What are your thoughts about the practice of force-feeding individuals who refuse to eat?

As nurses, we sometimes find ourselves in situations where we are asked to carry out clinical tasks we believe are ethically unsound. For instance, let’s look at the case of the Guantanamo-Bay prisoners who went on a hunger strike in June 2014. The military nurse assigned to them refused to force-feed the prisoners “because it felt wrong,” he said (http://www.washingtonpost.com/force-feed-detainees).

If he were to follow through with the orders to force-feed a suspected criminal, this is how it would likely play out: strapping the prisoner to a chair or bed, pushing a long rubber tube into his nose, down into his stomach, while he twists and flails, fighting to maintain a semblance of dignity.

Nurses choose to become nurses because they want to help those who are vulnerable, physically and emotionally. Nurses approach their patients as a whole entity, the mind and body a seamless system. They listen to their patients talk about their fears and anxieties. They sit with them during the night when they are awake in pain, and administer medications to ease their discomfort. They advocate on the behalf of their patients. The nursing code of ethics is clear about the role of a nurse:

The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems (http://www.nursingworld.org/Mobile/Code-of-Ethics).

According to that code, the nurse at Guantanamo acted within his rights. He acted with respect, and preserved the prisoners’ autonomy to make decisions on their own behalf. By refusing to force-feed the prisoners, he was protecting each of their individual rights.

The Guantanamo Bay case is clear-cut, but what about circumstances that are not so black and white, like force-feeding a patient with Anorexia Nervosa?

Withholding feeding, and fluids, is common practice in the terminal stages of an illness. But anorexia is not considered a terminal disease, yet patients do die from poor nutrition. Thus, feeding them is a life saving measure. But, unlike the Guantanamo prisoners, what if anorexic patients are not competent, meaning they cannot express their wishes due to cognitive impairment from severe malnutrition? What if these individuals had already displayed, through aggressive behavior, that they did not want to be fed? Do medical professionals, and family members heed those pre-incompetent wishes? But most people with anorexia have difficulty making decisions, so though they are fearful of gaining weight, and therefore starve themselves, they are not necessarily suicidal. So it’s hard to know the exact wishes of the patient (https://www.childrensmercy.org/ forced feeding in anorexia nervosa.pdf).

.

Other than force-feeding someone as a means to save a life, how else does this benefit a patient who is uncooperative, who has been administered feedings and intravenous nutrition numerous times without lasting success? When does the intended beneficent act venture into an act of great emotional, and physical, harm for the patient (https://www.childrensmercy.org/ forced feeding in anorexia nervosa.pdf)?

The ethical questions are endless. But, for nurses, and other medical professionals treating those with anorexia, they are worth examining.

Please note: the information set forth in this post is not representative of the opinion of the author, Melissa Cronin.

 Photo by Marisa Ross.

I’m excited to introduce my first guest blogger and accomplished writer, Patrick Ross, of Committed: A Memoir of the Artists Road. Patrick and I are fellow alums of the Vermont College of Fine Arts, where I had the opportunity to read parts of his powerful account of his journey across the United States to engage with creative individuals. But the book is more than about traveling; it’s about identity, and his journey of self-discovery. Starting on page one, Patrick bravely shares his vulnerabilities and demons. In this post, Patrick takes an honest look at what it means to live the life of an artist.

“Here’s a tip for artists who are in it for a lifetime. When the tide is in, write. Wake up at two in the morning if you have to and write. But if the tide is out don’t sweat it. That’s when you get your busywork done.” – Flutist and songwriter Steve “Voice of Golden Eagle” Cox, quoted in Committed: A Memoir of the Artist’s Road (p. 124).

Am I an artist who is in it for a lifetime? I’d like to think so. That was a theme of my travel memoir Committed. While on a cross-country trip interviewing artists of every type who had embraced an art-committed life, I found myself inspired to live the same way. It led me to earn an MFA in Writing and to write Committed. But just how committed am I to that life nearly five years after those interviews?

I interviewed Steve “Voice of Golden Eagle Cox” in Memphis, Tennessee. I thought of him at times as I spent the latter half of 2014 writing nothing more creative than short blog posts. No personal essays. No follow-up books. Nothing.

For a time I had a built-in excuse: Committed was published in October, so there was promotion leading up to its release, then more after its release. When promoting yourself as a writer, who has time to actually write? That frenzy of interviews, guest blogs, readings and book-signings largely came to an end. But still I didn’t write. The tide still wasn’t in.

Steve’s wisdom on the tide of creativity struck me the day he shared it with me, and so it was one of the small morsels from hundreds of hours of interviews that made it into Committed. But at the time I also sensed a lack of drive in Steve. He kept saying he was “open to possibility,” to write more music, to return to the road, to be creative.

I certainly didn’t see myself as superior to him in that scene, as my internal monologue suggests: “I am open right now to possibility in the same way a defeated prey is open to a predator’s jaws. It is an openness grounded in passivity (p. 124).” But as I progressed on my road trip, and became more open to possibility myself, I then found myself driven to seize that possibility.

Near the end of that road trip I interviewed another songwriter, radio DJ Rochelle Smith. Sitting in her Boise, Idaho, studio, she told me it had been a while since she had done any solo performing. “I guess I’m looking for that next project. I’m not sure what is coming, but I feel something is (p. 218).” She had earlier told me that she agreed to the interview because she had asked the universe if she should, and it had said yes. In Committed, I connect her in my mind with my Memphis interview:

“She’s presumably asked the universe and is waiting for an answer. I think again of Steve Cox, the Voice of Golden Eagle. He said the universe had proclaimed to him that a wondrous new path would be coming soon, and that he’d be ready when it arrived. But what if you don’t have the patience to wait? What if you’ve cleared your way through the tumbleweeds, the dried hulks of your past, and are anxious to drive forward (p. 218)?”

As I read this passage now I feel guilty, that I’m somehow suggesting that Steve and Rochelle now longer had any wisdom to offer me, that I’m ready to move forward and leave them with their passivity.

One of the most difficult aspects of writing Committed was telling the story as true as I could, including revealing the impressions that were being formed in me as I met with these artists who were so generous with their time and their stories. One reviewer of Committed, not surprisingly a professional writer, picked up on this:

“I was also grateful for the absence of gloss that might infect other essays on art. The artists Ross interviews in their own homes and studios are presented without makeup, so to speak. I could smell the cat litter, the coffee brewing in the kitchen, and the musty wardrobes. I saw dust bunnies beneath the sofa and front steps in need of repair. And so when Patrick was swept up in a sweeter aura that some artists exuded, I understood that here was an artist making a special impression upon the author (Amazon.com review by novelist P.J. Reece of Committed: A Memoir of the Artist’s Road).”

I have continued to grow since that 2010 trip. What I know now is that I was in no position to judge these two musicians for any perceived passivity. I’d add that both Steve and Rochelle were artists that made a special impression on me; that’s why they receive a disproportionate amount of attention in the book as I attempted to share their “sweeter aura” with my readers.

So this winter has proven to be a dry one creatively. There has been no tide because the water has frozen over. At times I have longed for even the hint of possibility, the notion that perhaps the universe had something waiting for me. On far too many days the story of my art-committed life seemed written in the past tense.

You can’t force the tide to come in. But you can be ready for it when it arrives. And in the last three weeks or so, some cracks have formed in the ice. A bit of cold water has stealthily streamed onto shore. I’ve seized on those drops, writing a few pages of choppy, rough prose for my next book. I’m refusing to judge its quality right now, but instead just reveling in the fact that I am, apparently, still a creative writer living an art-committed life.

There is much defrosting still to do. This winter has been the most brutal for me emotionally in nearly a decade. But I understand that Steve “Voice of Golden Eagle” Cox was not just wise in understanding that creativity is a tide, but that we have to remain open to possibility. You can’t seize something that isn’t there, but you can be ready for it when it arrives.

Patrick Ross is a professional storyteller. He works by day as a speechwriter and communications advisor in the Obama Administration while finding time to teach creative writing online with The Loft Literary Center. The author of Committed: A Memoir of the Artist’s Road, he has an MFA in Writing from the Vermont College of Fine Arts. Learn more at http://www.patrick-ross.com.

Most of us avoid talking about death. The topic is not, well, the most pleasant one to address because, inevitably, it means a discussion about what happens before we breathe our last breath. Dying. That’s the part of the conversation where you say, “I hope I go in my sleep,” or “I hope it’s quick and painless.”

Since we can’t run away from dying or lock it up in a closet – sorry – I thought I’d share what Atul Gawande has to say about it in his latest book, Being Mortal. He takes an anxiety-producing topic and fearlessly broaches it through mind-boggling research and affecting stories. Though, I should warn you, the book is not emotionally easy to read. The stories come one after another: Alice’s frequent falls and car accident, Bella’s descent into blindness, Ruth’s stroke, Sarah’s lung cancer.

For much of history, death just happened. People literally dropped dead: you had a sore throat, and the next day you died. Our bodies didn’t “crumble” over time like they do now, thanks to advances in medical technology (28).  We have antibiotics, breathing machines, intravenous fluids, dialysis, chemotherapy. There is always one more drug, one more experimental therapy a physician can pull out of the medicine cabinet to keep you alive, even if it’s only for a few more weeks. Physicians, especially surgeons like Gawande, are trained to fix people. But, in doing so, are we causing more harm than good? Are we denying the aged, and terminally ill, sought after comfort?

But some people are willing to do anything – surgery, take pills – with the hope of maintaining independence, but, as Gawande says, “what do we do when it can no longer be sustained (23)?” Perhaps your parent has have lived on her own for the past fifty years, tending the garden, walking the dog, driving to the grocery store, and so on. But now, due to poor balance and a broken hip (FYI: about 350,00 Americans fall and break a hip every year), she can no longer engage in any of those activities. She can no longer safely cook her own meals or walk to the bathroom. She needs someone to be with her, 24/7. How do we keep the aging population safe while, at the same time, foster their independence? Who will be the one to care for our frail grandparents, parents, or spouses? These are just a few of the difficult questions that lack a single-dose answer.

Through interviews with patients, his dying father, other physicians, and proponents of institutional change, Gawande, and readers, learn that the “sustenance of the soul” is possible through imagination: community co-op living, mobile teams to check in on the elderly, and greenhouse living – long-term care facilities designed to look like a home (128). He debunks the myths of hospice – to do nothing and “let nature take its course (160).” If anything, hospice allows the aged and ill to live a bit longer in their own homes by fostering patient dignity and autonomy.

How all of this comes to fruition may not sound so simple, but Gawande guides us, with a cheat-sheet of questions to ask those who are dying:

1)   What do you understand about your illness, or prognosis?

2)   What are your fears? Goals?

3)   What do you care about?

4)   Given the circumstances, what trade-offs are you willing to make?

5)   If your health deteriorates, how would you like to spend your time, and whom do you want to make decisions for you?

Medicine is not only about repairing people’s hearts or fixing their broken bones.  It’s about maintaining an individual’s well being, emotionally and mentally. It’s about helping human beings live meaningfully by encouraging them to be the author’s of their own lives, up until the very last sentence.

Gawande, Atul. Being Mortal. New York: Metropolitan Books. 2014. Print.

I’m a prose writer, a memoirist, and essayist. I don’t pretend to be a poet, but I dabble in a bit of poetry here and there. I don’t adhere to meter, heptameter, hexameter, or iambic pentameter. I don’t write limericks, ballads, or sonnets. I write vers libre (free verse). I write to share the emotional truth.

Yellow – the most visible color.

Banana peels, tractors, raincoats, school buses, beach flags.

Highlighted words: scars, survivor’s guilt. Sticky notes on the refrigerator, on the bathroom mirror, scrawled with indelible ink: call psychologist, take antidepressant, Attend brain injury support group.

Flashing traffic lights: Slow Down. Double yellow lines: Do Not Pass. Diamond shaped signs: Road Closed Ahead. Rectangular signs: Highly Flammable. Children at Play. Watch for Bicyclists, Joggers – and pedestrians.

Caution tape – a reminder. Ten died. We survived the impact – of the speeding car. Sixty-three of us.

Yellow – the most visible color. In the dark. From a distance. Even from the corners of my eyes.

Be daring. Take a risk. Write a poem. And, please, share.

In the wake of the Iraq and Afghanistan wars, we’ve learned more about post-traumatic stress disorder. But have you heard about post-traumatic growth (PTG)? Richard Tedeschi and Lawrence Calhoun, psychologists at the University of North Carolina in Charlotte, conceived the concept in the 1990s. PTG involves a positive psychological change that occurs after experiencing a traumatic event. PTG can be measured through what is called the PTG inventory. But each one of us copes differently, and who is likely to experience PTG depends on several factors, such as personality traits, mood, and gender. http://www.posttraumaticgrowth.com/what-is-ptg/

If you are interested in learning more about PTG, consider reading What Doesn’t Kill Us: A Guide to Overcoming Adversity and Moving Forward by Stephen Joseph: http://www.profstephenjoseph.com/

Here are some other resources that might be of interest:

Post-Traumatic Growth: Positive Changes in the Aftermath of Crisis. Richard Tedeschi, Crystal Park, Lawrence Calhoun. March 1998.

Super Survivors: The Surprising Link Between Suffering and Success. David B Feldman and Lee Daniel Kravetz. June 2014.

American Psychological Association: www.apa.org/post traumatic growth