Re-Creating a Nightmare of Good Intentions : Dr. David Feldshuh’s ‘Miss Evers’ Boys’ examines a dark hour in medicine: the 40-year Tuskegee syphilis study.

As Dr. David Feldshuh was writing his play about the notorious 40-year-long “Tuskegee Study of Untreated Syphilis in the Negro Male,” he faced a conundrum: He wanted the play to be gripping drama. But he also wanted it to tackle complex questions about medical ethics.

He got a gauge of his success the night his play, “Miss Evers’ Boys,” premiered at Baltimore’s Center Stage last fall. During one scene that re-creates a spinal tap, an audience member fainted, and Feldshuh was called to the balcony to treat him.

“It was an interesting kind of nexus of my life as a playwriting physician,” Feldshuh says. “I’m there as a playwright, looking at the play to see if it works. And I find myself practicing medicine. Does this mean it works? Or that it works too well?”

Los Angeles audiences can make their own decisions once the play opens at the Mark Taper Forum on Thursday. Winner of the 1989 New American Play Award, “Miss Evers’ Boys” dramatizes the U.S. Public Health Service “study” from 1932 to 1972 in which 400 Macon County, Ala., blacks who had syphilis were falsely led to believe they were receiving treatment--while doctors merely observed the progression of their disease.

By turning that study into a workable drama, Feldshuh follows a theatrical tradition that dates back to Shakespeare’s histories, not to mention Greek tragedy. Again and again, reality has provided raw material for the stage. It was only a matter of time until so tragically powerful a news story made it to the stage or screen.

The play’s setting is Macon County during the Depression--a place of poverty, minimal education, and even more minimal medical care. The promise of hot meals and burial stipends lures human guinea pigs into a medical program where patients get some “tonic” and pills maybe once a year, suffer through painful and often useless tests, and don’t get penicillin treatment even after it becomes commonplace. (See story, Page 84.)

Against that larger backdrop, Feldshuh weaves his tale of four fictitious tenant farmers and their nurse, Eunice Evers. As their similarly afflicted friends begin to get better from penicillin they are denied, Miss Evers’ boys drink May tea and sit in the moonlight to stave off pain and disability.

They trust in the government and, more importantly, in their Nurse Evers. She cares about them, drives them to the doctor, and assures them they won’t have to be buried in feed sacks like other poor blacks. After the first 14 years, each gets a “certificate of appreciation” and $14--”a dollar a year,” Evers explains.

According to Feldshuh, the initial impetus for the Tuskegee Study back in 1931 was not so reprehensible: a doctor’s suggestion to monitor black syphilis sufferers for six months or a year, using that study as a wedge to get medical funds for poor blacks. That goal that was never realized. Instead, the study became a self-perpetuating bureaucratic nightmare that went on for 40 years, involved scores of government and private doctors, and only stopped when the Associated Press broke the story in July, 1972.

“This play is not a vendetta,” Feldshuh says. “I have for the most part a great deal of respect for the motives of many of the people initially involved. Rather, it is an attempt to understand how well-meaning people fail to see the moral implications of their actions. The question then becomes ‘Is there something today that well-meaning people are doing wherein there is also a lack of moral insight?’ ”

In 1981, when former actor Feldshuh was in his residency in emergency medicine, he read in a medical journal about “Bad Blood,” historian James H. Jones’ highly regarded book on the Tuskegee Study. After he read it, he couldn’t stop--he read medical reports and Congressional testimony and, as the years went by, did personal interviews as well.

“I was drawn to this subject because I recognized feelings in myself that concerned me,” says the 46-year-old playwright. “I asked myself a simple question: ‘Would I have done what these physicians did had I been there?.’ I don’t know, but I think I was fearful enough that I wanted to find out exactly how it was they let themselves do it. I wanted to explore the process through which they allowed themselves to participate in something that was clearly in retrospect wrong.”

For nearly a decade, and through 27 drafts--so far--he has attempted to first learn from, then teach, the lessons of the Tuskegee Study.

But he was writing a play, not a docudrama. So first, Feldshuh took many of his moral and ethical questions and lodged them dramatically in the character of Nurse Evers. Evers is “suggested by” Eunice Rivers, the real-life Alabama nurse who served as staff, chauffeur and on-site overseer for nearly the study’s entirety, although less actively after her retirement in 1965.

Rivers, who died a few years ago, “never testified in front of Congress (as Evers does in the play) and to my knowledge, had concerns about the study but did not go public with them,” Feldshuh says. The fictitious Evers, however, has many doubts. The playwright says her character evolved as he asked himself what doubts Rivers “might have had but was unable to express?”

Feldshuh has rewritten since Baltimore, focusing more attention on Evers, and actress Starletta DuPois, who plays Evers here, considers the role a “tour de force for an actress.” The New York-based actress, who coincidentally studied nursing at Harlem Hospital School of Nursing before going into acting, has been reading “Bad Blood” herself. “But I have to read some, then put it down,” DuPois say. “How could it have gone on so long?”

That is the question Feldshuh asks throughout his play, and nowhere does he ask it more dramatically than through Evers’ torment. “Here is a woman who exists as a black in a white world, female in a male world, nurse in a doctor’s world. She loves her patients and has at the same time great allegiance to her profession. Now what is she going to do when the profession demands that she treat her patients from a distance and not up close? A doctor tells her, ‘You’ve got to step back and look from a distance,’ and she says ‘I can’t.’ ”

She is, says Feldshuh, a woman who “seems to be making the right decisions at each point but the overall journey is clearly down the wrong road. She is trapped in a vortex of small decisions, and it ultimately not only pulls her down but finally pulls her apart. It separates her from herself.”

There were dramatic dilemmas to resolve in presenting syphilis as well. “How do you show syphilis without talking about it, and how do you make it dramatically involving without simply reciting that this disease does this or that?” Feldshuh asks. “You have to have a strong visualization--an image of what this disease can do to one person to appreciate what it could do to a people.”

So Feldshuh’s four farmers attempt to escape the despair of their lives in part through “the gillee “ a competitive dance that the playwright created from an amalgam of rural entertainments from the period. “I knew that one of the things that syphilis can do to you is make it difficult for you to use your legs, and this gives you the image of a potentially brilliant dancer caught by a disease that in one of its manifestations can cripple you. Then, instead of this play being about disease, it is about conflicting passions and aspirations that work themselves out within a net of this disease.”

Syphilis, says Feldshuh, “was called ‘the great pox,’ which suggests how prevalent it was throughout history (and still is, with U.S. cases at their highest rate now in 40 years). It was going on everywhere in the world and in Macon County, where there was no health care, prevalence was high.

“It was also called ‘the great imitator’ because of how diversely it presented itself. Syphilis could have no effects, a mild or a devastating effect. It was a complex, subtle disease and that made moral thinking about it also complex and subtle. You could point to somebody and say ‘It’s not so bad. We’re not treating him and he’s fine.’ ”

Few of these poor, uneducated men even knew they had syphilis, and fewer still knew what the Tuskegee Study entailed. Unlike today’s research subjects, who presumably are informed of the risks and benefits of participation before choosing to do so, these men gave no “informed consent.”

“As one of the doctors says, ‘Those men should have been given a choice,’ ” says Feldshuh. “One of the reasons we’ve evolved this safeguard (of informed consent) is (because of) the Holocaust and the Nuremberg trials, which stated that people should be given full awareness of the consequences of what things might affect them.

“Any time you’re at the boundary of medical technology or medical experimentation or at that tricky line that separates the frontier of treatment from experimentation, you’re going to be dealing with ethical issues that are central to the play,” Feldshuh says. “Informed consent is like checks and balances in the government. You don’t assume that the motivations will always be ethical. You set up a process to create controls.”

New York-born and Dartmouth-educated, Feldshuh studied acting at the London Academy of Music and Dramatic Art, then moved on to Minneapolis’ Guthrie Theater (where, in the late ‘60s, in a Guthrie West Coast tour, he played the Taper). He continued moving up at the Guthrie until at age 27 he was the theater’s associate director.

He was treading diligently upwards on that career path, he recalls, when one day he came out of rehearsals of the French farce, “An Italian Straw Hat,” and was transfixed by a television news broadcast of the massacre of the Israeli athletes at the 1972 Olympics in Munich. “It made me wonder ‘What am I doing here,’ and I realized there were questions I wasn’t really asking myself. I was relatively successful at a young age, so I knew the ‘dis-ease’ wasn’t related to a lack of achievement in my career. I had to look elsewhere; I had to look within myself.”

The energetic and driven Feldshuh apparently asks himself few idle questions. A year later, he was off to a Zen Center in San Francisco and to Esalen, investigating such things as Gestalt therapy and bioenergetics, trying it all. But his quest was also eminently practical--he turned his research into a dissertation called “Seven Consciousness Expanding Techniques and Their Relevance to Creativity in Actor Training,” and in 1975, picked up his doctorate in theater arts.

Feldshuh went back to the Guthrie, created its first hospital touring show, and in 1976, entered medical school. He thought about and rejected psychiatry, wanting something both “more hands on and more concrete,” and decided on emergency medicine. He supported himself in part by directing plays at night, and after finishing medical school, juggled a free-lance directing career and emergency medicine.

Before tackling “Miss Evers’ Boys,” he’d written just one play, a theatrical adaptation of several fables called “Fables Here and Then,” which toured extensively and at one point featured his sister, actress Tovah Feldshuh. He spent considerable time researching “Miss Evers’ Boys,” and had just a “very rough draft” in 1984 when he accepted the job of artistic director of the Center for Theatre Arts at Cornell University in Ithaca, New York. Busy teaching and running the center during the school year, he’d work on his play during summers at his lake-side place outside Minneapolis.

Feldshuh, who has also somehow managed to continue both his emergency room work and his directing, is asked if there are parallels between life as a director and life in the emergency room. He shakes his head, yes: “In both cases, you are called upon to make decisions, frequently rapid decisions. . . . If you’re not willing to make a decision and take responsibility for decisions, you shouldn’t be directing and you shouldn’t be doing emergency medicine. Neither are environments conducive to serene cogitation.”

Feldshuh’s inability to let go of his play for so many years worked well in terms of its development. Not only are there more workshop opportunities for new plays these days, but instead of demanding to premiere a new play, more and more regional theaters are now willing to host the second or third production. “Miss Evers’ Boys,” for instance, went through three readings at Minneapolis’ Illusion Theater, plus the 1989 Sundance Institute Playwriting Workshop and last fall’s world premiere at Center Stage before getting to the Taper.

“Miss Evers’ Boys” is currently playing the Illusion, where a production opened June 29, and another production is set for Atlanta’s Alliance Theatre Co. in September. Taper artistic director Gordon Davidson says there’s also been interest here in terms of moving the play on to other stages (around the country)--and possibly, the big screen--after the Taper, “but it’s a question of how, when and where.”

Davidson had been in touch with Feldshuh on and off since Feldshuh’s Guthrie days and particularly since Feldshuh moved to Cornell. A Cornell graduate himself, Davidson had been chairman of an advisory panel that oversaw creation of the new Cornell center, and says he’s been aware of “Miss Evers’ Boys” for a long time. He hoped to do the play at some point, he says, “and when Center Stage could do it first, I said fine, and found the next available time.” When it appeared last spring that Arthur Kopit’s play, “Discovery of America” would not be ready this season, Davidson dropped “Miss Evers’ Boys” into the Taper schedule to replace it.

Davidson speculates that “Miss Evers’ Boys” will wind up in many regional theaters “because it’s eminently do-able. Its cast size and subject matter make it just the kind of play that belongs in theaters that serve communities. The New York question is always who and when and where because the auspices, commercial and noncommercial, are always complicated there.”

Asked if there has also been movie interest, Davidson replies that “there was some early interest (in Feldshuh’s play) around the time of the Baltimore production, but not necessarily linked to it. We thought it was better to finish the journey of the play as a play. I’m sure that there will be some increased interest once the show is seen here (but) one tends to want to hold off.”

Feldshuh, meanwhile, is making minor edits on the play, and in fact was still fiddling with it during previews last week. But now he’s mostly “working on the rest of my life. I have a two-year-old son, a wonderful wife and a lot to occupy me there. I have more than a full-time job with working in medicine and with Cornell. But if ‘Miss Evers’ Boys’ should go to any other medium, I’d look at it again. Or if I should find another story that possesses me in the same way that this story has possessed me, then I might write another play.”