“Well, that was a bit too much like my life.”

I’m at the theatre with four other doctors; I’ve invited them along to get their reaction to this new play that is also an adaptation of a memoir by Middlemore (ex) intensive care doctor, Dr David Galler. The book came out in 2016, well before the pandemic, yet the conversation this play has with its audience feels urgent and current.

I’m a playwright but my day job is as a paediatrician, working my way around many of our most under-resourced health services – my literal job is to plug the gaps in staffing. My co-reviewers tonight are all consultant anaesthetists. Some of them have worked with David Galler in the bearpit/ reality survival show* that is the current state of play in most of our hospitals. (The pandemic hasn’t caused this by the way – but it has made the resource gaps in our system much more obvious).

But back to the play. This is a big work: 13 actors playing 18 characters, over a 2 hour running time divided by an interval. The set and lighting design by Rachel Marlow and Bradley Gledhill utilises the full depth and breadth of the Waterfront Theatre stage, with elegant concentric semicircles of transparent plastic drapes, LED screens that fly in and out and panels of venetian blinds that come down like a stage curtain for some parts of the narrative. Throughout, large pieces of set furniture (beds, office desks, dining tables) are rolled on and off with tight efficiency by the actors. Projections add layering and metaphor to the onstage action while a subtle sound design by Matt Eller, including a beautiful song performed in Hebrew and Te Reo Māori (composing and arranging credits go to Poulima Salima), adds to the emotive impact. 

Costume design by Nic Smillie is on point – there’s not a white coat in sight, thankfully. White coats to denote ‘doctor’ on stage/screen is one of my bugbears; the last time I wore a white coat in hospital was in 1996 as a junior doctor. These days the only people that wear white coats in hospital settings are actors who work as ‘clown doctors’. (Rant over, thanks for indulging.) My co reviewers rate the design. “I liked how the layers reflected the different layers of care and the experiences that intersect, but maybe aren’t seen by each other,” one says.

Playwright Gary Henderson has focussed the narrative around the fictional life story of Rafal ‘Raffie’ Beckman (Ian Hughes), an experienced intensivist who – like Galler – is affected by his Jewish culture and the suppressed memories of his mother Roza (Donogh Rees), a Holocaust survivor. Through the play Beckman, along with his staff – Nurse unit manager Carol (Nicola Kāwana), junior doctors Edie (Jen Huang) and Dev (Shaan Kesha) and nurse Ana (Stacey Leilua) – wrestle with their compassion and the life and death stories of three families: Chris (Semu Filipo), a cyclist injured in a hit and run; Seleni (Petmal Petelo Lam), a young woman living with diabetes; and Tiara (Stacey Leilua), a patient with a severe brain injury.

“It’s true to David’s book,” says my friend, “just much more compressed as it has to be for theatre.” I agree – the focus is on the human stories and the real people behind the bodies and the clinical histories. All three of the stories are centred on the experiences of people who happen to be of Māori and Pacific ethnicity, as is appropriate for the South Auckland setting, but they are universal stories. The reactions of the grieving sister (Michaela Te Awa Bird), the protective mother (Elsie Ropati) and the worried wife (Margaret-Mary Hollins) are all too real.

Polata’ivao and Henderson are not afraid to go there with showing racism and bias in the health system either. I feel extreme discomfort watching the fictional (Asian) doctors show off their uneducated bias when dealing with large body size, as I do whenever doctors are critiqued in stage shows (it happens often), but I must admit it’s a fair call.  Not the Asian part, but the fact that most of our health workforce don’t have the lived experience to understand what it’s like for many of the people we look after. We have research studies and ‘cultural safety courses’ but this is no substitute for the healthcare workforce actually reflecting the population we look after. But I should really get back to the play. 

It is the health system that Galler reserves most of his critique for. Another moment of discomfort I have is watching two well-off, middle aged Pākeha men (David Aston’s soothing Health Minister, and Hughes’ Raffie) discussing important policy decisions to do with disadvantaged communities – but then I realise I am upset because it’s exactly what happens. There are advocates, yes and many of them are white men – but where are the communities and their researchers who should be enabled to advocate for themselves? 

Dr David Galler has left clinical practice to be more actively involved in policy and advocacy work, but as he shows through his avatar Raffie in the play, even with all the advantages of being educated and able to speak with power, all too often there is timid bureaucracy and politicians too focussed on a three-year election cycle to action what’s needed. A recurring narrative is Dr Beckman arriving with yet more research reports to back his calls for revolutionary change in our health care system, only to be patronisingly dismissed by the Minister.

While Raffie is pulled from one clinical crisis to another, he is also pulled back to his family. Henderson employs the effective narrative technique of having Beckman’s father Leon (Greg Johnson) constantly present, observing and commenting on his son’s experience – we begin to suspect (spoiler alert) that there is a fluctuation in reality, but don’t have it confirmed until halfway through that Leon is a figment in Raffie’s mind.  It’s effective because it is so real for a bereaved person to see and talk to their dead, and also because it gives a viable excuse for the playwright to show us what his main character is thinking. 

Raffie is a man torn between wanting to care for his dying mother, needing to be there for his colleagues and the patients he cares for, and dealing with the gnawing guilt of not being there when his father died. It’s a stretching I am familiar with and see my colleagues go through, and these pressures are exactly what leads to burnout in the health professions.

In some conversations ‘burnout’ is now being recognised as ‘moral injury’ – that feeling that no matter how much you want to help your patients, the system is not giving you the resources to do your best. Even worse, as the ‘ambulance at the bottom of the cliff’, there is nothing you can do to stop more seriously unwell people landing in your ward and needing your help.

But the moral injury is also the feeling that no matter how much you put your loved ones on hold, you’re just a cog in ‘the system’. Just like the patients are seen as just bodies rather than people, so too are the workers. Often it’s the smaller things that underline just how unvalued you are, the proverbial straw that breaks the camel’s back. In a recurrent and darkly funny gag, a cost cutting move sees the hospital stop funding the free biscuits for the staff that sustain them when they work overtime; then the free milk for tea and coffee goes, and finally access to the staff pool that Raffie uses to calm himself so he can face giving a family bad news.  It’s so real, and it’s happening to your local nurses and doctors in real time.

And yet when things go wrong under pressure – as a moment in the play shows – the way the system is set up is never held to account, and the workers are left to deal with their feelings alone. But also as the play shows, when the system abandons you, it is your colleagues – and sometimes the love from your patients and their families – that help you up to keep going for another day. For Raffie, it is ultimately his connection to his parents and their powerful story of survival that anchors him. 

After the play, and marvelling at the fact no one’s on call phone has gone off, my colleagues and I adjourn to a nearby bar to talk about the play and our lives for another couple of hours. For some, it’s the first time in memory they’ve been to a theatre show. (“Oh my god! how can actors remember all those lines?”) Being able to stay out for a drink and post-show debrief is an unheard-of luxury.

The consensus is that the play was hard to watch, but it’s the truth. Maybe if we’re not being heard in our service meetings with managers, our never-ending reports/ critical incident reports and our Parliamentary Select Committee presentations … perhaps a play will help? 

Our world portrayed on stage is still a sanitised and trimmed down version – intensive care units are rarely so tidy with those squeaky-clean new beds – and understandably most of the medical procedures are simplified (intubation first time without even needing to use a laryngoscope or drugs! amazing skill!) – but the sentiment is what counts and that part is right on the money. 

As the waiter comes to take our last orders, we all agree that the individual human stories – and the people we come home to – are what keeps us going. We also rate the opportunity to collectively vent, and maybe a shared theatre experience is exactly the therapy that’s needed. ATC has provided a substantial discount for healthcare workers to attend this show, a gesture that was greatly appreciated by other colleagues I saw in the foyer.

Ultimately, Things That Matter reminds us of the human stories at the heart of our beleaguered healthcare system, and offers a way forward – based on that recognition of our humanity – for change.  As Raffie says at the end, “If not for myself, then for whom? If for myself, then who am I? And if not now, then when?”

*’reality survival show’ is not a pitch for an actual show.

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