#i wonder if he even had the emotional capacity to process that he was neil's very first concern above all else

[grooviestguru]

sometimes i think about how neil's first words to the foxes after baltimore was to immediately ask where andrew was, and i wonder if andrew heard him

[dissonantdreamer]

You know how in Ellie’s journal she wonders if Joel was comforted by her being there.

What do you think? It’s entirely possible that he’s in so much pain that he can only register it’s Ellie and not much more. Yet there’s a side of me that wants to believe that seeing Ellie one last time was sort of his dying wish. Just being able to see her might have brought him closure.

Gosh I’m sad now

Okay okay so this scene has so much more depth and I’ll split this response into two sections I’m going to give my initial thoughts and then I’m gonna refer to the behind the scenes from a few interviews on the scenes because the process and the insight to the internal dialogue we don’t see that makes it all a real fuckin’ stab in the gut, twist the knife of emotion.

Gonna make myself real fuckin’ sad under the cut:

That scene, for me. That was all about Ellie, her trauma, her pain. What breaks her and pushes her over the edge into the darkness. Joel’s brain is mush. He’s firing on one cylinder. The body is pumping blood, the lungs are taking air in and out. The light is all gone. He hears her say his name, seemingly responds, moving his hand and breathing in. If he processes anything with Ellie, it doesn’t last, he stills. I personally don’t think he had the capacity to understand exactly what was in front of him. Not with the way his head was bashed in. At least in a way that would be gratifying and wholesome. In a way where he sees her and is at peace. I don’t think there was much of Joel left in that body. Because that is realistic. That from personal experience, when someone is on their way out, they don’t always know who or what is in front of them, they, they see whatever their brain is producing to ease this pain, to ease the mind as it shuts down. And you want, more than fucking anything to believe that you just being there helped in some way. That they’ll fade with you on their mind. It’s not like the movies. The only person that could be comforted by that thought is you and it’s a lie you can keep telling yourself if you want. No one will question that.

Joel did however, in my opinion, have a moment of clarity long before that moment, surrounded by this group of people he thought he was helping, when he realizes that his past has come back to kill him. A moment where he reflects and concludes that it was worth it, he got five years with Ellie. Four of them in a place of safety where he got himself back, got the man, the father, Sarah saw, back in some capacity. I believe he didn’t think he was ever going to see Ellie again, and found some final comfort in the love he had for her before the club even hit his head.

Now for some actual insight Troy (and Neil) shared taken from two podcasts worth givin’ a look see if you haven’t already.

TLOU2 Spoilercast

and Let’s Get Into It

Troy Baker has a podcast and he interviewed Neil on it and they talked about the scene and one thing that Troy fought Neil on changed literally everything in the scene. Joel’s gone he’s barely there, his neurons are barely firing and in an earlier draft they wanted him to hear Ellie and say, “Sarah” because she is part of his story (she’s kept alive in other ways in his home). They filmed two versions, one where Joel does say “Sarah” and the version we see. Neil agreed that it was more powerful without him referring to Sarah. That led them to shave off some other dialogue in Ellie’s house where Sarah would be mentioned, that Joel wouldn’t follow after the WLF, because he could have easily hunted down the officer that ordered his daughters death, but he didn’t he stayed with Tommy and did what he could to keep them both safe. Because that’s the real Joel, the Joel that would protect what family he has left.

Troy shares something about Joel’s mental  process during the scene in another interview, where he has been hurt he knows he’s going to die. The line of internal dialogue that Troy believes he didn’t articulate, didn’t convey wordlessly through his acting,  has stuck with me for months, “this is what happens when you drop your guard. I allowed myself to trust. I allowed myself to love. I allowed myself to feel. I allowed myself to be safe. And this is what you get.” Joel sees it as a moment of regret. Troy goes on to say that despite that regret, just like on the porch, Joel would fucking do it all over again. For Ellie. Because he got to have that life with her however brief. It was worth it.

I can’t say for sure she brought him closure when she broke down that door. Not when he was so close to death. I believe that every moment up until his lights dimmed, Joel took comfort in knowing Ellie. That while he may have Sarah to look forward to, in this moment, in this brief blip of his life, his kiddo brought him back to himself. Gave him a better final run than he could have ever asked for.

I think in a way, that is more comforting, to face down your own death with someone you love on your mind. To let go of fear knowing that he loved and was loved by Ellie in her own way. That she wanted to try and fix what was broken, that she came to him, that he could still be forgiven another time. It’s just that time ran out and he was content with that, because in his life, through all his struggles, he kept surviving. He kept fighting. Kept looking for his next reason to fight.

In the end, he found that reason to keep fighting, and for him?

After everything he had done?

It had been for something. 

[the-desolated-quill]

The Quill Seal Of Approval Awards - The Best Of 2017

It’s an established scientific fact that the real world is horrible. Full of nasty, hideous and deeply unpleasant things like racism, corruption, global warming, terrorism and prawn flavoured crisps. No wonder more and more of us are turning to the world of fiction to escape from our unhappy lives.

Yes a number of good stories have come out this year, and as it’s the last day of 2017, it’s time once again for the Quill Seal of Approval Awards. Where I pick my personal favourite stories of the year and hopefully persuade you to give them a try if you haven’t already.

Before we start, two things. One, this is my list. If you disagree with my choices, that’s absolutely fine. Go make your own list. And two, full disclosure, I haven’t been able to see everything 2017 has to offer for one reason or another. So please don’t be angry at me because movies like Get Out aren’t on this list. I’m sure Get Out is as brilliant as everyone says it is and I’m sure it would win a Quill Seal of Approval Award. I just never got around to watching it this year (also fuck you Golden Globes. Satirical horror is not the same thing as comedy horror. From what I’ve heard, Get Out is not remotely like, say, Shaun Of The Dead or Zombieland. Satire is not synonymous with comedy, you know? It doesn’t need to make you laugh. That’s not a requirement of satire. I mean look at Black Mirror. That’s satirical. What about George Orwell’s Animal Farm? That’s satirical. Would anyone ever consider either of those to be comedies? No! Of course not! Do you know why? Because they’re fucking depressing, that’s why! If you thought either of those were funny, you require serious psychiatric attention, you sicko!)

...

I’m sorry, I went off on a total tangent then. What were we talking about?

A Series Of Unfortunate Events (TV Series)

There had been rumours for ages that we were going to see another attempt to adapt Daniel Handler’s post-modern series of gothic children’s books after the painfully lacklustre movie starring Jim Carrey, and on Friday the 13th January (on my birthday! EEEEEEE!!!), we saw Lemony Snicket’s A Series Of Unfortunate Events arrive on Netflix. Speaking as a massive fan of the books, I absolutely adored this adaptation. TV is just such a better medium for the Baudelaires than the movie was.

Adapting the first four books of the series, Season 1 follows Violet, Klaus and Sunny Baudelaire, having recently lost their parents in a terrible fire, trying to keep their fortune out of the clutches of Count Olaf; a vile villain and even worse actor. The series is being adapted by Barry Sonnenfield and Daniel Handler himself, and not only remains close to the original source material, but also expands on it thanks to the TV medium. It also boasts a great cast. Neil Patrick Harris is incredible as the villain Count Olaf, able to walk the line between comic and sinister effortlessly. Malina Weissman and Louis Hynes are both great as Violet and Klaus, and share excellent chemistry on-screen, selling the sibling affection better than the movie did. There’s also Patrick Warburton as Lemony Snicket, who offers deadpan comic narration, as well as K. Todd Freeman as the incompetent Mr. Poe, Aasi Mandvi as the eccentric Uncle Monty, Alfre Woodard as the petrified Aunt Josephine and Catherine O’Hara as the perfectly innocent, I swear, optometrist Doctor Orwell.

Admittedly this may not be to everyone’s taste, but if you’re into family friendly viewing that intelligently mixes both the surreal and the macabre, then I’d say definitely check out A Series Of Unfortunate Events. It’s perfectly wretched :)

Wonder Woman

Warner Bros and DC may have completely fucked up their shared universe thanks to the total cock-up of Justice League, but one good thing did come out of the DC Extended Universe this year. Wonder Woman.

Finally making her cinematic debut, Wonder Woman is definitely one of the strongest superhero movies to be released in recent memory. Patty Jenkins does an amazing job bringing this feminist icon to life and Gal Gadot gives quite possibly one of the best performances in any superhero movie to date. This naive, but passionate warrior who takes it upon herself to try and save the world from the evil influence of the Greek God Ares. But what I especially appreciated was how the movie went beyond the simple hero vs villain story and really created something both powerful and socially relevant with its themes of love and sacrifice. The main takeaway from the film is that evil isn’t an external force or outside threat. It’s something that exists in all of us. We all have the capacity for violence and treachery, but if we could all just learn to love and support each other, and work together, we could help change things for the better. It sounds incredibly hokey when you say it out loud, but the movie conveys it extremely well.

If you haven’t already, definitely check out Wonder Woman. It boasts a strong female protagonist and an intelligently written and emotional story with a noticeable lack of the sexist tropes and cliches you’d normally find in these kinds of movies. Hopefully Wonder Woman will be the start of a whole new wave of female talent both in front of and behind the camera (and when I say women, I don’t just mean white women... please! Feminism only works if all women benefit from it after all. Let’s see some more women of colour in the director’s chair and on the red carpet).

War For The Planet Of The Apes

The long awaited conclusion to Caesar’s story, War For The Planet Of The Apes is simultaneously both the darkest and the funniest of the rebooted Planet Of The Apes movies. As the human race lash out against the apes in their desperate bid to survive, we see Caesar face his ultimate test. Will he lead his tribe to salvation or be consumed by inner darkness just as Koba did in the previous movie?

While not the strongest movie in the Caesar trilogy, it’s still exceptionally good. Andy Serkis gives the best performance so far as Caesar, and you really feel for him as he undergoes his inner conflict. He’s by far one of the strongest protagonists to come out of a Hollywood blockbuster, and War serves as a fitting end to his story. Director Matt Reeves continues to make us care deeply for the apes’ survival, with characters like Maurice, Rocket and newcomer Bad Ape providing many touching and comedic moments to alleviate the tension and darkness. We also see some strong human characters, such as the mute Nova, played by Amiah Miller, and the antagonistic Colonel, played by Woody Harrelson, who definitely stand head and shoulders above the other human characters in the previous films.

A lot of filmmakers could learn a thing or two from these films. 20th Century Fox should be immensely proud of this trilogy, and I hope the franchise will remain this intelligent and impactful in the future.

Captain Underpants: The First Epic Movie

No! Stop it! I can see you sniggering! ‘Oh! Quill honestly thinks this puerile kids movie full of toilet gags is worthy of some kind of award, does he?’ Well, actually yes. Yes I do. And before you judge me, have you actually watched the movie? No. I didn’t think so. So why don’t you get off your high horse and go into this with an open mind because I’ll think you’ll find Captain Underpants is one of the best kids movies ever, so there!

Based on the popular (and surprisingly controversial) series of children’s books written by Dav Pilkey about two troublemaking schoolchildren, George and Harold, who hypnotise their mean principal into thinking he’s a superhero and go off on a series of whacky adventures, Captain Underpants: The First Epic Movie is an excellent adaptation that captures the books’ humour and message perfectly. Yes it’s filled with toilet gags and fart jokes (and I can see you rolling your eyes dismissively already, you snob), but it all serves a purpose, and the message behind Captain Underpants is incredibly unique for a kids film. That sometimes a little rule breaking is okay provided it doesn’t go too far. Children are often forced to conform to societal norms, and discouraged from certain things because they’re ‘inappropriate’. Captain Underpants serves as the perfect antidote to that, encouraging children to actually have fun and let their imaginations run wild. The toilet gags and adolescent humour in this film are very funny. It’s not very high brow or sophisticated, but it doesn’t really need to be neither. That’s the point. Captain Underpants is basically a celebration of the childish and the silly, implying these things have value in and of themselves rather than just dismissing them as being ‘immature’.

If you have kids, this would be a perfect movie to show them, and you just might reconnect with your inner child in the process. And if you need further convincing that Captain Underpants is worth watching, consider this. Did you know Harold is gay? Yeah! In the final book of the series, Harold meets his future self and discovers he’s married to a man and has two children. So it’s a cleverly made family movie that encourages children to be creative and to not feel constrained, and offers positive representation for the black and LGBT communities. Suddenly this movie doesn’t feel so puerile anymore, does it?

Logan

I never thought I’d see the day I’d actually be praising a Wolverine movie. 

After two failed attempts, 20th Century Fox finally offers a Wolverine movie that doesn’t make me want to fall asleep, tear my hair out in frustration or gouge by eyes out with ice cream scoops. Logan is not only the best Wolverine movie, but quite possibly the best movie in the entire X-Men franchise. Hugh Jackman gives a brilliant performance in his last ever portrayal of the character and Patrick Stewart is equally as good as an elderly Professor X.

Logan is as tragic as it is thought provoking, deconstructing the idea of a superhero and spelling out in no uncertain terms how Wolverine utterly fails to meet that criteria. It’s dark, hard-hitting and surprisingly poignant as we see Wolverine desperately try to redeem himself, escorting a group of young mutant children across the border whilst metaphorically passing the baton to them. He may have failed to be a superhero, but he could well have saved a new generation of mutants that will succeed where he failed.

If you haven’t already, you need to watch this movie. Even if, like me, you don’t like Wolverine very much, you should still watch it. Logan more than makes up for past mistakes, I assure you.

The Tick

Are you getting sick to death of the over-saturation of superhero movies and TV shows these days? Then The Tick is the perfect antidote for you!

Based on the comics created by Ben Edlund, The Tick essentially drops a Saturday morning cartoon character into a Christopher Nolan-esque environment. Serving as an affectionate parody of the superhero genre, The Tick is both incredibly funny and surprisingly clever. Peter Serafinowicz does a stellar job in the title role, giving a performance almost reminiscent of the late Adam West, and is both charming and hysterical. But the true star has to be Griffin Newman as the Tick’s sidekick Arthur. While his surroundings are incredibly wacky and surreal, Arthur himself is treated with the utmost care and sincerity. He is to all intents and purposes the main character, as we see him try to overcome his own anxieties and insecurities in order to expose a plot from supervillain the Terror. He is the emotional centre that the show revolves around and is what elevates The Tick from being just a simple parody to a legitimately good superhero show in its own right.

The first half of Season 1 is available to watch on Amazon Prime, with the second half due to be streamed in February 2018. if you haven’t already, check this show out.

Horizon Zero Dawn

Finally we end with a video game, and it’s a very special video game (well it would be. It’s on a best of 2017 list). Horizon Zero Dawn. Created by the same people who did the Killzone games, Horizon is an open-world adventure game set in a post post-apocalypitic world where machines dominate the landscape and humanity have gone back to basics, living in isolated tribes and shunning the technology of the ‘Old Ones’.

Two things make Horizon Zero Dawn stand out. The first is the world itself. Guerrilla Games have created a very rich and nuanced setting, and as you explore the environment and collect datapoints, you begin to piece together how exactly human society as we know it initially fell hundreds of years ago. The machines are well designed and each have a very specific purpose, and the tribes are incredibly well thought out with believable hierarchies, belief systems and societal structures. It’s simply fun to explore this world and interact with its inhabitants.

The second is the protagonist the entire game revolves around. Aloy. A young outcast woman who goes in search of her parents and ends up discovering herself. She’s a classic archetypal hero and one of the best female protagonists to come out of the video game industry for quite some time. She’s a fully realised, three dimensional character with her own goals and motives, and is at no point ever sexualised or objectified. Even when she’s captured by the baddies, the game never resorts to sexist tropes or cliches. Just as Wonder Woman represents a significant milestone for women in film, Aloy represents a significant milestone for women in video games. She’s intelligent, resourceful and immensely likeable and I was completely emotionally invested in both her as a character and her journey. It’s not only fun to explore the world of Horizon Zero Dawn. It’s fun to explore the world of Horizon Zero Dawn with her. If you have a PS4, definitely get this game. It’s a must-own and you won’t regret it.

And that’s it for this year. All that’s left for me to say is Merry Christmas, Happy New Year and I hope that your 2018 is less shit than your 2017 most likely was.

[topmixtrends]

THE FIRST-EVER Broadway revival of Tony Kushner’s Angels in America recently opened at the Neil Simon Theatre in New York City. The production, starring Andrew Garfield and Nathan Lane, is as close to a perfect representation of the AIDS-era masterwork as any theatergoer could hope to see: the play’s alternately intimate and epic impulses are here happily aligned, and under Marianne Elliott’s direction, the two-part play more than lives up to its extravagant subtitle, “A Gay Fantasia on National Themes.” Twenty-five years have passed since Angels first came to Broadway, and though the play remains politically relevant today, such relevance registers as beside the point: its themes now feel not so much “national” as borderless. I saw the whole production — all seven-and-a-half hours of it — over the course of a single Saturday, and left the theater freshly awed by the play’s endless appetite for life in all its wonderful and terrifying variety. This new staging, more than any I’ve ever seen, matches the ambition and heart of Kushner’s text. It could hardly be better.

And yet, for all the production’s distinctiveness — for the electric field of feeling that seems to follow the performers; for the eerie, neon buzz of the design; for the sheer legibility of the script across the decades — it’s hardly the last word on Angels in America. No production is. That, at least, is the unspoken message of The World Only Spins Forward, a new oral history of Angels, written by Isaac Butler and Dan Kois, who conducted, edited, and arranged the 250 interviews that constitute the guts of this propulsive, moving account.

So many books about the theater derive their power from the sentimental idea that the best productions and performances remain in the past, beyond the reach of the present-day reader. The World Only Spins Forward refuses to partake in such theatrical rubbernecking. Profiling a multitude of Angels productions — not just the original Broadway staging, but others that came both before and after — The World Only Spins Forward makes the case that Angels, like all truly great pieces of theater, transcends any individual production that might lay definitive claim to the play. In this way, though the book’s focus is on the past, it ultimately points to the future: even if you don’t get to see a production as wonderful as the current Broadway revival, you still haven’t missed out. With a work as great as Angels, there are no lost opportunities.

¤

Kushner’s play first appeared before the public in April 1989, in a staged reading produced by the Eureka Theatre Company in San Francisco. This was only one of countless developmental steps on Angels in America’s long road to Broadway. “There were eleven thousand workshops,” one of the play’s early stars tells Butler and Kois. “It was well developed.”

More than any piece of theater that preceded it, Angels both reflected and transcended contemporary concerns like AIDS, Reaganism, and gay rights. Audiences were ravenous for the play, and on the power of this enthusiasm, Angels quickly moved up the theatrical food chain. A host of theaters presented early versions of the play while Kushner was still writing and revising it; to read about these separate interpretations, some of which featured different creative teams and casts, is to marvel at the sturdiness of Angels. No matter the artistic context, the play thrived.

At the tiny Eureka Theatre, where Part One made its world premiere in 1991, director David Esbjornson staged the expansive play using the humblest of materials: a shower curtain, bungee cords, sawdust. “It was in some ways the most beautiful version of the play,” says actress Kathleen Chalfant, “and the most Poor Theater version of the play.” There was something deeply moving and oddly funny about the production’s handmade ethos. Critics loved it. Reviewing the show in the Bay Area Reporter, Deborah Peifer wrote, “To call this a brilliantly realized, profoundly funny, wickedly thoughtful piece of theater is to discover the severe limitations of language. I found myself wanting to say, simply, it’s more than I ever imagined.”

A swift, spare staging of Part One subsequently opened in 1992 at London’s Royal National Theatre. Directed by Declan Donnellan, this production unfolded on a mostly empty stage dominated by a huge American flag on the back wall. To increase the play’s tension, Donnellan overlapped the beginning and ends of scenes. Here, too, the response was rapturous. Frank Rich of The New York Times wrote, “Mr. Kushner has created an original theatrical world of his own, poetic and churning, that, once entered by an open-minded viewer of any political or sexual persuasion, simply cannot be escaped.”

Other pre-Broadway productions also demonstrated the play’s multiplicity, its capacity to thrive under vastly different budgets and directorial visions. At the Juilliard School, Michael Stuhlbarg (Call Me by Your Name), Elizabeth Marvel (Homeland), and other students showed that the play could work in the hands of young actors. In Los Angeles, at the Mark Taper Forum, a difficult rehearsal process nonetheless produced a bigger staging that “sealed your sense that this was the play of its age,” according to San Francisco theater critic Robert Hurwitt. “This was a masterpiece.”

The complete, two-part play finally opened on Broadway in May and November 1993, respectively. Directed by George C. Wolfe, the New York production was far more elaborate than any that had preceded it; stagehands called it “the Money Store” because of all the overtime they earned. And yet, though many of the actors who appeared in the Broadway premiere — among them Stephen Spinella, Joe Mantello, and Marcia Gay Harden — gave performances that are now legendary, The World Only Spins Forward situates these actors among a vast ensemble of other performers who also worked on the play as it grew. Again, the book here emphasizes the play’s pluralism, and demonstrates how Angels was propelled forward by the labor of all the actors who worked on it, not just the ones who opened the show on Broadway.

Naturally, many of the actors who didn’t follow the show to New York had strong, complicated feelings about the whole matter, and The World Only Spins Forward makes quite a bit of hay from this unavoidable fact. Indeed, one of the book’s most interesting chapters bears the subtitle “Getting Fired From Angels in America.” Kathleen Chalfant, one of the performers who did make it to New York, says, “There was, in one way or another, quite a lot of blood on the sand, as there always is in a long development process.” Many actors who worked on the show were terrified of being replaced. Jeff King, who played one of the lead roles early on, says, “It felt like my neck was stretched over a stump and I was waiting for someone to chop my head off.” The axe fell, and King was cut.

Most painfully, Kushner opted not to bring Oskar Eustis, a close friend who had commissioned the play and co-directed the Los Angeles iteration, to Broadway. “There were a lot of hard phone calls,” says Kushner, “but nothing compared to talking to Oskar about the fact that he wasn’t going to go with it. There’s very few things I’ve ever had to do that were harder.” Kushner gave the job to George C. Wolfe, who’d had a recent success with Jelly’s Last Jam on Broadway, because he felt Wolfe could bring the right kind of razzle-dazzle sensibility to the project.

And yet, for some of the fired artists, their experience working on those early versions of Angels counted as extraordinary and life-changing. “Very few people have that chance, being involved in something that is truly grand and important,” says Michael Ornstein.

I never had the same joy as an actor after that. I lost my taste for doing these plays that I didn’t feel were important, that I didn’t feel as much for. I thought about how the gods took the life of the runner of Marathon, because they knew he would never feel that way again, after he ran to announce the victory of the battle.

This sentiment is also shared by those actors who did ride Angels to Broadway. “I stopped acting after Angels in America,” says David Marshall Grant. “I didn’t think there was anywhere else to go. I felt like it touched me — I’m getting emotional, I’m sorry. (Cries.) It touched me very deeply.” Carolyn Swift, from the national tour, recalls,

It kind of ruined me in a sense. When it was over and I went back to auditioning, I knew that it would never be the same for me. And I kind of began plotting my departure from the theater after that. It was like having a brilliant lover, and after that lover goes, you just know.

Angels was such a monumental experience that it made other projects feel insubstantial in comparison. Having worked on such a singular piece of theater, it became harder for the play’s alums to go back to more earthbound productions, whose shortcomings were rendered all the more apparent in the wake of Angels in America’s achievements.

¤

Still, Angels launched far more careers than it ended. Eustis would go on to become artistic director of the Public Theater, producing shows like Hamilton and Fun Home. Joe Mantello, who starred in Angels on Broadway, is now one of the best and most prolific directors in New York. (His many hits include Wicked and The Humans.) Stars like F. Murray Abraham, Cherry Jones, and Debra Messing all appeared in the play, whether in development or on Broadway. Indeed, to read The World Only Spins Forward is to marvel at how many theater artists currently working in the United States began their careers, in some way or another, on those early productions.

This is true of the later productions as well. Roughly half of The World Only Spins Forward is devoted to versions of Angels that followed in the wake of its Broadway debut. We learn not just about the national tour, but about an opera treatment, a controversial student production, auteur-driven productions from Ivo van Hove and David Cromer, and London’s 2017 National Theatre production (the production now playing on Broadway).

The book also traces the play’s winding journey to the small screen. Conversations about a film adaptation began as early as 1991, before Angels had even made it to Broadway. Robert Altman was Kushner’s first choice to direct, but budgetary problems and creative differences ultimately brought the project to HBO and Mike Nichols, whose theater background made him an ideal candidate for the gig. Legitimate quibbles can be made about the film — in literalizing the play, some of its imaginative magic is lost — but Kushner’s vision still comes through with force and clarity. Meryl Streep, Al Pacino, Mary-Louise Parker, and the film’s other stars are excellent. As Frank Rich says in The World Only Spins Forward, “It’s one of the very, very few successful film adaptations of a major American play. Maybe one of three: Kazan’s Streetcar, and Nichols’s Virginia Woolf.”

The effect of reading about this interpretation, and the others brought to life in this book, is to make Angels appear all the more impressive and timeless an artistic achievement. It’s a play that can work whether it stars an Oscar winner or a high school student; whether it has a Broadway-sized budget or no money at all; whether it enjoys a Hollywood special effects team or little more than a shower curtain, a bungee cord, and a pile of sawdust. In illustrating this fact, The World Only Spins Forward makes Angels seem like an endlessly productive volcano, one that spits out productions of all shapes and sizes, each scorching with the desire for “more life,” a blessing the play’s hero gives the audience in the Epilogue for Part Two. Readers who know Angels will appreciate the effect of this overflow more than those who don’t, but even the uninitiated are sure to be moved by the play’s impact on the world.

“Here’s what I think might be the thing about Angels in America,” says director David Cromer. “It’s never been defined by a single production, and I don’t think it can be […] It’s like The Cherry Orchard. It’s not conquerable. It’s a mountain you can never totally climb.” It is this idea, as manifest in Butler and Kois’s kaleidoscopic and fabulously entertaining book, that firmly turns the book’s attention to the future. One leaves the narrative hungry not for productions past, but for productions yet to come. More life, the book seems to exclaim. More Angels.

¤

Harrison Hill’s writing has appeared in The Threepenny Review and American Theatre Magazine. He is an MFA candidate at Columbia University’s nonfiction writing program.

The post There Will Always Be More “Angels” appeared first on Los Angeles Review of Books.

from Los Angeles Review of Books https://ift.tt/2IFjMvJ

[isaacscrawford]

De-Medicalizing Death

There’s been an unexpected, and excellent, consequence to California’s new medical aid-in-dying law. For many terminally ill patients, immersion in the process of securing lethal drugs ultimately renders them unnecessary. How did this come about?

Passed by the California legislature in late 2015, the End of Life Option Act allows physicians to prescribe a lethal concoction of drugs to some patients with terminal illnesses who meet certain criteria. The law, commonly described as providing “medical aid in dying,” took effect on June 9, 2016. It stipulates only that the requesting patient be considered terminal (less than six months away from death), possess full decision-making capacity, and be physically able to self-administer the life-limiting drugs. Although the physician is obligated by law to inform the patient of alternative care options, such as psychological counseling or symptom management with palliative care services, there is no direct requirement that the physician arrange or provide them. In its barest form, the option can serve as a dispensary for life-ending medications.

California’s medical community was taken by surprise by the rapid passing of the law in late 2015. It came on the heels of the dramatic case of Brittany Maynard, a young woman with terminal brain cancer who elected to move from California to Oregon to access medical aid in dying under that state’s Death with Dignity Act. Hospital systems and physicians in California suddenly found themselves with an urgent need to rapidly formulate policies around this new right of patients. Some, such as the Catholic Health Systems, opted out on religious grounds. Others scrambled to put basic policies in place for patients who met inclusion criteria. And some institutions decided to put significant time and resources into supporting this new legal reality in the most comprehensive way possible.

One standout example is the University of California, Los Angeles (UCLA) Health Centers. After literally thousands of hours of discussion, the working group determined that the intake process for patients requesting medical aid in dying should be conducted by trained psychotherapists (psychologists and clinical social workers) instead of physicians. Dr. Neil Wenger, director of the UCLA Health Ethics Center, led the effort to create processes and infrastructure to respond to this law. “We wanted to be able to offer a service that doctors tend to gloss over,” he said, when asked why they chose to lead with talk therapy. The intake consisted of an extensive set of questionnaires designed to assess all possible sources of distress. Any patient with physical or psychiatric needs was referred on to the appropriate services. But as the UCLA committee expected, most of what patients needed was to discuss their feelings about their approaching death and process their grief and sense of loss. This mirrors data from the entire state of California as well as Oregon, which suggest that the distress prompting patients to request these lethal medications primarily stems from their fear over losing control at the end of life. It is not, as many may think, due primarily to physical suffering.

The intake questions explored goals of care, quality of life, and patients’ emotions around their impending deaths: Were they ready? What scared them? What made them anxious? Did they feel their lives were complete? What did they feel makes life meaningful? What decrements in quality of life are too great? What haven’t they said and to whom? Anne Coscarelli, psychologist and founding director of the Simms/Mann–UCLA Center for Integrative Oncology, described the conversations that came from this intake process as revelatory and comforting for the patients. Several patients ultimately completed legacy projects, such as video or written messages and stories, for their children and grandchildren. This invitation to talk, which opens up a discussion that most of us are taught to avoid, turned out to be a game-changer.

Only a quarter of the patients ultimately went on to ingest the lethal drugs they came requesting. The actual data is more complex: Some who requested this service did not meet the basic requirements to receive it. Others died before they had a chance to ingest the medications. But the staff from UCLA reported case after case in which patients’ goals shifted from wanting to hasten their deaths to deciding to live out the remainder of their lives.

Ours is a culture that does not talk about death, even when it should be impossible to ignore. Despite the fact that 89 percent of people think that it is a doctor’s responsibility to discuss end-of-life care with their patients, in reality, only 17 percent of patients report having had such a conversation, according to a 2015 survey from the Henry J. Kaiser Family Foundation. As a doctor who practices both critical care and palliative care medicine, I have presided over thousands of deaths. Most of my patients have suffered with chronic illnesses for years: metastatic cancers, failing lungs, and progressive debilitation from dementia. And yet almost none of them have discussed their own death with their doctors, or even their families. Most have no idea that they are actually dying. In this culture that operates on a fantasy of immortality, with unrealistic promises made by television shows and advertisements, doctors see themselves as failures if they are unable to cure their patients. We physicians are trained to lead patients into battle after battle, into the next procedure or intervention, banking always on that magic pill or miracle cure.

This broad cultural unwillingness to acknowledge death results in a phenomenon I call the “End-of-Life Conveyor Belt,” where high-tech treatments are automatically attached to bodies as they progress through the stages of dying. As the baby boomers age and our treatment options blossom, more are being exposed to the suffering brought about by these protocols. The tremendous anxiety we see over loss of control is understandable. It is no wonder that people in many states have asked for, and finally won, the right to take back that control with a pill.

The effort by UCLA Health seems to be working. Placing highly trained psychologists and clinical social workers in the critical role of “first responder” to a patient’s request to hasten death has rendered many of these requests obsolete. In choosing this approach, UCLA is effectively “de-medicalizing” the experience of dying by prioritizing the need for deep reflection. In this way, the program provides patients with an option that doctors are not primarily trained for.

Patients requesting support to hasten their deaths are only a small subset of the population of the dying. They are in some ways canaries in a coal mine, their request for medical aid in dying is alerting us to the unmet needs of the wider population of dying patients. And what I am seeing is that our new legal responsibility to steward these patients responsibly through this rocky terrain will build practices and skills that will help all of those at the end of life.

Where goes California, thus goes the nation. California was the fourth state to legalize medical aid in dying and has since been followed by two more. And UCLA’s approach, with trained psychologists guiding patients through this tricky terrain, shows us the way. Let’s take advantage of this wave to take better care of all our seriously ill patients. And let’s make sure we give patients what they really need and hope that lethal drugs are always the last tool in the toolbox.

Article source:Health Affairs