In advance of the event, Guy Glass has had the opportunity to speak with Margo Weishar about her play: 

Guy: 
Hello Margo. It is such a pleasure to speak with you. For anyone who may be deciding if they want to come to the reading, can you tell us a bit about the play and the subject matter? And about how you became interested in writing about Elizabeth Blackwell. 

Margo: 
What really interests me is people who break out of the norm. 
People who do things that are completely extraordinary, and what motivates them to do that, and what is their personal cost in doing that. 
Elizabeth Blackwell became the first woman to graduate from medical school in the United States, and then she had a career in promoting women in medicine. But I also wanted to show her as a human being. The only pictures we have are of an old woman, but she was a vital, curious, intelligent, daring, brave person who fought against incredible odds to get where she was. And so that’s who I really wanted to investigate. You know, we all rely on these pioneers to break barriers down so that people like me can walk through them. But what does it take from them to do that? What are the choices they had to make in your own lives to make that possible? So that was the question that really ended up fascinating me. 
 

I got a theater degree because it was something I’ve always done in my life, and I decided I really wanted to formally go and learn. And when I started working with playwright Michael Hollinger, I took a class on solo performance. 
I always loved historical fiction, and I liked plays that were based on historical women. And so, I thought I’ll look at Elizabeth Blackwell as a subject for this solo performance. I started researching and found there was a wealth of primary source information. Not only she, but also her sister Emily became a doctor, and then a lot of her other family members were prominent. There are letters between the nine brothers and sisters in collections at Harvard and at Oxford which I could read online. The more I read and the more material I looked at, the more I felt, wow…this woman had an amazing life! After I did the solo performance, I started developing it as a play. And I really liked where it was going and refined it to the point where I had a public reading at Villanova in May of 2024. 

Guy: 
As you know, I am also a physician-playwright. There are not all that many of us! Can you say something about what it was like as a doctor transitioning to becoming a playwright? Do you feel like you have a special perspective because of being a doctor?  

Margo: 
I feel like my life has had two parallel tracks because I grew up around theater and performing. My father was a scenic designer who was a graduate of Yale Drama School. I am the first and only doctor in my family. I was always that kid who was good at science, but also the lead in the play. I produced and directed the first musical production at Penn med school ever: Sondheim’s Company with a full orchestra, which we put on with all the med students. So, it was always part of my life even during my medical training, although there was a time when I had to kind of put it on the back shelf. 

As far as playwriting, I feel very passionate about telling certain stories that haven’t been told. And now as a woman who has lived a life, had a career, raised three children, and now has a grandchild, I have a lot of life experience. I felt like that kind of voice is somewhat rare in the playwriting world, especially telling stories about women. And especially about women in science. I’ve had the opportunity to play on stage Ada Lovelace, the daughter of Lord Byron, who is credited with developing the first computer and the first computer language. 
I’ve played Maria Sibylla Merian, an artist and biologist in the 1700’s, who drew beautiful studies of insects and plants.
I directed a play about Henrietta Swan Leavitt, a Harvard astronomer in the early 1900’s. I’ve always been fascinated by these incredibly accomplished women who history has ignored. I really felt like that was my impetus for trying my hand at it. I didn’t know if I’d be any good at it. But having my work read by others I could see it was starting to reverberate with people. People were liking it and I was liking what I was hearing. The whole skill was very new to me and quite surprising. 

Guy: 
One of the things I don’t think people who are outside the theater world realize is just how long the development process of a play can take. In what way do you hope the reading at the College of Physicians will help you, and what do you expect will happen next? 

Margo: 
I have another amazing mentor, Ed Sobel, a professor at Villanova and a professional dramaturg. Ed has been working with me on focusing and refining the play. And it is just an amazing thing for me to work with somebody who is so great at what he does. Because he’s asking me questions and really trying to focus on what the essential story is that I want to tell. Having good actors is another good thing. The way people say things will help me to streamline.  

And of course, the last and most important element is how it plays to an audience, somebody who’s seeing it and hearing it for the very first time, what they will come away with and whether I can achieve the emotional impact of what I’m trying to say. As you know, things can be back to the drawing board after that experience. I might hear certain things that really hit perfectly or other things I never even considered. It’s not like a novel, where you finish it, you publish it, and it goes out in the public. You can have multiple full productions before you publish a script because sometimes something doesn’t work in a production. Maybe it’s just the wrong actors. And then you go see it somewhere else and you think, no, that scene was great. You have to see it. It’s a collaborative art, and we need all those people, designers and directors, to interpret what we wrote before we can say, yes, this is the final version. 

It’s interesting. I was in London last week and I got to see a Tom Stoppard play called Indian Ink. This play had been produced 30 years ago. 
And when Stoppard went back to it, he changed the ending. 30 years later! So even Tom Stopford can say yes, I think I can do it better now. 

Guy:  
Thanks for talking to me today, Margo. And best of luck on the reading. 

Margo:  
Thank you! 

Modern medicine’s emphasis on extending the human lifespan has, in some cases, transformed dying, once a communal and spiritual event, into a cascade of arduous procedures. Deftly synthesizing the wisdom of many experts with his own insights and experiences, Palmer offers compelling, accessible, and refreshingly honest advice on how to shape our lives and legacies so that we are better prepared to die as we see fit—highlighting agency in aging in the face of ageist norms. 

Just last week, New York Governor Kathy Hochul announced that the state will join 11 others and Washington, D.C., in legalizing medical aid in dying (MAID), or when physicians prescribe a lethal dose of medications to patients with fewer than six months to live. 

“New York has long been a beacon of freedom,” Hochul said, “and now it is time we extend that freedom to terminally ill New Yorkers who want the right to die comfortably and on their own terms.” 

The governor’s rhetoric emphasizes a collective cognitive dissonance: As physician (and fellow politician) Dan Morhaim observes, “our culture celebrates personal autonomy,” but when it comes to death and dying, “we collectively abdicate” that value. 

Citing Morhaim and others, Palmer provides valuable context for our relationship with mortality (along with additional information about MAID). During the nineteenth and early twentieth centuries, the average death was relatively quick and happened at home, with little involvement from healthcare providers and medical technology. Today, dying is protracted and tends to take place in hospitals or nursing homes; healthcare providers and medical technology are highly involved; and life can be prolonged with organ transplants, chemotherapy, and more. 

“There is a significant difference between dying peacefully in your bed at home and dying yoked to tubes and machines in an ICU,” Palmer writes, “receiving futile care that only prolongs the dying process for perhaps a few days while providing a horrendous quality of life.” 

Drawing on surgeon Atul Gawande’s [1] work, Palmer argues that, at best, physicians are uneducated about aging and dying and what might matter to patients approaching the end of their lives. At worst, they are financially motivated to perform aggressive interventions that may do more harm than good.  

According to numerous studies, frail patients do poorly in hospitals, and Palmer points out that doctors nearing death tend to eschew the very treatments they give to their older patients, such as surgeries and radiation. 

“I don’t want my last conscious thought to be of doctors stabbing needles into my veins, my ribs breaking from chest compressions, and a large-bore tube thrust into my throat and lungs,” the end-of-life activist writes. “When a patient is young and robust, such curative measures may make good sense despite their violence, but not for an old, debilitated, frail patient.” 

But we have choices: “where to die, how much treatment to have, and how to spend the limited time we have left.” 

“While, in a real sense, no death is ever ‘good,’” Palmer underscores, “planning and preparation can make death less awful and painful.” 

Legislation to make MAID available to the terminally ill is one step in that direction. However, critics argue that MAID may endanger the elderly and disabled, who might feel pressured to end their lives out of fear of causing hardship to their families. Opponents also contend that such policies reinforce the toxic notion that a life with a disability or chronic illness is not worth living. Also, some individuals may seek MAID due to high treatment costs, but MAID should not substitute for accessible care and support. 

Racial inequities in healthcare are also relevant; Black people might opt for MAID because they are more likely to receive inadequate pain management due to stereotypes that they are drug-seeking or pain-tolerant.[2] Palmer could have engaged more fully with these valid concerns. Fortunately, the Medical Aid in Dying Act in New York has a number of guardrails meant to ensure the patient’s decision is informed and voluntary, including a conflict-of-interest prohibition and a mandatory mental health evaluation. 

Well before we are terminally ill, we need to be having routine conversations about dying with our loved ones and physicians. To that end, Palmer endorses The Conversation Project. He also suggests creating an advance directive, or a legal document outlining your healthcare wishes, and choosing a healthcare proxy—not necessarily your closest relative—when you’re young or in good health. One way to think about your healthcare wishes is to complete the sentence “I would want to live as long as I could still…”, as recommended by physician Eleanor Tanno. Another is to consider an “exit strategy,” or an illness for which you would decline treatment.[3] 

Some other tips from Palmer for a “good” death: 

• Write a personal mission statement; letters of gratitude to loved ones; and legacy letters, also known as ethical wills, that capture your essence, beliefs, and stories to pass on to future generations. 

• Make a folder containing everything your children must handle when you die. 

• Join a “village,” or “virtual retirement community.” 

The author also illuminates the benefits and limitations of palliative and hospice care, delineates various eco-friendly alternatives to embalming (reader: as of writing this, I’d like to be affordably composted), and presents ideas for making funeral and memorial services more substantive—and even fun. 

Achieving a Good Death is a touch dogmatic, but Palmer demonstrates in the book’s rich appendices that he practices what he preaches. In a letter to his family about his own end-of-life wishes, he shares the pain of witnessing his mother’s final years in a nursing home: “I want to prevent what happened to her from happening to me.” 

“If my mental function is seriously compromised with little chance for full recovery, please seek opportunities to encourage death’s approach… Are my kidneys faltering? Let them,” he writes, giving new meaning to author Mel Robbins’ self-help concept. 

The book’s main flaw—one the author himself acknowledges—is that it is primarily aimed at those with friends and families. Readers without such connections may feel less comforted than grimly recognized by Palmer’s planned memorial service playlist featuring the Beatles’ “Eleanor Rigby.” 

Ultimately, Achieving a Good Death is a stimulating must-read for mortals that will leave you equipped for a more peaceful, dignified, and meaningful end. 

Achieving a Good Death: A Practical Guide to the End of Life
Chris Palmer
Rowman & Littlefield, 2024

[1] Gawande, Atul. Being Mortal: Medicine and What Matters in the End. Metropolitan Books, 2014. 
[2] Substance Abuse and Mental Health Services Administration. The Opioid Crisis and the Black/African American Population: An Urgent Issue. Publication No. PEP20-05-02-001, Department of Health and Human Services, Office of Behavioral Health Equity, 17 Mar. 2020, samhsa.gov/sites/default/files/meeting/documents/csap-nac-presentation-03172020.pdf.  
[3] Harrington, Samuel. At Peace: Choosing a Good Death After a Long Life. Hatchette, 2018. 

Web image by Medhum.org.