Playwright Jacob M. Appel, in his program notes for Causa Mortis or The Medical Student, suggests that his plays are defined by "strong female characters." I disagree. At the Detroit Repertory Theatre's world-premiere production, what I saw was shrill female characters.

The script is undoubtedly funny; it is madcap, full of jokes. I could envision a version of this show that attempted to bring out the humor through character and relationship, although there is only one relationship of note here. In the absence of a grounded approach, as in this production's larger-than-life presentation, an ensemble needs to perfect its timing and polish every joke in order to keep the audience laughing every instant. Once again, what I saw came up short; instead, the thinly sketched, stressed-out characters barked at each other for occasional laughs. 

In a generic American hospital, patient Eleanor Powell (Sandra Birch) is refusing surgery to remove a wristwatch from her brain, where it has lain dormant for decades. To the consternation of her daughters (Leah Smith and Kelly Komlen) and a bumbling new medical student who can't catch a break (Lisa Lauren Smith), she intends to stay hospitalized indefinitely in the company of her newest roommate (Yolanda Jack), who has recently come down with quadriplegia and retrograde amnesia. In a series of predominantly two-person scenes, the daughters take turns arguing with their mother, with the hospital staff, and with each other; the medical student endures a series of dressings-down from the chief surgeon (Deborah Carter); and a complex maybe/maybe not plot delivers quite a few surprises.

Birch is easily the most comfortable balancing over-the-top characterization with carefully timed bits and jokes; as the wackiest of the cast, she's almost exhausting to watch. My favorite scenes were between her and Jack, as Eleanor taught the new patient the ropes of the hospital. These two were the only ones to relate with affection, a welcome change from the cutthroat, high-stakes feeling of almost every other interaction. Deborah Carter, as Eleanor's surgeon, struck an imposing figure, but frequently struggled with the cadence of the language to the detriment of her comedic timing.

Director Bruce E. Millan seemed content to throw everything at the audience and see what sticks. Although the time is defined as the present, the surprisingly literal, somewhat crowded set, the sound design, and the costumes were all reminiscent of the 1980s — another detail that could have been milked for humor but was instead not justified at all. (Another reviewer mentioned chuckling at the use of the St. Elsewhere theme, for which I may be a bit too young.) I wanted to be wowed by this hyperreality; unfortunately, for every joke that landed, I saw another fly by that could have required a hold for laughs.