‘I had a friend, I know it sounds weird, but there was a pine tree just outside the window of my room’ A person with COVID-19 in a corona intensive care unit (CICU) at a Swedish hospital expressed these words in connection with a follow-up interview concerning her experiences during the period of illness. The interview was part of a research study focusing on experiences of patients with COVID-19 who had been treated in respiratory care in the CICU.1

The person, let us call her Elisabeth, was in her late 50s, in good health, and working fulltime in a service-related profession when she was infected with COVID-19. After a first contact with the local health care centre, she was transported to the CICU and was immediately taken into respiratory care. After 11 days on a respirator, Elisabeth had to stay another 2 weeks in the hospital. During this time, isolated and alone in the room, Elisabeth noticed the pine tree outside the window, a tree that became her friend and lifeline to the world. Relationship to the other is of significance for the field of health and well-being in a broad sense, and more specifically, when the patient has to be alone and isolated in a room (cf. Buber, 1994, 2002). However, according to Buber (1964) the relationship with others not exclusively has to be between humans, but might also be between humans and nature, such as a tree. He emphasised that as human we have both an ability and responsibility to relate and bond to a world consisting of more the human.

In this article, Elisabeth's narrative regarding experiences of her friendship and communication with the pine tree will exemplify and illuminate the complexities of humans' need and desire to have a relationship with the other. The fundamental ambition is to discuss and generate philosophical insights into various understandings and beliefs regarding the relationship between a human and a tree and discuss the significance of whom or what the other might be in a caring situation. Furthermore, the phenomenon of loneliness and its relation to the need and desire for togetherness are outlined and explored. Elisabeth's words in her narrative will be explicated throughout the paper and will also form the foundation of our philosophical interplay as an approach to challenge and provoke diverse ways of understanding and reflecting on the other as more-than-human (c.f. Abraham, 1996).

1 THE HUMAN AND NATURE—AN INTERTWINED RELATIONSHIP

Nature, such as trees, is of great importance for humans, and it is evident that being in or in close connection to nature has a positive impact on people's well-being (see e.g., Nilsson et al., 2011; Nisbet et al., 2011; Ritter & Dauksta, 2013; Sadowski et al., 2020). Many of these studies, however, mainly focus on people being in nature, but there are also studies that recognise the importance of viewing nature—forests and trees—as a spectator, especially in connection to hospital stays (see e.g., Ulrich, 1984; Ulrich et al., 2020; Vincent et al., 2010). Studies have shown that having the opportunity to view nature through a window, for example, a wild forest or a landscaped garden, hospital patients experienced less stress, improved mood and faster recovery (Bratman et al., 2015; Ulrich, 1984). Furthermore, Vincent et al. (2010) have shown that hospital patients who viewed images of natural scenery experienced reduced stress and pain and an enhanced frame of mind.

To meet and be in nature, in the forest, a stroll around the trees is of significance not only for a person's well-being but also for their sense of belonging. Affective encounters with the natural environment can contribute to the feeling of kinship and intertwining between the self and nature, which in turn leads to another view of nature, and specifically trees—that the trees are animated or souled (Häggström, 2020). Similar kinship with the pine tree is Elisabeth expressing: ‘I saw my pine wave “Good Night” every night, and it was ready for me in the morning … sometimes rocking in the wind, sometimes sparkling in the sunshine and even white with snow’. Elisabeth viewed the pine tree as a ‘friend’ who was always there; ready to act— someone who never left her side—her anchor in the world at that time (Figure 1).

The pine tree, my good friend. This picture illustrates the togetherness with the pine tree outside Elisabeth's room, a pine tree that became her friend during her hospital stay. Photo: Åsa Engström

Increasing feelings of control and safety is important for all humans, and maybe especially for people in intensive care (Wassenaar et al., 2014). This can be achieved by relationships with another human, or with someone more-than-human, for example, a tree. Elisabeth expressed a feeling of safety by viewing the pine tree; it became her fixed point and connection to the world—a kind of lifeline: ‘It really started when I woke up one night, the blinds were down, and it was pitch black in the room. I was terrified, thought I was packed in a box…or under the ground…Then we [Elisabeth and the caring staff] agreed to keep the blinds and curtains open to avoid more horror experiences.’ Through this seemingly simple action, Elisabeth could see her friend—the pine tree—as soon as she woke up. This example also illustrates the essential feeling of belonging—belonging to a world shared with others—or as Elisabeth said about the pine tree, it was ‘my contact with the world and life’. The pine tree was her contact with the world outside the hospital room.

Hailwood (2000) argues that a plant, such as a tree, should be valued based on its otherness. Above all, Hailwood dismisses the idea of a tree's instrumental value, that is, to look at nature only based on its value to us as humans. Instead, Hailwood believes that nature, plants and trees, should be considered independent of humans—a tree can have its own agency, and thereby the other can be more-than-human. It is essential not to objectify nature, stressed by Buber (1994). Blenkinsop (2005) further discuss Buber's view between human and nature, and he states in his conclusion that: … there is an ecological relationship in which we are immersed and that this relationship, although often unseen and unacknowledged, is fundamental to our humanity … (Blenkinsop, 2005, p. 303).

An issue raised by Pedersen (2014) is ‘how “subject” can be regarded if we detach it from the idea of the human as something unique, distinct, autonomous, and separated from other life forms, and instead view human and non-human subjects as co-constituted and in constant interaction with their surroundings’ (p. 84, own translation). Abraham (1996) argued that as humans, we share the world with more-than-humans, and he also developed and used the term ‘more-than-human-world’. This term has influenced how humans' interplay and relationship with plants, animals and the natural environment can be understood and described. By listening to trees, we learn, according to Haskell (2017), how to inhabit the relationships that give life its source, substance and beauty. Given this, what happens when something more-than-human, for example, a pine tree, emerges as a subject? In Elisabeth's narrative, the pine tree became a subject: ‘…so that pine tree, it was like my friend, because it was the only one I had’, as she expressed their relationship. Thus, the tree as a subject supported connectedness for Elisabeth. Without the pine tree, Elisabeth had felt alone and disconnected from the world existing outside the hospital room.

2 LONELINESS VERSUS TOGETHERNESS WITH A PINE TREE

Loneliness is always part of human life; it belongs to our existence and as humans, we cannot avoid it. According to Dahlberg (2009, p. 197), ‘loneliness as a phenomenon is characterized as transcending the immediate situation containing loneliness’. While Elisabeth was critically ill and felt lonely in the room, she experienced safety in the presence of the pine tree, which gave a kind of consolation—it was someone she could communicate with, a connection to the world and life that goes on regardless of her illness. Gagliano (2018) emphasises that plants such as trees have the ability to communicate, which Elisabeth also exemplified in her narrative. The pine tree, for example, ‘told her’ what the weather was: ‘…it was like it told me that today it is…oh, it has snowed today. It was probably the April weather. It was a day that was very snowy and so on’. The tree also waved her ‘good night’ in the evening when she was alone in the room, and no one else did—it was someone she could communicate.

Frank (1991) suggests that sharing losses and difficult experiences seems to be the easiest way to live with them, and Elisabeth shared her difficult experiences and loneliness with the pine tree. In terms of loneliness, Elisabeth expressed feelings of being alone, even though there could be several persons, registered nurses, physicians, staff nurses, around her. Dahlberg (2009) emphasises that feelings of loneliness can emerge in the midst of a group of people. In such situations with a lot of people around, Elisabeth expressed the feelings with the following words: ‘It was staff who came in, but they did what they were supposed to do…someone once sat and talked to me, held my hand when I was a little sad, it happened that I was, so it has been the most fantastic care of all. But still, I was very lonely anyway, and then I had my pine tree’.

If there are too many people in a room, it may be difficult to establish interaction and connection with a specific person with whom to really sense and build a friendship. A feeling of loneliness can also occur if the caring staff, for example, the nurse or the physician, do not understand the patients' needs and questions. Especially when the person in question is vulnerable and needs care, it is difficult to be alone with one's own worrying thoughts (Dahlberg, 2009).

Being all alone in a hospital room, as was the situation for Elisabeth, decreases the sense of togetherness. Elisabeth was alone in the room, without her family and friends and their fellowship, but she was also separated from all other people usually encountered during an ordinary day. That, in turn, may lead to a feeling of being excluded from participating in the world. In this situation, the pine tree became Elisabeth's connection to the world, a friend who never left her side. Receiving consolation meant Elisabeth felt that space and time were available and that she was not alone (c.f. Norberg et al., 2001).

Dahlberg (2009) stresses that the phenomenon of loneliness can only be understood by framing its outer horizon, which in turn is ‘the companionship without which one is lonely’ (p. 204). She, however, emphasise the importance of not polarising the phenomena of loneliness and companionship. Instead, there is a multifaceted and close relation between the two, and loneliness and companionship can be seen as ‘an existential unity’ (Dahlberg, 2009, p. 204). Being present in others' lives and confirmed by others is a desire and a need every person has (Buber, 1994, 2002). For Elisabeth, she was present in, and confirmed by, the life of a pine tree.

3 SOME CONCLUDING WORDS

To conclude, nature, for example, trees is of significance for humans' well-being and feelings of belonging (c.f. Ritter & Dauksta, 2013; Ulrich, 1984). Some even argue, as mentioned above, that a tree might be animated or souled, and Häggström (2020) raises the issue that maybe intersubjective meetings between humans and plants, such as trees, are not as controversial as it might seem at first sight. Instead, she argues that it is a question about how communication is defined and how adaptive one is towards unknown forms of communication. Of significance is instead the ability and sensitivity to actually view the other for its otherness and not narrow the other to the same.

In the case of Elisabeth, it is evident that she experienced and valued conversation and togetherness with the pine tree outside her room, a pine tree that became her friend during her hospital stay: ‘The pine tree, my good friend’. Her friendship and communication with the pine tree, for example, when the tree waved good night to her in the evening and was ready for her in the morning, can also be regarded as an example of the importance of having timely routines, a kind of rhythm of day and night.

Elisabeth's friendship with the pine tree decreased her feelings of being lonely. It seems that a person is more sensitive to loneliness during a period of illness (Dahlberg, 2009). This, in turn, indicates the essential need to identify and address these issues, as there is a profound relationship between loneliness and well-being. However, not only people can offer company and togetherness, especially when being ill and vulnerable, nature—a pine tree—can be that much-needed friend. A tree outside the window can symbolise freedom and a kinship with one's familiar world (cf. Verderber, 1986).

In line with the argumentation in this paper, the importance for the nursing practice is to consider supporting people to view nature by, for example, opening curtains or blinds. This is especially of importance for those working in the intensive care unit (ICU) when the patients often are bound to the bed. By this seemingly simple action, nature can serve as a contrast to the often high-technological environment of the hospital (c.f. Tunlind et al., 2015)—a way to balancing tech with nature. It might even be that tech inhibit rest and sleep for people in ICU, while nature promotes it, or as, among others, Bratman et al. (2015), emphasised, to have the opportunity to view nature through a window may improve a person's mood and faster recovery.

Finally, there are embedded complexities in humans' needs and desires to have a relationship with the other—human and more-than-human (c.f. Buber, 1964, 1994). An issue of significance to discuss, consider and reflect on is therefore; whom or what the other might be. For Elisabeth, while she was critically ill and no one was permitted to visit her, the other of importance was the pine tree. ‘I definitely do not want to get critically ill again. It was a difficult period, but I can long for the moments I had with my pine tree…my plan is to go and visit my friend on occasion…it was us against the world’.

ACKNOWLEDGEMENT

The authors thank ‘Elisabeth’ for narrating your experiences about your friend, the pine tree. Elisabeth is named something else.

CONFLICT OF INTERESTS

The authors declare there are no conflict of interests.

ENDNOTE 1 The interview in focus for this article took place during the summer 2020, about 2 months after the person stayed in the corona intensive care unit, followed by informal talks during the autumn and winter 2020/2021 (data collection Å. E). The Ethical Committee in Sweden approved the study (registration number 2020-02805).

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