Black Triage by Galen H. Brown

I am writing these notes on April 10th, 2020, at my parents' house in New Hampshire, having evacuated from our home in New York City with my wife and our two cats the week before the COVID-19 pandemic got bad there. The stories and images I have heard and seen of my city and of the world are surreal and frightening; like so many of us, I grieve for our collective loss, fear for the future, and feel powerless to help other than by remaining isolated in order to avoid becoming a vector for futher spread, or a burden on the healthcare system myself.

In about 2005, I had the good fortune to observe a continuing medical education lecture at Dartmouth-Hitchcock Medical Center on triage during mass-casualty incidents. I was familiar with the concept of triage, generally, but not with how it is practiced, and I came away haunted by the black triage category, which includes not only the dead, but also those who can not be saved with the resources available. They may be beyond help entirely, they may not be able to survive long enough to be reached by the life-saving care they require, or treatments that might have saved them must be used on patients who are more likely to be saved by the limited resources available. If you have one ventilator, and two patients in respiratory failure, you give the ventilator to the patient who is more likely to be saved by it.

At around the same time, I began work on a piece for string orchestra, which I intended to entitle "Black Triage." I had no commission for it, so it remained a low priority, but every now and then I dug it out and worked on it. I think I finished the second movement sometime in the early 2010s. I started the third movement in about 2015, and finally finished it in 2018. It took 13 years to complete, but I think it's some of my best work. Given the title and the inspiration, I hope that it will never be more relevant than it is during our current global crisis.

Score available here: http://galenbrown.com/wp-content/uploads/2018/06/Galen-H-Brown-Black-Triage-Full-Score.pdf

galenbrown.com