Dec 11, 2005 08:25 AM
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(Updated Dec 11, 2005 08:25 AM)
Nurses have the obligation to be mindful of a client’s humanity. In the play W;t, how one can be denied basic human needs as they undergo a health crisis is overpoweringly examined. The care we provide, as nurses must go beyond the problem that one may be experiencing. We must never forget that this patient is a person not a condition. This individual does not always understand fully the situation that they may be in. Those individuals will have many questions and many fears as a result of not having a total understanding of the situation that has developed for them. This play would be a very good resource for nursing students because it shows both the decent aspects of caregivers as well as the harmful facets of healthcare providers.
Reading the cover of the play W;t we discover it is the award winning, first effort of author Margaret Edson. The lead character is Vivian Bearing, Ph.D. Dr Bearing is a hard driven professional educator who zealously instructs her pupils on seventeenth century poetry. I would call her a hard-nosed bookworm. In this play the tribulations of Dr. Bearing are examined as she enters the realm of healthcare. Dr. Bearing must come to terms with her diagnoses of Stage four ovarian cancer and the resultant prognosis of the condition being terminal in nature. The difficulties she faces as a result of the disease and the treatment of the disease are pronounced. However, her primary battle seems to be the maintenance of her dignity and stature as a person.
The first interaction between characters within the play give an indication of what is to come for Miss Bearing. Dr. Kelekian, Vivian’s oncology researcher specialist, blurts out to her that she has cancer then asks her to take a seat (p.7). This is an example of how Vivian is not at the center of the doctor’s concern. Her feelings were not considered or how one may take the best precautions to protect her mental state of being. Dr. Kelekian took no measures to prepare her for this potentially devastating and life altering news. Kelekian continues to use pompous medical terms to describe Vivian’s condition and what methods of treatment exist for that condition (p. 8-9). He did not take the time to explain things in layman’s terms. He uses medical terminology that is beyond the comprehension of the common person. Kelekian asks Dr. Bearing to sign an informed consent for treatment to begin (p. 11). An informed consent is not simply a document to grant permission for a procedure. An informed consent describes every procedure that will be done and every side effect from any prescribed treatments. She was not given all the information she needed to make a sound judgement call. Vivian believed she was going to be cured of the disease (p66). Dr. Kelekian withheld the information that she was terminal. This was probably done to procure a test subject for his research rather than alleviate or lessen her suffering. As nurses we need to preserve a client’s right to choose. In order to promote a client’s ability to choose we must provide all information we can on every foreseeable aspect of the care they will receive within the scope of our practice.
Another failing of the healthcare providers becomes evident during doctor’s rounds. Dr. Kelekian and his students come in to check up on Vivian, her progress and her treatment history. They did not explain to her what they were doing and why they were doing it. They went ahead and did whatever they liked and spoke as if she were not in the room. This behaviour towards her is another example of her dehumanization by members of the healthcare system. They have not acknowledged her as being a person; therefore they have transformed her into the treatment itself. Her former student Jason, is directly involved with her treatment. He also has difficulties in providing holistic care. He must be directed to interact appropriately with his patient (p. 40).
Not everyone in this play displays these negative characteristics at all times. It is interesting that it is the physicians that demonstrate the lack of the quality of caring. At one point Jason asks the primary care nurse, Susie “What do they teach you at nursing school?” (p.78). Jason does not grasp the art of transcendence care. Jason is focused on the science of providing care. Oxford Canadian Dictionary of Current English defines care in two ways (p. 115). It first defines care as the process of looking after something or someone. It then defines care as serious attention in doing something properly or safely.
Susie exemplifies the art of caring. She is genuinely interested in Dr. Bearing’s state of being. She is not just present and in the room with Vivian. Susie takes the time to discuss events with Miss Bearing. Susie takes the time to develop a trusting rapport with Vivian (p. 64-69). If Susie shows a fault it is her using the term “sweetheart” when conversing with Vivian (p. 64). This term is too familiar, it is one that does not promote the professional relationship nurse’s must create with their patients. Professional nurse’s should not use first names or slang terms such as ‘dear’, ‘sweetheart’ or ‘grandma’.
Susie is also advocating for her patient. When Vivian’s pain surpasses her tolerance levels she informs Kelekian about her present lack of pain management (p. 71). Susie suggests it may be time for Patient Controlled Analgesic or PCA. This would allow Vivian to administer pain medications to meet her pain needs. The other added benefit would be that Vivian would remain lucid. She would continue to have the ability to interact with her environment. Dr. Kelekian believes that “She’s earned a rest” (p. 72). Kelekian orders 10mg pushed intravenously every hour. This dose is quite high and may be beyond therapeutic effect. It would effectively cause a decrease in level of consciousness and promote sleep. This is an ethically questionable action by Dr. Kelekian and one that Susie recognizes as such. Susie tried to get Kelekian to order the PCA, but to no avail.
As nurses we have many responsibilities that we must be dutiful to. It has to be our foremost premise to our practice that our patient’s needs are paramount. We must be able to recognize when and what actions need to be taken. Each person must be treated with all the respect and rights inherent to being a person. We must treat our patients as we would be treated. W;t is a fantastic demonstration of the importance of maintaining the autonomy and sanctity of a person’s being. A person is not the condition or the disorder with which one is stricken. A patient is ever present and all hearing. They hear everything that is said, whether they appear lucid or not.
W;t should be read and experienced by all healthcare providers. Its message is palpable to the senses and the heart. It is a fine display of what should and should not be done by healthcare providers.
