Reality’s touch

” Who would you like to be after college?” “ A physician” I respond. I’m sure what comes up to people’s minds is the image of a doctor in a white coat, that is magically coming up with the perfect cure for his patient. There is a lot hidden behind the physician’s smile and confidence presented in this idyllic image… This was the first time that reality and concreteness related to society was presented to me in a class. It took me some time to accommodate to this novelty, and the main reason is that reality is shocking. I had no books to hide behind, and in order to fully comprehend the material presented to me I had first to accept the reality of our society and of the health care system in the United States. It wasn’t easy for me since I’ve always tried to escape from the concrete difficulties that health care is experiencing. I’ve always looked at the humanity, morality and the immense theory contained by this career, but I had never faced what in real life is the most important aspect of what we do for ourselves and our community: the political and economical bases of health care that affect deeply the real purpose of being a doctor. Health is not discounted! Health is not a right! It shocked me, disgusted me especially because I grew up in Italy, where even though not extremely successfully, health is for everyone. The analysis of the privatized health care system here made me however critically develop possible solutions and plans of actions that could be put in action in the future. This is an aspect that enriched the experience I had in this course. It stimulated me to actively elaborate onto the history and present data in order to see what can make a difference. What I will never forget is the shiver I got, when listening to a “Doctor’s touch” and to a life philosophy  that I consider morally vital. I finally heard from the outside world what I’ve been listening for a long time inside my thoughts. An inspiration that can become reality!

The wheel of life…

I have been lucky enough to get to know my great grand mother. As the wheel of life turns however, I also had to experience her end of life care and the approach that my family took. My parents involved me a lot into the situation even though my young age. I’m grateful since this experience opened my eyes in regard to death and the meaning that life has. At the age of 96 , after years at home, with my greatgrandmother being completely dependent onto my grandmother, my greatgrandmother, when understood that her time had come, actively decided to stop being under medications, eating and even drinking. What could my family do in front of such a strong decision? Was it right to attach her to machines and force her to a vegetative life that wouldn’t have honored the amazing woman she was and the harshness that she overcame in life. We all stayed next to her, gave all the love we could and accepted her decision if that was what she wanted to do. She looked happy serene. I remember my tears in front of her decision asking myself how a human being could be so strong to take such an approach towards death.

After reading Nina Berstein’s article I started questioning myself: “ How can the context surrounding us affect the individual’s approach to dying and the one of his family? “ In my country in fact, having a public health system, the approach to end of life care is much more different and in a way more free to follow the course of nature. Having a for-profit mechanism, as described in the article, determines how an individual has to die. What is therefore the sense of expressing your will on your death, if at the end, the envy of money of the society you live in, puts in second place the peaceful desire of his citizens, among which many of them have helped in the past make this country the place that it is now? Is an individual really free to express how he wants to die, in the for-profit system that the end of life care has become in the United States?

Are YOU ready ?

As Galston states in “Live Long and Pay for It: America’s Real Long-Term Cost Crisis”, “Americans will have to accept a broadened principle of personal responsibility as part of any viable twenty-first century system of social insurance.” Do we however see this goal to be possibly reachable seen how society in the United States has been run until now? Everything is well centered on the individual and his individualistic success. Additionally reality today is obliging a large part of the population to be barely able to take care of the issues and expenses of the present. Is an individual really willing to be planning about his longterm care when he might not be financially capable of taking care of his family in the present? Seeing how Germany has been successfully handling this situation makes me think back onto the idea of constrained choice, and on the principle of making an individual choice for the benefit of the broader spectrum of the society. Would the idea that our own preventive actions onto our long term care, will be helping the larger context around us, be a good method to handle the fear of facing one of the most critical stages of life: lack of self-sufficiency and death?

Distraction: our worst addiction

Tony Swartz, author of “The way we are working isn’t working”, argues in this article about one of the main addictions that pervades our society today: distraction. Interestingly he doesn’t discuss his argument by commenting on other’s distracting behaviors, but refers directly to his own experience. He looks both at the biological and sociological causes that bring about this condition. “We willingly accept the loss of concentration and focus, the division of our attention and the fragmentation of our thoughts, in return for the wealth of compelling or at least diverting information we receive.” is one of the many strong statements he presents, in order to describe how distraction has become an addiction, because we gave up to the detachment from reality that it gives. He refers directly to a survey done last year reporting that the average “ white collar” worker spends at least six hours a day on email not counting the time spent shopping on line and onto the social networks. On the other hand, it is scientifically proven that for an average middle age individual the level of attention while reading has radically decreased exponentially with the increase in use of the net. We are addicted to the detachment of reality… Isn’t it the worst addiction?

Is it always unacceptable to vanish?

Robert Zussman, in “The patient in the Intensive Care Unit” presents the idea of the patient “vanishing.” He explains that the patient vanishes when in the intensive care unit both because the disease is robbing him of his personhood and also because doctors and nurses are indifferent to his identity. My question is if I personally were a patient in an intensive care unit, on the border between life and death, would it be my first worry in thinking how are the people around me taking in consideration my identity?

We are trying to find many different contexts where to accuse physicians, their moral judgment and their role in respect to the patient.  Patients are trying want more and more importance. They rightly want more control over the manipulation of their bodies but they shouldn’t forget that who at the end is going to be able to change their sort is the figure of the doctor. I agree on how striking it is to think that a doctor in an intensive care unit doesn’t see any emotional difference among  his different patients, but maybe he voluntarily doesn’t want to for the right reasons. Before overgeneralizing and building up a common judgment over their role, we should first look at the situation from the other side of the coin, as if for once we were the doctors who had to understand through empathy the reality hiding behind the patient eyes.

The voluntary emotional detachment that they exhibit might be a way to find the courage everyday to save many lives without losing hope and desire to continue in their mission.

Is it comfort or exageration?

Just to follow up on my post ” Would you live forever in an hotel?” , I wanted to share with you one of the many lists available for anyone on the internet showing the most luxurious hospitals in the world. It scares me how they make us equalize the image of a comfortable and friendly atmosphere to the one of a luxurious room, which doesn’t say anything more than exaggeration!

Maybe when we will realize that health and patient  happiness do not rely onto luxury, we will be able to turn onto a new and rightful chapter of our health care system…

Please check this out and realize how the moral richness of medicine has been diverted by the interest of money:

http://www.therichest.com/luxury/the-10-most-luxurious-hospital-rooms-in-the-world/?view=all

Would you live forever in a hotel?

As Rosenberg states, the initial idea behind hospitals was that it would give a care as the one that someone could have at home, to people who for different causes couldn’t rely on one. At the end however he concludes that the “health care system will continue to reflect the special character of our attitudes toward sickness and society.” As happening today, the ideal model hospital is seen as confortable place, where as if entering into a hotel hall you can be served with any choice of care, test or surgery. As if in a hotel room, every patient is going to have his private room, with view onto nature and exposed to the healthiness of natural light. This is a desirable perfection, however, I see the symbol of a hotel as a heavenly place in which however you cannot stay regularly. I see it as a place where it all depends onto how much you will be willing to pay. Will  a “modern hospital” be ever able to make the patient feel at home, until an health care system based on interest and profit will nourish the basis of the inequality in our society?

The identity of the system

It was after Dr. Patricia P. Rieker’s lecture, that I started reflecting about the discussion we had onto suicide rates and the differences present between male and females, but also among different ethnicities in the United States. How can the society around us manipulate our choices up to this level? Reading the Report: “ Younger Native Americans face higher suicide rates”, I was able to collect all my reflections together in order to understand better how can community and culture have the control over an individual’s desire to live.

Could social constructions be for us what “water is for a fish?”

While reading the article “ The Social Construction of Illness: Key Insights and Policy Implications” by P. Conrad and K. K. Barker, a question instantly came to my mind: who would our society, our knowledge and our self be without the presence of social constructions? We communicate, interact and share our ideas. This is the nature of our being and unconsciously leads us as a community to build social constructions. It is interesting to see how the idea of “illness” is seen as a social construction, seen as something “ based on social ideas about what is not “desirable”. I agree with this statement to a certain extent since our today’s society is negatively affecting our self-concept, however isn’t it the nature of a community to be setting certain kinds of standards or ideals to accommodate to? Being healthy for example, could represent an individual’s goal in life, and how could we restrain that individual from feeling unsatisfied if he discovers to have an illness?

I found that the metaphorical quote used, “ The last thing fish would notice is water” perfectly pictures my argument in showing how really it is our cultural background and the life that surrounds us that is naturally nourishing our social constructs. This cultural landscape, our water, is what then shapes our identity and our vision of ourselves, as the example exposed of the deaf community that rejected the principle of cochlear implants refusing to see their illness as a medical condition. We need water to survive. We need social constructs in order to develop as a society. What has to change is the quality of the water we swim in and therefore the nowadays cultural landscape that is oppressing us.

The true value of what for me is granted… No flight back home yet!

Before stepping into this class I thought I finally had clear in my mind who I wanted to be and the reasons of my choice. As I sat down and canalized into the first lecture, I had to start questioning multiple, even too many, of my convictions and also of my morals. Last year I moved to the United States, from Italy, in order to expand my limits and integrate into the American Educational System. Since the beginning of my journey, everything seemed clear in my mind: “America is going to open for you doors that at home, giving the same effort, you will never able to see.” I tried to step aside from the system of my country given the low level of opportunities offered to my generation, given a system of favoritism and underestimation of the new generation’s contribute to the system.

Attending lecture these last weeks, has caused a lot of new dilemmas coming through my mind: have I made the right decision? I always tried to avoid the reality behind the US Health Care system, mainly because I was heading towards its positive advantages wanting to become a physician, and also because I had never personally lived in the United States and never really experienced the reality of the system.

At the beginning I was just feeling disturbed. Every time our professor pronounced the price of a medical procedure, a hospital stay or any other kind of cost that a patient has to go through, I felt angry, almost disgusted. This is mainly because this evidence completely contrasted the complete admiration that I have for this Nation’s work ethic and enthusiasm towards innovation. I was exposed to concepts that conflict entirely with the values that I have been exposed to as I grew up. I have always taken for granted my health care, as all other citizens of my country as also legal and illegal immigrants  in my country.