Dr. Atul Gawande: Make End Of Life More Humane

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Dr. Atul Gawande: Make End Of Life More Humane

TERRY GROSS, host:

This is FRESH AIR. I'm Terry Gross.

Many of us know someone who was treated for incurable cancer with chemotherapy,
hoping the treatment would extend the amount of time they have left. But they
suffered terrible symptoms from the chemo, and when the chemo didn't seem to be
effective, elected to try even more aggressive treatments, treatments that only
seemed to cause more suffering before they died.

Dr. Atul Gawande writes about such a story in the current edition of the New
Yorker. The larger question he raises is: What should medicine do when it can't
save your life?

He considers difficult decisions doctors and patients have to make about end-
of-life care, including when to stop therapy, when to say no to more chemo or
to a ventilator because it will only cause more suffering without extending
life in a meaningful way. He always writes about what it means when you opt for
hospice care. Gawande is a surgeon who also writes about medicine for the New
Yorker, where he's a staff writer.

Atul Gawande, welcome back to FRESH AIR.

You know, you write about how so much of the choice about whether to continue
with therapy and to go to experimental therapy and how harsh a therapy to
enlist for is often left to the patient and their family to decide. But we
patients aren't doctors, and we don't have all the research at our fingertips,
and it's hard to know.

And as you point out, patients often wait for the doctor to say: There's
nothing more I can do for you. And at that point, you stop treatment. But as
you point out, there's usually not a point where a doctor says there's nothing
more we can do for you because there's always something that can be done. What
do you mean by that?

Dr. ATUL GAWANDE (Surgeon; Staff Writer, The New Yorker): Well, it is this
interesting evolution. We were this completely paternal profession. We didn't
even tell you when we had an incurable condition. You know, we thought that
that would just be more than people could handle.

We have moved away from the paternalistic mode of here is what we're going to
do, and you don't need to worry your pretty little head about that, to a world
that's almost the diametric opposite.

We are willing to throw all of the options out there and just say, you tell us
what you want to do, and the options that are there, you know, right up to the
end include, you know, if you start having trouble breathing, do we want to put
you on the ventilator? Do we want to put you in the intensive care unit?

Your kidneys, when they shut down, you know, shall we put you on dialysis?
Should we shock your heart when it stops? A feeding tube when you stop being
able to eat? A tracheostomy to keep you on a ventilator as time goes on?

The moment of crisis always comes, and we want medicine to help with many of
those steps. We don't want to abandon things that might get us more of the life
we want. But medicine's focus, what we do as doctors, is we sacrifice time now
for the possibility of prolonged life.

But we all have more, wider values, things we care about besides that. We want
to be with others and family. We'd like to be mentally alert as much as
possible. We'd like to avoid suffering, and we'd like to spend our last time
doing stuff we care about and not just, you know, taking in treatments that
make us suffer.

GROSS: Well, what you're talking about is kind of antithetical to a lot of the
treatments that we get when we're dying, because those treatments are so
debilitating, you're not going to be yourself. You're barely going to be
cognizant sometimes by the time you're done with all the treatments.

The likelihood of the real meaningful moments at the end with family are often
diminished because the person who is dying can't speak or think clearly
anymore. Is that your experience? I mean, I've seen that.

Dr. GAWANDE: Yeah, you know, I walked through our intensive care unit. I had a
patient in our medical intensive care unit who I had to see for a surgical
consultation, and I ran into someone I'd gone to college and medical school
with who happened to be the critical care physician on duty that day. And she
had just had it. She felt like - she said, you know, I'm running a warehouse
for the dying here, because eight out of the 10 people in her unit that week -
in fact, for that month - were people with terminal disease, whether it was
end-stage heart failure, end-stage liver failure, end-stage cancer, and in the
big picture, she didn't feel like there was really anything she was doing to
help improve their lives, and in many ways, felt like she was causing more
suffering.

So these were people who were on the ventilator, on dialysis, you know,
tracheostomy and feeding tube in this kind of warehoused oblivion, toggling
between conscious and not being conscious, and even when they're conscious,
they're not really clear about what's going on where and how.

And what's sort of terrifying about it is that these were people that came into
the hospital thinking that, well, maybe we'd be able to get through this, and
yes, I think I could get home this time. And then the care escalated to the
point that they never got to say goodbye or I love you or I'm sorry, and, you
know, they've got their husband or wife or other family sitting with them, and
they will pass on from this world without ever having realized that, you know
what? This was the moment. This was it. And is this way you'd really want it to
have happened?

GROSS: How would you, as a doctor, identify what a patient wants at the end of
their life?

Dr. GAWANDE: You know, it's interesting. When I started writing this article, I
did it because I didn't know how to do that. I didn't really understand, and
what struck me was a study I read. It's called the Coping with Cancer Project.

And the Coping with Cancer Project looked at hundreds of patients getting care
for end-stage cancer, and the striking thing was two-thirds of them had not had
any discussion about what they wanted at the end, despite the fact that they
were, on average, they proved to be four months from death.

The one-third that had a discussion with their doctors about their goals for
the end were less likely to be in the ICU, less likely to die on a ventilator
or be shocked, more likely to take hospice. And the fascinating thing is they
suffered less, they were more capable and more alert for longer in their lives,
and then six months after they died, their family members were less likely to
be suffering from major depression.

I was often in that two-thirds that was steering away from that discussion
rather than having it, and I needed to know how to do that.

GROSS: What is that discussion that you're referring to?

Dr. GAWANDE: I met with a woman named Susan Block, who's kind of an expert in
these discussions. She's a palliative care specialist at the Dana Farber. And
she described a list of things that she has in her head that she tries to go
through in the course of the discussions with patients.

And one things she pointed out to me is that this discussion is often one you
cannot have just in one moment in time. It's a sequence of things.

And her list was not do you want this chemotherapy or not, or do you want this
operation or not. It was: How do you want to spend time as options in your life
become limited? How do you want to spend your time? What tradeoffs are you
willing to make? What concerns do you really have about what lies ahead here?
Do you actually know what your prognosis is? You know that you're dealing with
an incurable disease, but do you know, you know, what the timeline often is?
And who do you want to have make decisions when you reach the point that you
can't?

That series of conversations is incredibly hard, and what makes it even harder
is the patient is not the only one who needs to have that conversation. The
whole family needs to, because she told me about some research that showed that
when patients even know the answers to these questions - and they often haven't
really reached that point - two-thirds of the time, they're willing to take
treatments they don't actually want if they think that the family wants them to
go ahead with it. And so you need to get everybody kind of on board. And
that's, you know, that's not often the way we think about it. But when it
happens, it goes better.

GROSS: This palliative care specialist who you talked to about end-of-life
conversations, she had one of those conversations with her own father when he
was dying, and she asked him what level of being alive is tolerable for him.
And he said as long as he could eat chocolate ice cream and watch football on
TV, it was still worth being alive.

And that helped guide her when she had to make difficult decisions on his
behalf about his medical care. So are you conducting these kinds of
conversations now with your patients?

Dr. GAWANDE: You know, as a consequence of writing through the article, I'm
starting to think about how to walk through it this way. And the unexpected
thing to me was that it's not just with my patients, it's with my own family.

Jack Block, her father, 74-year-old professor father, had a spinal cord tumor
and had to undergo an operation that had a 20 percent chance of leaving him
quadriplegic. And by some - well, you know, it's not entirely happenstance that
that's a story I told, because my 75-year-old surgeon father has the same
story.

And that story that she described really just rung with me. In the course of
writing the article, my father's been with this incurable spinal cord tumor for
the last three years. A year ago, it progressed to the point of paralyzing his
left hand, and he had to stop his surgery practice.

And then a month ago, it reached a point that he started stumbling, and then
one day called me that he wasn't able to stand up from sitting.

He got some steroids that reduced the swelling of the tumor in the short term
enough that those capabilities came back. And he was planned for the same
operation that Jack Block, Susan Block's father, went through.

And so I - you know, we had a series of conversations, and I remember one of
these extremely vividly in my living room, where we went through this
conversation. In a way, it was, you know, it brought us closer than we'd ever
been, and it was a conversation before any crisis could come.

But he was going to undergo this operation to try to relieve the pressure and
keep him from progressing to quadriplegia. And I asked him what tradeoffs he
was willing to make. I asked him almost the same question: What are you willing
to go through to be alive here?

And I told him about Jack Block's answer, you know, if I can eat chocolate ice
cream and watch football on TV, that would be good enough for me. He said
that's not good enough for me.

He said, you know, I'm social. I need to be with people. It's - and he's a
surgeon. I think he needs to feel a little more control, that being on a
feeding tube, no question, that's not in there. But even if I can eat and watch
television, but if I'm quadriplegic and I can't interact and get out in the
world and do those things and I have this incurable tumor anyway that will in
time get me, he said, don't wake me up if, after the surgery, I'm quadriplegic.
Don't do the ventilator. Don't do the tracheostomy. Don't do the feeding tube.

And I understood it. The thinking through that the writing made me go through
and talking to these palliative care specialists and understanding what great
care could look like, it has affected how I treat my patients, but it's also
affecting how I handle things with my dad.

Now, the good news: He got through the operation, a nine-hour operation to
create more space in his spinal cord for the tumor to grow, and unbelievably,
he just did fabulously. He was eating corn flakes on the third day after
surgery, sitting up in bed. He was home eight days after the operation, and
we're all thinking about, okay, we've got ourselves another year or two. What's
on our list? What do we want to do?

GROSS: My guest is surgeon and medical writer Atul Gawande. His article
"Letting Go: What Should Medicine Do When it Can't Save Your Life?" is
published in the current edition of the New Yorker.

We'll talk more after a break. This is FRESH AIR.

(Soundbite of music)

GROSS: If you're just joining us, my guest is Dr. Atul Gawande, who writes
about medical issues for the New Yorker. His latest article is called "Letting
Go: What Should Medicine Do When it Can't Save Your Life?"

So many people at the end now choose hospice, and when you choose hospice, it
often means giving up on other medical care that you can get. What types of
care do you have to decline from that point on?

Dr. GAWANDE: You tend to decline things like calling 911 and going to an
emergency room if something goes wrong. You are not going in to see the
oncologist about the chemotherapy or going in to see the surgeon about whether
you'll try to take out part of the tumor.

You are still seeing doctors and nurses about whether there are things that can
be done to make your life better, and that was a surprise to me. I went on
walking around on visits with a hospice nurse because my mental image of
hospice was just it's a morphine drip.

It was not what I found, which was a nurse who was helping people address,
well, how's your breathing, and what can we do to make your breathing as good
as it can be, given the circumstances. Or what do we do to make sure we have
you on your heart medications to try to prevent a heart attack?

All of those more complicated steps of asking, you know, how do we get you out
for the weekend when we want to get you out for the weekend, that is part of
what they do.

GROSS: So there is an experiment going on now that you write about that I
thought was very interesting. It's called the concurrent care experimental
program. Would you describe that?

Dr. GAWANDE: Yeah, AETNA started it, the insurance company, and they recognized
what we recognize everywhere, that people with terminal disease, at the end,
only a minority choose hospice. And if they choose hospice, it's just in the
last few days, at the most.

And so what they did is they said, well, let's offer hospice to people without
making them sign the form that says I'm giving up my chemotherapy, the option
to go to the emergency room or the surgeon or the radiation and so on. But they
still sent the hospice nurse to visit at home and ask all the questions about,
you know, how can we make your life better now?

And so no surprise, enrollment in hospice went from 28 percent for those
families to 70 percent. But the real surprise was that once they had both
available to them, they went to the hospital less. They were less likely to die
in the ICU. They spent 25 percent less money at the end of life, and the
families were happier.

And what it seemed to be was that the either-or divide, in order to get good
care for what your goals are other than prolonging life, you have to give up on
the idea of prolonging life, you know, that - it blew up that idea. It said you
could try what they called concurrent care. It could use a sexier name than
that, but - and that has been now studied enough to see that this has been
replicated.

GROSS: Now, the kind of end-of-life conversation that you were talking about
earlier that you think doctors should have with patients - in which the
patients and the families can clarify what they want the end of their life to
be like and what physical compromises they're willing to go through in order to
have treatment and what they don't want to go through - are those kinds of
conversations the things that were described as death panels during the debate
about health insurance?

Dr. GAWANDE: Yeah. The - I mean, it got mutated into that. The health reform
bill had funding to have those kinds of discussions. These discussions at the
end of life are long, they're multiple, and sometimes they're not with the
patient themselves, but with the family members.

I describe one oncologist discussing the care for a 29-year-old with a brain
tumor that was at end-stage. And he'd been through two rounds of chemotherapy
and radiation, and he was ready to stop, but his family wasn't.

And the oncologist had separate visits for the father - actually visited the
father at home and talked through, you know, every possible option and what
ultimately needed to be done, which was that the family needed to be there for
their son.

And that's not covered by insurance. You know, she said to me: I can't tell you
how much easier it would've been to just sign him up for another round of
chemotherapy - and, by the way, she would've been paid better.

The health reform bill had a provision to allow for these doctors to have these
conversations and fund them for them to happen, and it was stripped out because
of the argument that this amounted to a death panel.

GROSS: And were you angry about that?

Dr. GAWANDE: You know, at the time, I just thought it was kind of ridiculous. I
knew it was an exaggeration, but this is politics, and some of that is bound to
happen.

What I didn't appreciate until I really tried to delve into writing about, you
know, what do we do, what's the most beneficial thing we can do to make end-of-
life care better and cope with the costliness of it, that's where I realized,
wow, this was the pivot of it. This is where it can happen.

Now, funding for those discussions isn't the only thing that needs to happen.
The ability to even change medical training, to walk doctors - and also, you
know, non-doctors, even non-clinicians - through how to have these
conversations well is going to be a crucial part of being able to transform a
system of care to not just be about the time we have.

The most fascinating thing about it, though, is that we see this as all about
tradeoffs. You know, are we going to give up $80,000 drugs that would give us
two months of life? The reality is that at the end, the way we care for people
probably worsens their life and shortens their life.

A study of 5,000 Medicare patients that match people who chose hospice against
people who didn't choose hospice found that those who chose hospice didn't die
any sooner than the people who chose to stick with going to the hospital and so
on.

And furthermore, for conditions like lung cancer and heart failure, those
patients actually live longer in the end, by weeks - in the case of heart
failure, three months longer, and that reveals to us that we have some
dysfunctional decision-making towards the end, where that fourth round of
chemotherapy is certainly not buying them time and is probably stealing not
just quality of life, but stealing time from people.

GROSS: Atul Gawande, thank you very much.

Dr. GAWANDE: Thank you.

GROSS: Dr. Atul Gawande's article "Letting Go: What Should Medicine Do When it
Can't Save Your Life?" is published in the current edition of the New Yorker.
You'll find a link to the article on our website, freshair.npr.org.

I'm Terry Gross, and this is FRESH AIR.
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Jay Roach, Steve Carell Pair Up For 'Schmucks'

TERRY GROSS, host:

This is FRESH AIR. I’m Terry Gross. It may not be the most admirable thing to
gossip about what jerks we encountered at some dinner party, but we do it and
that guilty pleasure is at the heart of the new comedy “Dinner for Schmucks.”
That’s opening in theaters this weekend.

Our guests are Steve Carell, who stars in the film, and Jay Roach, who directed
it. Carell is a veteran of “The Daily Show,” and starred in “The 40-Year-Old
Virgin” and “Little Miss Sunshine.” Carell recently announced that next season
will be his final season on the NBC comedy series “The Office.” Jay Roach
directed the three “Austin Powers” films, as well as “Meet the Parents,” “Meet
the Fockers,” and the HBO movie “Recount.”

In “Dinner for Schmucks,” Paul Rudd plays an ambitious young financial analyst
whose mean-spirited boss hosts an annual event he calls the Dinner for Winners.
It’s actually a competition in which he makes his subordinates bring the
biggest idiots they can find. They all make fun of the guests and the boss
decides who's the biggest jerk. Carell plays Barry Speck, the idiot that Rudd’s
character brings.

Steve Carell and Jay Roach spoke with FRESH AIR contributor Dave Davies.

DAVIES: Well, Jay Roach, Steve Carell, welcome to FRESH AIR.

Steve Carell, talk a little bit about this character.

Mr. STEVE CARELL (Actor): Barry Speck, I see him as a guy who lives on the
fringe of society. He’s an incredibly optimistic person, wears his heart on his
sleeve and just wants to make everyone else around him happy, and in doing so
it has the exact opposite effect. He tends to spread misery...

(Soundbite of laughter)

Mr. CARELL: ...wherever he goes. But it’s so well-intentioned and so well-
meaning, and he has such a big heart. And that’s really what drew me to the
character. I just, I found him to be a very kind character, but someone who
inflicts damage.

(Soundbite of laughter)

DAVIES: A true gift for saying and doing the wrong thing.

Mr. CARELL: Yeah.

DAVIES: And let’s listen to a clip from the film. This is Steve Carell’s
character, Barry Speck, who is sitting down for lunch at an important meeting
for a client of his friend. And, well, you'll get the idea. Let’s listen.

(Soundbite of movie, “Dinner for Schmucks”)

Mr. CARELL: (as Barry Speck) Where are you from?

Mr. DAVID WALLIAMS (Actor): (as Mueller) We are from Switzerland.

Mr. PAUL RUDD (Actor): (as Tim) Barry, you know what? We're going to focus on
business right now.

Mr. CARELL: (as Barry Speck) Switzerland. I love Switzerland. It is one of my
favorite countries. I love your army knives, with the toothpicks, and your
cheese. Does the cheese come out of the cow with the holes? Our countries are
not enemies. They are friends. We are friends.

Unidentified Woman (Actor): (as character) You have been to Switzerland?

Mr. CARELL: (as Barry Speck) No. But I have a friend who drives a Volvo.

DAVIES: And that is Steve Carell from the film “Dinner with Schmucks.” He is
our guest, along with the film’s director, Jay Roach.

Steve, so this guy, he talks a little too loud and a little too distinctly.

(Soundbite of laughter)

Mr. CARELL: Just a little too much.

DAVIES: A little too much.

(Soundbite of laughter)

Mr. CARELL: Yeah, well, he’s – when you see that scene play out, David Walliams
plays this Swiss industrialist with piercing blue eyes. I think he decided to
wear these ultra light blue contacts and dye his hair blond. So it’s this image
that Barry is going up against is so steely and so cool and so intimidating, I
think that adds to the whole idea of the scene.

DAVIES: And he is utterly unfazed.

Mr. CARELL: Oh yeah. Well, again, all Barry is trying to do in that scene is
help his friend Tim. And everything comes from such a generous place with him.
And, you know, it’s very sweet. And as Jay said as well, it also - I think
underpinning all of it is a sense of sadness, you know, a true sense of loss in
his life. He’s somebody - and when Jay and I first started talking about the
character, I said I feel he's the type of guy who always needs to keep moving,
either physically or mentally, because if he stops, if he reflects for too
long, he’ll spin into a terrible depression, because his life is sort of
pitiful, you know - certainly in the minds of others.

DAVIES: Now, I know that there was a lot of script revision and a lot of
improvisation in the film. Do you guys remember whether the scene we just heard
was kind of as originally written, or riffed?

Mr. JAY ROACH (Director): The predicament of the scene was scripted pretty
carefully, actually. But that thing you just heard was almost entirely made up
by Steve on the spot, and - as were a number of other things. We had a great
script by Dave Guion and Michael Handelman, but once you have such a great
predicament script and a lot of great lines, you know, obviously then what
happens when you work with brilliant improvisers, they find other things,
particularly when their character - they're so just completely connected to the
character the way Steve is, and yet they're playing with dialogue and playing
with different lines but it’s always, you know, dialed in to the character and
to the suspense of what’s going on in the scene. So that was a really good
example of the mixture of script and brilliant improvisation.

DAVIES: Right.

Mr. CARELL: I don’t think improvising will solve a problem in a script. I think
it can embellish. You can find different jokes or different options, but if the
script isn't solid, if the narrative isn't good, you have nothing to go on as
an improviser. And that’s kind of the way I try to go about it, is that I just,
you know, I try to place, obviously, myself where the character is and say
things and do things that the character might do in that moment and - or just
react to things that other people are improvising. That’s always – to me,
that's always the greatest gift to get, is, you know, when somebody else
throws, you know, a curve ball in and you have to react to it. And it can
change up the scene, it can - even if the lines are exactly the same, it can
give the scene a different kind of essence. And so that's, I think, the fun it.

DAVIES: One of the things that's really funny about improvisation is that -
it’s when the audience knows that your improvising, because then you come up
with a line and they think not only, hey, that's a clever line, but man, he
just came up with that line off the top of his head. And...

Mr. CARELL: (Unintelligible) is...

DAVIES: Yeah?

Mr. CARELL: I– sorry to interrupt. I think the best thing is really when you
have a scripted line that people think was improvised. That to me is – that to
me is the best. And there are moments in this movie that people think are
improvised but they're scripted, only because they were so well played. So that
to me is really the most wonderful moment, is when it’s seamless between the
two.

Mr. ROACH: Yeah, I was going to disagree too, because I love it when the
audience - I like that they are trying to sort of in the back of their mind
wonder what - whether some of it's being made up. But I actually love it when,
like when Steve does it so often, you can't tell the difference. And I think,
like, there's a difference in, like, "Saturday Night Live" or when you’re
watching a certain kind of skit comedy live, when you really love that sense of
the high-wire act. Like, oh, they're making it up and they're going to have to
keep the ball in the air and – but when, when you – the best improvisers, I
think, you enjoy not knowing and you sort of sense it’s going on in the
background.

DAVIES: Our guests are Jay Roach and Steve Carell.

We’ll talk after a short break. This is FRESH AIR.

(Soundbite of music)

DAVIES: If you’re just joining us, our guests are actor Steve Carell and Jay
Roach. They both collaborated on the new film “Dinner for Schmucks.”

Jay Roach, you’ve had a great career doing comedies. You did “Meet the Fockers”
and “Meet the Family” and the “Austin Powers” films, but I really loved the HBO
film “Recount,” which you directed, which is the...

Mr. ROACH: Thank you.

DAVIES: ...dramatic recreation of the Florida recount following the 2000
election. You want to talk a little bit about making this stuff work on film?
It’s a complicated political and legal tale, and you’ve got to give it drama
and suspense.

Mr. ROACH: You do. But the story had so much built-in drama and suspense. It
was an incredible script by Danny Strong, and he just found a way, you know, to
keep you on the edge of your seat. It was really - I credit that script more
than a lot of what I did. And I – and then I - then the only thing I would say
that I tried to add to it was a little bit of humor. It was such an absurd
situation in so many ways, with some fairly absurd characters. And I find when
you – I like films where they cast people who can be funny and can find irony
in a situation to play very dramatic parts. So I, you know, casting people like
Kevin Spacey and Laura Dern and Denis Leary to me was kind of the secret to
having people pay a little closer attention because they knew it wouldn’t be
too serious.

DAVIES: Yeah. There’s a wonderful moment where the Denis Leary character and
the Kevin Spacey character are talking about butterfly ballots and hanging
chads. It’s like a minute that explains this and it works just beautifully.

Mr. ROACH: Oh thanks. Yeah, that was one of my favorite scenes too, which could
have been just really expositional, but those two guys found a way to turn it
into something. They improvised a little bit. We didn’t improvise much on it,
but that, some of that was Denis and Kevin just going off.

DAVIES: Right. And the visuals of actually illustrating what they're talking
about, which I think is your craft at work, was terrific.

Let’s listen to some of that scene.

(Soundbite of movie, “Recount”)

Mr. DENIS LEARY (Actor): (as Michael Whouley) Right now we're down by less than
2,000 votes. Meanwhile, there's a 175,000 ballots out there that their count
machines have declared non-votes, okay? So that's 175,000 uncounted ballots.

Mr. KEVIN SPACEY (Actor): (as Ron Klain) How does a thing like that even
happen?

Mr. LEARY: (as Michael Whouley) Because punch card ballots are (bleep)
primitive. You’ve got cardboard chad that get punched but don’t go all the way
through the holes so they're hanging at the end of the ballots.

Mr. SPACEY: (as Ron Klain) Hanging chads.

Mr. LEARY: (as Michael Whouley) Chad.

Mr. SPACEY: (as Ron Klain) What?

Mr. LEARY: (as Michael Whouley) There’s no S.

Mr. SPACEY: (as Ron Klain) The plural of chad is chad?

Mr. LEARY: (as Michael Whouley) That’s great democracy.

Mr. SPACEY: (as Ron Klain) Jesus.

Mr. LEARY: (as Michael Whouley) Yeah. So when you take these ballots, and you
put them through the tabulating system, who happens is the hanging chad get
pushed back into he holes and the machines read it as if the holes were never
actually punched. So then these are discarded as undervotes. But wait,
sometimes hanging chad don’t even hang, they're just dimpled.

Mr. SPACEY: (as Ron Klain) Dimpled.

Mr. LEARY: (as Michael Whouley) Yes. Okay. Which means that the voter didn’t
align the ballot properly in the machine or just didn’t push hard enough to get
the chad to go through to the other side.

Mr. SPACEY: (as Ron Klain) Well, how hard is it to punch a paper ballot?

Mr. LEARY: (as Michael Whouley) Pretty (bleep) hard when you’re 80-something
years old, you’re arthritic and you’re blind as a (bleep) bat. Unfortunately
for us, blind as a (bleep) bat tend to vote Democratic. Not to mention the fact
that the Votomatic sometimes these things don’t get cleaned up for years and
years and years, so they can get completely jammed up with chads.

Mr. SPACEY: (as Ron Klain) Chad.

Mr. LEARY: (as Michael Whouley) And the next...

Mr. SPACEY: (as Ron Klain) Sorry.

Mr. LEARY: (as Michael Whouley) The next thing you know it’s impossible for the
voter to actually penetrate it at all, so you just end up with dimpled chad. It
tends to happen in poorer neighborhoods where they don’t have up-to-date brand
new voting equipment. I don’t have to tell you who those people - generally
speaking – vote for. Okay? All I'm saying, Ron, is, we have to have actually
live human beings doing this recount. That’s where you...

Mr. SPACEY: (as Ron Klain) Well, what about Kristen Daly? They don’t want...

DAVIES: You know, doing a film on politics is such a minefield, particularly
with this many, you know, prominent and living characters.

Mr. ROACH: Yeah. Yeah.

DAVIES: And I know that and there was a lot of effort in the script to make it
historically accurate. Much of the dialogue is verbatim from first-hand
accounts. And many folks liked it, including James Baker, who was a key member
of the Bush team. But Warren Christopher was unhappy.

Mr. ROACH: Right.

DAVIES: Said that they'd invent – that the film had invented a character and
put his name on it.

Mr. ROACH: Yeah.

DAVIES: How do you deal with criticism like that?

Mr. ROACH: Well, I'm glad you asked me about that, actually, because I was
always puzzled by that. We – I got to listen to a lot of the interviews Danny
did and...

DAVIES: That’s the writer. Yeah.

Mr. ROACH: Danny Strong did, right, the writer. And, you know, and people have
come up to me since confirming that Danny got it right. I mean that there, a
lot of what happened in those rooms, a lot of what - the choice the Democrats
made, you know, which were, in my opinion, I mean I actually identified with
Warren Christopher because I, like him, believe that an election should be run
in a sort of statesmen-like way. And he was criticized for it at the time and I
suppose in the film, to some extent, for seeing it that way. But I wanted to
ennoble that and so I really rooted for him. But we – I still think we got that
right. And I was disappointed that that – that it came out that way, because I
just think it was not – I don’t think – I think he was worried about how he was
portrayed, but I wish he wasn’t and I think it was fairly portrayed.

DAVIES: Right. I mean just to clarify for folks who may not have seen the film,
and Warren Christopher was there to direct the Gore effort and his notion was
this needs to be a statesmen-like effort. We're not going to sue. It’s not a
street fight.

Mr. ROACH: Right.

DAVIES: And the Bush team, much more ready to mix it up and seeing this as a
political brawl that they had to win.

Mr. ROACH: Yeah.

DAVIES: If you’re just joining us, we're speaking with actor Steve Carell and
director Jay Roach. Their latest film is “Dinner for Schmucks.”

We have to talk about “The Office,” you know, the NBC series which - this is
seven seasons now, right? And it is the last. Is that right, Steve Carell, for
you?

Mr. CARELL: Not the last for the series.

DAVIES: For you? No?

Mr. CARELL: The last for me. Yeah. I want to honor my contract, and that was
always - my contract was always for seven seasons, and I want to fulfill that.
And then I just, I thought it was time to move on. I'd like to spend some more
time with my family. I have two little kids. And it just seemed like the time
was right for me.

But, you know, I've been asked this before. I think the show is incredibly
strong and the writers are great and the cast is really an ensemble. I've
always thought of myself as a member of this great ensemble cast, so I see it
as just one member of that ensemble sort of drifting off. And the show has
shown itself to be very resilient and, you know, to incorporate new characters
and new scenarios and storylines. So I have no doubt that it will continue to
be incredibly strong.

DAVIES: Well, that’ll be a challenge, losing this member of the ensemble, I
think. Why don’t we listen to a clip from a recent episode. This is Steve
Carell, our guest, playing Michael Scott, who has corralled the staff of the
Dunder Mifflin Company for another meeting that nobody really wants to attend.

(Soundbite of TV show, “The Office")

Mr. CARELL: (as Michael Scott) Who enjoys the weekends? Of course. Now, the
weekend is always great if you have someone, which I do. I have Donna. She is
hot. She has a Pilates butt. But we need to find something to do this weekend
beside have sex. Did I say that? Yes, I did. And the reason you are here is
that I need ideas for things that Donna and I can do on the weekends. So just
shout it out.

Mr. LESLIE DAVID BAKER (Actor): (as Stanley Hudson) I have an idea for your
weekend.

Mr. CARELL: (as Michael Scott) Okay.

Mr. BAKER: (as Stanley Hudson) Let me go back to my desk right now.

Mr. CARELL: (as Michael Scott) Okay. You get out of here, big dog. No, no, no,
no. You guys sit down. I need ideas.

Ms. JENNA FISCHER (Actor): (as Pam Beesly) Stanley got to go.

Mr. CARELL: (as Michael Scott) Yeah, well, Stanley doesn't help with anything.
Come on. Shout 'em out, shout 'em out.

Mr. ED HELMS (Actor): (as Andy Bernard) Walk around apple orchard.

Mr. CARELL: (as Michael Scott) Oh.

Mr. HELMS: (as Andy Bernard) Super romantic.

Mr. CARELL: (as Michael Scott) That's fun.

Mr. RAINN WILSON (Dwight Schrute) Eel fishing.

Mr. CARELL: (as Michael Scott) All right.

Mr. CRAIG ROBINSON (Actor): (as Darryl Philbin) Curl up with your favorite DVD.

Ms. KATE FLANNERY (Actor): (as Meredith Palmer) You and Donna should hit the
Poconos. They have heart-shaped Jacuzzis. Room enough for three.

Mr. CARELL: (as Michael Scott) We actually went to the Poconos last Tuesday. We
headed up there, we went to a little Chinese bistro, um, P.F. Chang's.

Ms. MANDY KALING (Actor): (as Kelly Kapoor) Why would you go all the way to the
Poconos to P.F. Chang's when we have the Great Wall in Scranton?

Mr. CARELL: (as Michael Scott) Because when your super-hot girlfriend says I
wanna go to Mount Pocono, you go to Mount Pocono.

DAVIES: Still funny to me.

(Soundbite of laughter)

DAVIES: Steve Carell in “The Office” with that ensemble cast. You really think
that your role could be replaced, all modesty aside?

Mr. CARELL: Yeah. I do. You know, I don’t even think it’s a matter of replacing
the role. I think it’s a matter of just sort of shifting the dynamic of the
show. I – and ultimately, I think it might not be a bad thing, because, you
know, I think shows can get complacent or audiences can become complacent about
them. And even if a show stays consistent and very high in quality, people get
used to it and then they want something else to happen. And I think this might
be a good thing.

DAVIES: And you’ve been making a lot of films. I mean you’ve been really,
really – are you going to stay as active making films?

Mr. CARELL: I would love to. Yeah. I mean that’s the hope. But you never know.
I don’t take any of it for granted. I'm very fortunate to have had this level
of success, so - I guess I'm always waiting for the other shoe to drop. I'm
always waiting for the career to go off the cliff, so I'm prepared. If it does,
I'm fine with that and I've had a good run. So - but yeah. I mean I'd love to
continue to work. It’d be nice.

DAVIES: Well, you'd said you wanted to spend more time with your family and...

Mr. CARELL: Well, that’s just to engender good will and sympathy.

DAVIES: That’s what you say when you really don’t want to explain why you’re
leaving “The Office"?

Mr. CARELL: That’s right. Yeah. It’s...

(Soundbite of laughter)

Mr. CARELL: I don’t even remember my kids' names.

(Soundbite of laughter)

DAVIES: Steve Carell, Jay Roach, thanks so much for speaking with us.

Mr. CARELL: Thank you.

Mr. ROACH: Thank you.

GROSS: Steve Carell and Jay Roach spoke with FRESH AIR contributor Dave Davies.

Carell stars in the new movie “Dinner for Schmucks,” Roach directed it. The
film opens this Friday. You'll find links to clips from the film on our
website, freshair.npr.org.
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Sugar Pie DeSanto: After 50 Years, 'Go Going' Strong

TERRY GROSS, host:

The early 1960s was a great time for female rhythm and blues singers, with
talents like Etta James, Betty Everett, Koko Taylor and Irma Thomas, to name a
few. One of the most unusual was an athletic young woman who stood four feet 11
inches and was half Filipina, called Sugar Pie DeSanto.

Rock historian Ed Ward has her story.

(Soundbite of music)

Ms. SUGAR PIE DESANTO (Singer): (Singing) I see you looking, darling. You dig
what you see? I know what you think. There ain’t much of me. I ain’t got big
hips. Tiny little waist, and I ain’t 38 no place. But I got every - everything
I need. Yes, it’s gonna keep my man satisfied now. ‘Cause if you know how to
use what you’ve got, it doesn’t matter about your size.

ED WARD: Sugar Pie DeSanto was born in Brooklyn in October 1935 and was
christened Umpeleya Marsema Balinton. Her father was Filipino, her mother
African-American. Her mother had been a concert pianist, but Sugar Pie says her
father couldn't carry a tune in a bucket. He moved the family to San Francisco
when Peliya, as they called her, was four, and soon enough the young girl
discovered dancing and singing and made a fast friend with a neighbor named
Jamesetta Hawkins, who was a member of a girl gang called the Lucky 20's.

Jamesetta wound up in jail for her gang activities, and when she got out, she
formed a singing group with one of Peliya's younger sisters. Peliya looked on
in envy as Jamesetta was discovered by bandleader Johnny Otis and re-christened
Etta James.

She started entering talent contests in San Francisco and won so often, they
told her to stop entering. At another talent contest in L.A., Otis saw her
again and offered to record her. He made good on his offer, and gave her a
stage name too: Little Miss Sugar Pie.

She continued to record throughout the late '50s, often with her husband Pee
Wee Kingsley, and they finally found success with a song called "I Want to
Know" on an Oakland-based label, Check. Shortly thereafter, their marriage fell
apart, and Sugar Pie went to Chicago, where Chess Records had offered her
$10,000 to record for them. She signed in 1962, but didn't see any success
until 1964.

(Soundbite of song)

Ms. DESANTO: (Singing) Baby, my red dress in the cleaner, but (unintelligible)
baby, my red dress in the cleaner, child. But my (unintelligible) will steal
the show. Yes, it's fitting, child. It's fitting, and it ain't the back that's
cut too low. Ain't wearing my high-heel sneakers.

WARD: Riding on the back of Tommy Tucker's "High-Heeled Sneakers," "Slip-in
Mules" told how sneakers hurt De Santo's feet, but not to worry: She'd be the
hit of the dance anyway. Then the hits kept coming: "Use What You Got" and
another song about clothing.

(Soundbite of song, “Soulful Dress")

Ms. DESANTO: (Singing) I'm going to put on my dress and go get some folks
(unintelligible). Get that tight-skinned waist and that low neck line. Lord,
I'm going to the party. Gonna have some fun. Gonna shake and shout until the
morning come. If you want to keep your man, you better get as sharp as you can.
I’ll be at my best when I put on my soulful dress. I'm gonna to...

WARD: “Soulful Dress" is probably Sugar Pie's best-known song these days, not
least because Texas songstress Marcia Ball has had it in her set for years, but
it also established Sugar Pie’s persona: an assertive young woman who took no
mess. With this and its successor, "I Don't Wanna Fuss," hitting the charts,
Sugar Pie went off to tour Europe, and they're still talking about her shows -
wild dancing and standing back flips included - and her using martial arts on a
hefty guy who invaded the stage in England.

Back in Chicago, she met Shena DeMell, an unsuccessful songwriter who was the
girlfriend of one of Chess's most successful ones, Billy Davis. In no time, the
two women had written a strong song - too strong for one woman to sing, but
just strong enough for two, if the other was Etta James.

(Soundbite of song)

Ms. DESANTO AND ETTA JAMES: (Singing) I don't want to believe the bad things
about you. Oh no now. ‘Cause if they are true, I'd have to get along without
you. Oh, oh now. I said the word is out on you. It’s all about the things you
do. Moving and a grooving, using and fooling, chasing around every skirt in
town. If it’s true, you'll be on your way. Do I make myself clear? Do I make
myself clear? I said you...

WARD: That hit the Top 10, so the duo did another one, which evoked the years
when they ran for Lucky 20s.

(Soundbite of song, “In the Basement")

Ms. DESANTO AND ETTA JAMES: (Singing) Oh, now tell me where can you party,
child, all night long? In the basement, down in the basement, yeah. Oh where
can you go when your money gets low? In the basement, whoa down in the
basement. Well, if a storm is taking place, you can jam and still be safe in
the basement. Yeah, yeah, yeah, yeah.

WARD: But this didn't do as well, and Sugar Pie DeSanto went back to writing
some more with Shena DeMell. Her next record was a result of that
collaboration.

(Soundbite of song, “Go Go Power”)

Ms. DESANTO: (Singing) I've got that go go power. I'm gonna kick off my shoes
and dance. I've got that go go power, now. I'm gonna kick off my shoes and
dance. Going to get up from my seat, yeah, and I feel it that heat. Dancing my
flapping feet. Ooh and I go, go, go, go, go. Yes, Lord, till the break of dawn.

WARD: “Go Go Power” didn't chart, and it was Sugar Pie's last record for Chess.
Sugar Pie kept on writing songs and recorded for a few more labels without much
success and eventually moved back to the Bay Area, settling in Oakland. She's
been married twice to Jim Moore, her current husband, who's 17 years younger
than her; he also manages her as she continues to perform - not only in clubs
in California, but in blues and jazz festivals all over the world.

In September 2008, she was given a Pioneer Award by the Rhythm and Blues
Foundation. When it was time for her to perform, she kicked off her shoes and
did a back flip.

GROSS: Ed Ward lives in the South of France. He reviewed Sugar Pie Desanto, “Go
Go Power: The Complete Chess Singles, 1961-1966.”
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