Alison Whittaker's play about nursing Vital Signs

I just published a review of Alison Whittaker’s new play Vital Signs in Beyond Chron. You can check it out. Here is a longer version.

Nurse Alison Whittaker’s Vital Signs:

A Reality Check on Life and Work At the Bedside

By Suzanne Gordon

As the lights dim in a small theater in the Mission district of San Francisco, a trim 57-year-old RN takes center stage and begins her woman-one show, Vital Signs: The Pulse of an American Nurse. She paces the room and delivers the following lapel-grabbing soliloquy:

“If I asked you to smile and stick your tongue out, you would.  If I asked you to follow my finger, you would. If I told you to take off your pants and show me your genitalia, you wouldn’t argue with me. You’d take off your pants and show me your genitalia.  Believe it or not, if I told you to bend over and spread your buttocks and show me your anus, you’d willingly bend over, spread your buttocks and show me your anus.

“I could stick a suppository in you or give you an enema. If neither a suppository nor an enema worked for you, I’d glove up, lube up my finger, gently slide it up your anus and dis-impact you.  I’d do what it takes.  I’d get it out.  I could put a tube up your penis, all the way to your bladder; you’d thank me.  I do these things these extremely intimate things to strangers, People I’ve just met, people like you.  It’s my job.  I’m a nurse.”

Talk about up close and personal! For the next 75 minutes, Whittaker takes us to work with her on the neurology unit of a major California teaching hospital.  The resulting visit to the frontlines of health care is often hilarious, sometimes sorrowful, but always riveting. And, most important of all, it’s an incisive reality check on what goes on behind the scenes, every day, as skilled and dedicated care-givers struggle to work together on behalf of their patients under conditions not always conducive to quality patient care. On the night I attended Vital Signs, many in the audience were RNs or aides, whose nodding heads and belly laughs bore all the signs of instant identification with the material. When the lights came up, they gave Whitaker a well-deserved standing ovation.

Originally, scheduled only on Saturday and Sunday nights at The Marsh, Vital Signs has now been extended until July 21, with an additional performance added on Friday evenings, due to the packed houses it has drawn so far. (For tickets, go to www.themarsh.org/alison_whittaker.html)

No Coincidence

Sure, there’s a disclaimer in the program book that says Whittaker’s play is “broadly fictionalized” and “any resemblance to real people and institutions, living or dead, is entirely coincidental.” I guess you could say Willy Loman’s resemblance to real-life salesmen was “coincidental” too? But, in this case, Whitaker–a playwright with twenty years of hospital experience–makes her intentions clear in the liner notes: “Although I think the public has a general understanding of the role of the nurse, I don’t feel our story has been fully and accurately portrayed.”

Through her skilled portrayal of multiple characters—both patients and hospital staff members–Whittaker not only helps audiences understand what RNs really do, in their daily 12-hour routine

of high-stress multi-tasking. She also spotlights, in lovingly comic fashion, RN inter-action with myriad other players on the scene—patients, their families, unit clerks, housekeepers, aides, nurse managers, doctors, and even the occasional out-of-touch “Nurse Week” visitor from academia.

With so much ink and airtime elsewhere, physicians get just a walk-on role in Vital Signs. As Whitaker explained to me after the show:  “I feel like there is so much about doctors but there’s nothing about nurses and nurses’ aides.  I work on the night shift. It’s kind of the joke on the night shift, where are the doctors?  Patients are constantly saying, ‘ I need to talk to the doctor, and we’re thinking, ‘Well, good luck!’  I am certainly not anti-doctor and I work with some great doctors.

Catering by KFC

Whittaker’s play is a much-needed antidote to the sugar-and-spice/ everything’s-nice version of nursing that is so often promoted by hospitals, and even some nursing organizations. The play includes a great little spoof of that RN-“appreciation” ritual known as “Nurses Week.” During this annual exercise in feel-good gestures that don’t last long, many cost-cutting employers shower their overworked nursing staff with trinkets and triviality, while denying them the unit-based resources they need to deliver quality patient care.  “They give us buckets of Kentucky Fried Chicken or sandwiches from Subway when really we deserve Chez Panisse,” Whittaker says.

One of the most memorable scenes in Vital Signs occurs when “Katherine,” a well-meaning nursing professor is invited to address a group of frustrated and exhausted nurses about “self-care.”  Katherine wonders whether the assembled nursing staff is taking enough time off, after work, for shared fun together?  Doing things like “having a frappachino at Starbucks or getting a seaweed facial at the Nordstrom spa or perhaps going out shopping at the San Francisco Galleria. Do you all do that?”

“Everyone,” Whittaker tells the audience,” is looking down at the floor.

“Certainly, you must do some fun things together?” the professor persists.

“Are you all happy with your work environment?, she asks.” Again there is silence.

Finally one truth-telling RN speaks up:

“Patients are much sicker. Last night, I had a patient who had just had brain surgery, developed a cerebral spinal leak and had a drain that had to be monitored every hour. Then in the early morning he climbed out of bed and had a seizure. At the same time, I had a patient who was in a MVA, had 8 spine surgeries, is in chronic pain and requires such high doses of narcotics. I was afraid he’d stop breathing. In the middle of the night I got an admit from the ICU. Thank god the patient was recovering from a stroke but we had to change her diaper every 2 hours and she was over 300 pounds. And now we are being told that we have to sign a paper in the patient’s room every hour to show we were in there. The hospital should trust our judgment.  I don’t know how the nurses will be able to hold up under the pressure.”

“Katherine looks quite surprised.” Whitaker reports. “All the nurses are now looking at her curiously.”

“’Are many of you having such a hard time?’ she asks.
Everyone in the room nods.

The visiting professor then turns to the nurse manager, Arlene, and asks whether she is aware that “nurses are under such stress?”

Says the manager with a shrug: “No one ever said that nursing would be an easy job.”

Showing Why Ratios Matter

In this and so many other ways, Vital Signs is a great model for how working RNs should give voice to their professional concerns, particularly as they relate to the gap between hospital administration rhetoric about “teamwork” and actual workplace conditions adversely affecting patient safety, like under-staffing. Even in California, with it’s still unique and much-needed state-mandated nurse-patient staffing ratios, patient loads can be overwhelming because of the complexity and acuity of the ills and injuries of those receiving in-patient care. That’s why the California Hospital Association’s recent attempt to weaken staffing ratios, aided and abetted by SEIU/United Healthcare Workers leader Dave Regan, has triggered such an uproar from Whittaker’s own union, the California Nurses Association (CNA) and even SEIU-represented nurses in the state.

A native of Toronto, Whitaker was not originally trained as an actor or writer. Her play is the product of more than a decade spent developing and honing new skills. (And, if you think writing a play is easy—even after a lifetime as a professional writer—let me assure you, based on my own experience, co-authoring a play called Beside Manners, it is not!)  Whitaker took acting and writing classes at the Marsh, where she received help and encouragement from David Ford, who teaches solo performance at the theater.

In Vital Signs, she had to be careful not to violate patient confidentiality or the trust of her co-workers. “ I disguised every patient,” she explains.  “I changed details, changed the diagnoses. I made many of them composites and many have come from different settings in which I work.  I also checked with all of the people with whom I work to make sure they were okay with the play.  They were.”

Last year she launched Vital Signs at the San Francisco Women’s Festival and at the Marsh. She has promoted it by passing out postcards at city hospitals, by word of mouth and through various nursing and healthcare networks. Her own union, the CNA, which recently commissioned  a great nursing-related theatre piece in Chicago, performed by Anna Deavere Smith (who was recently demoted from nurse manager to working RN again on Showtime’s Nurse Jackie), must be thrilled about the fact that a rank-and-file member has put on another one-woman show, with the dramatic flair and story telling ability of a home-grown-Anna. It’s time to broadcast that good news far and wide!

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Steve Earlce