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The Film Wit (2001): Within the Nursing Perspective of Human Dignity by Kathryn Antonawich

The film Wit (2001), based on Margaret Edson’s 1993 stage play of the same name, is about a woman who is going through her final weeks of life as she endures eight months of an experimental cancer treatment (“Wit.”). It is a dramatic film meant to teach an important lesson about care of others and empathy to the viewer. It is often used related to nursing to teach about humanity and dignity for all patients. The film provides viewers with an opportunity to identify with the inner riches of a person whose own superiority is cast away by experimental treatments, that create a context for her dehumanization by a sterile care environment. As the protagonist's human depth is revealed amidst the suffering, both she and her care providers are transformed toward greater compassion and joy as they learn to face death together, with the aid of metaphysical poetry.

The film does all of this through the use of different cinematic aspects such as camera angles, and music that could be seen as foreshadowing the protagonist’s own feelings throughout her treatment, even though many times her face may not show it. In use with student nurses, the film can show just how complex a human being is and help to educate on bed side manner, by allowing them to step into the shoes of the patient and how they are feeling. Although the protagonist did not heal physically, she was able to heal spiritually and emotionally through the help of the nurse, others who have shown her kindness, and through her love of the writer John Donne.

“You have cancer. Ms. Bearing, you have advanced metastatic ovarian cancer”… these are the first words heard by Vivian Bearing from her doctor, Dr. Harvey Kelekian (Larson). Most people when they hear these words begin feeling anxiety, dread and fear, but once Vivian appears on screen she does not appear to show any emotion and as if she does not completely understand. This is an understandable reaction considering her news and everyone reacts to shock differently. Her doctor then goes further to explain that she had a Stage 4 incidious carcinoma, indicating that it went undetected during routine vaginal exams. This is when he begins to introduce his research, targeted chemotherapy.

Dr. Kelekian

During this scene the camera employs close-up camera angles, alternating between both characters, which evokes a sense of intensity that allows the viewer to feel what Vivian may be feeling, even though she may not necessarily display this emotion on her face. While Vivian is on the screen she is filmed from a high angle, which creates a sense of her being looked down upon. Dr. Kelekian is filmed from a low angle, which suggests and foreshadows a sort of superiority that he feels over Vivian (“Mise-En-Scene: Camera Movement.”). This along with the use of a mix of soft lighting and natural light, also allows the viewer to see the very small changes in Vivian’s facial expressions, indicating confusion and demonstrating some redness around her eyes as if she is about to cry, but is holding it back (“Mise-En-Scene: Cinematography”). This combination of lighting and acting a long with some makeup allows the viewer to understand that though she may look like she is okay, she definitely appears slightly fearful.

In nursing this is an important key when helping a patient. Not many patients outwardly show their fear or anxiety, so it is taught that the nurse should pay attention to auditory, and facial cues. During the first scene, Dr. Kelekian seems to be overwhelming Vivian with information that she does not outwardly express but it can be implied by Vivian’s (Emma Thompson) facial expression and some of her actions like as her face begins to grow more somber as she continues to be shown on the screen. It is also demonstrated when she says that Dr. Kelekian was being “very thorough” which is usually and auditory cue that a patient is receiving a lot of information. After this he states “…and as research it’ll make a significant contribution to our knowledge” this is where the idea of the doctors and fellows associated with Vivian’s care mainly caring about the research and how it will help them. Vivian seems to take note of this when she is taken aback at this statement and nods her head while repeating the word “knowledge” (Larson).

In nursing school it is taught that when a patient first receives a diagnosis they should have a few days to a week to prepare and understand the information and then they should have a follow up appointment so they have time to take it all in before they have to begin making decisions about treatment. Often patients will be in a state of shock when first receiving a diagnosis so in the movie Wit (2001), the lack of dignity for the patient shown by some of Vivian’s care provider begins as soon as he appears on screen. He does not give her time to come out of her initial phase of shock before implementing treatments and trying to involve her in his clinical trial. This further demonstrates the idea that many of her care providers only see her as a test subject and her diagnosis, rather than a human being.

As soon as this scene ends the film enters into a scene where Vivian is in the hospital and her hair is gone. She says “I should have asked more questions” further indicating how overwhelmed her made her. During this time and throughout the movie as a whole non-diegetic music plays, but it seems that the sound of the songs correlate to Vivian’s emotional and or physical state as she continues to progress through treatment. In this particular transition between scenes the song “String Quartet No. 15 in E-flat minor, Op. 144” (Shostakovich) begins to play. Usually a song in a minor key indicates suffering, sadness and overall has a negative connotation. This song occurs as aynchronous sound (occurring at the same time) to when Vivian says she should have asked more questions (“Sound.”). She is probably feeling regret by saying this statement because she did not realize how terrible she would feel physically and emotionally. She then goes further to explain that she is fed up with people asking her how she is feeling (Madison Repertory Theatre). She states that she always responds “fine” but most of the time she never truly feels fine. Through the use of the song previously mentioned, it gives insight to the negativity that she is feeling before she even begins to explain her situation. It sets the viewer in a place that allows them to prepare to hear about something going wrong based on the somber sound of the song.

This scene then cuts to a scene of Vivian, appearing in a flashback where she is speaking to her professor about John Donne’s Holy Sonnet 6 (Madison Repertory Theatre). However, they then begin quoting a different poem. The Metaphysical poem that they were quoting was actually John Donne’s holy sonnet 10 “Death be not proud” (Donne). This poem that addresses death as a person, and as a “slave to fate, chance, kings and desperate men” (Donne). This implies that there is no superiority through death and ends with the line “Death, thou shalt die”. This brings about the idea that there is a resurrection after death, since death itself shall be gone (Donne).

Vivian continues to allude back to this poem throughout her treatment and suffering as a source of comfort. It is first introduced in this scene when it is clear that she is in a hospital bed, and is can be interpreted that she is beginning to breakdown her superiority and start to think about the fact that she could very well be dead soon (Madison Repertory Theatre). Every time the poem continues to appear throughout the movie it can be noted that her physical health while worse, is allowing her spiritual health clarity thus improving it and preparing her for what is to come. Due to the theological connotation Donne has with his poetry and the hint to resurrection in the poem, it is suggestive that Vivian follows some type of religious system. Later in the movie the use of props and setting is significant because it the background of the film at the current scene a painting was found in the professor’s office of Jesus. This painting later appears at Vivian’s bed side as she is struggling to overcome the pain she is enduring. She looks at the painting and it is clear that she cares deeply about that painting, whether that is because her professor and long time friend gave it to her or because her belief in Jesus, is unknown, it is possibly both. However, this prop further provides evidence of her humanity and spiritual transformation to losing her superiority complex and becoming (Donne).

During this flashback with her professor in the film the song “Spiegel Im Spiegel” by Arvo Part begins playing (Leonard Roczek and Herbery Schuch). Throughout the film this song plays multiple times, often while Vivian is narrating. The song literally means “mirror in the mirror” and it is often used as meditation music (The Cross-Eyed Pianist) . It aids with internal reflection usually and especially is used for internal reflection in the movie. When this song is played throughout the film Vivian, is often feeling reflective as she looks back on her life, her experience and explores internal self. She reaches several spiritual breakthroughs as this song is playing suggesting the breakdown of her character as she begins to understand humanity and kindness more and more throughout the film (“Sound.”).

After this scene the film cuts to when Vivian is first brought into the hospital. The lack of caring health care providers is astounding in this scene (Larson). Many were acting extremely serious even when Vivian tried to make a joke with the MRI technician about her name the woman did not laugh and instead acted as though she was wasting time by her visual cues and her flat affect. During this time Vivian begins to discuss her life and her background while getting tests done. She discusses her past research and all that she has done in her life.

example of an Mri

At one point during this she finishes getting her MRI done and Vivian makes another joke about the technician wanting her to stay since her wheelchair was gone, and the technician takes it seriously once again and says “I definitely have to get you your wheelchair” to which Vivian responds not to “inconvenience yourself on my behalf”. This is just another contribution to the lack of proper bedside manner attributed to some of her health care providers. This indicates the starting point of when Vivian starts feeling dehumanized by the way she is being treated. Later in the film she goes further to speak about the kindness that she seeks but is not receiving from anyone until she gets to know her nurse further.

After this the nurse Susie is then introduced on the screen as she brings Vivian into the examination room and she introduces her to Jason Posner, Dr. Kelekian’s fellow. She provides Vivian with a lot of information about what he is going to do with Vivian including a health history and pelvic exam. In nursing this is a very important thing to do as many patients come into a room worried about what will happen and unsure as to the procedures that will occur. It is the nurse’s responsibility to help ease some of the anxiety the patient is feeling by providing the patient with the information they need and ensuring that they allow the patient to ask questions if there is any confusion. This helps the patient to know that someone is in their corner every step of the way and shows the patient that they are not just a diagnosis but a person with a mind who is deserving of explanation and safety. Susie does a good job of demonstrating this action and though it may be small, it is the first shred of kindness that Vivian has been shown since entering the hospital.

The conversation them moves into Jason’s health history where he the respect she was receiving vanishes. While interviewing her he does not make eye contact with her. The camera angle emphasizes this further demonstrates this, as it shift between close up angles of both characters to a medium shot of Vivian, eye level, with Jason out of focus but in frame looking at his profile. It shows that he is not even faced toward Vivian and making absolutely no eye contact ("Wit").

Dr. Kelekian's Fellow, Jason

Jason appears uncomfortable throughout the whole exam and the way he asks questions seems shaky. The camera then demonstrates unmotivated movement as the camera pan around Jason but still keeping Vivian in frame to further show Vivian’s reactions and Jason’s body position, which is slouched. This proves that he is just trying to rush through the exam to get the information he needs for his research. He also uses medical terms that Vivian does not understand throughout the interaction which, in most people, increases anxiety, though Vivian does love new words, he should have used different terms.

the Health History

During the health history it is uncovered that Vivian does not have any friends or family there to support her. Nurse’s should always be there for their patient’s in a supportive way throughout care no matter what, but especially in situations where the patient does not have family. It is important that the care team supports the whole person, including mental health, and with emotional support patients tend to have improved treatment outcomes and decreased anxiety. In terms of the film, Susie is later a larger part of the film in this aspect. There is a scene where she walks into Vivian’s room and asks her about why she has no visitors. Vivian says that she does not want them but according to her body language and eyes it seems like she does.

It seems that during this situation, Susie understands the purpose of support and how important it is, as a nurse should, and she tells her that she would check in on Vivian and ensure that she is ok. She holds up on her promise as well. Later in the film Vivian has to take herself to the hospital because she became neutropenic, meaning she had a low white blood cell count, and contracted an infection. In this scene Vivian very visibly lets her guard down as she is rocking and placing her arms and head on her knees while sitting in a chair. Susie check on her and comforts her while taking her to the triage room and takes her temperature and will not let her see it indicating that she does have an infection because her temperature was high. She calls Jason and explains the situation to him and he comes into the room looking disheveled with messy hair and wrinkled scrubs ("Wit").

Jason comes into the room and Susie is holding Vivian steady while giving her some juice to help restore some electrolytes. She tells him more about her status and he just brushes it off and tells Susie to get more blood tests and urine cultures. As he leaves there is a perfect example of patient advocacy which is extremely important in nursing. The film cuts to Susie stopping Jason as he is leaving and telling him to ask Dr. Kelekian to lower the dose of her targeted therapy as she believes it is too much for her to handle. She has solid evidence too, with the current state that Vivian was in, and he said “no way full dose. She can take it”. He does not take into consideration that Susie noticed a change and is worried.

Toward the end of the film Vivian needs company so she purposely stops her therapy running through her Central IV so that the Susie can come in. During this time Vivian breaks down into tears because she feels like she is out of control and she tells Susie that she is scared. For the first time in the film she acknowledges her emotions to Susie because she built a rapport with her of trust. Susie comforts her and lets her know that everything she was feeling at that moment is valid which is very important to do as it helped to calm her down. She even offers her tissues offering her emotional support. She then offers her a popsicle to help her feel good because it keeps her hydrated and she can digest it.

susie and Vivian

A significant step in the film occurs when Vivian offers Susie the other half of her popsicle and they sit together and talk for a while, until the topic takes a serious turn to what Vivian wants her code status to be, Do not resuscitate (meaning if her heart stops they would let it) or Full code (meaning if her heart stops they would intervene). During the conversation Susie is being gentle and understanding, and she allows Vivian to ask all the questions she has as she is breaking the news to her that she is dying. Throughout this conversation it becomes clear to Vivian that she wants to be a “Do Not Resuscitate” code. Before Vivian comes to this conclusion Susie talks to her indirectly about quality of life, and how the doctors like to save lives even though the patient’s quality of life will significantly decrease. This is also an important aspect of nursing, as maintaining a good quality of life is a top priority.

Vivian's Death

As previously mentioned, many of Vivian’s care providers view her as a diagnosis and a test subject rather than a human being. This is proven further when Jason, Dr. Kelekian’s fellow, disobeys orders for Vivian to be “Do Not Resuscitate” or DNR. As he is performing CPR and calls a Code Blue (cardiac arrest) Susie yells at him to stop, and that she is DNR. In this scene there is a full body shot of Jason on top of Vivian administering CPR, this is so that the viewer can understand the full extent as to what is occurring in the scene, and receive the full effect of what the scene wants to portray as a high intensity moment. He screams back “She’s research” indicating that he only really cares about the research, and not Vivian as a human being with dignity, deserving of respect. Early in the movie this is also proven when he says he “wants to get his oncology fellowship over with” so that he can do medical research.

Throughout the film Wit (2001), Vivian Bearing is put through many different situations whether through her experimental cancer treatment, her health care providers lack of respect, or her coming to terms with her own mortality. Though in the end she feel victim to the disease that is cancer and it’s many devastating effects, she grew as a person emotionally and spiritually with the help of her nurse Susie. This allowed them both to further understand the purpose of compassion and human dignity. Vivian also was able to let down her walls and understand that compassion and kindness is necessary in life even though it took her up until her death to understand. This film teaches an important parable throughout it that no matter a persons background or character, they are deserving or respect and dignity. This proves to be very useful in teaching student nurses for this very reason as patients are human beings who need care and support as they are battling some of the most stressful times in their lives. The film accurately demonstrates the importance of care for the whole person especially in matters of life and death.

This essay fulfills the requirements set for the Final Project for Parables in Pop culture (T/RS 228) at The University of Scranton, under direction of Dr. Cyrus P. Olsen III, for spring semester 2020, under the conditions of COVID-19 lockdown.

Works Cited

Created By
Kathryn Antonawich
Appreciate

Credits:

Created with images by Marcelo Leal - "Medical" • National Cancer Institute - "A Caucasian woman's head is being secured by a Caucasian female technician, preparing the patient for magnetic resonance imaging (MRI)." • National Cancer Institute - "Couple Clasping Hands"