Music, Medicine and Mind

Neurologist Aaron Berkowitz, B.A./B.S. '99, grew up with a love of classical music, especially the Romantics like Chopin and Rachmaninoff. He also played the piano with dreams of one day dabbling in composition. At the same time, Berkowitz imagined a career in medicine. So when he came to GW as an undergrad in 1996, he pursued a double major in music and biology.

The disciplines of music and medicine don't seem to overlap in any Venn diagram of possible careers, but Berkowitz has been able to combine the improvisation inherent in some types of music with his work as a physician serving marginalized communities and contributing to global health equity.

But like a meandering melody of a Chopin nocturne, Berkowitz's path from collegiate neophyte to the seasoned physician he is nearly 30 years later has been a winding one.

After graduating from GW in 1999, Berkowitz took a year off to study music in Paris before enrolling in medical school at Johns Hopkins University in 2000. By his third year, however, the high pressure, long hours and little sleep began to wear him down. So he decided to turn back to his love of music and attend Harvard for a Ph.D. in ethnomusicology-an anthropological study of music from the cultural and social aspects of the people who make it.

After finishing his ethnomusicology degree in 2009, Berkowitz returned to Johns Hopkins to finish earning his medical degree and then completed his residency in neurology at Harvard Medical School's Brigham and Women's Hospital and Massachusetts General Hospital in 2014.

Then Berkowitz was finally able to create his own career Venn diagram of the two, something he says wouldn't have been possible without his experience at GW.

Berkowitz cites two GW professors as being particularly formative for him, the late biology professor David Atkins and the late music professor Robert Parris.

"The opportunity to pursue biological sciences and music planted the seeds for those parallel medical and creative pursuits," Berkowitz said. "Both professors [Atkins and Parris] were incredibly generous with their time, mentorship and encouragement both in their respective fields and in supporting me to pursue my other interests outside their disciplines."

The best documentation of Berkowitz's ability to combine what he learned from both disciplines is his 2020 book, "One by One by One: Making a Small Difference Amid a Billion Problems," in which he reflects on life as a young physician working with the NGO Partners In Health in Haiti from 2011, when he began his neurology residency at Brigham and Women's Hospital, to 2018-four years after he completed his residency.

Berkowitz traveled from Boston to the Caribbean nation-one of the poorest in the world-where, he was told, there was only one other doctor in his field.

"At the time, there was one neurologist for Haiti's population of 11 million," Berkowitz said. "That would be like having one neurologist for all of Manhattan or Los Angeles County."

Almost immediately, the conditions on the ground in Haiti offered Berkowitz the chance to put his powers of improvisation to the test. In the book, Berkowitz describes an email from a Haitian doctor, Martineau Louine, describing a 23-year-old patient named Janel who he had evaluated for headaches and attacks of vertigo, as well as trembling movements of his right arm and right leg that affected his walking.

Berkowitz describes his reaction to the CT scan of Janel's brain.

I'd looked at thousands of CT scans during the eighty-hour weeks of my recently completed residency. But this CT scan was unlike anything I'd ever seen. The ventricles-hollow cavities deep within the brain-were filled with a mass of abnormal tissue…It was complex, its contour bulging out wildly in all directions, compressing and distorting the surrounding brain structures…

It was the largest brain tumor I'd ever seen.

Because there were no neurosurgeons in Haiti trained to perform complex brain surgery, Berkowitz had Janel flown to Brigham and Women's Hospital. Janel was young, and there was hope he might respond well to treatment, perhaps even recovering and returning to school.

Ultimately, Janel needed five surgeries at Brigham and Women's, repeated hospitalization and long-term rehabilitation. He didn't make a full recovery, but was walking, talking, eating and even singing thanks to the treatment Berkowitz helped him receive in Boston.

"It's not the huge save we were hoping for, but he's still alive after what was likely to have been a deadly condition," said Berkowitz, who has not been able to travel to Haiti due to the civil unrest that has gripped the country for several years.

"My idea in this book was to trace the tragedies, triumphs, and everything in between that come with this challenging work," Berkowitz said. "I learned so much from my colleagues in Haiti and our patients, and was so inspired by their incredible courage and faith in the face of neurologic disease. So I wanted to share their stories."

But even if the treatment of Janel had resulted in the "huge save" Berkowitz and his colleagues hoped for, it couldn't have been replicated on a larger scale. So, improvising once more, Berkowitz-working with the nonprofit global health organization Partners in Health -began teaching neurology courses for internal and family medicine practitioners and trainees in Haiti.

The success of those courses inspired Berkowitz and his colleagues to start a more intensive program that would enable more of its population to have access to neurological care: they trained 4 physicians in Haiti as neurologists, the first neurology specialists to be trained in the country.

In addition to his neurological training, Berkowitz says drawing on his ethnomusicology education helped him be successful by enabling him to understand Haitian culture and communicate across cultural, linguistic and socioeconomic boundaries.

"That anthropological framework is the foundation of ethnomusicology, and I think it gave me the perspective to be able to be a good collaborator and colleague there, and to make sense of working in an environment like that as a foreigner from a high-income country," Berkowitz said.