Doctors' Brains

It's 9:45 Tuesday night, and the house lights have just come on after the final scene of Wit--the surprise Off Broadway hit about a terminally ill English professor and her experience as a patient in a cancer treatment program (it won the Pulitzer Prize for drama this spring but missed out on the Tonys because of its venue). The audience is heading for the doors. But Tuesday nights are different from all other nights at Manhattan's Union Square Theatre.

Wit raises such important questions about care of the dying--and all hospital patients--that once a week the cast remains after the show for a postperformance discussion of the play led by a guest moderator. A sonorous male voice thus interrupts the exodus to invite playgoers to stay and participate in the "talk-back."

Tonight's moderator is Dr. Peter Halperin, a psychiatrist who directs the division of behavioral medicine at the School of Medicine, State University of New York at Stony Brook. Halperin explains that he has brought several medical students and colleagues--one of them an oncologist--along with him. He begins by reflecting on the painfully realistic scene in which Professor Vivian Bearing is informed by her oncologist--in almost unintelligible medicalese--that she has advanced ovarian cancer.

Not only does the doctor fail to deal with his patient's state of shock and feelings of terror, their conversation leads to Bearing's participation in a course of treatment almost as devastating to her body, soul and self-esteem as the disease itself. Soon, she finds herself in the hands of her physician's young research associate, an oncology fellow far more interested in cancer cells than in the human beings who have them. How, Halperin wonders, can doctors relate more humanely to their patients?

The cast, now dressed in street clothes, joins Halperin on stage. Kathleen Chalfant, who plays Bearing, sits to his left. The actor who portrays the senior oncologist takes his seat as well. Finally, Paula Pizzi enters. An olive-skinned young woman with long, straight black hair, she plays Bearing's nurse, Susie Monahan. In this role, Pizzi initially conforms to a familiar nurse stereotype--appearing deferential to the male authority figures on the medical staff. Yet, to protect her patient, Pizzi's nurse soon takes on the doctors. The latter consistently view her as their handmaiden and resist all her insights and suggestions.

Playwright Margaret Edson insists that the nurse is the hero of the drama. She is the only true caregiver in the hospital--the one character who actually connects with the patient, Bearing. Like all expert nurses, her caregiving is informed by a sophisticated understanding of disease, of the use of modern treatments and of how to monitor patients with a variety of high-tech equipment. She is not just a "naturally" loving or kind person.

Because of this, Monahan recognizes that the side effects of treatment may be too toxic for her patient, and she intervenes when she realizes that the patient's doctors haven't addressed vital issues like pain control and when to end futile aggressive treatment. Indeed, it is Monahan who forces the physicians to respect their patient's last wishes. The nurse is, in fact, the only one who "gets it" both emotionally and medically. As a result, Pizzi has just received--as she does every night at curtain call--the second-largest round of applause, after that bestowed on Chalfant for her unforgettable lead role.

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