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There, They’re, Their

May 14, 2012

Jean Dominque Bauby blinked every letter to write The Diving Bell and the Butterfly. Why blink? Bauby suffered a massive stroke that essentially left him locked into his body. He couldn’t move or speak and was essentially paralyzed. All he was capable of was blinking. He set out to write a novel of his experiences by blinking each letter to a physical therapist who waited patiently to transcribe the novel. Each word took about two-minutes to spell out and the entire book took ten months. Bauby writes about his everyday life from the perspective of someone with locked-in syndrome, the first book of its kind.

Many may question whether Jean-Do is there as a person since he is entirely dependent on others.  This man can think and is aware of what is going on around him. It is almost an insult to him as a person to consider him not “there”. He is not an empty-shell of a body or an inanimate object. He even managed to figure out a way to write a book. (Something that very few of us can brag about.) Since this man is still living, he is there. I believe a person is a self until that person passes and is no longer a living, breathing, and thinking being. As long as a person can form thoughts, opinions, and beliefs, they are a self. A self begins at birth and ends at death. By saying Jean-Do is not “there”, it can be inferred that since he is unable to move, he is dead or lifeless. I am sure people believe that since he can not act like a normal person that he is not “there”, however, if they were in his situation, I am sure they would have the opposite opinion. Self resides in the mind and soul of the person that is alive. Jean-Do has lost neither of these and therefore is present.

For further evidence of why I feel the way I do, please view the video below. Henry is old man who had suffered several strokes. He had lost the ability to communicate and was in a near wordless, silent state. Based on music therapy theories, nurses gave him an iPod filled with music from his youth. The music brought Henry back to life! The change was both physical and mental. The neuroscientist in the video states,  “He’s reacquired his identity for a while through the power of music.”

If people believed Henry was not there, just as they might believe Jean-Do was not there, they probably would not have employed music therapy. Although music is what “woke up” Henry, I am sure he is a thinking, feeling human even when there is no music. Just because he can’t verbalize things does not mean he is not there, similar to Bauby.

A Ticket to Somewhere

May 14, 2012

What better place to people-watch than in an airport while you wait for your flight? As I sit in the terminal for over an hour, it is easy to observe people from all walks of life. They are all ages, races, and ethnicities: literally a melting-pot. On Sunday night flying home from Minneapolis, Minnesota, I discreetly glance around trying to find subjects and to not be obvious in the process.

I spot a thin man in army fatigues. He is African-American and probably in his twenties. His eyes are the most prominent feature of his face. They protrude from his face, extending forward and diminishing his other features: a slight mouth, narrow chin, and a slender nose. Along with his eyes, his forehead consumes his face. His shaved head exaggerates the size. Overall, this man is very slight. His face and body are thin, rather than having stereotypical jarhead muscles and lack of neck. Without the army fatigues, he would not look like a war hero or anyone experienced at fighting. His movements exude hesitation, not confidence. He keeps his eyes downward and his body language is entirely submissive. Could it be this man is returning from deployment, only to be suffering from PTSD or is so affected by the war to become entirely introverted? The large eyes that are so hypnotizing are empty and wide, like a child’s. I wish I could tell what he is thinking, but his eyes lack emotion. They aren’t windows into the soul. The flight attendant begins calling for people to pre-board. Families with children and disabled are announced to board, but veterans or members of the armed forces are not. After the families and disabled walk onto the plane, the army man tenderly approaches the flight crew, gesturing with his ticket to see if it is okay to board. They vigorously nod yes.

I hear the second person before I see him as he is sitting behind me in the airport terminal. From his voice I can tell he is an older gentleman, possibly late fifties- early sixties. His voice is animated and lively. As I begin to listen to his conversation, I realize he is talking about his love of art with a complete stranger. This passion is responsible for his energetic tone. When the stranger agrees, he becomes more spirited. I discreetly glance behind me to see that this man is the age I pictured in my mind. He has large, square wire glasses, matched with a white beard and a nearly bald head. The plaid flannel shirt and jeans add to the kindness in his face and voice. As he vivaciously gestures with his hands, I get the feeling that he loves life and is very active in his old age. The last thing I hear is him telling the stranger how excited he is that he is flying first class for the very first time.

An Interview Resumed

May 14, 2012

Moretta: Why did you become an animal assisted therapy volunteer?

McCoy: Well, I had Daisy as a puppy originally to raise her to later become a guide dog for the blind. But she didn’t pass their tests so she wasn’t able to do that. I thought that since she is very obedient and calm and just a great dog, I really didn’t want to just keep her as a normal pet. I felt she had potential! (Chuckles) So my friend suggested animal assisted therapy. I did a little bit of research and found the program at CHOC and looked into how to certify her and all that. I basically decided to do it because I had just retired and was looking for a new way to spend my time, uh, a new hobby so to speak.

Moretta: What was the process like for volunteering at CHOC?

McCoy: Well first I had to get Daisy certified like I said earlier. Then you have to submit an application and do an interview and then once accepted the volunteer has to abide by the hospital’s volunteer rules, like attending training and having the necessary immunizations and also pass a background check.

 Moretta: How long have you done this?

 McCoy: I have been at CHOC, lets see…  it will be three years in September.

Moretta: What makes this type of volunteering better than other kinds of community service?

McCoy: I think it’s the reaction from the children. I have always loved kids and helping them, you know. I mean I taught for so long that this was just another way to reach out to kids, but different than what I was used to so it makes everything a little, uh, more refreshing. The dogs bring… uh, uh… a sense of joy into otherwise sad little people. You know animals’ love is unconditional. They don’t care if you have hair or don’t have hair. If you can walk or can’t walk. It’s an unconditional love and that’s why I think this is so important.

Moretta: How do the children react when Daisy is around?

McCoy: The moment Daisy enters the room it transforms the room into something familiar to them such as a backyard where they’re used to throwing a ball with their dog. A dog kind of breaks the ice a little bit and the children are a lot more… um … apt to respond and to do things.

Moretta: Do the patient’s ever talk about the dogs? Like how they make them feel?

McCoy: Patients have described dogs as really happy and hmm… soft and playful. They just love them. Their faces light up and the feeling in the room becomes lighter.

Moretta: Can you give me an example of a patient that reacted strongly to animal assisted therapy using Daisy? 

McCoy: One particular child I can specifically think of, who was having a bone marrow transplant who’d been very sick and really had gone into his shell and the physical therapist had been trying to do, um, physical therapy with him and he really just was not interested so I was asked to come in with Daisy to see if it could help at all. Once I got her into the room… um, it was a whole other world.

And then there was another little girl. She was a brain tumor patient and probably about eight or nine. She was probably in the ICU for probably 2 weeks and she really didn’t open her eyes or respond to anything until Daisy was bought in. She had tubes running in and out of her head to drain the fluid from her brain …um, I threw a sheet down on her bed she, Daisy I mean, jumped up on the bed and she laid her hand on the dog and that was it. She opened her eyes. She uh… immediately responded to Daisy laying next to her. It was a real great experience for her right then especially since everything was taken away from her and at that moment it kind of gave her a feeling of being a kid again.

Moretta: Do you think animal assisted therapy makes an impact on patient healing time? I’m basically asking if you think it does more than just lift their spirits.

McCoy: Hmmm… I would say that it does do something. I’m no doctor and haven’t treated a patient so I don’t have any concrete evidence or a specific story of a time the patient met an animal assisted therapy dog and miraculously recovered, but I would have to say that the change in mood and everything I talked about seems to be evidence that it does something.

Moretta: Would you like to add anything that I didn’t cover?

McCoy:  Well first I’d like to thank you for interviewing me. I feel so special! (Laughs) All I really would want to end on is that it really is gratifying to see an animal make such a difference. I mean I do this for free, but I feel like I am being paid because I always leave the hospital so content with what I have just done. I really feel like Daisy is making a difference in these kids lives, especially ones who have been basically living in the hospital for several weeks. They don’t get to run and play, but having a dog come into their room brings some of the outside world to them and I think it really does a lot for them. I hope to do this for as long as Daisy is willing!

Self: A Matter of Opinion

May 14, 2012

Rebecca Skloot writes about a woman she has never met in The Immortal Life of Henrietta Lacks. Mrs. Lacks died of cervical cancer. Before her death, doctors took cancerous cells from her cervix for research purposes. These cells never died and were used to discover many things that would benefit the medical world, including the vaccine for polio. Through tiresome research and investigation Skloot discovers the truth behind Henrietta Lacks, her family, and the doctors that made her cells a legacy.

In my opinion, every “self” begins with cells. Miniature, tiny things that human’s can’t see without a microscope. As these cells divide and produce new cells over and over again, a human, and thus a self, forms. The cells are like a seed. They grow and grow until out pops a tiny plant. Humans grow into their “self” with environmental factors, such as what their parents teach them, what they eat, where they live, and what they do as they grow. Like a plant, they will grow and achieve greatness if nourished, but will shrivel and die if sustenance is withheld.

Our self is a melting pot of everything external and internal. Internal would be genetics, hormone levels, brain chemistry, or anything going on underneath the surface that affects who we are. In contrast, external factors are everything that have been put into this person, from what they have been taught, how they style their hair, or however the world has influenced them.

When our selves die, we become only a memory. The people we held dear before death cherish memories from when we are alive. I will not address what I believe happens to souls, bodies, or anything similar after death, but I do believe a person is kept alive in pictures, memories, home videos, and stories no matter what belief’s someone has. Although their “self” is gone, a loved one will never truly be gone from this earth until memories cease to exist.

However, Skloot explores different meanings of self. Not everyone will agree that self is only when a human is living. For example, Deborah, the daughter of Henrietta, believes her mother is alive during her autopsy and can feel every cut, scrape, or pinch. Her mother is in pain, even if she is a corpse. I believe her cells and her being are gone, unaware of any sensations in the world. She is no longer a “self”. The lawsuit between Moore and Golde makes me think about my beliefs because I can see both sides of the story. (For a summary of this case visit here http://www.lawnix.com/cases/moore-regents-california.html) I can agree with Moore or Golde since I see value in both of their arguments. A perspective I do agree with is by some of the scientists. They contend that because the genes have been altered in the majority of HeLa cells, they are no longer Henrietta. Since the genetics are different, the internal causes of self are totally different than Henrietta’s causes. Her “self” has been altered and is no longer hers.

The Grass Is NOT Always Greener

May 14, 2012

The American health care system is not perfect. There are flaws and kinks in the system. However, the quality of care in the United States is above and beyond every other place in the world. It may be easy to complain when your insurance doesn’t pay for that check-up, but be happy you don’t have to see doctor whose office is on the side of a road.

Perceptions

May 14, 2012

As a child, Lucy Grealy developed cancer in her jaw. As a result, doctors removed parts of her jaw, which left her with some facial disfigurement. Autobiography of a Face is Grealy’s first hand account of a childhood of looking abnormal with a less than supportive family. She perceived herself as hideous and mocked by everyone around her. She became more introverted as her self-perceptions seemed to grow stronger.

Self perceptions are a funny thing. They grow out of what we are told about ourselves, how we are treated by others, and possibly what we think of our appearance when we look in the mirror. They can be positive or negative depending on these factors. I feel that Lucy Grealy never was able to form her own self-perceptions. She was always hindered by how she thought she looked and how she felt others treated her as a result.

I think my self-perceptions come from what I have been told by others and what I believe about myself. If someone tells me I have a specific quality, I will believe them only if I agree with their opinion. It is difficult to test them against an unbiased reality because there are always biases. No matter the test or process to determine an answer, there is a bias in choosing that test over others or just using an already created process. I think self-perceptions change constantly. My self-perceptions as a ten-year-old are entirely less developed than they are now. As a person grows, learns, and accomplishes more throughout his or her life, self-perceptions change. They can also change by how others treat you or where you are in your life. For example, if you started a new job and end up being terrible at it, then your self-perceptions may become more negative. Then after a few months you get better at your job, your self-perceptions may change once again. This concept of how we perceive ourself is ever evolving and will never be definite until our death.

One of my strongest self-perceptions is that I am practical. I know this through my behavior and people telling me I have this quality. Below is a list of why I have formed this self-perception.

1. I am aware of my body. I stop eating when I’m full, no matter how good something tastes. I go to sleep when I’m tired, even if my favorite T.V. show is about to be on. I do these things because I have learned that the sick feeling after over-eating is not one I like and that being exhausted the next day isn’t worth staying up late.

2. My last purchases on my debit card were gas and bills. These things are where my money goes first. Once I have paid for these, the remaining money I put towards fun things, like going out to eat or to the movies.

3. I enjoy movies that would make sense in real life. Movies that have events that couldn’t happen in real life (i.e. The Notebook because they die in each others arms at the same time) are not practical and therefore I can not believe them. Since I don’t believe them, it is very difficult for me to enjoy them, especially romantic comedies.

4. My closet is organized by color.

5. I really like to read so when a book is really popular or about to become a movie, I have to read it. I bought The Hunger Games for this reason. Two representatives from twelve districts are selected to participate in the games and fight until their death. The last surviving representative is the winner. I really disliked this book for one reason: you know the ending after reading the first page. The is so impractical and takes any enjoyment out of the book. There is no suspense because the narrator of the story competes in the games. Therefore, it is pretty obvious that she survives. I still don’t understand how this book is so popular.

7. Our house has a chore chart. I live with four other girls and it seems reasonable that everyone is assigned one chore a week. (i.e. trash, kitchen floor, etc.)

8. The fact that I am doing this post two days before it is due because I have the free time.

The Dirty Details

May 14, 2012

It was my second shift as an intern in the hospital. Even so, I had finished training about two weeks prior and was confident because all the information was fresh in my mind. I know how to bathe a patient, how to ambulate a patient, move a patient from bed to wheelchair, etc. On the mandatory written and practical tests, I had received high marks. I was feeling good and was just about ready for anything. However, this was a slow morning. I counted how many times I walked around the floor looking for something to do, managing to do over fifty laps. My new Target watch was getting a lot of action as I constantly looked at my wrist to see if any time had passed. With all the walking, I definitely got my recommended exercise for the day. Just when I couldn’t hide my yawns any longer, an aide poked her head out the door of a room and waved me down. Finally!

“I need your help changing this patient’s diaper,” she sighed, “It’s already his fourth since I got here.” I should have realized then that this wasn’t going to be good. It was only 11:30am and her shift started at 7am. This patient was averaging one new diaper per hour. That’s a lot of dirty diapers. Nevertheless, the training manual stressed, “Assist hospital staff and physicians as requested” and I didn’t want to disappoint anyone my second day.

I walked into the room and began putting on my gloves. With one more step inside, the smell hit me like a semi-truck. It smelled like a park bathroom in the middle of a heat wave. Oh well!, I thought, This is what I signed up for. Time to start breathing through my mouth.

The patient looked frail and sickly, sort of like Gollum from The Lord of the Rings. He wheezed in and out,

periodically hacking in an attempt to cough something up. His arms were restrained to railings on the bed and he wasn’t able to communicate in any way. I went to the patient’s right side of the bed and the aide went to his left side. When you change a patient, you roll them to one side of the bed, remove everything, and clean them. You put in a clean diaper, roll them to the other side, and pull the clean one completely on.

Everything was running smoothly until the patient rolled towards the aide. At this point, the dirty diaper was removed. I was just about to put the clean one on him. Before I could do so, he began going number two straight onto his bed. It was like molten lava erupting from a once-extinct volcano flowing onto the blue protective pad and pristine white sheet. We couldn’t do anything but wait until he finished, cursing under our breath at our bad luck. Internally, I was freaking out since this was my first real diaper change.  Once he stopped, his condom catheter decided to fall off.  As he couldn’t control when he urinated, we now had a bed full of number one and number two: a bloodbath of brown and yellow. As if this was not enough, one of the ties from the wrist restraints decided to drift into the mess as he began thrashing, dragging the tie and what was stuck to it across his naked body. Everything that could go wrong went wrong.

In a wise move, the aide said we needed to get extra supplies: wipes, diapers, and sheets. When we came back to the room, we decided to protect ourselves. We suited up in full isolation room gear (yellow gown, mask, and gloves), which typically is reserved for only the most contagious patients. We were ready to conquer this mountain.

From here on out, the aide did the majority of work. As she could probably tell from my shocked face, I had been thrown into the deep end of the swimming pool a little too fast. I basically began handing supplies to her as she did the dirty work of cleaning this man and restoring our sanity. At the okay from her, I quickly dismantled my protective shell and raced to the sink. I couldn’t shake the feeling of having poop all over me. I felt like this until I got home, took a shower, and burned my clothes. Only after a couple weeks was I able to laugh at what happened as if I was part of a prank or a cast member on Scrubs.

Looking back, even though I can find humor in what happened, it is important to realize that this patient is human. Even if we had to deal with the mess he caused, it wasn’t his fault. However sick he was, he obviously couldn’t control his actions and what happened wasn’t because of malicious intentions. About nine million men and women in the United States over the age of sixty-five similarly rely on permanent long-term care. It’s always important to remember that this patient, and those like him, is human. He was once a son, brother, or father. At one time he was able to do things for himself and this episode was probably more embarrassing for him than it was for us.