Session 7 - Lecture 1 - Women's Health Flashcards
2 - Describe the first stage of grief.
Shock: Life at an Abrupt Stop
[Image of lady standing at the cliff edge]
Female recounts the experience when she was first diagnosed with breast cancer. Patient had found a lump and was under the belief that everything was fine, until after the 3rd check up when she was taken to many specialists and the doctor informed her she had breast cancer.
This is when the first stage of grief kicked in - the patient experienced SHOCK. She said that it had felt like “a rug had been pulled from underneath [her]” - life suddenly doesn’t follow the path you’d expect it to follow. All she was thinking is will I be able to see my daughter’s 21st, graduation, wedding etc. Suddenly, everything the patient initially believed before suddenly changes.
It is during this stage that nothing (or hardly anything) the healthcare professionals say to them will be registered. As soon as the word ‘cancer’ hits, that’s all they can think about. She was told some more information at the time but none of it registered, she vaguely remembers being told she was going for an MRI the following Monday.
After the appointment, her partner, who was currently away on business, called (who had previously offered to come with her to the appointment but she was so firm in her belief that it would be nothing that she declined). She told him what they had said and he told her - “don’t drive”. This advice was also given by the doctors - as the shock from the news means you won’t be able to remember anything/can’t concentrate on the road. The patient stated she did indeed drive home, because “of course, that’s just what you do”, but she recalls that she cannot remember any of the journey home and getting home.
3 - Describe the second stage of grief.
Denial … or Unrealistic Optimism?
[Don’t ever give up hope girl! It will all work out!]
The patient went home and discussed her diagnosis with friends, family and neighbours. One particular neighbour stood out to her because they had said she was being “overly positive” about the diagnosis. To her, she felt that if anything, this was a good thing, because she believed that having a positive mental attitude would help (positive mind, positive body). So it was a bit like knocking someone when they’re down for something supposedly good? But what the friend perhaps recognised, although possibly she may not have done so with such an astute definition in mind, was that she was going through the second stage of grief - DENIAL. What this meant was that the patient hadn’t fully come to terms with what the condition truly meant, and thus she was in denial of how it would impact her - manifesting as ‘unrealistic optimism’.
4 - Describe the third stage of grief.
Anger: expressed as Blame
[THIS MUST BE MY FAULT!.. GUILT]
Once the diagnosis has start to sunk in a little bit, the feelings of shock and denial start to fade and anger comes in.
Although the patient may have felt angry at her neighbour for verbalising that she had been “too positive” in her outlook, the next stage of grief is anger and that is mainly at the patient themselves.
The patient starts to question, “AM I being too positive, too rosy?” and starts to blame themselves for not taking better care of themselves previously - “was it my lifestyle? I do have a very stressful job, so maybe I brought it on myself …” “did I overindulge on the alcohol? Maybe one too many glasses of wine, that extra gin and tonic here and there …” The patient becomes angry, and sadly, this manifests as blame, where the patient blames themselves that they are at fault for this unforeseeable event. It sometimes may manifest to blame at others, but this is more likely to be a secondary effect of the denial stage, such as in the example above - where she was angry at her neighbour for stating that she was being “too positive” in her outlook.
4 - Describe the fourth stage of grief.
Hope
[Image of a women ‘drawing a line’ between two cliffs]
This is the stage which really gets your patient better. They start to have hope in the world again and their lives.
Some patients will have protective factors for the patient hope, such as children, which gives them hope they will get better to see their children grow up. Often, patients find a ‘hobby’ or a goal that gives them a purpose, for example, starting up a business. This changes the patients’ way of thinking and their priorities alter to match this.
But what really gives the patient hope, is the holistic care from their doctors, team and other healthcare professionals. In this case, where the patient was diagnosed with breast cancer, what gave her hope was the surgeon she sought out that was going to reconstruct her breast for her. It wasn’t just that it was physically and technically demanding and succeeded in doing so, but because the professor listened to the patient, and understood why she wanted this particular treatment. It wasn’t just a case of taking the tumour out so she was no longer sick, it was about getting her back to where she was before and living her life (as best as) how it was before, where she can still enjoy the things that gave her that hope initially (having her daughter grow up and be happy). In short, the doctor treated her holistically. Holistic care gave the patient hope. Hope gave the patient their life.
(A note: The physical experience she went through by the surgeon, Professor Dixon, was reconstruction involving him (a breast surgeon) and a plastic/cosmetic surgeon. One women, 6 hours, 2 surgeons, 2 surgical teams. That is very expensive. Professor Dixon had to firstly, not only have to work out the technical ability of putting an implant in when he had just removed a tumour - a procedure that is not normally done, because there is risk that the tumour is going to be hidden by the implant - he had to be certain this would not happen, and understanding the histology behind this and the potential for an implant to benefit, not just this case, but in multiple populations of breast cancer patients, where an implant would be a beneficial direction of treatment to the patient. But THEN, he had to convince, not the plastic surgeons, not just to do it, but to reschedule their whole work arrangements so that they could all operate at the same time, the medical teams, the medical directors for the expenses of the surgery. This is systems. Systems thinking, what allowed the teams to work together, is what the surgeon demonstrated.
A note about chemotherapy: chemotherapy, to put it mildly, is not nice. It is quite possibly one of the most horrific things someone might ever have to endure in their life. “It is not something I would wish on anybody, even my worst enemy,” is what our cancer survivor said. “It feels like the worst hangover you’ve ever had. For 48 hours. 6 times. It was horrible.” She said that you never got a break, in between treatments all you’re doing is desperately trying not to get poorly or in contact with anyone that can make it worse. But each time, it does get worse. When asked about her worst symptom, the patient simply just said it was just the “[vomiting] out of every orifice. Repeat.” But eventually I got through. And I got through through hope.)
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7 - Describe where healthcare professionals come into the Kubler-Ross Change Curve
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