As loved ones grow older, sometimes the hardest conversations to have are about the future and what happens next. Whether the topic is about aging-in-place and discussing necessary modifications to one’s home in order to remain living comfortably, safely, and independently, or eventual part- or full-time care options—it is never an easy talk to have.
An article by Christopher Cussat for Western Pennsylvania Hospital News showcases a recent theatrical performance at Allegheny General Hospital (AGH), in partnership with the Jewish Healthcare Foundation (JHF), Forbes Hospice, and the Area Agency on Aging, which used the platform of dramatic arts to encourage more open and frequent conversations about aging among family members in the community.
The play was entitled, “Dusk,” and it explored end-of-life decision making through the experiences of a typical American family. It was presented free of charge in the hospital’s Magovern Auditorium and was written by Spokane, Washington playwright Bryan Hartineaux.
According to Debra Caplan, Senior Vice President of AGH, there is a local movement building to raise awareness about the value of advanced planning around end-of-life issues. “AGH and the Northside Leadership Conference have joined this mission to help individuals understand the importance of ‘having the conversation’ with family and healthcare providers. The constant challenge is to enable individuals to feel comfortable talking about their wishes and plans.” She adds that the “Dusk” performance addressed this issue in a non-threatening, even humorous setting. “The unique, dramatic reading enabled the audience members to learn about end-of-life issues in a safe venue that let them absorb the information and begin to determine their personal next steps.”
“Dusk” is part of a series of programs that the AGH Northside Partnership initiated with the Northside Community in 2009 regarding end-of-life planning. In collaboration with several local organizations, it presented “Vesta” in 2009—a play also written by Hartineaux which focused on end-of-life issues in the African American Community.
But this latest creative installment explored the difficulties involved in coming to terms with making life-sustaining treatment option decisions on both a medical and personal level. Specifically, “Dusk” is the story of an aging father, a fractured family, and their struggles with healthcare decision-making. The play’s main character, Gil Everette, has recently had a heart attack and is now in congestive heart failure. On the eve of his 65th birthday, Gil and his adult children, along with a medical social worker on hand, explore his wishes regarding life sustaining treatment options. This occurs while he is challenged by his children to fill out and sign a physician’s orders form. According to Keri Harmicar, AGH Northside Partnership Coordinator, “Dusk” is a thoughtful exploration of this familiar family tableau, and the story is told with a keen awareness of related medical and legal problems—yet it is rich in character and humor.
Following the reading, there was a panel discussion by: Randy Hebert MD, Medical Director, Forbes Hospice and Division Director, Palliative Care, Department of Medicine, West Penn Allegheny Health System (WPAHS); Justin Engelka, Hospice and Palliative Care Manager, AGH; Mildred Morrison, Director of the Area Agency on Aging; and Nancy Zionts, Chief Program Officer, JHF. This allowed the audience to ask questions about the play and specifically about the ethical, medical, and other related issues surrounding end-of-life. Caplan explains, “The panel of experts that followed enhanced the experience—they provided direct answers to questions from the audience, dispelled myths, and listed local tools and resources for end-of-life decision making.” She adds that as a result, attendees left with a heightened awareness of the issues and concrete information to share with their families.
“Part of our overall mission is to explore the myriad of issues surrounding death and dying,” says Caplan (who also oversees the AGH Northside Community Partnership). “Producing this play was a great way to start a conversation focusing on end-of-life decision-making with one’s family and physician. We encouraged people to attend with a significant other—a spouse, grandparent, son, daughter, or other person who has played a prominent role in their lives,” she adds.
Harmicar notes that dramatic theatrical presentations can also stimulate conversations on end-of-life issues. “‘Dusk’ increases our understanding, particularly about and related to things associated with physicians’ orders, complex decision-making forms, advanced directives, and the like.” Caplan agrees, “The performance arts can be utilized as an important vehicle to further our understanding of this complex topic and bring the conversation to the community.”
“Dusk” originally premiered in Spokane in 2007 where theatre critic, Jim Kershner, said, “This play delivers exactly what it promises. It puts you inside what feels like a real, honest, family crisis, and it makes you grapple with an issue that will be even more common as the baby boomer generation comes of age.”
The performance of “Dusk” was one of many local outreach efforts connected through Closure, an initiative of the JHF that utilizes a series of community conversations, online learning (www.closure.org), and a free speakers’ bureau comprised of healthcare-related professionals who volunteer their time.