Breath of Life: Interview: Texas Medical Center News

2015 TMC News Article:
http://www.tmcnews.org/2015/10/breath-of-life-opera-bridges-the-medical-and-arts-communities/?x=6

The Native

by Ronda Wendler; Texas Medical Center News 2003

Jefferson Todd Frazier, native Houstonian, sixth-generation Texan, founder of American Festival for the Arts, breathes life back into opera: “This is something I was meant to do.”

“I grew up watching my father do heart transplants, watching his career rise and bring a lot of attention to Houston and the Medical Center.  He’s now done over 900, which is more than anyone, ever.  I would work with him in the summers, in the research lab.  He has always had patients die because there weren’t enough donor hearts available, so he’s become really interested in mechanical devices – both with the thought that eventually someday they might replace the heart, be a total artificial heart, and also that in the time being they might take over the work of the heart for a long enough period of time to find a donor heart, helping patients survive long enough to get a heart transplant.  They call that a “bridge to transplant”.  He has worked for 30, 40 years with many pioneers in the field, and contributed to their devices through the research and troubleshooting done here at the Texas Medical Center – at the Heart Institute at St. Luke’s Hospital.  As to the goal of creating a permanent device, they’re almost there; they’re on the cutting edge.  There are people right now living on these artificial hearts for long periods of time, some of them choosing not even to receive a transplant because they actually feel a lot better with an artificial heart since they don’t have to be on rejection medication.  But the main purpose is still to get a person healthy enough to be ready for a transplant.  There is still a very limited supply of hearts and people who donate them.  Many people on the list die waiting for a heart.  So, these devices are what my dad has been working with throughout his whole career; that’s what he’s really interested in and where he thinks he can help people the most. 

When I started working up there in the summers, I would watch the devices and some of the research, but the most exciting thing for me was to watch a heart transplant – in my opinion, the most dramatic thing that medical science does.  It was exciting that it was my dad doing it, and that it’s here in the Medical Center, and that people come from all over the world for it.  When I was working there during the summers and he was doing a heart transplant, he would call me in so I could go into the room and watch him.  It was amazing.  You would see this very sick person coming in, and their heart would be large and diseased, like a muscle that has worked too hard.  It looked bulky, and stressed, like any of your own muscles, worked too hard, might become tight and inefficient.  It’d barely be beating.  They would just cut the whole thing out – before they would cut it out though they would stick tubes in the aorta and the other arteries, going to a machine, and the machine would take over.  The machine is a continual flow machine, which means it’s not pulsing flow – blood is just constantly running through, which in itself is interesting, that the patient doesn’t have a pulse.  It was a big breakthrough just learning that the body can survive that way.  That there is no pulse is so strange, and the patient’s heart is gone; once you cut the heart out, you can’t put it back in; that’s it  – at this point there’s a feeling there’s no turning back, because there isn’t.  The patient’s life is suspended, and it’s almost as if they’re not alive; they don’t have a heart, and the machine is pumping and there’s no pulse, and that started to get me thinking a lot about, well, what’s really happened to this person, this spirit?  Because they’re not really here, but they’re not gone …  what I sense is that the person’s life is suspended; they’re in a different world.

Then what happens is the donor heart comes in.  It really does come on ice, in a cooler.  It looks so healthy; it’s really small, no bigger than a fist, streamlined, bloodless, sort of flat.  In your chest you have this layer of skin called a pericardium, which is a white sac around your heart, keeping fluid and supporting the heart almost like a shock absorber.  For the procedure the pericardium is opened and pulled out, and it’s all just this clean, white shell … that’s weird, too; there’s nothing bleeding, just this big white, cavity … and they put the new heart into it and sew it around the tubes, pulling the tubes out as the new heart pulls on.  Then they slowly start to transfer the blood from the machine into the heart, and it hits the heart, and it fills the heart up, and sometimes instantaneously, sometimes in a few seconds, when the warm blood fills up that heart … the heart just – boom – starts to beat, on its own.  It wasn’t beating before.  My dad says it just remembers how to beat.  That’s a nice phrase we use in the opera, as the doctor explains to the intern: The heart just remembers how to beat.  And it beats not in the cooler, but when it feels connected to the body, in the anatomy; when the blood – which in the opera we call the breath of life – fills it.  Life is such a strong force, connected with this blood, that it brings the heart into the body with it – the heart wants to live, and starts to beat.  Scientifically, this is amazing, a miracle.  I’ve tried to tell this story through an opera, because though it happens every day, heart transplantation is a unique side of medicine; people hear about it sometimes, but don’t understand what’s really happening. 

So after the heart starts to beat and the operation is wrapped up the patient, usually just fine, goes back to his or her life; it’s actually been quite a simple procedure.  The interesting thing is, this procedure, made possible riding on so much scientific and technological advancement, relies as much on a leap of faith by doctors, no matter how technically astute they are.  Doctors can’t scientifically explain why the heart starts to beat; it just does.  At some point, you can know as much as you can about medicine; then it becomes an art, where you try to be in tune with the body and respond to it, adjusting levels.  This is one of those times.

The recipient has a new life, but there’s a whole other side: Someone else had to die for it, usually tragically, because their death had to leave the brain dead and the body still working.  So what about the donor’s family; what about that person’s life, inside this new person – how do recipients feel about that, and how do donors’ families feel, knowing that not just a piece, but the heart, which is associated with the soul, of the person they knew is giving someone else a second chance to live that, in a way, was supposed to have been the donor’s?  When I started to think about how many distinct people this one procedure affects in such a profound way, I began to develop the idea of telling that story through opera.

So I talked to my dad about the idea of telling this incredible story through an opera, and interviewed one of his patients, a priest – I was very interested in how he felt about the transplant, spiritually.  He said when he was waiting he never prayed for a heart because that would be praying for someone to die; he just prayed for his destiny.  And he talked about what seemed like dreams, some time when he was sort of not here and not there, which may have been at that certain point in the procedure between hearts – they don’t quite know.

Also, in Japan, heart transplants were illegal until recently because they believed one wasn’t dead until the heart stopped beating.  A heart could never be taken because that would be murder, and it was more than that, because it was very important that their ancestors, whom they worshiped, be whole.  Trading hearts really threw some challenges into their structure of worship: the heart was so tied to someone’s soul and someone’s life that heart transplants were inconceivable.  At the same time, they wanted the technological advances, so many younger Japanese who want to break out of the more traditional thinking come over here to train.  They’re still careful with it, and they still don’t do this procedure much in Japan.

All of these nuances became characters in the opera – the hospital priest, the doctor, the recipient, the recipient’s wife, the donor, the donor’s mother – because they all have to make similar leaps of faith for this procedure to work, to take a step into the unknown and agree that all of the questions can’t be answered on any one side, even by the priest.  At the same time, something has brought them together, with a window of only a few hours, and such an opportunity has been put in front of them for life to continue.

When I first told my dad about the idea, he didn’t know how we would do it – were we going to do the whole thing in the operating room, with machines everywhere?  Which was interesting, because that’s the doctor’s side of it – he does know all the other sides, but is so preoccupied with his role, of necessity he doesn’t have time to fully consider all the lives tied into each other.  When he read the libretto, which is the text, the drama and what will be sung, he really thought it could work – that it had all the things an opera usually has.

The story concerns a young priest counseling the donor’s mother who is trying to make the decision to give her young daughter’s heart, and what it means for her in the afterlife – is it a sin?  Then the recipient, an older man, rather reluctant to receive the heart because he feels undeserving, that there are so many things he regrets about his life; while this young girl never had a chance, does he deserve a second one?  His wife, who really wants her husband to be able to continue living with a new heart and have the opportunities he’s previously missed; the doctor, who is purely technical about the process – he’s never done a transplant before and doesn’t want to know anything about the donor or the recipient – they’re making scientific history – and his Japanese intern, who tells him the patient’s soul has to be considered, as does what’s happening with his family.

 

At the beginning of the second act, they’re at the point where the man’s heart is gone; there’s no turning back, and in his mind he doesn’t want it; they’re putting in the new heart –  they’re starting to let the blood in but it’s not beating – the procedure isn’t going well.  And in front of the scene, the recipient meets the donor in this other-worldly place, and as they come to terms with what’s happening and agree that it should, the heart starts to beat.  This is how the drama and the spiritual connect with the technical: in the operating room, the heart has to want to beat, and remember how.  The doctor, steeped in scientific method, reaches a point where he finally leaves his training to do this ultimate procedure – then finds himself having to let go of his scientific grasp in order for the procedure to work.  And the audience is left at this very dramatic moment where science has become an art, and the spiritual has united with the scientific, and all of the characters in the opera have taken some sort of leap of faith into the unknown for the sake of life – that life is good, and such a strong force, so fragile, yet so valuable, that even in a situation where it’s being stressed and challenged, it still, when given the chance and the right elements come together, will survive. 

Life is such a strong force that humans have developed this particular way of making the most out of it: In that, it must be good: Would God have brought us together, and offered us this methodology, if he didn’t want us to take advantage of it?  That became a line in the opera as well; there are so many questions that can’t be answered that a leap of faith is required.  The opera is titled The Breath of Life, and the feeling is that that’s when life is transferred; it’s almost more in the blood than in the heart; the blood breathes life into the heart and accepts it into the body – and then it joins, beating.”

 

Source:

 

Frazier, J. Todd.  Interview, 2 August 2003.


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