Pulse
Experimental Theater
Actor-turned-doctor David Feldshuh recently returned to Minnesota to discuss his award-winning play about the Tuskegee syphilis experiment.
Would you have participated in the Tuskegee syphilis study? That’s a question that has haunted David Feldshuh, M.D. And it’s the question that prompted the University of Minnesota-trained emergency physician to write the play Miss Evers’ Boys, a fictional account of the experiment.
Feldshuh first learned of the Tuskegee study during his residency at Hennepin County Medical Center in 1981. The experiment, which started in 1932, was conducted by the U.S. Public Health Service and for 40 years tracked the progression of the disease in 400 African American men, most of whom were illiterate sharecroppers. The subjects were told they were being treated for “bad blood,” not syphilis. The physicians, who were both black and white, refrained from using penicillin even after it became widely available in the 1950s.
By the time the intent of the study was publicly exposed in 1972, 28 men had died of syphilis, 100 were dead of related complications, at least 40 of their wives had been infected, and 19 of their children had contracted the disease at birth.
As terrible as the study was, Feldshuh says it is not clear to him that he would have abstained from joining it. He said he thinks of himself as an ethical, humane doctor, but so did the physicians leading the study. “I can find in myself instances where I did not connect with my patient. I either looked down on the patient, or sometimes I got angry with my patient,” he says. Feldshuh, who now practices in rural New York and returned to the University of Minnesota in April to talk about the play, says he sometimes felt that way after hearing a patient swear or finding needle tracks on a patient’s arm.
Having gone into medicine to help people, Feldshuh says those feelings made him uncomfortable—and that made him want to write about the attitudes and thinking that allowed the experiment to happen.
The Play’s the Thing
Feldshuh was no stranger to the stage when he started writing Miss Evers’ Boys in the early 1980s. After graduating from Dartmouth College in 1965, he trained at the London Academy of Music and Dramatic Arts and the Ecole Jacque LeCoq in Paris, where he learned to mime. He worked as an actor and associate director of the Guthrie Theater in Minneapolis until 1974. After leaving the Guthrie, traveling around the country, and studying at the Esalen Institute in California and a Zen monastery, he decided to go to medical school.
Feldshuh, who directs a theatrical center at Cornell University in addition to practicing in the ER, spent seven years writing 34 versions of the play before it was finished.
In it, a white doctor strives to make a unique contribution to science and a black doctor wants to combat racial prejudice by demonstrating that venereal disease affects whites and blacks the same. The central character, Miss Evers, a public health nurse who is based on a real person, Eunice Rivers, is caught between her duties as a nurse subordinate to the doctors and her loyalty to the men who are being subjected to the study.
After its local premiere at the Illusion Theater in Minneapolis in 1990, the play won acclaim from the American Theater Critics Association and was the 1992 Pulitzer Prize runner-up for drama. It also was made into an
HBO movie.
A Message for Medical Students
A fit man in his 60s who speaks with a cadence usually reserved for the stage, Feldshuh told his story to the university audience with an adept mix of anecdote, moralizing, and self-deprecating humor. He said that he is proud of the fact that the University of Minnesota Medical School, with assistance from the Minnesota Medical Foundation, has hired Guthrie Theater actors to perform the play for first-year medical students as part of the Physician and Society course.
Feldshuh says doctors are in danger of ethical violations when they start to view patients as subjects or cases rather than as human beings, as it opens the door to self-deluding logic and the belief that the ends justify the means. “The art and humanities help people appreciate people and in doing that, they reinforce a central element of healing: the connection with someone else,” he explains.
Course director, Jim Pacala, M.D., an associate professor of family medicine at the University of Minnesota, says the play is a compelling way to introduce students to concepts of research ethics, such as truth-telling, informed consent, and the conflict care providers and investigators sometimes must deal with.
“One of the problems of a medical school education is that you are so immersed in the culture of medicine that you tend to forget the humanistic aspects of the endeavor you are engaged in, and it sets you up for losing perspective,” Pacala says.
He is concerned that without constant vigilance, subject abuse will occur again. Areas of potential danger include genetic research, radiation exposure during imaging experiments, and using patients in poor countries as subjects.
Pacala says that in order to manage the complexities of illness, physicians must see patients in terms of their tissues, diagnostics, and diseases but that plays such as Miss Evers’ Boys can help doctors keep alive that much-needed voice that says, “This is a person with pneumonia who could be my sister, brother, or mother.”—Scott D. Smith