The lay Wit by Sussie Monahan - Essay Example

?The play Wit (W;t) by Margaret Edson won the Pulitzer Prize for drama in 1999. Margaret Edson wrote her play after she had an experience working at the AIDS-oncology research hospital as a unit clerk. Though it might be a very low-level job in a hospital, but it gave the author an opportunity to witness many things first hand, both the actions of doctors and caregivers as well as reactions and feelings of patients. There are many themes that are brought to the light, vital themes for any human being. The lead theme of the play is the topic of life and death, Salvation Anxiety, lives’ values, human relationships, dignity etc. However, there is much more to the play. It stirred widespread interest among not only general public and critics, but also attracted a lot of attention of the physicians. The play was reviewed in medical journals – a very rare occurrence for a play. Furthermore, the play being used in the curriculums of medical students to improve the patient cares. There are number of issues being pointed out – the balance between therapeutic care for the patient and having him as an object of medical research; medical ethics, relationships between doctors and patients. However, the author also reflects on the role nurses have in a medical system. Susie Monahan, the primary care nurse, does not have any higher education than a nurse school. Unlike doctor Jason Posner, she never attended the university and do not know anything about poetry – the specialty of the patient she is taking care of, professor Vivian Bearing. And at times Susie has to face it – there are times when her lack of education is pointed out in some way, like in conversation she had with Vivian before giving her injection of morphine. VIVIAN.I trust this will have a soporific effect. SUSIE. Well, I don’t know about that, but it sure makes you sleepy. This strikes VIVIAN as delightfully funny. She starts to giggle, then laughs out loud. SUSIE doesn’t get it. SUSIE. What’s so funny?...Oh! It’s that ‘Soporific’- means ‘makes you sleepy’. SUSIE. It does? (p.48) In Mrs. Bearing’s flashback, this very word brought a joy of discovery when she was a child, and launched her career. Susie was happy this blunder brought some joy to the suffering patient, she joked about her own ignorance. (p.48) Mrs. Bearing being subjected to a number of tests, examinations and treatments become just a research object for doctors, who treat her with great indifference and very impersonally. A distant formal greeting and a formal answer, - “How’re you feeling today?” – “Fine” - that is an usual interaction between Vivian and her caretakers despite her obvious condition and circumstances. At times young Dr Posner has to be reminded that Vivian is a human and has to be treated accordingly. Susie Monahan is always polite with her patient, even if it might seem useless to Posner. “JASON. Like she can hear you. SUSIE. It’s just nice to do.” (p.49) The only comfort Dr. Bearing receives is from the primary nurse, the only one who actually cares for Vivian in any real sense especially when the physical and emotional pain and agony become unbearable. Susie simply wants to give health care that is in line with her professional obligations and with basic human decency. Susie notices no one visits Vivian, she offers to call anyone dear to Vivian and finally, promises she will “just pop [her] head in every once in a while to see how you’re coming.” At first, the display of kindness made Vivian uncomfortable, when Susie offered: “If there’s anything you need, you just ring” (p.21) But then with time two women form a bond, even though they are so different. This very bond provides Vivian emotional and physical support. The special relationship between the nurse and the patient was very beneficial for Vivian Bearing - a very strong woman; she walked through life all alone, having no one caring for her. She is fascinated by the words and their meanings, all through her life she thought that “being extremely smart would take care of it”. (p.45) Yet, in her time of greatest distress and being “taught”, (p.23) she does appreciate Susie kindly taking care of her. VIVIAN: Now is not the time for verbal swordplay, for unlikely flights of imagination and wildly shifting perspectives, for metaphysical conceit, for wit. And nothing would be worse than a detailed scholarly analysis. Erudition. Interpretation. Complication. Now is the time for simplicity. Now is the time for, dare I say it, kindness. (p.45) Susie is the one to give her comfort when Vivian realizes that her life is out of her control (p. 42) and she is going to die, and the torment, helplessness and fear bring her to tears. Susie also brings her popsicle – a treat that can also bring a physical relief. (p. 43) This is one of two meaningful interactions Vivian had – the other one being a visit from her former professor and mentor, E. M. Ashford. (p.51) All these interactions help build therapeutic relationships between Susie Monahan and Vivian Bearing – a very important ingredient in the medical treatment process. Mitchel & Cormack summarise the concept of therapeutic relationships by saying that “patients themselves value therapeutic relationships which offer respect, trust and care and it seems that such relationships may in themselves prove to be healing in the broadest sense.” (1998, p. 50). Once proud and arrogant professor finally learns to appreciate care she gets and it becomes very important for her. She learns to value Susie’s opinion. (“Susie says that I need to begin aggressive pain management”, p.46) With Susie’s help she makes a decision to signs a “do not resuscitate” order. But what was more important to her, she asks Susie “You are still going take care of me, aren’t you?” (p.45) Simply having Susie taking genuine care of her brings Vivian relief. There is a hierarchy in clinic, obviously, with Dr. Kelekian being superior, then there is young Dr. Posner and then there are nurses. Kelekian and Posner do feel their importance and allow themselves to show it at times in their interactions with each other, with patients and with nurses. Both of them are researchers. They feel they are “above” clinicians – simple doctors and nurses. As Dr. Posner puts it, “They want us to be able to converse intelligently with the clinicians. As though researchers were the impediments. The clinicians are such troglodytes.” (p.37) It is impossible to overestimate Monahan’s role in the clinic. She is well trained nurse, and she sincerely cares for her patients. It is obvious, at times she disagrees with the decisions doctors make concerning the treatment or the doses of medications and chemotherapy. Susie: (following Jason) I think you need to speak to Kelekian about lowering the dose for the next cycle; it’s too much for her like this. JASON. Lower the dose no way. She can handle it. She’s tough. She can take it (p.23) Some things doctors do not care to do themselves – like telling the patient the truth that her treatment was not successful and she will die, or presenting her with the choice of being resuscitated or not. For doctors “She is Research!” (p.54), whereas Susie sees Vivian’s suffering and respects her as a human being, even though Vivian “was not cupcake [in the hospital] either.” (p.49) She does not need to ask poor patient “Are you in pain?” (p.47) to see the obvious and to add to her suffering by being so insensitive. Susie also considers it her moral obligation to let Mrs. Bearing know of the choices whether she would want to be kept alive or, considering all the pain, she would prefer to be “DNR”. These issues were neglected by Dr. Kelekian and Jason and left to Susie to deal with. Doctors “like to save lives. Anything’s ok, as long life continues”. But, as Vivian put it “you don’t agree about this?” (p.44) However, even though Susie does not always agree with doctor’s actions, she is always respectful of them and never allows herself to rebel as she knows it will not be to the benefit of her patients. Then, there comes the time for a patient advocacy. The nurse should indentify the unmet needs of the patient and then act appropriately. According to Janie B. Butts and Karen Rich, Nurses are called on to assure that all appropriate parties are involved in patient care decisions, that patients are provided with the information needed to make informed decisions, and that collaboration is used to increase accessibility and availability of health care to all patients who need it (p.42) Susie Monahan does exactly that. She presents Vivian with the options of resuscitation and helps her to make decision. At different time Susie confronts Kelekian about allowing Mrs. Bearing to use Patient-Controlled Analgesic, when the situation warrants it. SUSIE. But what about Patient-Controlled? She could be more alert – KELEKIAN – (teaching) Ordinary, yes. But in her case, no. SUSIE. But – KELEKIAN (to SUSIE) She’s earned a rest. (p.47) The other time Susie openly resists doctor Posner when he is trying to resuscitate Vivian despite her request to die peacefully. Monahan has to block him from the body and remind him of Vivian’s wish. All these issues and more make the play Wit a valuable study subject of relationships between doctors, nurses and their patients. References: Butts, Janie B. and Rich Karen Nursing ethics: across the curriculum and into practice.Jones & Bartlett Learning, 2005. Print Edson, Margaret. Wit. Nick Hern Books. 2000.Print Mitchell A & Cormack M. The Therapeutic Relationship in Complementary Health Care. London: Churchill Livingstone.1998. Print Read More