WITBMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7229.257 (Published 22 January 2000) Cite this as: BMJ 2000;320:257
- Madeleine Harmsworth, freelance arts critic
By Margaret Edson
Now showing Union Square Theatre, New York, USA. Coming to London this year
She is unlovely, unloved, and unloving, a middle aged professor of 17th century poetry (her specialty the fiendishly difficult Holy Sonnets of the metaphysical poet John Donne) at a US university. Vivian Bearing, the heroine of Margaret Edson's Pulitzer prize-winning play, is also dying of advanced (stage IV) metastatic ovarian cancer.
When we first see her she is dressed in a hospital gown, trails an intravenous drip, and, beneath a bright red baseball cap (the only spot of colour throughout), is completely bald. At this stage, she is also spirited, aggressive, and bold, ready to tackle her illness with the same incisiveness and inquisitiveness with which she has learnt and taught her subject. And with the same sardonic wit.
But, it is Vivian's added misfortune that she is being treated at a major teaching hospital, where she is instantly perceived by Dr Harvey Kelekian, chief of medical oncology, to be a prime candidate for his programme of experimental chemotherapy. He deduces that this is one helluva tough lady, both physically and psychologically; and another advantage must be her very aloneness, her convenient lack of concerned, possibly nosy, family and friends.
Edson's gruelling first play is not for the squeamish, but, powered by Judith Light's magisterial performance in the lead role, it is so intellectually and emotionally challenging that it is worth going through the ordeal. At one level, it is a deeply sympathetic study of a not very sympathetic character in a state of crisis. Watching the intensely proud and private Vivian trying to hang on to her dignity and cling to her defences in the face of appalling discomfort and insufferable pain forces our respect, and ultimately our affection. But it is Edson's chilling indictment of the medical profession that has the most devastating effect. An elementary school teacher who worked in the cancer and AIDS unit of a research hospital between studying for degrees in history and literature, she clearly speaks from experience.
In the interests of accumulating data for their research, Kelekian and his eager young research assistant Jason Posner coldly and calculatedly subject Vivian to “the impossible”—eight cycles at full dose of “hex and vin” (hexamethophosphacil and vinplatin)—giving her hope while knowing she is doomed. They do not even dispense their “death drugs” with grace. Kelekian is a bald deliverer of bad news (“You've got cancer”) who proceeds to blind his patient with jargon. Posner regards the obligatory course in “bedside manner” as “a colossal waste of time.” Only primary nurse Susie Monahan, dim but compassionate, is capable of seeing her patient as a human being as opposed to a specimen.
Lay members of the audience, like me, emerged from the theatre shocked and shaken, if not entirely surprised. It is our fervent hope that for any doctor among us the play (which should be compulsory viewing for the entire medical profession) will be a lesson well learnt.
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