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Let Me Down Easy

Jan 10, 2012

Anna Deavere Smith’s popular play—Let Me Down Easy—which will premiere on the PBS series Great Performances on January 13, explores the American health care system through characterizations of patients and physicians, including ASCO member and Dean of the Stanford School of Medicine Philip A. Pizzo, MD.

After the broadcast premiere, the program will be available for screening in its entirety at pbs.org/gperf.

In the following interview, ASCO Connection Editor-in-Chief Jonathan S. Berek, MD, MMS, Director of the Stanford Women’s Cancer Center, talks to award-winning playwright and actor Anna Deavere Smith about the themes of her play, including the need for better physician-patient communication and the importance of treating “the whole person.” Ms. Smith was nominated for the 1993 Pulitzer Prize for Drama for her play Fires in the Mirror and can currently be seen as hospital administrator Gloria Akalitus on Showtime’s Nurse Jackie.

Dr. Berek: What led you to write about health care?

Ms. Smith: Back in the ‘90s, I was invited to be a visiting professor at Yale School of Medicine by then Chair of Internal Medicine Ralph Horwitz. He wanted me to interview doctors and patients about the doctor-patient relationship with the idea that there are many things that inhibit the doctor from listening to a patient, and in doing so, you might treat the disease but not the person.I had created about three different productions of the play by fall of 2009 when it was time to bring it to New York. President Obama was bringing forward the health care bill and debate was full-fledged. I decided to make sure the play would focus on health care reform in a way that it could be part of the conversation.

Dr. Berek: Is the theme of Let Me Down Easy health care reform, terminal illness, the doctor-patient relationship, or all of the above?

Ms. Smith: It’s about all of that. A play is different than an essay. It’s different than a political argument. I think of every audience as bringing their own experience. I think of my work as trying to give people an opportunity to think in a different way and hopefully more deeply about things that are going on in their lives.

Doctors have been very attracted to this play because it does look at the doctor-patient relationship, and I think it causes some doctors to think: "Wow, I went into this in the first place as a healer but what are the things that make that challenging?" Not just health care, but the fantastic advances in technology—in many ways—change what a doctor is. It’s a very interesting moment in the history of medicine. The “Marcus Welby” days are long gone.

It pleases me that when I performed this play in Washington both [HHS] Secretary [Kathleen] Sebelius and Francis Collins [NIH Director] asked me to talk to their staffs. That’s the type of thing I wanted the play to do—to speak to broader audiences and to be observant to the people for whom this is a reality—as this industry and this field of knowledge changes.

Dr. Berek: What kind of research did you do?

Ms. Smith: The play is based on verbatim interviews I did with more than 320 people. I interviewed people from the Dean of the Stanford School of Medicine, Phil Pizzo, to well-known cancer patients—from Governor Ann Richards and ABC film critic Joel Siegel and Lance Armstrong—to people not in the public eye, including a wonderful young doctor in New Orleans who I talked to after Katrina. She worked in a public charity hospital, and she speaks very sparingly about what happened to her patients—poor people who were left in the hospital for six days before they were evacuated.

It was interesting to me that the audience who comes to the theater—educated people, middle-class people, people with resources—they responded to this character very powerfully. Many Americans are concerned that we may be becoming more and more a winner-takes-all society and that we will not be a society that takes care of people as people.

Dr. Berek: What surprised you while doing these interviews?

Ms. Smith: The most surprising thing was how much I took to the material. When Dr. Horwitz invited me to come to Yale, I really stalled for a very long time. I didn’t know what I had to say to these very smart people. It looked to me like a project for scientists. So I was surprised by how much this really was useful to me.

I’m a student of expression. Unlike other projects that I’ve done, when I interviewed someone compromised by disease, I really only had to ask one question: “What happened?” And then the vigor with which they spoke and the imaginative way in which they expressed themselves helped me see that, if someone is sick, hurt, compromised, or someone they love is sick, hurt, compromised, they love to go to the mountaintop to tell me their story.I had all the time in the world; a doctor has a brief amount of time—15 minutes probably, less than that now—to do the physical exam. As a result, many patients feel unheard. One thing I learned is that doctors need to become better listeners. You can only discover a patient’s true feelings by listening.

Dr. Berek: How can physicians become better listeners while dealing with the time constraints inherent in their work?

Ms. Smith: It’s important to effectively incorporate other health care workers and train them in communication skills, particularly in the area of breaking bad news and providing a good support system after the delivery of bad news.

Dr. Berek: Let Me Down Easy involves a politically charged subject; how do you get past that to tell the human side of this story?

Ms. Smith: I think it’s a travesty that we don’t have universal health care in this country. This may amuse you—I also play a hospital administrator on Nurse Jackie. She’s a kind of toughie. I have the opportunity as her to cite some of the problems we have in health care, not in my words but in the words of the writers. My background [via the play] helps me to give the words life. My goal is not to judge anything but to try to present things in a holistic way and then leave it up to the audience to draw their own conclusions.

Dr. Berek: Is there anything you’d like to communicate to oncology professionals?

Ms. Smith: I did a lot of my research at the M. D. Anderson Cancer Center. Oncology is an area that has special opportunities because unlike something like plastic surgery or rheumatology or orthopedics, cancer care invites all kinds of teamwork.

Cancer is also extraordinarily demographic. It’s an equal opportunity employer. It has the world’s attention. I think it’s a place where innovation can happen not just in science but in the nature of care itself. So what I would like to say [to oncology professionals] is I admire them. I admire the opportunity they have to make a difference in all kinds of ways. This is an opportunity to bring a different idea of healing that has to do with healing the whole patient, giving dignity to the whole patient, giving authority to the whole patient.

For more on the development of Let Me Down Easy, including insight into the characters portrayed, view a video interview with Anna Deavere Smith on the Stanford School of Medicine website (tinyurl.com/ADSinterview)


Behind the Scenes with Philip A. Pizzo, MD

One of the people portrayed in Let Me Down Easy is ASCO member and Dean of the Stanford School of Medicine Philip A. Pizzo, MD, who discusses his experience as a character in the play.
 
AC: How did you become one of Anna Deavere Smith’s characters in Let Me Down Easy?

Dr. Pizzo: I first met Anna Deavere Smith when she visited Stanford a few years ago to participate in our annual strategic planning leadership retreat. Among the topics we were addressing was the impact of unconscious bias on leadership, diversity, and career development. In preparation for her participation, Anna interviewed a number of Stanford faculty, including me. We had a far-ranging discussion about medicine and health care. At that time, she was conceptualizing an outline for what eventually would become Let Me Down Easy.

Initially, I believe she wanted to tell a story about “the human body.” Over time that evolved to a portrait of death and dying. As the conceptual framework evolved, Anna returned to Stanford to interview me again. I suspect that she wanted to connect the stories of other individuals within a factual context about health care, which is what I provided.

AC: A Los Angeles Times review singled out your character’s lines as having the most impact, particularly in regard to health care reform and end-of-life issues. How do these tie together for you?

Dr. Pizzo: I did see the review in the LA Times and was, of course, pleased that the writer found my comments to be meaningful. That said, I have no way to assess whether that reviewer’s comments would be matched by others or not. From my perspective, Let Me Down Easy is very much about the human condition and the inevitability of death and dying and how we approach the end of life individually and collectively.

While the characters and individuals she performs come from remarkably different life journeys, Anna is able to weave the individual stories into a uniquely connected portrait, albeit one that will look and feel differently to each individual observing the performance. What at first seems to be unconnected vignettes become pieces of a complex puzzle, which emerge with varying degrees of transparency over time. Her performance is dynamic and organic and interconnects observations that are at once profound and light, deeply moving and funny.

AC: What was it like to see yourself depicted on stage?

Dr. Pizzo: I have seen Let Me Down Easy only once. I felt (and still do) self-conscious about “being performed.” Of course, while the show was touring, I received messages from colleagues and friends that Anna had really “nailed my character.” If anything, that made me even more self-conscious.

When I did attend the performance, I found myself deeply moved by the play. As a pediatric oncologist and also a physician who was deeply involved in the care of children with AIDS early in the epidemic, I have been all too well-versed in death and dying. Despite that, I derived unique and special insights from the various perspectives offered by the seamlessly interconnected but amazingly diverse words spoken by the characters Anna performed. I must admit that when it came to my character, I felt no identity or connection, and in many ways, found myself an observer. It didn’t seem to be me, although that is not what my family felt. My own ego is not tied to this performance, and so my only hope is that whatever role I played helps to heighten awareness, sensitivity, compassion, and care about about life, dying, and death.


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