Cell 2 Soul: The Humane Health Care Blog

Chicken Skin

In Hawaii, they have and expression for something that gives one goosebumps.  It can be spooky or just a bit surreal.  We heard a "chicken skin" tale about health care on Story Corps today.

Listen to:  Strange Encounters with a Hospitalist. 

Reunion with the Dead

by Richard Sobel

As I entered the room I was suddenly confronted with every patient who had died under my care in the 26 years I had served the community. They appeared in order, the first person I hardly knew: he died shortly after I arrived in the village as the community physician, but the last to appear had died just a month previously. I had known this vivacious young girl since her birth 18 years previously. Surely, if this were a dream, it would be the nightmare of any clinician even if the treatment of each patient had been beyond reproach.

(Photo of Revivim settlers, Life Magazine, 1948)

Read here for full text: Download ReunionSobel

Touch Conveys Emotions

This is an important article documenting the ability of simple touch to communicate emotion non-verbally.  It has major implications for how we relate to others and how care givers (nurses, aides, physicians) can initiate the healing process.

Hertenstein MJ, Holmes R, McCullough M, Keltner D.  The communication of emotion via touch.   Emotion. 2009 Aug;9(4):566-73.

Abstract

The study of emotional communication has focused predominantly on the facial and
vocal channels but has ignored the tactile channel. Participants in the current
study were allowed to touch an unacquainted partner on the whole body to
communicate distinct emotions. Of interest was how accurately the person being
touched decoded the intended emotions without seeing the tactile stimulation. The
data indicated that anger, fear, disgust, love, gratitude, and sympathy were
decoded at greater than chance levels, as well as happiness and sadness, 2
emotions that have not been shown to be communicated by touch to date. Moreover,
fine-grained coding documented specific touch behaviors associated with different
emotions. The findings are discussed in terms of their contribution to the study
of emotion-related communication. (PsycINFO Database Record (c) 2009 APA, all
rights reserved).

Marginal Notes: Eye of the Beholder

 

"Peepers" copyright©2008 by Emily B. Maurer

 

“Luisa said that if we ever get over to the Ukraine, we can stay at her house for free," my wife told me.

 

A puzzled look settled on my face.  "Who is Luisa?" I asked.

 

"Luisa — Florence's live-in companion. She came to America to look for work and ended up taking a job as an au pair. When that fell through, she started working for Florence."

 

"How is Florence getting along these days?" I asked. Florence lived in the small clapboard cape at the end of our street. >>more

 

Brian T. Maurer has practiced pediatrics as a Physician Assistant for thirty years.  His "Marginal Notes" column appears periodically in the Cell2Soul Blog. The title "Marginal Notes" is taken from a quote by Henry David Thoreau: "I love a broad margin to my life."

See the Patient, Not Just the Problem

Toronto Writer and Dermatologist James Shaw presents us with an important vignette.  Perhaps, it was Osler who said, "It's more important to treat the patient who has the disease than it is the disease the patient has."  One needs to bind this mot to one's forehead.  Physicians, nurses, therapists, patients and their families need to consider this.  Dr. Shaw's vignette makes the lesson indelible.

"The only window that opened was the short one with hinges across the bottom. It opened inward by pulling on the latch, like a mailbox. I gave it a pull, letting in traffic noise for a moment, then closed it.
It would have been difficult for Mrs. Whittier (name changed) to step up onto the radiator and squeeze through that window. But the night nurses hadn't noticed when, in the early hours of Saturday morning, she climbed onto the thin ledge and jumped to her death..."  Full Article  Download A reminder.

You can reach Jim Shaw at: Email. 

If Doctors Had More Time To Listen

by Julie Weed  NY Times June 6, 2009

To read, go to Permalink .

This is a thought-provoking piece.  I am not a fan of boutique practices, but we definitely need to give patients TIME.

It's the platonic ideal of the Free Doctor and Free Patient. Download Plato Physician  .

Human Connections

Susan Kaplan, a psychologist from California, has sent us a powerfully moving story chronicling the disconnects that can occur between patients and doctors.  This is a constantly recurring theme.  Her essay is a valuable resource for patients, physicians, and families.

“'Thank you for agreeing to meet with me today, Dr. Walker. There are a lot of things I still don’t understand about the twins’ birth.  Do you mind if I ask you some questions?'

Laura Rosenberg had left Dr. Walker’s practice shortly after Zack and Alex’s birth nearly thirty years earlier, feeling he was to blame for the poor outcome of her pregnancy..."  Download Human Connections

Dr. Kaplan would like to hear from you after you've read her essay, SK email

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Plato's Doctors

In Laws, Plato wrote that there are two classes of patients, slaves and freemen. And, similarly two kinds of doctors:  slave doctors and freemen doctors. Slave doctors run about and cure the slaves, or wait for them in the dispensaries; while free doctors attend and practice upon freemen. They carry enquiries far back, and go into the nature of the disorder. They enter into discourse with their patients, instructing them as far as they are able.  For the full quote go to: Download Plato Physician  .

      

So, what has changed since Plato made this observation?

Breast Cancer: Don't Look Away

"A good friend tells you she has breast cancer.  Suddenly, unexpectedly.  Like watching a suicide leap, that day becomes large, yet focused, a singularity, burns a hole in you...

[A few years later now] she comes to my premedical and medical school seminars to share her story.  She is a natural, a great teacher.  Every student has benefited from her narrative.  The lessons: how to be a patient, how to pick a doctor, how to be a good doctor, how to arise unencumbered from a serious disease.   We have learned much from her.

Read Larry Zaroff's* remarkable essay: Download A Historian Examines Her Breast Cancer

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NY Times Sunday Magazine, September 5, 1993

"I have always adhered to the philosophy that one should speak and show the truth, because knowledge leads to free will, to choice. If we keep quiet about what cancer does to women's bodies, if we refuse to accept women's bodies in whatever condition they are in, we are doing a disservice to womankind."  Matuschka

* Bio:  Larry Zaroff has had four careers. He focused for 29 years on cardiac surgery, including a stint as director of the cardiac surgical research laboratory at Harvard.  He spent the next 10 years concentrating on climbing and did a first ascent of Chulu West, a 22,000-foot peak on the Nepal-Tibet border. His third life has been at Stanford, where he received a Ph.D. in 2000, and where he teaches courses in medical humanities. His fourth career has been as a writer for the NYT science section. He has received awards as the outstanding faculty advisor for the Human Biology program and in 2006 was honored as Stanford's Teacher of the Year.

The Care of the Patient by F.W. Peabody

Francis Weld Peabody’s The Care of the Patient is the most cited article in the medical literature.  This is even more impressive when one considers that it deals exclusively with the humane aspects of medicine and not science.   All care providers, patients and patient's family members  would benefit from reading and rereading it every few years.  It is especially important for medical students and trainees.  The Care of the Patient used to be on the web - but not any longer.  We had a student type it out a few years back and you can find it: Download The_care_of_the_patient 1