The HBO movie, ‘Wit’, follows the heart-wrenching story of academic scholar Vivian Bearing as she undergoes an intensive chemotherapy regimen to combat her stage four ovarian cancer diagnosis. The film chronicles Vivian’s patient experience in the hospital setting as she undergoes treatment. Throughout the course of the movie, we see Vivian slowly stripped of her identity as an English scholar and intelligent professor. With every progressing scene, she settles more into the role of the patient as she grows sicker and more helpless. In addition to a grim diagnosis, the majority of Vivian’s hospital experience is soiled by nursing staff and doctors that exhibit little compassion towards her. To some of the lab techs and nursing staff, it seems that she is more of a patient than a person. Many are task-oriented and their lack of desire to know or understand Vivian is communicated with their silence. Even to the doctors, she seems to be just research—simply a patient that they will gather data from. Repeatedly they ask her how she’s feeling, but their questions and responses lack true empathy. Her primary nurse, Susie, is the only healthcare provider in the film that seems to express empathy and care for Vivian. It’s disheartening to watch a human life be treated so carelessly, but a story such as this demonstrates the need for compassion and good therapeutic communication between healthcare providers and their patients. In the next few paragraphs, some examples of non-therapeutic communication from the movie will be discussed, as well as alternative ways situations and conversations could have been handled.
Patient Interaction: Scene One
The first instance of non-therapeutic communication was in the opening scene of the movie where we first met Dr. Kelekian and Vivian Bearing. Dr. Kelekian and Vivian are seated at his desk when he first breaks the news to her that she has cancer. During the conversation, Vivian’s facial expressions suggest that she is experiencing confusion, frustration, and perhaps a bit of shock. Dr. Kelekian then goes on to describe how fast her cancer is spreading and how aggressive the treatment is that her cancer would require. He follows this by stating, “Better not teach next semester” (Bosanquet & Nichols, 2001). This is non-therapeutic communication because he is advising Vivian and thus undermining her freedom to make her own choices and solve her own problem (Edwards, 2019). A more therapeutic technique may have been to say something like, “Vivian, if you were to decide to seek treatment for your diagnosis, the medication you would be receiving is very intense and may affect your ability to continue to teach during treatment. How would you feel about that? Do you have any questions?”. This would be offering reality and asking open questions so that Vivian would be able to think through her options and verbalize her feelings or concerns (Edwards, 2019).
Patient Interaction: Scene Two
A second scene in this movie that displays poor therapeutic communication is early in the film when Vivian waits in a room with a medical technician to undergo a CT scan. We see no introduction or friendliness shown by the tech. After ensuring she had the correct information, the tech quickly exits the room and starts the CT scan without explaining what would happen next or walking Vivian through the procedure—both of which seemed to leave Vivian feeling confused and likely helpless. When the CT scan concludes and the tech returns to the room, she asks Vivian coldly, “Where’s your wheelchair?” (Bosanquet & Nichols, 2001). Vivian replies that she doesn’t know. The CT tech responds, “Well how are you going to get out of here?” (Bosanquet & Nichols, 2001). The tech ends the conversation by saying, “I guess I got to go get you a new wheelchair” (Bosanquet & Nichols, 2001). This kind of communication was probing and seemed to be more an interrogation (Edwards, 2019). It seemed to make Vivian feel like she was an inconvenience, and that somehow, it was her fault that her wheelchair was not in the room. Vivian even says something about being an inconvenience towards the end of the scene. The tech could have solved the problem herself and figured out a wheelchair situation while using an open question when interacting with Vivian to see how the patient feels about being left alone while she retrieves a chair (Edwards, 2019). “Oh, I see that your wheelchair is gone. No trouble. How would you feel about waiting here a moment while I go and get you a chair?”.
Patient Interaction: Scene Three
A third scene in this movie that displays the use of non-therapeutic communication is when Vivian is in isolation after receiving another full dose of chemotherapy. Isolation, even though it was for her own good, likely made Vivian feel lonely. She already wasn’t receiving visitors during her stay in the hospital, and isolation precautions limited her interaction with even the hospital staff. As we see Vivian lying in bed, Dr. Kelekian soon enters the room, does a quick follow up, and leaves. Dr. Jason enters the room next. Without introduction, he begins flipping through the contents of her charts and abruptly begins complaining about how he doesn’t have time for the task. This probably makes Vivian feel unimportant and like she is being an inconvenience once again. After sputtering off something about checking I/O’s, Jason says, “Professor Bearing how are you feeling today?” (Bosanquet & Nichols, 2001). Vivian replies, “Fine, just shaking sometimes from the chills”. Jason replies to Vivian by saying, “IV should kick it anytime now. No problem. Listen, I got to go. Keep pushing the fluids, okay?” (Bosanquet & Nichols, 2001). He then quickly exits the room. Jason’s reply to Vivian’s concern for chills in non-therapeutic. He is reassuring her that her IV will kick in and help and is belittling her concern—both of which communicate a lack of understanding of Vivian’s concerns and displays no compassion (Edwards, 2019). It is like he is not really listening to her. A more appropriate therapeutic response would have been to empathize with Vivian, and maybe even focus in on her concern about chills with asking an open question (Edwards, 2019). He should have said something like, “I understand that chills can be very uncomfortable. Is there something I can do for you to help you to feel better? Would you like a warm blanket?”. Dr. Jason also could have used active listening to show concern. To use active listening, he could have walked to her bedside, and sat down with her, or placed his hand on her hand and showed a facial expression of compassion (Edwards, 2019). Any of these therapeutic techniques would have been good choices.
Self-Evaluation and Plan
After viewing this movie, I see the essential nature for good therapeutic communication skills between healthcare professionals and patients. Though Vivian’s case was terminal, maybe she would have felt a little less confused, scared, and isolated in the last few months of her life if more of the healthcare professionals around her had shown compassion and treated her with more dignity. In the future when I am a practicing RN, I want my patients to trust me and feel safe with me. I want to be intentional in the way that I communicate with them, so they feel understood and genuinely cared for. I would never want a patient of mine to feel like they are just a number, or an inconvenience. It would break my heart for a patient to feel that way or have any experience similar to the main character in this film. I think that sometimes healthcare workers can become task oriented and lose heart for what they’re doing. To us, it may just be another day at work, but to our patients it’s often the worst day or experience of their lives. I feel like it’s just so important to be sensitive and aware of that fact. To fight for that, I want to develop better therapeutic communication skills. I feel like I am better at some of these skills than others. After working in a healthcare setting for a few years, I have learned to empathize with my patients and their families, as well as communicate clearly when it comes to restating and clarifying information. I plan to continue to implement and practice these skills this semester while I work at the hospital. I also plan to learn through gaining experience with patients in clinicals throughout this program. I think that these experiences will help me to develop better therapeutic communication skills and enable me to be the best nurse that I can be when I graduate.
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- Bosanquet, S. (Producer), & Nichols, M. (Director). (2001). Wit [Motion picture on DVD]. United States: HBO Home Video.
- Edwards, A. (2019). Communication in the Context of the Nurse-Client Relationship [PowerPoint slides]. Retrieved from (http://sole.hsc.wvu.edu/Site/4121/File?InstanceID=779526).