Margaret Edson’s W;t: lessons on person-centered care
Toronto, Ontario, Canada
|“She slips off her bracelet. She loosens the ties and the top gown slides to the floor.”|
American playwright Margaret Edson’s 1998 play W;t has been described as “ninety minutes of suffering and death mitigated by a pelvic exam and a lecture on seventeenth-century poetry.”1 When W;t was first published, most theater companies rejected it on the grounds that its subject matter would be too difficult for audiences to bear. Moreover, when the play opened at Union Square Theatre in New York, producers were forced to hire psychologists to attend to the audience members who were too distraught to leave after the performance. That the play has solicited strong reactions is not surprising. W;t does, after all, tell the story of a woman’s arduous and ultimately unsuccessful battle with metastatic ovarian cancer. But to view W;t merely as a defeatist play about death is to ignore the reality that it is also a revitalizing play about life, and that it contains crucial lessons for healthcare professionals about the “human” side of medicine. One of the central themes around which W;t revolves is the tension between theory and practice, between the abstract and the concrete, as it relates to such concepts as illness, suffering, and death. In the play, English Professor Vivian Bearing comes to see that the abstract knowledge she gained from her studies of John Donne’s Holy Sonnets does not hold up in real-life matters of life and death. Vivian comes to learn that it is only by embracing her own and others’ concrete humanity that she can find meaning in her journey of illness. The lessons that Vivian learns about her own illness provide a useful dramatized study. They also raise important questions about how healthcare professionals can learn to bear witness to the suffering of others.
The Vivian to whom we are introduced at the beginning of W;t is a character who defines herself through her role as a professor of English and renowned scholar of John Donne. Vivian’s experience with cancer, like Donne’s Holy Sonnet Six, “begins with a valiant struggle with death, calling on all forces of intellect and drama to vanquish the enemy.”2 Perhaps as a defense against facing the reality of her illness, Vivian initially attempts to understand her experience with cancer in the same abstract and “scrupulously detailed”3 way that she approached her study of Donne. When Vivian is first diagnosed with stage-four metastatic ovarian cancer and is informed that her disease stems from an “insidious adenocarcinoma,” her instinct is to analyze the very words of her diagnosis and to seek out academic sources on the disease. “Insidious. Hmm. Curious word choice. Cancer. Cancel,” Vivian muses, and then immediately decides that she “must read something about cancer … Must get some books, articles. Assemble a bibliography.”4 As if “[her] only defense is the acquisition of vocabulary,”5 Vivian attempts to gain control of her situation by mastering the medical terminology with which her doctors “anatomize”6 her.
In the same way that Vivian escapes her own terrifying reality by interpreting her illness in the abstract, the doctors in the play also shield themselves from the reality of Vivian’s predicament by viewing her disease as abstract science. So blinded by theory are the clinical fellows described in the play that when the chief doctor, Harvey Kelekian, asks them to identify “problem areas” associated with Vivian’s treatment, they list every symptom including “myelsosuppression” and “nephrotoxicity”7 but fail to identify the one that is most obvious: hair loss. The objectifying power of medicine is a theme throughout the play and is depicted most clearly in the character of a clinical fellow by the name of Jason. As a researcher, Jason sees the human side of medicine as irrelevant to his career. As he puts it, “there’s a whole course on [bedside manner] in med school. It’s required. Colossal waste of time for researchers.”8 Throughout the play, Jason sees Vivian merely as cancer “Research”9 and shows minimal warmth, sensitivity, and curiosity in the way he treats her.
The result is that, over the course of her illness, Vivian begins to feel that “what [the doctors] have come to think of as me is, in fact, just the specimen jar, just the dust jacket, just the white piece of paper that bears the little black marks.”10 What’s more, Vivian comes to see her own self personified in her doctor’s overly academic character. She remarks that “the young doctor, like the senior scholar, prefers research to humanity” and that “at the same time the senior scholar, in her pathetic state as a simpering victim, wishes the young doctor would take more interest in personal contact.”11 By seeing herself in her doctor, Vivian realizes that “the senior scholar ruthlessly denied her simpering students the touch of human kindness she now seeks.”12
Whereas in the academic setting Vivian did the teaching, in the real-life environment of the hospital, Vivian now becomes the student. As she experiences the excruciating pain of chemotherapy, she begins to understand the true meaning of suffering. As she puts it, “One thing can be said for an eight-month course of cancer treatment: it is highly educational. I am learning to suffer.”13 This type of suffering, Vivian realizes, cannot be adequately understood or expressed in the abstract. As she says, “I want to tell you how it feels. I want to explain it, to use my words. It’s as if…I can’t…There aren’t…”14 As Vivian begins to realize that “We are discussing life and death, and not in the abstract…we are discussing my life and my death,”15 she becomes more and more “disinclined to poetry.”16 Donne’s Holy Sonnets, which once served as Vivian’s primary inspiration, now become a source of discomfort. Indeed, when Vivian attempts to recite a sonnet containing the lines “My span’s last inch, my minute’s latest point…” it occurs to her that although she had “always particularly liked that poem…in the abstract” now she sees the image of her “’minute’s last point’ a little too, shall we say, pointed.”17
With Vivian’s acceptance of her suffering as a concrete human experience rather than metaphysical poetry comes her ultimate liberation. As she approaches her final days, Vivian begins to break away from the intellectual armor behind which she has been hiding and embraces her own—and others’—humanity. As she notes, “I thought being extremely smart would take care of it. But I see that I have been found out. Ooohhh.” 18 In this state, Vivian begins to find comfort in the simple “touch of human kindness” of her nurse, Susie. As she comes face-to-face with her mortality, Vivian comes to see that, “Now is not the time for verbal swordplay, for unlikely flights of imagination and wildly shifting perspectives, for metaphysical conceit, for wit. And nothing would be worse than a detailed scholarly analysis. Erudition. Interpretation. Complication. Now is the time for simplicity. Now is the time for, dare I say it, kindness.”19
When Vivian dies and walks off the stage “reaching for the light” she “takes off her cap and lets it drop. She slips off her bracelet. She loosens the ties and the top gown slides to the floor. She lets the second gown fall”—as if to remove every last layer behind which she has been hiding. In her final exposed state, Vivian is “naked, beautiful.”20
By telling the story of a cancer patient who finds meaning in her illness by facing suffering as a concrete human experience, W;t raises important questions about how healthcare professionals can learn to witness the suffering and aid in the healing of their patients. The message that emerges is that the process of dealing with illness, suffering, and mortality involves something radically more fundamental than knowledge and expertise. At the core of true healing, W;t suggests, lies the “touch of human kindness” and the courage to face, listen to, and be moved by one’s own and others’ suffering. W;t serves as a reminder, in today’s disease-oriented milieu, to uncover the whole person who lies beneath the diagnosis. Although the process of breaking out of our intellectual armor and stepping into the complex life-world of our patients may introduce discomfort and ambiguity, W;t reminds us that this is also an essential ingredient in humanistic, person-centered care.
- Toby Zinman, “Illness as Metaphor,” American Theatre 16, no. 8 (1999), 25.
- Margaret Edson, W;t (New York: Oxford University Press, 1993), 14.
- Edson, W;t, 20.
- Edson, W;t, 8.
- Edson, W;t, 44.
- Edson, W;t, 43.
- Edson, W;t, 41.
- Edson, W;t, 55.
- Edson, W;t, 82.
- Edson, W;t, 53.
- Edson, W;t, 58.
- Edson, W;t, 59.
- Edson, W;t, 31.
- Edson, W;t, 70.
- Edson, W;t, 69.
- Edson, W;t, 6.
- Edson, W;t, 53.
- Edson, W;t, 70.
- Edson, W;t, 70.
- Edson, W;t, 85.
ATARA MESSINGER, MA, is currently a medical student at the University of Toronto. She obtained her BArts &Sci. from McMaster University and completed a Master’s degree in Philosophy at Tel Aviv University. Her research interests include the history and philosophy of medicine, and the role of the humanities in medical practice and education.
Fall 2018 | Sections | Literary Essays
Highlighted in Frontispiece Volume 11, Issue 2– Spring 2019