Olga Krasnobay-Oganezov, RN
Analysis and Personal Reflection of Wit
Pro Nursing Practice NUR 4130 OL64 (35884)
Due Date: 03/11/2019
“You have cancer” – the most horrible words one can hear. These words open a movie Wit, the story of a 48-year-old Dr. Vivian Bearing, who is diagnosed with stage IV metastatic ovarian cancer and is supposed to undergo painful, experimental treatment. The drama takes place at the research hospital where an accomplished professor and scholar of seventeenth century poetry spends her last weeks of life and finally finds peace.
Throughout the movie, Vivian mostly interacts with the healthcare personnel; despite her scholarly accomplishments, she has lived an isolated life, admiring the company of books rather than people. Her main interactions are with Dr. Kalekian – primary oncologist, head of the research, sober and determined “troglodyte”; Dr. Posner – research-oriented resident, “result-hungry “overachiever, former Bearing’s student; and nurse Susie – warm, comforting and patient-focused.
From the very first scenes, it becomes clear that Ms. Bearing is perceived and addressed differently by her caregivers. I believe that a choice of words can affect patient-caregiver interactions to the point of achieving therapeutic communications or a lack of thereof. Dr. Kalekian addresses professor Bearing as Dr. Bearing and not by her first name. This pure act of professional respect and scholarly dedication leaves the patient no chance to refuse the rigorous course of treatment or even question it. She would do anything to aid a fellow researcher in his project. However, Vivian does not understand till later how painful it would be to become a research sample and stop being a patient. Dr. Posner is very uncomfortable in his one-to-one communications with professor Bearing, he calls her professor in their first encounter during the physical exam – he is not hiding his callous lack of compassion to her as a human being from the very beginning. At the very end, when Vivian dies, he makes a daring attempt to resuscitate her against Vivian’s will simply because “she is research!” – at this moment, the viewers realize that the heroic attempt had to do with the fear of loss of his precious data and not the emotional connection with his former literature professor. The treatment that she gets from her doctors is depersonalized in nature. During Grand Rounds, Ms. Bearings makes a bitter observation, “What we have come to think of me is, in fact, just the specimen jar, just the dust jacket, just the white piece of paper that bears the little black marks.”
The only person who treats Vivian with dignity and respect is nurse Susie. The nurse neither dehumanizes nor does she patronize her patient. Susie treats Vivian the way she wants to be treated. In the beginning of their relationship, Susie addresses Vivian as Ms. Bearing, and closer to the end, as their relationship become more intimate and personal, they switch to first name basis. For the nurse, the scholarly titles are meaningless, she sees her patient beyond the letters after her name and treats her with respect, compassion and human kindness. Vivian makes the whole speech about how meaningless the question “How are you feeling?” becomes in patient-doctor interactions. However, she opens up to her nurse and expresses her exact feelings of pain and fear. Susie is always able to find a minute to console Ms. Bearing in a way of holding her hand, offering her a popsicle, spending time talking to her, and, finally, addressing the most difficult topic – Vivian’s code status. The fact that Susie is the one who brings up the DNR topic shows how deeply she cares for Vivian. Why did none of the doctors address the advance directives questions? Did they not know that the possibility of a cardiac arrest is very tangible in Vivian’s case? The answers are veiled and implicit – the doctors are more than aware of the situation; however, Vivian’s life is too valuable for research purposes. At some point of this ethical dilemma, “do no harm” got overpowered by “anything for the research”. With this development, the nurse has to assume a role of a true patient’s advocate – she sees her patient past her research status and explains to Vivian what could be done if her heart stops. Most importantly, she assures Ms. Bearing that it is OK to stop fighting and accept her fate even if this decision affects the research. It seems that Vivian desperately needed this reassurance and permission to stop fighting. In this emotional moment, Susan promises Vivian to be with her till the very end. Susie fulfills her promise in the most dramatic scene of the movie when Vivian’s heart stops. This moment is not a quiet and peaceful one. Nurse Susie has to rise up against the code team’s effort to resuscitate the patient against her will and forcefully cancels the code. Even though the script does not allow Susie to show her intellectual side, she portrays what a real nurse should be – caring, fearless, and kind.
This movie raises many ethical issues. The one that stroke my soul the most was the ignorance of medical team toward patient’s resuscitation wishes. I am extremely sensitive to this topic because cardiac arrest codes are a big part of my everyday ICU practice. We, as the ICU team, never push families into signing DNR for their loved ones. In contrast, we approach this topic slowly and carefully, with great degree of sensitivity. If the family decides to go through with the DNR status, we make sure that the patient goes comfortably with all the support he or she might need; moreover, we make sure the whole medical team is aware of the code status. Codes are idealized and glorified on television to such extent that the viewers (who become patients later) do not know what to expect. They know nothing about the fact that every code holds a 50% chance of their loved one not to wake up regardless how long the code was, or how many ribs are usually cracked during CPR, or that the chances of puncturing lungs with the rib fragments are 68%. Patients and families need to be educated about the codes to make informed decisions. Nurses and doctors need to work together to address this ethical issue and make the practice more humane and respectful.
