Health Reform as Theater: Let Me Down Easy

For a Broadway stage, the set is simple and spare – a long, white leather couch, a handful of wooden tables and chairs. No ornamentation is needed; the stories being told on the stage are what command the audience’s attention. Let Me Down Easy is health reform as poignant, funny and gripping theater.

A supermodel compares the high-powered physicians a cosmetics company gets her after she signs a lucrative contract to the doctors she had access to during her working-class childhood. A middle-aged woman emotionally refuses dialysis because of the terrible injuries her daughter sustained while undergoing dialysis when a hospital’s mistake left her covered in blood. And a cancer patient hospitalized with a post-chemotherapy fever describes being told not to take it personally that her chart has been lost: “that happens here quite a bit.”

Every word is true, every story describes a personal struggle with illness, dying and the medical care that sometimes happens in between. Twenty people speak, each in a separately titled vignette, but only one person appears on stage. That’s Anna Deavere Smith, who carefully selects verbatim excerpts from interviews she conducted and then meticulously mimics those interviewees’ body language and speech patterns in a manner so convincing that, in the miracle that is theater, she disappears into her characters. Some are well-known – Lance Armstrong, former Texas Gov. Ann Richards – others are not – a musicologist, a Buddhist monk, a rodeo bullrider.

What struck me as someone who works in health care was the power of Smith’s stories and how different they were from the stories we usually hear. They were – I don’t know how else to put this – honest.

By “honest,” I don’t mean simply factually accurate. Factually accurate anecdotes rain down upon us, each one lovingly trimmed and buffed so that just the right facts shine through. No, by “honest” I mean stories that are unafraid to expose the messy realities of how money, race, personal connections and just plain luck can determine our medical fate.

Supermodel Lauren Hutton, for instance, admits that she loves getting access to the best doctors in New York City — “Before I signed that contract, I didn’t know these docs. I got paid in docs” – but she isn’t going to rock the boat. “When you go to the doctor, why waste your precious time [asking questions]?”

Time is also precious to Kiersta Kurtz-Burke, a doctor at New Orleans’ Charity Hospital, but in a way that could not be more different. In a long, anguished monologue describing the ordeal of Hurricane Katrina, Kurtz-Burke recalls the surprise, anger and anguish she felt when she realized patients at private hospitals had been evacuated hers had not. The hospital’s African-American nurses had warned her, “They’re not going to come and get us,” but Kurtz-Burke had retained her faith in the government. As days pass without food or electricity, she comes to realize, “You know what, it must be [like] that your whole life. The feeling of being abandoned.”

Ruth Katz, the cancer patient whose medical record was misplaced, might have felt abandoned, as well. Except, when the conversation turned to work history as the medical resident tried to reconstruct her medical records from scratch, she mentioned she was associate dean of the Yale School of Medicine. “They found my files within half an hour,” Katz concludes.

It is Yale that gave birth to Let Me Down Easy, when the medical school commissioned Smith to interview staff members and patients for a candid presentation during medical grand rounds. Smith, an award-winning actress and playwright and MacArthur “genius grant” recipient,took the project to the next level, eventually spending nine years interviewing more than 300 people.

An article in the New York Times Magazine dubbed Let Me Down Easy, “The Health Care Monologues” (The Vagina Monologues author Eve Ensler is one of Smith’s interviewees). In reality, health system questions share the stage with more profound and existential concerns about health and life and death.

Smith “seeks answers to…open-ended questions about the power of the human body, its susceptibility to disease, and the divide between spirit,” is the way one Times drama critic put it.

Not a bad reminder about what health care reform is truly about.

4 replies »

  1. Wow! What a way to get a message across to people! We need more honesty (and I’m using your definition) in our lives.

    The extreme partisan 60 vote requirement of every piece of legislation and the abuse of the filibuster tactic in the US Senate indicates that our democracy is broken.
    This could have dire consequences for our nation whose very foundation is built on the fundamental concept of democracy.
    We are in very deep trouble beyond just health care reform at this point.
    Believe it!
    Dr. Rick Lippin

  3. Did anybody read about James Bain? Released today after spending 35 years in prison for a crime he didn’t commit: http://www.cnn.com/2009/CRIME/12/17/florida.dna.exoneration/index.html
    This is just the latest example of our nation’s moral and financial legalcare crisis. Demand Affordable Accessible Legalcare for All! http://www.SinglePayerLegal.org . Read the damning article exposing our two-tiered legalcare system at http://www.jpands.org/vol14no4/rice.pdf

  4. This play is moving and memorable for both people in the healthcare field and the general public. Smith is masterful in her performance, and will have you laughing hysterically in one act and tearful three minutes later. As a physician and public health professional, I still found new themes and messages that I had not encountered before. It’s a brilliant way to communicate themes of her qualitative research.