Nosocomial

27 Feb 2019

Nosocomial

We speak to Nicola Baldwin about Nosocomial- a devised play about AMR, diagnosis and the unseen work of healthcare scientists.

What made you choose theatre rather than other forms of media to get the message across?

We met while I was researching another play, commissioned by a theatre company. Elaine (Cloutman-Green) attended (as a member of the public) a participatory workshop. We had a shared interest in theatre, but what struck me on visiting Elaine’s own lab, was how ‘performative’ healthcare science is, how utterly dependent on performing the correct actions in the correct order and sharing an understanding among teams that everyone will perform their role, in order to save lives.

It’s made me rethink healthcare, and in fact health, as a series of correct actions.

What did you learn about healthcare scientists that you didn’t know previously?

That healthcare scientists are people too! On two levels, firstly that prior to working on Nosocomial, I didn’t appreciate that healthcare scientists existed as a profession, and this has been felt by all the actors and creative team. It seems obvious now that when a doctor talks about ‘doing some tests’ it’s like a waitress in a restaurant taking your order; there has to be a whole kitchen out of sight which prepares and cooks and organises what comes back to you.

On the other level, I learned that when you, as a healthcare scientist, discover a person has cancer, or a patient you have been treating all their life, is improving, you feel this in the same way anyone else would, but because of your job, there’s no place for you to express that emotion. Because that would make you less effective at your job…

I learned that healthcare scientists are aware that their work is out of view, and most of the time they just get on with it because the science is what matters to them, but once in a while, you know, it would be quite nice if someone else in the restaurant said…. “by the way, we do have an excellent kitchen and chefs”; that their work is enormously high-pressured because the buck stops with them.

 I also learned that there are aspects to their job which make all this worthwhile, as the place they really work is the wild and wonderful theatre of human microbiology.

What was the biggest challenge in bringing Nosocomial to the stage?

The original idea was for the science fiction element to be uppermost, with research to support that. In fact, when we applied to SfAM for funding, the pitch was for a fact-based, science fiction drama. But as soon as we started, the personal testimonies of the healthcare scientists took over, and it became about them.

So, then I realised that the biggest challenge was to do these precious stories justice

What was the most consistent message that came from the workshops with healthcare professionals?

If I was to sum this up on their behalf, I would say that these are engaged, highly qualified professionals who are committed to their work and their patients, but who are underappreciated.

But they love science. No matter if she started at 5.30am for a 7,00am meeting before a long day…. Elaine’s eyes still light up talking about bugs!

collaboration diagram

 

Did you find it a challenge to strike a balance between entertainment/narrative and facts/message?

Because of the way we worked, as a collaboration between a theatre-loving scientist and a science-curious playwright, I think it was more about trying to find a language in the play that did everything. Our shows last September were R&D and we listened to what everyone said afterwards. The play is still developing, and I like to think that the final version of any successful drama finds its balance in the audience thinking about it afterwards.

WAS there an overriding educational aspect to the play or a theme that you particularly wanted audiences to absorb?

It’s not like theatre and TV are awash with representations of healthcare science, so we had pretty much an open playing area by just bringing the world into the light.

I think by taking us into that world, in the words of the people who work there, it educated people about healthcare science, and microbiology. I actually think about my own health differently now, from understanding the science behind it. I’m much more receptive to messages on TV news about AMR because I’ve got a better grasp of the microbiology.

We’re trying to reflect the drama of healthcare science, which exists because – and this was an early theme Elaine and I discussed – microbiology is not linear. Like any narrative, it can have twists and dead ends.

We thought the drama would be mainly about the narrative of the central character JO, trying to work out what’s happening, but in fact it’s also about KITTY, HELENA and PAUL working through their diagnostic protocols in the lab; dealing with uncertainty and how to approach differential diagnoses.

So, if the educational aspect is an understanding of healthcare science, the theme is an understanding of how to approach uncertainty in a logical way. I love that.

Casualty, ER, Holby City- audiences LIKE a hospital drama- what’s your favourite medical drama and why?

Quincy MD. Since being a kid I loved that show, which is of course about pathology!

In Silent Witness, the team seem to be habitually puzzled by the basic science, such that they need to explain everything to each other. Quincy (once you’ve got past the wide lapels and professional women=air-stewardesses side of it) seems to capture the energy and boundless curiosity of medical science. 

Jack Klugman as Quincy
Jack Klugman as Quincy

 

Following the work-in-progress performance- did you get any feedback that led to any aspects being reconsidered?

We didn’t have any hugely negative feedback, but of course that can be hard to gauge if people hate it and leave. Our R&D draft was 50 minutes long and it will expand into a 70 minute or so version during this year, so we had a lot of feedback on what people would like to see more of.

We’ve got a reading coming up on March 8, and an NHS event on March 13 and we’re planning to continue evaluation with other audiences as the final draft develops.

Ideally, where would you like to see Nosocomial in a year or two?

Still playing. I’d like to see Nosocomial touring, and also published so it can be done more widely. We’d like to do a film version so it can reach audiences where a full production wouldn’t be feasible. 

Ideally, it would spark a wider conversation about healthcare science, understanding and managing our health, for individuals, but maybe socially.

Oddly, we had a few couples come up after performances where one partner worked in theatre or the arts, and the other in healthcare, as a scientist, paramedic or healthcare professional, who were (a) delighted to find a play they both liked, (b) really excited to be able to share each other’s worlds and talk about their work.

If Nosocomial can carry on - zipping the ‘opposing’ worlds of arts and science together - that would be a continuation of the original conversation between Elaine and I which sparked the play, and if that conversation continues rippling outwards over the next couple of years, that would be an amazing legacy.

There will be a reading of Nosocomial on March 8 to celebrate Healthcare Science Week and International Women's Day 2019

Nosocomial was funded by an SfAM grant