“Look at those hands move over the keyboard!” Sue whispered to me. “They look like spiders leaping around with a life of their own.”
“I’m glad you dragged me out to this recital. Even a classical dolt like me can appreciate a really remarkable talent, I whispered back.”
“How would you know?” Sue teased. “You never come with me unless I force you to, like this time.”
“Shhhhh,” came a loud hiss from the lady seated behind us.
I’m not a classical music buff although my wife is, and I usually don’t accompany her to concerts and recitals, but this time she insisted that I go with her to hear Thomas Costa, a young prodigy, who was just starting to get national attention. “You’’ll be happy in the future that you’ll be able to say, yes, I heard him play when he was still relatively undiscovered,” she said.
That’s why I was very surprised when, on a Monday morning a few weeks later, Alice, my receptionist, pointed out his name on my schedule. “He’s your first patient, and oh, can you ask him to sign my program that I just happen to have with me, after you see him?” she asked.
He was already in the exam room, as I walked in and introduced myself. He really is young—but taller than he looked performing—big hands, I thought as we shook carefully. Don’t want to mash down on those flying fingers too hard, though actually he could probably crush mine. “How would you like to be addressed—Mr. Costa, Thomas, or Tom?” I asked.
“Tom works,” he replied with a shy smile.
“Well then Tom, what can I do for you today?”
“It’s about my hands,” he said.
“Before we go further, Tom, I want you to know that I know next to nothing about classical music, although my wife and receptionist do and are fans of yours. So if your question involves anything technically musical, I’m not your best choice.”
“That’s why I made an appointment with you. I asked my GP who might be a good neurologist who did not follow classical music closely, and he suggested you. I wanted to see someone who would have a very open mind.”
“I’ll try to keep one,” I said. “Please tell me why you’re here.”
“It’s about my hands,” said Tom. “Sometimes when I’m quiet, sitting or lying down, they seem to move like they are doing it on their own.”
“Like tremors or trembling?” I asked.
“No, more like they are playing a piece of music.”
“Does it ever happen when you are actually playing the piano?”
“No, just when I am not doing anything.”
“Does it ever happen like when you’re using your hands like driving or eating or on the computer?”
“And when did you first notice this?”
“About two months ago.”
I went on with additional questions but there wasn’t much more to add. His hands weren’t doing anything in the office, so I couldn’t see his problem, if there was one, for myself. A full physical exam followed by a neurologic exam were unrevealing.
“Has anyone else seen these hand movements?”
“My mother has, and she’s worried and insisted that I see a doctor.”
“Well, what I’d like you to do is to ask her to video them if it happens again, and bring it with you on your next visit. In the meantime I’d like you to get these tests done.”
Testing was unrevealing and I shared the negative results with Tom at his next visit a week later. He played the video of the hand movements for me on his smart phone. I agreed that they looked more like his fingers were playing something and just not experiencing simple tremors. “If you think they are moving as on piano keys, do you recognize what they are playing?” I asked.
The MRI of his brain was normal, and so was the spinal tap that he had very reluctantly agreed to. Over the course of a month, Tom reported that the movements were happening more often, were becoming stronger, broader, more sweeping, and they were now interfering with sleep. “I have to sit on my hands when I am with people so they don’t see them move. And you asked me once if my hands were playing a piece of music? Well, now I think they are. What’s happening to me? Am I going crazy?” He was understandably worried and agitated.
“From what you’ve told me and from my evaluation of you, no, I don’t think you are psychotic,” I said. “But do you think you could be, in a way, rehearsing—playing air piano like playing air guitar?” I asked.
“Why would I do that when I can do it on an actual piano anytime?”
“Tom, I’m puzzled too and have no answer. I’l like to try you on some medicines to see if they help. I also would like to have you seen by an expert in movement disorders up at the University, if that’s okay with you. A Dr. Stille. I’ll also continue to see you but I think we need more brains working on your problem.”
The drugs I tried him on made no difference. Stille put him through more tests and also drew a blank. He did refer Tom to a psychiatrist here locally, Bob Mannix, who I knew well and had worked with previously. “Just to cover all bases,” Stille told Tom. Tom reluctantly agreed to go.
On Tom’s next visit with me he said that he now felt compelled to be at the piano all the time when he wasn’t eating or sleeping. “I feel like my hands are forcing me to go to the keyboard to play. Like they have their own life and I am only a vehicle for transporting them. They are no longer content to just go through the motions, they want to do it on the piano. They are taking me over.”
The way he was describing his hands as entities separate from himself sounded very disturbing. “Have you told Dr. Mannix this?”
“Yes, and he wants to try me on some other medicines, but I’m worried about the side effects.”
Maybe something for schizophrenia, I thought.
Tom continued, “And now the music that they play are sometimes pieces that I have not studied or played before! How is that possible!?”
I mumbled something about perhaps learning them subliminally from having heard them, but Tom insisted some were works that he was sure he had never heard played.
“Listen to this review of Thomas Costa’s performance with the Philharmonic!” said Sue after dinner one night. “‘After receiving a prolonged standing ovation punctuated by cheering for his performance of the Beringer Piano Concerto Number Six, Costa returned for an encore. Selecting the even more difficult and seldom-played Rasputin Fireworks Fanfare, Costa exploded at the keyboard. The audience could not contain their enthusiasm and even as echoes of the last thunderous chords still lingered in the air, they leaped to their feet as one, joined by the members of the orchestra.’ Wow.”
This was just before his last visit with me.
“Congratulations, Tom,” I said, “You received a fantastic review of your performance. Especially your encore piece.”
“But that’s just the thing,” said Tom, looking haggard. “I went back to the piano intending to play another piece, and my hands just took over. I hadn’t even practiced the Rasputin!” He looked at me expectantly.
I didn’t know what to think or say. “I don’t think I’ve been any help to you Tom. I will keep on the lookout for any information relating to your condition, and you’re always welcome to come back and see me, but for now, see what Dr. Mannix comes up with.”
“You think I’m losing my mind too.”
“Tom, you are a brilliant talent and have been under a lot of stress. So while I don’t think you are out of your mind, I really don’t know what is going on. I have never heard or read of anything like this. But I will keep looking. With your permission I would like to stay in contact with Dr. Mannix who I know and have worked with in the past. May we talk about your condition?”
“Yeah, I guess,” he said in a low, discouraged voice.
“Let’s schedule a recheck for a month, but remember, you’re welcome to come back at any time.”
“What’s the use?”
I called Bob Mannix three weeks later. The anti-psychotic drugs hadn’t made a difference. In fact, he said, things were worse. Tom was losing weight and looked drawn and tired; he was at the piano for hours day and night.
“He feels desperate,” said Bob. “Said that if we couldn’t help him he would try something else.”
“He is going to try an exorcism.”
“He feels that his hands have their own life and that they have taken control of his mind and body. I couldn’t dissuade him.”
My next view of Tom was on the 6 o’clock TV news a few days later. Tom was in handcuffs, looking gaunt, disheveled, and confused, being taken in from a police cruiser to be booked, as the news anchor voiced over, “Thomas Costa, talented and renowned young pianist, is being investigated in the death of Father William Boyle who was found dead by strangulation at Mr. Costa’s studio. The police say that Father Boyle was at the studio to perform an exorcism and that Mr. Costa insists that it was not he but his hands who strangled the priest.”