Wit by Margaret Edson

This is a truncated medical version of the script. Note: The full script is 66 pages. This document is 14 pages.

Key
Yellow highlight: indicates medical procedures and/or word pronunciations Units: Provide beat breakdown and/or context of word choices, procedures, and/or characters actions

Setting (pg. 5)
Most of the action, but not all, takes place in a room of the University Hospital Comprehensive Cancer Center. The stage is empty, and furniture is rolled on and off by the technicians. Jason and Kelekian wear lab coats, but each has a different shirt and tie every time he enters. Susie wears white jeans, white sneakers, and a different blouse each entrance. There is no break in the action between scenes, but there might be a change in lighting. There is no intermission. Vivian has a central-venous-access catheter over her left breast, so the IV tubing goes there, not into her arm. The IV pole, with a Port-a-Pump attached, rolls easily on wheels. Every time the IV pole reappears, it has different configuration of bottles.

Unit 1: Vivians entrance (pg. 7)

Vivian Bearing walks on the empty stage pushing her IV pole. She is fifty, tall and very thin, barefoot, and completely bald. She wears two hospital gowns one tied in the front and one tied in the back a baseball cap, and a hospital ID bracelet. The house lights are at half strength. .. She disconnects herself from the IV pole and shoves it to a crossing technician.

Unit 2 You have cancer (pgs. 8 - 10)

Kelekian: Please sit down. Miss Bearing, you have advanced metastatic ovarian cancer. You present with a growth that, unfortunately, went undetected in stages one, two, and three. Now it is an insidious adenocarcinoma (definition), Adenocarcinoma (pronunciation) which has spread from the primary adnexal mass (definition) Adnexal: Pronunciation ----------------------------------------------------------------------------------------------------------- Epithelial Carcinoma In invasive epithelial carcinoma, (phrase found in the first paragraph/ second sentence of the article) epithelial carcinoma (pronunciation) the most effective treatment modality is a chemotherapeutic agent. We are developing an experimental combination of drugs designed for primary-site ovarian, with a target specificity of stage three --You will be hospitalized as an inpatient for treatment each cycle. You will be on complete intake-and-output measurement for three days after each treatment to monitor kidney function. All the initial eight cycles, you will have another battery of test. The antineoplastic will inevitably affect some healthy cells, including those lining of gastro-intestinal tract (definition) from the lips to the anus, and the hair follicles. We will of course be relying on your resolve to withstand some of the more pernicious side effects. Kelekian: The first week of each cycle youll be hospitalized for chemotherapy; the next week you may feel a little tired; the next two weeksll be fine, relatively. This will repeat eight times, as I said before This treatment is the strongest thing we have to offer you. And, as research, it will make a significant contribution to your knowledge Here is the informed-consent form (prop; pg. 12) Vivian: Eight cycles of chemotherapy. Give me the full dose, the full dose every time. (pg. 15)

Unit 3 Chest x-ray Pgs. 15-19

Susie Monahan, Vivians primary nurse, gives Vivian her chart, then puts her in a wheelchair and takes her to her first appointment: chest X-ray. This and all other diagnostic tests are suggested by light and sound.) pg. 15 - 19

Technician 1: Name Vivian: My name? Vivian Bearing. Technician 1: Huh? Vivian: Bearing. B-E-A-R-I-N-G Vivian V-I-V-I-A-M Technician 1: Doctor Vivian: Yes, I have a Ph.D. Technician 1: Your doctor Vivian: Oh, Dr. Harvey Kelekian (Technician 1 positions her so that she is leaning forward and embracing the metal plate, then steps offstage.) I am a doctor of philosophy Technician 1: (From offstage) Take a deep breath, and hold it. (Pause, with light and sound.) Okay. Turn sideways, arms behind your head, and hold it. (Pause) Okay. Technician 1 returns and puts her in the wheelchair.) I am, in short, a force. (Technician 1 rolls her to upper GI series, where Technician 2 picks up.) Technician 2: Name Vivian: Lucy, Countess of Bedford. Technician 2: (Checking a printout) Technician 2: I dont see it here. Vivian: My name is Vivian Bearing. B-E-A-R-I-N-G. Dr. Kelekian is my doctor. Technician 2: Okay. Lie down. (Technician 2 positions her on a stretcher and leaves. Light and sound suggest filming.) During the procedure, another technician takes the wheelchair away. -Technician 2 deposits her off at CT scan. Technician 3 has Vivian lie down on a metal stretcher. Light and sound suggest the procedure. After the procedure, Technician 3 puts Vivian back in the wheelchair and wheels her toward the unit. Partway, Technician 3 gives the chair a shove and Susie takes over. Susie rolls Vivian to the exam room.

Unit 4 Examination pg. 25

Hmmmm. Well, thats very interesting. (Nervous pause) Well, I guess Ill start the examination. Itll only take a few minutes. Why dont you, um, sort of lie back, and oh relax. (He helps her lie back on the table, raises the stirrups out of the table, raises her legs and puts them in the stirrups, and puts a paper sheet over her.)

Unit 5 Pelvic Exam pgs. 26-28

Jason (He begins the pelvic exam, with one hand on her abdomen and the other inside her, looking blankly at the ceiling as he feels around) Okay. (Silence.) Susie, isnt that interesting, that I had Professor Bearing Jesus! (Tense silence. He is amazed and fascinated.) Um. (He tries for composure) Okay. Were about done. Okay, Thats it. Vivian: Yes, it is mildly uncomfortable to have an electrocardiogram (definition), electrocardiogram: pronunciation but the agony of a proctosigmoidoscopy (definition: note- alternative name is Sigmoidoscopy) sweeps it from memory. Yes, having a former student give me a pelvic exam was thoroughly degrading and I use the term deliberately but I could not have imagined the depths of humiliation that Oh, God (Vivian runs across the stage to her hospital room, dives onto the bed, and throws up into a large plastic washbasin.) Pronunciation: Proctosigmoidoscopy (YouTube) Proctosigmoidoscopy (How to say) Proctosigmoidoscopy (Merriam-Webster)

Unit 6 Emesis (pgs. 29-30)

Vivian: Now, watch this. I have to ring the bell. (She presses the button on the bed.) to get someone to come and measure this emesis, and record the amount on a chart of my intake and output. This counts as output. (Susie enters) Susie: (Brightly) How are you doing, Ms. Bearing? You having some nausea? Vivian: Uhh, yes. Susie: Why dont I take that? Here. Vivian: Its about 300 ccs. (cubic meters) Susie: That all? Vivian: It was very hard work. (Susie takes the basin to the bathroom and rinses it.) Susie: Yep. Three hundred. Good guess. (She marks the graph.) Okay. Anything else I can get for you? Some Jell-O or anything? Susie disconnects the IV bottle with the orange label and takes it with her as she leaves. Vivian lies still. Silence. Scene change.)

Unit 7 Late detection (pgs. 31 35)

Examination medical sheets (exam table) Examination paper (covering up the patient)

Kelekian enters, followed by Jason and four other Fellows.) Kelekian: Dr. Bearing Vivian: Dr. Kelekian Kelekian: Jason (Jason moves to the front of the group.) Jason: Professor Bearing. How are you feeling today? Vivian: Fine. Jason: Thats great. Thats just great. (He takes a sheet and carefully covers her legs and groin, then pulls up her gown to reveal her entire abdomen. He is barely audible, but his gestures are clear.) Jason: Very late detection. Staged as a four upon admission. Hexamethophosphacil with phosphacil with Vinplatin to potentiate. Hex at 300 mg. per meter squared, Vin at 100. Today is cycle two, day three. Both cycles at the full dose. The primary site is --- here, (he puts is finger on the spot of her abdomen.) behind the left ovary. Metastases are suspected in the peritoneal cavity here. And here. (He touches those spots.) Full lymphatic involvement. (He moves his hands over her entire body) At the time of the first-look surgery, a significant part of the tumor was de-bulked, mostly in this area here. (He points to each organ, poking her abdomen.) Left, right ovaries. Fallopian tubes. Uterus. All out. Evidence of primary-site shrinkage. Shrinking in metastatic tumors has not been documented. Primary mass frankly palpable in pelvic exam, frankly, all through here. Kelekian: Okay. Problem areas with Hex and Vin. (He addresses all the Fellows, but Jason answers first and they resent him.) Fellow one: Myelosu

Jason: (Interrupting.) Well, first of course is myelosuppression, a lowering of blood cell counts. It goes without saying. With this combination of agents, nephrotoxicity will be next. The kidneys are designed to filter out impurities in the bloodstream. In trying to filter the chemotherapeutic agent out of the bloodstream, the kidneys shut down. Kelekian: Intervention Jason: Hydration Kelekian: Monitoring Jason: Full recording of fluid intake and output, as you see here on these graphs, to monitor hydration and kidney function. Totals monitored daily by the clinical fellow, as per the protocol. They leave her with her stomach uncovered.

Unit 8: Medical terms look them up (pg. 35)

Vivian: I receive chemotherapy, throw up, am subjected to countless indignities, feel better, go home. Eight cycles. Eight neat little strophes. Oh, there have been the usual variations, subplots, red herrings: hepatotoxicity (liver poison), neuropathy (nerve death). They are medical terms. I look them up.

Unit 9 Imagine (pg. 37)

The illustration bore out the meaning of the word, just as he had explained it. At the time, it seemed like magic. So imagine the effect that the words of John Donne first had on me; ratiocination, concatenation, coruscation, tergiversation.

Unit 10: Fever and neutropenia (pg. 37)

Vivian: Fever and neutropenia. They said to come in. Susie: You did the right thing to come. Did somebody drive you?

Vivian: Cab. I took a taxi. Susie: (She grabs a wheelchair and helps Vivian sit. As Susie speaks, she takes Vivians temperature, pulse, and respiration rate.) Here, why dont you sit? Just sit there a minute. Ill get Jason. Hes on call tonight. Well get him to give you some meds. Im glad I was here on nights. Susie: Temp 39.4. Pulse 120. Respiration 36. Chills and sweating. Jason: Fever and neutropenia. Its a shake and bake. Blood cultures and urine, stat. Admit her. Prepare for reverse isolation. Start with acetaminophen. Vitals every four hours. Susie connects Vivians IV, then wets a washcloth and rubs her face and neck. Vivian remains delirious. Susie checks the IV and leaves with the wheelchair.) (After a while, Kelekian appears in the doorway holding a surgical mask near his face. Jason is with him, now dressed and clean-shaven.) Kelekian: Good morning, Dr. Bearing. Fifth cycle. Full dose. Definite progress. Everything okay? Vivian: Yes. Kelekian: Youre doing swell. Isolation is no problem. Couple of days. Think of it as a vacation. Vivian: Oh. (Jason starts to enter; holding a mask near his face, just like Kelekian. Kelekian: Jason Jason: Oh, Jesus. Okay, okay. (He returns to the doorway, where he puts on a paper gown, mask, and gloves. Kelekian leaves.) Vivian: In isolation, I am isolated. For once I can use a term literally. The chemotherapeutic agents eradicating my cancer have also eradicated my immune system. In my present condition, every living thing is a health hazard to me (Jason comes in to check the intake-and-output.) Jason: (Complaining to himself). I really have not got time for this Vivian: Particularly health care professionals. Jason: (Going right to the graph on the wall)

Just to look at the I&O sheets for one minute, and it take me half an hour to do precautions. Four, seven, eleven. Two-fifty twice. Okay. (Remembering) Oh, Jeez. Clinical. Professor Bearing. How are you feeling today? Vivian: (very sick) Fine. Just shaking sometimes from the chills Jason: IV will kick in anytime now. No problem. Listen, gotto go. Keep pushing fluids. (As he exits, he takes off the gown, mask, and gloves)

Unit 11 I Survived Pg. 43

I have survived eight treatments of Hexamethophosphacil and Vinplatin at the full dose, ladies and gentlemen. I have broken the record. The article will not be about me, it will be about my ovaries. It will be about my peritoneal cavity, which, despite the best intentions, is now crawling with cancer.

Unit 12 No kidney involvement yet. Pg. 44

Jason: Professor Bearing. Just want to check the I&O. Four-fifty, six, five. Okay. How are you feeling today? (He makes notations on his clipboard throughout the scene) Vivian: How are my fluids? Jason: Pretty good. No kidney involvement yet. Thats pretty amazing, with Hex and Vin. Vivian: How will you know when the kidneys are involved? Jason: Lots of in, not much out. Vivian: That simple. Jason: Oh, no way. Compromised kidney function is a highly complex reaction. Im simplifying for you. Vivian: Thank You. Jason: Were supposed to. Vivian: Bedside manner.

Jason: Yeah, theres a whole course on it in med school. Its required. Colossal waste of time for researchers. (He turns to go.)

Unit 13 Cancer is Awesome Pg. 46

Yeah. Yeah, thats right. It is. Its awesome. How does it do it? The intercellular regulatory mechanism especially for proliferation and differentiation the malignant neoplasia just dont get it. You grow normal cells in tissue culture in the lab, and they replicate just enough to make a nice, confluent monolayer. They divide twenty times, or fifty times, but eventually they conk out. You grow cancer cells, and they never stop. No contact inhibition whatsoever. They just pile up, just keep replicating forever. (Pause.) Thats got a funny name. Know what it is? Vivian: No what? Jason: Immortality in culture. Vivian: Sounds like a symposium. Jason: Its an error in judgment, in a molecular way. But why? Even on protistic level the normal cell-cell interactions are so subtle theyll take your breath away. Golden-brown algae, for instance, the lowest multicellular life form on earth theyre idiots and its incredible. Its perfect. So whats up with the cancer cells? Smartest guys in the world, with the best labs, funding they dont know what to make of it. Vivian: What about you? Jason: Me? Oh, Ive got a couple of ideas, things Im kicking around. Wait till I get a lab of my own. If I can survive this fellowship. Vivian: The part with the human beings. Jason: Everybodys got to go through it. All the great researchers. They want us to be able to converse intelligently with the clinicians. As though researchers were the impediments. The clinicians are such troglodytes. So smarmy. Like we have to hold hands to discuss creatinine clearance. Just cut the crap, I say. Vivian: Are you going to be sorry when Do you ever miss people? Jason: Everybody asks that. Especially girls. Vivian: What do you tell them?

Jason: I tell them yes. Vivian: Are they persuaded? Jason: Some. Vivian: Some. I see. (With great difficulty.) And what do you say when a patient is . Apprehensive frightened.

Unit 14 Popsicle pgs. 52 53

Vivian: The epithelial cells in my GI tract have been killed by the chemo. The cold Popsicle feels good, its something I can digest, and it helps keep me hydrated. For your information. (Susie returns with an orange two-stick Popsicle. Vivian unwraps it and breaks it in half.) Here. Susie: Sure? Vivian: Yes Susie: Thanks. (Susie sits on the commode by the bed. Silence.) When I was a kid, we used to get these from a truck. The man would come around and ring his bell and wed all run over. Then wed sit on the curb and eat our Popsicles. Pretty profound, huh? Vivian: It sounds nice. (Silence)

Unit 15 Just let it stop Pgs. 54 - 55

Susie: What you have to think about is your code status. What you want them to do if your heart stops You can be full code, which means that if your heart stops, theyll call a Code Blue and the code team will come and resuscitate you and take you to Intensive Care until you stabilize again. Or you can be Do Not Resuscitate, so if your heart stops well well, well just let it. Youll be DNR. You can think about it, but I wanted to present both choices before Kelekian and Jason talk to you. Vivian: You dont agree about this? Susie: Well, they like to save lives. So anythings okay, as long as life continues. It doesnt matter if youre hooked up to a million machines. Kelekian is a great

researcher and everything. And the fellows, like Jason, theyre really smart. Its really an honor for them to work with him. But they always want to know more things. Vivian: I always want to know more things. Im a scholar. Or I was when I had shoes, when I had eyebrows. Susie: Well, okay then. Youll be full code. Thats fine. (Silence) Vivian: No, dont complicate the matter. Susie: Its okay. Its up to you Vivian: Let it stop. Susie: Really? Vivian: Yes. Susie: So if your heart stops beating Vivian: Just let it stop. Susie: Sure? Vivian: Yes.

Unit 16 It hurts Pgs. 56-61

Vivian: Oh, God, it is so painful. So painful. So much pain. So much pain. Susie: I know, I know, its okay. Sshh. Just try and clear your mind. Its all right. Well get you a Patient-Controlled Analgesic. Its a little pump, and you push a little button, and you decide how much medication you want. (Kelekian storms in; Jason follows with chart.) Kelekian: Dr. Bearing: Susie Susie: Time for Patient-Controlled Analgesic. The pain is killing her. Kelekian: Dr. Bearing, are you in pain? (Kelekian holds out his hand for chart; Jason hands it to him. They read.)

Vivian: (Sitting up, unnoticed by the staff.) Am I in pain? I dont believe this. Yes, Im in goddamn pain. I have a fever of 101 spiking to 104. And I have bone metastases in my pelvis and both femurs. (Screaming.) There is cancer eating away at my goddamn bones, and I did not know there could be such pain on earth. (She flops back on the bed and cries audibly to them.) Oh, god. Kelekian: (Looking at Vivian intently.) I want a morphine drip. Susie: What about a Patient-Controlled? She could be more alert Kelekian: (Teaching.) Ordinarily, yes. But in her case, no. Susie: But Kelekian (To Susie) Shes earned a rest. (To Jason) Morphine, ten push now, then start at ten an hour. (To Vivian) Dr. Bearing, try to relax. Were going to help you through this, dont worry. Dr. Bearing? Excellent. Vivian (Weakly, painfully leaning on her IV pole, she moves to address the audience.) (Scene change. She gets back into bed as Susie inject morphine into the IV tubing. Vivian lies down and, in a final melodramatic gesture, shuts the lids of her own eyes and folds her arms over her chest.) They (Susie and Vivian) laugh a little together. Slowly the morphine kicks in, and Vivians laughs become long sighs. Finally, she falls asleep. Susie checks everything out, then leaves. Long silence. Scene change. Jason and Susie chat as they enter to insert a catheter.) Unit 17 Vivian is out Jason: (He checks the I & O sheet.) Two hundred. Seventy-five. Five-twenty. Lets up the hydration. She wont be drinking anymore. See if we can keep her kidneys from fading. Susie: What do you want? Dextrose? Jason: Give her saline. Susie: Now, Ms. Bearing, Jason and I are here, and were going to insert a catheter to collect your urine. Its not going to hurt, dont you worry. (During the conversation, she inserts the catheter.) Jason: What do they teach you in nursing school? (Checking Vivians pulse.) Shes out of it. Shouldnt be too long. You done here?

Unit 17 Call a Code pgs. 63-65

Jason strides in and goes directly to the I & O sheet without looking at Vivian. Jason: Professor Bearing. How are you feeling today? Three P.M. IV hydration totals. Two thousand in. Thirty out. Uh-oh. Thats it. Kidneys gone. (He looks at Vivian.) Professor Bearing? Highly unresponsive. Wait a second (Puts his head down to her mouth and chest to listen for heartbeat and breathing.) Wait a sec Jesus Christ! (Yelling.) CALL A COLDE! (Jason throws done the chart, dives over the bed, and lies on top of her body as he reaches for the phone and punches in the numbers. To himself.) Code: 4-5-7-5 (To operator) Code Blue, room 707. Code Blue, room 707. Dr. Posner P-O-S-N-E-R. Hurry up! (He throws down the phone and lowers the head of the bed.) Come on, come on, COME ON. (He begins CPR, kneeling over Vivian, alternately pounding frantically and giving mouth-to-mouth resuscitation. Over the loudspeaker in the hall, a droning voice repeats Code Blue, room 707. Code Blue, room 707.) One! Two! Three! Four! Five! (He breathes in her mouth. Susie, hearing the announcement, runs into the room.) Susie: What are you doing? Jason: A goddamn code. Get over here! Susie: Shes DNR! (She grabs him.) Jason: He pushes Susie away. Jason: Shes Research! Susie: Shes no code! (She grabs Jason and hurls him off the bed.) Jason: Ooowww! Goddamnit, Susie! Susie: Shes no code! Jason: Aaargh! Susie: Kelekian put the order in you saw it! You were right there , Jason! Oh, God the code! (She runs to the phone. Jason struggles to stand. Into the phone.) 4-5-7-5. (The code team swoops in. Everything changes. Frenzy takes over. The code team knock Susie out of the way with their equipment. Susie, into the phone.) Cancel code, room 707. Sue Monahan, primary nurse. Cancel code. Dr. Posner is here.

Jason: Oh, God Code Team: -Get out of the way! - Unit staff out! - Get the board! _ Over here! (They throw Vivians body up at the waist and stick a board underneath for CPR. In a whirlwind of sterile packaging and barked commands, one team member attaches a respirator, one begins CPR, and one prepares the defibrillator. Susie and Jason try to stop them but are pushed away. The loudspeaker in the hall announces Cancel code, room 707. Cancel code, rom 707. -Bicarb amp! - I got it! (To Susie.) Get out! - One, two, three, four, five! - Get ready to shock! (To Jason.) Move it! Susie: (Running to each person, yelling.) STOP! Patient is DNR! Jason: (At the same time, to the code team._ No, no! Stop doing this. STOP! Code team: - Keep it going! - - What do you get? - -Bicarb amp! - No pulse! Susie: Shes NO CODE! Order was given (She dives for the chart and holds it up as she cries out.) Look! Look at this! DO NOT RESUSCITATE. Code team: (As they administer electric shock, Vivians body arches and bounces back down.) - Almost ready! - - Hit her! - CLEAR! - Pulse? Pulse? Jason: (Howling) I MADE A MISTAKE! (Pause. The code team looks at him. He collapses on the floor. Susie: No code! Patient is no code.