The healing space

By Janet M. Cromer, RN | June 12, 2007

Cynthia Medeiros, LICSW, made her theatrical debut in September 2006 in the Pulitzer Prize-winning play Wit, which tells the story of Dr. Vivian Bearing, an English professor who assesses her life with emotion and humor as she undergoes experimental chemotherapy for Stage IV ovarian cancer. What made this debut unique was that it took place at the Dana-Farber Cancer Institute's (DFCI's) Jimmy Fund Auditorium, and the cast, production crew, and audience all shared intimate knowledge about what the play's protagonist was going through. Medeiros is director of patient care services administration at DFCI, and she was joined by other DFCI employees who played all the parts and filled all the technical positions, from grant writing to lighting and set building.

The play was a combined production of the DFCI Creative Arts Program and the Zakim Center for Integrative Therapies at DFCI. The Zakim Center is dedicated to integrating the practice of complementary therapies into traditional cancer treatments, and the Creative Arts Program explores the use of art as a companion to cancer treatment. In the Creative Arts Program, art is seen as a way to offset the overwhelming effect of diagnoses and treatment plans and to help patients find a quiet and healing space inside.

Creative arts as a resource for healing
DFCI's Creative Arts Program began in 1997 when a patient, Mary Louise O'Connor, who was an artist and a poet, asked to do an internship for her doctoral program. Susan DeCristofaro, RN, MSN, OCN, director of patient and family education, supervised O'Connor and in the process became convinced of the healing powers of art. "M.L. came in with her Cray-Pas, paints, and tambourine," DeCristofaro says, "and set up our first art studio in the resource room." When O'Connor died two years later, DeCristofaro took on the mission of expanding the program to include more art, writing, music, and drama.

In addition to offering biweekly workshops, the Creative Arts Program sponsors an annual arts week with workshops, exhibits, and performances for patients and staff. Occasionally, doctors will teach workshops on such arts as poetry writing or photography. It helps, according to DeCristofaro, to show patients that doctors have another side, a human side.

"The message is 'art is healing,'" says DeCristofaro, who recently gave a presentation about DFCI's production of Wit at the annual conference of the Society for the Arts in Healthcare. "Florence Nightingale spoke of art and nature, and the importance of a patient's environment," she adds, pointing out that 45 percent of patients who are treated for cancer may not be cured but still need to learn to live with the disease. "Cancer is a chronic illness now," DeCristofaro says. "People want to have a sense of healing in body, mind, and spirit, and witness their experience in whatever way they choose."

Growing as part of a larger community
Medeiros took on the role of Vivian Bearing in Wit, she says, because she had learned so much from patients and families in her role as a clinical social worker. "I wanted to use what they had taught me. That way I could get into the journey of Vivian Bearing, get into her soul," says Medeiros. "The patients show me how to live my life."

Wit's director for the DFCI performance was Susan Hitchcock-Bryant, RN, MPH, who has experience directing community theater. Medeiros says the participants formed new bonds coming together as a cast to mount a professional production. After a few months of rehearsals, Wit opened to an audience of patients, professional colleagues, family, and friends. The power of art to bring together such a diverse group of people in order to explore highly charged issues was demonstrated by the discussion about ethics that followed the play. Cast and audience both participated, and those who were there described the experience as outstanding.

Playing the role of Vivian Bearing had a profound effect on Medeiros. "I grew as a person," she says. "I found myself identifying with the character and finding the balance of being a person and accommodating to the situation." Written in 1997 by playwright Margaret Edson, much of the play focuses on Bearing's feelings of not having control over her priorities and treatment. Medeiros says that although DFCI staff pride themselves on offering a humane experience to patients and families, the play was a reminder of the importance of taking the time to listen to patients. Medeiros adds that she is most proud of the reviews from DFCI patients who told her, "You really told my story; this really, really feels real."

Art as empowerment during therapy
Jessica Case, BFA, is a professional artist and creative-arts specialist who oversees the multifaceted Creative Arts Program for adults. Patients have access to a fully equipped art studio located in the resource library that they are welcome to use on their own or with a facilitator, free of charge. Staff and volunteers provide individual lessons as well as workshops on jewelry making, paper flowers, gel-transfer prints, and mosaics. Case says jewelry making is particularly popular because "it's nice to have a functional piece of art to show off to family and friends." The studio is set up for a range of diversity in ages and cultures, and men drop in as often as women. Case also takes steps to assure that all the tools and materials used for art projects can be easily disinfected for use by immunosuppressed patients. With that precaution in place, patients are free to choose their media and own expressive style.

Creative arts in an oncology setting, Case says, offers many benefits. "Art is meant for release and enjoyment," she says. "We don't make interpretations because it's left open to the patient what their expressions mean." Patients say making art helps them relax, and creating something makes them feel good. Case observes that people leave the art center mentally and spiritually empowered even when fatigued or experiencing side effects from their treatment. "In the art studio, they get to meet someone who is concerned for them as an individual, not as a patient," Case says. She also says that participating in the creative process allows people to be in the moment while they are also looking forward to and creating their future. When Case started at DFCI, she already knew the challenges and satisfactions of working with people undergoing cancer treatment. She learned from her mother who has been a DFCI RN for 27 years.

Art can be either a private or a public endeavor. A current exhibit at the Best Western Hotel in Boston's Longwood Medical Area showcases patient art, which is sold matted and framed to benefit the program. Two display cases featuring rotating exhibits of patients' artwork are a striking presence in the resource library. Case remembers a concerned husband who approached her once because his wife, an artist, had stopped painting after she was diagnosed with aggressive cancer. After he and Case put together a show of the artist's work and held an opening, the patient returned to making art. Case says, "We brought her and her family back to a state of normalcy."

In addition to painting and other forms of visual art, DFCI's Creative Arts Program also includes writing, drama, poetry, music, and dance. It has staff trained as clowns, and the HumorUs Healers, a volunteer troupe of clowns who visit patients in the clinic and while receiving treatment as inpatients at Brigham and Women's Hospital. Music therapist Lorrie Kubicek, MT-BC, gives music lessons, offers therapy, and brings music to the bedside of patients receiving chemotherapy in the infusion room.

Encouraging kids to be kids
Martha Young, MS, CCLS, is a patient-and family-education specialist. She enjoys her nontraditional role as a child-life specialist in the pediatric resource room located outside the Jimmy Fund Clinic. Young provides structured and free-form therapeutic activities on a daily basis with the aim of incorporating the creative arts into education.

Young does a lot of medical play and medical art with pediatric patients and their siblings. She uses it to educate her young patients about things they may be experiencing. For example, when children need tension release they can squeeze and mold Play-Doh, or make a target and squirt syringes full of paint at it. When building self-awareness of how cancer has changed or not changed them, Young suggests tracing their body and filling in the outline as "who you are now." Collages about current identity are also popular, Young says, adding, "I consider play to be part of creative arts."

Using different forms of art with pediatric patients, according to Young, promotes a normative experience during illness, aids growth and development, and gives children a normal social interaction. "As you get to know the patient and family," she says, "you get to know their needs and skills and how they change from week to week." Young stresses the importance of having a range of expressive modalities available. To that end, a Lesley University creative-writing intern helped script an original play about sun safety that was performed by Jimmy Fund patients for a school assembly.

Dana-Farber Cancer Institute provides the world's most advanced treatments for pediatric and adult cancers. The staff members involved in the Creative Arts Program also know that embracing and integrating the creative and performing arts with that treatment adds an essential dimension of healing, and strengthens the continuity of the journey called life.

To learn more about how the arts are employed at Dana-Farber, visit the Dana-Farber Creative Arts Program home page.

This is the second of a three-part series on medical humanities in the Greater Boston area. Janet Cromer is a freelance writer and regular contributor to On Call. She received the Will Solimene Award for Excellence in Medical Communication for her On Call article "Drawing Out the Best in People" (September 2005), which described the work being done at the Boston Institute for Arts Therapy.