Thread by @tjwebbmd

A pre-med student I mentor recently watched Wit, and then sent me this text:

"I kept looking for any shred of evidence to defend the way the doctors were acting, and I couldn't find a thing."

I told him that he's about 10 years ahead of where I was at his age.

#medtwitter 🧵

2/ The play "Wit" by Margaret Edson has a strange but important role in my journey to becoming a physician.

As a college freshman I was pre-law and did #theatre whenever I could for fun. At the end of the year, I was cast in Wit as part of senior directed one-acts.

3/ The play is about the fictional Dr. Vivian Bearing, English professor and leading expert on the Holy Sonnets of John Donne, and her diagnosis, treatment, and death from ovarian cancer. The play focuses on themes of mortality, personhood, and what it means to be fully human.

4/ Donne's Holy Sonnet 10 serves as the theme of Dr. Bearing's journey.

Death, be not proud, though some have called thee
Mighty and dreadful, for thou art not so;
For those whom thou think'st thou dost overthrow
Die not, poor Death, nor yet canst thou kill me.

5/ From rest and sleep, which but thy pictures be,
Much pleasure; then from thee much more must flow,
And soonest our best men with thee do go,
Rest of their bones, and soul's delivery.
Thou art slave to fate, chance, kings, and desperate men,

6/ And dost with poison, war, and sickness dwell,
And poppy or charms can make us sleep as well
And better than thy stroke; why swell'st thou then?
One short sleep past, we wake eternally
And death shall be no more, Death thou shalt die.

7/ However, the additional theme and narrative that runs parallel to Dr. Bearing's mortal journey is her interactions with doctors, nurses, the hospital, and the healthcare system she is increasingly immersed by through the course of her illness and treatment.

8/ In our production, I was cast as Dr. Jason Posner, the Oncology Fellow who delivers most of Dr. Bearing's in-person medical care. Dr. Posner is solely interested in research and sees his patients primarily in that light; as research objects rather than human beings.

9/ His relationship with Dr. Bearing is complex; he took her course on Donne's Holy Sonnets in undergrad, and the awkwardness of their power dynamic now being reversed is very obvious. However, he took her class as an academic challenge and it's clear the lessons didn't stick.

10/ Despite this connection to the patient, he consistently treats her as a body with cancer, giving only a grudging nod to bedside manner, and no thought at all to her dignity or empowerment in her care. She is consistently dehumanized and humiliated through their interactions.

11/ Perhaps most egregious, he treats Dr. Bearing's career, which has defined her life, as a mere academic achievement of his own; he talks about getting an A in her class, but then quickly says "We don't have to talk about your interesting work" when taking her social history.

12/ Our Director took pains to ensure that we thought of these interactions properly, and understood the vulnerability, humiliation, harm, and dehumanization that so many people, like Dr. Bearing, experience at the hands of physicians.

13/ She arranged for us to visit the Nursing School's simulation center, where each male actor had the experience of laying in stirrups on the exam table (fully clothed) while the cast stood over them, to better understand the vulnerability of the exams simulated in the play.

14/ This was an experience that was never repeated throughout my subsequent years of medical school or residency, but probably should have been. Honestly, I've thought of it every time I've done a pelvic exam over the past 11 years, and it's made me a significantly better doctor.

15/ For me, the play was the first time I even imagined a career in medicine. It was the first time I ever wore scrubs. It was the first time I interacted with medical equipment, medical terminology, or the unknown world of medical history taking, physical exams, or grand rounds.

16/ My relationship with Jason Posner was the most complex of any character I've played. I despised his arrogance and his neglect of the human being under his care. But his lines were great.

17/ As I memorized line after line of what was meant to be obtuse medical jargon, I found it was actually really, really interesting stuff. He got to say things like, "The intercellular regulatory mechanisms—especially for proliferation and differentiation..." Great stuff.

18/ My journey mirrored Dr. Bearing's, though from an infinitely safer and privileged position; as I became immersed in the world of the play, I acquired language and vocabulary and an insider's perspective. There were deeper motivations, but a few months later I became pre-med.

19/ After the play wrapped, it was a long time before I thought about Wit again; not until I started experiencing clinical medicine more than 5 years later. Then, I began to think of that medical jargon, so impenetrable to Dr. Bearing and the audience, and how it made sense now.

20/ Made sense to me, but not to my patients; and I thought about the way that each interaction with Dr. Posner left Dr. Bearing with research to do on her own, because he had failed to use that medical knowledge to educate and empower her about her own body and her condition.

21/ So I started to use every visit to try to empower and educate my patient. My medical knowledge was a tool for them, to empower and help them, not to maintain the power difference between us.

22/ I thought about the humiliation of Dr. Bearing's medical exams and the vulnerability of laying in stirrups on that exam table, and focused more and more on ensuring that my patient felt safe and that I had my patient's trust whenever I needed to touch their body.

23/ And I thought about how the doctors in the play had made decisions for Dr. Bearing instead of with her, giving lip-service to shared decision making while neglecting her will and consent. And I determined that my patients, not me, would make the decisions about their care.

24/ But the hardest lesson of all was to cast off the professional habit of always taking the part of the doctor, playing devil's advocate or making excuses for each story of abuse, neglect, or harm. This is the tension my pre-med friend felt as he watched Wit for the first time.

25/ I now teach medical students. And the best lesson I have to offer them is that being a Physician means that the patient in the room with you, whoever they are, is your people; not the other doctors who have treated them.

Your first obligation is to your patient. Always.