Transforming Care: A Christian Vision of Nursing Practice (10 page)

There is another danger in starting our discussion of personhood with
the notion of embodiment. When we think of embodiment we often first
think of the body as it is portrayed in anatomy and physiology textbooks:
as a system of cells organized into tissues, organs, and organ systems that
function together as a body. The body is portrayed as a physical something
that can be operated on, studied by science, and so forth. This picture of
the body is extremely useful and important for nursing practice, and it
produces what we might call an objective account of the body, an account
that is the result of focusing on the body as an object of study. The result of
such study is a picture of the body as a sophisticated but purely physical
mechanism.

We need to recognize, however, that this picture of the body as an object is an abstraction. Our first experience of the body is our own lived experience of being embodied, of seeing the world from this particular location, reaching out for a cup of coffee, waking up and stretching in the
morning. To begin to see bodies as objects rather than people requires us
to abstract the body from its immediate context of the concrete, living person and to focus solely on its physical (physiological, biological) aspects, as
an object. This process of abstraction is part of the process of education as
a nurse, and although it feels natural once one has been socialized into
nursing, it is worth remembering that it is not natural for those outside the
health care context (Chambliss 1996, 26-28). Although this abstraction is
both important and necessary for scientific study of health and disease
processes, we should keep in mind that abstractions are always partial and
that the concrete person is more than physiological processes.

Keeping this cautionary note in mind, we will use the term embodied
to refer to the concrete person: the embodied subject. Embodiment does
not refer to only one aspect of the person, namely his or her physical dimension, abstracted from the other dimensions (emotional, social, moral,
spiritual, and so forth) or abstracted from the fact that such a person is an
"I," a subject. Instead, embodiment refers to a unified, integral someone
who can say "I," an embodied subject, the concrete person before any ab straction occurs. Embodiment is, first of all, the person as a unified, particular "I."

Part of the character of embodiment involves the occupation of a location, here and now. This means that as a creature I am not just any old
where, nowhere in particular; certainly I am not, more fancifully, everywhere in general. Thinking back to our example, Janet was in a particular
location, Ann's room, standing beside her, with the early morning sun
shining on the floor and wall. Being finite, being creatures, means that we
are always located in a particular place and time. Spatial and temporal location is what makes being a human "I" possible at all. And it is also a central aspect of the recognition of another person as an "I" in her own right.
Janet recognizes this particularity when she addresses Ann by name. To
call another by name is tacitly to recognize that person as an "I," a concrete
person, rather than as an abstraction or a role. When we refer to someone
as "the congestive heart failure in room 3574" or "the complainer down the
hall" we diminish that person's subjectivity. Names are important precisely
because they recognize our embodied specificity, the particular person
that we are rather than the interchangeable occupants of a hospital bed.

In addition to location in space and time, embodiment also implies
that I have some independence from my surroundings and can interact
with them in ways that are satisfying and meaningful for me. Enjoying the
taste of freshly baked bread or the warmth of a cozy house on a cold winter's evening offers evidence of my relative independence and ability to interact with my environment in ways that are satisfying and pleasurable
(Levinas 1961, 11o). The senses of rightness and well-being that we discussed in the last chapter are related to enjoyment. Enjoyment is one way
in which we feel those senses in our everyday lived experience. In other
words, we become aware of our sense of rightness in moments when we
experience enjoyment.

When we are not able to interact in satisfying ways, we experience this
as a lack of independence and find it frustrating and sometimes painful.
Enjoyment, then, is an integral, interior aspect of the subjectivity of embodiment. We see this even in situations where one might not expect to see
much joy. Ann's desire to have her hair combed is a small request, but it
touches the core of her subjectivity and offers evidence of her ability to experience some of the basic physical pleasures of life. The caring nurse, in
fact, notices when such requests diminish or disappear. This is a bad sign,
an indicator that a client is losing a sense of self. In these cases the client has a diminished sense of subjectivity, manifest in the lack of enjoyment of
minor bodily processes. Enjoyment is a delight that comes with wellbeing, and its absence is always a danger signal.

Even when well-being is no longer robust enough to sustain much independence as we normally think of independence, in terms of directing
the course of one's life and activities, it is still possible for an individual to
experience the small physical activities of the day as a source of satisfaction. The enjoyment of embodiment constitutes the standing possibility
for thanksgiving: a heartfelt thanks for goodness, delight, and life. And so
we return to themes developed in our first chapter, as we see that for the
Christian nurse even the most mundane activities can be experienced as
participating in worship and gratitude and delight.

But there is more to our relative independence than enjoyment. Separation from our environment as bodily creatures makes us beings that can
have certain amounts of control over what we do, where we go, what we
will eat, who we will talk to, what we will say, and what we will decide.
Janet's activities in the hospital room were
actions, the activity of a being with
agency, as was Ann's request. Being an embodied person, an "I," means to be a point
of origin of deliberate, voluntary, particular actions; in other words, it means having agency (Merleau-Ponty 1962, 137). To
be an "I" is to have agency with respect to
my surroundings. Again, of course, we need to recognize that this is a description that begins with how things ought to be. Too often in life we experience a frustrating lack of agency in our own case or that of others.
Sometimes this is merely temporary, other times it is lifelong, and always it
is cause for a certain level of frustration and lament. This brings us to a
second aspect of being an embodied person, namely dependency.

Ann's situation indicates ways in which she is capable of acting as an embodied agent, but it also points to the other side of embodiment - dependence. Dependence is universal. We are dependent on the ground on which
we walk and on the air we breathe. These universal dependencies remind us of our constant dependence on God's continuing creative and sustaining
work. We also depend on the other people and the social institutions that
provide the context within which we act and live. Human life makes sense
only within an interdependent web of relationships. As embodied, dependent, and interdependent creatures, then, we are vulnerable. Embodiment
is a fragile state; enjoyment is always precarious. And because we are embodied and vulnerable, we cannot ignore the environment within which we
function. When we discuss health and environment in the next chapter we
will see how dependent we are on environmental factors, but for now it is
important to note that embodiment always involves a tension between
agency and dependency. We are always vulnerable because we are always
dependent. In fact, part of embodiment involves our knowledge that there
will come a time when each of us ceases to be an "I," when the elements out
of which we are composed no longer make up a person. The vulnerability
of embodiment constitutes the standing possibility for lament: an anguished cry against suffering, degradation, and untimely death.

Health is not only to be well,
but to be able to use well
every power we have to use.

FLORENCE NIGHTINGALE

There is yet another side to being an embodied person, related to both
vulnerability and agency - namely, openness (Levinas 1987, 146). Embodiment means permanent exposure to incoming disruptions. Because
we are located in space and time and in relations of interdependence with
other people, we are always in a position to be interrupted by other things
and, more importantly, other people. This is not something we have any
choice about. Right from the start of life we find ourselves constantly in relationships where others make decisions that affect us. As we grow and
gain some relative independence we have more control over some of these
mutual interactions, but especially in occupations such as nursing that involve constant attentiveness to others' needs we are never free from the demands of others. And though a bit more time away from others' demands
generally sounds attractive, none of us really wants to be isolated and completely alone; there are few things more damaging to selfhood than extended solitary confinement. A basic part of embodied personhood is this
openness to other selves.

Openness means that persons are always formed by reciprocal interdependence. Janet competently took information from an objective body -
blood pressure, oxygen levels, pulse, urine output - but while she was doing that she also attended to Ann as a whole person. Janet greeted her
warmly, asked an open-ended question, listened for the answer, complied
with the request, and didn't draw attention to its complications. This sug gests a fundamental openness, an attunement to others. It also requires
that we set aside expectations and prejudgments so that we can be open to
others as the vulnerable, enjoying, embodied beings that they are (Olthuis
2002, 128). Openness thus also points to the responsibility we have to and
for the other person. While we generally begin with an assumption of our
own freedom and agency, part of being an interdependent person is to feel
the need to relativize one's own freedom because of responsibility to another person. To be a person is to be called to put one's agency to work for
the good of the other person, to care for that other person. We experience
our own openness when we recognize that we have a responsibility, here
and now, in this relationship, to care.

Being a person involves having a responsibility to care for others, and
this responsibility is a part of the interdependence that marks the human
condition. Most nurses, of course, have no trouble remembering that they
have a responsibility to care for others, particularly clients, since that is
built into their professional identity. But this relationship of responsibility
is a reciprocal one, not a one-way street. At the same time that the nurse
cares for his or her client, we frequently find that the client responds by
trying to take care of the nurse. The client denies her pain because she
doesn't want her care-giver to feel distress. Or the client makes sure he asks
about the nurse's life and family. These gestures can be awkward, but they
indicate that the client feels a need to be in a reciprocal relationship. Sometimes it is tempting for the nurse to brush these gestures aside as impertinent, and they can be inappropriate and intrusive. But at the same time,
recognition that the client is not an entirely passive object of the nurse's
care is an important part of the relationship between these two embodied
persons. It is a relationship of interdependence, though not of equal dependency. Failure to recognize this interdependence and reciprocity of the
nurse-client relationship can result in what William May has described as
the "conceit of philanthropy," which assumes that the world can be neatly
divided into care-givers and care-receivers, which lends an air of superiority to the care-giver (May 1975, 37).

This recognition that being a person always involves interdependence and responsibility naturally brings the discussion for Christians to the notion of persons as bearers of the image of God. One way we bear the image of God is
in being God's stewards - representatives, co-workers, co-authors, signs of
God's reign - here on earth. To be an image-bearer is also to be oriented toward our neighbor (Berkouwer 1959,151). In discipleship, life becomes a truly
human life, lived in service of God through attending to one's neighbor.

This means, of course, that there are at least two image-bearers in any
relationship: the one who is being neighborly and the person to whom one
is neighborly. Recalling our discussion earlier about location, we can say
that the term neighbor involves a closeness that includes openness and care
for the other. So the call to be a neighbor is the call to image God in caring
action. Using our freedom to respond to others' vulnerability in responsible action shows us to be image-bearers. In our example, Janet shows
God's image by her attunement to Ann, by showing her respect and care.
And Ann, reciprocally, images God to Janet, so that Janet finds herself in
the presence of the sacred as she ministers to Ann's physical, emotional,
and social needs. The call from God that I experience when I see another's
vulnerability and need is a fundamental part of what it is for me to be a
subject (Bloechl 2000, 46).

Who would think himself
unhappy if he had only one
mouth, and who would not
if he had only one eye? It
has probably never occurred
to anyone to be distressed at
not having three eyes, but
those who have none are
inconsolable.

BLAISE PASCAL

Thus the other person also bears God's image. In fact, the very suffering and pain of another reflect the image of God in that person. The reason we call it suffering is related to the dignity and sacredness of life and
the recognition that concrete, individual lives ought to exhibit well-being.
We can recognize the absence of something as tragic only when we know
that its presence is part of the proper ordering of a good creation. This recognition of sacredness is not a respect for "dignity of life" generally, as an
abstract principle, but recognition of the
concrete dignity of this particular person,
here and now. The dignity of Ann's particular, individual life bears the image of
God, the Provider and Sustainer of life,
and her suffering is painful precisely because it is a breakdown of the rightful
well-being of the other as a living person.
The task of neighborliness is not blindly
or abstractly directed at humanity in general. It is directed to the other person precisely because the other bears God's image
in his or her vulnerability and need.