In sickness and in health

Scientist and esteemed professor Charlie had it all — a brilliant academic career and a loving relationship with her wife, Maggie — when a neurodegenerative disease struck her down in her prime. For the past six years, Maggie’s taken on the role of caregiver while Charlie’s become increasingly incapacitated. When a doctor suggests an experimental brain implant that seems to offer miraculous results, Charlie and Maggie seize the chance to get their old life back, only to discover that the treatment leads to personality, identity and behavior changes that neither of them were prepared for, leaving Charlie to struggle over which version of herself she ought to be.

This intersection of medicine, ethics and existentialism, which forms the basis for the new play “Homo Ex Machina,” is of keen interest to its author, Stanford University bioethicist Karola Kreitmair.

“For me the play is about, ‘how do we choose who we are?’ Do you have a duty to yourself to be exactly as you think you should be or do you have duties to others around you? Is your identity contingent on what you owe others?” Kreitmair said of her work’s central question.

Kreitmair has a background in philosophy and is currently part of Stanford’s Center for Biomedical Ethics, where she assists patients and families with making difficult health care decisions, researches neurotechnology, and teaches undergraduates and medical students about ethical issues in patient treatment.

“Usually philosophers don’t spend a lot of time in the ER working with patients who are making life-and-death decisions. I really like that aspect of it; important decisions I make actually have an impact on people’s lives,” Kreitmair said.

Theater has been a passion of hers since she was a teenager, when she began directing and writing. She’s written numerous plays but said “Homo Ex Machina” is the first that directly brings together her interest in the arts with her bioethics career.

In “Homo Ex Machina,” Charlie (played by Stephanie Crowley) is talked into the experimental treatment by her neurologist, Ava (Diana Roman). Post-implantation, Charlie and the devoted Maggie (Stephanie Whigham) struggle to adjust to Charlie’s newfound radical self-reliance and freedom from illness, as well as some major neuropsychiatric effects (including impulsive behavior and sexual attraction to a grad student, played by Jake Goldstein). Charlie tries to make up for lost time, while Maggie, whose own career as a filmmaker has been sidelined, finds her identity has become very entwined with Charlie’s dependence on her for most aspects of everyday life.

“When this surgery happens and suddenly she gains all of this independence back, I don’t know that I can blame (Charlie) for going a little crazy,” Crowley said. “Especially when her wife, who has become very entrenched in this caretaker role, is kind of pushing back against that, almost like she’s saying, ‘I wanted you to get better but not this much better.'”

Crowley said the play is the most challenging she’s done in years.

“It’s really fascinating because, at least from my perspective, it rides that line between fantasy and reality,” she said of her character’s experience with the brain implant that strongly affects how she feels and thinks.

“We’re seeing glimpses into Charlie’s mind, how she sees the world before and after her experimental surgery,” she said. “There’s a lot of emotion. It goes from these really tender, quiet moments to these huge overblown Greek tragedy kinds of things, but it’s all cohesive at the same time.”

Kreitmair compared the show to the classic story of “Faust,” in which a man makes a pact with the devil in order to improve his earthly life. Some might also find parallels to Daniel Keyes’ “Flowers for Algernon.” And though it’s a tragic story in some ways, it’s also full of comic moments, as Charlie grapples with the manic euphoria (and hypersexuality) that come along with her physical recovery.

“The humor, the drama and the tragedy are very close to each other. I think that those things in real life aren’t that far apart,” Kreitmair said.

The disease that Charlie receives treatment for in “Homo Ex Machina” is a fictional one, but Kreitmair called the play a “thinly veiled reference” to Parkinson’s disease and deep brain stimulation (DBS), which is now a widely used treatment for a variety of neurological (and other) issues and which functions much as it does in the play.

While the treatment is remarkably effective in reducing the debilitating tremors, stutters and pain many patients suffer, Kreitmair said the non-physiological effects, such as those experienced by Charlie, have been understudied.

“I think medicine isn’t always equipped to handle these kinds of issues, which is why ethicists like me are so interested,” she said.

“People who undergo DBS often end up becoming more sort-of manic: becoming gamblers, more risk seeking, more sexualized, more hyper-actualized, I like to call it,” she said. Problems arise when loved ones are not as accepting of these changes, even when the patient themself embraces them. These effects are often reversible when the device is deactivated, but then the disease’s symptoms return.

“Do you have to go back, because of the other people?” she said, “or do you get to keep this new version of yourself that you kind of like?”

In the play, as in life, there is no easy answer.

Crowley had originally auditioned for the role of Maggie, Charlie’s wife, because her own husband has a neurostimulator implant and she has served as his caretaker on and off for the past seven years (although his is in his spine rather than his brain). She said she’s done a lot of research to prepare for her role as Charlie, including not only working on how to portray the physical symptoms of Charlie’s disease during the early parts of the show but also learning about the field of avian evolution, in which Charlie is an expert.

“There’s a whole lot of words in this script that I’ve had to look up and write down the pronunciation,” she said with a laugh.

Kreitmair said that in early drafts of the script, she experimented with the genders of the characters, considering how traditional husband and wife roles might be impacted (or subverted) by the situation. After holding auditions, however, she realized that by making Charlie and Maggie a same-sex couple, she could remove the question of gender roles in their relationship and accentuate the fact that, pre-illness, their relationship was on extremely equal footing. And, Kreitmair added, by switching the role of Charlie’s grad student/object of attraction to a male, another element of identity confusion for Charlie emerges.

The play, which will make its world premiere May 3-6 at Stanford, is funded by a grant Kreitmair received through the university’s “Medicine and the Muse” program, which this year is celebrating the 200th anniversary of the publication of Mary Shelley’s seminal sci-fi novel “Frankenstein.” Like in “Frankenstein,” the characters of “Homo Ex Machina” must consider both the wonders and the potential drawbacks of science and technology.

For Kreitmair, the show’s premiere is a chance to explore these major issues, which are at the heart of her professional life, in an entertaining, accessible and profound way.

“I think theater gives us the opportunity to take what might be actual life and distill it down to the most existentially threatening moments and put those on stage,” she said.

What: “Homo Ex Machina”

Where: Prosser Studio (in Memorial Auditorium), 551 Serra Mall, Stanford.

When: Thursday-Sunday, May 3-6 at 8 p.m.; Sunday, May 6, also at 2 p.m.

Cost: $5 students/$20 general admission in advance/$25 at the door.

Info: Go to Homo Ex Machina.