- Tuberculosis takes on a new light for USF medical students steeped in science -
Dr. Lois Nixon, center, with LaBoheme's central characters Rudolpho (Gregory Schmidt) and Mimi (Darynn Zimmer), and some medical students who attended the performance.
When you ask medical students about tuberculosis, they are likely to respond that it is:
a) A chronic infectious disease caused by Mycobacterium tuberculosis, which usually affects the lungs, but can attack other parts of the body.
b) A central theme of Giacomo Puccini’s operatic masterpiece La Boheme, in which the tragic heroine still manages to break into song while dying of consumption.
c) Both A and B
For the USF medical students who were introduced to a night at the opera recently, the correct answer was C. More than 50 first and second-year students attended a free dress rehearsal performance of La Boheme Nov. 14 at the Tampa Bay Performing Arts Center in downtown Tampa. They were led by Lois LaCivita Nixon, PhD, professor of medicine in the Division of Medical Ethic and Humanities, and accompanied by several medical faculty members.
The evening offered the students a rare opportunity to escape the intensity of their basic science and clinical studies.
“It was great being able to dress up, take a break from your studies for a while, and be part of a cultural event in the community,” said Annabella Ferrari, a second-year medical student who attended LaBoheme along with her brother Fabio Ferrari, a first-year student.
Last year, while studying art history in Italy, Fabio accompanied his great-uncle to a spectacular outdoor performance of the opera Aida in Verona. “As a beginning medical student, your schedule is so packed with hardcore science facts,” Fabio said. “I appreciate having the opportunity to learn about medicine from another perspective, through the arts, literature and music.”
For Dr. Nixon, the night out was another chance to drive home the message that medicine and the arts go well together.
Dr. Nixon has been working with basic science and clinical faculty, including Chris Phelps, PhD, in Anatomy, Duane Eichler, PhD, in Molecular Medicine, and Richard Schrot, MD, in Family Medicine, to more broadly integrate the humanities across the four-year medical curriculum instead of limiting it to a single block of study.
“Opera and other art forms provide useful insights into the human condition -- suffering, disability and aging -- that differ from information presented in science courses and clinical encounters,” said Dr. Nixon, who has accompanied students to Broadway plays, exhibits at the USF Contemporary Art Museum and the Dali Museum, and films at Tampa Theatre. “The stories told by artists, writers and filmmakers challenge students’ expectations and help them to understand personal and social complexities and tolerate ambiguities.”
Themes appeal to young audiences
Before attending La Boheme, many students who signed up for the opera sat in on a lunchtime discussion of the associations between tuberculosis at the time the Italian opera was written and its re-emergence in certain populations today.
Dr. Nixon provided the humanities perspective of the 19th century plague that claimed the life of Mimi, while USF pulmonologist Allan Goldman, MD, and microbiologist Ray Widen, PhD, presented an overview of the clinical and diagnostic aspects of the disease.
La Boheme tells the story of young Bohemians living in Paris in the 1830s. The central characters, Mimi, a poor seamstress, and Rudolpho, a poet, meet, fall in love, quarrel, separate and reunite before Mimi dies. Much action takes place with their friends at the Café Momus – think “cultural hotspot like the Starbucks on Howard Avenue” Dr. Nixon suggests -- where the struggling writers and artists meet to socialize and share ideas. Considered a popular introduction to the flamboyant world of opera, La Boheme inspired the modern rock musical Rent and the movie Moulin Rouge (in which the cabaret actress and courtesan played by Nicole Kidman dies of tuberculosis). Its common themes of getting a job, finding love, jealousy and fear, and coping with loss appear to resonate with younger audiences.
“In the 19th century, people didn’t go to the medical text to learn about TB – they listened to the artists, painters and writers,” Dr. Nixon said. “The opera routinely characterized diseases like tuberculosis, which occurred above the waist, as a very romantic way to die -- unlike diseases like syphilis, which occurred below the waist and was considered taboo.”
Vintage posters depicting the 19th century plague
of tuberculosis, in Italian (above) and French(below).
Not such a “romantic” way to die
In fact, for many afflicted by the epidemic, TB was a pretty horrible way to die. Transmitted from person to person by respiratory droplets, the tuberculosis organism may persist within lymph nodes for many years before being reactivated in later years. Symptoms include chronic coughing, fatigue, emaciation, fever and night sweats, spitting up blood. In the lungs, it leads to scarring and increased difficulty breathing, Dr. Goldman said. “It’s certainly not glamorous to drown in your own blood, waste away from malnutrition, or suffocate to death.”
TB is as much a socioeconomic disease as a medical malady – much more common in poor, developing countries in Africa, Asia and Eastern Europe than in countries that can afford the diagnostic tests and drug regimens.
“TB remains a major public health problem and one of the leading causes of death in the world today, with 8 to 10 million new cases each year,” Dr. Goldman said. “In the United States, it’s much less prevalent, infecting about 4 to 6 percent of the population.”
Dr. Allan Goldman discussed the clinical features of TB.
However, in recent years, even the United States has experienced a resurgence of the opportunistic infection with the emergence of multi-drug resistant strains of TB. The very young and the old, malnourished and homeless people, patients with HIV/AIDS, cancer patients and others with compromised immune systems are most vulnerable to TB, Dr. Goldman said.
Before antibiotics became available in the 1940s and 50s, many of those afflicted were isolated from their communities – shipped off to tuberculosis sanatoriums, like Saranac Lake in New York, for fresh air and rest.
Recovery was sometimes assisted by collapsing the infected lung either through a therapeutic pneumothorax, which introduced air into the chest, or a thoracoplasty, which broke the overlying ribs and crushed the chest wall, Dr. Goldman said. “These draconian measures would somewhat help prevent spread of the disease to the other lung.”
Dr. Ray Widen talked about diagnostic aspects of TB.
One student asks if Mimi is infecting her Bohemian friends. With direct, close contact it’s a definite possibility, said Dr. Widen, who gives a lecture on tuberculosis to second-year medical students as part of the Principles of Microbiology, Immunology and Infectious Diseases course. Fortunately, he said “most healthy people exposed to TB never get the disease; their immune system walls it off.”
“If someone has tuberculosis and they don’t cough, they won’t liberate the bug,” Dr. Goldman added.
“She (Mimi) coughs a lot!” Dr. Nixon said.
A long death scene
Sitting in the upper deck of the Tampa Bay Performing Arts Center’s Morsani Hall, the medical students are surrounded by students and teachers from area high schools. They watch the opera unfold, while keeping an eye on the English subtitles beamed onto a screen above the stage. As the hour grows late, the climactic death scene stretches on. Mimi and Rudolpho, in soaring song, relive their love story in the attic apartment where they met.
“Die already!” a few students murmur, perhaps thinking of squeezing in some late-night study before their next morning’s class.
Dr. Nixon realizes that only a small percentage of the students who attended La Boheme may ever seek out another opera. But that’s O.K, she said. “Even if it’s just one performance, introducing them to new ideas and new ways of seeing things is important.”
- Story by Anne DeLotto Baier/USF Health Communications
- Photos by Eric Younghans/USF Health Media Center
