A Lesson from the 'Phantom'

By M. Cecilia Wendler

It was a hectic sort of day, one that began ordinarily, with my name on top of the list of nurses "floating." Staffing other units during time of fluctuating census is a common occurrence in acute care, and as a registered nurse on a surgical ICU, I have come to view these days as special opportunities for growth. It was in this unlikely situation that I would discover the lesson from the "Phantom of the Opera," the true meaning of compassion and the importance of the aesthetic link in nursing practice.

I had been reflecting for days following my attendance at the "Phantom of the Opera," the Andrew Lloyd Webber opera whose Twin Cities run had found me in the audience on three different occasions. I was engaged in a lively inner exploration of the meaning and nuances of this important production, learning lines and discussing at length its imagery and implication.

Many of my friends and nursing colleagues had also attended, creating fascinating conversation at work and at home. But it was a patient, her husband and a day of "floating" that gave me a fullness of understanding of the true meaning of the work.

I had been asked to help out on the medical ICU that day, a welcome assignment to our "sister" unit. It was a very busy place that day; the morning passed breathlessly as both of my assigned patients underwent interventional cardiology procedures. Soon it was midday.

The charge nurse requested that I assist in providing nursing care during lunchtime break periods. I approached one nurse in an isolation room, who gratefully indicated she was more than ready for lunch. As the nurse peeled off her isolation garb, I was offered this terse report: "She has a weird fungal infection; she's dying. We just got the 'Do Not Resuscitate' order. The husband has been in denial, but now he has finally agreed. By the way, he's dysfunctional. He doesn't like much of anyone, so just stay clear of him. Actually, you don't have to do anything in here; I'll be back in 45 minutes." And she was gone.

As I gowned, gloved, and masked for contact and respiratory isolation, I remember the music from "Phantom," and the ballroom scene: "Masquerade! Paper faces on parade, Masquerade! Hide your face so the world will never find you." I smiled to myself at the metaphor-and then I entered the room.

The room was darkened, the shades, pulled. My patient, a young woman, lay chemically paralyzed and massively edematous. Eight IV pumps infused pressors, sedatives, paralytics and painkillers; A Swan and arterial tracing added glow. The room was cluttered with the evidence of a prolonged hospitalization: two sets of pneumoboots, several wash basins, support stockings washed of their soiling yet again, now, hanging to dry; a cooling blanket; extra linen; trashed filled, even overflowing; and the mon-
itoring screen smeared with some unknown substance. The hiss of the ventilator filled the room. But the moment that stopped the sense of time passing was the first instant I saw the husband.

He, too, was gowned, gloved and masked. He sat on the edge of a chair too small for his hulking body, hands crossed over that of his wife, his face buried in the bedclothes. He did not look up when I entered the room.

"Oh, my …" I thought, "Where can I begin?" The computer screen flashed for the patient's current vitals. An IV bag was nearly dry. There was enough cleaning to attend to, to fill two hours of time. And all I could do was to look at this sad man.

It is always a deep challenge to come into an intense situation such as this when there is no relationship established. But I wanted very much to reach out to him, this husband, and this soon-to-be widower, to let him know I could see and understand his pain. What I could not seem to do was to find the words that would help me to meet his inner self.

At that very moment, the finale of the "Phantom" replayed before my eyes. In my head, I could see Christine, the heroine of the opera, lying on the stage. She had just expressed her hatred of the Phantom, who demanded Christine choose between the death of her lover or an eternity spent in darkness with the Phantom. In that instant, Christine finally perceived the anguish, loneliness and pain of the Phantom's loveless life and performed a miraculous act of compassion. She stands, fully upright, caresses his horrible face, and sings: "Pitiful creature of darkness; what kind of life have you known? God give me courage to show you: You are not alone." And then she kisses him. Fully. On the mouth.

At that moment, that timeless instant, I, too, knew what to do; a voice in my head said clearly and simply: "Choose compassion." I approached the figure of the bent-over husband, placed my hand gingerly and lovingly on his shoulder and whispered to him: "Sir, would you accept some comfort from a stranger?"

The result of my touch and those few words were transformative, for him and for me. He stood fully upright, all six-plus feet of him and wrapped his massive arms around my shoulder. He buried his face in my arms and he cried. And he cried. And he cried. And all I did was-hold him.

I accomplished nothing in terms of physical care for that patient for those few short minutes. But I bridged the gaping chasm in the life of this young husband, father, and soon-to-be-widower, by recognizing his suffering and compassionately offering myself to him. Our time together was brief but rich and powerful and I am certain that the experience was as life renewing for him as it was for me.

I am convinced that the secret to longevity in bedside nursing is in full openness to the experiences that confront us every day. The renewal of self-preventing the overwhelming loss of the nurse's being-in-the-world, while witnessing suffering, struggle and death-lies not in the "doing" of nursing but in the "being" of nursing. We cannot be afraid to kiss the Phantom, because, when we do, like the Phantom, we can finally and forever leave behind the safe mask of professional separation and engage openly in the compassionate caring that distinguishes us as nurses.

"A Lesson from the 'Phantom' " will appear in The HeART of Nursing: Expressions of Creative Art in Nursing.