Throughout the 2010s, Diamanda Galás worked on a musical interpretation of Das Fieberspital (The Fever Hospital), a German expressionist poem written by Georg Heym in 1912, setting the foreboding text (about the treatment of patients diagnosed with yellow fever) to a complex arrangement for live and multi-tracked vocals, piano, and electronics. The work was performed in concert during various stages of its development, and before Galás readied a recording of it, she issued De-formation: Piano Variations, a 21-minute solo piano composition inspired by the poem, in 2020. Even without Galás' inimitable, multi-octave shrieks and wails, it's hard to imagine the piece coming from anyone else, as it sounds like a more abstract, stripped-down iteration of her piano-and-vocals performances, as captured on releases like La Serpenta Canta or All the Way. Beginning with a sequence of stark, doom-filled thuds from the extreme left end of the keyboard, the piece continues in a stop-start manner, varying between clambering note clusters and ominous processions. While it's hard to tell if there's an intentional narrative arc to the piece, things start to get more vivid during its middle third, even ascending to a spiritual-esque tone at one point. It's not accurate to say that it sounds at peace during its final minutes, but it's certainly front-loaded with its heaviest emotions. De-formation seems a little scattered, but it's a fine prelude to the eventual release of the fully realized Das Fieberspital.