Backstage with Grand Rounds: Experiencing Cancer

UI - At this blog, we rarely venture outside of the local Iowa City area theatre companies, mostly because manpower insists we focus our efforts. However, there is a production this weekend that we feel must be promoted. Two faculty members of the University of Iowa College of Medicine have created a play about how patients deal with cancer. They found local artists to produce the show. Every once in a while a show does more than illuminate the human condition, a lofty goal all by itself. This show goes beyond that by donating all proceeds to the Cancer Center at UIHC. They suggest a $5 donation, but for such a worthy cause, we should all try to dig deeper. It runs April 25 and 26 at 8 pm at Shambaugh Auditorium on the University of Iowa campus. More information can be found here.

We had a chance to talk to two of the three playwrights, Marcy Rosenbaum, Ph.D. and Loreen Herwaldt, M.D., as well as the director, Annette Rohlk, about this unique production.

Thank you, all of you, for taking the time to talk about this production. First of all, can you give us a quick synopsis of the show?

Annette Rohlk: The show is called Grand Rounds: Experiencing Cancer. Many are not aware what Grand Rounds are. They are lectures given within the medical society to learn more about things within the medical field. This particular Grand Round will be centered on experiencing cancer. It takes you on a journey from different patient’s perspectives and experiences as well as the perspective from the medical team. It allows the patient to have a voice and it allows the medical team to respond to that. In addition to bringing this show to the public, we will also be performing at a medical conference at the hospital...bottom line...the purpose of the production is education. Everyone will walk away learning something about themselves after they watch this show.

Has this show been performed before?

Marcy Rosenbaum, Ph.D.: No.

Loreen and Marcy, how did you two meet?

Marcy: We met when Loreen was completing her sabbatical project and deciding what to do with it. I think Kristi Ferguson, then Director of the first year medical student class focusing on medical interviewing and personal and professional development, introduced us to each other. We collaborated in incorporating "In Their Own Words" into this class using reader's theater. We would recruit 10-12 students and they would perform the piece during class and then all students would discuss their reactions in small groups. We even performed it at a conference in England. Because of our shared interest in communication, we also collaborated in teaching residents and other health professionals about communication skills.

And what lead you to work on this project together?

Marcy: I think the success and impact of "In Their Own Words" and using performance as a teaching tool was part of what led to the current project. It was Loreen's idea to do a research-based play about dealing with cancer. She was influenced by works that presented people's narratives in a theatrical way, such as Fires in the Mirror by Anna Devere Smith. I had previously conducted interviews with women with breast cancer and gynecological cancer as part of other research projects and felt strongly about finding a way to share these stories with a broader audience. In Loreen's sabbatical project she had interviewed some people who had cancer as well.

Loreen Herwaldt, M.D.: I got the idea of doing this when reading a grant notice. We didn’t apply for that grant, but it got us started. We got a small grant from the Gold Foundation to start the process.

And Annette, how did you come to be involved in this show?

Annette: Marcy approached me; she told me a little bit about their project and asked if I would be interested in directing it. I was thrilled that she had asked me. I have lost several friends and family members to cancer. It truly touches everyone. And once we decided that all proceeds would be donated to the Holden Comprehensive Cancer Center at the UIHC, it made the project even closer to my heart.

I am very interested in the interview process that you did to get the stories you used for this show. How many interviews did you do? Just a ballpark figure is fine.

Marcy: The play is based on interviews with approximately 60 different people.

Can you tell me a little bit about what it was like to talk to patients who have cancer? Were they excited to talk or reticent? Did you have to draw them out?

Marcy: What I found in conducting interviews with women with breast and cervical cancer was that most were very willing and even anxious to talk about their experiences, to tell their stories. Several commented afterwards that getting to talk about the myriad feelings and experiences they had was helpful to them. I also think that sometimes it is easier to talk to an interviewer or clinician about potentially difficult experiences because you don't feel you need to protect their feelings as you might feel with your loved ones or family members.

Loreen: I interviewed some family members and they seemed glad to talk with me. I also interviewed some authors who had written about having cancer. They seemed very interested in talking with a physician who wanted to hear their stories. I interviewed two MDs who had malignancies and they were very open as well.

Did you talk to the families, too, or just the patients?

Marcy: Just patients.

Were the individuals comfortable with the idea of their stories being used in a play? And do any of the interviewees planning on attending the show?

Marcy: We did most of the interviews well before we decided to create the play. The characters are all composite characters and we haven’t given away their identity. Most of the interviewees aren’t from this area and some died after we interviewed them. So it is unlikely that any of them will be in the audience.

This is such an emotional topic. How did it affect you two while interviewing and later writing the play?

Marcy: I felt like it was a huge honor to get to hear people's stories about dealing with cancer. Things would definitely get emotional during interviews sometimes. I just tried to be a good listener and supporter when people would, for example, cry during interviews. Writing the play was also an emotional experience as we spent a lot of time revisiting transcripts of people we had interviewed, several of whom are no longer living. I think the hardest part of the writing was not being able to include all the important and emotional stories we heard in the piece.

Loreen: I agree. Both of us bonded with the people we interviewed and both of us became very attached to their stories. It was very hard to trim the material to a manageable amount.

How did you choose which stories to include in your play?

Marcy: We spent a lot of time looking at all the stories we had collected, 15,000 pages of transcripts, and picking out the ones we thought we the most powerful. We also wanted to make sure and cover key issues in the cancer experience - diagnosis, treatment, communication, recovery, support, death - so we would try and pick the best stories dealing with each of these issues. Sometimes if was really hard to choose. We also tried to pick a balance between negative stories and positive stories. Because our intent with the play has been to communicate with medical professionals. We know if it is all negative, it is harder to stay open to the message.

Loreen: We also had people read the play and come to some dramatic readings of the play at different stages. We used the feedback we got to continue trimming the material and focusing on the strongest stories.

I read on your website that a third writer, Austin Bunn, pulled together what you had originally and created composite characters. Can you tell me a little bit about that process?

Marcy: In our early versions, the piece was a series of monologues featuring about 16 different people with some dialogue between them. It was a long piece and we felt that it would be more engaging for an audience if there was more interaction between characters. We let Austin know our intentions with the piece and some of the stories and characters we felt particularly attached to and then just let him work with it for a few months on his own. He narrowed it down to 6 composite characters, including a new one that served as a sort of a narrator.

Loreen: I think he also helped us identify the most powerful stories and the ideas we felt were most important. He helped us focus.

Annette, how involved in the rehearsal process were the writers? Was the script finished before rehearsals or was tweaking going on during rehearsals?

Annette: The script changes have emotionally come to a close! You have to remember, these authors have been working on this script for over five years! To tell them they are done making changes...well that’s an emotional step. We spent many hours drilling through small changes in the script and last week we even removed some lines and changed the ending. But overall, the production is the same, the characters are the same...but the playwrights, the actors, myself, and hopefully, the audience will never be the same. This is a moving piece of theatre. The actors have given me goose bumps during some moments and the playwrights have had tears. Come prepared to laugh, to cry, to remember loved ones and ultimately come prepared to support those who have and who will suffer with cancer.

Did you have an audition process or did you invite actors?

Annette: Ideally, I would have had issued standard auditions for this production. However, due to time constraints, I did not offer an audition process. I have been involved in many theatrical productions in eastern Iowa and there were many talented actors to choose from! I simply told them about the project and soon I had a full cast. There are six members in our cast, and each one embodies their character so well. Marcy and Loreen have attended some of our rehearsals and their comments have been how in awe they are with the accuracy of the actor’s choices. For not having auditions, I think we have an amazing cast!

In your director's note on the website, you dedicate this show to a number of people who have passed away. Please stop me if I'm getting too personal, but it sounds like you do have a personal connection to this subject matter. Is that what drew you to this show? If so, how has this experience helped you deal with your own losses?

Annette: I think to direct any production, you have to choose a script that speaks to your heart. This script, these playwrights and these actors, have definitely done that. I have had a great number of losses within my circle of friends and family to cancer. I still remember how they fought and how their doctors supported them. Cancer is a terrible thing to endure, and the memory of it never goes away.

I also believe in supporting events and activities within the local community. A past production helped to support the Iowa Braille School keep their doors open, I participate in Bowling For Kids Sake annually with Dreamwell Theatre, and now this production will help the Holden Cancer Center at the University of Iowa Hospitals. It warms my heart to be able to use theatre, a hobby I enjoy very much, to support those in the area. It seems like the right thing to do.

Along those same lines, I know often when a cast is working on a play about a very emotional subject, there are some rehearsals where all you really do is talk about the subject. Personal experiences and stuff like that. Did your cast have one of those kind of nights? How did it help the process?

Annette: As a director, I think you should always allow for an evening of character analysis and I believe you build the characters and ultimately the play from there. So, yes, we did take time to analyze the play and discuss the ins and outs of what these characters have endured. Luckily the struggle to fill the “back story” of our characters was eased because we had Marcy present to help discuss the characters. Many of the characters were people that she knew personally and it drew the cast in deeper, knowing that they were portraying ‘real’ people. Marcy had previously created a documentary of one of the women that eventually became one of the characters in the script. We were able to watch that to help grasp her personality and characteristics. A few weeks later we took some time at another rehearsal to recap what we talked about and to see if more questions had come up about the character and how to interpret some of the lines. Again, Marcy was there to help!

Can you tell us about one story or one character in the show that really affected you?

Annette: There were two characters actually that spoke to me deeply. The first is Peter, played by Jeff Emrich. Peter is a simple man of few words, but very wise. He reminds me very much of my father who had passed away last year. Watching Jeff portray Peter is a lot like having my father around me at every rehearsal. The other character that spoke to me is Joanie, played by Patricia Wade. Patricia has a very quiet demeanor but when she steps into the role of Joanie, she breathes life into her. She is often the character that is still ringing through my heart when the show ends.

This show is not produced by any of the area theaters. How has that made it more of a challenge for you, if at all? Are you doing more than just directing the show or is there a staff doing the other producing work involved in putting a show like this together?

Annette: Well, let me first say, putting on any community production is ALWAYS a lot of work. I have to take my hat off to all of the area theatres. Marcy and Loreen have had no prior experience in the theatre world and Marcy has said many times that she is amazed at how much time and energy is put into each production. She is absolutely right. You really have to love the art and put your whole self into each production. To the community I beg you—support your local arts—they work so hard to bring you quality productions!

So, to answer your question, you always do more than just direct a show. It’s never as easy as, show up, direct and go home. You eat, breathe and live the production until it goes up and then you grieve when it’s over. I have spent hours considering lighting choices, inserting music choices, pre-show music. I have been working with the playwrights and the cast at rehearsals, trying to make sure that everyone is on the same page. We also have been working with Sheena Rohlk, (my lovely & talented niece!) who designed the poster. Thank goodness Sheena joined in because she has done an AMAZING job with the poster. It looks so professional. The entire cast, playwrights and myself have been working to hang the posters throughout the area. My employer at Leepfrog Technologies agreed to host a website for us. I have spent many, many, many hours on updating and designing the layout and gathering information. I ‘think’ it is finally done. I also have to insert a huge thank you to Brian Tanner. He has gone above and beyond. He is not only acting in this production, he has been helping me get through the musical cues and lighting cues. Jeff Emrich has been helping to coordinate rehearsal space and also storing the set when we are done rehearsing. It’s definitely a team effort. No one ever puts a show up by himself or herself. We have a special page on the website where we thanked those that have helped with the production. I encourage everyone to visit that page. There are so many who have been involved with this project! Thank you so much!

I noticed on your website that Dreamwell Theatre is providing technical support. Can you tell me a little bit about that?

Annette: Dreamwell Theatre. Now don’t get me started on them, I’ll be talking all day! I’ll try to keep it brief. I was involved with Dreamwell a few years ago as an actress and I fell in love with everyone involved in that theatre. I later joined the board and had a ball putting up productions with them throughout the season. I still have many friends from there and they were kind enough to lend us their lights and sound system so that we could create a “real” theatrical experience. We never could have produced this show without their support. Period. They never questioned the use of their equipment. They believed in the cause we were working toward. You really couldn’t ask for a kinder, or more community based theatre board than Dreamwell’s. Thank you, Dreamwell.

What are you hoping the audience will take away from your show?

Marcy: We are hoping that patients with cancer will relate to the stories that are told by the characters and will feel that their own stories are valuable and that someone has “heard” them. We are hoping that healthcare workers will learn more about the patients’ experience of cancer and simple things they can do to improve the patients’ experience of getting healthcare for cancer.

Annette, tell me something else I need to know about this show.

Annette: I think the main thing to remember is that all of the proceeds for this production will be donated to the Cancer Center at UIHC. All the money stays local. There is no set fee at the door. We are just asking for a minimum of $5 if you can afford it. If not, please come anyway and enjoy an evening of theatre. Thank you in advance for your support.

After each production, the playwrights, director and cast will be present for a ‘talk back.’ So if you have questions or comments, you can stay and ask them directly! If you are shy, there is an email address listed on the More Info page of the website.

Thanks so much, Annette, Loreen and Marcy. I am going to try to make the show!

Annette:I hope you do!