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Books/Cancer Patient

 
Wit: A Play
 

by Margaret Edson, paper, 84 pp, $12, IBSN 0571198775, New York, NY, Faber & Faber, 1999. Review based on performance directed by Derek Anson Jones, November 1999, Union Square Theater, New York, NY.
 
Reviewed by
Abraham Philip, MD
 

 
The play Wit is an engaging and absorbing drama about a cancer patient as she experiences established practices in medicine. The protagonist, Vivian Bearing, PhD (Judith Light), is a renowned professor of English. In her own assessment she has made major contributions to our understanding of the metaphysical poet John Donne and his Holy Sonnets. From such exalted heights she is thrust into an entirely new world of hospitals, physicians, and chemotherapy, when she is diagnosed with stage IV ovarian cancer. Initially, her approach to her illness is rational and probing, though mixed with cynical responses to the situation that she is pushed into by current medical practices. Without much choice, she is made the initial patient in an experimental chemotherapeutic protocol. The process by which she reassesses her life and work, and critiques medicine with profound insights and cynical good humor, transforms both the patient and audience.

The playwright grips us intellectually and emotionally from the first few lines of dialogue: the typically perfunctory "Hi. How are you feeling today?" and the reflex response, whatever the patient's answer or condition, "Great. That's just great." In the next two hours of uninterrupted drama, the patient at center stage freezes the action around her -- the parade of doctors, nurses, technicians, and medical students -- to comment on her life, its metaphors and conceits. Through the eight cycles of chemo that ultimately take her life, she realizes the irony that it's not the disease that makes her sick but the treatment itself, to wit, when she is forced to return to the hospital with fever and neutropenia: "In my present condition every living thing is a health hazard to me . . . particularly health-care professionals."

The play parodies our habit of breaking bad news impersonally, without even the offer of a chair to break the shock. Eloquent irony is introduced in the person of Jason Posner, MD (Grant Show), who, while a biochemistry major, had taken one of Professor Bearing's required poetry courses. Physicians' idiosyncrasies and the foibles of unsympathetic and mechanical technicians are woven into the play in wonderfully crafted sequences. A masterly scene parodies grand rounds, which are neither grand nor worthy of applause, but rather full of "subservience, hierarchy, gratuitous display, sublimated rivalries." Bearing describes her role in the proceedings: "I just hold still and look cancerous. It requires less acting every time." In this scene she sums up the crucial difference between her past and present life: "Once I did the teaching, now I am taught."

In another scene Professor Bearing helps Jason verbalize why he is so interested in oncology, exposing the limitations of his vocabulary despite his "well-rounded education." Dr Posner is absorbed in his research, working to unravel the mysteries of cancer cells "and their endless powers of multiplication . . . immortality in culture." For him, bedside manners and empathy are, as poetry had been, unwelcome chores. Although the dying Bearing is called "sweetheart" and "sweetie," no one gives her a hand when she is vomiting or an empathetic touch when she is in dire pain. In my own medical training, I was encouraged to sit at a patient's bedside during history taking and physical examination, and therefore found the sterility of the clinical scenes shocking.

But to portray the play as simply an exposť of the medical profession would be an injustice, as it is an equally searing critique of academia in general. Bearing and her mentor, E. M. Ashford, argue at length about the appropriateness of a comma versus a semicolon in a Donne poem. In another brilliant scene Bearing lashes out as she lectures on a poem of Donne's, "If Pysonous Mineralls," projected on a screen. Her powerful whacks with the pointer are metaphorical blows meted out to her students. Despite her appreciation of fine English poetry, her humanity is not moved by her students' difficulties, and her demands on them are unceasingly exacting. A powerful prickly personality, Vivian Bearing is capable of dry asides even during gut-wrenching nausea or while discussing code status. But, as her time draws to a close, a change occurs in the way she reflects on life, death, and Donne. The most awesome irony is that while Vivian Bearing is sterile (emotionally, physiologically, and symbolically), she never had a love affairhas not given birth or accepted anyone into the essence of her bodyshe ultimately succumbs to ovarian cancer, a malignancy of a life-giving or renewing organ.

The play, brutally human at one level, is layered: it disturbs, enlightens, and, strangely, comforts. The author won the 1999 Pulitzer Prize for distinguished drama by an American author, an award that is richly deserved. Margaret Edson is a kindergarten teacher in Atlanta, who while earning degrees in history and literature worked in the cancer and AIDS unit of a research hospital, and the events in the play unfold with authenticity. Several productions of Wit are planned. While the play's ferocious intensity may intimidate, its transformative power should be provocative and enlightening for those of us who must make life-and-death decisions for our patients.

 
 
AUTHOR/ARTICLE INFORMATION

 
Abraham Philip, MD
Massachusetts General Hospital
Boston

 
Books, Journals, New Media Section Editor: Harriet S. Meyer, MD, Contributing Editor, JAMA; Jonathan D. Eldredge, MLS, PhD, University of New Mexico, Health Sciences Center Library, Journal Review Editor; adviser for new media, Robert Hogan, MD, San Diego.

 
 © 2000 American Medical Association. All rights reserved.