Like many a medical school student, Madeline Leong initially expected to become a primary care physician. But along the way, she was introduced to the field of palliative care. That ended up becoming her vocation — and inspiration for her avocation.
In addition to her position as a palliative care doctor affiliated with Johns Hopkins Hospital, Leong is also a playwright. Her one-act, 90-minute work "Life Support," about a man in a Baltimore hospital resisting his inevitable demise, will be performed at Hopkins medical facilities starting Thursday by an ensemble of seasoned local actors.
"It's not the most happy topic," Leong says. "But the play isn't that sad. I wanted to try to present both sides of what it's like when a patient is facing end-of-life decisions, and when a doctor is trying to do the right thing."
At the center of "Life Support" is a 65-year-old man named Karl, who is on his fifth wife and, due to complications from a bone marrow transplant, his last leg — not that he accepts anything about mortality. A businessman with a track record of getting and staying ahead, Karl is convinced he can overcome this obstacle, too.
The play spins a plot that gradually reveals intriguing details about the characters' lives, experiences and relationships. But all the while, Leong fuels the drama with the kinds of situations faced every day in hospitals when a patient's prospects fade, when tough choices need to be made.
Dr. Rachel Li, the doctor in "Life Support," is rather like Leong herself. The fictional physician is 29, the playwright 30. And like Leong, Li is a native of Los Alamos, N.M., most famous as the birthplace of nuclear weaponry.
Early in the play, Li delivers something of a bombshell to Karl — the news that things are not going well with his recovery. She raises the inevitably awkward subject of decision-making in case the worst happens.
The paperwork Li asks Karl to look over isn't fictional. "Maryland Advance Directive: Planning for Future Health Care Decisions" is a real form. The mere mention of it sets off a bitter exchange between Li and Karl's young wife, Lori, who likens the directive to "bringing in a death panel."
Lori: "My husband is a fighter ... And you bring doom and gloom."
Dr. Li: "Also known as reality."
Not a reality people typically want to face.
"Our reflex as Westerners, and, especially, as Americans is, 'Oh, it's death — we don't talk about that,'" says Brent Englar, director of "Life Support."
Leong knows that reaction well.
"People put up walls," she says. "I try not to do that. In palliative care, we always start with asking who you would want to make decisions for you if you couldn't make them — that person is your health care agent. Then we ask that you have a conversation with that person and tell them your wishes. This is a huge step."
Various factors can cloud the selection of a health agent, Li says, as in the case of a patient with both parents living; choosing between them may add fresh strains to an already tough time.
Deciding on a health care agent is only the start.
"The other thing is to talk to your doctor about what you would want for end-of-life care," Leong says. "This can be a harder step. Your doctor can provide more specifics. The [Maryland Advance Directive] gets into such detail. There is so much misinformation out there — we don't actually 'pull the plug.'"
In "Life Support," the characters gradually arrive at a calmer place. Lori sees things more clearly; Karl and his estranged son draw a little closer. The option of hospice care is raised and, after initial resistance, accepted. (There is no death scene.)
What transpires in the play is the sort of thing Leong has often witnessed firsthand.
"I don't use the exact words I've heard in the hospital to write dialogue," she says. "But the emotions in the play are real. Sometimes, very fragmented families come together in amazing ways in these situations; that's nice to see. People have different coping skills."
Leong has had to hone her own coping skills.
"Like any sane person, I had some hesitation about going into palliative care," she says. "And some people still think I'm crazy. But I found out that I liked it. ... Of course, it's still really sad. There are a lot of losses you have to go through. But I just felt I could be useful."
Writing "Life Support" is an extension of that effort to be useful. It may help audience members face important matters they have avoided. It may even alert medical staffers to things that could be made better; one scene points out the invariable shortage of chairs in hospital rooms. ("Doctors need to sit down and talk to patients, not stand over them," the playwright says.)
Leong, who started writing at an early age, addressed the sobering topic of advanced cancer in her first play, "Stage IV." Out of several submitted works by local playwrights, Mobtown Players selected it for a staging in 2013.
To bring "Life Support" to the stage, the playwright secured funding from the Arnold P. Gold Foundation, which is dedicated to advancing compassionate medical care.
Leong's next play will look at hospice care.
Given that her world, on the job and off, revolves so much around issues of illness and death, does Leong worry about burnout?
"I try not to think about that," she says. "I don't think too hard into the future. I just try to be as helpful as I can, then go home and write about it."