A heart attack mid-concert ... what's the determined maestro to do? Mariss Jansons carried on conducting, and watched his reputation soar. By David Lister. Photograph by Rory Carnegie
On the 25th of April 1996 Mariss Jansons had a heart attack while conducting La Boheme. In a scene that would have been cut from a Hollywood B movie as being barely credible, he slumped from the podium, but his hands kept on conducting. And those hands, seemingly determined to guide the orchestra through the last few minutes of Puccini's opera, were all that were visible to audience and musicians as Jansons fought for his life.

The managing director of the Oslo Philharmonic, the orchestra Jansons had taken from near obscurity to become an international force, rushed to the stage and shouted "Is there a doctor in the house?" One third of the audience stood up. Norway's concert goers are a middle class, professional lot; but no research up to that moment had pinpointed quite how middle class and professional.

Jansons had a second heart attack five weeks later and survived. No, more than survived. His reputation, as music director of the Oslo Philharmonic and latterly also the Pittsburgh Symphony Orchestra, grew. The Latvian- born maestro is now acknowledged as one of the finest conductors in the world.

Jansons and Oslo are often mentioned alongside the similar achievement of Sir Simon Rattle with the City of Birmingham Symphony Orchestra. Since taking over the Oslo Philharmonic in 1979, he has lifted it and himself to international prominence, developing the now all too rare relationship between maestro and musicians, devoting enough time to them to build up a formidable music ensemble. The music critic Norman Lebrecht, who has written a study of the world's great conductors, says of Jansons: "He is possibly the most inspiring conductor alive, one of the mystic few whose mere presence seems to transform the sound that players make. With due care and much rest, he could live a full span, but Jansons is not a man to conserve energy."

This autumn, that energy was given a searching test. Jansons and the Oslo Philharmonic received the ultimate accolade. They were invited for a week-long residency at the Musikverein in Vienna, the ornate, chandeliered home of the Vienna Philharmonic. Jansons was elated. "In this hall, you experience such mystery," he enthused after the first concert. His wife was frightened; his doctors were furious. Five nights conducting adventurous, challenging and exhausting programmes by a man whose arteries, two Harley Street consultants confirmed, were too frail for bypass or transplant; a man who has a defibrillator in his chest (a machine that detects an irregular heartbeat and adjusts it with an electric jolt).

The fear that an ambulance might have to be summoned mid-symphony injects a not wholly welcome tension and electricity into the conducting of a man who already sends frissons of excitement through audiences with his expansive style. A malign growth on his thumb has prevented him from using a baton for some years. So he conducts with his hands, and they are compulsive viewing: sometimes the palms are face up to the orchestra, as if in supplication for a good performance; sometimes they sweep across the stage as if trying to levitate the violins over to join the cellos.

For Jansons, now 54, conducting was in the blood and in the daily routine. His late father was the conductor Arvid Jansons, head of the Riga State Opera. It was he who suggested Jansons junior to the Oslo Philharmonic. Mariss studied in Russia, then Vienna, where he was spotted by Herbert von Karajan, who invited him to work with the Berlin Philharmonic. The Soviet authorities, fearful of another Sixties defection, forbade it and he became assistant music director of the Leningrad Philharmonic. His home is still in the city, now, of course, St Petersburg; before his heart attack he used to drive between there and Oslo. In his early days with the Oslo Phil, he would pack the car with food before leaving Russia as he couldn't afford western prices. He loves St Petersburg, the city that gave him his musical education, but his face clouds over when talking about life there now, a city where the concert halls are half empty because audiences are afraid that they will not get home safely afterwards: "There are many difficulties," he says. "I cannot understand actually how the people can survive. It's terrible. They are poor They have no hope. The freedom they have is very positive, but the question is should we pay for freedom with such a price."

Jansons is a youthful looking, stocky bundle of energy. Expressions dart about his open face; his hands speak; he does not brood. But when I ask him about the night of his heart attack, he does go quiet for a moment. "It was terrible, really terrible," he says softly, then adds curiously: "It was very exciting." Ever the maestro, he is suddenly talking about the music. "I like enormously this opera. I conducted and everything went fantastically and seven minutes before the end I suddenly felt terrible pains in my left arm and heart and I knew immediately it was very serious. The question was what to do now. I must save my emotional energy. So I decided I will do very small movements. If I conduct normally then it's the end.

"Stopping was not an option. I felt worse and worse and worse. I had no strength and it was completely dark in my eyes and I said to the orchestra leader I feel very badly. Then I don't remember anything. The musicians told me afterwards that I still conducted." He pauses, considering the unthinkable as if for the first time. "If I had stopped conducting immediately, perhaps it would have been better."

He did not conduct for six months after the heart attack. The Proms was one of many performances he had to miss. Britain has missed out on Jansons and will continue to miss out for some time - it is indicative of his personality that he hates the idea of offending one London orchestra by accepting an invitation from another, and though a former principal guest conductor with the London Philharmonic, he prefers now to stay aloof from the intense political rivalry among the London orchestras as he knows his schedule won't allow him to conduct all of them. Those who do see him in his concerts abroad may be witnessing a conductor in an exploration as much spiritual as musical.

"Being so close to death has brought an extra dimension, more subconsciously but a little bit consciously, too. I think I get deeper as a musician. I like more quiet music now. I like slower tempos like the Beethoven Second. The slow music and slow tempos is much more difficult because if you can fulfil the slow tempos then the more you have to say. Many people take faster tempos because they don't have to say anything. You are afraid it will be boring, particularly when you are young. But now I am not afraid of this."

Nor of much else, it seems. One assumes he is a little inhibited on the podium by his health problems. But he denies this absolutely. "On stage I don't think about my illness at all. I don't want to come on the stage and think `I'm an ill person, please excuse me.' Doctors can't give me advice because no one can measure what I do. They all say, do less. But that is very abstract. What does it mean, do less? If I were not a conductor, I don't think I would survive these heart attacks. We conductors, we exercise ourselves.

"My wife [Irina, his second wife] is very worried. She says I am crazy and I must do less, it's better you live longer, she says, not think about how the concert is exciting. I see this, too. But at the same time I'm an artist and it's my life. The doctors in Russia always said I had some problem. But I didn't believe. My father died from a heart attack and I wasn't careful enough, and the age between 50 and 55 is always a most difficult time for men. Age, heredity and cholesterol, I learned a lot in the recovery clinic in Switzerland. Those three things are so important."

After our talk, the newly health conscious Jansons went and tucked into some Sachertorte, the Austrian capital's famous chocolate cake. "But this is Vienna," he shrugged, when he saw my reproachful gaze. "I cannot ignore the cake in Vienna"