The Pulitzer-prize winning play, Wit, is touring the country to broad critical acclaim. During its recent run at The Kennedy Center for the Performing Arts in Washington, D.C., it was also the starting point for a conversation about death and dying among theater-goers, experts in end-of-life care, and the show’s entire cast.
The play itself can be tough-going. However, playwright Margaret Edson avoids the sentimentality that would have made a tear-jerker out of what is actually a provocative look at how many Americans die: Alone, in hospitals, in crisis situations. The lead character, Vivian Bearing, is a professor of seventeenth century literature and an expert on the Holy Sonnets of John Donne. Her acerbic take on the world adds some levity to scenes that might otherwise be unbearable.
Some in the audience questioned the accuracy of certain scenes, but Judith Light, who plays Bearing, noted, “It’s not a documentary of Vivian Bearing’s life, but her life as she views it, from her perspective."
During an after-performance question and answer period, Light told about 500 audience members that she felt that Wit was doing what its author, Margaret Edson, had intended for it to do: “This play is a way to open the conversation,” Light said.
Several groups cosponsored the event: ABCD, The Hospice and Palliative Care Center of Metropolitan Washington, The Friends of the National Institute of Nursing Research, the National Institutes of Health, the National Institute of Nursing Research, the National Cancer Institute, and The Agency for Healthcare Research and Quality.
Franklin Health, Death with Dignity, and Bristol Myers Squibb sponsored a pre-show gathering for about 200 attendees. Speakers included Neil MacDonald, M.D., a pioneer in palliative care who now directs the Cancer Ethics Program at the Center for Bioethics of the Clinical Research Institute of Montreal; Patricia A.Grady, Ph.D., director of NINR; John Eisenberg, M.D., M.B.A., director of the Agency for Healthcare Research and Quality; John English of The Hospice and Palliative Care Center of Metropolitan Washington, and Joanne Lynn, M.D., president of ABCD. The audience included policymakers from federal and local governments, as well as healthcare professionals from various organizations.
MacDonald lauded NINR for “taking a leading role in end-of-life research,” a field in which he has been active for twenty years. He described the difficulties the play presents, especially in its searing presentation of medical researchers.
“At one point, Bearing says, ‘It’s not about me, it’s about my ovary,’” MacDonald said. He countered this by saying that “humane care and research are all of a piece. Wit presents a devastating view of the research physician. But research is not inherently dehumanizing."
Eisenberg discussed his agency’s focus on health care quality and research, noting, “AHRQ is about closing the gap between what we know and what we believe we know. We need to do more with what we know.”
Lynn told the crowd, “You can’t imagine what it’s like to see this crowd of people gathered to promote care of the dying. This event is special because it is in Washington, D.C., where federal policy is made. And federal health policy must change before the way we die changes.”
After the performance, Lynn, MacDonald, and pain researcher Betty Ferrell, Ph.D., joined the cast for a discussion led by the Kennedy Center’s theater educator, Mark Kirkstan.
One physician who saw the play, Judith Salerno, chief consultant for geriatrics and extended care at the Veterans Health Administration, said, “ It was difficult as a clinician who has cared for dying patients to watch Judith Light’s performance. I felt both empathy and implicated as a health care professional. The message—the need for improved care in the last phases of life—was resounding and echoed again and again in the Q&A session. I felt privileged to be a part of the evening and came away convinced we can do better.”
Kirkstan’s first question of the panel was to ask them to explain how Bearing, surrounded by people who cared, still missed receiving something. What, he asked, was missing?
Ferrell pointed to the dehumanizing experience Bearing endures. “They forget she is a person; there is the loss of control, identity, meaningfulness….There is abundant good care in this country,” she said. “But there is also a terrible deficit.”
MacDonald described problems that persist when care and cure are carefully delineated, rather than provided on a continuum of care. And Lynn noted, “We have not lived this way—so long—before. We mostly get to grow old and die slowly.” And that issue may well be a starting point for changing federal policy on end-of-life care.
According to Linda Cook of NINR, her colleagues took time the following day to discuss points made during the Q&A with coworkers. “As a yardstick of how important the actors felt the evening was, the entire cast was present for the Q&As, not just the lead actors. And it was significant that about two-thirds of the audience [for a sold-out show] stayed after the play.”
Grady said, “The evening events encapsulating the play ‘Wit’ exceeded expectations. The question and answer forum following the play, in particular, generated a new momentum for end-of-life research and care. It was gratifying to see scientists, opinion leaders, health care providers, the public, and actors in the play sharing experiences and highlighting the need for positive change. Through more research, ways will be found to improve care of the dying.”
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