Sophocles (et al) and Modern Medicine

One of the ‘missing  in action’ items in my mailbox (from July!) … from the Boston Globe:

Sounds of agony pour from the man at the front of the room, his face red and convulsed with pain.

“Death!’’ he shouts, imploring someone, anyone, to end his life, his shrieks filling the amphitheater. “Death! Why after all these years have you not appeared?’’

The wailing man is an actor. His part is that of a Greek hero-warrior begging to be euthanized as a burning poison eats away at his flesh. His lines were written more than 2,000 years ago by Sophocles, the Greek playwright. And his audience this evening consists mainly of doctors, more accustomed to saving lives than to ending them.

As medical technologies extend the lives of the sickest, medical schools across the country have struggled to find a way to help doctors better navigate new moral quandaries around death and dying. The recent performance of scenes from Greek plays at Harvard Medical School represents one of the more unusual and emotionally powerful approaches.

Called End of Life, the program uses ancient Greek tragedies to spark discussion among medical students and professionals about the ethics of treating patients facing painful, prolonged deaths.

Several professors, doctors, and students who have taken part in End of Life agree that the 90 minutes of raw, honest theater and emotional discussion add a dimension of reality to medical ethics education that textbooks cannot.

“An awful lot of what goes on in taking care of patients involves feelings, like trust and hope and compassion,’’ said Christine Mitchell, a nurse and director of the office of ethics at Children’s Hospital Boston. Mitchell attended both of the performances Harvard has hosted this year. “We usually focus on the head part and not the heart part. It’s not easy to combine the two.’’

If Bryan Doerries, the project’s founder, has his way, more medical schools will employ ancient Greek drama to strengthen their medical ethics programs. The two scenes used in the End of Life readings illustrate the ethical dilemmas and emotional baggage that complicate medical situations for the terminally ill, their families, and caregivers.

“This was dramatically different than what we had done before,’’ said Dr. Sadath Sayeed, who teaches Harvard Medical School’s ethics class and helped bring the program to the school. “It’s a lot about emotion, the feelings, the experience itself. It’s harder to get that in a classroom.’’

Still in its infancy, the End of Life project is not yet on any school’s list of ethics requirements. Doerries, a New York-based educator trained in the classics, will take it to the University of Virginia next fall, where students and faculty across disciplines will judge for themselves the relevance of Greek tragedy to modern medicine.

Of the 133 medical schools in the United States, most teach some form of medical ethics as part of their standard curriculum, a representative of the American Association of Medical Colleges said.

Classroom topics range from research ethics and genetic testing to informed consent and euthanasia, often discussed in light of case studies doctors can draw on in making their decisions.

But a study published in 2008 in the American Journal of Hospice and Palliative Medicine found that doctors’ stance on end-of-life topics depended on other factors, such as religious affiliation, ethnicity, and experience in treating dying patients. Those with strong religious beliefs, for example, were about four times more likely to object to physician-assisted suicide than those without such beliefs.

In light of that, it becomes imperative that medical students receive training early that stresses the emotional aspects of medicine, Sayeed said.

One of the scenes in the End of Life readings is from “Women of Trachis,’’ in which Heracles, accidentally poisoned by his wife, implores his son to stop his searing pain by building a pyre, tying him to it, and lighting it on fire.

“It had this line, ‘I am asking you to be my doctor,’ and he is begging his son to kill him,’’ said Spencer McClelland, a third-year Harvard medical student who attended the End of Life session in March. “A lot of these things are really intangible when you’re a student. To have anything that humanizes them before you go through this face-to-face with a patient is invaluable.’’

Several medical schools have pioneered innovative teaching methods that take a more holistic view of medicine and ethics. Columbia University’s Program in Narrative Medicine, already a decade old, teaches doctors how to foster empathy with patients and interpret their stories of suffering as a means to promote healing.

Still, Doerries believes theater has an impact classes cannot achieve. “Theater has a power to destroy hierarchy,’’ he said. “Not forever, but for long enough for those in the audience who may be intimidated to speak.’’

Sitting in front of an audience of about 60 people, Rabbi Herman Blumberg, a chaplain at Boston’s Hebrew Rehabilitation Center, talked at last month’s End of Life performance about the complicated obligations that arise when illness sentences patients to a life of pain.

He described the emotional impact of watching the actor’s anguished scream as a tearing of the soul.

“I’m going back to it again and again and again,’’ he said. “The realization of just how painful pain is. I find myself listening more fully with my whole being.’’

via:  Screams from Greek stage aim for doctors’ hearts – The Boston Globe.

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