St. John’s University, New York City, New York, United States (Spring 2011)
Writers and physicians often share the same sensibilities and skills required to describe the disease process and its wider effects. But while the literary artist, unlike the physician, relies on his imagination to realize the experience of his fictional characters, he can also engage the imagination and senses of an audience through actors, sets, lights, sound, and language. Most importantly, drama speaks to the intellect—all great dramas have been dramas of ideas. In recent years, medical discourse has taken center stage in the intellectual drama. Representations of the afflicted and their caregivers are central to modern theater, whose depictions of the body and its pathologies take their authority, language, images, and characters—a roster of professionals—all from medicine. Contemporary medicine is a rich source of material for playwrights; its daily discourse explores conflict between human values and rapidly changing technology, which frequently gives rise to the ethical issues debated on stage. Discussions of issues surrounding the end of life are no exception.
A case in point is Brian Clark’s Whose Life is it Anyway? The question posed by the title is viewed from three vantage points in the drama: medical, philosophical, and legal. The protagonist, Ken Harrison, is a hopelessly paralyzed young sculptor who sustained his injury in an automobile accident. He remains confined to the hospital where technology dominates his will—he can no longer make free and rational choices. In virtually every scene, the hero’s immobile form is the dominant stage image. Effectively removed from society by his injuries, the hero chooses to end his life rather than endure an existence where his spirit controls neither his body nor his brain, which are artificially maintained through technology. He believes that living in such a state denies that which distinguishes him as a person. The hero’s antagonist is Dr. Michael Emerson, the Consulting Physician, who maintains that his patient lacks the necessary knowledge to challenge any medical decisions. Failing to recognize that an individual’s functions extend beyond the physical and the psychological, Dr. Emerson believes that Ken is simply clinically depressed.
Whose Life is it Anyway? argues that our cognitional-volitional function allows us to fulfill our human destiny; without free will, Ken, and others like him, can no longer pursue their life’s purpose. Presuming that the goal of medicine is the restoration of health, the play suggests that if therapy is inadequate to restore us to pursue our spiritual goals, then medicine should not assume an aggressive role in our final days. In short, ethically, as well as legally, Ken Harrison has the right to the conscious decision he makes.
Although no satisfactory resolution to the conflict occurs in the drama, the relationship that evolves between Ken and his physician implies that the professional and moral agency of the physician must not necessarily override the respect for a patient’s right to self-determination. A rare reconciliation of the conflicting parties ends the play. Upheld by the law, the hero wins the battle to be discharged from the hospital and regain his freedom. Instead, cognizant of the good will of his caregivers, the hero expresses what amounts to a final choice—a desire to spend his last days in their company.
© Faber and Faber, 1999
W;t, by Margaret Edson, presents an unremitting view of the female body as a physiological site; the main character is a patient in the last stages of advanced ovarian cancer. The action takes place during the last two hours of her life—passed in a research hospital where she has been participating in an experimental chemotherapy program. The sentience of pain and physicality are omnipresent in the drama. The spectator is spared little as the woman’s treatment and physical decline are graphically represented. Vivian Bearing, the protagonist, is a professor of literature with a specialty in the poetry of John Donne. She suddenly finds herself in a world where her skills and realized success help very little in comprehending and coping with her present reality.
In the hospital she encounters a former student, Jason Posner, now a clinical fellow on her case. To Vivian’s humiliation, she discovers that Jason, who found a course he took on bedside manner to be a “colossal waste of time,” is more concerned with research than with his patients. Despite a lifelong fascination with words and sounds, she is also confused by medical terminology, where a term such as “insidious” signifies “undetectable” instead of “treacherous,” as she understands it. The language is that of strangers—inhabitants of a new, alien community on whom her life depends. The procedures to which her body is subjected are as new to her as the IV pole to which she is attached. Her accommodations are unfamiliar, and her wardrobe is limited to a hospital gown. She must invent herself anew, acquire new knowledge and skills in order to gain familiarity with an existence in which her former identity has been anatomized.
The heroine marks one significant gain: she achieves a warm and endearing relationship with her primary nurse, Susie. In contrast to Jason, Susie is kind and protective of her patient. As such she is representative of many primary caretakers in cancer centers who are thoroughly attuned to the emotional needs of patients. Compassion is likewise forthcoming from Vivian’s former mentor, E. M. Ashford, who appears in a dream-like sequence to comfort the dying woman. Instead of discussing the poetry of John Donne, the senior scholar reads from a children’s book, The Runaway Bunny, the theme of which is the redeeming power of divine love. It illustrates the power of feelings in forging significant human relationships. The last the audience sees of Vivian Bearing is of a figure moving slowly—alone—towards a light. Her journey is necessarily solitary. Redemption is a singular experience.
Before It Hits Home, written by Cheryl West, is the first major drama to address the subject of AIDS from the Black perspective, charting the emotional geography of an African American family forced to face the issue when the oldest son, a jazz musician, becomes ill. Given statistics that indicate that HIV/AIDS has disproportionately affected African Americans, the play addresses what it perceives as a collusion of denial regarding AIDS among this stigmatized population, which perceives acknowledgement of the issue as a threat to a favorable image of self, family, and community. The protagonist in West’s play, Wendal Bailey, faces social ostracism on several counts: he pursues a bisexual life—cause for conflict throughout the drama—and he has AIDS. Moreover, he has withheld knowledge of his illness from his family, further distancing himself from those who care most for him.
Initially, Wendal is in denial. He distrusts the medical profession, and, in a scene where a white, female doctor confirms the diagnosis he fears, the racial tension is palpable. Yet his hostility vanishes at her comforting touch and an unexpected gift—a music cassette he had secretly desired. Later Wendal admits, “It’s nice to be touched with a hand instead of rubber gloves.” In contrast to the doctor, Wendal’s mother, Reba, upon learning the truth of her son’s illness, becomes irrational—suddenly viewing her entire home as contaminated. While her first impulse had been to assume the responsibility of nursing her son back to health, upon learning the nature of his illness, she acts atypically and rejects his care. Her homophobic response eventually extends to her abandoning her home altogether, betraying her culturally inscribed obligations as caregiver.
Homophobia in Wendal’s family is not restricted to his mother. His father, brother, and young son each turn from him on learning of his illness. The strongest of the male figures, Wendal’s father Bailey, is also the most complex. On learning the truth, he denounces his son and, in a violent scene, throws Wendal to the ground shouting, “Take your sissy, fairy ass and get the hell out of my house.” When he sees that Wendal lacks the strength to lift himself up, his anger turns to grief; he drops to his knees and cradles his son in his arms. In a surprising reversal, he assumes the role of caregiver relinquished by his wife. Where his initial response had been to cast Wendal out, the last scene of the drama finds him pleading with God to give him “just one more day” with his dying son.
Michael Cristofer’s The Shadow Box presents an unvarnished view of terminally ill hospice patients as they come to terms with their approaching death. The drama records a significant development in medicine: the shift to alternative approaches to end-of-life care. Reflecting the hospice vision, the drama reveals how the quality of life and respect for human dignity can persist even when all treatment options have been exhausted. Hospice conceives of the ill person as part of a larger whole, acknowledging the patient’s interrelatedness to others. Since what happens to the patient impacts the family, the drama foregrounds the latter’s struggle to accept the death of a loved one.
Characteristic of those nearing the end of life is the tendency to ponder the past and reflect on previous successes and failures. Cristofer’s characters are never so affective as when, in their misery, they recall fleeting moments of happiness and feel regret for injudicious choices. In The Shadow Box the characters bear the reality of their lives by interacting with those who listen to them, encouraging them to express their turmoil. The fictional creations have the vitality of whole beings who chronicle their own lives in their own voices. They reveal intense inner lives, and the stage—its fictional characters free of rules regarding confidentiality—does not spare the audience any of the clinical details. Illustrating the hospice philosophy, the dramatist depicts the patient as a living person who should seize each moment and live with renewed vigor. In an example, one character, Brian, notable for his failure as a writer, commits himself anew to his craft and proceeds to write with a passion.
In one of its true achievements, the drama plots the characters’ passage through the different stages of grief. Described by Elizabeth Kűbler-Ross’s On Death and Dying just a few years before the play appeared, these stages permit all characters to accept the finite nature of life— overcoming fear and discovering their own inner strength. At the conclusion of The Shadow Box, each character reaches deep within himself to reaffirm the life and dignity of those who have arrived at death’s door.
The stories of those whom we meet on stage vary greatly. Yet, as they come to a close, we are left with the insight they all convey: the power of love and compassion to sustain the human spirit in crisis. The truth is projected in diverse ways: in the reconciliation of Ken Harrison and his physician, who had opposed his patient’s wishes; in Vivian Bearing’s reconstruction of her life, which she achieves with the help of a caring nurse and beloved mentor; in Wendal Bailey’s solace, which he finds in the warmth of his physician’s touch and in the embrace of his forgiving father in the hospice community of loved ones and strangers, who find the strength to overcome fear and draw upon their inner resources to gather the kindness and courage they offer to those who confront the end of existence as we know it. Vivian Bearing could well sum up the truth for all in the words of her beloved poet, “Death, thou shalt die.”
Clark, Brian. Whose Life Is It Anyway? New York: Dodd, 1979.
Cristofer, Michael. The Shadow Box. New York: Drama Book Specialists, 1997.
Edson, Margaret. W;t. New York: Faber and Faber, 1999.
Russo, Ann. Exploring AIDS in the black community. Sojourner: The Women’s
Forum 15.1 (1989): 37-38.
West, Cheryl L. Before It Hits Home. New York: Dramatists Play Service, 1993.
ANGELA BELLI, PhD is professor of English at St. John’s University in New York. She has served as chair of the English department and as president of the New York College English Association. She is the author of Ancient Greek myths and modern drama: a study in continuity; co-editor of Blood and bone: poems by Physicians; co-editor of Primary care: more poems by physicians; and editor of Bodies and barriers: dramas of dis-ease. Her participation in the meetings of professional organizations has been devoted to exploring issues in modern drama and in literature and medicine. Her many contributions to literary and medical publications have had a similar focus.