A Doctor for a Song

Dr. Steven Zeitels has a fan. Many fans, really, but on this January morning one fan of an especially vocal strain is invading the otherwise sterile aesthetic of an operating room at the Massachusetts Eye and Ear Infirmary.

The fan is cheering Zeitels on, offering words of encouragement that seem lifted from a pastel box of Necco candy hearts. "You're Superman!" and "Sweet!" he shouts as the world-class laryngologist works, expertly snipping away at a stubborn mass of scar tissue obstructing the airway of a blissfully unaware patient. Each gory moment is captured by a camera attached to a microscope that allows Zeitels to peer down the woman's throat into her voice box, transmitting to a spectator-friendly monitor that practically invites a running NFL-style play-by-play.

"Stevie Z, going long," the talkative fan obliges in Al Michaels fashion as the 46-year-old doctor threads a near-impossible stitch using Thumbelina-sized tools. "It's fourth down. There's a lot of yardage. I don't think it's possible."

Zeitels laughs off the background chatter and proceeds with the same steady, ambidextrous hands that used to carve leather goods with images of Joni Mitchell album covers for extra cash between classes at Boston University. He's sitting behind his patient, operating his instruments through jaws pried open by a tapered universal modular glottiscope that bears his name on the patent.

"Geez, that's hard, Steve. It's harder than Chinese algebra," the fan marvels as tiny scissors patiently make their way through stubborn, unwanted membrane. "Don't kid yourself, Steve loves the melodrama," he whispers to another observer. And finally, as the delicate stitch is nearly complete, this play-by-play man practically hyperventilates: "Comin' over the top!" and "Oh, this is huge!"

When the tricky three-hour procedure is done, Zeitels reports that he's reopened a nearly completely constricted airway to about 95 percent of its full range without resorting to lasers, which blast away healthy membranes along with the bad stuff. The middle-aged woman on his operating table will have to wait to find out whether biopsied tissues reveal any disease, and her tracheotomy tube won't be removed until her doctor is convinced that the mysterious growth won't reoccur, but for now, Zeitels looks pretty darn impressed with himself.

His fan looks impressed, too, though for a different reason.

"I'd sell my brother into slavery for vocal cords like that," says the tall, bespectacled onlooker as the monitor gives a now-unobstructed view of the woman's pristine cords, also known as vocal folds. This groupie is jealous because he knows enough to recognize folds that have been spared the abuses of high-impact singing seen so often in Zeitels's more famous patients.

A couple of technicians in the room chuckle under their surgical masks.

The line might be funny anyway, but it's an especially significant statement considering that the fan is folk-pop singer and longtime Boston fixture Livingston Taylor, and his singer-songwriter brother is Sweet Baby James.

It isn't every laryngologist -- or voice doctor, in less fancy terminology -- who operates for a celebrity audience. Zeitels is unique, and not just because he lets hyper-curious celebs like Livingston Taylor hang around the OR when it's not the singer's own turn under the knife. Recognized among the top physicians in his field, Zeitels is laryngology's premier historian, a prolific inventor, and the guy at the forefront of research that may revolutionize the way impaired voices are treated by doctors everywhere.

His client list includes not only the Taylor brothers (Livingston had surgery for vocal fold hemorrhaging and says that James has consulted the specialist, too) but also Cher, Steven Tyler, Gary Cherone, and assorted other pop/rock singers. Among 400-plus entertainers who've sought him out for surgeries in the past decade are Broadway musical actors, broadcasters, a singing clown, and several internationally famous classical vocalists. Most Wednesdays, the doctor's clinical offices at Massachusetts Eye and Ear Infirmary sing out with at least a few crooners demonstrating their range. Often, the place sounds more like an audition hall than a hospital.

Zeitels makes a point of saying that performers represent only about 25 percent of his practice; the other 75 percent is made up of equal parts cancer patients, those with neurological disorders such as paralysis, and non-entertainment-related heavy-voice users such as lawyers and teachers. And while some in the media like the shorthand label of "voice doctor to the stars," the vast majority of his artist patients don't have instant name recognition.

Still, he sees his share of famous faces, and when you operate on celebrities in jeopardy of losing their careers, you do tend to get noticed. This was true even before Zeitels found himself in front of TV news cameras in June 2002, fielding questions alongside Julie Andrews.

Andrews is the most high-profile of Zeitels's current patients. Much has been reported about her struggle to regain her singing ability after disastrous surgery by another doctor to remove noncancerous nodules on her vocal cords in 1997. Now, Zeitels is both her personal touchstone and the surgical face on an initiative called the Voice Restoration Program, heralded at that June press conference for bringing together some of the best minds in Boston medicine and science -- Massachusetts Institute of Technology's Robert Langer, Massachusetts General Hospital's R. Rox Anderson, and MEEI's Robert Hillman, James Kobler, and James Heaton, among them -- to develop implants capable of restoring vocal fold pliability as never before. Zeitels and his colleagues have asserted that the team could even create a kind of "super singer," an experienced vocalist whose instrument is ageless and invincible.

For vocal folds to function optimally for phonation, "they have to close, and they need to be pliable," Zeitels says, explaining how air pushed up from the lungs through the windpipe causes vibration in the vocal folds, forming a vocal signature when it reaches resonating chambers in the mouth and nose. "The only thing we can do today [to influence pliability] is remove or reposition something. In the future, what you put in will be just as important as what you take out." And what the Boston team envisions putting in is some magic combination of biomaterials, which they're improving rapidly enough for Zeitels to hope could lead to clinical trials this year.

In the meantime, there are other things for the surgeon and his team to crow about, including his and Anderson's recent success using a pulsed-dye laser to normalize vocal-fold growth abnormalities without removing or burning them, and promising gains in eradicating early vocal cord cancer by cutting off blood to the tumor. Next month, the Annals of Otology, Rhinology & Laryngology will report Zeitels's groundbreaking employment of the pulsed-dye laser to treat the abnormalities in-office, under local anesthesia.

"I don't think I've ever met a man more dedicated or focused," Andrews says in a voice that, while still a little rough around the edges, is "less gravelly and growly," thanks to Zeitels.

Andrews has lent her marquee name and support to the initiative not just because it may one day restore her own singing voice, but because there are thousands whose prognoses may be improved and thousands more whose phobias, lack of awareness, and limited expectations keep them from seeking treatment today.

"Let me just say that [singing again] would be icing on the cake; it would be miraculous," she admits. "But I'm not wildly hoping for it, and I'm very grateful that I'm as busy as I am."

It's the sort of statement you'd expect from this grande dame of stage and screen, and yet her selfish fans can't help but wonder: Aside from acting regal in teeny-bopper movies and squeezing out a few bars during holiday variety shows, is she all done as an entertainer?

"Not necessarily" is all Zeitels will say. But he smiles a little and rubs his trim red beard as he says it, in a way that burnishes the words with confidence and possibility.

That's really Zeitels's specialty, when you get right down to it: hope.

He's the doctor of last resort for most of the patients he sees, sometimes sweeping up after botched surgeries, years of misdiagnosis, and failed treatment. It's not uncommon for a performer to call him in the middle of a tour or recording session, needing immediate help to save a career.

Zeitels has the bravado and the sort of background the rich and famous look for. He grew up in New Rochelle, New York, the son of an orthodontist (father) and a teacher (mother). He comes with the usual wall of degrees and awards, and his credentials, besides being director of the division of laryngology at MEEI, include associate professor at Harvard Medical School and author of the coffee-table-sized Atlas of Phonomicrosurgery. In addition to redesigning many of the tools he uses for surgery, from suspension gallows to infusion needles, he's designed almost 20 different procedures and operations.

But most important to his patients is Zeitels's combination of knowledge, enthusiasm, and bedside manner. Even Steven Tyler, not prone to squishy praise, calls his hometown laryngologist "a wonderful guy" who's "monumental to me." (The Aerosmith frontman also recalls how he first sought out Zeitels with a sinus infection several years ago -- "I went to somebody in Boston because here I am living in the town everybody goes to when their ass is falling off" -- so you know it really is him on the other end of the phone.)

Zeitels's approach does have its detractors, however.

Los Angeles-based voice specialist Morton Cooper, a PhD who calls himself "the nonmedical voice doctor to the stars," argues that most noncancerous vocal problems are fixable by modifying voice technique. What's more, this 73-year-old author of Change Your Voice, Change Your Life and Stop Committing Voice Suicide, with a client list that runs from Kirk Douglas to O.J. Simpson, objects to the "medicalization of voices" by surgeons such as Zeitels.

"You don't do surgery on a leg cramp; a failing voice is a voice cramp," Cooper says flatly. He adds that Zeitels and his team are "asking for a disaster" with their super-singer notions, and he suggests this radical research approach: "If you think it's so successful, doctor, why don't you try [the implant] on yourself?"

Zeitels's unflappable response: "First, we're not taking people who don't need surgery and giving them surgery; we're taking people who can't function anymore, and we think the result will bring them back ... better than you thought.

"Second, I am actually looking forward to having the [implant] procedure done on myself, probably within the next 10 years, because my vocal stamina has substantially reduced from being on the lecture circuit for 15 years."

In Zeitels's spacious seventh-floor office, celebrity images are everywhere that typical doctor clutter isn't. Arranged on a table, pictures of Andrews and Tyler share space with an infant laryngoscope circa 1913, part of a collection of scary-looking medical gadgets. A candid of President Clinton jabbering intently into Zeitels's ear and a 19th-century portrait of Jacob Solis-Cohen, America's first specialized head and neck surgeon, seem oddly OK working the same room as an 8-by-10 of musical headbangers Van Halen.

This office is the grand junction of Zeitels's life, where his professional accolades collide with his proudly assembled famous-client list, a passion for antiquing (Gustav Stickley furniture, in particular), and evidence that he's a newlywed, married in June to a Chilean otolaryngologist -- otherwise known as an ear, nose, and throat woman -- who understands his 24/7 career.

He manages about five hours of sleep a night, wife Maria Zeitels reports, but "his mind is always busy." So busy that she concedes it isn't easy to find time for the things they both enjoy -- walks, movies, a wide range of music, and her home cooking. While she studies for equivalency exams that would enable her to practice medicine in the United States, he zooms ahead on the self-obsessed, star-surgeon fast track. He's "really trying" to find balance, she insists. Maybe, but to the casual observer, it's hard to see the scales leveling anytime soon.

"I have three parts to my life: patients, discovery and research stuff, and teaching other surgeons," Zeitels says. And yes, he's talking about his professional life, though the obsession does seem to bleed out to where even his colleagues and patients find it pervasive. "I used to tell him: You're not just committed, you're obsessed," says Robert Hillman, director of the voice and speech laboratory at MEEI and Zeitels's longtime colleague. And like most zealots, Zeitels doesn't shy from talking about his obsessions or himself, at great length.

Mezzo-soprano Denyce Graves says: "I'm an opera singer, and I love what I do. But if [Zeitels] gets you on the phone and he starts talking about vocal cords, you've just got to make sure you block out three or four hours, because he'll talk your ears off about it."

Graves, who was hemorrhaging into her vocal cords before Zeitels performed surgery in 2001, indulges her long-winded doctor, because she says he understands the special concerns of opera singers, whose voices must be note-perfect every time. "It's about the art of beautiful singing, so any little thing that goes awry is noticeable in the operatic singing voice," she explains.

Frederica von Stade, another well-known mezzo-soprano on Zeitels's patient roster, agrees and adds that the doctor's voice project perhaps resonates with classically trained singers in a way that few others can appreciate.

"The strides he's trying to make might seem very specific and not as important as heart or cancer research," she says, "but the voice is the expression of the soul, and it affects many more people than those who use it to perform with. Just the thought of not being able to express yourself with your voice is awful."

Von Stade, who has been seeing Zeitels for more than 15 years, recalls one clinic visit when he had her sing the entire "Voi che sapete" aria from Mozart's The Marriage of Figaro. It's this kind of attention and appreciation for the craft of singing that von Stade says sets him apart from other laryngologists.

Despite having no practical voice training himself, Zeitels appears to have earned the trust and respect of singers who play to sold-out arenas worldwide.

Cher, for example, pays him the ultimate rock compliment when she says, "He's like a lead guitar player; he's got that kind of ego." The kind of ego that invites headaches by courting divas as patients? "Yeah, but he eats it with a spoon," she answers admiringly. "The more challenged he is, the more excited he is."

Frequently, the challenges show up at his doorstep without a lot of warning. Cher, for example, made an emergency bus trip from Chicago to Boston during her current "farewell" tour, unhappy that another doctor had instructed her to fly with a sinus infection that turned out to be coupled with a slight vocal cord hemorrhage. Zeitels prescribed medications, rest, and diet changes that had her back onstage in a couple of weeks.

And on rare occasions the mountain even goes to Mohammed. Two years ago, Zeitels spent two days on tour with Aerosmith. Steven Tyler explains: "I said, 'I want you to live with me; I want you to see the amount of [vocal fold] swelling before, after, and during the show, so you know exactly how my body works with the amount of abuse I give myself.' I wanted him to have that diagnostic information."

Zeitels says the experience was illuminating and invaluable, not to mention undeniably cool -- even to a physician whose personal tastes favor lower-decibel Steve Winwood.

In the 11th-floor clinic where Zeitels tends to patients at MEEI each Wednesday, a hopeful pop/R&B singer gets the same treatment and access to cutting-edge technologies as a rock legend.

"Sing something," Zeitels tells Hassan Sleiman, a 27-year-old New Yorker in search of a recording contract. "Umm ... well.... My wife's birthday was Monday, and we were a little bit bad, so I'm a little tired right now," confesses Sleiman, known professionally as Haaz.

Zeitels refrains from lecturing. "Sing anything," he gently insists.

When Sleiman finally lets it rip, he unleashes melismatic trills that seem at least good enough to get him into a boy band. The untrained listener would never guess that the singer is using only a fraction of his vocal cord function, or that he couldn't hit a controlled note before Zeitels removed scar tissue nearly three years ago. But via a stroboscope that makes rapid movements visible, anyone can see that Sleiman's cords aren't vibrating evenly.

For most people, that's undoubtedly a very livable condition. Just as, for most people, the clinic's professional voice studio, with its upright Yamaha piano and soundproofed walls, is only interesting when Julie Andrews stops by to attempt some vocal gymnastics for her speech pathologists. But for Sleiman, "livable" isn't going to sustain his artistic side. So if and when there's an implant ready, this young singer says he hopes to be first in line.

That makes Zeitels smile and sigh at the same time. "I've got a list like you wouldn't believe," he says.

Janice Page a former arts and entertainment editor for the Los Angeles Times, is a freelance writer living in Brookline.