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IRA FLATOW, host:

Seems like all the key players are weighing in on the health care debate. You have your politicians, your insurance companies, your hospitals, your pharmaceutical companies. And now we have the theater. And my guest today interviewed over 300 people, finding out how they view their health, their doctors, their health care system.

And she had to weed through all of these hundreds of people, and she chose 20 of those interviews and she turned them into a documentary-style theater production now on Broadway called Let Me Down Easy. And in it, she performs 20 interviews. I mean, she performs these interviews, and she embodies each persons speech pattern, their body movements. If you know who these people are and you recognize some of them, you really see how well she does it.

She has an injured bull rider to a doctor in New Orleans during Katrina. And its really a cross-section of our country on this controversial issue. And she brings the thoughts and the feelings of people from all different backgrounds onto the stage. And now shes in here in our studio. And she - some of her characters have things to say that youre surprised to hear that they would say these things.

And sitting next to me is Anna Deavere Smith. She is a playwright, an actress. You can see her as the hospital administrator in Showtimes Nurse Jackie, as well as a professor at New York University. Welcome, its a pleasure to have you.

Ms. ANNA DEAVERE SMITH (Actress; Playwright, Let Me Down Easy): Great to be here.

FLATOW: Why this project? What made you undertake this project?

Ms. SMITH: Well, I should just correct one fact, that actually the Second Stage is Off Broadway

FLATOW: Off Broadway.

Ms. SMITH: not on Broadway.

FLATOW: Well, I consider it

Ms. SMITH: But its all right near 48th and 8th area.

FLATOW: Legally. Right, right.

Ms. SMITH: Well, I was actually invited, as far back as the late 90s, to go to the Yale School of Medicine and to make a project in which I interviewed doctors and patients

FLATOW: Mm-hmm.

Ms. SMITH: in whats called Medical Grand Rounds.

FLATOW: Mm-hmm.

Ms. SMITH: And, for Medical Grand Rounds to present to perform at Medical Grand Rounds, which is really a lecture series for doctors. And it was a really extraordinary experience that I didnt actually do until 2000. But as long ago as 2000, I started thinking about these issues, just because talking to patients, in particular, was a very rich experience, since what Ive been doing since the early 80s is collecting talk

FLATOW: Right.

Ms. SMITH: just really interesting talk. And when something has happened to someone to compromise their health, they often have a lot to say, and its very interesting to hear.

FLATOW: And so this is really very topical right now

Ms. SMITH: Thats right.

FLATOW:the stuff that youre portraying on the stage.

Ms. rof. SMITH: Yeah.

FLATOW: And I when I watch these 20 people that you portray and I knew you interviewed 300, Im saying to myself, how do you weed out the other 280?

Ms. SMITH: Well, thats

FLATOW: Is that always the biggest problem?

Ms. SMITH: Its always the hugest problem with all of my work. Some of your listeners probably saw my play Twilight: Los Angeles, which was about the Los Angeles riots and again I had over 300 interviews that I had to somehow whittle down to an evening of theater.

FLATOW: 1-800-989-8255 is our number, if youd like to talk with Anna Deavere Smith, who - do you have a favorite?

Ms. SMITH: Oh, no.

FLATOW: No, theres no - just like asking which is your favorite kid.

Ms. SMITH: Yeah, you cant. My mother had five and she never she went never down that road.

(Soundbite of laughter)

Ms. SMITH: Thats not a very good idea.

(Soundbite of laughter)

FLATOW: But was there an overriding theme that you found?

Ms. SMITH: Well, yeah. I think that the overriding theme really is stated in the beginning of the play that its about every single person in that - in the play has something that they love about their life.

FLATOW: Right.

Ms. SMITH: And has a relationship to possibly losing that very thing. So, I think that this play is about love and death, its about love and loss, its about the resilience of the human spirit, the vulnerability of the body, and the price of care.

FLATOW: Mm-hmm. Well, like to see if we can get right into one

Ms. SMITH: Okay.

FLATOW: If you want to choose one. How about Phil Pizzo?

Ms. SMITH: Okay, so Phil is the dean of the Stanford University School of Medicine. And you want me to do the whole thing?

FLATOW: If you can. We have about six minutes till the break.

Ms. SMITH: Okay, great, okay. So, this is called - and I give everything a title because I think people deserve to have their sections titled, and this is called Developing Nation. What I fear is happening is that we are slipping into a health care system that looks very much will look very much, unless it's changed dramatically - like that of a developing nation. Well, think about it. This simple fact: The survival projections on a worldwide basis are much higher than they've been in the past. But those can be radically changed by a couple of significant factors. One of them, which is preventable, is the epidemic of obesity.

You know, obesity in its own right will engender the evolution and development of so many other morbid diseases that it can erode much of the progress thats been made in survival and longevity up until now. And secondly, we have the emergence of new infectious diseases that challenge us year in and year out. And those two will make a tremendous a tremendous difference. The whole focus right now on health care reform is largely an economic one. But underlying that is a huge set of views and expectations. The whole difficult challenge, if you will, of rationing or regulating health care is going to have to be a part of the public debate.

We spend a significant portion of our heath care dollars on the last six or eight months of life, right? That would be all right if it led to success. But the fact that it simply results ultimately in death, and sometimes with as many complications as benefits, is a really important part of this dialogue. You know, when I hear the debate go on from members of our Congress, theyll say, well, I dont want you to tell me what my grandmother should get or what my mother should get. But the reality ultimately is that each of us have to make some decisions about that.

We do it in a way on an individual level, and then we slip into a kind of a slippery slope with one parent or a child or a loved one saying do this, when, in fact, doing it isnt going to result in any true long-term benefit. What are our expectations of what constitutes reasonable care, at really both ends of the aid spectrum, is going to have to be a part of this public debate because it tracks right back to the economics and what were going to spend. I think that the discussion has to begin by a significant cultural frameshift which is really quite encompassing.

You know, in addition to being a pediatrician, Im also an oncologist. There was a study that was done just a couple of years ago that asked if oncologists, how often did they introduce to their patient that they were at the end of known therapy, rare - rarely done. Rarely does the dialogue take place that, you know, we - we have expended a reasonable, or a reasoned amount of treatment. And we need to move towards comfort and care. And I think thats a cultural phenomenon that doesnt exist throughout the world. I mean, youve traveled the world, Anna, and you know how people talk about death and dying in other societies. Its different than we do it here. The kind of discussion that I describe that a doctor may need to have with her or his patient about death and dying may be one that a medical student or even a resident never has organized supervision around. Shocking, isnt it? Shocking. And I think that there are probably at least two or more reasons why this doesnt happen as much as it should. One is the lack of skill and sophistication. The other is in some ways a concern that if you begin to move towards that discussion, youre taking away hope from a patient. And then a third one which is a hard one for me to say, but I think, nonetheless, represents an honest reflection is that it takes a lot of time.

FLATOW: Very nice. Anna Deavere Smith reading a little bit from her play, one-woman show, Let Me Down Easy, on SCIENCE FRIDAY from NPR News. And you used this doctor to say things that people dont want to say - talk about end of life issues.

Ms. SMITH: Well, I went to talk to him because hes one of the most eloquent and passionate people actually that Ive met on the subject, and he has actually been in the play for a long time. I think its very interesting how he starts, that if we dont do something about this, something dramatic about it, that were headed right towards a health care system thats going to look like a developing nation. I think its very hard for us to imagine that as Americans.

FLATOW: And he says we need to make these difficult choices.

Ms. SMITH: And with but and one of the dramatic things we have to do is make difficult choices. And I think we see how nearly impossible it is for politics to be the site. As much as we need politics to frame this discussion and to put it on the table for us, we see that we cant imagine that these tough

FLATOW: Yeah.

Ms. SMITH:conversations are really going to happen in a political way.

FLATOW: But theyll happen in the theatre. Theyll happen on your stage.

Ms. SMITH: I hope in theaters and places like that - schools.

FLATOW: Schools, and people will come away from your performance and say this is something we can talk about.

Ms. SMITH: Well, Im glad you think that way.

FLATOW: Well, 1-800-989-8255. Were going to come back and talk lots more, take your phone calls. Were also tweeting at Sci-Fri, S-C-I-F-R-I, and were going to talk about Let Me Down Easy. And well talk about why you chose the name for that play - its quite interesting, I saw how you did it - with Anna Deavere Smith. You know her from Nurse Jackie, you havent seen her here on off-Broadway, youll - maybe she will be touring some more - play will go on the road. You never know. Stay with us. Well be right back after this break.

(Soundbite of music)

FLATOW: Youre listening to SCIENCE FRIDAY from NPR News. Im Ira Flatow. Were talking this hour with actress and playwright Anna Deavere Smith about her one-woman show about health in our country. Its a terrific play. Its called Let Me Down Easy. Its at the Second Stage Theater in New York and its running through the 6th of December.

Ms. SMITH: Yes, right.

FLATOW: Any plans to go on the road, take it around?

Ms. SMITH: Were looking at that. Id love to.

FLATOW: Yeah.

Ms. SMITH: Id love to.

FLATOW: Thats great. Lets - we hope because we have lots of actors, actresses, producers, directors coming through here who are off-Broadway either at your theater or Ensemble Studio Theatre, these other places where these great little plays happen and then they have trouble getting out to the rest of the public.

Ms. SMITH: Hmm.

FLATOW: So, were hoping for you that

Ms. SMITH: Well, thank you.

FLATOW: Lets go to the phones, because we have lots of people who would like to talk to you. Lets go to Kathleen(ph) in Bartlesville, Oklahoma. Did I get that right?

KATHLEEN (Caller): Hi, yes, Bartlesville. Hi, Anna.

Ms. SMITH: How are you.

KATHLEEN: I am great now. I have been a fan of yours since the late 90s. I attended a lecture you gave at Cincinnati Conservatory.

Ms. SMITH: Oh, yeah.

KATHLEEN: And I wanted to ask you to I wanted to highlight two aspects of your work process. And the first thing, as a musician myself, you said that the way in which you constructed each individual character was you would listen to the rhythm of their speech over and over, you know, when youre on the subway, whatnot. And it became almost like a percussive element in your development of the speech pattern. And I found that fascinating. And if you can elaborate on that and then the other thing that I one of the many things I took away from that evening - was that you say the real communication begins when people get beyond grammar, which struck me

FLATOW: Interesting.

KATHLEEN: because Im the daughter of an English major.

And that but its true, you know. And I just are you going to be in New York still doing this in January?

(Soundbite of laughter)

Ms. SMITH: No. You should get here by December.

KATHLEEN: Well anyway, congratulations. I would love to hear, you know, about your - any other aspects of the process. And youre on my short list of 10 people

(Soundbite of laughter)

KATHLEEN:that inspire me, so

Ms. SMITH: Oh, thats nice. Well, you know, I think that part of language is music, that we are making music when we speak. And when I was a child, my grandfather said to me if you say a word often enough it becomes you and my acting process is that simple. Thats all it is, is talking to people, taking an excerpt of what they said and saying it over and over again with the idea of walking in a persons words the way you would walk with - in a persons shoes. And I think that rhythm is a part of that. And probably when we first start learning to talk, it has a lot to do with rhythm. Im sure theres a linguist who can say it more eloquently than I can. I was just thinking today about how children learn ma-ma, first and its usually that theyre taught ma-ma, rather than ma, right?

(Soundbite of laughter)

Ms. SMITH: I think with the idea that were starting them down the track and, in fact, when people break their rhythmic patterns in my experience is when they really start to get to the good stuff of what theyre saying, which may or may not be what I thought I was looking to hear.

FLATOW: Yeah, well, thats too bad because were on the radio and shes such a great actress, her body language is all missing from when she is reading, just this great body language on stage. Youre also - as part of your characterizations and the topics that you pick is putting other people in other peoples shoes

Ms. SMITH: Yeah.

FLATOW: is having physicians being in other peoples shoes that they never thought they might be in. And Im thinking of the charity hospital segment where she believed she could give the poor the same treatment as the rich.

Ms. SMITH: Right.

FLATOW: And she didnt understand what it meant to be poor until Hurricane Katrina.

Ms. SMITH: Oh, no, she understood what it meant to be poor before. This is an extraordinary young doctor who I met when I went to New Orleans right after Katrina, Kirsta Kurtz Burke(ph) - just a wonderful, wonderful human being, went to Barnard, very advantaged Caucasian woman. And she loved working in a public hospital, as she said, because, you know, a lot of people work in public hospitals just for the training.

FLATOW: Right, right.

Ms. SMITH: We - we all know that, right? And the poor patients because learning is clumsy.

(Soundbite of laughter)

Ms. SMITH: But the way she looked at working in a public hospital, as she says in the excerpt in the play, she goes: But to me you have a tremendous opportunity to see what it would be like in some sense, without living it, to be poor and to open up your heart and your mind to these fantastic people coming into the hospital.

What a fantastic way to think about things. And too rare in our country. It was that - during Katrina she worked as doctor and as a - at Charity, a public hospital, some say the oldest in America, or it was - its now closed - for some time, with the belief that she could take care of poor people as well as she could take care of rich people. But being at Charity during Katrina, and on the fifth day, still not being...

FLATOW: Right.

Ms. SMITH: rescued was a shocking thing to her, to see that her patients and the nurses just had to go on as if business was as was business as usual, making the best of flashlights when they had no electricity and 106 degrees and no food. This was an eye-opener to her, knowing very well that private hospitals had gotten the people out in private helicopters.

FLATOW: Yeah. It was and this whole thing of putting your people youre putting people in other shoes that they would not normally be is part of the theme of the play. 1-800-989-8255. Lets see if I can get a question or two before I want to go to the cowboy. Youll hear about the cowboy. Jennifer in New York, hi. Welcome to SCIENCE FRIDAY.

JENNIFER (Caller): Hi, Anna, thank you so much for your work. Im a Masters student in Columbia Universitys new narrative medicine program out of the medical school.

Ms. SMITH: Great.

JENNIFER: And I think the one of the effects of this program will be changing medical education in medicine. And your work is a big part of our studies. And I have a question many of us had for you when we saw your show about how you prompt the people with whom you speak. What how do you invite them to speak with you and what questions do you ask them that elicits these stories?

Ms. SMITH: Well, I try not to ask very many questions, because I think that narrative is an organic sort of a thing that we all have, like breathing. And part of getting to know who someone is to see how their narrative works. So in the case of one of the things one of the reasons, in fact, that this project became so interesting to me after I was at Yale, was because I really only had to ask a patient one question to get some of the most beautiful language. People spoke, they sang, they prayed.

One man, his little granddaughter came in to read to me from her journal everything that shed written when her grandfather was waiting for a heart transplant. And the simple question I asked each patient was just, what happened to you?

And they had a lot to say. And you know, in medicine, unfortunately, with 15 minutes, I think its rough. So that was really the beauty of this project, is its one area of our existence that people will speak at great length about with not very much prompting.

FLATOW: Thanks for calling.

JENNIFER: Thank you.

FLATOW: 1-800-989-8255. Before we run out of time - because well have some more time to talk - I want to do the monologue - Brent Williams the rodeo bullfighter, because he was a great surprise about what he had to say.

Ms. SMITH: So this is called Toughness.

I got hung up by a bull. Weighed over a ton. Wasnt a mean bull, but when I hit the ground, I was on my side and he stepped on my left side with two back feet, broke four ribs, L2, L3. And there was a guy, urologist for the hospital was sitting in the front row when I got stepped on and he came back and he told me, kid, you better go to the hospital. He said, I bet you ruptured your kidney or your spleen or something. I said, no, I just broke some ribs. He said, no, Im serious. You need to get that checked out. Im serious. Im a urologist in a military hospital. He got on the phone, he called the hospital. And a civilian can only go to a military hospital if its a life or death situation. And he called and he told them it was a life or death situation. I was kind of laughing. I didnt believe him.

Then they took me to Brooke Army Medical Center in San Antonio, Texas and made me piss in a cup. And I pissed straight red blood. Then they said they was going to take out my left kidney. I begged them. I said, look, you know, Im going to sit here, Im going to ride bulls. If I only got one kidney, I'd just as soon have two. So they tried a new deal. They put a stint in there and they saved half my kidney. So I got one and half kidneys instead of one.

And them doctors, they get paid a flat rate. Its not like theyre trying to rape me to make more money to pay their Mercedes Benz bills, whatever they got. And Ill bet, missie, that most of them guys dont even drive them fancy sports cars like the other doctors do. Cost me a flat rate, 1,200 bucks. Yeah, 1,200 bucks. Flat rate. Didnt matter if I got a CAT scan or whatever they did to me. It didnt change when I was in the ICU for six days. And then they took me to the next level, it didnt change. I didnt get no doctors bill or nothing. And I was in there for 11 days. Everyone pays a flat rate no matter what it is.

And personally, I think, I think we need to go to a deal like that. And I think and I think I had better doctors there, doctors who really want to be doctors, not these [deleted] these days, just go to college, spend all their parents money going to college, come out and make a killing, dont really give a [deleted]. You tell me a poor doctor and Ill kiss his [deleted]. But well see, well did you take my kidney out?

Yeah, I have insurance I have a family policy for through Blue Cross of Idaho. Two hundred and sixty bucks a month to cover all of us, like $7,500 deductible, which is stupid. We dont ever meet that. I mean, paying all this money and then, you know, because we got to pay $7,500 for them to meet it? I mean, all they do is rape us. They its just like all the people got the money. They rape the poor until they rape the middle class till the middle class becomes poor. And then theyll start raping the rich. And I mean, theyre going to break the country, I think. But basically Im an optimist.

(Soundbite of laughter)

Ms. SMITH: See, Im an optimist? Yeah, I mean, you know, when you ride a bull and you do good and you ridin' 'em, I mean, you feel like, you know, there ain't nothing in the world that can probably, you know, beat you up or anything like that, you know, it just be like life couldn't be better, you know? Like, this is what life is supposed to be. And it feels - because, you know, theres so much power in it, you know? If you think about it, we shouldn't be able to stay on top of a bull whos trying to buck ya off, because you know, we weigh like, you know, 150 pounds, you know? And they weigh like 2,000 pounds, you know?

And you know, I think the way you stay on top of a bucking bull is just determination. Well, I - I mean, I think - I don't really want to think about it, if I couldnt ride bulls. I mean, it would just be like a big old empty space in me, I think, I mean - be all right, I have my ranch, my cows, but it probably be like maybe even better - maybe even bigger empty space in me than when, well, like my brother died. I don't know what it'd be like, you know?

It's a pretty big space, but I guess I feel like when I'm done rodeo-ing, it probably be like the day my brother died, you know?

Toughness? When we was in western Utah, this bull shoved my face right through the metal chutes, tore my face all up, and took five hours to sew me up. And next day they was going to straighten out my nose. And I had a rodeo that night so I didn't want them putting me under anesthesia, or however you say that word - I told them to do without it.

And so when they straighten out your nose, they take these two metal rods and shove them up your nose, work their way up and feel like it was going out through my brains and out the top of my head. And everybody said it should have killed me. They didn't even knock me out. I have a high tolerance for pain. So I guess that'd be toughness.

But good thing about it was, once they straightened out my nose, I could breathe, and I couldn't breathe since I broke my nose in high school rodeo.

(Soundbite of laughter)

FLATOW: That's great. That was - that was great. This is SCIENCE FRIDAY from NPR News. I'm Ira Flatow.

We're listening to a monologue from "Let Me Down Easy." That was - I mean, he obviously was just the opposite of what you would have expected him to say. I need - we need a flat rate.

Ms. SMITH: Yeah.

FLATOW: We never have did it surprise you when

Ms. SMITH: He's a Republican. He's one of the most conservative of my friends. And I was surprised. I was very surprised that he came to that.

FLATOW: Wow. So where do you go from here with this? Do you hope that you can play forever this play? Would you like to go on the road?

Ms. SMITH: Well, it's a repertory theater, so I won't be playing forever. Id love to take it on the road. Like with my other plays, I'd love to be able to make a film of it.

FLATOW: Really?

Ms. SMITH: You know, "Twilight" is still alive as "Fires in the Mirror," in schools. And I think that wouldn't have happened if there weren't a film that teachers can use to show their students. So I'd love to have that opportunity too.

FLATOW: Do you ever think about rotating your other characters?

Ms. SMITH: You know, I would love to. It would drive everybody crazy, like the stage manager wouldn't like that.

(Soundbite of laughter)

Ms. SMITH: The director would probably tear his hair out when he came to town. But I'd like to do a project where I can rotate characters. So that may be what's up for me next.

FLATOW: And do you hear from people who've seen this

Ms. SMITH: Oh yeah

FLATOW: ...how it's affected their lives?

Ms. SMITH: Well, that's interesting. Well, I think - that's a really interesting way to put the question. Everyone's invited and almost all of the people in the play have seen it now.

One very interesting person is Ruth Katz, who is the - been in the play. She's the oldest of the alums in the play, and I dont mean by her age. But she was in the Yale Medical School version. And shes still in the play now. She's now working for Congressman Waxman. She did invite 150 of her friends and relatives from all over the country to come see it. And they were all there one Saturday night. So I imagine it has had some effect on her. I was very pleased to meet everyone.

FLATOW: This must give you great satisfaction, this play.

Ms. SMITH: Well, I love people and I love ideas. And this kind of way of working that I've developed over many years allows me to be in touch with all different kinds of people. I did interviews on three continents for this play, and it gives me ideas in people, and that's what I love the most.

FLATOW: I think the theater, and a lot of the arts, has great power. We can sit and debate, you know, Congresspeople, whatever, debate the issues. But when you see it on the stage, you see a great film about it, there's much bigger power, great power there to talk, to reach people.

Ms. SMITH: Well, I think - I really appreciate you giving a wonderful plug for the arts. We certainly need that plug right now in the country, given the fact that many nonprofit organizations - art organizations being nonprofit usually, more often than not, are - its a rough time. I dont need to tell you that.

But I think one of the things that the arts does is, is it messes up the lines. It doesnt look at things in terms of black and white. It's not just about winning and losing. You know, it was said to me that Thomas Jefferson could never be found in verbal undress.

FLATOW: Hmm.

Ms. SMITH: He had to watch everything he said. Every politician has to watch every word they say. Were given the liberty to say the wrong thing. And sometimes that's exactly what a public needs in order to have a point of entry into the conversation.

FLATOW: We're very happy that you're here and that you did say those things on stage. And we hope for a long run, hope for an extended run, a film, whatever you'd like to make out of this play , 'cause it's terrific.

Ms. SMITH: Thank you.

FLATOW: Thank you for taking time.

Ms. SMITH: Thank you so much.

FLATOW: Thanks for coming into the studio today. Anna Deavere Smith is an actress-playwright. She wrote, produced "Let Me Down Easy." And she's also professor at the Tisch School of Arts at New York University. And it's at the Second Stage Theater in New York. Its running through December 6th. We hope it goes on the road. Thank you again for being with us today.

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