Back to Front PageVOLUME 6, NUMBER 4

'Wit' Gives Young Physicians a Taste of Their Own Medicine

Tandy Cronyn and Kathryn Hunter Williams in a production of "Wit" by PlayMakers Repertory Company at the University of North Carolina

A woman stands on center stage clad in a hospital gown, dragging an IV, a baseball cap planted on her bald head.

She begins: "I have been asked, 'How are you feeling today?' while I was throwing up into a plastic washbasin. I have been asked as I was emerging from a four-hour operation with a tube in every orifice, 'How are you feeling today?' I am waiting for the moment when someone asks me this question and I am dead."

The speech is part of the opening lines in the Pulitzer Prize-winning "Wit"-a play that, through its portrayal of a patient's harrowing cancer therapy, scrutinizes the inhumanity with which patients are at times treated in teaching hospitals.

The play's potential lessons haven't been lost on medical educators. "This play is the perfect medium to show students what's really happening out there," comments Ken Rosenfeld, M.D., assistant professor of Medicine at UCLA and director of the Pathways of Caring Palliative Care program in Los Angeles. "I believe this is something extremely important that every medical school should consider in its curriculum."

Written by Margaret Edson, "Wit" follows professor Vivian Bearing's battle with stage IV ovarian cancer in an unnamed teaching hospital. Bearing, an exacting instructor and expert in the intricacies of poet John Donne, experiences from her doctors the same cold professionalism to which she subjected her students.

Indeed, in scene after scene, Bearing is treated more than anything like a lab rat. In one instance, physicians and research fellows recite technical details to medical students as if she weren't even there. In another scene, a physician tries to perform CPR on Bearing-prolonging her life would result in more material for his research-despite her Do Not Resuscitate order.

In yet another scene, Bearing broaches the subject of bedside manner with the research fellow who is treating her. His response: "Yeah, there's a whole course on it in medical school. It's required. It's a colossal waste of time."

In fact, with the exception of one nurse, health care professionals are portrayed as brusque researchers for whom patient interaction is a necessary evil. And while the shoe may not fit most physicians, the play is a sharp reminder of how easily doctors can lose sight of patients' emotional needs.

"Our medical training does a phenomenal job teaching us about technical care, but the needs of the dying include a lot more than technical concern," Dr. Rosenfeld says. "'Wit' is the best medium by which emotional impact can be taught to residents. The way it exposes the experience of the dying with medical care is brilliant. It makes what's happening very clear to the audience."

Dr. Rosenfeld arranged for the production of "Wit" at UCLA and conducted small group discussions with students following the performance.

The University of South Carolina School of Medicine (USC) also numbers among the schools that have tapped "Wit" as a teaching resource. "Tears were flowing from our students after watching what the main character had to go through," says Richard Hoppmann, M.D., professor of Medicine at USC. "It made them realize what they really will have to deal with. It couldn't have come at a more perfect time as our seniors were preparing to graduate."

USC used the play as a teaching tool in its "Capstone" month during which senior medical students participate in a four-week block of mini-rotations, medicine and literature groups, and other programs to conclude their medical schooling.

"It's amazing what a difference compassion can make in a patient's hospital stay," comments USC student Natasha Ruth. "Bedside manner comes primarily from experience. You can't necessarily learn it in a classroom. Many of my peers never had to deal with the death of a loved one or family member," says Ruth, who lost her mother a couple years ago. "Until you experience it, you really have no idea."

"Medical students are under so much pressure to make good grades, to be the best," says Ruth. "Sometimes care and compassion take a back seat. But the play made me realize that they're just as important."

Information: Ken Rosenfeld, M.D., (310) 478-3711, ext. 41250; Richard Hoppmann, M.D., (803) 540-1000; Information on Doctor-Patient Communication: Jennifer Bush, (202) 828-0041

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