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Wednesday, January 27, 2010

Flection, not Reflection

Posted by Bri Lauren

“I didn’t want to go in that day, but mom made me. She said this round is almost over and after I get my medicine we can go to McDonalds. It was really cold out that day and the wind hurt my head. We got inside and today was my turn to push the button on the ride with the doors. Mom went to talk to the tall lady at the desk and I wanted to play. That day there was a girl at the playing table. She wasn’t like me because she had really pretty long brown hair. I went over to play with her hair because I don’t have any to play with.

We played my favorite game Uno! I always win and beat her 3 times. We colored pictures of my favorite dinosaur and pretended we were in a jungle. I was mad because mom made me stop playing to get my finger pokie. The lady in the long white jacket told me she needed to read my blood. That day it hurt really bad because I had to get another pokie in my arm so my cancer can get better.

My body was done drinking the medicine and I made a bracelet for my new friend with the long hair. That day mom had to talk to the lady in the white coat for a long time. I was happy because I got to play more with my new friend. I didn’t know why but mom was upset when we left and cried. Mom hugged and kissed me a lot that day. Next time will be fun because me and my friend are going to play Uno again and draw more animals!”

Empathy is something that is not often addressed in classroom. This is very ironic to me because a big part of being a successful doctor is being able to listen and relate to the patient. In effort to better understand the patient, a reflective writing from their standpoint will take you beyond the emotion of the moment. A self-reflection is used to better future practice. A reflection is an image of a person from a different standpoint. The purpose of reflecting on your work is to understand where to bend and mold to improve. It is easy to merely self reflect and continue with out any change. In order to transform, a self-flection is needed (Gillie Bolton, 2005).
Writing from the standpoint of a 5 years old patient with leukemia allowed me to see what was really important in their life. There is a heart-wrenching innocents when a child does not fully understanding the meaning of cancer. In a case like this, there comes a point where happiness is the only thing that matters.

Monday, January 25, 2010

La Mujer está Muerta

Posted by Bri Lauren


Patient X lies in pain on a once clean stretcher now coated in left over dirt and grim from their fall. The doctors casually joke around about their weekend adventures until they receive the x-rays. The computer lights up indicating the photos are ready for analysis. There is an obvious disconnect of the stylus process in the right ulna. The doctor calls orthopedics and passes on the patient. A cold silence strikes X as the stretcher rolls into the procedure room. Orthopedics speak under their breath about what method is best to reset the bone. The doctors calmly tell X they will need a cast and a small injection is necessary to ease the pain. Everyone in the room but the patient speaks the language of sugar coating. It is time to put on the happy face and pretend that what is about to happen will not hurt.

Their wrist is numbed and they think the worst is over. As the doctors give false comforts to aid in the element of surprise, the patient exhales in relief. With no wavering one doctor firmly holds the patients forearm and without a word communicates he is ready to begin. In one swift motion the other doctor grasps X’s fingers and jumps all of her body weight into pulling the chipped bone back into place. You can hear a slight click over the patient’s screams; the bone is set. As tears of disbelief roll down the patients face their wrist is casted. Now it is over.

Surprise is a key factor that all doctors have working on their side. Everyday patients seek help to cure their aliments. The patient not knowing what the immediate future holds serves as a haven for comfort. These lies all doctors tell are not really lies, just omitted facts from the truth.

When patient XX came in with a cough, they left with 2 months. Before I entered the room to give the diagnosis I forced my mind to go numb. It was at this point I understood how this self-preservation coping mechanism easily slips into sociopathic mannerisms. Feeling the raw emotional vulnerability of a patient is not a comfortable place doctors want to travel. Empathizing with every patient can bridge the gap between the conscious and unconscious mind. Knowing that XX has lung cancer and wanting to cry with them as I reveal the deadly secret is not possible. Becoming emotionally detached seems to be the only refuge from the daily pain inflicted by the truth.


Just in case.

Posted by Bri Lauren


Hola amigos,
If you get lost just look for el giant aqueducto in the middle of the city and turn left. Vale? muy bien, muy bien.
~Lola
http://en.wikipedia.org/wiki/Aqueduct_of_Segovia

Monday, January 18, 2010

Coming out of the closet...

Posted by Bri Lauren


It has taken 10 years for me to finally feel secure enough to share this with everyone. I now feel cofident that coming out of the closet will help others with the same issue. I am addicted to chocolate. If you are smart, when there is chocolate around, you will get out of my way. Today for a snack, I had a cup of thick creamy chocolate with fried dough for dipping. The American culture needs a lesson on Churros y Chocolate. It is a fact that every women has attacked a cup of melted chocolate with junk food suitable for dipping. This dirty little secret is something that all American women take part in behind closed doors. I am going to be the one to bring this vital custom home with me so we no longer have to be closest chocolate junkies.

It is still very abstract to me that españoles can eat all the time and eat foods that we only associate with weight gain. A typical lunch and dinner starts with a huge bowl of soup or a heaping dish of pasta. The second course is always a meat dish (which 99.9% of the time is pork) with bread. Dessert is two pieces of fruit and café con leche. If this buffet doesn’t fill you up, you only have to wait 2 hours for snack time. You can go the traditional wine with your choice of smoked mini ham sandwiches, patee con queso, Spanish omelets, or spring rolls. There is also the more feminine approach of café con leche with some type of pastry stuffed with a rich, thick chocolate and whipped cream.

After all this eating, I expected to see case after case of clogged arteries my first day of internship in the emergency department. This was not the case. Even at the hospital it is rare to find a person approaching that fine line between overweight and obese. When discussing this topic among the doctors there answer was simple, “we don’t worry about what we eat, we just live life.” It is really uncommon to find weight watchers, the zone diet plan or other obscure yo yo diet trends in Spain. Everyone is forced to walk at least 5-10 miles a day to go to the market for groceries, meet some friends for coffee, or go to school or work. Food isn’t used as an emotion tool for coping, but rather a pivot point for socialization and bringing people together. When the Spanish sit down for a meal they actually chew their food and acknowledge others at the table. You can expect a typical American to inhale dinner and ignore everyone at the table in order to catch the newest episode of Jersey Shore. It is more common in the states to live to eat, rather than eating to live. The Spanish culture understands their priorities and how to take time to live life.


Sunday, January 10, 2010
Posted by Bri Lauren

When I arrived at mis padres house I naturally went to the kitchen to grab a cup of coffee. Right next to the coffee maker was something suspended covered by a cloth. When I took off the cloth I thought jigsaw was going to pop out somewhere and I was now a part of Saw VII. It is safe to say that every spanish house has this "jamanero" and to apply for a visa one of the questions should be, "do you eat pork?" I have only been here for 2 days and already I have had pork 7 different ways. Spain is a vegetarians worst nightmare.
Last night I had my first taste of la vida noche en Segovia. After a nice long siesta I ate dinner with my family at 10 and then went out with my host sister Elena. All my host mother wants to do is feed me! Every dinner has 4 large courses, soup, meat(some type of pork ofcourse), fruit and dessert. In the states we are leaving the bars at 2, but in Spain at 2 the bars are just getting crowded. We danced all night at the disco (club) and stumbled in around 6 a.m.
I have yet to see an overweight person. How is it possible to eat lots of dessert and what we consider to be fatty meat without packing on the pounds. The major difference is walking and the quality of food. On average españoles walk to 90% of their activities and are basically stress free because of siestas. During siestas they are able to leave work for 3 hours cook a decent lunch and take time to rest, go shopping or nap. They make time to enjoy the day and live a life outside of work. The norm for food is everything is fresh and organic. There is no need to look for that little green circle saying, "USDA certified organic." It is hard to image going 2 miles without seeing 3 Tacohuts, 5 McDonalds and a KFC, but that is reality over here. What is considered to be fast food in Spain are small cáfes with fresh food prepared that day. 
Obesity is a rare disease in Spain, but is something that is taking over the U.S. The typical American thing to do is to put the blame on anyone but yourself. Usually I would disagree and say nobody made you eat that last Happy Meal but yourself! In this case I am starting to wonder if the American way is set up for failure. If I wanted to walk to the nearest mall or grocery store to do some shopping in the states, it would be at least 7 miles or more to get there. Riding my bike isn't an option either because there are not always side walks and dodging Escalades every .2 miles is not something that I want to do. In our crazy fast pace life it is hard to find time to inhale some food in the 30 minute lunch break we are permitted. It is obvious why we are a fast food nation. 
In the states the term being healthy is very superficial and associated with only ideas of body image. Stress and state of mind are hardly ever considered in the equation of a healthy lifestyle. People need to understand that stress on the mind creates stress on the body. It is an oxymoron to follow a strict fat free diet, work out 3 hours a day and not take time for yourself and enjoy life. The secret to weight loss is not the new fiesta style Taco Bell drive threw diet and hours on the stair master. The cure to this disease is a diet that many people need, a lifestyle change.