Striving for Music: Joe Henderson and Phil Woods' Struggles Performing with Emphysema

Introduction

Chronic obstructive pulmonary disease (COPD) is a highly prevalent respiratory condition, an important cause of lost life years and its importance is still growing. By 2030, COPD is expected to be the fourth leading cause of mortality, morbidity, and disability worldwide. It is usually caused by significant exposure to noxious particles or gases, including inhaled tobacco smoke.¹

Despite a large number of quantitative studies, there are comparatively few qualitative studies that have explored the perspectives of patients with chronic respiratory conditions.² In COPD management, the observation of patients' expressions of creativity may help to capture a global expression of illness experience and provide insight into the heterogeneity of their perceptions.³ Indeed, as stated by Öhman,⁴ it is possible to find new concepts helping to develop methods for the management of patient impairment. It has been suggested that "sometimes a work implying a much smaller number of people whose experiences are analyzed in-depth may be as valuable as large, randomized, multicentric studies; [...] in research, publishing, and practice, the individual always matters."⁵ It is common knowledge, according to their Wikipedia sites, that Joe Henderson (1937-2001) and Phil Woods (1931-2015) suffered from emphysema.^6,7 This disease most likely corresponds to the disease known as COPD in the academic press, as pointed out by Minai et al who state that the more recent guidelines have moved away from an artificial separation between chronic bronchitis and emphysema, favoring the more descriptive term, COPD.⁸ Throughout this text, references to the disease named "emphysema" will be considered as a manifestation of the disease known as COPD.

As Henderson and Woods were public individuals, it is impossible and unethical to search and report private medical data. Hence in these cases, it is pertinent to consider using pathographies. Pathography is a medical genre that has been advocated to reconstitute the life of a noted person, often an artist hindered by a severe disease, to obtain a better understanding of his/her creativity. ^{9,10, 11} Henderson and Woods were prominent jazz players practicing jazz music at a high level as saxophonists, usually in large venues and with renowned fellow musicians. Jazz music offers to musicians the possibility to freely interact with other players in a group configuration and with an audience.¹² However, Henderson and Woods developed COPD during their long careers, leading them to individual strategies that turned out to be quite different. This is demonstrated in their recordings of live performances on YouTube, which is one of the most popular social Web sites on the Internet and is often used to share patient educational materials with large numbers of individuals with chronic diseases.¹³ It also allows viewers, by thorough observation of musicians' performance with their health status in mind, to view, upload, and even post data as comments.

The concept of "coping" is stated by Papava et al as a "psychological process developed at a conscious level [...] use[d] to manage the difficult and stressful situations of life."¹⁴ This study relied on abstracted pathographies of Henderson and Woods to analyze available YouTube videos of their public performances before and after the occurrence of respiratory impairment to obtain valuable clues on their strategies for coping with COPD in their effort to maintain their creative output and vitality.

Material and Methods

I. Pathographies

"Historical biography from a medical [...] viewpoint" was how following definition byHwang et al¹⁵ established the pathographies of Henderson and Woods. There was no published study of Henderson's life and career until the Doctor of Arts dissertation of J. G. Harris in 2016,¹⁶ which had no medical intent but is the more thorough work available on this subject. Other sources were also cited when judged useful on specific points (interviews with fellow musicians, press articles). As for Woods, there is a published biography done by the artist in collaboration with a journalist which was considered sufficient for the scope of this text.¹⁷ However, in both cases, no medical reports of the respiratory condition of the subjects were searched for.

II. Artists' Music

YouTube was used, as a popular video-sharing platform, and the third most visited social media site in the world.¹⁸ For each artist, two videos were selected according to the following conditions: correct visualization of the musician in full-length activity, acceptable sound quality, and choice of one document preceding by at least five years, and following by at least one year the likely diagnosis of emphysema. The search was conducted on the YouTube site by using the following keywords "name of the artist"—"AND"/"OR"—"live performance." Adequate material was obtained allowing a thorough analysis of the musical performance. For each event of interest occurring during the viewing of these videos, the timing tool available in YouTube was used and the obtained number was stated in the "Results" section. YouTube videos posted by marketing agents, duplicate or incomplete videos, and live-streaming videos were excluded.

Results

I. Pathographies

(The main pathographic data of Henderson and Woods are presented in Table 1, which is found at the end of this article.)

According to the noted pianist Mal Waldron, "Joe is like a champ... a genius!."¹⁶ He was a heavy smoker who often appeared smoking or with a cigarette in a hand in the sleeves of his records. He did not obtain public recognition until the age of 48 years and bitterly stated his perceived theft of ideas by other musicians as stated by his friend Pete Yellin.¹⁹ Henderson was known in his professional environment by the nickname "The Phantom."²⁰ He was reserved and had a great desire for privacy¹⁶ despite a necessarily important public exposure because of his artistic activity. To the best of my knowledge, Henderson never said a public word about his health. Only fellow musicians stated his declining health which took a turning point at age 60: a hospital admittance with a provisional diagnosis of emphysema occurred in 1997; a few months later he was affected by a stroke which led to the cessation of any musical activity until his death in June 2001. Thereafter, his quality of life was certainly awful as reported by Koransky:²¹ "It took a half-hour for him to assemble his instrument; [...] he played a few phrases. Then he stopped and just looked down at his knees. A few minutes later, he started to cry. When he realized he couldn't play anymore, Joe's life actually ended."

According to the noted pianist Bill Charlap,¹⁷ Woods was "larger than life." Unlike Henderson, Woods enjoyed early professional and public recognition, notwithstanding equivalent crafts to Henderson (Table 1). In 1957 he married Chan Parker who was since 1955 the widow of Charlie Parker, an undeniable legend of jazz music. In 1968 the couple moved to France where Woods worked until 1972. He returned then to the USA, divorced, and remarried. Woods did not deny heavy exposure to tobacco, alcohol, and to a lesser degree, other addictive substances.¹⁷ He publicly stated that his declining health was caused by emphysema. He admitted using oxygen as soon as 1995 and called it "his amplifier."¹⁷ An important difference in the pathography of Henderson and PM seems the ability of Woods to socialize and create strong personal links. The following three points support this assertion: in 1983, he received in his band for six years Tom Harrell who was diagnosed as schizophrenic at age 19 and was extremely disabled by the medications he had to take, despite being a recognized artist;²² early support to a dedicated association³³ devoted to jazz music; companionship with younger talented musicians (one of them was Grace Kelly, aged 14 when he began to work with her). However, it has to be noted that Henderson assembled an all-female quartet that toured in the eighties and recorded in 1986 and also led a big band that recorded in 1992 and 1996.

Analysis of Artist's Music on YouTube:

I. Joe Henderson: The Frail Taciturn

Two videos were selected for analysis. The first example displays a live performance of a quintet led by pianist McCoy Tyner in 1986 in Nurnberg, Germany.



Henderson is aged 49 and seems healthy. There is high energy throughout the performance. The solo begins at 1:43 with a powerful long note and lasts more than five minutes. The playing consists of a high flow of notes at a very fast tempo. Henderson stands a little stooped, his eyes are closed, and there is no visible prominent forehead vein when he plays high notes (see further). Once, a remarkably amazing idea makes his fellow musician, Freddie Hubbard—one of the most famous trumpet players in jazz music—nod his head with approbation (3:00), exchange a glimpse with the pianist who ceases his playing until 3:47, probably to direct all the attention of the public to the saxophonist. Henderson has only minimal communication with the band, indicating the end of his intervention by a slight move of his body to the right (6:13). There is an ovation from the audience. Henderson salutes and lifts his saxophone as a trophy; he then replaces carefully the cap of his saxophone mouthpiece. The second video takes place in 1998 in Bern, Switzerland, probably a few months before the stroke that will break his career.



Henderson is the leader of the band and presents excerpts of his publicly acclaimed version of George Gershwin's opera "Porgy and Bess." The first piece is "Oh, I Got Plenty o' Nuttin,'" incorrectly spelled "I Got Plenty of Nothing" in the video. The beginning of the piece is lacking and the solo of Henderson begins at 0:34; curiously he wears the same jacket as in 1986. His intervention lasts a little more than 2 minutes. The musical phrases are short and because of his thinness, one can see the solicitation of respiratory accessory muscles (not used in non-diseased people). There are prominent forehead vertical veins when he plays. At 2:52, Henderson stops his solo, probably because of exhaustion, and has a quick sorry glimpse to the audience which applauses. It takes a few seconds for him to take his breath while replacing cautiously the cap of his mouthpiece; he is later seen using his saxophone as a crutch and he will later take off his jacket. At 11:27, Henderson is in better shape and masterfully plays "Summertime" with the band. His intervention (12:11) is longer and far more applauded; Henderson thanks the audience with the same emphasis as in 1986.

II. Phil Woods: The Empathic Warrior

Two videos were selected for analysis. The first example takes place in 1988 in Barcelona, Spain. Woods is the leader of a quintet including Harrell, who displays his usual attitude during concerts, related to his psychiatric disease: when not playing, he stands still, his head slightly bent, holding his trumpet in his hands, his two arms dangling.



At 43:51 the group plays "Repetition," often played by the Woods' mentor, Charlie Parker. Harrell makes his intervention; then Woods announces himself musically at 50:03 and they both play a short shout chorus which acts as an interlude separating the soloists. His contribution is much more theatrical than Henderson in 1986: while maintaining a perfect technique, Woods moves rhythmically and includes in his playing excerpts of well-known songs and astonishing sound effects. He announces the end of his intervention to Harrell, who stands next to him motionless, with a brief lifting of his instrument to the left (52:34). A new interlude is played and the piece comes to its end naturally. At 55:26, Woods has very kind words to present Harrell. The second video takes place in 2011 at an American convention devoted to jazz music.



The tune is "The Man with the Hat" that Kelly wrote in honor of Woods, aged 79 at the time. Woods plays without oxygen and lets Kelly take the lead; he plays the second voice of the piece, which needs less energy expenditure. After the exposition of the theme, Woods obviously needs time to take his breath (1:08 to 1:22) during the solo of Kelly. At 2:06 he is ready for his intervention and will play until the end, almost always motionless and without saying a word (a probable strategy to spare energy).

Discussion

This work shows how jazz musicians undergoing increasing respiratory problems linked with tobacco-related COPD (emphysema) coped with this disease during their careers. This situation is particularly unique because it involves strategies for making the disease less visible ²³ for their fellow musicians and an audience.

I. Coping strategies in COPD

Clearly, the personalities of Henderson and Woods were different. Henderson was called "The Phantom" by his peers because of personality traits that seem to have been the hallmarks of his social behavior toward his musical fellows, students, and audience. Despite these drawbacks, he was very much appreciated by his colleagues.¹⁶ Woods had seemingly a far more different personality. Two citations will be given among many pieces of advice expressed by his peers: "a very bright guy, a good writer, and an intelligent, worldly person with a great sense of humor" (pianist and composer Jim McNeely¹⁷ [p9]); "Thank you, Phil, for all you gave to me, and to all of us lucky enough to be touched by your genius, achievement, and deep feeling (trumpet player Bryan Lynch ¹⁷[p 206]). Stoilkova et al²³ studied coping styles in patients with COPD before and after pulmonary rehabilitation (a procedure used to alleviate the symptoms caused by COPD) and suggest that different ways of coping may lead to different improvements in the burden of COPD: exercise intolerance, anxiety, or depression. The following means of coping with breathing difficulties caused by COPD are proposed by the authors: active confronting coping; palliative reaction; avoidance; seeking for social support; passive reaction pattern; expression of emotions; and fostering reassuring thoughts.²³ In addition, it has been suggested that invisibility is the metaphor that captures best the experience of breathlessness in COPD patients.²⁴

Hence, it may be postulated that Henderson constructed a major part of his personality on invisibility (leading to the spontaneous nickname "The Phantom") and it is no surprise that his breathing difficulties were treated in the same way. The following styles may be applied to Henderson according to Stoilkova et al:²³ palliative reaction and/or avoidance and/or passive reaction patterns.

In regards to Woods, it is not likely that he chose invisibility to pursue his career: he can be seen in several photographs wearing a nasal cannula for ambulatory oxygen therapy. Hence, the following styles may be applied to Woods according to Stoilkova et al:²⁴ active confronting coping and expression of emotion.

II. Additional Points

Firstly, Woods, of Caucasian origin, had higher longevity than Henderson, of Afro-American origin (83 vs 64 years). It has been reported that, although African-Americans have a lower prevalence of COPD in the United States, they may develop COPD with less intense cumulative smoking and at younger ages than Caucasians²⁵, even if their educational attainment and income are correct.²⁶ However, as stated by Rothman²⁷ and Haaga, one cannot link an untimely death with a single factor in jazz musicians. Secondly, the engorgement of the forehead veins seen in the second video of Henderson could be due to greater effects on venous return of the Valsalva maneuver occurring when playing high notes on a wind instrument, the expiratory effort being impaired by COPD.²⁹ This maneuver, performed by a forceful attempt of exhalation against a closed airway, is recognized as an effective method to dilate the jugular vein, but normally not the forehead veins.

III. Limitations of the Study

The validity of pathographies in the analysis of biographies of diseased people is controversial. They are considered by several authors as good ways of improving medical education and empathy with patients.¹⁰ However, it may also be considered fruitless³⁰ or even an inappropriate way to focus a patient's experience on a diseased organism. ³¹ In the cases of jazz musicians such as Henderson and Woods, it is believed of interest to use new media of communication to study "real-life" behavior of respiratory-disabled subjects whose breathing is the main way to express themselves when working with fellow musicians or displaying their musical creativity in front of large audiences. However, as stated previously,^27,28 one cannot establish valid causality links between the personal biography of subjects and the simple account of their illnesses, especially when medical data are lacking.

Conclusion

This study shows that coping with COPD may differ in jazz musicians whose breathing is the main way of expression by using the thorough examination of publicly diffused media. This concept may be extended to other diseased patients and, as stated by van Ark et al³² to general medical education: [jazz music] "relates to medicine and medical education both as a metaphor for interprofessional education and teamwork, organization and culture, as well as a tool to enhance improvisation and communication skills."

Table 1.

Endnotes

• ¹ Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2019. Available here. Accessed February 25, 2023.
• ² Pozzar M,, Volpato E,, Valota C,, Pagnini F,, Banfi P. I. How people with chronic obstructive pulmonary disease perceive their illness: a qualitative study between mind and body. BMC Pulm Med. 2020;20(1):120. doi: 10.1186/s12890-020-1157-3
• ³ Luthy C., Cedraschi C., Pasquina P., Uldry C., Junod-Perron N., Janssens J. P. Perception of chronic respiratory impairment in patients' drawings. Journal Rehabil Med. 2013;45(7):694-700. doi: 10.2340/16501977-1179
• ⁴ Ohman A. Qualitative methodology for rehabilitation research. J Rehabil Med. 2005;37(5):273-280. doi: 10.1080/16501970510040056
• ⁵ Deeper understanding. Lancet Psychiatry. 2019;6(9):713. doi: 10.1016/S2215-0366(19)30304-9
• ⁶ Joe Henderson. Wikipedia, the free encyclopedia. Available here. Accessed February 25, 2023.
• ⁷ Phil Woods. Wikipedia, the free encyclopedia. Available here. Accessed February 25, 2023.
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• ¹⁰ Evasco M. Teaching Literature and Medicine through Pathography: Developing Interpretive and Narrative Competencies through Creative Nonfiction [dissertation]. Manilla: De La Salle University; 2020. Available here. Accessed February 25, 2023.
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