Sunday, April 7, 2013

The End of Sight at the End of Life

I presented this talk on Thursday 4/4/2013 at the Harvard University  "Think Tank" on Health and Aging. The two-day conference, held at the Charles Hotel in Cambridge,Massachusetts, brought together prominent scholars from the Harvard School of Public Health as well as global experts in economics, health care policy and longevity, for a fascinating and thought-provoking colloquium on the demographics and consequences of aging in all societies.

It remains difficult for physicians to confront and accept end-of-life issues in their patients, because our professional education and ethos inform us to do all we can as doctors to fight disease and prolong life. Can we afford to continue to do so with no limits and constraints? Even if we could, should we? Those are the moral and existential questions which confront us today.

For ophthalmologists, it is extremely difficult to accept end-of-sight issues in our patients. 

Over the decades, our specialty has proudly trumpeted its splendid life-enhancing victories over various causes of visual loss: certainly against cataracts, where we can safely and permanently remove them, replace them with a plastic intraocular lens, and restore sight, and we have been performing that miracle for years. We have been less successful in the management of glaucoma, macular degeneration and diabetic retinal disease, the other three leading causes of blindness, not only in developed societies, but increasingly in less developed ones as well, as the world's population is aging. These are diseases which we cannot yet cure, and over which we are only beginning to have some control. 

Based on cross-sectional studies done most recently in 2011, in the United States alone, almost three million people have advanced macular degeneration, my own mother being one of them, and over a million more have end-stage glaucoma or advanced diabetic retinal disease. There is a race, indeed a heated one, between research and development to bring new therapies to bear against these diseases, and the increase in their prevalence as we live longer lives.

The burden of those three diseases – glaucoma, macular degeneration and diabetic retinal disease - continues to loom over us, as they affect an elderly population which grows ever larger. The economic burden of these diseases thus continues to increase, as their progression causes more visual loss and medical visits, and more costly rehabilitation, low vision services and custodial care.  And what about the emotional burden? The emotional burden, for the patient and their family, is incalculable.

What is the price of vision, which is to say, what is the price of not going blind?

A 2012 global eye health survey performed in Spain, Russia, China and the US found that almost 70% of respondents in each of those countries would rather lose a limb, or ten years of life, than lose their sight.

Of course, eye specialists constantly preach preventative measures: annual eye exams for those over age 50, cessation of smoking, wearing UV-coated sunglasses when outside, weight loss, and eating a balanced diet, as the food journalist Michael Pollan reminds us, of real (that is, not processed) food, mostly plants, and not too much. To this I would also recommend the eating of cold water fish, in moderation, for their salutary omega-3 fatty acids, and to supplement with safe doses of Vitamins C and E, and the co-enzymes zinc, lutein and zeaxanthin. 

But we don’t always see the results of these strategies in clinical practice. At times, we face other more painful realities. 

So, how does an eye specialist deal with the patient and their family when that patient, who has end stage macular degeneration, glaucoma or diabetic eye disease, says to us, fearfully and plaintively, “Doctor, am I going to go blind?” ?

Our knee jerk reaction is, of course, that there must be something else to offer: to add another drop, to try one more injection, one more procedure, one more surgery. While we have been able to transplant corneas for over a century now, we cannot yet successfully transplant retinas or optic nerves, let alone whole eyes. So there are limits to our current technology, and when we do have to say to that patient, “I am sorry, there is nothing more to offer,” then what happens? Where does that conversation go? 

That patient is usually already infirm, perhaps with degenerative joint disease or rheumatoid arthritis, or suffering from the relentless consequences of bad choices over a lifetime, such as smoking and poor dietary habits, which have led to pulmonary disease and the metabolic syndrome of atherosclerotic cardiovascular disease, diabetes, and hypertension.

Yes, the patient is certainly alive, but what will the quality of that already difficult life become now, as they progressively lose vision? How will that patient now imagine their grandchildren, whose faces they have blissfully enjoyed seeing, often too infrequently? How will they drive their car, watch their favorite television shows, do their puzzles and sudokus, read their books and e-mails, or call their friends, all those comforting activities that stem the tide of the loneliness, and now the darkness too, that inexorably envelops them?

For a few patients, as I have poignantly witnessed over the decades, end-of-sight becomes a life no longer worth living. One such narrative documents at once the arc and trajectory of one man’s vision, and is also a constant reminder of why I became a physician and surgeon in the first place:

In 1995, I had the privilege of assuming the eye care of a prominent modern artist, a brilliant and inquisitive man, vibrant and trim and athletic even in his late 70s. His artistic style could be described as a wonderful amalgamation of the freedom  and gesture of the abstract expressionism of Pollack with the monumentality of the cubism of Cezanne and Picasso.

He had been diagnosed with cataracts, and was despondent because the cataracts had made it increasingly difficult for him to actualize his artistic vision and creations. I performed cataract surgery in both eyes, a few months apart,  and he and his art seemed to flourish afterward; indeed his palette regained the blues and purples and an overall vibrancy that the cataracts had stolen.  I remember giving a lecture on art and visual perception about a year after his cataract surgery, and he graciously came to that talk to explain to the audience the changes in his visual perception and his art before and after the eye surgery.

About five years later, for no explicable reason, he developed strokes to both of his optic nerves, a few months apart, with rapid and profound visual loss. The optic nerve is part of the central nervous system, an extension of the brain, and cannot regenerate if damaged. I sent him to the best neuro-ophthalmologists for subspecialty care.

A few months later, after extensive evaluations and treatments, he came back to me for follow-up, still with substantial loss of vision in both eyes. As I examined him, he leaned in and said to me, almost in a whisper, “Vincent, if I cannot paint, I cannot live.” About six months after that second eye had sustained profound visual loss from the stroke, he passed away. 

The memorial service was held in New York City, about a hundred miles from my office. As life would have it, I was scheduled for a busy  surgery session that day and I did not make it down for that very personal event.

About a month after the memorial, I received a note, which I still have on my desk. The note was from the artist’s spouse, herself a leading voice in American literature. lt read, “Dear Vincent,  He was so devoted to you. You were the architect of his eyes.” She told me that he had fallen, was hospitalized, and died of complications, yet I still wonder about the last days and thoughts of that wondrous mind and spirit.

No, ophthalmologists cannot accept end-of-sight.  Not easily at all. And that is how it always should be, because it will continue to catalyze us to find cures for all causes of visual loss, so that our patients, and at some point we are all patients, can enjoy the beauty of this world while we are still here.

@ Vincent de Luise MD  A Musical Vision

Saturday, April 6, 2013

The Long and (Wood)Winding Road of Two Clarinets

This essay is a research document that accompanied  my donation of Viktor Polatschek's two Albert/Muller/Oehler system clarinets, an A clarinet and a Bb clarinet,  to the Boston Symphony Orchestra (BSO), on Sunday, August 12, 2012, under The Koussevitsky Music Shed at Tanglewood. The clarinets have been shown publicly at Symphony Hall in Boston since the fall of 2012 as a highlight of a feature display on the current clarinet section of the BSO. I am indebted to Ms. Bridget Carr, senior archivist of the BSO, and to Ms. Jill Ng, senior major gift officer of the BSO, for their assistance with this project.
Viktor  Polatchek's two Albert/Muller/Oehler system clarinets
Manufactured c. 1909 by F. Koktan and Sons, Vienna

This is a story about three musicians, two of whom never met and the third the link between the two, about the richly resonant and textured woodwind instrument that has defined their lives, and about the love they each have had for their chosen instrument and its craft. It is also a story about mentorship, heritage, stewardship and legacy, connecting episodes in the lives of these three musicians, with the clarinet epicentric as their muse, and with clarinetistry as the roadmap. It is an interesting story which fills in some holes and closes some loops along the way, much as pressing the many rings and closing the many holes of the clarinet help to make its sound so unique, elegant, tonally even and seamless through the diatonic scales.

There are three interconnected strands to the circuitous journey of two clarinets, from their manufacture in the early 1900s in the workshop of the pre-eminent woodwind maker in Vienna, Austria, Franz Koktan and Sons, to their purchase by the then principal clarinetist of the Vienna Philharmonic, Mr. Viktor Polatschek, to his crossing the Atlantic in 1930 to become principal clarinetist of the Boston Symphony Orchestra (BSO), to their being given to Mr. Eric Simon by the Polatschek family sometime after Polatschek's death in July, 1948, to their being given by Mr. Simon to me in June, 1994, to my donating them to the Boston Symphony Orchestra on August 12, 2012.

Viktor Polatschek (1889 - 1948)

Viktor (Victor) Polatschek was born January 29, 1889 in Chotzen (Choceň in Czech) Bohemia, in what is today the Czech Republic. He began to study the clarinet in 1903, at age 14, in Vienna, at the Konservatorium fur Musik (later named the Akademie fur Musik), the Vienna State Music Academy. He studied with Professor Franz Bartolomey from 1903 to 1907, graduating with highest honors, and then re-enrolled in 1909 to study with Professor Hermann Gradener. He began teaching at the Vienna Music Academy in 1921 while playing at the Vienna State Opera. He kept his academic post until September 30, 1932. His students included Alfred Boskowsky, Viktor Korda, Hans Kremsberger and Eric Simon.

In 1910, at the age of 21, Polatschek was appointed as one of the two clarinetists of the Vienna Philharmonic Orchestra (VPO) and at the Wiener Staatsoper (Vienna State Opera(VSO)) in 1912,. He was named principal clarinet of both VPO and VSO in 1921, and held those positions until 1930.
Viktor Polatschek in 1930, at age 41,
when he joined the BSO
(courtesy BSO Archives)
Polatschek was also active in clarinet pedagogy at the Vienna Music Academy, and composed several works for clarinet which also have a teaching function. Notable are his etudes based on themes from famous works, including one based on Schoenberg’s Pierrot Lunaire, as well as  two important and challenging clarinet primers, the 12 Etudes for Clarinet, and Advanced Studies for Clarinet. Polatschek was also a musical adviser to the Edward B. Marks Music Corporation.

In 1930, at the urging of Maestro Serge Koussevitsky, Polatschek emigrated to the U.S. to join the Boston Symphony Orchestra(BSO), and shortly thereafter was named principal clarinet of the Orchestra. During his 18 years with the BSO, Polatschek played the lead parts of the wondrous clarinet literature for symphonic ensembles. He soloed in the Mozart Concerto K.V. 622 on November 14 and 15, 1930, and the Brahms Quintet for clarinet and strings, Op 115, on April 27, 1933.
Polatschek continued teaching at Tanglewood at the Berkshire Music Festival during the 1930s and 1940s. He was said by one of his students, Professor Henry Gulick of Indiana University, to be “an impeccable musician, with great taste in music, with a very courtly and refined personality.”

On July 27, 1948, while rehearsing the Bach-Mozart series of concerts with the BSO at the Berkshire Music festival at Tanglewood, Polatschek sustained what was presumed to be a massive heart attack, was moved to a hospital in Stockbridge, Massachusetts for treatment,  and died. He was 60 years of age. His widow and sister survived him.

According to Pamela Weston, in her book More Clarinet Virtuosi of the Past, referenced in the FSU PhD thesis of TL Paddock in 2011, “A Biographical Dictionary of American clarinetists,” Vienna’s clarinetists, including Polatschek and Wlach, played a German-made clarinet, the Oehler-Albert system clarinet, which is also called the “German ‘simple system’ clarinet.”

A short the history of the clarinet

The clarinet, a single reed instrument developed from the ancient chalumeau, was largely the work of the workshop of Johann Christoph Denner of Nuremberg. By 1707, Denner had perfected an instrument which we would recognize today as a primitive clarinet, with few holes and minimal keys. Over the next century, various design modifications took place to allow the still evolving clarinet to play several octaves, with all notes largely in tune.

A modern day clarinet

Two Denner clarinets from the early 1700s.
Note the minimal use of keys.

In  1810, Iwan Müller (Ivan Mueller) developed a clarinet mechanism that he called the “German simple system” which included two “brille” (spectacle-looking metal rings) on the upper joint. It was Müller who had the clever idea to add pads of kid leather stuffed with felt to the keys, and countersink the holes,  creating air-tight seals, and thus improving the clarinet’s chromatics dramatically.

Oskar Oehler (1858-1936) combined the so-called Albert clarinet system of Belgium (1844) with Muller’s German “simple system,” and added his own modifications, to create the Albert/Muller/Oehler clarinet system.

The Oehler system "adds tone holes to correct intonation and acoustic deficiencies, notably of the forked notes (B and F). The system has more keys than the Boehm system,up to 27 in the Voll-Oehler system (full Oehler system). It also has a narrower bore and a longer, narrower mouthpiece leading to a slightly different sound. It is used mostly in Germany and Austria. Major developments include the patent C, low E-F correction, fork-F/B correction and fork B♭."

Franz Koktan was a Viennese maker of Oehler-system clarinets (Anthony Baines, Woodwind Instruments). Viktor Polatschek and Leopold Wlach, Polatschek’s student and another prominent clarinetist, played Oehler clarinets. Wlach succeeded Polatschek as principal clarinet of the VPO and VSO after Polatschek moved to Boston.

The clarinets that Polatschek and Wlach played were crafted by Franz Koktan and his son, Franz II (Franz junior), who continued his father’s clarinet workshop from 1907 to 1945. The following data about the Franz Koktan clarinet manufacturing family was obtained from The New Langwill Index:

Koktan, (1) Franz (b) Klein Oreschowitz / Bohemia 12 July 1842; (d) Wien (Vienna)  3 September 1901) WWI ; fl Wien  (Vienna), 1880-1901. From the same village as Bradka, he is first listed in Wien in 1880 as a specialist in clarinet.
Wien 1888, 1892 (flute, clarinet, bassoon).
Koktan, (2) Franz, junior (b) Wien 29 January 1881; (d) ibid October 1971) WWI fl Wien 1907-c 1945. Son of (1), he worked in the shop after his father’s death; 1907 successor; 1924 admitted master. Clarinet specialist; reported to have attempted between the wars to manufacture the Heckel-model bassoon in Vienna.

Eric Simon
(N.B. I have researched Eric Simon's life from his memoirs and papers, which reside in an archive that his family donated to Yale, and which is now accessible as:  The Eric Simon Papers in the Irving S Gilmore Music Library at Yale University, New Haven, CT.)

Eric Simon (1907-1994) was a clarinetist, composer, music editor, and one of the great clarinet pedagogues of the 20th century. He and his good friend and colleague Leon Russianoff trained many of the world's greatest clarinetists in the mid-twentieth century.
 Eric Simon was born in Vienna in 1907 and began to play piano at age 8. In 1921, at age 14, he switched to clarinet, and began taking clarinet lessons from Viktor Polatschek in Vienna, at which time Polatschek was principal clarinetist of the Vienna Philharmonic and the Vienna Staatsoper. After Polatschek came to America to join the Boston Symphony Orchestra as its principal clarinet, Simon continued to study with Polatschek's successor at the Vienna Philharmonic, Leopold Wlach. Polatscek and Wlach both played German-system clarinets - the Albert/Muller/Oehler clarinets.
Simon moved to Sherman CT in 1949 where he lived for the rest of his life. From there, he traveled into NYC to teach at Mannes College of Music, to give clarinet lessons and to edit, transpose and transcribe a significant amount of the clarinet literature, for several music publishing houses.  Many of today’s most popular clarinet music scores, from Schirmer’s Music Publications and International Music, bear the name of Eric Simon in the top left corner, right under the name of the composer.
My own musical journey began in elementary school when I sang in the chorus in a 1960 performance H.M.S. Pinafore. Our family moved to Garden City in 1961, where I began fifth grade. It was the afternoon of October 3rd of 1961, during the New York Yankees-Cincinnati Reds World Series, that my father, who was not a baseball fan at all (he, being Italian, much preferred soccer to baseball), came home carrying three musical instruments, a flute, a trumpet and a clarinet, to see if I might want to take music lessons. He asked me to try them, which I did (after the Yankee-Reds game, of course, which the Yanks won), and, for some still inexplicable reason, liking the sound and feel of the clarinet the best, I chose that instrument and never looked back
Fifth and sixth grade were a joyous musical time. Our music teacher and conductor, Mr. Thomas E. Wagner, was legendary throughout not only Nassau County but all of New York State (NYS Teacher of the Year) as a music instructor and pedagogue, and somewhat of a "pied piper" to his music students, as he too was a clarinetist. Several of my classmates and schoolmates who also played under him as their band director have gone on to professional music careers (Douglas Hedwig at the Met Opera Orchestra on trumpet, Mark De Turk as a professional clarinetist and university musicologist, and pianist and organist John Tesh, of Entertainment Tonight and "The Red Rocks").
Although middle school music was a blur of squeaks and squawks, I stuck with the clarinet, to the consternation of my sisters in the next bedroom, but in high school things took off. Our high school band and orchestra conductor was the disciplinarian and perfectionist, Mr. John Chadderdon, himself also a clarinetist. Those of us who were serious about our instruments were expected to audition for both. Mr. Chadderdon expected, and received, nothing less than excellence at all times. He rehearsed us intensely, and took us to the NYSMA (New York State Music Association) competitions each year, where we played the highest (6A) level compositions, and won each of the three years I was in high school. Indeed, senior year, our concert band played the band transcriptions of the complete Borodin second symphony and the Dvorak ninth symphony in concert !
In high school, I studied with Paul Doty, who was a clarinetist with both the New York City Ballet and New York City Opera. In my senior year, as was the custom for first desk players, I got to choose a solo piece to play with the symphonic band. I wanted to perform the Weber Concertino or the Mozart Concerto, but the latter was too long, and (Mark) DeTurk, one year ahead of me, had played the Weber the year before. So I chose the Ernesto Cavallini Introduction, Theme and Variations. It thankfully went well, in late December of 1968, despite the fact that I had a 100 degree fever that night. I crashed at home through the week of winter break, too feverish and weak to attend my grandfather's funeral three days later.
I also was invited to play saxophone in a rock band, the All-American Band (which included Hedwig and Tesh, as well as Bob Eggers, a superb vocalist and guitarist, who went on to Yale and became pitchpipe of Yale's Whiffenpoofs, America's oldest a cappella singing group, and is the currently active as the group's archivist). This rock band was a great escape from academic work and gave me a taste of the great pleasure and great challenges of learning to play improvisationally.
I went on to Princeton University the following fall, and stayed with the clarinet, joining the infamous Princeton University Band, where I helped to write those hilarious and very off-color half-time shows for which certain Ivy schools (Princeton, Yale, Harvard and Columbia) are well-known. In the fall of 1972, as Band president my senior year, I remember being in One Nassau Hall (once the capital of the United States during the Revolutionary War) on more than one occasion, in then President Robert Goheen's office, trying to explain why Princeton's alumni shouldn't be that upset in their numerous phone calls and letters they sent President Goheen about the salacious double entendres we were announcing and playing on the football field ! That is when Princeton University first initiated a censorship board to "help out" the Band with its half-time shows.
Off the football field, the Symphonic Band was led by the beloved Dr. David Uber, principal trombone of the New York City Ballet, and a fine interpreter of the music of William Schumann, Gustav Holst and Percy Grainger. The Princeton University Symphonic Band joined forces with Harvard's Symphonic Band to perform at Avery Fisher Hall in the spring of 1972, which we recorded on vinyl LP, essaying Holst's Planets, and Grainger’s Lincolnshire Posey.
During medical school at Weill Cornell Medical College, I continued with the clarinet, playing occasionally with the Doctors' Symphony, which back then met at the 92nd street Y or at Mount Sinai. As an intern and fellow in San Francisco, I had just enough extra money to take lessons with David Breeden, then the principal clarinet of the San Francisco Symphony, and during ophthalmology residency at the Bascom Palmer Eye Institute in Miami, I studied with William Klinger, the principal clarinet of the Florida Philharmonic. While in Miami, I got to meet a former violinist of the Budapest String Quartet, a Mr. Polyatkin, who had retired to Miami Beach, and spent several remarkable evenings with him and his new string quartet, playing the Mozart and the Brahms quintets. On one memorable night, Mr. Polyatkin and his wife invited me to accompany them to hear the Beaux Arts Trio at the Dade County Auditorium. After the performance I spent that evening in the Green Room with the Polyatkins and the Beaux Arts’ great musicians, Isidore Cohen, Bernard Greenhouse and Menaheim Pressler, listening to their marvelous stories about the glories of chamber music before and after the Great War.
During my thirty-year career as a clinical ophthalmologist, I stayed close to the clarinet and classical music. I began to delve deeper into the clarinet chamber literature, with piano or strings, giving a number of lecture-recitals on Mozart, Brahms, Schubert and Schumann, interpolating the backstory of their musical lives and medical illnesses with performances of their ineffable chamber works for clarinet.
In 1991, I organized and lectured at The Connecticut Mozart Festival, a thirteen-concert Festschrift of Mozart and his music, to honor the bicentenary of the composer's death (and finally got to play that Mozart Concerto, dressed up as Anton Stadler, to boot). Earlier, in 1987, I collaborated with Jonathan Lass M.D., a fine cellist, professor and chair of ophthalmology at Case Western Reserve University in Cleveland, in founding the annual classical music recital that took place annually for twenty years, during the meetings of the American Academy of Ophthalmology. A remarkable number of ophthalmologists are also outstanding instrumentalists and vocalists, and the orchestra was of the highest caliber given that these musicians were not music professionals.
Six years into my career as an ophthalmologist, in 1988, I began to care for a patient, Mrs G.L. Born in Vienna, she was a Mozart lover, and having found out about my own love of Mozart and the clarinet, began to help translate some of the German primary sources I showed her of Mozart's life and medical problems. She invited me to lecture and perform in recital at Heritage Village, the retirement community in which she lived, and told me in passing that she happened to be the first cousin of a certain Mr Eric Simon, and whether I had heard of him.
I was elated to hear of this coincidence, because, as every clarinetist knew, Eric Simon was the pre-eminent clarinet pedagogue and musical editor for our instrument. "Edited by Eric Simon" or "Transcribed and Transposed by Eric Simon" was a common finding in many Schirmer editions and International Music editions for the clarinet. In fact, the edition of the Mozart Clarinet Concerto KV 622, published by Schirmer, in the reduction from A clarinet and orchestra to Bb clarinet and piano, was the product of Eric Simon's editing and transposition. It remains a classic edition and is still one of Schirmer's best sellers.
Over the ensuing years, Mrs. L. kept asking me if I wanted to meet Mr. Simon, and of course, I said yes each time. But, for some reason, I didn’t get  around to it for another five years. During that time, Mr. Simon would call me at home or on my cell phone (quite new then), often at odd times of day, in that quiet, mysterious, Yoda-like voice of his : "Vincent, this is Ehreek Sigh-Mohn" and we would talk, often for hours, about the clarinet, its textures and nuances, about various interpretations of the clarinet literature, about which was the best clarinet book I had read (a tie between Jack Brymer’s and Keith Wilson's), about whether I liked Reginall Kell more than Frederick Thurston (I liked Kell more), about what I thought of Richard Stoltzman's vibrato (I liked it because it was Dick Stoltzman’s after all, and I didnt think it was overdone) and about how amazing it was that there had finally been a female member of the Berlin Philharmonic, (and this under von Karajan!), and it was a clarinetist, the brilliant Sabine Meyer. Often, on these phone calls, he would ask me to visit him, but I always demurred, what with patients the next day, or surgery to do, soccer or swim practice with the kids, vacations and all of the rest of life that took precedence.
In June, 1994, during one of Mr. Simon's phone calls to me, he at one point in the conversation casually asked once again for me to come visit him at his home. This time, out of a combination of respect for him and sheer exhaustion, I agreed. He asked me to bring my Bb clarinet, to prepare the first Brahms clarinet sonata, the f minor, Op. 120 No.1, with its difficult opening measures of vast and exposed intervals, and to bring the score that he had edited from Schirmer's.
How did he know I had that particular score?  I guess because everybody who played the clarinet at the time had that score, which Simon edited, in the volume “Masterworks for Clarinet and Piano;” that was the score from which we all learned the Brahms sonatas. The original 1896 Simrock edition (Simrock was Brahms' publisher in Leipzig) was too difficult for us American clarinetists to obtain.
I practiced the Brahms for about a week, and called Mr Simon back that I was ready to come to see him. It was to be the following Saturday. It turned out that he lived in Sherman, Connecticut, only about forty minutes away from my home, another curious coincidence.
I got there around 11 am, to see a lovely, tidy, one-story steel and glass house not dissimilar from the famous Philip Johnson "Glass House" in New Canaan, set back from a pond on a verdant piece of land, forested with enough trees to create a dappled effect on it.
I entered through an open door into a small vestibule which opened onto a large living room. A Steinway grand piano was in one corner, near the only bank of windows, which faced the pond, but every other space- wall and floor, and cabinet- was covered with sheet music!
There was no place to sit, because the couch and all the chairs also had sheet music on them. Mr. Simon was in the corner near the piano, hunched over gnome-like, and greeted me enthusiastically. He asked me to take out my clarinet, put the Brahms score on the music stand that was already set up, and begin the f minor sonata, he accompanying on piano.
After the eighth measure, he stopped me. I shuddered, expecting the worse. And it came. He paused, and then for the next thirty minutes, he critiqued my playing, the quality of my tone, the tightness of my embouchure, my tonguing, my legato, my phrasing. I was so embarrassed and angry at myself that I had actually driven up there just to be humiliated like that, that I wanted to leave. He sensed my frustration because at that moment he said: "Vincent, don’t worry. Last Saturday morning, Richard Stoltzman was standing right where you are standing, and I critiqued him just as severely!"

What ??!! 

Things went better from there, and I got through the first movement reasonably unscathed. I really wanted to go on and play the autumnal, elegiac and poignant second movement with him, but we never did.
Instead, he began to talk to me about the clarinet and its history, and he  started to show me some musical scores; first editions dating back to the 1890s, of the two Brahms sonatas and the quintet and trio, of the original 1920 Durand edition of the Saint-Saens sonata, of the first edition of the Poulenc sonata, of an early edition of the sinfonia concertante for winds and orchestra (KV 297b, Anhang 14.01) that may or may not have been one of Mozart’s compositions, of his (Simon's) correspondences with his friend Leon Russianoff, and of letters from and to Benny Goodman.
It was amazing.
I was witnessing music history.
Here was a master teacher of the clarinet, of my chosen instrument, one of the last living links between the great 19th century and early 20th century clarinetists of Vienna, Germany and France, of Langenus and Bellison and Bonade, and the present day. I was at once astonished and mesmerized. I didn’t realize that four hours had already passed by that point, and I told Mr. Simon I really had to go.
As I left his home and was walking to my car, he called me back and said that he wanted to give me something. So I went back to the front door and he handed me a large and heavy cardboard box, and told me to look inside.
In it were dozens of scores.! And what wonders were contained therein !
I had a glimpse of the Simrock first edition of the great b minor Brahms clarinet quintet and the Simock edition of the two Brahms clarinet sonatas as well ! There was the Saint-Saens sonata,  one of the Weber concertos, the Poulenc sonata and the d’Indy trio, and a number of chamber works by composers I had never heard of (and I thought I knew the clarinet chamber literature).
Beneath the scores, there was also a black music case. Mr. Simon asked me to open it, which I did, and he said, "Vincent, these are Viktor Polatschek's clarinets. You know the name. He was the principal clarinetist of the Boston Symphony for many years." Actually, at that time, I didn’t know that name at all. And, I also didn’t know what to say.
What I did notice was that the clarinets in that music case weren't Boehm-system instruments; that is, they weren't the French-made Klose/Buffet Boehm system, which is what most of us play in the US.
I assumed that they were German clarinets, with the Albert/Oehler system, to which  Mr. Simon concurred, and I told him that I probably couldn’t get a good sound from them. He responded that I needn't worry, and that I should just take care of them. I thanked him profusely for these gifts and I left.
There were a few more phone calls with him over the summer, mostly of me thanking him for his largesse, but those phone calls came to an end too.
Mr. Simon passed away four months later, in October 1994, at the age of 87. I had given him my word that I would take care of the clarinets, and indeed, the clarinets have laid safely in my library for the last eighteen years. The scores still do as well, and when I play the Brahms sonatas, the Saint-Saens, the Mozart, I only play from the editions which he gave me. For some reason, I feel closer to the composers and to their music when I do.


In 2009, I began to correspond with Dr Nick Zervas, a neurosurgeon at the Massachusetts General Hospital and a board member of the Boston Symphony Orchestra, about the possibility of donating the two Albert/Oehler system clarinets to the Orchestra, for them to archive, house and display in Symphony Hall.  I had never played the two instruments that Mr Simon had kindly given me, but I felt over the years that they should eventually be donated to a musical institution, and returning them to the BSO was the right thing to do.

I didn’t have any documentation, besides Mr. Simon's parting words to me, that they were Polatschek’s.

I examined the clarinets under high magnification, identifying the etched inscriptions of "F. Koktan, Wien" on the upper and lower joints of both clarinets, noting the Albert/Oehler mechanisms in both instruments, marveling at the fine condition of the East African hardwood (Melanoxylon dahlbergii) of which they were composed, Piecing together the findings and the three interdigitated stories, I became certain that the two clarinets that Mr. Simon gave me that day in the summer of 1994 were indeed the clarinets of his teacher, Viktor Polatschek, of the Vienna Philharmonic, Vienna StaatsOper and Boston Symphony Orchestra.

I then had the clarinets evaluated  by a highly regarded organologist and renowned historian of the clarinet, who  researched the serial numbers on the upper and lower joints of both instruments and confirmed that  the clarinets were made in Vienna in Koktan's workshop between 1905 and 1910.  

On August 12, 2012, under the Koussevitsky Music Shed at Tanglewood, during the intermission between the Beethoven Fourth Symphony and the Mozart Piano Concerto No, 23, in A, KV 488, with the help of Bridget Carr and Jill Ng at the Boston Symphony Orchestra, I donated these two splendid, Viennese clarinets to the Orchestra. The donation took place at a sacred source of classical music, at one of its epicenters, Tanglewood, in Lenox Massachusetts, where Viktor Polatschek played those clarinets so elegantly, each summer from 1930 to 1948. 
  BSO Archivist Bridget Carr receiving the
  Polatschek clarinets from me at Tanglewood
Aug 12, 2012

I have helped ensure that these two historical instruments have been brought back to their last musical home, to Symphony Hall in Boston, where, under the baton of Maestro Serge Koussevitsky, the clarinetist Viktor Polatschek played them so marvelously those many years ago.

Sic transit gloria mundi

At Symphony Hall in Boston on Saturday, May 5, 2013
with the Polatschek clarinets on display.

   Polatschek clarinet mouthpiece .
   Note the multicolored sock swab

The Polatschek clarinets on display
 at Symphony Hall

@ Vincent P. de Luise MD, A Musical Vision, 2013.