The stage performance was about to begin. A cancer nurse in the audience turned to a physician friend sitting next to her.
“I brought my tissues,” the nurse told her friend. “I’m afraid I’ll cry.”
Tears typically are not encouraged for nurses, doctors and other professionals who treat terminally ill patients. For one thing, it tends to throw off family members expecting precise medical care.
For another, medical professionals work consciously to keep emotions in check. Grieving over one dying patient makes it all the more difficult to approach the next person with cancer or Alzheimer’s or you name the unrelenting illness.
All of which sets up a dilemma. We want doctors, for example, to be coolly competent, yet treat our loved ones like people, not diseases. We want the most advanced technology medicine can offer circa 2003 with a retrofitted Marcus Welby, MD, bedside manner.
Empathy for patients
Is it possible?
“A great definition for empathy [among doctors, nurses or therapists toward patients] is the ability to put one foot in the emotional turmoil, yet keep the other foot on the firm bank of objectivity,” said Dr. Kathy Neely, chairwoman of the Medical Ethics Committee at Northwestern Memorial Hospital.
Easy to define, hard to do. That’s why Neely and others in the Northwestern University medical community have staged annual dramatic performances the last two summers–acted by real-life workers at the hospital–to accent the issues of empathetic medical care. The performances are for Northwestern medical staffers only. Each “play” is followed up with a discussion among actors and audience members.
“When is the next performance?” asked one woman in the audience after a 5 p.m. weekday showing. “I want to tell my co-workers to make sure they come. Everybody needs to see this.”
In 2002, the Northwestern ensemble performed a one-act version of the Pulitzer Prize-winning play and HBO movie “Wit” (starring Emma Thompson). This summer’s performance germinated from wintertime e-mails sent to Northwestern personnel (including janitors and secretaries) calling for “positive stories” and “what we do well” during a patient’s most troubling times, Neely said.
A local playwright from the Serendipity Theatre Company, Courtney Shaughnessy, assembled the 40-plus responses into a flowing hourlong format. Five Northwestern staff members–a psychiatrist, nurse, patient representative, real estate manager and administrative assistant–played multiple roles, including themselves at times.
“What surprised me is how much people are willing to share, such as bathing a dying young nephew,” Shaughnessy said. “The detail [in the e-mails] was almost overwhelming at times.”
Some of the details: A nurse subtly relieved another nurse who was yelling instructions to a frail, elderly deaf patient. The second nurse sat down and simply held the patient’s hand with its “purple spots” and “skin that felt like paper.”
A simple need
One man portrayed in the play was a lung-cancer patient undergoing chemotherapy without any visiting friends or loved ones. Whenever a doctor, nurse or other staff members asked what they could do, he simply replied he wanted a chocolate milkshake. His answer was the same for days–“I just want a chocolate milkshake, a cold chocolate milkshake!”
One afternoon a nurse brought in a McDonald’s chocolate milkshake. Colleagues followed suit, and the man eventually got his sweet-tooth wish answered by the dozens.
The performance was presented seven times to Northwestern medical audiences during the last six weeks. It will be performed for 200 cancer-care nurses as part of a medical conference this fall, and a videotape version is regularly lent out to hospital departmentsIt is directed by Adam Belcuore of the Serendipity company, who required everyone who auditioned to sing “Amazing Grace,” one of the musical numbers in the play.
“We practiced three times a week for three weeks,” Shaughnessy said.
Audiences of more than 50 Northwestern staff members clearly enjoyed themselves and felt moved at performances.
“This is why I became a nurse,” one RN said about the positive perspective of the play.
“I have been feeling so empty, and this play filled me up,” another staff member said.
Neely said the popularity of the program encourages the Medical Ethics Committee to make the production a regular part of education efforts at the hospital.
It is a way for the ethics committee to be part of the hospital landscape beyond the “SWAT team” role it plays when a patient’s family members might question end-of-life care or medical decisions.
The drama project started when Neely attended a performance of “Wit” at the Goodman Theatre. The plot follows a mirthless literary professor who suddenly needs friends and human warmth as she battles ovarian cancer.
“I wondered what it would be like if we did `Wit’ at Northwestern,” Neely said. “I had the nerve to e-mail the director [Belcuore] about my idea.”
As it turned out, Neely played the star role in a one-act adaptation of “Wit.” This year she was tempted to return to the stage but decided she was too busy “doing the doctor thing.”
“The program is working for our purposes,” Neely said. “If we have a formal presentation with one speaker, we draw one sort of crowd. The performance draws a different and broader crowd.”
