Everyday Mindfulness

Responding to the Pandemic From the Heart

What can an ancient Greek play show modern audiences about the circumstances nurses have found themselves in over the course of the COVID-19 pandemic? That’s the question Dr. Cynda Rushton and Theater of War Productions hope to answer when The Nurse Antigone premieres to audiences around the world. 

A project by and for nurses, The Nurse Antigone presents dramatic readings of Sophocles’ Antigone on Zoom—featuring professional actors and a chorus of frontline nurses—to help frame discussions about the challenges faced by nurses before, during, and after the COVID-19 pandemic. Mindful’s managing editor Stephanie Domet connected with the organizers, and we’re pleased to bring you that conversation on Real Mindful.

Stephanie Domet: Thank you both so much for joining me today for this conversation. I’m really excited to get a chance to spend some time with you and to hear about this project that you’re working on. I think I’ll start by asking each of you to introduce yourselves. 

Cynda Rushton: I’m Cynda Rushton. I’m a professor of nursing and bioethics at Johns Hopkins, and I am in this project because I am deeply committed to helping my profession heal in this pandemic. 

Bryan Doerries: I’m Bryan Doerries. I’m the artistic director of Theater of War Productions. We are a social impact theater company that uses storytelling and theater as a tool for helping communities address issues of public health and social justice. We’ve been collaborating with Cynda for some time and are really excited to embark on this current project with her. We’re going to dive much deeper into the community that she serves and we hope to serve. As I’m sure you know, in the United States, there are roughly four million nurses alone who have been the most overexposed and under-resourced medical professionals during this pandemic. And it feels like a moral obligation to be focusing as much attention and energy and resources on them as humanly possible. 

CR: I, of course, 100% agree with that. And you know, I feel like we’re at a real pivotal moment in our profession because of the incredible consequences of the pandemic that made the fractures in our healthcare system so visible. As well as the fractures in the ways in which we have regarded nurses’ work and their contribution to health and healing, and we don’t want to miss the opportunity to make that visible and in a different way. And also to invite the public to really bear witness to the experience of what it is to be a nurse at this time. 

SD: How will The Nurse Antigone help with that? 

BD: Well, The Nurse Antigone is a project that we’re developing with nurses by nurses and for nurses at every level as a way of doing two main things. One is communalizing the experience not just of the COVID-19 pandemic, but of issues that predated the pandemic that, as Cynda mentioned, were accelerated by the pandemic. Issues like pay inequality and exposure and lack of agency within healthcare systems and decision making. Institutions that put profit over humane care, that put nurses in the crosshairs of really challenging ethical decisions that then lead to moral distress and ultimately moral injury. And so on one level, the project is about creating a space. I’m not so interested in safe spaces. I’m not sure anything can be achieved in our world without risk, and I think nurses live that and embody that in their work. But a brave space where nurses can bear witness to the truth of their experiences over the last 20 months. A space to think about the future as well, which is, I think, very hard in the eternal present of acute crisis. And the other thing is to create a platform and a vehicle for public discourse about the past, present, and future of nursing. A space to let nurses tell their stories and be heard and validated, but also empower nurses to lead that dialog with the general public without the interference of institutions. 

SD: Why is Antigone the right text for this? 

BD: Well, you know, Cynda is the one who actually suggested it some time ago. It’s in our repertoire. We’ve been using Antigone for a number of other things, including racialized police violence for the project called Antigone in Ferguson. That has a very specific bent to it as a project. And Cynda pointed out to me that actually, of all the plays that we perform in our repertoire, which are many Greek plays and ancient plays, Antigone speaks in some ways most forcefully to the question of moral injury, of which Cynda is an expert, so I defer to her in part two of this answer because I think she knows it best. 

CR: Antigone really illustrates the circumstances that nurses find themselves in so often. You know, there are these competing obligations and it’s inevitable, the sort of moral residue that even when you do the right thing, there are consequences and those consequences bear on our sense of who we are. And that it really does require a kind of courage that is not about being unintentional in that courage, it is actually razor-focused courage around being able to live up to our values of what it means to be in this role. I think it’s going to really ignite some real connection for nurses that maybe they haven’t even been able to articulate themselves around why they show up every day and why they’re here and why it matters. 

BD: We use ancient texts actually to create distance, not just to create resonance. Distance creates the space where people feel less defensive, where they can make their own connections, and where they can interpret the story on their own terms. We don’t legislate what the story means to nurses or to the general public. We empower nurses to be the principal people, helping us interpret the story because they’re closest in proximity to a series of issues that we think will illuminate in really powerful ways. We have some hunches about ways that it’ll resonate. Of course, Antigone is a young woman who puts everything on the line to do what she believes to be right, which is to bury her brother Polynices after a civil war has ended in Thebes only milliseconds before the play begins. Against the edict of the new king Creon, she violates the law in order to do what she believes just and right and in accordance with her law, which is the law of love. She says in Greek, I was born not to hate, but to love, to bring together through love. This sacrifice, which ultimately ends with her losing her life, raises a whole series of questions. I think it also illuminates the challenges of speaking out against institutional violence and the misogyny that’s baked into the play. I think it will resonate deeply with the structural and also overt misogyny that nurses, which are predominantly still women as a profession, have faced and continue to face. 

We don’t perform tragedies to send people home to wallow in their own lack of agency. We perform tragedies as I presume the Athenians did in the fifth century B.C.: to wake people up to the slim possibility of making a change before it’s too late. Not just nurses who may need energy and support to make critical changes to keep our healthcare system alive, but also the general public, in their complicit role as the chorus that is the audience that’s watching and is a bystander and has the ability to act. 

So one of the questions that’s sort of intrinsic to tragedy is: Does Antigone have to die in order to advance social change? These nurses are now facing burnout on a scale never before imagined and all kinds of other results of the last two years compounded upon decades, if not centuries, of mistreatment by medical institutions. And these nurses who now, in some ways, have been betrayed by the general public and by the breaking of a very fundamental social contract that existed between them and the general public. Do these nurses have to suffer in order for change to be effected? Or can a group of nurses perform Antigone instead? And then, can we advance social change without actual suffering? And I really think that’s at the center of what Athenian drama was about. It presented scenes of suffering to a democratic populace that then could interrogate their own role in the suffering that they were watching. And that’s what we’re going to ask audiences to do as well. The play can both communalize the trauma as well as incite action and thought and reflection, mindfulness and interrogation around our role. 

SD: Are you going to overtly ask the audience to do that? 

BD: Yes. So to be clear, the structure of our events is very simple. It’s not a theater production where we perform Antigone then we call it a day with all of our work. We kind of break the play that we’re performing. It’s never about polish. There’s no production value. We’re doing this on Zoom. People are dressed as themselves. Many of the nurses will come in their scrubs from their workday. Our actors aren’t wearing costumes. Any money we would have put in the production value is actually spent on audience cultivation to make sure that the right audience is in the room. We perform the play and it takes about 45 minutes. It’s a sort of streamlined version. 50 minutes, maybe. And then as soon as it’s done, the professional actors go away and are replaced by four or five nurses who are a first or second chorus. Our first chorus will actually be a chorus of nurses. Our second chorus will be our community panel, who will also be nurses and other people who have a vested interest in nurses. And they will respond from their hearts and their guts to what they heard and what resonated with them across time. There’s no legislating what they’ll say, and there are no wrong answers. They’re modeling for the audience a candor and a way of moving forward using the vocabulary of the play to discuss something that was maybe hard to discuss with our current vocabulary. 

And then as soon as the community panel, the second chorus, is done, other co-facilitators and I ask questions of the audience about the play and the discussion. This lasts longer than the performance because the discussion is the main event. People raise their hands and speak their truths and interpret the play and take the risk of being vulnerable and present with their own thoughts. The questions are designed to sort of frame some of these themes that we’ve already laid out. And these questions will evolve over the 12 performances we have planned because we’ll be learning from the audience and from our nurse chorus along the way. 

And if we’ve done our work, then the structure of the whole thing sort of disappears and we disappear. All of a sudden this dialog between nurses takes place, and dialog between nurses and the general public takes place in a way that would never have happened had we not performed Sophocles’ Antigone. It’s a tool or a catalyst to get us to that place. And that’s how it works. The whole event is around two hours from beginning to end. 

SD: Cynda, it sounds like it’s a really powerful experience. What can you say about your own experience of this kind of thing? What have you seen or observed? 

CD: Well, what’s interesting is I think it’s easy to sort of start in your head, but you’re very quickly drawn into your heart, into your own experience that maybe you haven’t allowed yourself to acknowledge. You know, Bryan’s done performances around end of life issues, and I think that was the very first place where we connected. Giving voice to complexity and the sacredness of being with people as they’re dying is a way to articulate the inchoate part of our experience that we don’t even know what to call it. And so that’s been my experience every time. And there’s this sense of an arc to it. All it takes is one person willing to be vulnerable and say what others are thinking out loud. That then releases and invites others to allow themselves to be a little more vulnerable and a little more honest about what really is true. 

You and I have talked about this, Stephanie, part of healing is saying what’s true. There have not been many places where nurses have felt they were able to say what’s true. And so I hope this will be part of that catalyst to really invite honest reflection and to ignite the possibility that we can transcend this suffering. And that by coming together in this unique communal way, we can actually harness our goodness and our intentions, and support each other in the next phase of our profession. 

SD: Bryan, you mentioned that you choose classical works because they offer distance and resonance. Can you talk a little bit about why that distance is important and how it helps achieve what you’re trying to do? 

BD: Yeah, so I think it’s actually our principal tool. There are several tools that are intrinsic to Athenian tragedy. But we do Shakespeare, we do contemporary plays, we do modern speeches, and poems and things like that, too. But the distance, whether it’s cultural or temporal or both, is an immensely helpful tool when dealing with trauma and moral distress and loss and grief. Primarily because we’re not saying to the audience, “this is you.” We’re asking the audience to reflect on what they see of themselves in the story. 

SD: Cynda what’s going through your mind?

CR: One of the beautiful things about this method, as Bryan points out, is the discovery part of it. And you know, the connection with mindfulness is really an invitation to notice your own experience and responses, and to pay attention to that, not to judge it, but just to notice. I think in many ways progress is predicated on being uncomfortable because we can become so devoted to the status quo that we don’t even recognize what we are participating in and also the ways in which we are missing opportunities to do something different. So much of what I end up doing in other spaces is really the same thing as discovering. It’s inviting people into a place of discovery and discomfort for the purpose of insight, being able to see things with new eyes, to inquire and, as Bryan says, interrogate their own experience and the experience of others. Right now, I think isolation [is prevalent]. I hear this so often with nurses who are working side by side, and they believe that they are the only ones that are struggling. And there’s something so important about saying, “we’re all in this together and we are all suffering and that it’s not because we’re weak. It is because we care.” So it’s a really powerful tool to get out of our heads and into our hearts and guts, as Bryan would say. We’re not feeling anything at all or we’re feeling so much that we don’t know how to hold that either. And so I think there’s a way that this offers a path for some relief.  

BD: You know, we worry about the uncomfortable part for people who’ve already experienced extreme discomfort, but in fact, the ones who are most uncomfortable are the ones who are furthest in proximity to the suffering we’re describing. What I see when people who’ve suffered watch the plays, are people often smiling while watching plays. Smiling with recognition, smiling with validation. 

When I talk about my experiences with people who haven’t had them it just takes so much damn energy, and the plays provide the energy. They juice the room or the virtual space with an energy, a field of energy, and that energy and the syntax and the vocabulary of the play creates the possibility of this opening. It’s not therapy. I do think this shares some things with mindfulness. I think it’s interesting that they both celebrate that idea and also sort of interrogate it because yes, I think it’s like radical nonjudgment with regard to your own response and the responses of others by virtue of what you’ve just watched. But it’s not pulling back in any way from the idea of experiencing extreme emotion. 

One of the things I’ve really thought a lot about over the last 13 years is when you’re emotionally activated. I think maybe it’s just because Plato went so hard with his republic on the idea that poets manipulate our thoughts and thereby are sort of poisonous to democratic institutions. And they can. And the media can. But the other thing that poets can do is connect us with the emotions that we should be feeling, but don’t allow ourselves to feel. So we can actually have the rigorous ethical conversation that we need to have, which can only happen when we’re connected with the emotional and spiritual consequences of the decisions we’re talking about later. 

SD: I mean, ideally, mindfulness is doing that too. We talk about it at Mindful. It’s not to turn away from anything that arises, it’s to go in with curiosity and radical nonjudgment. 

BD: My experience of mindfulness has also sort of foregrounded interdependence as a sort of value. It’s not the plays per se, it’s the architecture of Greek drama. Sitting in the amphitheater surrounded by other people, shoulder to shoulder who may have experienced these things and then collectively facing them while watching characters who were all playing roles and then being able to maybe for a fleeting second, dispassionately step back from the roles that we’re playing and by virtue of that, maybe have a space where we can think before our next decision about whether we’re making it based on automatic thinking or because of something we’ve been told or taught. Or can we take off these costumes for a moment and engage with each other on a more direct level? 

Theater is something we consume, something we purchase. We go to the theater and in the theater, we are silenced. We’re plunged into darkness. 20th century naturalism is predicated on the audience never being heard, and then the cinema takes over and just makes that ubiquitous. We go into dark spaces to watch stories play out for us in which we are not invited to be part of it. This is where Zoom, and in fact, the pandemic accelerated our model into this digital amphitheater we’ve now created where we turn the lights on. And the word amphitheater in Greek means I see you, you see me. We see in both directions. In some ways, Greek tragedy plus Zoom equals an amphitheater that Sophocles couldn’t have imagined. 

But with the Greeks who were watching Sophocles’ Oedipus, for instance (our pandemic project, which Cynda has been part of and knows) would have watched in 429 B.C. It’s a play that deals with a plague as a central part of the play during the second wave of the plague. So it seems like ignored prophecy, failed leadership, arrogance,  institutional breakdowns, and the habitual clinging to behaviors, you know, all these things that are at the center of what we’ve experienced. There’s no question in my mind that this play would have resonated in those ways for the Athenian audience, if you read Sophocles’ depiction of Bethany in play, and you run it up against Sophocles’ depiction of the Theban plague and then you run it up against what we’ve just experienced, and what nurses are experiencing. 

So, you know, here is a technology evolved to communalize many different traumas and experiences, but one of them being the experience of a pestilence and watching helplessly as people that you love and care for die, and so the one last I wanted to say about the play and why I know it will resonate, and why Cynda was so right to suggest that we do it, and that’s that the play is fundamentally about the burying of Antigone’s brother, and the burying of Antigone’s brother Polynices is about grief and robbing someone of the ability to bury their brother is deferring the possibility of their grieving. And there are so many ways in quite literal and also in metaphorical ways that nurses have been deprived of the capacity to grieve. 

CR: So true, Brian. It is so true. When you think about the consequences of the pandemic, one of the things that has really weighed so heavily on nurses is patients dying alone. The lack of dignity of the numbers of people who died and not being able to do that in a way that reflected dignity and respect for the ending of that human life. And those elements of grief are compounded by loss of identity, loss of relationships with people on their team, loss of people who they worked beside, who died because they showed up with COVID. And so there is this sense of disenfranchised grief that nurses have carried again and again and again, that feels important to honor. 

This Q&A has been condensed for clarity. Click the audio player above to hear the full interview.

In this episode of 12 Minute Meditation, Cynda Rushton leads a guided meditation to welcome all of our emotions and feel at home in our body, mind, and heart.
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