Nursing & Humanities, Alice Munro SLIDES FOR A PRESENTATION OF HUMANTIES AND NURSING: CHRONIC AND TERMINAL CARE ISSUES PRESENTED IN ALICE MUNRO'S "THE DAY OF THE BUTTERFLY," BELLE & SEBASTIAN'S "IT COULD HAVE BEEN A BRILLIANT CAREER," AND TONY KUSHNER'S "ANGELS IN AMERICA"

"The Day of the Butterfly" by Alice Munro is a quiet portrayal of elementary schoolgirls in 1950s Canada learning one of their classmates has a terminal illness.

"It Could Have Been A Brilliant Career" performed by Belle and Sebastian is a song about a young stroke victim and his caregiver.

"Angels in America" is a television-film adaptation of the Pulitzer-Prize-winning play by Tony Kushner, and depicts the AIDS epidemic in 1986 before any cure or medication had been discovered.

FOUR

From the standpoint of a professional Nurse, these artistic depictions of terminal and end-of-life illness teach us emotional lessons about the experience of survivors -- they ask not only how does the patient feel, but ask also how does the caregiver feel as well.

FIVE

Learning about these issues can be important for a nurse's handling of chronically or terminally ill patients, but these issues can only be learned by examining works of art -- they aren't taught in an anatomy class.

SIX

Alice Munro's "The Day of the Butterfly" is a short story first published in 1952, about the awkward experiences of Helen, a schoolgirl, in dealing with the terminal illness of Myra Sayla, one of her elementary school classmates.

SEVEN

"Day of the Butterfly" is about how death affects small children, but here the adult response to Myra's illness -- to throw a bogus birthday party for her at the hospital, aware that she may not live to her next birthday -- is somehow hollow and awkward.

EIGHT

In 1952, standards for end of life care were very different than today -- doctors frequently withheld the diagnosis from a terminally ill patient, while informing his or her family, as in this scene between Burl Ives and Paul Newman from "Cat on a Hot Tin Roof." [Show scene where Paul Newman informs Burl Ives that the doctors lied to him and he is dying of cancer.]

NINE

Four things that distinguish "The Day of the Butterfly" as a short story:

Descriptive imagery: "This sound made Myra's future turn shadowy, turn dark"

Symbolism: the blue butterfly brooch given by Helen to Myra

Emotional sophistication: Teacher tells the schoolgirls "Do you think you would be very happy if you were left back there?"

Irony: Birthday party held on the wrong day to cheer up Myra

TEN

Even shorter than Munro's story, songwriter Stuart Murdoch's lyrics for "It Could Have Been A Brilliant Career" paint the picture of a stroke victim in his early 20s and his girlfriend, turned caregiver.

ELEVEN

While we listen to the song, you may want to read along with the lyrics, by Stuart Murdoch, the lead singer and songwriter of Belle & Sebastian:

He had a stroke at the age of 24

It could have been a brilliant career

Painting lines in a school that was too well-known

Painting lines with a friend that had gone before

She challenged everyone to a fight

But the prefects all backed down

And they ran her out of town

Cause she drank and swore and spoke

Out of turn, she was the village joke

She had a stroke at the age of 24

It could have been a brilliant career

Getting clients to finance her strategies

Filling time in on Safeways on Saturday

She wears the clothes of an emperor

But her paintings are a sham

And they're going for a grand

When the dealers come to view

Do they ever see the real you?

He had a stroke at the age of 24

It could have been a brilliant career

Selling lies to the boys with the old dansettes

Pulling the wool, playing the fool, it's no wonder that

He is dribbling spit tonight

And the one he sent away

Was the only one who stayed

With a spoon and a decent book

And you can tell by the way she looks

He is sorry and resigned

Belle & Sebastian are the foremost practitioners of a musical genre known as "twee." What is twee? As one music critic said of Belle & Sebastian's first album "Tigermilk" -- it's "sunny pop music with rainy lyrics."
THIRTEEN

It's important to note that Belle & Sebastian frontman Stuart Murdoch was diagnosed in the late 1980s with myalgic encephalomyelitis, which left him housebound and bedridden for almost seven years. When he writes about chronic illness, he is writing from personal experience.

FOURTEEN

Four elements of artistic composition in the song:

*Use of rhyme (He is sorry and resigned / as he wets himself for the final time)

*Repetition (every verse opens with the phrase "It could have been a brilliant career" *use of metaphorically suggestive details: "She wears the close of an emperor"

*Autobiographical…so it's well-informed about chronic illness

FIFTEEN

The stage play "Angels in America" by Tony Kushner originally had to be staged on Broadway in 2 parts: the entire drama was about seven or eight hours long in performance. It won the Pulitzer Prize for Drama on its premiere, just as Mike Nichols' excellent HBO film version of "Angels in America" swept the Emmy Awards for original television films, garnering a win for Al Pacino in the lead role of Roy Cohn, a high-flying attorney dying of AIDS in 1980s Manhattan.

SIXTEEN

The story entails multiple storylines but is generally intended to be an accurate description of AIDS victims and their caregivers in 1986, when AZT was not yet approved by the FDA and today's protease inhibitor drugs had not been developed: AIDS was a terminal rather than chronic illness in "Angels in America."

SEVENTEEN

Tony Kushner writes politically and intellectually charged dialogue about common experiences relating to terminal illness. In this famous scene, Roy Cohn's doctor informs him he has AIDS. Roy Cohn -- exchibiting classic signs of "denial" about his sexuality and the terminal nature of his disease -- informs the doctor that the official diagnosis in public will be "liver cancer" and that he will phone First Lady Nancy Reagan to be put on a trial for the new drug AZT. [Show scene between Al Pacino as Roy Cohn and James Cromwell as Doctor Henry.]

EIGHTEEN

Four elements of artistic composition to watch for in this scene:

Political analogy: Roy Cohn's discussion of "Clout"

Dark humor: Roy Cohn asks Doctor if he sees track marks, is he a heroin addict?

Psychological complexity: Roy Cohn threatens to sue the Doctor if the Doctor "outs" him

Dramatic Irony: Doctor Henry at the end of the scene tells Roy to use his political connections to get on the federal drug trial for AZT.

NINETEEN

Munro's story reminds us of a dark past in the care of terminal illness, when we did not inform the patient of what he or she was undergoing. The human cost of this decision is portrayed in the story.

The theme of the story is dying, but the mood is stark and unadorned.

Munro has often been compared to Chekhov -- a great short story writer and also a medical doctor who dealt with epidemic and chronic disease in the late 19th century.

TWENTY

Stuart Murdoch's song lyrics remind us that a wry or bleak sense of humor often accompanies the experience of a caregiver -- the irony is that here, the caregiver is a girl that the sick person had dumped in high school (one of the many issues that can complicate the caregiving experience with non-trained professionals).

TWENTY-ONE

The "Angels in America" film finds humor and hope in the midst of the worst sort of medical crisis: a community-wide epidemic disease that has never been identified before, and for which there is no known cure.

TWENTY-TWO

Munro's tone is quiet -- her story was written in 1952. Murdoch's tone is meditative. Kushner's tone is more angry and despairing.

TWENTY-THREE

All these works shed light on the human condition by showing…