What Does Grace Mean to You?

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What Does Grace Mean to You?
PAULINE W. CHEN, M.D.
New York Times Health Feed
Last Modified: Saturday, October 18, 2008 at 4:16 a.m.

I recently saw actress and playwright Anna Deavere Smith’s show “Let Me Down Easy” at the American Repertory Theatre in Cambridge, Mass. A portion of her new work is devoted to health care and to the stories of patients and doctors.

An Obie Award winner, MacArthur Fellow and Pulitzer Prize nominee, Ms. Smith has a singular theatrical style. Alone on stage, she transforms into characters based on hundreds of people she has interviewed, including many she met on visits to hospitals across the country and on different continents.

Ms. Smith plays a young doctor who stayed behind at Charity Hospital in New Orleans during Katrina, in awe of the dignity of her African-American patients but angry that their predictions of being rescued last would indeed come true.

Later she’s a patient who at first seems cantankerous in refusing dialysis, only to reveal she remains haunted by memories of the undignified way in which her daughter, suffering from AIDS, was discharged from the hospital, wrapped in her own blood-soaked sheets.

Then she transforms into a physician who laments a U.S. health care system that cannot offer even basic preventive care, and who as a medical school dean somehow feels responsible.

I recently asked Ms. Smith about listening, about what all of us, as patients and doctors, might learn from her experiences interviewing and listening over the last 30 years.

“When you first start to decide to listen in a way that is more than just listening in a conversation, it’s probably a good idea not to expect yourself to listen for very long,” Ms. Smith said to me. “Practice keeping your own inner monologue out of the way of what is being said to you, so that you can hear not just what somebody is saying to you, but also what they’re trying to say.”

Ms. Smith continued: “I would say that listening actually takes practice because you have to get out of the way of what it is that you’re hearing.”

Sitting in the audience that night, I had thought I was listening. But I wasn’t getting out of the way of what I was hearing. I couldn’t help but hear my own internal voice, sifting the stories Ms. Smith told: Do I agree with what that character is saying? Do I know this character? What’s up with that character’s hands?

But then Ms. Smith became Ingrid Inema, a Stanford pre-med student from Rwanda. The character, a young woman, looked lost on stage, sitting next to a great pile of books, her face partly obscured by a baseball cap. But her voice was clear. She talked about living through the genocide in her country, about not being able to forgive because the perpetrators have never come to ask for forgiveness. And about how she decided to let go.

“I release you,” I can still hear Ingrid saying, her voice resonating out from the darkness of the stage. “I am not holding you in my heart anymore.”

I thought about these words as I exited the theatre that night. In the lobby were two bulletin boards covered with scribbled notes, and across the top of each was a sign that read, “What Does Grace Mean to You?”

These were the audience members’ spontaneous responses to the show. A few were single sentences, others several paragraphs. All were filled with the kind of stories that make your heart swell, many of them about how friends, family members, politicians, teachers and even doctors dealt with illness or human frailty.

That night in the theatre, I realized, grace had emerged for me in the words of Ingrid Inema. She was able to release a part of her self, a horrible atrocious part of her past, and thus free herself to live in the present.

Until I heard her words, I had not acknowledged the inner voice that carried on in my own head in the theater that night, despite my belief that I was really listening to the narratives that unfurled on stage. I did not acknowledge that listening to others, particularly to patients, requires letting go of a part of yourself, as Ms. Inema did, and as Ms. Smith does.

I never did post my own note on the theater bulletin board that evening, but I have started a board of my own, a list in my mind of examples of, and opportunities for, grace in my own life.

* The surgeon who stayed in the room as his patient died, standing silently and comforting the grieving wife.

* The young woman with metastatic melanoma who, as the doctor apologized for a particularly painful procedure, smiled and then said, “I can take anything for my two children. I’m willing to do anything for even a little bit of time.”

* The attending physician who told his intern who was trying desperately to hide her tears over a recent patient death, “It’s okay to cry. When you stop caring is when you should get out of this business.”

What does grace mean to you?

Post your comments on the Well blog, “Doctors and Patients, On Stage.” And listen to my conversation with Anna Deavere Smith by clicking on the podcast link above.

http://www.tuscaloosanews.com/article/20081017/znyt04/810173022&tc=yahoo