Humans in Healthcare #38 | The 4th Wall

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I’m on a theater kick lately.

Starting as a theater major in college, one of the fundamental classes I took in my first year was Intro to Acting. We were required to read Respect for Acting by revered actor and teacher, Uta Hagen. She teaches us that acting is a craft that requires respect and mastery through dedication and preparation.

One of the exercises we were given for the class was to pair up with a partner. One person would develop their narrative and act out a routine scene from a day in their life, complete with props (it had to be believable) while the other person was tasked with creating their narrative that would be shared when they knocked on the door and entered the room of their partner. Each narrative was unknown to the other person.

The exercise would be performed in front of the class and had to engage two ideas from Hagen — the 4th wall (an invisible, imaginary wall that separates actors from the audience. While the audience can see through this "wall", the convention assumes the actors act as if they cannot) and Immediacy (the fight to prevent anticipation, to prevent thinking and planning ahead, to prevent setting yourself for an action already knowing what its consequence will be).

I was paired with a guy named Phil and was tasked with acting out my scene, while I waited for him to enter my pretend room. The day of the class when we were to perform, I lugged my props across campus in the dead of winter (dedication to my craft!). I put on some Franz Ferdinand (yes, so emo), in my pretend dorm room, while I waited for my friend to come by so we could grab something to eat.

Knock, knock. I open the door. Phil enters. Immediately, I see the distraught look on his face. No longer is this a friend who is picking me up to go eat — this is a man who is deeply hurting.

My mom’s dying, he says. And the tears come.

End scene.

While that particular scene was made up, it is rooted in reality, perhaps the reality for some of you reading this right now. Something similar can happen when we open an exam room door, a car door, an office door, or a computer door (screen). What we expect to see may not be what faces us on the other side. In the scene, my narrative was expecting a friend to pick me up to eat. Instead, it was a person whose life was changing forever.

Daily events are a series of scenes and acts in the grand play of life. They are not all good, they are not all bad. But they exist and we exist in them, with them, and with each other’s narratives. And much of our learning in life is in how we respond to them, relate to them, and make space for them.

That exercise and theater in general have taught me so much about the grand play of life and how I interact with it as a friend, partner, mother, and clinician.

What acting teaches us about humanity

The 4th wall (an invisible, imaginary wall that separates actors from the audience).

In life, it’s often flipped. It’s an invisible wall that separates and disconnects us from each other. The invisible, but real burdens we carry. The invisible, but real scars we carry. The invisible, but real traumas and hurts and heartaches that we carry. How many of us exist in a 4th wall? What will it take for us to see beyond it? To break down the wall so it is no longer invisible? This is something I try to be mindful of and appreciate when I am interacting with others. What is their 4th wall? Are they putting on a brave outward face, but fighting an inner battle that I can’t see? How can I show up for the people and be invited to their 4th wall? Sometimes simply showing up and caring can be enough.

Immediacy

We live in an increasingly on-demand society where it is becoming less common to make space to pause. A productivity mindset, grind, and hustle outweigh the natural seasonality of life and the need to rest. Social media has conditioned us to react vs respond and scroll by each other on the way toward our next click.

And despite how much we plan, we cannot always control the outcome of our plans. We cannot control how others respond. In healthcare, patients have bad outcomes despite our best efforts.

We can tend to want to immediately fix other’s problems or our own problems out of discomfort. In many ways, a desire for immediacy is a mechanism to avoid discomfort. But on the other side of discomfort is growth and the only way to it is through it.

To fight against the desire for immediacy, we must train ourselves to live in the present pause, what Viktor Frankl says is the space between stimulus and response, and “in that space is our power to choose our response. In our response lies our growth and our freedom.”

Craft

Finding success (or being a good clinician or creator) isn’t just about talent — it’s about the development of character, ethics, and a point of view. Being a good clinician can be meaningless if we don’t uphold our ethics — our moral code, first do no harm, and the sanctity of the patient and provider relationship. And if we fail to develop a point of view (what we value and how we operate from that), our character becomes wobbly.

As Hagen states,

Service

Acting is about generosity. It’s about serving the other person. It’s about being willing to be open to what your fellow actor has to share, even when it’s unexpected. It’s about being curious about their story without the immediacy to jump to conclusions and control the outcome. Like in the pretend scene, I didn’t expect that news, but when I heard it, I had to be humble enough to be in that space of pain with my fellow actor. Relationships (ideally) are the same way. How true is this when we walk into an exam room, either as a clinician or patient? How true is this in our friendships or with our co-workers or kids?

Humanities — the connection between art and science

I think Steve Jobs said it best:

The theater and the art of acting can teach us so much about how we show up as friends, parents, partners, and colleagues. Like the theater, life is a communal adventure. We must serve the play by serving each other.

How are we serving each other?

In humanity,

Amy

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