Patient Protection Acts That Can't Be Legislated
Role Models: Characters in Plays Outperform Politicians
Stories set in ICUs and nursing homes can teach students about "bedside matters" -- about humanity and "acceptance"
From what I can tell, my students don't care about Obamacare.
Heavy course loads, along with hefty student loans, have these health-science students focused on earning credentials (certifications and licenses) that will qualify them to make a good living by providing good (better than decent) patient care.
Students working toward credentials in nursing, physical therapy, occupational therapy, sports medicine, and diagnostic imaging are not caught up in the epidemic of discord and stridency that has metastasized from The Patient Protection and Affordable Care Act. These health-science students are banking on realizing a good return on their significant investments of tuition and time.
Health-science majors tend to be some of the brightest undergrads, in my experience. Nursing students have to make their way through biology, chemistry with biological applications, biostatistics, anatomy and physiology, microbiology and pathology, pathophysiology and pharmacotherapy, and lots of labs. Physical Therapy and Sports Medicine students have to tackle kinesiology, musculoskeletal therapies, and therapeutic modalities. Diagnostic Imaging students are exposed to radiographic physics and instrumentation, radiation protection and biology, and pharmacology and radiologic anatomy. And there are extensive "groans, moans and bones" practicums and clinicals.
An antidote, of a sort, is a curricular IV line that infuses literature, composition, and communications skills (and arts) into the intellectual bloodstreams of those students. Injecting a course of literature, with cinematic adaptations, can be a patient protection plan. A course that features healthy doses of humanity is a prescription for compassion. Just what doctors (of Medicine and Humanities) should order.
How to prescribe and administer such doses? For a communications course I teach ("Medical Moments") I had plans to encourage the reading of Atonement, Cutting for Stone, The Daughters of Mars, The English Patient, The Cider House Rules, and One Flew Over the Cuckoo's Nest with a prompt from Louisa May Alcott's 1863 memoir Hospital Sketches and with references to Florence Nightingale's 1859 Notes on Nursing: What It Is and What It Is Not. Too ambitious: the commitments of health-science students preclude a deep plunge into military medicine and what I came to think of as "Nurses in Novels and Novel Nurses" - which would confine A Farewell to Arms to barracks.
So, I began with short stories and stage plays that became screenplays -- and which have empathetic nurses commendably helping caregiver-colleagues, as well as patients, come to terms with AIDS, Alzheimer's, paralysis, and Cancer.
If only every grade-school student could sit in Margaret Edson's classroom. If only every adult would enroll in her two-hour course of instruction in humanity offered in the play awarded the 1999 Pulitzer Prize for Drama (among many other laurels) and available from the Dramatists Play Service as well as the original publisher Faber and Faber.
I ask students to read the play as a preview to the superb HBO video starring Emma Thompson and directed by Mike Nichols -- to be followed by a re-reading of the text. With informed repetition, there's discovery as well as reinforcement
In education jargon, there is a most profound "learning outcome": a vivid sense of the indignities and humiliations, along with the "rueings" and reflections, of a patient undergoing experimental chemotherapy for stage-four metastatic ovarian cancer ("there is no stage five").
There are brief (but still notable) scenes that should instruct the diagnostic imaging students in technician-patient relations.
Most significantly, there are scenes in which primary nurse Susie Monahan attends to the psychological and human needs of a patient who is isolated in more than just the clinical sense. The oncologists tell the patient that by taking the "full dose" of chemo (to deal with "full lymphatic involvement") she is making a great contribution to knowledge. By prescribing a full dose of Wit, a student body's involvement is heightened. The play contributes knowledge - awareness and sensitivity - beyond any textbook.
Whose Life Is It Anyway?
Brian Clark's play, set in a London hospital, takes us to the bed of a quadriplegic who, following quips and double-entendres, proclaims that his "life" has been so drastically diminished (by a near fatal roadway accident) that his existence is not worth preserving. Pretty heady medical, moral, mental health, and law issues -- in a play that has its playful moments.
In the text, the supervising nurse (Sister Anderson, she of the "stainless steel heart, easily sterilized of emotion") cautions the new probationary nurse who is being flirted with by staff, "This hospital exists to cure accidents, not cause them." In the 1981 film version (starring Richard Dreyfuss), head nurse Rodriguez cautions the student nurse, "Your job is to lower the temperature of the patients, not raise the hopes of the orderlies." While drawing well from the play, the film version (co-written by the playwright) enlivens the humor and makes the drama all the more telling.
In both the text and the film adaptation, the exchanges between the medical social worker and the acerbic "quad" (whose mind is anything but paralyzed) are especially instructive for students headed to careers in physical therapy or occupational therapy.
Angels in America
Tony Kushner's award-winning play is probably too provocative for my classrooms -- and maybe for me as well, as a teacher. The politics alone would take a semester's worth of explaining. Not my job.
Still, there are significant medical moments: Belize, a very competent nurse, is provided with many of the most descriptive lines -- but his hates are too unrelieved, for me, as a reader. "America -- terminal, crazy, and mean," is not the message I choose to share. Yes, the play's lines surely do make one think about things many of us would rather not think about, but I can't place all my hope on - and ask students to model their ministrations on -- fantasies; the revelations of a winged angel, and her prophecies of "the Great Work."
Rather than impose such a reading, I have students view Life Support, a dramatization of the true-life struggles of an HIV-positive woman who copes, in part, by trudging the streets of Brooklyn as an AIDS outreach worker and awareness educator. Maybe that's a way to get a few students to consider dipping into Tony Kushner's socio-political epic of viral and emotional strains -- and the fears contracted and transmitted. There might even be a "referral" to the HBO miniseries.
Away from Her
What does -- or should -- produce wonder and admiration is Sarah Polley's screenplay that so faithfully and movingly translated an Alice Munro short story into the feature film Away from Her. In a story about memories and forgettings, the performances of Julie Christie and Gordon Pinsent are memorable, unforgettable.
Except for the few fourth- and fifth-year students who have done extensive clinicals in nursing homes, few of my students fully appreciate how unsettling it can be when a spouse of over forty years realizes that her (or his) dementia cannot be dealt with at home. In the Alice Munro story (neatly published as a Vintage Contemporary), the husband finds he can confide in Nurse Kristy, who, with just the right mixture of comforting and candor, explains what and how a sufferer loses to Alzheimer's -- and what a loved one loses in the succumbing. Considerately, Nurse Kristy prepares the husband for his wife's almost inevitable need for "extended care": the need for more and more assistance in an assisted-living "home" -- as the resident sufferer "progresses."
Upon "delivery" of the new resident, Nurse Kristy gave the doubting husband the assurance, "We'll take good care of her, I promise." When the Alzheimer's sufferer begins to "progress," the husband's hopefulness becomes hopeless. Indeed, both the wife and the husband are sufferers. Nurse Kristy prepares the husband for the adjustment and the acceptance. Life lessons in a superbly crafted nutshell.
These stories (I'm sure there are others) make vivid the embarrassments and fears of patients; their efforts to deal with deterioration, endure pain, and cope with unhinging and detachment. The reader, the viewer, and the re-reader can take cues from caregivers who ease the way to acceptance.
As Margaret Edson's cancer patient explains, for the "ultimately sick," it's "time for kindness."