1	Humanism & Medicine Richard Kasama, MD, FACP
2	Scenario The patient presents to the emergency room after several days of high fevers, abdominal pain, and a groin mass. Examination and diagnostic studies are consistent with an incarcerated inguinal hernia.
3	Scenario What you tell the patient Ms. Smith, I’m sorry you had to wait so long but the radiology department is really slow tonight. Any ways the test show the mass in your groin is an incarcerated hernia. This means that if we don’t operate soon the bowel loop will become more ischemic and you could become septic and die. I’d like to prep you for the OR . What the patient hears Ms.Smith ….. mass in your groin ….. hernia …… operate ……. bowel …… die.
4	Alternate Scenario What you say to the patient Ms. Smith I’m Dr. Kasama. I’m sorry you had to wait so long. Do you mind if I sit and discuss the results of your tests? It shows that you have what we call an incarcerated hernia. That’s a part of your bowels that’s been trapped in a hole or what we call a defect in your abdominal wall. At this point it’s also cutting off the blood supply to that part of the bowel which could cause it to die or become infected. The best treatment is to fix it with surgery. Do you have any questions? Is there anything I can do to make you more comfortable? What the patient thinks I have a problem with my bowels I need to have surgery or it could get worse The doctor seems to be nice and wants to help me.
5	Dr. Jekyll & Dr. Hyde Hyde Arrogant / Condescending Impatient Irritated Rough Evasive or Vague Disingenuous Deflects blame Distracted Jekyll Understanding Patient & Unrushed Gentle Caring Reassuring Honest Calming
6	The Patient Fear and anticipation Guilt Isolation or abandonment Confusion Pain Loss of control
7	The Patient’s Perspective I’m your most important patient Unreasonable expectations Faster recovery Denial This is not happening to me Family issues Financial issues Religious issues
8	The Patient Pain Disorientation & Confusion Wake/sleep disturbance Drugs and side-effects Immobility
9	Diagnosis
10	Post-Chemo
11	Post Chemo
12	Post Transplant
13	My Experience I awoke in intensive care, with 49 new stainless steel staples, immobilized by a forest of i.v. lines, ekg leads, ng tube, duo tube, three Jackson-Pratt drains, a t-tube drain, foley, Swann and central lline, radial and femoral A-lines, compression boots and endotracheal tubes while still partially sedated. My earliest memories, admittedly warped by narcotic induced hallucinations, was being extubated. I can vividly describe the experience of having the E-T tube removed and watching my lung being pulled inside out. Surprisingly to me in place of the round alveoli you would expected to see I saw small yellow plasticized cubes. I went back to sleep. I awoke that evening with the sense of being trapped on by back in an uncomfortable bed. I was developing respiratory distress, difficulty breathing, gulping for air, despite the humidified face mask oxygen. We started with simple things first but ultimately I needed BiPAP.
14	My Angels Angel one - a friend that made me promise to see my doctor. Angel two - appeared as a nurse named Molly assigned for the weekend shifts Angel three - was my sister Angel four - was a transplant fellow Angel five - were the comrades at the Family House.