I missed our classes viewing of "Wit" the other day, so instead of participating in the class discussion, I had to answer these questions, instead. Suits me fine.
Dr k is presented as the archetypal phd-md, detached the from the human element of his work. He makes the error of assuming that, since they were both professors, the protagonist would have the same cultural context for her condition. His interactions with vivian seem nearly inhuman from the audiences perspective. The rigours and requirements of research is something vivian links black to her own experiences in research. This commonality seemed to be central to vivian's decision to sacrifice the remainder of her life to the advancement of knowledge. Although dr k's behavior might seem monsterous, it is consistant with the relationship formed in the opening scene, a relationship of academic collegiality. The reminder here is not to treat personal tradegies as routine, even if they are to you.
The fellow has a similar yet opposite problem. He's inexperienced, but shares the same absorption into the complexity of the science. That's his job, but 'bedside manner' is not a priority for him. Despite his bungles, I think he accidently did a good thing when he shared his deep passion for his work with vivian, she saw her own passion for the great mysteries of life and death echoed bac to her from someone she taught. The end of the movie implies there may be hope for the fellow, as he finally admits he's made a mistake and advocates for his patient at the expense of his research.
Susie represents a rare, isolated presence in the scope of the movie. The fellow rags on her for not having a well rounded education, however she's the only one actually meeting vivians needs during the entire film. The two points of view come together here, and the interaction hit home to me, the teasing represents the struggle of these disparate facets of care provision to reconcile and learn from one another. The nurse could benefit from educational enrichment, while the fellow could use some grounding in immediate reality. The teasing masks veiled flirting, which offers hope that the human factor will cross pollinate te thinking towards improvement.
The ct guy represents the ultimate in non-care, leaving vivian in the scanning room while taking a break, detached from her care but also uncaring about it, treating it as an assembly line job.
To my mind, vivian agreed to the treatment so she could spend her death the same way she spent her life. Sacrificing the empty, playful moments of her life for the advancement of knowledge and scholarly rigor. We see her regrets, her passions and and her pride played out in her interactions with the healthcare team, where she satirizes her environment while appreciating the same paradoxes that interested her and motivated her throughout her life. Vivians own detachment subjects her to a withdrawn state that leads her to rely exclusively on her caregivers to determine what she needs. I can't say what lead to her decision to be DNR, besides the obvious rational analysis of her situation.
Vivian suffered losses of her work, which was her life. She found bits of it in her interactions of all of the health care team, the paradoxes, the jokes only apparent to her that we view through her experience. That gap is reunited in a scene where she shares a laugh with the nurse. Vivians needs were met in the sense that she was mentally prepared for what awaited her, but they weren't met by any external factor but the nurse that cared for her.
Dr k's communication techniques were discussed earlier, although ill add that his attitude towards the disease processes of his subjects, as maladaptive as it may be, represents an individual's attempt to model trancendent acceptance of the situation, the deficit lies in communicating this acceptance to the subject. The fellows interactions were mainly governed by inexperience and naivety, a level of which he can probably get away with as a researcher. Forgive me, but I dont remember who jason is.
'how are you feeling today' hit home, and its a reminder to be aware of how interactions that go unexamined can devolve into thoughtless routine.
Suzie's communication was unique in the film in that it was patient centered instead of disease centered, a dichotomy that is hyperbolized for clarity in the contrast between md-phds and nurses.
Dr kelegian sent off his fellow to conduct an assessment completely unprepared for his task. This tendancy of preparing students through trials by fire is not exclusive to medicine or research.
Just as the mangement of problems in general is focused on primary or preventative treatment, I think making sure the person communicating with the seriously ill or their families should endeavor to establish whatever rappot with the subject can be made in the time allowed.
Dr k should have been more up front about the chances of her treatment's success, but this is mitigated somewhat by the relationship he established with the patient initially, where she learned this information without it being explicitely said.
In caring for the terminally ill and their families, I feel its important to provide information and help the subjects meet their needs by asking questions and offering suggestions.
I think all of the elements in the dying patient's bill of rights are appropriate. They were not all expressed in vivians case by far, many of the people she dealt with did not provide compassionate care.
Advance directives provide a means for patients to exert control over what happens to them in the event they are deprived of the ability to make decisions. They are of fundamental importance to the human rght of self determination.
Objectively speaking, vivian would have been better off enjoying the time she has left rather than languishing in a hospital. Her decision, despite the suble presentation of her condition, was a choice she made and was willing to die with. Subjects for these experiments are self-selected, although if it was someone not as sarp as vivian they would have been mislead with false hope for a cure.
Im not sure what I would change about my care of the seriously ill. My impulse is to make them laugh, I hope the rest will come from experience.