Questões de Inglês

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Her husband and two young daughters, 8 and 3, were led away from the bedside as the intubation tray was being opened. Quickly intubated, compressions made obtaining central access more difficult, but I placed an internal jugular line hoping things would go well enough that it might be used for a Swan-Ganz catheter. Compressions, fluids, advanced cardiac life support protocols . . . all the while cardiac tracing into dysrhythmia. Occasionally, the monitor would only stare blankly asystole, across its screen. And the blood pressure. Doses of medication and drips and fluid, nothing would move the blood pressure. She was only 36. I reached deeper into algorithms, knowing the next vial off the code cart would run the answer into her collapsing circulation. The answer that would also push away the pain growing in my own stomach. I believe I tried everything, and trusted each new intervention would be the one. None of it ever changed the course. Doses of medications, drips, compressions, bagged breaths, time, and her heart finally stopped. She was only 36. I silently asked her why. A nurse touched my arm and said the two words whose weight made my next breath difficult and whose grip was tight around the pain in my stomach. “The family”.

They had been taken to the waiting room. It was pale blue and the row of lights indicated the soda machine was still empty. My throat was dry. The youngest daughter sat on Dad’s lap looking at pictures in an outdoors magazine. The older sat watching her hands rest in her lap. Her husband’s eyes lifted to me and met mine. I didn’t, couldn’t, say a word. I took in the breath to begin, and he knew. The words never meant quite enough, “All we could ...” They seemed small, like a string of toy boats against a stormy sea, “... her heart ...” I only had to say them, they would have to live them, “So sorry ...”

(Adaptado de Kevan Pickrel, Empty Pockets. Ann Intern Med. 2003; p. 139-525. Disponível em: http://www.orderofnurses.org.lb/ Modules/Tables/UploadPDF/1070_19,09,YYon%20Being%20a%20Doctor%20full.pdf Acesso em: 1 mar. 2017.)

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Her husband and two young daughters, 8 and 3, were led away from the bedside as the intubation tray was being opened. Quickly intubated, compressions made obtaining central access more difficult, but I placed an internal jugular line hoping things would go well enough that it might be used for a Swan-Ganz catheter. Compressions, fluids, advanced cardiac life support protocols . . . all the while cardiac tracing into dysrhythmia. Occasionally, the monitor would only stare blankly asystole, across its screen. And the blood pressure. Doses of medication and drips and fluid, nothing would move the blood pressure. She was only 36. I reached deeper into algorithms, knowing the next vial off the code cart would run the answer into her collapsing circulation. The answer that would also push away the pain growing in my own stomach. I believe I tried everything, and trusted each new intervention would be the one. None of it ever changed the course. Doses of medications, drips, compressions, bagged breaths, time, and her heart finally stopped. She was only 36. I silently asked her why. A nurse touched my arm and said the two words whose weight made my next breath difficult and whose grip was tight around the pain in my stomach. “The family”.

They had been taken to the waiting room. It was pale blue and the row of lights indicated the soda machine was still empty. My throat was dry. The youngest daughter sat on Dad’s lap looking at pictures in an outdoors magazine. The older sat watching her hands rest in her lap. Her husband’s eyes lifted to me and met mine. I didn’t, couldn’t, say a word. I took in the breath to begin, and he knew. The words never meant quite enough, “All we could ...” They seemed small, like a string of toy boats against a stormy sea, “... her heart ...” I only had to say them, they would have to live them, “So sorry ...”

(Adaptado de Kevan Pickrel, Empty Pockets. Ann Intern Med. 2003; p. 139-525. Disponível em: http://www.orderofnurses.org.lb/ Modules/Tables/UploadPDF/1070_19,09,YYon%20Being%20a%20Doctor%20full.pdf Acesso em: 1 mar. 2017.)

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Mental Illness Recognized as Major Global Issue
Photo: Reuters // Beawiharta

Mental health is now a top priority for the World Health Organization, a group well known for battling infectious, physical diseases.

The WHO* made the announcement at a conference this week in Washington D.C., where government officials, medical professionals and representatives from aid groups are discussing the issue. Mental well-being will now be fully incorporated into the group’s broader goal of promoting health around the world.

In an interview with NPR, the WHO’s Dr. Shekhar Saxena said that depression, anxiety and other mental illnesses are costing the world more than $1 trillion per year.

That’s in line with a study that was recently published in The Lancet Psychiatry. In that same interview, Saxena pointed out that many countries have severely underfunded mental health programs, alluding to places that have a population of 19 million, but only three psychiatrists.

Top photo: A man suffering from mental illness sits chained on a bed in his room inside his family home in Curug Sulanjana village in Serang, Banten province, Indonesia March 23, 2016. In a program launched this year, Indonesia sends teams of workers into often-remote hamlets to help free patients kept in chains and ensure they get the medical treatment they need.

(SIMRIN, Jonathan. Mental Illness Recognized as Major Global Issue. In Seeker. 13 abril 2016. Web 2017. Disponível em: http://www.seeker.com/world-health-organization-mental-health-issue-1727746344.html?utm_source=facebook&utm_medium=dnews social&utm_campaign=blog. Acesso em: 28 mar. 2017.) * NOTA: WHO – sigla para (World Health Organization) em inglês; em português, OMS (Organização Mundial de Saúde).

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Dr. John B. Murphy specializes in geriatrics and family medicine. He teaches and practices medicine in Rhode Island.

Q: As a physician who takes care of elderly people, what’s the difference between taking care of someone who’s quite old and someone who’s not?

DR. MURPHY: There’s lots of differences. The one that always comes to mind first is they have more stories and those stories are important to them. And it’s how I remember my patients. I now focus exclusively on taking care of older patients. But I was originally trained as a family physician before I did my geriatric training. And until just four or five years ago, I still had some children in my practice and many adolescent and middle aged people in my practice, although it was mostly older patients. And but the stories that patients tell me are what distinguishes that population the most. They’ve got richer and a longer history to draw on. It’s much more complex, it’s like taking care of the infants and children that I used to take care of because invariably, there are family members involved of the care. You have the 50 year old who comes into my office for hypertension and diabetes, or whatever, it’s the rare situation where I’m talking to family about that. Maybe the spouse coming in and wanting to know about diet or something. But there’s not that involvement of the family. It’s the rare situation that a patient comes into my office nowadays without a family member. Far more often than not, there’s a daughter or daughter- -in-law who comes in the office with the patient. And, in fact, there are some sons who come in, but I think I’m probably more likely to see the ex-daughter-in-law come in with her ex-mother-in-law than I am to see a son. And there are some sons who are doing superb jobs, but it tends to be the daughters and daughters-in-law who are doing the work.

Q: There must be some medical conditions that are much more serious for the elderly. Can you list off a few of those sorts of things?

DR. MURPHY: Oh, yeah. There’s a balance. I mean, feet are really important, for some people diabetes is important. But feet are what we walk on, and one of the major things that you need to be able to do in caring for older people is to make sure that they’re going to maintain their independence, be able to walk and not fall. Falls, hip fractures, are potentially inter-cranial bleeds, subdural hematomas and things that can occur with those falls, are a major issue. And so preventing falls is a key thing as a geriatrician that one’s thinking about, and feet are a part of it. In hospitalized or bed-bound patients, skin is a key issue. I’ll be making rounds in the hospital with some medical residents and they religiously will listen to the heart and lungs every time they go to see a patient, and if I have an older person who’s admitted for an infection in their leg or urinary tract infection, well I don’t think it’s inappropriate to be listening to the heart and the lungs. It’s very inappropriate to not look at the heels as they’re lying in bed, or their back to look for the early signs of pressure sores. And in fact, far more important to be looking at those things than it is, in that case, to be listening to the heart and lungs. So there are those sorts of issues. It takes longer for one of my patients to get from the waiting room to get to my exam room. It takes more to get them from the chair that I’m speaking to them in to the exam table. Hearing deficits create difficulty in communication. The communication issues for people who have cognitive deficits multiply. And so those complexities in gathering data and implementing plans, I think, make it a little bit comparable to the psychiatric situation where you’re dealing with the whole family. Visual problems, again, a lot of sensory deficits make it much more difficult. And our patients have much less reserve. Three days for anybody in a hospital bed recovering from a pneumonia, you’re going to be tired for a little while after. If you’re doing that at 93, it’s going to take a long time to recover from a brief hospitalization even though the illness, the bacteria is dead, the pneumonia is gone, but the de-conditioning that occurs in just a brief period of time with somebody who’s in their late 80s or 90s is pretty dramatic.

(MURPHY, J. B. Dr. Murphy Interview. 20 set. 2007. Entrevista concedida a Michael Kirk. Disponível em: http://www.pbs.org/wgbh/caringforyourparents/interviews/interview_1.html. Acesso em: 20 jun. 2016.)

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Dr. John B. Murphy specializes in geriatrics and family medicine. He teaches and practices medicine in Rhode Island.

Q: As a physician who takes care of elderly people, what’s the difference between taking care of someone who’s quite old and someone who’s not?

DR. MURPHY: There’s lots of differences. The one that always comes to mind first is they have more stories and those stories are important to them. And it’s how I remember my patients. I now focus exclusively on taking care of older patients. But I was originally trained as a family physician before I did my geriatric training. And until just four or five years ago, I still had some children in my practice and many adolescent and middle aged people in my practice, although it was mostly older patients. And but the stories that patients tell me are what distinguishes that population the most. They’ve got richer and a longer history to draw on. It’s much more complex, it’s like taking care of the infants and children that I used to take care of because invariably, there are family members involved of the care. You have the 50 year old who comes into my office for hypertension and diabetes, or whatever, it’s the rare situation where I’m talking to family about that. Maybe the spouse coming in and wanting to know about diet or something. But there’s not that involvement of the family. It’s the rare situation that a patient comes into my office nowadays without a family member. Far more often than not, there’s a daughter or daughter- -in-law who comes in the office with the patient. And, in fact, there are some sons who come in, but I think I’m probably more likely to see the ex-daughter-in-law come in with her ex-mother-in-law than I am to see a son. And there are some sons who are doing superb jobs, but it tends to be the daughters and daughters-in-law who are doing the work.

Q: There must be some medical conditions that are much more serious for the elderly. Can you list off a few of those sorts of things?

DR. MURPHY: Oh, yeah. There’s a balance. I mean, feet are really important, for some people diabetes is important. But feet are what we walk on, and one of the major things that you need to be able to do in caring for older people is to make sure that they’re going to maintain their independence, be able to walk and not fall. Falls, hip fractures, are potentially inter-cranial bleeds, subdural hematomas and things that can occur with those falls, are a major issue. And so preventing falls is a key thing as a geriatrician that one’s thinking about, and feet are a part of it. In hospitalized or bed-bound patients, skin is a key issue. I’ll be making rounds in the hospital with some medical residents and they religiously will listen to the heart and lungs every time they go to see a patient, and if I have an older person who’s admitted for an infection in their leg or urinary tract infection, well I don’t think it’s inappropriate to be listening to the heart and the lungs. It’s very inappropriate to not look at the heels as they’re lying in bed, or their back to look for the early signs of pressure sores. And in fact, far more important to be looking at those things than it is, in that case, to be listening to the heart and lungs. So there are those sorts of issues. It takes longer for one of my patients to get from the waiting room to get to my exam room. It takes more to get them from the chair that I’m speaking to them in to the exam table. Hearing deficits create difficulty in communication. The communication issues for people who have cognitive deficits multiply. And so those complexities in gathering data and implementing plans, I think, make it a little bit comparable to the psychiatric situation where you’re dealing with the whole family. Visual problems, again, a lot of sensory deficits make it much more difficult. And our patients have much less reserve. Three days for anybody in a hospital bed recovering from a pneumonia, you’re going to be tired for a little while after. If you’re doing that at 93, it’s going to take a long time to recover from a brief hospitalization even though the illness, the bacteria is dead, the pneumonia is gone, but the de-conditioning that occurs in just a brief period of time with somebody who’s in their late 80s or 90s is pretty dramatic.

(MURPHY, J. B. Dr. Murphy Interview. 20 set. 2007. Entrevista concedida a Michael Kirk. Disponível em: http://www.pbs.org/wgbh/caringforyourparents/interviews/interview_1.html. Acesso em: 20 jun. 2016.)

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Dr. John B. Murphy specializes in geriatrics and family medicine. He teaches and practices medicine in Rhode Island.

Q: As a physician who takes care of elderly people, what’s the difference between taking care of someone who’s quite old and someone who’s not?

DR. MURPHY: There’s lots of differences. The one that always comes to mind first is they have more stories and those stories are important to them. And it’s how I remember my patients. I now focus exclusively on taking care of older patients. But I was originally trained as a family physician before I did my geriatric training. And until just four or five years ago, I still had some children in my practice and many adolescent and middle aged people in my practice, although it was mostly older patients. And but the stories that patients tell me are what distinguishes that population the most. They’ve got richer and a longer history to draw on. It’s much more complex, it’s like taking care of the infants and children that I used to take care of because invariably, there are family members involved of the care. You have the 50 year old who comes into my office for hypertension and diabetes, or whatever, it’s the rare situation where I’m talking to family about that. Maybe the spouse coming in and wanting to know about diet or something. But there’s not that involvement of the family. It’s the rare situation that a patient comes into my office nowadays without a family member. Far more often than not, there’s a daughter or daughter- -in-law who comes in the office with the patient. And, in fact, there are some sons who come in, but I think I’m probably more likely to see the ex-daughter-in-law come in with her ex-mother-in-law than I am to see a son. And there are some sons who are doing superb jobs, but it tends to be the daughters and daughters-in-law who are doing the work.

Q: There must be some medical conditions that are much more serious for the elderly. Can you list off a few of those sorts of things?

DR. MURPHY: Oh, yeah. There’s a balance. I mean, feet are really important, for some people diabetes is important. But feet are what we walk on, and one of the major things that you need to be able to do in caring for older people is to make sure that they’re going to maintain their independence, be able to walk and not fall. Falls, hip fractures, are potentially inter-cranial bleeds, subdural hematomas and things that can occur with those falls, are a major issue. And so preventing falls is a key thing as a geriatrician that one’s thinking about, and feet are a part of it. In hospitalized or bed-bound patients, skin is a key issue. I’ll be making rounds in the hospital with some medical residents and they religiously will listen to the heart and lungs every time they go to see a patient, and if I have an older person who’s admitted for an infection in their leg or urinary tract infection, well I don’t think it’s inappropriate to be listening to the heart and the lungs. It’s very inappropriate to not look at the heels as they’re lying in bed, or their back to look for the early signs of pressure sores. And in fact, far more important to be looking at those things than it is, in that case, to be listening to the heart and lungs. So there are those sorts of issues. It takes longer for one of my patients to get from the waiting room to get to my exam room. It takes more to get them from the chair that I’m speaking to them in to the exam table. Hearing deficits create difficulty in communication. The communication issues for people who have cognitive deficits multiply. And so those complexities in gathering data and implementing plans, I think, make it a little bit comparable to the psychiatric situation where you’re dealing with the whole family. Visual problems, again, a lot of sensory deficits make it much more difficult. And our patients have much less reserve. Three days for anybody in a hospital bed recovering from a pneumonia, you’re going to be tired for a little while after. If you’re doing that at 93, it’s going to take a long time to recover from a brief hospitalization even though the illness, the bacteria is dead, the pneumonia is gone, but the de-conditioning that occurs in just a brief period of time with somebody who’s in their late 80s or 90s is pretty dramatic.

(MURPHY, J. B. Dr. Murphy Interview. 20 set. 2007. Entrevista concedida a Michael Kirk. Disponível em: http://www.pbs.org/wgbh/caringforyourparents/interviews/interview_1.html. Acesso em: 20 jun. 2016.)