Stephen Sondheim and sudden death in older people
ByGabe Mirkin December 1, 2021
Stephen Sondheim was one of the most popular and best-known American composers and lyricists of the 20th century. His many musicals included West Side Story, Gypsy, A Funny Thing Happened on the Way to the Forum, A Little Night Music, Sunday in the Park with George, and Sweeney Todd. He won nine Tony Awards, an Academy Award, eight Grammy Awards, a Pulitzer Prize, a Laurence Olivier Award, and the 2015 Presidential Medal of Freedom.
He was active and productive all his life, but on November 26, 2021, he died suddenly at age 91. His lawyer and friend, Richard Pappas, said that Mr. Sondheim was healthy and did not have any known disease. On the day before his death, Sondheim celebrated Thanksgiving at a dinner with friends. His only reported recent illness was in the winter of 2020, when he tore a ligament in his leg after falling in his Connecticut home.
Sondheim’s lifetime ethic of working very long hours to perfect his magnificent musicals and plays was fostered by an overwhelming need to be accepted after he spent his entire childhood being rejected by both of his parents. He was the grandson of poor German Jewish immigrants and the son of wealthy parents, a father who manufactured dresses and a mother who designed those dresses. When he was 10, his parents divorced and he lived with a mother who totally neglected him. He had no brothers or sisters and no parents, but he had “plenty to eat, friends to play with and a warm bed.” He said, “My mother treated me like dirt.” She wrote him a letter stating the only regret she ever had was giving him birth. They did not talk to each other for the last 20 years of her life and he did not attend her funeral when she died in 1992.
At age nine, Sondheim was enthralled when he saw his first Broadway musical, Very Warm for May. After his parents divorced, his best friend was James Hammerstein, the son of the world-famous playwright, Oscar Hammerstein II, who treated Sondheim like he was his own son. Sondheim was a good student in school and was accepted at Williams College, and in 1950 at age 20, he was graduated magna cum laude and awarded a two-year fellowship to study music. When Sondheim was in his early twenties, Hammerstein had Sondheim write four musicals and reviewed and criticized each one. None of the musicals were ever produced professionally, but the experience was invaluable.
Great Broadway Success Led to Fame
In 1955, at age 25, the unknown Sondheim went to a party where he started to talk with Arthur Laurents, a playwright and screen writer who was working on a musical version of Romeo and Juliet with Leonard Bernstein. Laurents told Sondheim that they had just lost their lyricists, that he had enjoyed the lyrics that Sondheim had written for Saturday Night (a show that was in the planning stages), and offered to set up an interview with the world-famous Leonard Bernstein. Bernstein consulted with Sondheim’s mentor, Hammerstein, and then told Sondheim that he would write the music and Sondheim could write the words. That was the birth of the incredibly successful West Side Story, which opened in 1957 and ran for 732 performances. When the musical first opened, Bernstein was credited as “co-writer” of the lyrics even though Sondheim had written them all. Later, Bernstein arranged to list Sondheim as the solo lyricist, which was true. Bernstein received three percent of the royalties and Sondheim received one percent. Bernstein offered to even out the pay to two percent for each of them. Sondheim refused the offer, but later told reporters that he wished that “someone stuffed a handkerchief in my mouth because it would have been nice to get that extra percentage.” West Side Story was such an outstanding success that Sondheim’s career was firmly established and the rest is history.
Sudden Death in a Healthy Person
The most common cause of sudden death in an apparently healthy older person is heart disease (Nat Rev Cardiol, Mar 2013;10(3):135-42). Aging increases risk for:
• arteriosclerotic plaques that can break off to cause a heart attack
• irregular heartbeats
• congestive heart failure
A review of autopsies on almost 500 cases of sudden death in apparently healthy people found that more than 40 percent had heart problems (Heart, 2006 Mar; 92(3): 316–320).
Two years before he died, Sondheim had fallen and tore a ligament in his leg. This caused him to cancel many of his social events, limit his activity and walk with a cane. People who have to limit activity and lie or sit without moving day after day suffer progressive weakening of their heart muscle. Eventually the heart can become too weak to pump enough oxygen to the brain, they stop breathing and die from heart failure.
When you become inactive, you lose your skeletal muscles at an alarming rate, and losing skeletal muscle causes loss of heart muscle. In 1914, Dr. Ernest Starling described what is today known as Starling’s Law, that strengthening skeletal muscles strengthens heart muscle and not the other way around (Circulation, 2002;106(23):2986-2992). When you contract your skeletal muscles, they squeeze the veins near them to pump extra blood back to your heart. The extra blood flowing back to your heart fills up your heart, which stretches your heart muscle, causing the heart muscle to contract with greater force and pump more blood back your body. This explains why your heart beats faster and harder to pump more blood when you exercise. The harder your heart muscle has to contract regularly in an exercise program, the greater the gain in heart muscle strength. See Your Muscles Make Your Heart Stronger
Severe Loss of Muscle with Aging is Common
Between 25 and 50 percent of North Americans over the age of 65 suffer from severe loss of skeletal muscle (sarcopenia) that is significant enough to limit their daily activities (J Am Geriatr Soc, 2004;52:80–85). A regular exercise program is the best way to slow down this loss of strength and coordination, but even if you exercise regularly, you will still lose muscle as you age (Aging Male, September-December 2005). After age 40, people lose more than eight percent of their muscle size per decade and by age 70, the rate of muscle loss nearly doubles to 15 percent per decade, markedly increasing risk for disability and disease (Am J Epidemiol, 1998;147(8):755–763; Nutr Rev, May 2003;61(5 Pt 1):157-67).
A key to prolonging your life and preventing disease is to keep on moving. Lying in bed for many hours each day is a certain way eventually to kill yourself. Each day that you spend not moving your muscles weakens your heart until eventually you can die of heart failure.
Dr. Gabe Mirkin is a Villager. Learn more at www.drmirkin.com