The spirit of the music survives

Chicago Tribune

(KRT)

Dace Sultanov wheeled her husband, Alexei, to the electric piano in their Fort Worth living room, and he began to rehearse one of the most difficult pieces of music ever written.

Paralyzed by a rapid series of strokes in 2001, the once internationally acclaimed pianist could not walk or talk. Yet he had taught his right hand to play again and extract melodies from Chopin piano concertos, Mozart sonatas, Tchaikovsky children's pieces - a long litany of compositions.

On this morning in June 2004, he pointed his forefinger at the score for Rachmaninoff's Piano Concerto No. 3, a piece that most pianists approach with trepidation.

In playing the concerto, Sultanov stripped away thousands of notes from an ornately lush composition. He cut to its melodic core.

To a music aficionado, his efforts might have seemed a mockery of a classical masterpiece. Actually he was shrewdly reconfiguring it, playing it in a way he never did before the strokes twisted his body and destroyed his career as a piano star.

Sultanov assigned new roles to five fingers that once blazed through the piece. As his hand moved gingerly across the keyboard, his mind had to race ahead, identifying which notes were critical to give voice to the music he could still hear in his inner ear.

In effect, he was transforming a monumental score into the few shards of melody that his barely functioning body still could produce.

His wife asked Sultanov if he would like to try improvising. He gestured "yes," and she played a recording of Ella Fitzgerald singing "My Funny Valentine." Sultanov began riffing along on his electric piano, instantly finding Ella's key and chords, a sure indication that he retained his perfect pitch.

But he had held on to something else as well.

The sound of Ella's voice - soft and gauzy and, in a way, heartbreaking - rolled over Lorenz Hart's bittersweet lyrics. "Your looks are laughable, unphotographable, yet you're my favorite work of art."

As she sang, two tears rolled down Sultanov's expressionless cheeks, which turned pink.

Music still reached him.

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To the casual observer, Sultanov's achievement - making music with one hand while the rest of his body remained motionless and mute - might seem inexplicable. How does a man who cannot walk or talk manage to reconceive intricate pieces of music, then coax a single, functioning limb to play them?

The answers were hidden in Sultanov's brain, the true seat of his virtuosity.

"Regardless of how devastated he may look from the outside, on the inside he's actually very much preserved," said Dr. Mark Tramo, director of the Institute for Music & Brain Science at Harvard University. Tramo studied Sultanov's CT scans and MRIs last year at the Chicago Tribune's request, to try to understand why the pianist still could perform, albeit in a limited fashion.

The strokes destroyed parts of Sultanov's brain that receive incoming messages from the rest of the body. They also damaged crucial tissue that allows messages to travel from the brain to the rest of the body. These effects virtually wiped out Sultanov's motor abilities.

Yet his cerebral cortex - the outer shell of nerve cells that researchers believe helps manage how we understand our world - seemed untouched by the strokes of 2001, said Tramo.

"His musical abilities and emotional life and abstract reasoning and those structures of the brain that govern intellectual and aesthetic emotional life are actually spared," said Tramo. "His memory for music is preserved."

On a cellular level, the musical brain remains virtually uncharted territory, including its mechanisms for creating and understanding sound.

The calamity of Sultanov's strokes showed how quickly a virtuoso's brain can be robbed of its gifts - and how slowly and painstakingly they can be reclaimed.

Though science still is trying to crack the code of musical cognition, the current consensus suggests that sounds are processed through the auditory cortex of the brain, a dense tangle of nerve fibers in the vicinity of each ear. This region of Sultanov's brain - particularly on the right side - appeared untouched by his strokes, according to brain scans. So, too, the frontal lobe - where we plan, concentrate and reason - was mostly spared.

Studies suggest that musicians tend to distribute their knowledge of music deeply across both hemispheres of the brain, so Sultanov may have drawn his memories from a wider field of undamaged tissue than a non-musician.

"It's an unknown system. We don't know how it works," said Peter Cariani, a Tufts Medical School scientist who has been studying music and the brain for decades. "We don't know the principles by which it is organized, by which its computations operate."

He pointed out that scientists still debate whether music is governed by particular regions of the brain or by the specific ways in which neurons are firing in the brain, regardless of location.

And though recent studies seem to indicate the right side of the brain has a great deal to do with melody and the left with rhythm, related issues are wide open to debate, said Dr. Gottfried Schlaug, director of the Music and Neuroimaging Labat Beth Israel Deaconess Medical Center in Boston.

"There's not a lot of agreement among researchers on where a lot of the other things happen," said Schlaug. "Where does pitch processing really happen? Where does harmony actually happen?"

When Sultanov sat at the keyboard, it became apparent that some musical functions survived or were repairing themselves in his brain. He could play virtually any piece he used to know, though in minimalist form, plus new pieces he continued to learn by ear.

His doctors believed that by practicing and performing, he coaxed his brain into reclaiming lost ground.

Though his body no longer could serve him very well, the great musician within lived on.

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Dace Sultanov rolled her husband's wheelchair to the front of a huge ballroom in the Fort Worth Convention Center, where more than 1,000 people were about to hear a musical performance they did not expect.

They came to be sworn in as citizens, as did Dace and Alexei Sultanov, who dreamed of this moment long before Alexei's strokes. Having passed the citizenship test a few months earlier - Alexei Sultanov by answering questions with "yes" or "no" finger gestures - they decided to celebrate the occasion the way they've marked all the milestones in their lives, large and small: by making music.

A couple weeks before Thanksgiving 2004, they asked permission to perform at the ceremony.

"Alexei suffered a series of strokes, which left him partially paralyzed," presiding U.S. Magistrate Judge Charles Bleil told the crowd, introducing their impromptu performance.

Once Bleil concluded his comments, Dace Sultanov switched on the portable electric keyboard and the duo launched into "America the Beautiful." Her majestic chords and the inevitable boom-chicka rhythm track supported the single-note melody line Sultanov produced with his right hand.

Dressed in a bright red shirt, an American flag planted in a slot on his wheelchair, Sultanov was beaming, performing for the first time before an audience as large as the ones that used to flock to his concerts.

The audience barely stirred while Sultanov played, a few individuals slowly rising to get a better look at the star-spangled performer and his wife, who sported the colors of the American flag. Several hand-held video cameras started popping up as well. Before Dace and Alexei finished the first chorus, a flock of TV news reporters already in the house to cover the swearing-in swarmed to the front of the auditorium, bathing the Sultanovs in beams of white light.

Faizul Sultanov, who had flown in from Moscow for the occasion, trained his own video camera on his son. As the slightly surreal scene unfolded, tears streamed down Dace's face.

When the two hit the final chord, the room shook with cheers, applause, shouts and standing ovations. No one clapped more exuberantly than Donna Witten, the physical therapist who had insisted Sultanov play the piano again and promised to be in the front row when he returned to the stage.

Few realized that it was almost precisely in this space, in a building long since razed, that Sultanov claimed the gold medal in the Van Cliburn International Piano Competition, 15 years earlier, to similar hurrahs.

While the applause swept across the room, while TV reporters moved in to get interviews with the Sultanovs for that night's local news shows, Sultanov raised his right hand, waving slowly but broadly to the audience - a brief reprise of earlier triumphs but a personal landmark nonetheless.

He still could move a crowd.

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In the months following Sultanov's jubilant performance at his swearing-in ceremony, he and his wife made the rounds of Fort Worth nursing homes and hospitals. They continuously expanded their repertoire of classics and bulked it up with popular tunes, such as Scott Joplin's "Maple Leaf Rag" and their biggest crowd-pleaser, "Deep in the Heart of Texas."

For vacations, they often drove to Galveston, about five hours' south. The fresh gulf breezes did wonders for Alexei's allergies. The couple collected seashells, splashed in the waves and fantasized about someday buying a big house on the shore.

On June 28 of this year, Dace's mother, Benita Abele, arrived from Riga, Latvia, for her annual visit. The trio barbecued steaks that night, Alexei using his increasingly responsive right hand to flip the meat on the fire.

The next day, after a big breakfast, Dace took Alexei swimming at the local Y. That night they gathered in the living room to watch the finale of "The Real Gilligan's Island," a TV reality show that Alexei loved to follow, Dace said, because he couldn't wait to see who would win the $250,000 prize.

Sometime after 10 p.m., Dace put Alexei to bed, reminding him that they were going to wake up early the next morning, at about 7 a.m., to go to a nearby lake before the summer sun became too hot.

Around 4:30 a.m., Alexei became uncomfortable in bed, so his wife repositioned him, as she typically did every 90 minutes or so. Then she closed her eyes and didn't wake up until sometime past 9 a.m., surprised she had overslept.

"Alosha, wake up, we have to get to the lake," she said to her husband. He did not respond.

She reached over to touch him, but still, nothing.

Then she realized he wasn't breathing.

"Mom! Mom!" she screamed.

Her mother, who was outside tending to the garden, ran inside.

When Dace's mother got to the bedroom, she saw Alexei lying motionless on his back, in bed, Dace straddled on top of him, pushing her palms onto his chest, a telephone cradled to her ear.

"Can you call ambulance or something?" Dace urged the 911 operator at 9:25 a.m.

"My husband is not breathing. He is blue. I woke up and he is not breathing."

The 911 operator asked Dace for her address, then instructed her to place her husband on the floor to give him CPR.

Dace grabbed Alexei's body underneath his arms, her mother grabbed his legs, and the two women guided his frame onto the wooden floor.

Then Dace put her lips to his and tried to force air into his lungs. But he didn't respond. She placed her ear on his chest, but she could hear no heartbeat.

"His face was peaceful, his eyes were closed," she said.

The paramedics and the Fort Worth Fire Department arrived a few minutes later, checking for a pulse but finding none.

"They pushed once or twice on his chest," Dace said.

"It's already over," they said. "He's long gone."

When the Fort Worth Police Department arrived, at 9:34 a.m., the paramedics pronounced Sultanov dead.

With emergency equipment parked outside, neighbors started coming in, friends began calling friends.

Dace and her mother remained motionless on their knees, "looking just stricken," said Sheri Kramer, the wife of Sultanov's neurologist.

The paramedics draped a thin, blue sheet over Sultanov's body. When Dr. Ed Kramer arrived, at about 11:30 a.m., Sultanov already was in the early stages of rigor mortis. In filling out the death certificate, Kramer cited cardiopulmonary arrest as the cause of death, occurring sometime between 4:30 a.m. and 9 a.m.

Sultanov's heart stopped, Kramer wrote, due to "brain stem dysautoregulation."

This meant the damage Sultanov's strokes had done to his brain stem may have disturbed the regularity of his respiration and heartbeat. There was no way to know exactly why Sultanov died, said Kramer, who added that even an autopsy might not have revealed a more precise cause of the death.

Though bulimia, which Sultanov struggled with for much of his life, can lead to fatal strokes, it did not contribute to the pianist's death, according to Kramer.

"He faced a constellation of health issues," the doctor said. "I believe he just died in his sleep."

After consulting with the Medical Examiner's office and with Dace, Kramer and the others concurred that no autopsy would be performed.

"Alexei had been studied so many times, we knew the neuro-imaging," said Kramer. "This was not (an) unexpected demise."

Before Sultanov's body was taken away, Dace found a pair of scissors and cut off her husband's long, brown braid, placing it in his nightstand drawer.

Then she called Sultanov's family in Moscow to deliver the news. Sultanov's father answered, but as soon as Dace told him what happened, he dropped the phone and Dace heard wailing and screaming in the Moscow apartment.

Sultanov's mother, Natalia, went into her bedroom and stayed there for a week. Faizul sold his last cello to pay for a plane ticket to Fort Worth, arriving two days later, on July 2.

By then, Dace had followed her husband's long-stated wishes to be cremated, placing his ashes on a shelf in their living room, surrounded by dozens of the stuffed animals and toys the couple had collected, symbols perhaps of a childhood Sultanov never fully lived.

As visitors came to the house to pay their respects, Dace often picked up these ashes and embraced them. Sometimes she retrieved her husband's braid of hair and held it close to her face.

More than 100 fans converged on The Modern Art Museum of Fort Worth for an official public memorial, Van Cliburn and other dignitaries offering grandiloquent statements, while Dace wept quietly at the back of the house. She wore the same red-white-and-blue top she had donned for the swearing-in ceremony. The coming Independence Day would have been the couple's first as American citizens.

After the ceremony, Aileen Hummel, a music therapist who also was a licensed pilot, hugged Dace and said she was sorry that she never was able to give Alexei the plane ride she had promised him a few months earlier. Sultanov had not been in the air since his strokes, and he had yearned to fly again.

Dace told Hummel that she still could give Sultanov a last plane ride.

Practically everyone who was close to the Sultanovs drove to Galveston on the first weekend of August for a private ceremony. Dace traveled there in a tiny Cessna 172 flown by Hummel and pilot Peter Brown.

She was determined to disperse her husband's ashes over the place he had loved most during the last months of his life, the seashore at Galveston. On the evening of Aug. 5, she arrived at a Galveston motel, bringing with her red roses from her back yard in Fort Worth and collecting at the front desk a dozen more she had arranged to be sent.

The next morning, which would have been Sultanov's 36th birthday, Dace pulled petals from the roses and mixed them into her husband's gray ashes, so everyone would be able see his remains as she released them from the plane.

At about 9 a.m., she and Brown drove to the tiny private airport where he had parked the Cessna, climbed into it and prepared for take-off. Dace brought with her a tube that she had painted red - Alexei's favorite color - and had filled with the ashes and rose petals.

Everyone else gathered at the beach, including Dace's mother, Ed Kramer and his wife, Sheri, plus their children and spouses, and Beverly Archibald, a longtime friend.

Kramer opened his car door, cranked up the volume on his sound system and played a bootleg CD of Sultanov at age 7, performing Mozart's Concert Rondo in D Major, the official start of a spectacular but truncated career.

When it finished, everyone sang "Happy Birthday" to Alexei, then walked to the edge of the water.

In a few minutes, Dace's plane appeared in the brilliant blue sky, the group waving to her from the beach and pointing digital and video cameras on high.

The plane circled out of sight, then returned about three minutes later, flying low at about 400 feet.

Dace looked out the window of the Cessna but wasn't sure she could go through with giving up Alexei's ashes.

"I don't know if I want to do this," she whispered, as the plane flew overhead.

She began weeping, tears streaming down her face, but then decided she could feel her husband's presence.

"I knew he wanted me to do it," she said later.

So, gingerly, she held the red tube up to the window, pushed it forward a few inches and pulled a string that opened its front flap.

A puff of dust and rose petals trailed out of the plane, disappearing into the blue.

When the plane landed, Dace ran into the terminal building at the airport and disappeared into the women's bathroom for 15 minutes or so.

Then she and the pilot drove to the beach to join the group, Dace hugging everyone. She began passing out large red paper cups she had brought for the occasion before pulling from a cooler a bottle of champagne and walking into the water.

There she uncorked the bottle and poured herself a cup, drinking it down.

She came back to shore and dispensed the champagne to everyone.

"Now Alexei can play again," she said softly, looking toward the heavens, "with both hands."

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(c) 2005, Chicago Tribune. Distributed by Knight Ridder/Tribune News Service.