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A Night of W;t and Wisdom
Play Raises End-of-Life Issues

By Linda Cook

An educational event to raise awareness about the need for end-of-life research, "An Evening of W;t and Wisdom: The Science of Care and Compassion at the End of Life," was held at the Kennedy Center on Mar. 9. The focus of the event was the Pulitzer Prize-winning play W;t and included a pre-play reception and a post-play question-and-answer forum. Sponsored by the Coalition for End-of-Life Research and Care, with the National Institute of Nursing Research, the sold-out event achieved its goal. Actors, speakers and attendees, which included multidisciplinary researchers and clinicians and the public, pooled their knowledge and explored the concerns that affect patients, families and healthcare professionals in addressing the last phase of life.

Pre-play Reception Highlights Last Days

"The healthcare system in our country is primarily directed at treatment and cure," said Dr. Patricia A. Grady, director of NINR, at the reception prior to the play. "Technological advances that extend our lives are, however, also extending the time leading to death — a time when the quality of life remaining is not always what many patients want or expect." She also mentioned that this issue was brought to the forefront in the late 1990's by two major studies conducted by the Robert Wood Johnson Foundation and the Institute of Medicine of the National Academy of Sciences. These studies documented that pain was undertreated in dying patients, and that there were discrepancies between the patient's wishes and actual treatment received. The studies called for more research directed at palliative care — care that keeps the patient as comfortable as possible. In response to the two reports, NIH launched a program to stimulate research on end of life issues, with NINR serving as coordinator.

Judith Light as Prof. Vivian Bearing, who has ovarian cancer, in the play W;t. (Photo by Joan Marcus)

Other reception speakers included Dr. John Eisenberg, director of the Agency for Healthcare Research and Quality; Dr. Neil MacDonald, director of the Cancer Bioethics Program of the Clinical Research Institute of Montreal; Dr. Joanne Lynn, director of Americans for Better Care of the Dying; and David English, president of Hospice and Palliative Care of Metropolitan Washington.

The Play W;t

The spelling of W;t is not a typo. It has meaning within the context of the play. As the teacher points out to her young student in critiquing her paper on John Donne, "'And death shall be no more, comma, Death thou shalt die.' Nothing but a breath — a comma — separates life from life everlasting." The student, who had used a semicolon instead of a comma, grew up to be the central focus of the play — Dr. Vivian Bearing, a professor of 17th century poetry, specializing in Donne's Holy Sonnets. Bearing is diagnosed with stage IV ovarian cancer and, as she puts it, "There is no stage five." She enrolls in a clinical research trial, and the care by the healthcare team — not ideal by anyone's standards — includes ineffective pain control and failure to follow the patient's advance directive. Emphasizing the importance of knowledge and compassion, the play also effectively reflects public concerns about end-of-life care in a witty and powerful way. At the end of the performance, W;t received a standing ovation that was immediate and long-lasting.

Post-play Q's and A's

After the play, most of the audience remained to participate in the forum "Beyond W;t — What Are the Questions? What Are the Answers?" Expert panelists included Dr. Betty Ferrell, a nursing research scientist from City of Hope National Medical Center; MacDonald; Lynn; Judith Light, lead actor; and the entire cast of W;t.

Light answers a question from the Kennedy Center audience as Lisa Tharps, who plays the nurse Susie Monahan, looks on.

During the discussion, one of the panelists commented that the play was a superb teaching tool for medical students and can have a far-reaching impact beyond medical textbooks and journal articles. Actor Light indicated that as they performed, she and the cast could sense a rapport with the evening's research and healthcare-oriented audience, and she expressed admiration for their work.

How the Event Evolved

Except for the poet John Donne, few others have made a point of contemplating death until absolutely necessary. This denial helps to live life without the constant shadow of the inevitable, but denial also can help perpetuate less than desirable healthcare practices. Therefore, increasing awareness and creating scientifically based change become key. Some members of NINR saw W;t when it first opened in New York and recognized the play's unique ability to showcase many issues confronted by dying patients as they encounter the healthcare system.

When W;t was scheduled for the Kennedy Center's 2000 season, NINR initiated a collaboration with the center's department of education, which produces "Spotlight on Theater" discussions of selected plays. NINR then took steps to help a multi-disciplinary coalition plan the educational event.

Members of the Coalition for End-of-Life Research and Care include NINR, National Cancer Institute, NIH's Office of Science Education, the Agency for Healthcare Research and Quality, Americans for Better Care of the Dying, Hospice and Palliative Care of Metropolitan Washington and Friends of the NINR.

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