"The Last Scene Of All"
Rituals originally evolved in order to manage the unmanageable fact of somatic change: birth, maturation, procreation, death. Contemporary culture and technology have loosened the inevitability of these life-cycle milestones: children can be planned or altogether avoided; adulthood—marriage, gainful work—can be postponed seemingly indefinitely; sexual initiation has broken from its containment by traditional ritual altogether and happens wherever, whenever. Even death, though it remains inescapable, has been disrupted in its timing thanks to medical advances. This last is good news. The bad news comes when our control of death reaches its limit and suddenly flips into helplessness—the diminished individual is barraged by conflicting voices with confusing options. In an effort to prevent this descent into chaos during the final phase of life, to set the stage for a peaceful passage, a new ritual has been taking shape in our national awareness: The Conversation.
Here in the state of Jefferson, a grass-roots organization, COHO (Choosing Options/Honoring Options), has made it their mission to facilitate this important communication, within families or between medical professionals and their patients. For the third year now, COHO is offering a free series of presentations packed with accurate information about the final years of life. As individuals differ, so do patterns of decline and preferences for coping. COHO aims to empower individuals and their families to make enlightened choices about this stage of their experience. And for the third year, the organization has turned to the potent connection between ritual and theatre to add depth and color to the picture conveyed through lecture, power point, and panel discussion.
In an effort to prevent this descent into chaos during the final phase of life, to set the stage for a peaceful passage, a new ritual has been taking shape in our national awareness: The Conversation.
On February 26, Megan Cole, who created the lead role of Vivian in the Broadway premier of Margaret Edson’s Pulitzer Prize-winning Wit, enacts excerpts from this play to explore the poignant, comical, outrageous experience of serious illness poised between the Scylla and Charybdis of medical science and mortality. Profoundly affected by her role in Wit as a patient with terminal cancer, Cole has continued to apply her theatre-craft to the practice of medicine, working with medical schools, caregivers, and “all organizations whose goal is the care and well-being of patients.”
The presentation on March 19 will feature an original play written and directed by Peter Quince and performed by his troupe of Threshold Thespians. Quince founded the Thespians as an antidote to the medical drama of television and film, shows like ER or Grey’s Anatomy, in which doctor-heroes solve microbial mysteries just in time to save lives. As Quince points out, the typical scenario has nothing to do with real-life crises, and it encourages a notion of death as an event that must be fought no holds barred. Unfortunately, battling death often requires aggressive interventions that do nothing to enhance quality of life and can seriously impair it.
Quince’s end-of-life plays tell a different story. One compares alternative versions of the same situation: son returns home to visit declining mother, whom sister has been caring for on a daily basis. The siblings have different ideas for their mother’s medical treatment. In one version, there has been no conversation to prevent hostilities and guilt; in the other it has, affording a passage free of conflict for all three family members. A second play enters the mind of a declining mother as her fearful children begin to back away from her stated preference for no heroic measures. This year’s play “Mom, not at Thanksgiving Dinner!” reverses the spin of the previous two. This time the mother, adventurous throughout her life, wants to make it clear that there are situations for which she would choose medical intervention. She feels she can rise to the challenge of whatever infirmity might result from her decision.
Quince emphasizes that the point of his work is not to advocate for one line of action over another, but to ease family members into breaking silence around this most difficult topic. His plays invite us to bestow on our deaths the same degree of planning that we typically devote to childbirth, graduations, and weddings. As a writer, he understands the necessity of capping a story with the right ending; he hopes to enable others to choose to the right endings for their own stories, final chapters that will affirm who they are.
According to Abie Goldberg, member of the COHO Leadership Council, the medium of theatre inspires the audience to both talk and action. Following Quince’s scenes from the end of life, the number of sign-ups for the Advance Directive Workshop, which caps the annual curriculum, explodes. Once the imagination has been invited briefly to live the future and assess its possibilities, audience members feel the need to do what they’ve been thinking about: fill out an Advance Directive. Goldberg, whose Ph. D. research focuses on palliative care, also notes that the empathy that Quince’s scenes inspire also illuminates the value of palliative measures at the end-of-life.
If the world is a stage, then we are each the protagonist in a drama of our making. Shakepeare never pulled his punches in reminding us of the “last scene of all.” In fact, King Lear could be said to progress from one version of The Conversation to another. In Act I, blinded by the illusion of absolute power, Lear’s orders for his end-of-life simply, and impossibly, demand more life. It is his trial by storm that opens him to acknowledging his mortality and joining the human race, thus enabling his quiet connection at the end with Cordelia.
Presentations at the Smullin Center in Medford take place at 2 PM and again at 7 PM. “The Wisdom of Wit” on February 26 is followed by “Forks in the Road: Choosing Levels of Treatment” on March 12, then the Threshold Thespians on March 19. For more information, check www.cohoroguevalley.org or call 541.292.6466.
Molly Tinsley taught literature and creative writing at the U. S. Naval Academy for twenty years. Her latest book is the spy thriller Broken Angels (www.fuzepublishing.com)