Monthly Archives: January 2016

Wicked Problems at the Movies III: “Wit”

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January 11, 2015

 

Nonpersons unperson persons.
                 William Gass

Real persons reperson unpersons.
                 Joseph Bentley

“You have cancer” are the first words that Vivian Bearing hears  from her oncologist, Dr. Harvey Kelekian.  ”It was something of a shock” she says,  ”I had to sit down.”   Dr. Kelekian,  looking up from his papers and seeing her for the first time,  says “Oh, yes, please sit down.”

Vivian Bearing, Ph. D., is the principle character in the movie Wit, adapted from the play by Margaret Edson.  Bearing is a renowned professor of English, an international expert in interpreting the Holy Sonnets of  the metaphysical poet John Donne, and a patient with newly-discovered stage-four, inoperable, ovarian cancer.

“Please sit down,  Miss Bearing,”  says Dr. Kelekian.  ”You have advanced  metastatic cancer.”  Without a pause he continues, “You present with a growth that, unfortunately, went undetected in stages one, two, and three.  Now it is an insidious adenocarcinoma…In invasive epithelial carcinoma the most effective treatment modality is a chemotherapeutic agent.  We are developing an experimental combination of drugs designed for primary-site ovarian, with a target specificity  of stage-three-and beyond experimentation.  You will be hospitalized as an in-patient  for treatment each cycle. You will be on complete intake-and-output measurement for three days after each treatment to monitor kidney function.  After the initial eight cycles, you will have another battery of tests.  The antineoplastic will inevitably affect some healthy cells, including those lining the gastrointestinal tract from the lips to the anus, and the hair follicles.  We will of course be relying on your resolve to withstand some of the most pernicious side effects.”

As we watch Professor Bearing slowly come to terms with the”insidious” tumor that is growing within her, and is destined to kill her, we become aware that she and Kelekian are living in two completely different worlds.  Bearing’s orderly and controlled world is shattered by news that gradually leads her to an awareness that she, the world’s foremost expert in the seventeenth-century poetry of death (“Death be not proud” is one of Donne’s most famous lines)  is soon to die herself.

On the other hand, Kelekian is delighted!  He sees sitting before him, not a human being, not a distinguished professor whose life will soon come to an end, but a research subject!    What is important, he tells her, “You must be very tough.  Do you think that you can be very tough?”   Kelekian wants her to hang on and not give up, not because her life has value, but because he needs the data that her treatment will generate.  ”The important thing is for you is to take the full dose of chemotherapy,” he continues.  ”There may be times when you’ll wish for a lesser dose, due to the side effects. But we’ve got to go full-force.  The experimental phase has got to have the maximum dose to be of any use…As research, it will make a significant contribution.”

Near the end of the movie,  Vivian Bearing,  suffering the horrible side-effects, not of her disease, but of the treatment for her disease, finally understands.  Speaking to the audience, she says:

I don’t mean to complain, but I am becoming very sick.  Very, very sick.  Ultimately sick as it were… I have survived eight treatments of Hexa-methophosphacil and Vinplatin at the full dose, ladies and gentlemen.  I have broken the record.  I have become something of a celebrity.  Kelekian and Jason are simply delighted.  I think they foresee celebrity status for themselves upon the appearance of the journal article they will no doubt write about me.
 
But I flatter myself.  The article will not be about me, it will be about my ovaries.  It will be about my peritoneal cavity, which, despite their best intentions, is now crawling with cancer.  
What we have come to think of as me is, in fact, just the specimen jar,  just the dust jacket,  just the white piece of paper that bears little black marks.
 

“Nonpersons Unperson Persons”

“Nonpersons,” a term coined by writer William Gass,  is reserved for those who consistently see  other people as objects and use them for their own purposes. People are useful to them as ways to further their own goals.  They have with little or no awareness that “patients” or “clients”  at the same time are human beings who deserve to be treated with respect and compassion.  In their treatment of Vivian Bearing, Dr. Kelekian, and the senior oncology resident, Jason Posner, are “Nonpersons.”  They are unable or unwilling to go beyond their perception of her as a source of data for their research. What they lack is a balanced view of Vivian as a patient with an incurable illness and  a human being who is suffering.  They objectify her, and rather than a person, she becomes the data they record on her chart.  They are anxious that she live, not because her life itself is valuable, but because the longer she lives the more data will be generated.

“Nonpersons unperson persons,” writes Gass.  Treating people as if they were objects to be used often changes how people see themselves, especially vulnerable ones such as young children or people who are ill.  When they are treated as if they were “unpersons,”  especially by people in positions of authority or who hold power, they begin to see themselves that way. This is what happens to Bearing. Because of how she was  defined by “research medicine,” she is”unpersoned”  - “It’s not about me, it’s about my ovaries.”  She comes to understand that her treatment had nothing to do with her, but only with what happens when the chemicals come into contact with her tumor. What has value to the doctors is her cancer and the results of the experimental treatment.   For them, the renowned, educated, complicated, interesting person known as  Vivian Bearing has no value.  In fact, as a person, she doesn’t even exist.

Early in the play Dr. Bearing tells the audience that what follows will be ironic:  ”Irony is a literary device that will necessarily be deployed to great effect,”  she says.  The irony becomes apparent when, through flashbacks, we learn that when Dr. Bearing is teaching and counseling her students, she also assumes the role of  Nonperson.  She does not, perhaps cannot, see them as young people struggling with difficult and complicated ideas, but only as uninvolved,  uninterested, even lazy students who sit in her classroom. And so that is how she treats them.  She is shocked when she overhears several students talking about how she makes them feel inadequate and stupid.

“Real Persons Reperson Unpersons”

“Real Persons” occupy a different realm.  They are those people who perform their organizational roles competently and successfully and at the same time understand that behind the presenting illness, the apparent weakness, or the repeated mistakes, there is a unique human being who has value and who deserves to be treated with dignity. The “treatments” they offer are not only professionally appropriate, they are delivered with compassion and understanding.

Many people who appear in hospitals, clinics, social service settings,  or classrooms, are “unpersons.”  When young, they were  damaged by their parents or by incompetent people in impersonal systems.  When older, they often make bad choices which lead them into punitive, uncaring, and unforgiving institutions. It is the “Real Persons” in these institutional environments who not only treat the patient or process the delinquent, but also, because they are able to see the person behind the problem, begin a process of  ”Repersoning.” The act of reaching out with compassion and understanding toward another person can change the story, allowing a process of “Repersoning” to begin.

“Real Persons” Appear

In the movie Wit we are offered an opportunity to watch this happen.  In the early part of the movie we are introduced to the “Nonpersons” who are in charge of the care and treatment of Vivian Bearing.  Later,  we become aware of  people who treat her very differently – Real Persons.  And it is Bearing herself who partially makes this possible.  For the first time in her life, she invites other people to move closer to her.   Terribly ill, and near death, she realizes that she wants and needs other people to care for her, and so she allows others to see her as weak, vulnerable and needy.  In a aside to the audience she says “Now is not the time 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 a time for simplicity.  Now is a time for, dare I say it, kindness.”

What she is hoping for are Real Persons: those who can see her as a valuable and worthy person who is suffering, and who will reach out to her in her worst moments with kindness and affection.

The Nurse and the Professor

The first “Real Person” who appears is someone she already knows.   Susie Monahan is the nurse who has been responsible for Vivian Bearing’s care since her first admission to the hospital and has done so with professional skill and competence.

And then, in a dramatic shift, Vivian Bearing says to Susie, “I’m scared,” and begins to weep.

“Oh honey, of course you are,” says Susie.

“I want….I don’t feel sure of myself anymore,” says Vivian.

“And you used to feel sure.”

“Oh yes, I used to feel sure.”

“Vivian,” says Susie, calling her for the first time her by her name, “It’s all right.  It hurts.  I know.  It’s all right.”  There is a silence and then Susie says, “Vivian, would you like a popsicle?

“Yes, please,” says Vivian.  Since the chemo killed epithelial cells in her GI tract, popsicles are about the only food she can digest.

Susie returns a few moments later with a popsicle, unwraps it, and then after a moment’s hesitation, breaks it into two halves, gives one to Vivian and keeps one for herself.  And as they share a popsicle,  they begin to talk like two people – friends – and not as nurse and patient.

“When I was a child,” says Susie, “we used to get these from a truck.  The man would come around and ring his bell and we’d all run over.  And then we’d sit on the curb and eat our popsicles.”

“It sounds nice.”

Suddenly the conversation shifts to a new level.  Susie goes beyond her role as a professional caregiver and decides that Vivian should know the truth.

“Vivian, there’s something we need to talk about, you need to think about.”

“My cancer is not being cured, is it,” says Vivian.

“Huh-uh,” responds Susie.

“And they never expected it to be, did they.”

“Well,” answers Susie, “they thought the drugs would make the tumor get smaller, and it has gotten smaller.  But the problem is that it started in new places too.”

After a pause, Susie says, “What you need to think about is your ‘code status.’  What you want them to do if your heart stops.”  Susie goes on to explain that she could request Code Blue which means a crisis team will rush in and start her heart again, or she could choose Do Not Resuscitate, “so if you heart stops we’ll …well, we’ll just let it.”

Finally, after a few moments, Vivian makes her choice:  ”Let it stop.”

“Okay,” says Susie, “I’ll get Kelekian to give the order and then…”

Vivian interrupts her:  ”Susie…you’re still going to take care of me aren’t you.”

” ‘Course, sweetheart.  Don’t you worry,” answers Susie.

The second Real Person who appears is Vivian Bearing’s professor from graduate school, Dr. E. M. Ashford, now in her 80′s.  Earlier in the film, we learned that their relationship as professor and student was distant, cold, austere, and demanding.  As she enters Bearing’s room,  Ashford explains that she was in town and, learning that Vivian was in the hospital, comes to see her.

“Oh, I feel so bad,”murmurs Vivian.

“I know you do.  I can see,” says Ashford.  As Vivian cries even harder,  she says  ”Oh, dear, there, there.  There, there.  Vivian. Vivian.”

And then, in a moment of almost unbearable tenderness, E. M Ashford, distinguished scholar and renowned  literary critic, slips off her shoes, climbs up onto the bed, and takes Vivian in her arms and holds her close. After a few moments, she reaches into her bag and brings out a children’s book that she had intended to give to her grandson, and begins to read:

The Runaway Bunny, by Margaret Wise Brown.

“Once there was a little bunny who wanted to run away,” she reads.  ”So he said to his mother, ‘I am running away.’”

“If you run away,” said his mother, “I will run after you.  For you are my little bunny.”

“If you run after me,” said the little bunny, “I will become a fish in a trout stream and I will swim away from you.”

“If you become a fish in a trout stream,” said his mother, “I will become a fisherman and I will fish for you.”

In the story, each time the little bunny invents a new way to run away, his mother tells him that she will find him anyway.

“Shucks,” said the little bunny, “I might as well stay where I am and be your little bunny.’

“And so he did.”

‘Have a carrot,’ said the mother bunny.”

As the story ends,  E. M. sees that Vivian is at last in a deep and peaceful sleep.  ”It’s time to go,” she says, a statement that clearly means that it is time for them both to go.   As she slowly moves from the bed, she leans over and kisses her. And then she repeats the last line from Hamlet:   “And flights of angels sing thee to thy rest.”

The Final Insult

Yet Vivian Bearing’s ordeal is not yet finished.  Jason Posen, the resident with responsibility for Bearing’s treatment, strides in, picks up her chart and says without looking at her, “Professor Bearing.  How are you feeling today.?”  As he reads, it suddenly dawns on him that the data on her chart signal that her kidneys have failed.  He looks at Vivian and says “Wait second,” then puts his head down to her mouth to check for breathing, then shouts, “Jesus Christ, Call a code, call a code!” Throwing himself across Bearing’s body, he grabs the phone and shouts to the operator “Code Blue, room 707.  Code Blue… Hurry up.!”  He begins CPR, alternatively giving mouth-to-mouth resuscitation and frantically pounding on her chest.

Hearing the call for Code Blue on the loudspeaker, Susie rushes in.  ”What are you doing?” she demands.

“A Goddamn Code!” Posner responds.  ”Get over here…She’s research!

“No, no,” shouts Susie, and grabbing Jason, throws him off the bed.

At that moment the Code Blue team rushes in,  and shouting “Unit staff out,” begins to apply their emergency procedures in an attempt to bring Bearing back to life.  Chaos follows. The Code Blue team surround the bed, pounding her chest and shocking her repeatedly with the defibrillator paddles while at the same time attempting to get Susie and Jason out of the room.

Finally, Susie grabs Posner and demands that he look at the DNR order affixed to Bearing’s chart. After a quick glance, he shouts at the top of his lungs, “Stop!…I made a mistake!”

And finally, because Susie insists, Vivian Bearing is allowed a peaceful death.

Wicked Problems in “Wit”

All art has at its center a problem and the problems at the center of great art are always wicked ones.  Oedipus Rex, King Lear, Hamlet, Great Expectations, Guernica, War and Peace,  A Farewell to Arms, The Brothers Karamazov are just a few examples.

The wicked problems in the movie Wit center on the dilemmas of Problem Levels and include problems that occur at the Personal, Relationship, Organizational and Institutional levels.

Central to the movie Wit is the illness and the death of Vivian Bearing.  But it more than that.  While the movie offers us ways to think about dying, it also takes us beyond the personal experience of Vivian Bearing and into the complexities of problems in relationships and organizations as she – and eventually we – struggle with at the end of life.

When people become seriously ill, most find themselves involved with a medical institution – usually a hospital – and with the State.  The hospital’s role is keep us from dying and the State’s role, once the hospital has failed, is to certify that we are dead, and to give permission for us to be buried.

Our passage from life to death is in many ways the  most personal of problems and, in addition, a quintessentially wicked one.   Since we are the only person who will experience it directly, it cannot be shared in any real sense with others.   To paraphrase Joseph Conrad, “We die as we live – alone.”  There is yet another wicked aspect to it:  Since we only experience it once, the path toward death that opens before us is unknown.  We may think about how we would like to die before we must face it,  but when we finally get close we have no previous experience to rely upon. Everyone improvises.  For Vivian Bearing, everything, from the diagnosis of her cancer, to the explanations of the research program she was being enrolled in,  to the way she was treated, surprised her.  Early in the movie, she says “I should have asked more questions, because I know there’s going to be a test.”

Yet while the experience of dying is a personal one, the fortunate ones among us do not go through it alone.  Other people join in as we move toward the end of life: family, friends, spouses, colleagues, therapists, surgeons, nurses and so on.  And it is in these relationships, and especially the relationships with those professional people who are responsible for treating us, that the wicked problem in relationships appear.

People whose work includes helping others – doctors, nurses, counselors, teachers, supervisors, managers,  leaders – have difficult challenges.  On the one hand, they are constrained by ethical, moral, and cultural norms and rules to act according to professional standards.  As a result, they tend to define those they serve -patients, clients, students – not primarily as persons, but as a members of a category.  And yet, for those of us who are receiving their services, such a relationship is often unsatisfactory and counterproductive.  Being treated as if we are primarily an object is offensive to us and reduces our willingness to cooperate.  On the other hand, if professional people cross the line into unexpected intimacies, different problems, equally if not more serious, can emerge.  Getting the balance right between professional and personal ways of responding is at the center of the wicked problems in professional and bureaucratic relationships.  All organizations and institutions have policy and procedure manuals with rules and regulations to follow.  Yet when it comes to making decisions with this patient or that client, there are no recipes to follow nor books with answers in the back that can be consulted in order to get it right.  ”Getting it right” is a judgement made by human beings. Working within the rules and regulations, they have to figure it out as they go:  case by case, person by person.

The  natural wickedness of professional problems is exacerbated when “Nonpersons” are involved. “Nonpersons” are those who seem incapable of seeing their patients, clients, or students as anything other than objects to be used for their own ends.  The movie “Wit”  is not only a profound and meaningful artistic experience,  it also illuminates the meaning of Gass’ aphorism, “Nonpersons unperson persons.”   “Nonpersons” who work with others usually end up inflicting some kind of damage.

Yet professional people have choices.  They can be diligent in ridding themselves of any “Nonperson” tendencies;  and they can cultivate the art of being Real Persons, those who have command of professional competencies and, when appropriate, offer compassion, kindness, and even tenderness.

It is the Real Persons in our lives who make the most difference.  They are the “repersoners” in our society,  as in “Real persons reperson unpersons.”   They go beyond seeing people only as patients, students, clients, or children, to also see them as persons – human beings much like themselves – to whom, as they do their work can also offer kindness, respect, and understanding.  They are the ones who, when they have the opportunity, help damaged people begin to heal.