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How I (learned to) listen to a voice.

IT IS AN HONOR TO WRITE a contribution to the "Collab Corner," and I am immensely grateful to my dear teacher and mentor, Margo Garrett, for affording me this opportunity. Like so many who are privileged to have been her students, I would not have the career I have today--in very literal and real ways--without the generosity of her wisdom, the precision and range of her insight, the warmth of her encouragement, and the constancy and longevity of her fierce support and love. Moreover, it is she who showed me, and instilled in me, a love for song and the voices that sing it. It is she who led me to Steven Zeitels, so I dedicate this essay to them, because without them, this story does not exist. This is the story of how I came to love voices, and how I learned to listen to them--which, I believe, are two parts of the same fascinating and all-encompassing whole.

It is perhaps fitting that I first met Margo not in person, but on a live recording, of Kathleen Battle's famed Carnegie Hall recital in 1991. I thrilled to Battle's voice, of course, but even as a young Korean-American child who thrived on playing Rachmaninoff and Chopin as quickly and loudly as possible, I remember listening to that recording and being struck by the majesty of Margo's playing--the regality of her pacing, her keen support, the lucidity of her hands, and the beauty and clarity of her sound. Most of all, I experienced a new, visceral sense that piano and voice were equals on that stage. I believe that is the first time in my life that I experienced truly "collaborative piano."

Nonetheless, I never came to know it as such until many years later. That remained a singular touchstone moment in my life, while I continued to study the solo repertoire with aplomb throughout high school. Musical collaboration came first to me, happily, when I matriculated to college. I feel transcendently lucky to have been at Harvard in the Robert Levin days, and when Patricia Zander lived just down the road in Cambridge. In her home and studio, and in his classroom and seminars, I learned how to listen to others. The wide ranging resonances of that phrase--"I learned how to listen to others"--cannot be understated, particularly in the ongoing development of a young pianist, who, by the way, was an only child. Chamber music brought me outside myself to see the joys and challenges of these musical and necessarily personal collaborations.

Still, for the first 20-some years of my life, my musical universe centered on instrumental music. Ironically, for many years, I think I held a subconscious prejudice against art song and opera because I felt it wasn't challenging enough (clearly, I had never to that point seen an orchestral reduction of a Strauss opera). I was young, and at that time, perhaps musically immature; I endured Bach to get to play Tchaikovsky (these days, when I have 30 minutes at the piano, I lose myself in Bach). I loved the finger-twisters--and in retrospect, there is no question that the technical dexterity I developed as a result continues to serve me every day I do laryngeal phonomicrosurgery. But in the context of my early musical development, voices just didn't speak to me.

The first ram to batter that wall in my heart may have been the great Lewis Lockwood, who taught a core arts course at Harvard called, simply enough, "Opera." (It would also turn out that the very first song I would ever play was in my senior year--"Batter My Heart" from Britten's The Holy Sonnets of John Donne.) Lockwood's was unquestionably a titanic mind, but he was also a profoundly gifted lecturer, and he somehow managed to open even my instrumental-centric heart to the glory of a voice, the richness of the operatic tradition, and to the possibilities of opera as, indeed, Gesamtkunstwerk.

That, along with Kathleen Battle--and a lot of divine providence--may have been the reason I thought I would go out on a limb and choose the vocal track, and Margo as my teacher, when I matriculated to Juilliard as a master's student in Collaborative Piano in 2004. It bends toward cliche, but I will nonetheless avow that there and then, I was bitten, hard, by the opera bug. In fact, it was at my rehearsal for the audition to Juilliard--for which my singer was a master's student in voice named Susanna Phillips--when I vividly remember being captivated by the sound of a singing voice. I thought to myself, so that's what a real voice sounds like. I think most of us who continue to work with and love voices always circle back to that feeling, that visceral experience, as Edith Bers describes it, the cry of one animal to another. We study, we look, we think, but ultimately, we love voices because we hear them and feel them.

There were, as the kids say these days, all the feels, back then at Juilliard. I was so green, and it was utter gluttony. In the early days, it felt like Camp Opera. I ran from Diane Richardson's expansive and thrilling opera repertoire class to Margo's classic vocal accompanying class, then to 4-6 hours of voice lessons in Marlena Malas's studio; after a quick bite for dinner, staging and orchestra rehearsals, or a liederabend. As Agnes Gooch sings to Mame, "If life is a banquet, I stuffed myself." But, oh, those voices!

And those singers. It is no coincidence that my love for the voice grew alongside my love for my singer friends. In retrospect, being part of their lives was some of my most important education. In their lessons, I watched as their teachers helped them work to figure out their anatomy and physiology and how to organize their bodies to create sound. I watched them deal with colds and observed the massive toll a simple upper respiratory infection can take in the life of a singer. I watched them steel themselves again and again for auditions, reveling in the joys of their successes and sharing in their disappointments. Through all of it, I developed a profound empathy for how difficult it is to build a career based on subjective assessments of the product of an internal organ which you cannot see, which has voluntary and involuntary neurologic input from the brain, is subject to the vicissitudes of dehydration, reflux, infections, and which changes not just from day to day, but from year to year. I learned that singers aren't crazy; they just have the hardest job in the world.

Amid my multidimensional and quickly progressive infatuation with the voice, and in the infancy of my education about the voice, I met Dr. Steven Zeitels. It was Margo who made this fateful connection, knowing of my longstanding interests in science and medicine; she had known him for many years through collaborations at Tanglewood and in Boston. She suggested I spend some time in his clinic, and fortuitously, he also came that year to Juilliard to give a lecture on vocal health. What amazed me then--and still does today--is the virtuosity of his thinking. I am acutely aware of the titans in my academic history whom I revere as virtuosos--a term I love to apply to them, because for me it captures the breadth and depth of their scholarship, the facility with which they mobilize and share it, and the ways in which their inquiries and passions extend into multiple disciplines and intellectual spheres. All of the virtuosos who have taught me personally have been in the arts and letters--Helen Vendler, Patricia Zander, Robert Levin, Margo Garrett--save one: Dr. Zeitels. No one thinks more comprehensively and obsessively about the larynx; no one enjoys talking about it more. That man loves the larynx.

It is only in very recent months that I have been able to start to appreciate what a pivotal, life changing moment that was in 2005, meeting him. I had, at that time, only the vaguest premonition but realest belief that there was something there for me. Nine years later, after medical school and residency at Baylor College of Medicine and MD Anderson Cancer Center, I came "full circle" to join Dr. Zeitels as his clinical fellow at Massachusetts General Hospital.

It was a transformative year, and it is a reasonable approximation to write that this was the year I learned to love--revere, perhaps--the larynx. This fellowship in laryngeal surgery was an immersive apprenticeship, a complete education in understanding the larynx, contemplating its function in three dimensions and real time, and dissecting--intellectually and literally, in surgery--the multilayered vocal folds. Much of the work and thought process seemed reductionist, intentionally. We literally used a microscope in surgery to dissect millimeters of tissue on the vocal folds. We used magnified laryngoscopes to maximize the clarity with which we could see, and therefore evaluate, the clinical anatomy of the vocal folds, the propagation of the mucosal wave during phonation, closure patterns, and the changing morphologies of the larynx as singers proceeded through phonatory tasks. I came to love the larynx through studying it, because its function in the human body is nothing short of a miracle.

It would be miraculous enough to consider the role of the larynx in respiration, in its position atop the respiratory tree, and the periodicity with which it participates in breath and the coordination of deglutition. But to understand the way in which it gives each of us voice, those two tiny pieces of tissue generate the sound to resonate in the structures of our face, head, and neck and create a vocal signature that is beautiful and sufficiently voluminous to fill a 3000-seat theater. My reverence of the art blossomed with my study of the science.

In the same way, my love affair with the voice grew with my study of its mechanism, and toward that end, Zeitels was a patient, wise, and exacting taskmaster. He accepted nothing less than perfect examinations in clinic; if the exam was at all blurred, or if a revealing phonatory task was neglected, or if the sound was suboptimal, I repeated the examination. He took me to task to emphasize the supreme importance of attention to detail, because it is in those small details--literally millimeters of tissue--that one often finds the answers.

The fuller truth is that the curation of a human voice is such a complex endeavor that one individual is unlikely to be equipped to manage it wholly. I always begin my talks on vocal health saying, "It takes a village" to curate a singing voice: voice teachers, voice therapists, diction coaches, movement instructors--and physicians. But I believe firmly that we do our best work when we are a team of curators that understand each other's vocabulary and speak a common language. Sometimes, we pull at different ends of the spectrum, like when voice teachers want singers to give them more vowel, and the coaches want to hear more consonant. Nevertheless, we collaborate toward a common goal, each with his/her own special skills and insights. At the NYU Voice Center, patient visits are indeed collaborative; I see each patient alongside a speech-language pathologist, because I value the expertise and perspective that speech-language pathologists bring to each encounter. I love working with voice teachers who comprehend and teach singers anatomy, and I cherish the mentors and training that have made me a surgeon with a profound love for the repertoire and art of singing.

We are our best when we collaborate in the care of singers, when we have multiple trained ears curating a voice, and when those ears and those experts continue in open dialogue with one another. I continue to expand my listening, and to understand the ways it informs the way I understand function as a clinician and surgeon. I attend my patients' voice lessons, their recitals, their shows, in order to hear their voices at various times of day, in different acoustic contexts, because I firmly believe it all helps me take better care of them. I invite voice teachers and coaches to come to my clinic with their students to see their vocal folds, watch endoscopically as their larynxes move through phonatory tasks, to participate in our multidisciplinary discussion, and to be partners with us in the ongoing care of these precious voices.

Once a collaborative pianist, I am now a collaborative surgeon--because when we all listen together, our collective insights, thoughts, and ideas, spur us on to take better care of singers than we ever could alone. They deserve nothing less, not just for the immense challenge of their work, but for the unmatched beauty of the gift they give to this world each time they draw a breath to sing.

Paul E. Kwak, MD, MM, MSc, is a laryngologist and laryngeal surgeon at the NYU Voice Center, and Assistant Professor in the NYU Department of Otolaryngology--Head and Neck Surgery, specializing in care of the professional voice and phonomicrosurgical resection of benign vocal fold lesions. He treats patients with vocal cord cancer, vocal cord paralysis, and laryngeal papilloma, and is experienced in surgical techniques for laryngeal microsurgery and use of the KTP laser. Dr. Kwak completed his clinical fellowship in laryngeal surgery with Dr. Steven Zeitels at the Massachusetts General Hospital, and his residency in otolaryngology--head and neck surgery at Baylor College of Medicine and MD Anderson Cancer Center. He is also a graduate of The Juilliard School, where he earned a master's degree in Collaborative Piano with Margo Garrett, studying vocal accompanying and opera coaching.

In 2003, Kwak graduated magna cum laude from Harvard University, where he studied the history of medicine and medical ethics and wrote an honors thesis on the history of trust in the physician-patient relationship.

Kwak spent a year abroad at Oxford University, on fellowship from Harvard, where he earned a master's degree in Comparative Social Policy, writing an honors dissertation on patients' rights legislation in the United States and in the United Kingdom. In February 2006, Kwak was awarded the Paul and Daisy Soros Fellowship for New Americans, and in May 2006, the Helen Fay Prize for Outstanding Pianist at Juilliard. He is a graduate of Case Western Reserve University School of Medicine, where he was named the 2010 Outstanding Graduating Medical Student.

Dr. Kwak's clinical and research interests center on the care of the professional voice, and his most recent publications examine physiologic and acoustic effects of opera performance, in ongoing collaborations with The Juilliard School, The Metropolitan Opera, and the Houston Grand Opera. Additionally, his work focuses on phonomicrosurgical approaches to benign subepithelial vocal fold pathology, paralytic dysphonia, and recurrent respiratory papillomatosis.

The springtime's pallid landscape,
Will glow like bright bouquet,
Though drifted deep in parian
The village lies today.

The lilacs, bending many a year,
With purple load will hang;
The bees will not forget the tune
Their old forefathers sang.

The rose will redden in the bog,
The aster on the hill
Her everlasting fashion set,
And covenant gentians frill,

Till summer folds her miracle
As women do their gown,
Or priests adjust the symbols
When sacrament is done.
             Emily Dickinson, "Nature's Changes"
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Title Annotation:Collab Corner
Author:Kwak, Paul E.
Publication:Journal of Singing
Article Type:Column
Geographic Code:1USA
Date:Mar 1, 2017
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