Medical School Uses a Play to Teach a Lesson in Compassion

After the 60 or so USC medical and premed students saw “Wit,” the acclaimed play about a woman’s struggle with cancer, they said it taught many lessons that would make them better doctors. For instance: Don’t ask very sick people how they’re feeling and ignore the answer.

That familiar clinical greeting serves as a running joke in the often funny drama about disease and death. Doctors repeatedly barge into the lead character’s hospital room and ask how she is doing, even if she is barely conscious or throwing up.

Awarded the 1999 Pulitzer Prize and set to appear on dozens of stages nationwide this year, “Wit” has deeply affected audiences, largely because it distills into 90 minutes some of medicine’s worst failings in the age of managed care.

The playwright, Margaret Edson, has said she did not set out to reform health care. But no recent work of art shows more promise of helping do that, scholars say.

Public discussion of the drama “could accelerate the rate of improving the care of very sick patients,” said Dr. Joanne Lynn, a George Washington University medical researcher and president of Americans for Better Care of the Dying.

The advocacy group co-sponsored a “Wit” viewing last month, inviting 500 health professionals, lawmakers and policy experts to a performance and question-and-answer session at the Kennedy Center in Washington, D.C.

Another health advocacy group, Last Acts, has placed ads in playbills for “Wit” productions, telling where to get information about “good end-of-life care.”

“Wit” strikes a chord because baby boomers are now facing their own mortality and that of their parents, said Betty Ferrell, a PhD nurse specializing in pain control at the City of Hope Cancer Center in Duarte.

“Much as, in the 1970s, there was a revolution in thinking about how we give birth, now the question is how we die, and I think the play addresses that,” Ferrell said.

The idea of taking a bunch of USC students to a performance at the Geffen Playhouse in Westwood came from Dr. Ronald Katz, chairman of anesthesiology at the university’s Keck School of Medicine. He saw “Wit” in New York and it impressed him enough to spend $1,000 for most of the students’ tickets to the local production, which ended a sold-out run last month.

Katz and two other USC faculty members accompanied the students, whose presence pleased the audience. Or so it appeared when cast members returned to the stage after the curtain to answer questions.

“Every physician should see this play,” Katz shouted from a front row, adding that dozens of future doctors were seated with him.

“Thank you very much, doctor,” said Kathleen Chalfant, who originated the role of the cancer patient and proud literary scholar Vivian Bearing five years and about 600 performances ago.

People clapped, in a resounding show of support for art in the service of medicine.

But the sentiment was not universal. A cancer specialist buttonholed Katz in the aisle. Because it portrayed cancer doctors as inhumane technicians, the play, he said, was a “cheap shot” at the profession.

An impromptu lobby symposium of USC students and faculty went on so long that a theater manager had to ask them to leave. Terrie Rowen, a first-year medical student, said the play had a powerful impact.

“It struck me as I watched it that here we are in a helping profession, but when some patient is in that situation we don’t necessarily help the patient, we end up helping the disease,” she said.

Dr. Pamela Schaff, a USC associate professor of medicine, said it is a pity that some doctors lose touch with their humanity. Schaff said she generally spends as much time as possible with patients, even at the risk of upsetting her schedule: “I’m always running late”

“Wit,” though rich in implications for the troubled doctor-patient relationship, ranges across the human condition, touching on language, poetry, science, loneliness and redemption.

Vivian (a name derived from the Latin word for “alive”) is an expert on the coy and witty metaphysical poetry of John Donne. Her work delved into one of Donne’s Holy Sonnets, which begins with the phrase “Death be not proud.”

She once determined that the two parts of the poem’s ultimate line should be separated by a comma, not a semicolon, as one edition had it. Such minutiae have so occupied her--she has never married and remains alone--that the program renders the play’s title as “W;t.”

In a pivotal irony, the dispassion and single-mindedness of her literary research, plus the stern way she treats her students, are mirrored in the treatment she receives at an academic medical center. Having enrolled in a study of an experimental cancer drug, she becomes little more than a fascinating research problem to her doctors. Thus she discovers, redemptively, the impoverishment of her detached outlook.

Not all the health workers are alike, though. An emotional climax occurs when a kindhearted nurse, representing the ideal caregiver, rubs Vivian’s hands with lotion as she lies unconscious. The gesture wrings sobs from the audience.

The class consisted of 19 undergraduates enrolled in a program that has admitted them to USC’s medical school. Katz was there, along with Erin Quinn, who has a doctorate in health services and gerontology and is associate dean of medical school admissions.

Asked why the play was so popular, these doctors of tomorrow said the story was told from the patient’s point of view, it conveyed the bewildering briskness of medical encounters and it revealed the emotional gulf often separating the very sick and their caregivers.

It dealt with something that isn’t trivial, said student Julienne Ong.

“What’s the most important thing you can do when you have only a small amount of time” with a patient? Quinn asked. “Listen.”

Asked how “Wit” might influence their doctoring, one student said it reminded her that doctors are here for patients, not the other way around. Another said that though a doctor might have performed an invasive procedure hundreds of times, it is a first for a patient, so she deserves complete attention.

“That’s what we have to remember,” said sophomore Celaine So. “Each patient has to be 100%.”

“Next time I’m working in the hospital,” Ong said, “I’m going to be careful not to ask a really sick patient, ‘How are you doing today?’ ”