Doctors and medical students from the University of Vermont College of Medicine stepped out of the hospital halls recently and onto the stage. The team put on the Pulitzer Prize winning play, “Wit,” to raise awareness about end-of-life issues and to spark discussion on a topic many people find to uncomfortable to talk about.
All the proceeds from the play went to benefit the UVM Palliative Care Collaborative. “Wit” is a story of a woman facing terminal ovarian cancer. It was written by a public school teacher, Margaret Edson, who lives in Georgia and had previously worked in a hospital. Edson attended the UVM showing of the play earlier this month, and answered questions from the audience after the show.
The UVM College of Medicine had never put on a play like this before. It came about because of the members of the medical school’s “simulation center,” which is staffed by professional actors – who help students and residents learn how to communicate how to do physical exams – suggested the idea of putting on the show.
“Vivian Jordan came to me with this idea and I essentially said, ‘I love it. What can I do to help,'” says Dr. Robert Macauley, the medical director of clinical ethics at UVM.
The actors in the play include doctors, med students and several local professional actors. Macauley also acted in the play, playing the role as the patient’s father. Macauley says the play brings up key facets of end of life care.
“And I have to say physicians don't come off very well in this play,” he says. “Their communication styles could use a lot of improvement. Their bedside manner could use a lot of improvement, and I think what Vivian was doing was highlighting … how to train learners of all levels about how to communicate, how to bring up difficult topics, and how to provide optimal end-of-life care.”
Macauley says the hope is that one that the play prompts audience members to have important conversations with their families.
“It's not really a feel good show. She dies in the end, which she states at the very beginning, so we all know where this is going,” he says.
“And hopefully people will even say, ‘What does that mean about my own care? How can I have conversations with my physicians in order to make sure that I get the care that I want and not the care that I don't?’"
Macauley says it's also inspiring for physicians and medical trainees to incorporate those lessons into their practice. One of the key components of being a good physician is equanimity, or an even-tempered composure, says Macauley.
“I think you need to maintain equanimity to the point that you can do your job and provide the optimal care,” he says. “But more and more we're recognizing that you can have great empathy and great feeling towards patients and it's not unprofessional to express that."
Macauley related a story by a doctor Melvin Konner. Konner says he was examining a patient and saw something that indicated that a patient's cancer had recurred, while he was only a few inches away from the patient’s ear.
“And he said, ‘Oh expletive,’ under his breath because he realized this person he cared about was now likely going to die of cancer.”
Macauley says then Konner felt horrible about it and the patient looked up and said, ‘It's OK It's just good to know you care.’
“And while I wouldn't recommend that trainees use expletives in that way,” Macauley says, “but to show I really do care about you as a person, I'm not just here doing a job I think is a very important lesson.”
