By the time he was a freshman at Yale studying music, he had decided he wanted to be a conductor. As a young musician in New York, he began working his way up through the musical theater world. Over the years, he has led the music for “Cats” and “Wicked,” among other productions. He and his husband, Martin Lowe, a fellow music director, live part time in New York and London as the work takes them.

In 2016, the theater director Marianne Elliott approached Mr. Fram with an idea. She wanted to update “Company,” Stephen Sondheim’s classic musical from the 1970s, by flipping the gender of the main character, who contemplates settling down as he turns 35, from male to female to make the show more contemporary. Mr. Fram agreed to collaborate and oversee the music.

That August, they met Mr. Sondheim, then 86, to ask for his permission.

“We were completely terrified, and we wanted him to say yes, so badly,” Mr. Fram said. “And to his credit, he basically said, ‘Do a workshop, capture it on video and send it to me and I’ll see what I think.’”

When Mr. Sondheim gave his approval, Mr. Fram, the show’s musical supervisor, rearranged vocals and gathered musical talent for the show. It first opened on London’s West End in 2018 and was slated to open on Broadway on March 22, 2020 — Mr. Sondheim’s 90th birthday. Broadway shut down on March 12.

The tight-knit Broadway world was hit hard by Covid. Danny Burstein, then starring in “Moulin Rouge,” was hospitalized; Nick Cordero, a 41-year-old Broadway actor then in Los Angeles, died. Mr. Fram was not hospitalized, and by early April, he thought he had recovered. But a few weeks later, things changed. “It was like someone turned off the switch on my metabolism,” he said.

In the middle of a yoga workout, he put his head down and thought he would faint. As the days passed, he developed joint pain, profound fatigue and breathlessness, feeling winded after walking just three blocks.

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