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Wit Health Reflection

Kristin Carter
820 668 499
HUMBER ITAL
NURS 209

Summary
In the movie Wit, released in 2001 by director Mike Nichols, it focuses on the cycles of
chemotherapy and the effects it can have on a patient. Vivian Bearing, a University English
professor who has an abundance of knowledge in poetry, is diagnosed with Metastatic Stage four
Ovarian cancer at the age of forty-eight. Vivians primary care takers are Dr. Kelekian, Jason
(Resident) and Susie (Nurse). Vivians treatment consists of eight cycles where she is
administered the full dose of chemotherapy for research purposes. This movie portrays Vivians
life in flashbacks, from her past, that relate to current life events throughout her treatment. Susie,
Vivians nurse, discusses her current state and offers Vivian the choice of DNR or code blue.
Vivian a woman of research shys away from it in order to humanely end her suffering. Former
professor Evelyn Ashford visits Vivian and reads her the Runaway Bunny to soothe her into a
soporific sleep. As Vivian passes she recites, Death be not proud Meaning that in her time on
earth she should have focused less on intellectual wit and more on compassion. If she lived her
life with compassion she feels as though there would have been more people with her till the end.

Physical Effects
The physical effects of ovarian cancer treatment can impede on ones everyday life and
routine. A common side effect that the patient could experience from therapy includes vomiting
and nausea; which was apparent throughout Vivians cancer journey. Vivian remarks, I havent
eaten in two days, whats left to puke [] Im going to barf my brains out (Wit, 2001).
This secondary reaction is present due to the effects of chemotherapy; the therapy is
known to aggravate the gastro-intestinal lining, resulting in vomiting and nausea. The effects of
vomiting and nausea are of various types of cancers treated with chemotherapy (Lewis et al,
2010). The effects of nausea and vomiting can be easily pinpointed, as it is noticeable in the early
stages of chemotherapy (Cancer Compass, 2013). The secondary effects can cause the client

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uneasiness for some time after treatment, potentially days to weeks, in regard to the amount
administered (National Ovarian Cancer Coalition, 2013). During the movie, Vivian was given the
full dose which was the resulting factor of her frequent nausea and vomiting which lead to her
constant discomfort. In addition, constipation can be another physical effect that is caused by
adverse reactions to antineoplastic drugs (Lilley, Harrington, & Snyder, 2011), due to an
inadequate diet triggered by (Lewis, 2010). Vivian experienced complications with eating due to,
epithelial cells in [her] gastro-intestinal system being killed by chemo, and the cold popsicle
[felt] good. It is something [she] can digest. It helps to keep [her] hydrated (Wit, 2001).
This demonstrates the irritation her stomach is experiencing due to her treatment, leading
to her inability to properly digest/absorb dietary requirements. The doctors exemplified concern
towards the constipation that Vivian was experiencing, Susie the nurse states, you have to go
down for a test they want another ultrasound, as they suspect a bowel obstruction (Wit, 2001).
Bowel pattern changes such as constipation are expected when treating a patient going through
chemotherapy. In conjunction, pain is also recognized as a primary vital sign that should always
be included amongst assessment of the patient. Pain is a prevalent aftermath that clients will
experience with ovarian cancer that is a result of nerve damages to multiple areas of the body
(NOCC, 2013). According to Lewis, (Lewis et al., 2010), which characterizes the effect that the
pain experienced throughout therapy can drastically have on ones life. For instance the
modification Vivian gave up her career in order to complete such an aggressive form of treatment.
Meanwhile, Vivian had to learn ways to cope with her pain and integrate it into her everyday life;
like when she states, I want to explain it, use me wordsI am in terrible painsuch word in
this case it signifies I am alive (Wit, 2001). Expressing that she has come to terms with the fact
that pain is an indication she is still alive and fighting through this difficult journey. Amongst
many physical effects, this showcases the top three symptoms that Vivian faced throughout her
course of treatment for her ovarian cancer.
Psychosocial Effects

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Over the course of treatment, Vivian had to comprehend her ovarian cancer as well as
coping with the psychological effects the disease can have on her. Vivian understands the
progression of the cancer and that the treatment was not effective, instead the cancer advanced to
other areas of her body. Vivian was able to come to terms with the progression of her cancer
while conversing with Susie, the nurse, when she states, my cancer isnt being killed is it? I
knew it, I read between the lines. (Wit, 2001). Validating that Vivian has accepted that the
disease has advanced to a terminal disease and she is actively gaining information on her illness,
as well as communicating her views and feelings about her current state (Lewis, 2010). This is a
crucial step for patients to take, nurses need to allow patients to express feelings and concerns
they may have regarding the illness they are battling. Allowing patients to speak openly and
honestly can help them accept their current state as well as living the rest of their life in a more
positive manner. Furthermore, the fear of dying can have an enormous impact on a patients
psychological state; it can be one of the most frightening steps to overcome throughout the
ovarian cancer process. In the movie, Vivian is seen crying when she states, Im scaredI dont
feel sure anymore (Wit, 2001), clearly showing her uneasiness of what to expect moving
forward with treatment. Vivian is also exemplifying prominent signs of fear towards her
approaching death. Throughout the movie Vivians behavior changes drastically, showing her
eagerness for everything to end, like when she states, it would be a relief to be a cheerleader on
her way to Daytona Beach for spring break (Wit, 2001). Highlighting that she wants to get away
from her suffering, she wants a chance to live life at its fullest away from her current struggling.
This behavior is an expected outcome when dealing with fear and can present itself at anytime
throughout the course of treatment when or during specific stages of chemotherapy treatment
(Lewis, 2010). In addition, Vivian is experiencing another psychological effect like body
alterations. Vivians views of her appearance are greatly shown when she says; come to think of
me is, in fact just a white piece of paper that bears the little black marks (Wit, 2001). This shows
the audience that in comparison to others she has a permanent marking that makes her different

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from others, making her stick out in a room full of people. This showcases that she is upset with
her physical appearance and the way others will now portray her as weak and that there will be a
constant decline in her appearance over the course of the treatment. When dealing with
chemotherapy, physical changes are one of the most common impacts a patient will face,
especially in respect to females. With the proper support team in place, it can ease the patients
views on such a change (Lewis, 2010).

Area of Priority of care

When caring for this patient the area of priority is pain management. Throughout the
movie Vivians pain was shown to not be relieved, due to the fact that she would mention to staff
the type of pain she was having, like, Im in so much painso painful (Wit, 2001). This
reinforces that the pain Vivian was experiencing was continual and taking a toll on her everyday
life. Pain and irritation can be treated by effective management, if care is not provided the
possibility of a psychological distress increases as well as with their daily functions (Mahfudh,
2011). This was present throughout Vivians treatment when her pain was persistent causing her
to have adverse effects like fatigue and an unfavorable approach to her treatment. The goal of
lessening or eliminating signs and symptoms of pain are established and implemented by the
Nurses (Portenoy, 2006). Vivian believed that the pain was the sole cause of her suffering, like
when she states, cancer is suffering and all I have been doing is suffering (Wit, 2001).
Reinforcing that Vivians pain was poorly managed, leading to her overall adverse effects as well
as displeasure. Overall, pain is a side effect for patients undergoing chemotherapy treatment that
needs to be monitored closely due to the fact that, nurses can make a difference between a
patient who suffers until the last breath of his/her life and a patient who is comfortable and dies
pain free: (Portenoy, 2006).
Nursing Interventions

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Nursing interventions that could decrease pain includes using pharmacotherapeutics.
Ways of managing pain using pharmacotherapeutics is administering opioids, non-opioids or
analgesics, which can incorporate aspirin, morphine, Tylenol and codeine (Lilley, 2011). The
effects of these medications are specifically used for generalized pain in patients undergoing
chemotherapy. Cancer patients typically manage their own pain via patient controlled analgesia,
which enables a patient to control their own pain relief. Secondly, frequently consulting patients
about the chemotherapy process and their own views and feelings on the cancer process. This step
can be crucial due to the fact that they (Mahfudh, 2011). Nurses play a key role in reassuring the
patient that you are there to support and respect their feelings and views on this process and to
answer any questions that they might have (Lewis, 2010). This stage of treatment is prominent in
care due to the unanswered questions the client may have and the pain experienced. Nurses need
to be accessible to the patient to reassure them of proper pain management as well as non-medical
techniques that can be preformed. Having the patient vocalize their pain and where it resides can
assist the health care team in order to organize an accurate plan of care. Lastly, exposing the
patient to a non-medicinal access in order to manage pain. Such as, leading the patient to
community organizations, support networks, pet therapy, music therapy and distractions
(American Cancer Society, 2013). Using support networks can enable the patient to open up with
other patients about concerns or even fears about their therapy. Being surrounded by others who
have undergone or are undergoing a similar treatment can lead the patient to the hope that they
are not alone. Providing distractions such as games, books or TV, can lead patients to remove the
focus from their pain. The use of distractions can help the patient to release some stress that they
are experiencing in regards to their pain or treatment. Mental imagery can assist the patient to
take their focus away from the pain and onto something more positive (American Cancer Society,
2013). Mental imagery can act as a form of meditation for the client, envisioning a happier place
than what they are in or where they are.
Inter professional members

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Inter professional members who can provide support to the patient are, social workers,
community resources and psychologists. Social workers can aid patients and family in emotional
support as well as any other support the patient may require. Social workers can work as
counselors opening the patients and families up in order to discuss the cancer, treatment or
immediate pain the patient is feeling. Social workers can make community resources accessible to
the patients and their families, which can benefit the patients adverse effects. Numerous hospitals
have access to professionals who specialize in pain management. These professionals are labeled
as anesthesiologists and/or neurologists (UPMC Cancer Society, 2013). These professionals work
with other health care professionals in order to decrease the patients pain effectively. Lastly,
psychologists are available to patients who are in need and assist patients with various forms of
relaxation, which can allow the patient to have time for relief.
Community Resources
Firstly, BC Cancer agency is a community resource that is available to patients who want
to confront their issues and cope with their problems; while also provides techniques for
managing pain. This community resource sheds light on the deeper emotions that cancer patients
may be carrying.
Secondly, Ovarian Cancer Canada is a community resource that focuses on discussing
concerns, questions and coping mechanisms with patients suffering from ovarian cancer. This
community resource is open to survivors of ovarian cancer, and allows them to connect with
patients still undergoing treatment in order to aid each other in their emotional recovery.