my heart. Oh Ce-
ceeelia!” Cecilia, electrified, turned to look at Mona. The
words had sounded eerily normal, like those of any ordi-
nary 10-year-old. But the little girl still sat staring into
space, still flapping her hands to the music. Cecilia stood
transfixed. She waited for more of Mona’s words until, with
sinking heart, she realized that the little girl had begun to
rock to and fro.
Academic Psychiatry, 30:1, January-February 2006