4 6 6
THE OW N BODY AS A NURSE’S LI VI NG EXPERI ENCE ON ASSI STI NG
OTHERS I N THEI R DYNG PROCESS
1Mar ia Ter esa B. Mar iot t i de Sant ana2
Mar ia Salet e Bessa Jor ge3
San t an a MTBM, Jor ge MSB. Th e ow n body as a n u r se’s liv in g ex per ien ce on assist in g ot h er s in t h eir dy n g pr ocess. Rev Lat ino- am Enfer m agem 2 0 0 7 m aio- j unho; 1 5 ( 3 ) : 4 6 6 - 7 3 .
I t r efer s t o t he st udy of t he r esear cher ’s per cept ion w hen analyzing her ow n exist ence, aim ing t o lear n
t he sense and m eaning of her ow n body as a living exper ience w hile assist ing t he ot her in t he pr ocess of dying.
The Mer leau- Pont y phenom enology and t he new her m eneut ic appr oaches w er e chosen. A point of cont act w as
est ablished bet w een t he living exper ience of t he appr oxim at ion of t he obj ect , unveiled by t he ow n body inser t ed
in t h e w or ld , t h e obj ect an d t h e su bj ect of t h e st u dy . Th e t h em es t h at em er ged w er e abou t t h e m
agical-r eligious k now ledge influences of t he peagical-r ceiv ed w oagical-r ld, t he agical-r eal k now ledge and t he t eaching- leaagical-r ning pagical-r ocess.
The phenom enon elabor at ed, r esult of t he st udy, allow ed t he lear ning of t he t hesis of t he exist ence of a sense
and m eaning for t he ow n body of healt h pr ofessionals w hen assist ing ot her s in t he dy ing pr ocess.
DESCRI PTORS: hum an body ; deat h; philosophy , nur sing; t hanat ology
EL PROPI O CUERPO COMO EXPERI EN CI A VI VI DA POR LA EN FERMERA AL CUI DAR DEL
OTRO DURANTE EL PROCESO DE MUERTE
Est e est udio r ealiza un análisis de la ex ist encia baj o la per cepción de la invest igador a, con el obj et ivo
de en t en der el sen t ido y sign ificado del pr opio cu er po com o ex per ien cia al cu idar del ot r o en el pr oceso de
m u e r t e . Se o p t ó p o r l a m e t o d o l o g ía f e n o m e n o l ó g i ca m e r l e a u p o n t y a n a y d e l a n u e v a h e r m e n é u t i ca .
Est ablecién dose u n pu n t o de con t act o en t r e la ex per ien cia de apr ox im ación , m ost r ado por el pr opio cu er po
com o par t e del m undo, el obj et o de est udio y el suj et o. Sur gier on t em as r elacionados con la per cepción del
m undo con influencia del saber m ágico- r eligioso, del saber r eal y de la enseñanza apr endizaj e. El fenóm eno,
pr oduct o del est udio, per m it ió com pr ender la t esis de la ex ist encia en su sent ido y significado par a el pr opio
cuer po del pr ofesional de la salud, al cuidar del ot r o que est á m ur iendo.
DESCRI PTORES: cu er po h u m an o; m u er t e; filosofía en en fer m er ía; t an at ología
CORPO PRÓPRI O COMO EXPERI ÊNCI A VI VENCI AL DA ENFERMEI RA NO CUI DAR DO
OUTRO NO PROCESSO DE MORRER
Tr at a- se de est udo da per cepção da pesquisador a, ao r ealizar análise de sua ex ist ência, obj et iv ando
apr eender o sent ido e significado do cor po pr ópr io com o ex per iência v iv encial ao cuidar do out r o no pr ocesso
de m or r er . Opt ou- se pelo per cur so m et odológico da fenom enologia m er leaupont y ana e da nov a her m enêut ica.
Est abeleceu- se um pont o de cont at o ent r e a ex per iência v iv encial de apr ox im ação do obj et o, desv elado pelo
cor po pr ópr io in ser ido n o m u n do, o obj et o de est u do e o su j eit o. Em er gir am as t em át icas sobr e o m u n do
p er ceb id o d as in f lu ên cias d os sab er es m ág ico- r elig iosos, d os sab er es r eais e d o en sin o- ap r en d izag em . O
fenôm eno elabor ado, r esult ado do est udo, per m it iu apr eender a t ese da exist ência de um sent ido e significado
par a o cor po pr ópr io do pr ofissional de saúde ao cuidar do out r o que est á m or r endo.
DESCRI TORES: cor po h u m an o; m or t e; filosofia em en fer m agem ; t an at ologia
1 St udy ext r act ed fr om Doct or al Disser t at ion; 2 PhD in Nur sing, Pr ofessor Feder al Univer sit y of Bahia, College of Nur sing, e- m ail: allw 1795@t er r a.com .br ; 3
PhD, Full Pr ofessor St at e Univer sit y of Cear á, Nur sing Depar t m ent , e- m ail: m asabej o@gm ail.com
D isponible e n ca st e lla no/ D isponíve l e m língua por t ugue sa SciELO Br a sil w w w .scie lo.br / r la e
Rev Lat ino- am Enfer m agem 2007 m aio- j unho; 15( 3) : 466- 73 w w w . eer p. usp. br / r lae
I NTRODUCTI ON
F
or m e, t he m ot ivat ion t o car r y out t his st udy d er i v ed f r o m m y co n cer n s as a r esear ch er, w h i chem er ged fr om m y daily r ealit y as a nur se and t eacher. I st ar t ed t o r eflect on m y ow n exper iences as a healt h p r o f e ssi o n a l i n ca r e d e l i v e r y t o p e o p l e w h o a r e
exper iencing t he pr ocess of dying and deat h; as w ell as i n t each i n g o t h er s t o d el i v er car e. Th e h u m an ex per ien ce of dy in g h as accom pan ied m e sin ce t h e
st ar t of m y act iv it ies as an u n d er g r ad u at e Nu r sin g st u den t , an d lat er as a n u r se at t h e I n t en siv e Car e Unit ( I CU) , w her e deat h is not an abst r act ion, but a
r eal pr oblem , v isible t o t he ey e, due t o t he fact t hat p eop le in sev er e h ealt h con d it ion s ar e h osp it alized t her e. St ar t ing fr om t his cont ext , I develop an analysis
of m y exist ence in t he lifew orld of t he hospit al, in an I nt ensive Care Unit , and in t he lifew orld of a universit y, w it h a v iew t o appr ehending t he sense and m eaning
of t he ow n body as a living exper ience in car e delivery of t he ot her per son w ho is dying.
Ex ist in g r esear ch abou t t h e ow n body as a
liv in g ex p er ien ce sh ow , in w h at is liv ed an d n ot in w h at is t h eor ized , t h at t h is p er cep t ion d ep en d s on t he self- know ledge of t he pot ent ialit ies inherent in t he
h u m a n co n d i t i o n i n co p i n g w i t h t h e p h e n o m e n a m an if est ed in t h e ow n b od y ’s ex t er ior an d in t er ior en v ir on m en t , as t h e sou r ce of or ig in of all sen ses
an d m ean in gs each per son at t r ibu t es t o ev er y t h in g t h at ex ist s in h im - / h er self an d in t h e w or ld ( s) h e r eceives at bir t h. The ow n body, as a living exper ience,
receives t he m eaning of being an inst r um ent of care. This can only happen because t her e exist s a body. I t is t he ow n body t hat dom inat es car e – r anging fr om
t he m ost obj ect iv e t o subj ect iv e act ions. Ev er y t hing get s in act ion in t he body w hen a nurse is delivering car e – body and psychodynam ic m ovem ent s. The ow n
b od y as an in st r u m en t of car e d eliv er y t r an scen d s t h e m er e act of doin g som et h in g or a pr ocedu r e or t ech n iqu e. I t is t h e pr esen ce, w h ich is com plet e in
t he care act ion, and w hich has a spirit ual st at e t hat is per m anent ly av ailable t o I nt er act w it h and t ouch t he ot h er s( 1 ).
An ot h er m ean in g at t r ib u t ed is t h e b od y as cor p or eit y. I t im p lies en t er in g t h e u n iv er se of t h e b ei n g w h o sh o w s h i m - / h er sel f an d p er cei v i n g t h e
b o d y ’ s s p a c e i n i t s d i f f e r e n t p e r s p e c t i v e s . I t i s consider ed as t he w ay of being of m an w ho is felt and feels, w ho t ouches and is t ouched in t he pr ocess of
t h e c o e x i s t e n c e c o n t a i n e d i n t h e e n t i r e h u m a n
d im en sion , as it is n ot som et h in g ob j ect iv e, r ead y
an d f in ish ed . Cor p or eit y is t h e ex ist in g , it is m in e, y o u r s, o u r h i st o r y( 2 ). An d , h e n ce , t h e o w n b o d y b e co m e s t r u l y h u m a n a n d m e d i a t e s t h e r e l a t i o n
bet w een m an and t he w or ld. The client and t he nur se, as cor por eit y, ar e per ceived in t he union bet w een t he being and act ion, in t he shar ing of know ledge and in
t he ex pr ession of v alues and affect iv it y( 3).
The ow n body as a living exper ience benefit s t h e coex ist en ce of r at ion alit y an d sen sit iv it y in car e
pr act ices, becau se it allow s t h e car egiv er ’s body t o expand it s pot ent ialit ies t hrough a cont inuous exercise of no longer being an “ in oneself ” t o t urn int o a “ w e”,
est ablishing a relat ion of int ercorporeit y, in w hich t he body t h at r eceiv es car e becom es t h e su bj ect of t h e car e p r ocess( 4 ). I t is t h e su b j ect iv e d im en sion t h at
p e r m i t s t a l k i n g a b o u t se n si t i v i t y, a e st h e t i cs, t h e im por t ance of being t oget her in car e for t he body.
I n consider ing t he subj ect iv e dim ension, t he
m eaning at t r ibut ed t o t he nur se’s ow n body as a living ex p er ien ce su sp en d s t h e ob j ect iv ist p er sp ect iv e of t he body as som et hing r eal and nat ur al. I n t he face
of t he real, nat ural body, nurses consider t heir desires and feelings and ar e aw ar e of t he im por t ance of car e deliv er y w it h sensit iv it y and aest het ics. Thus, based
on t h is aw ar en ess, aest h et ic an d t ech n ical car e can live t oget her in nursing pract ice, w hich j oins know ledge t h a t i s ca p a b l e o f d el i v er i n g ca r e t o t h e d esi r i n g
s u b j e c t , t o t h e e x t e n t t h a t t h e n a t u r a l s c i e n c e appr oach is r elat ivized. Aw ar e of t he desir ing subj ect an d t h e r eal an d n at u r al body, t h e n u r ses u nv eil a
hor izon of possibilit ies t o ex pr ess subj ect iv it y in car e for t he body( 5). The ow n body as a liv ing ex per ience is t he appr ehension of t he m eaning of t he body t hat
gain s space in t h e ow n w or ld; it r ev eals it self as a f lig h t f r om t h e p r esen t , est ab lish in g t h e ow n t im e, and cont ains t he dim ension of am biguit y( 6).
I n v iew of t hese st udies, I consider t hat t he ow n body as a liv in g ex per ien ce can be in ser t ed in t he m ovem ent of changing at t it udes in int ensive car e
p r act ices, em p h asizin g t h e h u m an izat ion of h ealt h pr ofessionals t o cope w it h deat h sit uat ions and conduct t h e d y in g p r ocess in t h e I CU. Th er ef or e, I b eliev e
t hat , in or der t o be cr eat ed on t he basis of t he ow n body as a liv in g ex per ien ce, t h e pr of ession al space needs t o develop t he per cept ion of t he “ int ensive car e
nur se- being” about him - / her self in t he w or ld. For t his t o happen, t he life hist or y play s a fundam ent al r ole, as it influences t he percept ion, t hat is, t he aw areness
4 6 8
Th i s p e r ce p t i o n i s e x p r e sse d b y l a n g u a g e . Th u s,
aw ar eness about t he v aluat ion of hist or icit y becom es essent ial, as t he ow n body t hat appear s is m ar ked by t h e ex per ien ces t h at con st an t ly em er ge.
METHODOLOGY
Ph en o m en o l o g y - h er m en eu t i cs w as u sed i n t h i s s t u d y. Th i s m e t h o d o l o g y d e p a r t s f r o m t h e
invest igat ion of t he ow n body, locat ed in it s experience lived in t he w or ld. I t m eans under st anding t he hum an body as an ex t ension, a space t hat is char act er ized
in t erm s of spat ialit y, volum e and m at erialit y, subj ect t o t he law s of t he m at er ial univ er se, as it is m olded w it h t he sam e subst ance as ot her non- hum an bodies.
Alt hough it s ex ist ence is m ix ed w it h all ot her bodies t h at su r r ou n d it , w it h com m on ch ar act er ist ics, t h e hum an body is not like t he ot her s. Ther e is som et hing
unique about t his body t hat m ak es it differ ent . I t is t he flesh. That “ [ ...] is neit her m at t er, nor spir it , nor su b st an ce. I n o r d er t o d esi g n at e i t , t h e o l d t er m
‘elem ent ’ w ould be needed, in t he sense in w hich it was used t o t alk about t he wat er, air, ear t h and fir e”( 7). I n t h is st u dy, t h e h u m an body is t h e in car n at ion of
t h e co n sci o u s a n d i n d i v i d u a t e d n a t u r e , w i t h t h e capacit y t o get t o know and t o know w hat one know s t hat ( s) he know s. I n t he w ay it is const it ut ed, differ ent
f r o m o t h e r b o d i e s , t h i s f l e s h e l e m e n t u s e s t h e p r o d u c e d k n o w l e d g e a s i n t e r n a l a n d e x t e r n a l references, enabling oneself t o circulat e in a perceived
w orld, st art ing t o exist in t he sear ch for an answ er t o t he quest ion: w ho am I ?( 8).
Un d er st ood in t h e lig h t of Mer leau - Pon t y ’s
phenom enology, t he hum an body is consider ed in t he sense of “ [ ...] a gener al t hings, half w ay bet w een t he space- t im e individual and t he idea, a kind of pr inciple
incar nat e t hat im por t s a st y le of being [ ...] t he flesh is an ‘elem en t ’ of t h e b ein g ”( 7 ). Th u s, t h is st u d y is a b o u t p u t t i n g o n e s e l f i n t h e d i r e c t i o n o f t h i n g s
t hem selv es as, if I am a conscience dir ect ed at t he “ t hings” t hat exist in t he w orld, I can “ ret urn” t o t hem w it h a guiding quest ion: w hat does t he ow n body of
t h e h e a l t h p r o f e ssi o n a l m e a n t o m e , a s a l i v i n g ex p er ien ce? Th en , I can f in d n ot on ly t h e act ion s, w h ich ar e t h e act ion s of t h e ot h er, b u t also f in d a
sen se i n t h ese act i o n s as, f o r m y b o d y, t h ey ar e t hem es of possible act iv it y.
I n follow ing t he select ed m et hodology, I adopt
t h e p h en om en olog ical at t it u d e of m ak in g t h e liv ed
w or ld appear as it is. Thus, t he subj ect of t his st udy
em er ged f r om t h e r ef lex iv e bases con st it u t ed alon g m y ex ist ent ial t raj ect or y, as an ow n body t hat ex ist s in t he w orld, coexist ing and int eract ing w it h ot her ow n
bodies( 9). The st r at egy used for t he st udy w as t he life h ist or y. I m ade r ecor ds in a diar y, w r it t en bet w een Januar y and Decem ber 2003. The applicat ion of t his
st r at egy allow ed m e t o dir ect ly capt ur e t he per cept ions of t he lived experiences, so as t o rescue t he em ot ions an d f eelin g s of t h e ow n b od y in p ast ex p er ien ces,
w hich give m eaning t o daily act ions ( 10).
Th e a n a l y s i s p r o c e s s w a s b a s e d o n t h e est ablishm ent of unit s of m eaning ext r act ed fr om t he
com plet e body of t he r ecor ded hist or y. The unit s w er e gr ouped int o specific cat egor ies accor ding t o sim ilar m eanings, and t hen r egr ouped in w ider cat egor ies or
allocat ed in n ew on es. Th is gav e r ise t o t h e t h em e ar ea, in t he light of exist ent ial phenom enology, w hich pr ov ided answ er s t o t he st udy ’s guiding quest ion ( 9).
ELABORATED PH EN OM EN ON : TH E STUD Y
RESULT
As a r esear cher, I assum ed t he r esult s as a
set of asser t ions or unit s of sense and m eaning t hat appoint t o t he ex per ience of t he subj ect and t o t his su b j ect ’s aw ar en ess ab ou t t h e p h en om en on . Th u s,
t he follow ing t hem es em er ged: influences of m agic-r eligious k now ledge, influence of agic-r eal k now ledge and in flu en ce of k n ow ledge on t each in g- lear n in g.
Them e 1 – influences of m agic- r eligious k now ledge
D esp i t e u n d er st an d i n g d eat h as a n at u r al phenom enon, t her e ex ist s a clear under st anding t hat t he first m agic- religious represent at ions are significant
in t he appr oach of t he st udy obj ect , t o t he ext ent t hat I const r uct ed, in m y ex ist ence, t he r epr esent at ion of m y self an d of d eat h , in f lu en ced b y ot h er s, in t h is
case t he adult s r esponsible for m e. This is illust r at ed by t he ex t r act of t he life hist or y t r anscr ibed below :
[ . . . ] d u e t o t h e r i t u a l s o f t h e Ca t h o l i c Ch u r ch ,
syst em at ically exper ienced since I w as ver y young, bet w een 5
and 7 years, unt il t he end of m y adolescence, m y parent s obliged
m e ever y year t o follow t he r it ual, on Good Fr iday, of kissing t he
I m age of t he Dead Lord [ ...]
Thus, I sit uat e m y childhood exper ience as a condit ioner t o appr oach t he st udy obj ect and, hence,
I descr ibe t he aw ak ening of t he aw ar eness of deat h
The ow n body as a nur se’s...
Sant ana MTBM, Jor ge MSB.
in child psyche: “ [ ...] t he child becom es aw are of it self
as an indiv idual, as m an is t he only being w ho t r uly h as t h is aw ar en ess, t h e on ly bein g w h o k n ow s t h at h is ex ist en ce on ear t h is f in it e, eph em er al”( 1 1 ). Th e
aw ar eness of deat h is associat ed w it h t he aw ar eness of oneself as an indiv idual and em er ges ar ound t he age of t hree. Hence, as a child, at t he sam e t im e as I
becam e aw ar e of deat h , I becam e aw ar e of m y self and developed m y ow n not ion of deat h, even w it hout liv ing t his ex per ience in t he fam ily or w it hout hav ing
seen a dead body. Th e ow n n ot ion is elabor at ed by t he child, as: “ [ ...] despit e hav ing no ex per iences of d eco m p o si t i o n o f t h e b o d y, [ t h e ch i l d ] k n o w s t h e
anguish and obsessions of deat h v er y ear ly ”( 12). Ver y ear ly m eans fr om bir t h. And t he anguish a n d o b s e s s i o n s o f d e a t h a r e r e p r e s e n t e d b y
ph y siological an d r espir at or y an gu ish . I t is t h e f ir st psychophysical cont ent ; it is t he individual act t hr ough w hich t he individual becom es aw ar e of him - / herself( 13).
I consider t his act as a deat h, of w hich one has no m e m o r y, a l t h o u g h t h e l i v e b o d y r e g i s t e r s t h i s t r au m at ic ex p er ien ce an d f eels t h e an g u ish , w h ich
aw ak es him / her t o t he aw ar eness of deat h it self and of him - / her self. Thus, t he appr opr iat ion of t he idea of d e a t h a n d d y i n g i s a co n se q u e n ce o f t h e ch i l d ’ s
int eract ion w it h his/ her ow n self.
Wh en , in m y ch ildh ood, I becam e aw ar e of deat h, t he pr edom inance of t he or ient at ion I r eceived
at t r act ed m y at t en t ion , in t h e sen se of t h e m ag ic-r elig iou s ic-r ep ic-r esen t at ion s ic-r elat ed w it h t h e im ag e of t he hum an body t hat m anifest ed t he phenom enon of
deat h, as r ev ealed by t he follow ing ex t r act :
[ ...] t he agonizing body w as st uck t o a cr oss; [ ...] and
in t he pr ocession held on Good Fr iday, in a coffin, [ ...] t he dead
body w as ly ing, r est ing, beaut ifully dr essed, ser ene, quiet –
alt hough his wounds were open, bleeding, because he had suffered
a violent deat h, deat h on t he cr oss [ ...] .
Th at im ag e of t h e h u m an b od y t h at I saw iner t , in t he coffin, w as not consider ed by t he adult s as j ust any dead body, it was hum an and it was God
an d h e h ad d ied t w o t h ou san d y ear s ag o, a d eat h t hat , ov er t im e and dur ing m any cent ur ies, “ [ ...] did not only affect t he fellow m en, but t he principle of t he
social w h ole it self.”( 1 2 ). I n t h is per spect iv e, w it h t h e aw areness of deat h, t he child I w as found inside herself r em ar k ab le st r en g t h s t h at m old ed b ot h h er w ay of
seeing t he deat h sit uat ions, in t he past and pr esent , and her w ay of dealing w it h t hem .
The analy sis of t he liv ing ex per ience dur ing
ch ild h ood allow ed m e t o p er ceiv e t h e d if f er en ce in
t h e m ean in g of d eat h f or ch ild r en an d ad u lt s. For
adu lt s, n or m ally, deat h m eans pain an d solit ude for t he people w ho sur vive. Fr om t he hum an angle, “ [ ...] deat h is n ot on ly t h e dest r u ct ion of a ph y sical an d
biological st at e, it is also t hat of a being in relat ion, of a b ei n g w h o i n t er act s”( 1 1 ). Th e d est r u ct i o n o f t h e h u m an r elat ion s am on g t h e in d iv id u als, cau sed b y
deat h, giv es r ise t o a r elat ion w it h t he v oid, as t he l i v i n g b o d y, w h en i t st i m u l at es t h e d ead b o d y b y t ouching it , by t he sound of t he v oice, by cr y ing, no
longer get s any answ er : t he void of deat h is felt fir st as an in t er act ion al v oid , w h ich p r ov ok es p ain an d r efu sal of t h e dead body, w h ose fu n ct ion s ( w alk in g,
t alk ing, sm iling, cr y ing) cease t o ex ist .
While t he adult per ceiv es deat h, fir st , as an int eract ional void, t he child perceives it as a provisional
m o m e n t o f a b s e n c e , a p l e a s a n t , i n t e n s e a n d u n con sciou s desir e of “ [ . . . ] goin g back t o t h e place w h er e y ou cam e f r om , t o t h e in t r a- u t er in e lif e”( 1 3 ).
Th e aw ar en ess of on e’s ow n or t h e ot h er p er son ’s deat h, in child- or adult hood, is undoubt edly one of m an ’s gr eat est con st it u t iv e con qu est s: “ [ . . . ] t h is is
no longer a m at t er of inst inct , but about t he daw n of hum an t hinking, t r anslat ed by a kind of r evolt against deat h”( 12). I under st and t hat t his r evolt against deat h
p r o v o k e s t h e p r o d u ct i o n o f a n i n t e n se v a r i e t y o f m agic- r eligious r epr esent at ions ar ound t he dead body in m an, especially w it h r espect t o t he r epr esent at ion
of God’s dead body.
The child I w as at t hat t im e neit her under st ood n or qu est ion ed, bu t on ly im it at ed an d su bm it t ed t o
t he ot her, t he adult . She per ceiv ed t hat t he ex it for her child conflict s w as t o do like God, as expressed in t he follow ing ex t r act :
[ ...] every year, in Church, during Lent , I saw t he im age
of t he Dead Lor d – t he iner t body of a beaut iful per son, nicely
dr essed, lying dow n r est ing, even having been condem ned, w it h
open w ounds, bleeding because he has suffer ed a violent deat h,
deat h on t he cr oss [ ...] , a hum an body t hat is idolized, ador ed,
revered by all, and m ainly by m y parent s [ ...] . The dead body was
t r anspor t ed and t r eat ed in a v er y special w ay and w as not
abandoned. Ther e w er e alw ays m any people w it h him ...
This r epr esent at ion exer t ed such a st r ong and
decisiv e in f lu en ce t h at I can n ot pr ecisely det er m in e t he inst ant of m y decision. My being, m y I det er m ined t hat no m or e day w ould go by w it hout w ant ing deat h
for m e, w it hout aw ait ing it ever y day and expect ing it lik e a f r ien d an d com p an ion , d esp it e t h e p ain an d suffer ing at t r ibut ed t o it . The hum an cor pse ar ouses
4 7 0
im ply an ex t ension of life. The non- abandonm ent of
t he dead im plies t heir survival, alt hough it is no longer a com m on liv in g per son , becau se t h er e is n o m or e hum an body, t ur ning deat h int o a m et aphor of life, in
a w ay t hat t her e exist s no concept , no idea of deat h, but an im age, a m yt h ( 12).
Despit e m y desir e an d in fan t an x iet y abou t
deat h, I did not t ake t he init iat ive t o m ake it happen, t o consciously seek it , as all of t hese r epr esent at ions w e r e st r e n g t h e n e d b y t h e e d u ca t i o n sy st e m t h a t
c o r r e s p o n d e d t o t h e c h i l d h o o d a n d a d o l e s c e n c e p er iod , as ex p r essed in t h e f ollow in g ex t r act f r om t he life hist or y r egist er ed in t he diar y.
[ ...] for 13 year s, I w as educat ed in a high school r an
by nuns and I lear ned t he dut y t o be a daught er of God. Ther e
w er e no r ight s, only dut ies, obligat ions, st r ict discipline of t he
r it uals, blind obedience [ ...] t his w as fait h, t his w as being a
daught er of God at a t im e of m any conflict s, m uch repression and
fear [ ...] . I developed a preference for t he Dead God.
This w as not one of t he happiest per iods in m y life, but I learned a lot , as t he religious ideas and d o c t r i n e s i n t r o d u c e d b y t h e e d u c a t i o n a l s y s t e m
p r ov ok ed t h e em er g en ce of d ou b t s ab ou t God an d f e a r o f t h e u n k n o w n , a cco r d i n g t o t h e f o l l o w i n g ex t r act .
[ ...] and if God does not exist and if Jesus is not God?
And w hat is t her e in deat h? For m e, deat h only m akes sense in
God and how Jesus did it . Jesus did not t ake away his own life. He
lived life and w ait ed for deat h, and deat h on t he cr oss, deat h of
t he phy sical- biological body felt and liv ed w it h it s hum anit y ,
w it h pain and suffer ing, despit e being God.
The quest ionings about t he exist ence of God, t he at t r act ion t o t he im age of Jesus’ dead body and t he cer t aint y of m y ow n deat h accom panied m e dur ing
childhood and adolescence. I st ar t ed t o liv e w it h t he em pir ical im age of deat h, t he im age t hat w as giv en t o m e by m y par ent s’ r eligion and by t he convent ional
r ep r esen t a t i o n s a b o u t i m m o r t a l i t y t r a n sm i t t ed b y school and, t herefore, sociocult urally const ruct ed. The a w a r en ess o f d ea t h i s a l so a co n seq u en ce o f t h e
individual’s int eract ion w it h ot her individuals, w it h t heir cult ure, besides t he int eract ion w it h t heir ow n self( 11). Th e u n con sciou s d oes n ot r ecog n ize d eat h or t im e
and, in his m ost int im at e or ganic and physiochem ical recesses, m an feels im m ort al. I t is only by experience, in coex ist ing w it h t he ot her, t hat t he hum an species
know s t hat it has t o die, as t he live body becom es a dead body – a cor pse. Hum an deat h is a k now ledge acquir ed by m an and, as it is an ext er ior know ledge,
it is lear n ed, n ot in n at e, an d alw ay s su r pr ises h im .
Th e r e f o r e , t h e i n d i v i d u a l a ck n o w l e d g e s i t a s a n
inev it able law : “ [ ...] at t he sam e t im e as pr et ending t o be im m ort al, m an w ill call him self m ort al”( 12).
Wit h t h e n ot ion of im m or t alit y acq u ir ed in
school educat ion, during adolescence, I perceived t he sense and m eaning of deat h as salv at ion. I consider t hat t his hist or ical- cult ur al cont ex t of m agic- r eligious
know ledge w as per haps not det er m inant , but definit ely condit ioned t he focus of m y int erest in t he sense and m eaning of t he ow n body as a liv ing ex per ience, so
t hat t he appr ox im at ion w it h t his st udy obj ect com es fr om v er y far in m y hist or y.
Them e 2 – influence of r eal k now ledge
Bef o r e b ei n g a h ea l t h p r o f essi o n a l , d ea t h
present ed it self t o m e again, w hile I w as st ill a st udent . Th is t im e, it w as n ot t h e im ag e of t h e Dead Lor d , alr eady abandoned and for got t en in a dist ant t im e. I t
w as act u ally an u n k n ow n cor pse, a w om an . At t h at t im e, I w as st ar t ing t o st udy anat om y and at t ended dissect ion classes at t he Nina Rodr igues Medicolegal
I n s t i t u t e i n S a l v a d o r. Th i s i s r e v e a l e d b y t h e ex per ience r egist er ed in t he diar y.
[ ...] t he body was naked, undone of clot hes and beaut y,
abandoned, w it hout anyone t o kiss or cher ish it , and exhaled an
ext rem ely unpleasant sm ell, m ixed wit h form aldehyde [ ...] a body
of flesh and bones w as t her e, w ait ing for som eone t o t ouch it .
And t her e w as nobody. I looked at t hat body and felt par alyzed
[ ...] I w as alone and asked m yself: The cor pse, aft er all? What is
deat h?
When t he dissect ion class st ar t ed, I w as no longer alone. Ot her bodies m ade m e get out of t hat f i x a t i o n a n d f e e l s h o c k e d , w h e n o b s e r v i n g t h e
t eacher ’s and his assist ant s’ ease, t he appr opr iat ion of k n ow led g e, alm ost f u n in d issect in g t h e cor p ses a n d h a n d l i n g t h e b o d y p a r t s. Th ese h u m a n b o d y
dissect ion closes also w ork as an init iat ion rit e as, for t h e st u den t s, it m ean s act u ally h av in g con t act w it h t he w or k obj ect of healt h pr ofessionals, especially in
m ed icin e an d n u r sin g an d , at t h e sam e t im e, w it h suffer ing and pain. The suffer ing and ov er com ing of pain ar e not only im por t ant t o acquir e know ledge and
adequat e at t it udes. They ar e also, in t hem selves, par t s of t h e n ecessar y at t it u d es. Th ese classes p r ov ok e co u n t l e ss e m o t i o n a l a n d o r g a n i c r e a ct i o n s i n t h e
st u den t s, an d t h ey dev elop def en se m ech an ism s t o cope w it h deat h sit uat ions ( 14).
Du r in g t h e w h ole an at om y su bj ect , despit e
h an d lin g t h e cor p ses, t h e q u est ion s of d eat h w er e
The ow n body as a nur se’s...
Sant ana MTBM, Jor ge MSB.
n o t d i scu ssed at an y t i m e. Th e “ r eal ” k n o w l ed g e,
or ganized fr om t he v iew point of r uling par adigm s, in w hich t he cur r ent of posit ivist t hinking pr edom inat es, w i t h a n a n a l y t i c a n d Ca r t e si a n v i e w o f sci e n ce ,
in f lu en ce t h e ad op t ion of t h e b iom ed ical m od el in academ ic h ealt h edu cat ion . I t is a m odel based on t h e scien ce of n at u r e, w h ich is solid ly f ou n d ed on
Car t esian t h in k in g, w it h a st r ict separ at ion bet w een m at t er and spir it , body and m ind. This m odel consider s t he hum an body as a m achine t hat can be analy zed
in t er m s of it s p ieces; d isease is seen as t h e b ad fu n ct ion in g of biological m ech an ism s.
This m odel’s concept ion per m eat ed t he ent ir e
b asic cy cle – Ph y siolog y, Ph ar m acolog y, Pat h olog y, Biochem ist ry, Hist ology and ot hers – as w ell as specific n u r si n g su b j e ct s. I n a l l st e p s o f m y p r o f e ssi o n a l
t r ain in g, t h e qu est ion of deat h w as addr essed v er y s u p e r f i c i a l l y : a t u n d e r g r a d u a t e l e v e l , o n l y t h e necessar y t o lear n how t o pr epar e t he dead body –
t he cor pse – t o be sent for bur ial; at gr aduat e level, som e hour s w er e dedicat ed t o st udying t he concept ion of deat h. Ther e w as no space t o addr ess t he quest ions
of deat h and, [ ...] w hen t he t eacher s r efer r ed t o deat h, it w as
j ust t o em phasize, for t he st udent s, t he biological aspect s and
t he t r eat m ent s’ t echnical- scient ific evolut ion [ ...] t he know ledge
about t he car e t o be deliver ed t o t he ill, including t he dying, w as
essent ially t echnical.
Th e b iom ed ical m od el ex clu d es d eat h f r om
hum an ex ist ence, as it ent ails a v iew of t he hum an body as a com plex m achine. The disease is seen as t h e dest r u ct ion of st at ist ically m easu r able biological
aspect s, w hile healt h is considered as t he absence of disease. According t o t his m odel, healt h professionals ar e “ t r ained” t o look at t he ill people’s body and seek
t h e cu r e f o r t h ei r d i sease, as t h e i l l h u m an b o d y pr esen t s defect s, becau se it h as su ffer ed an ex cess or sh or t ag e d er iv in g f r om cer t ain r eason s, su ch as
im pr oper use, accident or at t ack by unknow n agent s. Th ese p r of ession als’ r ole is t o in t er v en e, p h y sically or chem ically, t o fix t he defect in t he funct ioning of a
specific m echanism t hat is br ok e( 15).
As a st u den t , I h ad ot h er ex per ien ces w it h t h e l i v e a n d d y i n g b o d y, w h e n c o e x i s t i n g w i t h
hospit alized pat ient s, w here I per ceived t he pain, t he suffer ing, t he agony and t he solit ude of t his m om ent of dying, as regist ered in t he diary of t he life hist ory.
[ ...] I t ook care of t he sick body wit h dedicat ion. Washing
it , dr essing, feeding, adm inist er ing m edicat ion w er e r out ines
done wit h love, support ing, com fort ing, consoling, in short , t aking
car e t o live or t o die.
I n t h is w or k , I obser v ed, in t h e pr ocess of
deat h an d dy in g, t h at it is t h e psy ch oph y sical body t hat m akes t he differ ence in m at t er s of life and deat h: alive, it m oves, is dynam ic, anim at ed; inert , inanim at e,
i t i s a c o r p s e t h a t w i l l d e c o m p o s e . H e n c e , t h e psy ch oph y sical an d in car n at e body is t h e r ef er en ce f o r t h e p h en o m en o n o f l i f e an d d eat h t o h ap p en .
Wit hout it , t he hum an ex ist ence disappear s. What is dead has no body and, t her efor e, no hum an exist ence, lik e w h at h appen s w it h t h e Body of t h e Dead Lor d,
w hich t he Cat holic Chur ch r ev er es in it s cult s dur ing Len t u n t il t oday. Th u s, in or der t o pr eser v e h u m an e x i s t e n c e , t h e r e i s a n e e d t o t a k e c a r e o f t h e
psychophysical body and t he envir onm ent it is inser t ed in. I n t he r ealit y of daily life, t her e is t he body, t he place of t he hum an’s pr esence in t he w or ld, m aking it
p o ssi b l e t o co n st r u ct i t s h i st o r y an d l i v e w i t h t h e ot her s. When it is in dishar m ony, t he body m anifest s s i g n s , p r o f o u n d l y c h a n g i n g t h e p e r s o n a l i t y, l i f e
pr oj ect s, leading t o t he hope of cur e or, if t hat is not possible, t o despair.
The influences of t he “ real”, t hat is, scient ific
k n o w l e d g e , a cq u i r e d d u r i n g u n i v er si t y ed u ca t i o n , condit ioned m y specializat ion in int ensive t herapy and, lat er, m y in ser t ion in t h e j ob m ar k et , as a n u r se in
t h e I n t en si v e Ca r e Un i t o f a l a r g e g en er a l p u b l i c hospit al in t he cit y of Salvador. I t is in t he scenario of Em er gency Unit s or I CUs t hat m ost deat hs occur, w hich
con t ain s a pow er fu l t ech n ological ar sen al for copin g w i t h i t . I n t h i s, m o r e t h a n i n a n y o t h e r h o sp i t a l s c e n a r i o , h e a l t h p r o f e s s i o n a l s l i v e e t h i c a l a n d
ideological conflict s about ex t ending life and delay ing d eat h , w h i ch i s a so u r ce o f st r ess f o r ev er y b o d y, m ainly for pat ient s and t heir r elat iv es.
I m m e r s e d i n t h i s e n v i r o n m e n t t h a t i s p r o j e c t e d w i t h t h e m o s t a d v a n c e d r e s o u r c e s o f t ech n oscien ce t o gu ar an t ee t h e lif e of t h e pat ien t ’s
physical- biological body, t he healt h professional’s ow n body is also ex posed t o m an y r eact ion an d feelin g-creat ing st im uli. I w as exposed t o all of t hese st im uli
w h i l e I w o r k e d a s a n i n t e n si v e ca r e n u r se . Th i s ex p er i en ce co n d i t i o n ed m y p r o f essi o n al t r aj ect o r y t o w a r d s t h a n a t o l o g y a n d , f o r m e , t h e g r e a t e s t
difficult y I faced t oget her w it h t he t eam w as t o deal w it h t h e q u est ion of d eat h in t h e f ace of so m an y t ech n olog ical r esou r ces, sp ecialized r eal k n ow led g e
an d sk illfu l pr ofession als.
I n t h i s e n v i r o n m e n t , I l i v e d w i t h d e a t h , t echnological advances and t he hum an body on a daily
4 7 2
and not t hr ough t he t heor ized k now ledge, I v er ified
how I and m y colleagues developed at t it udes of denial t ow ar ds deat h. The confr ont at ion w it h t he dead body – t he corpse – connect ed m e w it h a significant loss –
t h e l o ss o f t h e p h y si cal - b i o l o g i cal b o d y, t h e b asi c st r u ct u r e t h at gr an t s ou r ex ist en ce. As I obser v ed, f r o m t h e b i o l o g i ca l v i ew p o i n t , a n d l o o k i n g a t t h e
h u m an body as a w h ole, deat h is n ot a sin gle an d inst ant aneous fact , but rat her t he result of a series of pr ocesses and of a gr adual t r ansit ion.
Th e m e 3 – I n f l u e n ce o f Kn o w l e d g e o n Te a ch i n g -Lear n in g
Th r o u g h t h e n ew l o o k acq u i r ed u n d er t h e in f lu en ce of t h e r eal k n ow led g e ab ou t t h e b od y as
t he place of exist ence in t he w or ld, about deat h as a const ant pr esence t hat needs t o be seen, consider ed and r espect ed, and about deat h as a r out ine pr ocess
o f e x i s t e n c e , I c h a n g e d t h e s c e n a r i o o f m y professional act ivit y. I st ar t ed t o per for m t he funct ion of nurse- facult y and left t he int ensive car e. Ther e w er e
count less changes and I had t o adapt t o t hese new st im u li on m y b od y an d t o t h is n ew r ealit y. Th ese fact s can be appr ehended fr om t he follow ing ex t r act .
[ ...] t he change in environm ent from a closed int ensive
car e unit t o open unit s – nur sing w ar ds and out pat ient unit s; t he
profile of t he pat ient under m y care – from crit ical t o chronic; and
t h e people u n der m y su per v ision – 6t h t er m u n der gr adu at e
st u d en t s.
Through t his new t eaching- learning funct ion, I
had t he oppor t unit y t o cir culat e t hr ough lar ge public and privat e hospit als, accom panying st udent s in t heir t r aining. The pr ofile of pat ient s at nur sing w ar ds and
out pat ient clinics gav e m e t he ex per ience of chr onic diseases, m any of which left sequelae or were incurable, a n d t h e p a t i e n t w a s i n t h e t e r m i n a l st a g e . Th i s
experience becom es explicit in t he following ext ract .
[ ...] t he pat ient s lived t heir dying pr ocess slow ly and
gr adually, w it hout using ar t ificial m eans t o m aint ain life.
How ev er, som et hing had not changed: w hat co n t i n u ed w as t h e at t i t u d e o f d en i al o f t h e d y i n g pr ocess and t he view of deat h as an enem y t hat had
t o b e b eat en . Th e f ollow in g ex t r act ex p r esses t h is p er cep t ion .
[ ...] when t he disease reached a st age out side t he reach
of cu r r en t m edicin e an d n ot h in g cou ld be don e, t h e h ealt h
professionals present ed sim ilar at t it udes: t hey cont inued t o deny
t he dying pr ocess, cam ouflaging it w it h euphem ism , abandoned
t he clinical case or gave it lit t le im port ance, j oined in t he conspiracy
of silence, w hile t he fam ilies felt unst r uct ur ed in t he face of
losing t heir r elat ive.
As t o t he st udent s, t hey w er e t her e w ait ing t o lear n, including how t o deal w it h deat h. How ev er,
healt h pr ofessionals - including m e, t he pat ient s and t heir relat ives – face m any difficult ies t o live w it h t his p h en om en on t h at elim in at es t h e b asic st r u ct u r e of
on e’s ex ist en ce – t h e psy ch ophy sical body. Wh en I l o o k e d f o r s u p p o r t i n t h e c u r r i c u l u m f r o m t h e u n iv er sit y ’s u n der gr adu at e cou r se:
[ ...] I r em em ber ed t hat , in t he under gr aduat e nur sing
cour se, I had not been pr epar ed t o deal w it h sit uat ions of deat h
and t he pr ocess of dying. I also r em em ber ed t hat t his m ade m e
suffer w hen I st ar t ed t o w or k in m y pr ofession.
I n t h e f a c e o f t h e s t u d e n t s u n d e r m y super v ision, m y concer n about deliv er ing car e of t he
ot her dy ing per son’s ow n body incr eased, especially consider ing t he or ganic st r uct ur e, t o w hich t he sense an d m ean in g of h u m an ex ist en ce is at t r ib u t ed , as
ex pr essed in t he follow ing ex t r act .
[ ...] I did not know how t o conduct t he t eaching- learning
pr ocess, as I had not been pr epar ed t o deal w it h t he quest ions of
deat h and t he her oic m easur es w hich I k new so w ell as an
int ensive car e nur se could no longer be used.
I n t his educat ional cont ext , I st art ed t o observe
healt h pr ofessionals fr om t he v iew point of t heir ow n body, in t he hospit al cont ext , in t he at t em pt t o const ruct a p olit ical- p ed ag og ical p r oj ect f or h u m an ized car e
delivery t o t he dying pat ient ’s own body.
REFLECTI NG ABOUT THE STUDY
M e r l e a u - Po n t y ’ s p h e n o m e n o l o g y, w h i c h
r ev ealed t o be t h e m ost appr opr iat e m et h odological o p t i o n f o r t h i s st u d y, m a d e m e l i st en t o t h e n o n hear able, allow ed m e m om ent s of “ closing m y ey es”
and act ing int r ospect ively, w it h a view t o giving m yself f eed b a ck a n d , t h u s, a p p r eh en d i n g t h e sen se a n d m eaning of t he ow n body as a living exper ience. Thus,
t h er e i s an i n t en t i o n al i t y t h at co n st i t u t es a sen se bet w een t he ow n body and t he w or ld, w hich m oves in open hor izons of pot ent ial int er pr et at ions of w hat is
p er ceiv ed an d , t h er ef or e, it s sear ch h as n ot b een ex haust ed as, t hr ough each appr ox im at ion, only par t of it has been unv eiled.
I n t he r esear cher ’s ex ist ent ial t raj ect or y, her ow n body as a liv ing ex per ience m ade it possible t o e s t a b l i s h a g n o s e o l o g i c a l c o n t i n u u m a m o n g t h e
experience, t he subj ect , t he obj ect and t he nat ural and
The ow n body as a nur se’s...
Sant ana MTBM, Jor ge MSB.
cu lt u r al in t er pr et at ion . Th is m ean s t h at t h e body is inseparable in t he world and t hat t he subj ect is sit uat ed in t he world t hrough t he own body. Besides, t his ent ire net w or k , const r uct ed w it h m agic- r eligious k now ledge as a child and adolescent , w it h real know ledge as an i n t e n si v e ca r e n u r se , a n d w i t h k n o w l e d g e a b o u t t eaching- learning as a nurse facult y unveils t he hidden connect ion of a sy st em ic and phenom enological v iew of deat h and dying, which im plies a change in t he sense and m eaning of t he own body, not seeing it as an obj ect or t hing, but as a relat ion bet ween t he I - OTHER-WORLD sy st em( 9). I developed a br oader not ion of t he body, ov er com ing t he classic dichot om y bet w een body and soul, m at t er and spirit , subj ect and obj ect .
Thus, t he appr oxim at ion w it h t he st udy obj ect allow ed m e t o develop t he t hesis about t he exist ence of t he sense and m eaning of healt h pr ofessionals’ ow n body in car e deliver y t o t he ot her per son w ho is dying, as a p ossib ilit y of r each in g a n ew v ision of h u m an deat h, in it s exist ent ial aspect , t hrough t he m eanings of healt h professionals’ ow n body. I believe t hat t hey a r e v i ct i m s o f su p e r f i ci a l a n d d i st o r t e d a t t i t u d e s t ow ar ds dying, t hr ough t he m aint enance of t r adit ional m y t hs t hat conceiv e deat h as t r agic, fr ight ening and painful. Healt h professionals can conceive deat h based o n t h e u n d e r st a n d i n g o f t h e b i o l o g i ca l p r o ce ss – organic and m ent al exist ence are one single t hing. I n t his per spect ive of t he ow n body as a living exper ience f o r h e a l t h p r o f e ssi o n a l s, t h e se n se a n d m e a n i n g at t r ibut ed t o t he pr ocess of deat h and dying or iginat e
fr om scient ific know ledge, t hr ough a science r eleased f r o m m e t a p h y si cs, f r o m cu l t u r e , f r o m t r a d i t i o n a l m y t hs and fr om com m on sense concept ions.
A m o n g o t h e r b e n e f i t s , t h i s k n o w l e d g e const it ut es a st r ong incent ive for healt h pr ofessionals t o t ake car e of t hem selves in deliver ing car e t o ot her d y i n g p e r so n s. Th i s se l f - ca r e co r r e sp o n d s t o t h e sear ch for pr ofound self- know ledge, about deat h it self insert ed in one’s exist ence, so as t o m ake it possible t o dist inguish bet w een ow n and ext er nal cont ent s and t o be apt t o ident ify t he m ain fact or s t hat affect t heir w ell- being and m ent al healt h.
I n t his perspect ive of change in t he concept ion of t h e ow n body of h ealt h pr ofession als an d people w ho ar e dying, bot h of t hem living t he exper ience of t he dying pr ocess, t he follow ing quest ions ar ise: how can healt h professionals conduct t he process of dying w it h d ig n it y an d sen sit iv it y t h r ou g h t h e sen se an d m eaning of t he own body? And how can t hey prepare t hem selv es t o conduct t his pr ocess? Thus, I per ceiv e t hat t he focus of at t ent ion on t he own body as a living ex p er ien ce w ill on ly b ecom e p ossib le if t h e h ealt h professional is sensit izes, as early as at undergraduat e level, t o an educat ion t hat considers t he own body as a cognoscent e body, incarnat e and insert ed in t he world. The exist ence of a full life, insert ed in t he cont em porary world, requires t he search for solut ions, m any of which ar e p r esen t in t h e ow n b od y an d can b e accessed t hr ough t he senses and m eanings of t his body as a liv in g ex per ien ce.
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