Frozen shoulders

Post-Transplant, Pittsburgh

I used to say that I didn’t have many friends who saw me in both pre-transplant and post-transplant days. I lived most of my pre-transplant days in Singapore. Those pre-transplant days that I lived in Pittsburgh I lived in isolation. The 2020 Coronavirus pandemic was in full swing by the time I arrived in Pittsburgh, and remote or semi-remote school lasted 2 years. By the time in-person activities opened up, I fell vastly sick, and spent most of my time at home. Friends whom I met pre-transplant barely knew me, and I made new friends post-transplant who did not know the past me.

All that changed on 22 March 2025, when a bunch of nurses from my pre-transplant days attended my violin chamber orchestra concert. It did indeed feel strange to see those nurses in the light of day, with all my movement intact. They felt strange to see me with no IV tubes attached that they have to avoid, no swollen body, and no need to hold me as I walk. I played the Symphony Singulière by Franz Berwald in the Violin II section, at second desk. That was a great accomplishment, because not only was the symphony rather difficult, but to make it to second desk less than 24 months post-transplant in an orchestra meant that my recovery was beyond imagination. At the drop of the baton, I put down my bow and heaved a sigh of relief, reeling in shock that my fingers could move so fast and I could control my bow so well.

As I smiled at the nurses seated in the second row of the audience, I had flashbacks of the times I begged them to help me braid my hair, asked them to open my yoghurt, or screamed at them in hunger for not helping me with my protein shakes. I remember those days in the white sheets and beige blankets that I sat on watching my hands tremble, struggling to press the right button. I looked down at my hands as I loosened my bow. My fingers are now slim, my finger nails are pink, and my hands are steady. Gone were the days I could not intonate my notes properly because my bloated fingers hit more string than necessary. Gone were the days that I didn’t dare to look at where my fingers were placed on the fingerboard because my fingernails were white, and while my hands still tremble, I am slowly gaining control of it.

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At 25 years old, I signed myself up for violin lessons. I wanted to carry my music with me wherever I go. With my throat swelling and my breath getting short, I have not been able to sing. I don’t understand the term “singing in the shower”, because I was already struggling to untangle my hair and reach to my toes to clean them, it was nearly impossible to draw more breath to belt out melodies. It seemed like an old age to learn the violin, but I had learnt the piano when I was younger, and I thought I would be okay.

I would be able to read music and play the violin, except that my fingers were not precise enough because they were always suffering from water retention, nor were my shoulders flexible enough because the pacemaker was inhibiting the movement, nor was my eyes sharp enough to discern that the bow was straight and at the right contact points with the strings, nor was my arm strong enough to provide weight to the bow, nor was my ears sharp enough to listen to the subtle changes in pitches.

I would go to many lessons light-headed from the lasix I had eaten a few hours ago, hoping that the lesson would brighten up my day. I would frustrate over not being able to accurately pitch double stops, nor be strong enough to hold down both notes, thinking that the violin was too difficult. I wanted to give up on learning the violin just like I wanted to give up on my life. I would head home every tuesday evenings, my feet swollen from standing over an hour during lessons, and massage my feet.

Somehow, with the guidance of my teacher, I past the cut of the school’s orchestra auditions. For a semester, I muddled my way through the orchestra, but did not get a chance to play in the concert. I went for the last rehearsal a day before the concert, but knew something was very wrong. I decided to skip out on the concert, and went into the hospital the day after.

A few evenings later, I texted my violin teacher that I had to pause my lessons indefinitely because I was sick. I had paid for the entire semester’s lessons and I was still to have about 8 more lessons. She told me she would hold my lesson timings until I returned, and would refund me the money. But that was not to be. I went into the hospital, and only emerged months later. That was the end of my pre-transplant violin lessons, and the end of studying with that teacher, for she took a step back from teaching.

Post-transplant, Adrian encouraged me to touch the violin. I fluctuated between happy and sad days at home, oscillating between rejoicing at my newfound human abilities and crying over my potentially lost capabilities. I tried to hold my violin in one arm, as it should be held, but my arm let go and the violin dropped to the bed. I tried a few times and gave up in exasperation. Adrian would hold the violin up for me while I tried placing my fingers on it, fingers which took a great combination of willpower and strength to place them accurately. I had just learnt to stand up three weeks ago and I was still figuring out which muscles to activate to move each body part. My fingers trembled involuntarily as they descended on the strings, and would not hold steady on the strings. The sound I produced was an unsteady wail of scratches.

I still kept my dream of playing in the orchestra. I found a violin teacher not far from my house that was willing to take on the challenge — of bringing someone pounded by illness to perfection. I was worse than a student starting from a clean state; I knew what had gone before, and I had fears and doubts of any possibility of playing again.

Leah taught me just like any other student, but was always wary of my current physical limitations. As our lessons began, she saw my trembling hands and placed them on the fingerboard, holding them steady. She watched my hands grow in strength, and waited until the right time to get me to try double stops again, “I think your hands are strong enough now.” Double stops require a lot of hand strength and control. The left hand would place two fingers on two different strings, while the right hand bows both of those strings. If the fingers were not firmly on the strings, or the bow was not steady, the sound would whimper. Under her encouragement, I tried again and again. She watched me smile as I made a clear, firm and ringing sound as I pulled my bow across the strings.

Leah watched me week after week as I shuffled my violin on my shoulder, finding the perfect spot for it to sit that would not annoy my fresh scars as I played. She gave suggestions and held my violin as I tested out new positions. She stayed by my side even as I changed my mind a few weeks later and wanted a new position or a new shoulder rest.

Unlike my past music teachers, she would never ask me to sing the pitches out loud, for she knew that my throat was suffering (my vocal cords were paralysed post-transplant). Instead, she would sing the pitches to me to help me find my notes. When I wanted to repeat a section, instead of humming the notes or describing the place in words, I would hastily play it on my violin. We communicated through music in the truest form.

In Leah’s house, the world stopped revolving and the tower of doctor’s diagnosis and advice crumbles. I couldn’t care less when I did not take my medicines just before class without a cup of water; I wanted to play (she would nag me and force me to drink a cup before letting me play). I couldn’t care if I woke up with my wounds aching, I would get dressed and head to her place. In her house, she held my hands as we stepped into the musical scenes we painted together.

Hand in hand, Leah and I discovered the flexibility of the human body. When I could wrap my arms around the violin to reach the highest position in an A major scale, she exclaimed, “That’s the first time I ever saw you do that!” We concluded that I was limited by my frozen shoulder, the shoulder that would not move because too much movement would make the muscles cut into my pacemaker. She allowed me to do the same scale a few times just so I can relish that moment. The next week, she made me repeat that scale again, just to be sure that the movement wasn’t a single lucky moment in time.

Leah stopped my playing as she heard the clanking sound of nails against the finger board. We examined my hands and determined that despite my then-weird looking fingers and hands, I had grew fingernails. We laughed as I bought my first nail clipper from Amazon. As time passed, we rejoiced together as my finger nails grew out and my nail bed cleaned itself up, and finally, as my nails turned from white to pink.

We tried vibrato. Vibrato is a technique where the violinist creates a fluctuation in pitch by rocking the left hand back and forth using the wrist or the arm. This creates a warmer tone and a more beautiful melody. For someone whose left shoulder had always been frozen, I struggled with vibrato pre-transplant. My shoulder would not relax sufficiently, and my muscles would tense up naturally to support the weight of the metal pacemaker that was keeping me alive. This time, we started from the beginning again.

Back and forth, back and forth.

I rocked my arm slowly, just like the first time I came into contact with this technique. I truly believed that I would never be able to play this technique, because my pre-transplant preconceptions told me that this notion was virtually impossible. As I played in the orchestra rehearsals, I watched in envy as the other musicians play vibrato so easily, so effortlessly, so melodically. Mine was a boorish rock, stunted by my mind’s push for the technique. A few months later, Leah asked if I wanted to try working on some vibrato. I said, “I want to show you my vibrato today.” I did produce some sort of vibration, some sort of warm tone fluctuation, that resembles an amateur vibrato, but Leah smiled widely. That was the beginning of me breaking the barriers of my prior limitations. Slowly, I learnt to express more vibrato, and complain about the tiredness of my arms when we do too much. Leah, too, pushed me gently, “I didn’t hear any vibrato in this section!”

Leah and I watched as my ears get more sensitive to the sounds and to be able to differentiate sounds that are barely a millimeter apart on the violin string. We celebrate as I first communicated through my bow, then my words, and one day, subconsciously through humming a phrase. We were both keeping our violins in our cases as I hummed the third movement of the Vivaldi Concerto in A minor for two violins. Without looking up, Leah said, “Yeah, we should do the third movement one day.” She caught herself as she said that, and we both looked at each other, mouths agape:

I could sing!

Under her guidance, I learnt to feel rather than to think. I stopped consciously thinking of where to place my fingers, how much strength to use, and mentally preparing myself for the next notes. I had to do that because my body and mind needed priming to get the passage right. I learnt to lean into the music, and breathed with it. I drew circles with my bow to express musical ideas and dragged my bow as I emphasised musical phrases. We played duets, we performed in recitals, we played for senior living homes, and we laughed together when either of us made mistakes.

We danced with our music. At the end of the concert, Leah was the first one to grab her coat and stand up. She was the first one to walk out of the audience, not towards the door, but to me. I saw her, and I walked briskly towards her, just like a kid running to her mum. She hugged me tight and said, “good job!” I hugged her tight back.

I couldn’t have done it without you believing that I would play in an orchestra from the first day of our lessons.

My arms were aching badly from putting all my heart in music, playing the last 30 bars in so much allegro and forte that one of my bow hair broke. As I packed my violin up in its lovely bright blue case, I reflected through all the moments that landed me on the second desk — the exasperation, the desperation, the frustration, and the joy, the excitement, the anticipation — of learning new pieces, new techniques, and playing. I played my best, as an appreciative tribute to the people in the audience who brought me to the stage: the nurses, my teacher and Adrian.

I know that one day I will wake up and the ache will not feel so heavy, and the mirror which I stand in front of to practice this instrument will someday reflect someone that I am proud of.