[This is the fourth installment in my series on Theater of War (Parts 1 through 3 were posted on 22, 25, and 28 June), the project co-founded by Bryan Doerries in 2009 to perform readings of classic plays in order to spark discussions of various social issues that have beset certain communities in the United States.
[I’ve been working my way through the company’s history in reverse chronological order with published articles from a number of different periodicals to demonstrate how ToW selects and adapts—Doerries, educated in the classics, translates and adjusts the plays and other texts the company uses—to address the different subjects and demographic groups.
[Part 4 is comprised of the final four articles of those I’ve selected, one from Forbes magazine from 2020, and three from the New York Times, covering readings (or other events) in 2017, 2009, and 2007. If any reader is just joining this thread, I recommend going back to the earlier parts to see the development of ToW’s process and the response from 2020 to 2024. (There’s a brief profile of Theater of War Productions in Part 1 and commentary throughout all three installments.]
“THEATER OF WAR:
USING GREEK TRAGEDY TO HELP
by Robert Glatter, MD
[Dr. Robert Glatter’s discussion of how Theater of War addressed medical first responders’ stress during the pandemic through readings of classic Greek tragedies, such as Sophocles’ Ajax, in Forbes appeared on the magazine’s website on 4 August 2020. Glatter is, himself, a medical professional.]
During the Covid-19 pandemic, being a frontline healthcare worker has been one of the most difficult jobs, involving both personal and professional challenges which are truly unprecedented.
Many workers have suffered in silence, experiencing ongoing feelings of anger, fear and betrayal. And for some, the pandemic has led to suicide—a painful reminder of the fragility of life, and the ongoing toll of this crisis.
Confronting death on a daily basis and feeling unable to provide optimal care of patients—from inadequate inventory of personal protective equipment (PPE) to safely treat patients, making difficult decisions involving allocation of limited lifesaving resources, or having lack of adequate staffing itself—embodies the concept of “moral injury” which has been devastating to all healthcare providers.
Moral injury is distinct from “burnout” and was first offered as an explanation for military veterans [who] were not responding to treatment of PTSD. It refers to the emotional, physical and spiritual harm people experience after “perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs or expectations.” Simply put, repetitive episodes of moral injury, combined with physical and emotional exhaustion can lead [to] paralyzing anxiety, depression, PTSD and ultimately suicide.
Addressing such moral injury is challenging to say the least, but a unique collaboration between the Johns Hopkins Berman Institute For Bioethics, Johns Hopkins Programs in Art, Humanities, and Health and Theater of War Productions, a production company that presents dramatic readings of Greek tragedies to modern and contemporary works— aims to do just that. At its core, Theater of War for Frontline Medical Providers represents an innovative project that has the ability to reach all frontline medical workers—nurses, doctors, respiratory therapists, social workers and hospital staff— who may be struggling in isolation, providing them the opportunity to name and communalize their experiences, connect with colleagues, and access available resources.
But Bryan Doerries, artistic director, and co-founder of Theater of War Productions, realized that his approach—originally conceived to help veterans cope with intense emotional distress and the lingering effects of moral injury from combat—could be communalized to help health care workers who experience this similar injury on a daily basis.
“To be clear, Theater of War Productions’ approach is not medicine, nor is it therapy,” said Doerries. “The aim of our projects is to lift people out of isolation and into community. If there is one thing I have observed over the past twelve years of doing this work it is that trauma, loss, and moral distress all leave people feeling isolated and alone.”
Doerries ultimately views Theater of War for Frontline Medical Providers “as a public health campaign, and the message of the ancient stories we perform for medical providers is simply this: You are not alone in your community, not alone across the country and the world, not alone across time.”
“Through Theater of War for Frontline Medical Providers’ performances, clinicians of all types are invited to connect to the universal struggles embodied by the Greek tragedies and through them to connect to their own experiences during the pandemic,” said Cynda Rushton, PhD, RN, Professor of Clinical Ethics at the Berman Institute of Bioethics/School of Nursing, Johns Hopkins University, who leads the collaborative effort with Theater of War for Frontline Medical Providers. “Through the performance and the panel that follows, it is possible to give words to feelings, thoughts and experiences that clinicians are carrying and in doing so to find some solace that they are not alone in their experiences and that they are neither failing or deficient because of their responses to these unprecedented circumstances. They learn that they are experiencing normal responses to an abnormal situation and by recognizing this, begin to restore their integrity by cultivating and strengthening their moral resilience.”
In a nutshell, Theater of War for Frontline Medical Providers’ current approach during the pandemic is this: harness the power and messaging of Greek Tragedy, and use it as a medium to explore moral dilemmas that frontline care providers confront on a daily basis via Zoom Webinars, followed by a de-brief that explores real-life issues which mirror the themes that are displayed during the actual production. After the performance, the actors are replaced by four panelists—a diverse group of front-line medical providers—who then respond to what they heard in the plays that melds with their own experiences of caring for patients during the pandemic.
[The Zoom webinars were a coronavirus-protection measure during the pandemic, when performances were also remote over Zoom. Before and since the pandemic, the discussions, like the readings, were live before an in-person audience. Note Glatter’s remark below.]
After the panelists’ remarks, a facilitator encourages the audience to join the discussion with a series of questions encouraging reflection and dialogue about themes raised by the plays. The discussion provides an opportunity for the medical workers in the audience to take center stage, sharing the impact of COVID-19 on their lives and finding comfort and support in the community of their peers.
The sharing of common experiences and their desire to improve life after such emotional trauma creates a powerful bond, but also empowers workers to approach management with constructive criticism and potential solutions as they embark on their emotional recovery and healing. Prior to the pandemic, Theater of War held powerful stage performances, but Covid-19 changed all that, requiring an adaptation to the world of online Zoom theatre.
Late last month, Theater of War for Frontline Medical Providers performed “Ajax” [442 or 441 BCE; by Sophocles (497/496-406/405 BCE)], a famous Greek Tragedy set during the Trojan War [legendary, decade-long siege and sacking of Troy, a city in Asia Minor, by the Greeks in the 11th, 12th, or 13th century BCE], to enable EMS providers to draw parallels between their personal struggles during the pandemic to those experienced by a mythical Greek figure. It explored the themes of anger, jealousy, revenge, misdirected rage, and guilt leading to suicide.
Presented on July 30th [2020], with over 900 Zoom viewers from over 18 countries, “Ajax” brought out feelings ranging from personal risk, betrayal, anger, sadness, abandonment, powerlessness, survivor’s guilt, along with remorse. In a post performance survey, 88% of respondents said that participating in Theater of War Frontline reduced their sense of isolation, while nearly 79% said that viewing made it more likely for them to use resources if needed, according to Doerries.
“When frontline medical providers, who may be reluctant to talk openly about the impact the pandemic has had upon them, their clinical practice, and their families, see their own struggles reflected back to them in ancient stories, it creates a non-threatening space in which it’s easier to talk about challenging topics, such as guilt, betrayal, deferred grief, personal risk, and deviations from standards of care, opening a door to pathways of healing, community, resilience, and moral repair,” added Doerries.
Communal activities via Greek Tragedy
Doerries further explains that the ancient Greeks realized that it wasn’t healthy for people to be “overwhelmed with emotion in the midst of violence, illness, and conflict. “But they also knew something that I think we’ve lost touch with as a society—that it is morally and emotionally toxic to defer and compartmentalize our emotions indefinitely. This is one of the factors that leads to burnout, depression, and even suicide,” he added.
“The Greeks knew that there had to be a time and place for people who had experienced violence and death to be given permission and empowered to acknowledge their emotions, collectively, as a community,” offered Doerries. “The word amphitheater in ancient Greek means ‘the place where we see in both directions.’ In the amphitheater, I see you and you see me. It is the place where we bear witness to the truth of our respective struggles.”
Doerries is “convinced that humans heal best in groups, and that isolation and betrayal are the wounds that cut the deepest. In this regard, and out of necessity, the Greeks developed tragedy as a tool to communalize the trauma of nearly 80 years of war and a pestilence that killed nearly one-third of the Athenian population [see my note on the Plague of Athens in Part 3, “Can Greek Tragedy Get Us Through the Pandemic?”].”
He qualifies that we are quite fortunate the process still works well. “It’s like an external hard drive that just needs to be plugged into the right audience: the ancient technology knows what to do, and so does the audience, as evidenced by the dynamic, powerful discussions that take place during our events.”
An article by Rushton, Doerries and colleagues published last month in the Lancet [C. Rushton, B. Doerries, J. Greene, G. Geller, et al., “Dramatic interventions in the tragedy of the COVID-19 pandemic,” Lancet, 23 July 2020] focuses on how their initiative is equipped to help medical providers, but especially in the setting of Covid-19. The authors write that “we have found that presenting scenes from ancient tragedies about complex ethical situations for frontline medical providers generates an open, non-threatening space in which health personnel can begin to process, interrogate, share, and bear witness to experiences of loss, betrayal, grief, and other forms of moral suffering during the COVID-19 pandemic.”
“A nearly universal response to moral suffering is that we feel alone; that we are the only one who is struggling; that everyone else is coping better than I am,” explains Rushton. “The design of Theater of War for Frontline Medical Providers creates a safe space for reflection, insight and wisdom by fostering a community of belonging: often clinicians are able to meet each other as human beings rather than their titles, roles or professions.”
“This dissolving of hierarchy allows us to connect to our shared vulnerability and to see the humanity in others and ourselves. It also allows clinicians to loosen the grip of unrealistic expectations and the disempowering narratives of powerlessness to see themselves as already having resources to meet the challenges they confront with the support of their community,” she added.
Dr. Loree Sutton, a retired Army Brigadier General, psychiatrist, and former Commissioner of Veterans Services in New York City, feels that Theater of War’s benefit may offer a form of deeper connection than we can gain from our virtual world which often seems relatively empty and fleeting.
“Theater of War for Frontline Medical Providers draws us in as active participants and engaged witnesses—the very opposite of what our social media world of tweets, clicks and ads is designed to elicit. In short, Theater of War for Frontline Medical Providers facilitates the experience of being human — eschewing titles depicting stature, hierarchy divulging status or expectations demanding performance or deliverables.”
“Participants, including medical providers, respond accordingly — with a renewed sense of purpose, engagement and connection to community, enjoined by Theater of War’s parting gift: the work serves to comfort the afflicted and to afflict the comfortable,” she added.
Mental Health Legacies of Covid-19
But the broader issue is that we need to discuss the mental health legacies of Covid-19. Simply put, there is a wave of adverse mental health effects building, and the legacy we will write will be determined by how we handle this surge of health-related effects.
Yet, Doerries argues that Covid-19 is actually an extension of a pandemic that has largely been under appreciated. “There was a pandemic before the COVID-19 pandemic—of unaddressed trauma and mental health; poverty, substandard housing; homelessness; addiction; educational apartheid; and state-sanctioned violence against communities of color,” he said. “COVID-19, and the awakening that has accompanied it, has brought all of this into the light, showing the world how social justice and healthcare are inextricably connected and interdependent.”
“Given what we have seen and learned as a society over the past five months—things that are impossible to unsee and unlearn—there is seemingly infinite work now to be done to address the mental and physical wellbeing of people who have been systemically cut off from adequate healthcare, including mental health services and resources: in order to be successful in this effort we'll also need to break down the stigma associated with accessing mental healthcare in many communities, when it’s available,” Doerries offered.
“I think this needs to start within the field of medicine, with frank and open dialogue about the impact of the pandemic on frontline medical providers, and then radiate out into the general population, in larger, community-driven conversations. My hope is that the mental health legacy of COVID-19 will be an awakening and consciousness that leads to social and mental health justice,” he added.
Rushton concurs and adds a sense of reality: “I suspect that we will see a full range of physical, psychological and moral responses that will need targeted and sustained attention. What keeps me up at night is whether we will be able to sustain the healthcare workforce during and after the pandemic. The level of exhaustion among clinicians across the country is profound. The heroic response has now progressed to a phase of deep disillusionment and despair as the pandemic marches on without an end in sight.”
Theater of War’s Positive Legacy
Theater of War for Frontline Medical Providers premiered on May 24th with 417 medical providers from the Baltimore area logging onto Zoom for a performance featuring Frances McDormand, Jesse Eisenberg, David Strathairn, and Frankie Faison. In a post-performance evaluation, 93% of respondents reported that the program offered new insights about their experience during COVID; 92% said the program made it easier to talk about difficult subjects related to COVID.
As a result of this success, the Arts in Health Initiative of the Laurie M. Tisch Illumination Fund provided a grant to fund 10 performances of the project in New York City.
“We got to know Theater of War’s extraordinary work through prior projects, and when they came to us with the idea of a new project to help frontline medical providers, we immediately saw why it is so timely and important, said Laurie M. Tisch, President, Laurie M. Tisch Illumination Fund. “Theater of War Productions is stepping up to help heal the people who are caring for us through this terrible pandemic, and we are proud to be among the supporters making it possible.”
“We know from the organizations in our Arts in Health initiative that the arts are a particularly effective tool to address issues related to mental health challenges such as trauma, and they provide unique ways to combat the stigma that makes it difficult for people to seek help. These are issues that frontline healthcare providers are facing every day as they risk their lives and health to save ours,” added Tisch.
It’s also possible that Theater of War’s approach may serve as a means to tap into and alter neural networks which develop as a response to emotional trauma, quite distinct from more traditional approaches such as cognitive behavioral or group therapy.
“There is every reason to believe that this type of theatrical production is facilitating a powerful form of processing that we know from other research is a means to potentially mitigate against the negative outcome of trauma,” said Christine Moutier, M.D., Chief Medical Officer for the American Foundation for Suicide Prevention. “That it uses not only major talent portraying events and themes related to moral injury may be a way to engage different parts of the brain that likely connect experiences and memory with emotional and intellectual neurological processing.”
“This may make it unique from other forms of processing that primarily engage our intellectual mind—like facilitated groups and individual conversations between us and therapists, peers or mentors. One hope is that participants would continue the dialog in some way and even build on those gains in their relationships at work or at home,” she added.
Moutier also offered that “it engages a tactic of using ancient events to evoke people's humanity living through present challenges, which the ancient tragedies also did in their own time.”
[Robert
Glatter, MD, is a contributor to Forbes magazine who covers breaking news in
medicine, medical technology, and public health. He’s an emergency physician on staff at Lenox
Hill Hospital in New York City, where he has practiced for the past 15
years. He also serves as an adviser and
editor to Medscape Emergency Medicine, an educational portal for
physicians, and an affiliate of WebMD.
Glatter’s other time is spent with his private house-call practice,
DR911, providing medical care to both travelers and residents in
Manhattan. He has a keen interest in
medical technology and public health education.]
* *
* *
“ARTIST IN
RESIDENCE FOR NEW YORK CITY”
by Jennifer
Schuessler
[Jennifer Schuessler’s report on Bryan Doerries’s being named an “artist in residence” in New York City ran in the New York Times of 3 March 2017. While it is about Theater of War Productions, this article is about an honor bestowed on Doerries rather than the performance work of his company.]
Bryan Doerries, the artistic director of the Brooklyn-based group Theater of War Productions, has taken community-based performances based on ancient Greek tragedy and other classic texts to more than 600 military bases, prisons, hospitals and other venues around the world, where he has used them to spur conversations about violence, trauma and survival.
But in the next two years, Mr. Doerries will be sticking to a stage closer to home: the entire city of New York.
The city’s Department of Veterans Services and Department of Cultural Affairs has announced that Mr. Doerries is its newest public artist in residence. During his tenure, Theater of War will stage more than 60 free events in venues in all five boroughs, drawing on its repertory while developing new productions tailored to different communities.
“For the last nine years, we’ve been designing projects and then taking them out into red-state America, frankly: military bases, prisons, megachurches,” Mr. Doerries said in an interview. “We don’t want that work to end, but this will allow us to go deep into some of the same social issues in a more concentrated way here.”
Theater of War, founded in 2009, is based on the idea that Greek tragedy is “an ancient technology,” as Mr. Doerries likes to put it, that when plugged into the right audience can provoke an intense, cathartic response. Mr. Doerries also has help from a deep roster of prominent actors, who both bring in curious crowds and break through their defenses with no-holds-barred intensity of delivery.
“Hercules in Brooklyn,” a piece that had its premiere in October at the Brooklyn Public Library, featured Paul Giamatti, Jeffrey Wright and Ashanti, reading excerpts from Euripides’ [480-ca. 406 BCE] “The Madness of Hercules” [ca. 416 BCE] in an over-the-top-style — “Make them so uncomfortable they wish they hadn’t come,” is Mr. Doerries’s typical direction. It was followed by an hour of searching discussion about gun violence, which many audience members had experienced firsthand. (The library will be the co-producer of Mr. Doerries’s residency, which is being supported by a $1.365 million grant from the Stavros Niarchos Foundation.)
The first presentation of Mr. Doerries’s residency will be a reading of Sophocles’ “Ajax” and “Philoctetes” [409 BCE] on March 20 [2017] at the Greene Space in Manhattan, featuring Mr. Giamatti, Frances McDormand, David Strathairn and Reg E. Cathey. That will be followed by a performance at the Crown Heights branch of the Brooklyn Public Library on April 6 and a bilingual presentation at the Pregones and Puerto Rican Traveling Theater in the Bronx on May 6.
[Jennifer
Schuessler is a culture reporter for the New York Times, covering intellectual life
and the world of ideas. She’s based in
New York.
* *
* *
“THE ANGUISH OF
WAR FOR TODAY’S SOLDIERS,
by Patrick Healy
[The New York Times published Patrick Healy’s report on ToW’s readings of Ajax and Philoctetes for audiences of servicemen and -women on bases around the country on 12 November 2009. These were among the company’s first performances after Bryan Doerries co-founded it that year.]
The ancient Greeks had a shorthand for the mental anguish of war, for post-traumatic stress disorder and even for outbursts of fratricidal bloodshed like last week’s shootings at Fort Hood. They would invoke the names of mythological military heroes who battled inner demons: Achilles, consumed by the deaths of his men; Philoctetes, hollowed out from betrayals by fellow officers; Ajax, warped with so much rage that he wanted to kill his comrades.
Now officials at the Defense Department are turning to the Greeks to explore the psychic impact of war.
The Pentagon has provided $3.7 million for an independent production company, Theater of War, to visit 50 military sites through at least next summer and stage readings from two plays by Sophocles, “Ajax” and “Philoctetes,” for service members. So far the group has performed at Fort Riley in Kansas; at the Uniformed Services University in Bethesda, Md.; and at last week’s Warrior Resilience Conference in Norfolk, Va.
The scenes from “Ajax” show the title character plotting to murder Greek generals who have disgraced him. Under a trance by the goddess Athena, he ends up slaughtering farm animals he thinks are the officers. Ajax’s concubine is depicted as trying to bring him to his senses; the final scene shows Ajax in agony, committing suicide.
The “Philoctetes” segment portrays Greek military leaders plotting to trick the hero into leading an attack on Troy, and shows Philoctetes struggling with both physical and emotional pain.
A special performance was held on Monday night [16 November 2009] for dozens of service members, veterans, relatives and Pentagon officials at St. Vincent’s Hospital in Manhattan [Catholic hospital, closed in 2010]. The actors in the one-hour reading were David Strathairn, Jeffrey Wright, Gloria Reuben and Adam Driver, a former Marine.
The investigation of Maj. Nidal Malik Hasan, the Army psychiatrist accused of killing 13 at Fort Hood in Texas [5 November 2009], loomed over the reading, though it was mentioned only a few times during the post-performance discussion. Still, there were echoes of Fort Hood, especially in the story of Ajax in the pain that soldiers and their loved ones faced then and now, and in the questions raised by the play about whether war can drive warriors to acts of evil.
“These plays are part of a 2,500-year history of mental and emotional pain for soldiers that run up to the present day,” said Mr. Strathairn, an Academy Award nominee for his portrayal of Edward R. Murrow in the 2005 film “Good Night, and Good Luck.”
Bryan Doerries, a writer and director who founded Theater of War, said the performances were not psychotherapy, noting, for instance, that the efficacy of his group’s work had not been studied in clinical trials. He described the effort as a public health project to help service members and relatives overcome stigmas about psychological injuries by showing that some of the bravest heroes suffered mentally from battle.
“Through theater we’re trying to offer some ideas and
experiences for our troops and veterans to think about when they don’t feel
comfortable opening up about their private thoughts,” said Mr. Doerries, whose
work grew out of an earlier effort, the Philoctetes Project, that drew media
attention for a performance at the Juilliard School last fall.
“Sophocles was himself a general, and Athens during his time was at war for decades,” he continued. “These two plays were seen by thousands of citizen-soldiers. By performing these scenes, we’re hoping that our modern-day soldiers will see their difficulties in a larger historical context, and perhaps feel less alone.”
Film screenings and theater performances have long been staples of mental health and rehabilitation services, intended to provoke discussions among viewers who might dislike talk therapy but who can identify with characters or plot points.
For active-duty soldiers, stigmas about therapy can be even greater, psychologists say. Concerns that they might be passed over for promotion or regarded as weak have prevented some from seeking help from mental health professionals.
“There is good evidence that active-duty personnel worry about the stigma of post-traumatic stress disorder,” said Richard J. McNally, the director of clinical training in the psychology department of Harvard University.
Some troubled veterans do not seek help even after their service careers are over, said Dr. McNally, who has worked in the field of trauma and memory, especially with war veterans, since the mid-1980s but is not involved with Mr. Doerries’s project.
“If seeing the Theater of War can reduce stigma and help veterans seek these treatments, then that will be wonderful indeed,” he added.
Because of the Fort Hood shootings the Pentagon canceled an interview about the project with Brig. Gen. Loree Sutton, an Army psychiatrist and director of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, which awarded the contract to Theater of War.
But General Sutton was on hand Monday night at St. Vincent’s, where she told the audience after the performance that Theater of War was an important vehicle for “sharing pain and the promise of learning and growing and healing.”
“We knew that never in the history of our republic have we placed so much on the shoulders of so few on behalf of so many,” she said.
The reading kept the audience rapt. As Ajax, Mr. Wright, who won an Emmy and a Tony playing Belize in “Angels in America” [1993-94], was by turns thundering and growling, and threatened to lash the back of his Greek enemy Odysseus “until it’s red with blood.” He implored a comrade, “Cut my throat right now.”
“I was the bravest in battle, never lost my wits,” Mr. Wright nearly screamed as his character faced his unraveling mental state. “What a joke my life has become.”
Ms. Reuben, as Tecmessa, who lived with Ajax as his wife, begged him to think of his loved ones before doing harm. “The stain of it will shame your family,” she said.
During the post-performance discussion with the audience, led by a panel of therapists and military personnel, veterans from the Vietnam War, Iraq and Afghanistan spoke about their own sleepless nights, drug addictions and isolation from family members. A Vietnam veteran described being homeless for 10 years, suffering breakdowns but at last “getting my dignity back” in part from mental health care.
A psychologist on the panel, Michael Kramer, said that combat stress for soldiers could “erode their personhood,” and he connected the ancient traumas with the modern-day pain that “we’re reading about in the papers.”
Tanya Weekes was among the audience members. As the evening concluded, her husband, Sgt. Daniel T. Weekes, who served in Iraq with the Army National Guard in 2004-5, slipped out into the hallway. He still struggles with memories of a particularly bloody bombing during his tour in Mosul, she said, though he has come a long way with psychotherapy. He found the scenes hard to watch at times, she added.
“And the play helped me, definitely, because I could relate to the characters,” Ms. Weekes said. “When soldiers come home from war, you never know what to expect. They might get violent. That was my biggest fear.
“We at home might not have been on the battlefield, but it sure feels like it.”
Sgt. First Class Tony Gonzalez, an Iraq combat veteran from Brooklyn who was on the panel, recalled that post-traumatic stress disorder was rarely discussed when he first joined the Army. He described his own pain after his platoon captain was killed and he went to pay respects to the man’s wife, also a friend and member of the military.
And he praised the use of theater to help put a spotlight on trauma.
“I’ve been Ajax,” he said. “I’ve spoken to Ajax.”
[Patrick Healy was a theater writer for the New York Times until 2015, when he shifted over to politics as the national political correspondent. He became political editor in 2018 and is now Deputy Opinion Editor of the Times.]
* *
* *
“THE DIFFICULT
PATIENT, A PROBLEM
by Abigail Zuger
[Dr. Abigail Zuger’s report on a reading of Philoctetes for medical students organized by Bryan Doerries at the request of a member of the faculty of Cornell University’s Weill Medical School ran in the New York Times of 6 March 2007. It appears that this was the first such reading, a prototype of what Doerries would do when he established Theater of War Productions two years later.
[This article was referenced in Elif Batuman’s 2020 New Yorker article in Part 3 and I gave the bibliographic citation for it and the New York Times article by Patrick Healy above in a note in that post.]
The sick man was a misery to himself and to everyone around him. For one thing, his personal hygiene was horrific. He stank. And he was constantly in pain, moaning and groaning until you began to wonder if he was doing it just for effect. Worst of all, he was a mean old cuss, angry and embittered after years of illness. All he did was complain.
A few dozen medical students, most of them in their first year at Weill Medical College of Cornell University, listened with concern to a presentation about him a few weeks ago. Eventually, they knew, they would run into difficult patients like this one.
The sick man had been a mover and shaker once, with a place in high government circles. But then he had the accident. His wound became infected. It was all downhill from there. He quickly became unable to work, and his distress upset everyone around him. Finally, his business associates forced him into long-term residential care.
Some of the faculty members in the conference room nodded in recognition. It was a case right out of a chronic-care ward in a Veterans Administration hospital.
The patient stayed in his residence for years. Not a single visitor dropped by. He grew prematurely aged, a miserable, stinking, moaning wreck. The infection in his foot was untreatable and oozed foul pus. Pain medication helped only slightly. He became obsessed, focusing all his anger on the old crowd, the false friends who had abandoned him. He blamed them for everything.
The diagnosticians in the room suspected that the patient had a chronic osteomyelitis of the foot, with an anaerobic component accounting for the odor. Perhaps the infection had spread elsewhere through the bloodstream. And then there were his psychiatric diagnoses: reactive depression with psychotic features, possibly an underlying character disorder. He had certainly been a little narcissistic way back when.
Nine years after the sick man’s admission, a stranger came knocking at his door. The visitor was a young man, just a kid, really. He knew the sick man’s history, but the sight and sound and smell were overwhelming anyway. The kid was filled with pity and revulsion in equal measure. He wanted to help, but had been advised by his supervisor to be dignified and professional, to do his business and leave. Still, the patient was so miserable. Every time the young man tried to leave, the sick man pleaded with him to stay. “Don’t go!” the sick man cried. “Please. Stay with me.”
The visitor was torn. What should he do? He could have been a medical student on his first clinical clerkship, transfixed by the misery of a patient everyone else had labeled a miserable old crock years before. He tried to reassure the sick man, but the usual platitudes sounded hollow, and the man became only more agitated, almost incoherent, pain and fury all garbled together.
Fortunately, at this juncture the demigod Heracles showed up to straighten everything out. The medical students breathed a sigh of relief and clapped heartily.
These students and this patient will, of course, never meet; that would require a giant warp in the fabric of time and history. The sick man with the infected foot, Philoctetes, was marooned by his comrades on a deserted Greek island back in the mists of ancient myth. The rest of the crowd all headed off to sack Troy, but the kid, Neoptolemus, son of Achilles, was sent back to steal Philoctetes’s magic bow and arrows (without which the Greeks could not prevail). The wily Odysseus was waiting on the beach for the kid to get the goods. It was all only a footnote to the bloody saga of the Trojan war.
But to Dr. Lyuba Konopasek, a pediatrician who directs the medical school’s first-year course in Medicine, Patients and Society, Sophocles’s play, from the fifth century B.C., had so much to say to medical students and doctors that she invited Bryan Doerries, a classicist and director, to stage a reading for her course.
After the actors finished, students and faculty members talked for a long time about how students often feel helpless in the hospital, torn between befriending patients with incurable illness and sticking to a professional script. Sophocles somehow got that tenuous position just right, just as he knew that sick people, isolated and transformed by chronic disease, dread being alone and forgotten more than they dread pain or even death.
“We have created a subclass of patients like Philoctetes with modern medicine,” Mr. Doerries said. “They are abandoned on their islands to live long, but have we risen to the challenge of taking emotional care of them?”
Dr. Edith Langner, an internist, said, “Philoctetes’ horror was the horror of abandonment.” And yet, she continued, as Sophocles accurately pointed out, it can take so little from doctors to turn that around: a daily visit, a few minutes of friendly conversation, or sometimes just a new young ear to hear the old story all over again.
[Abigail Zuger is a medical
doctor who works in New York City as an infectious disease specialist and
writes on medical issues for the New
York Times. She’s the author of Strong
Shadows: Scenes from an Inner City AIDS Clinic (W. H. Freeman Inc., 1995).]
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