The trajectories of tuberculosis (TB) and opera met in the mid-nineteenth century most notably with the production of La Traviata in 1853, and then La Bohème near the century’s end. With eminent scholars Linda and Michael Hutcheon, we talk about how these trajectories converged and how these resulting two operas then brought attention to the medical effects of the infection and the sociocultural influences on its spread. We also discuss how the discovery of germ therapy during the time between the staging of these operas affected the way social behaviors changed accordingly, that is, from understanding TB as hereditary to understanding it as infectious. We play audio clips from parts of the operas pertinent to perspectives provided. 

A big thanks to Drs Linda and Michael Hutcheon who in addition to providing their expertise and perspectives during the podcast, also contributed ideas for the production. 

Links
– The combined bio for Linda and Michael Hutcheon.
– The New York Metropolitan Opera on-demand video service where you can get access to high-quality video productions of La Traviata and La Bohème among many other operas and performances. (There could be a 7-day free trial available).
– Homer Simpson performing as Rudolpho in La Bohème singing Oh Dio! Mimi!
– We covered the effects of TB as an aesthetic ideal of beauty during the nineteenth century as represented in paintings earlier in episode 5.

Audio Credits
La Traviata
Preludio (National Philharmonic Orchestra; Richard Bonynge cond London Records 1979)
Prendi, Quest’È L’Immagine (Orchestra of the Opera House, Rome; Tullio Serafin cond; Victoria de los Angeles (Violetta); EMI Records Ltd 1960; digitally remastered 1992)

La Bohème
O Soave Fanciulla (Berlin Philharmonic; Herbert von Karajan cond; Mirella Freni (Mimi); Luciano Pavarotti (Rudolfo); Rolando Panerai (Marcello); London Records 1972)
Si. Mi Chiamono Mimi (ibid)
Mimi È Una Civetta (ibid)
Mimi È Tanto Malata! (ibid)

La Bohème photo from wikicommons

When the British band, The Who, released their double album, Tommy, in 1969, many of the songs in it became instant classics and served as anthems for the Baby Boomer generation ever since. The album was characterized as a “rock opera,” because when connected, the songs told the story of the “deaf, dumb, and blind kid,” Tommy. The storyline made possible subsequent musicals, first as a movie in 1975, and then as a Broadway play in 1993 and as a revival in 2024. Underlying the storyline in each of these genres are the psychiatric consequences of childhood trauma Tommy experiences. In this episode, we consider the psychiatric conditions Tommy exhibits through selected songs from the original Broadway production, and how they are used in education and training.

Dr. Anthony Tobia, who is the regional chair in the Department of Psychiatry at the Rutgers School of Medicine and is also the Service Chief of Psychiatry at Robert Wood Johnson Barnabas Health in New Brunswick, NJ. Dr. Tobia also holds a secondary appointment in the Division of General Internal Medicine there. His interests and scholarly work include the value and application of merging popular culture and psychiatry. The Who’s Tommy is among the many cultural works he has found helpful in depicting psychiatric problems for purposes of teaching health professions students and practitioners, and others in roles helping people with mental illness.

Links
Original Broadway cast album of The Who’s Tommy, 1993
Background on The Who’s Tommy movie, 1975.
31 Knights of Halloween didactic at Rutgers during October.

The Clinic & The Person is a podcast developed by our editor Russell Teagarden to summon or quicken the attention of health care professionals, their educators, researchers and others to the interests and plights of people with specific health problems aided through knowledge and perspectives the humanities provide.

Feature image recreated by Medhum using Tommy’s poster found on Wikipedia Common.

Rearranged by Kathleen Watt is subtitled “An Opera Singer’s Facial Cancer and Life Tranposed.”  At the outset of the book, the author feels on top of the world.  She can hardly believe she has the opportunity, as a member of the Metropolitan Opera Extra Chorus, to share the stage with some of her biggest idols.  She has a wonderful partner and a warm and close family. 

Then, one day, Watt discovers a bump in her mouth.  She is found to have a rare and aggressive oral cancer that is “breathtakingly tailored to obliterate my profession and my raison d’être, never mind my face” (p. 51).  She undergoes multiple reconstructive surgeries, some of which are unsuccessful or become infected.   While she is initially reassured she will be able to sing again in a few months, that goal proves unrealistic.  Watt’s partner is emotionally supportive for years, but even for her there is a limit.  When the author is unable to pull her own weight financially and develops an addiction to alcohol, the relationship unravels. 

The greater part of Rearranged chronicles Watt’s medical ordeals. Previously an active and productive person, she is now at the whim of her doctors’ schedules.  She gives up all hope of performing again. As anyone who has experienced an illness or the illness of a loved one knows, navigating the health care system can easily become a full-time job.   

The book ends optimistically as Watt’s condition stabilizes. She realizes she is lucky to be alive and accepts her “rearranged” looks.  She reconciles herself to a future where she will “henceforth sing mostly for myself “(p. 304), and redefines herself as a writer specializing in the performing arts. 

Rearranged is a book which teaches valuable lessons.  Watt endures extreme hardship, has her dreams shattered, and acquires wisdom that will benefit providers and patients.    

One lesson learned is that unempathic caregivers may compound a patient’s suffering.  “A multi-gigging freelancer with catastrophic coverage at best” (p. 31), the author has a miscommunication with an endodontist and is threatened with a lawsuit for presumed nonpayment.   And when she dares to question another doctor, he snaps at her: “Ha, ha!  I’m not going to teach you surgery” (p. 57).  Fortunately, other providers have a manner that is more conducive to healing: “Because he [the doctor] conveyed neither arrogance nor impatience, his confident command allowed me to trust him easily.  And at that moment, nothing mattered more to my successful outcome” (p. 55), and “Alone among my doctors, he had thought to lament my loss.  A helium cloud filled me at this simple expression of kindness.  Nothing at that moment could have been more restorative” (p.108).    

One can understand how traumatic it must be to have one’s facial features distorted as the result of illness.  For a singer it can be career-ending, not only because she needs to show her face to the public but because the vocal cavity may be damaged.  But, beyond this, because “the face is the single most important organ of human communication” (p.105), the author feels she has lost her identity: “I felt as bereft of myself as I was of my voice…I missed seeing my reflection in the faces of others.  I began to lose track of my own subtexts, and myself” (p.237)    

The author relates a vivid and frightening memory of experiencing post-operative delirium (sometimes called ICU psychosis). When she comes out of surgery and suddenly realizes she cannot talk because she has had a tracheotomy, she pounds on the wall.  She wishes she had had “healthy people to paste accurate information alongside my cockeyed perception, so I could avoid drawing mistaken conclusions from my misperceptions” (p.146).  Instead, she overhears attendants saying “Boy, she’s really out of it” (p. 149) and referring to her as “a royal bitch” (p.140).  At no time does anyone think to help “confirm her sanity, quell her fears” (p. 150).  Hopefully, health care professionals will read this and think about it the next time they see a patient right out of the OR.    

In closing, it bears mentioning that at one point Kathleen Watt consults with surgeon Iain Hutchison in London.  Hutchison is the initiator and sponsor of the Saving Faces Art Project, a series of paintings by artist Mark Gilbert which “portray the faces of patients before, after and in some cases actually during their surgery for injury, deformity or cancer” and whose purpose is to “communicate the strength of spirit which can enable people with facial disfigurements and trauma to lead full and happy lives.” (from https://savingfaces.co.uk/our-mission/art-project/ )  Likewise, the author of Rearranged inspires the reader by her strength of spirit in the face of inconceivable adversity. 

REARRANGED
An Opera Singer’s Facial Cancer And Life Transposed
Heliotrope Books, New York, 2023   
384 pages 

Kathleen Watt’s website: kathleenwatt.com