Medical Humanities:

How Cultural Representation Affects Outcomes

Physician’s Perspective

Patient Perspective

What Role does Representation Play in This Process?

• Does it affect the value we assign to bodies?• Does it predispose us to work harder for some

individuals and not as hard for others?• Does it prejudice us in ways that can be either

helpful or harmful to those with whom we interact?

Does it also impact how we come to view ourselves when we are ill ?

Cultural Construction of Breast Cancer

What dominates the visuals?

Visuals

What dominates the texts?

Quotes from Stage 4 Patients

• “I feel like I did not fight hard enough. That the recurrence is my fault for not doing more.”

• “I feel like I did this to myself. Other women have beaten cancer. The pink ribbon campaign shows that year after year. What did I do wrong? What more should I be doing to beat this?”

• Pink Ribbon Inc.

How Patients come to see themselves as a result of how they are represented

• http://www.bing.com/videos/search?q=pink+ribbon+incorporated+film+with+stage+four+women+scene&qpvt=pink+ribbon+incorporated+film+with+stage+four+women+scene&FORM=VDRE#view=detail&mid=87B99D14BEEB4220DB7D87B99D14BEEB4220DB7D

Aging

S O R R'(,

W H E N I R EA LIZ£D I FO R G O T YO UR

BIRTHDAY I Said the S word…

G

Geezerphobia \ ge-zer-fo-be-a \ -n. a completely Irational fear of birthdays.

Be Afraid

Be Very Afraid...

I heard you And your teeth

Don’t sleep togetherAnymore!

Happy Birthday Anyway!

The down hill marathon

Happy Birthday!!!!!!!!!!!

Just don’t let your brains fall out!

Happy Birthday!!!!!!!!!!

It’s your birthday and I know a little something I couldhook you up with…

A Life Support System.

Happy Birthday!!!!!!!!!!!

For your Birthday

I want toCome up to your roomTake off all of your clothes

And

put you in an outfit that Finally matches!!!!!!!

Happy Birthday!!!!!!!!

Alzheimer’s

• http://youtu.be/oXxoqxqAUj8

• http://youtu.be/IaB5Egej0TQ

Congenitally Joined Twins

Discussion of Siamese Twins, documentary by Jonathan Palfreman

Essay by David Clark and Catherine Myser, “Being Humaned: Medical Documentaries And the Hyperrealization of Conjoined Twins”

How this issue is framed

• Who are the stars?• Who are in secondary or supporting roles?• How do you recognize issues of status?• Are there exclusions to this narrative that

should be addressed?

Film depiction

• Point of origin: orphanage, poor family in India• Emphasis throughout on challenges and

superiority of western medicine• Underscores inferiority of medical practice in

developing (Third World) cultures• Evidence of success involves separation and

assimilation into Western society• Less emphasis on ethical questions and more on

problem solving

Another medical documentary which mediates a similar experience

• http://www.pbs.org/wgbh/nova/body/separating-twins.html

Representations of Bodies

• What meanings do you project onto these bodies?

• What assumptions do you draw about the people who present with these kinds of bodies?

Homeless

Obese

Anorectic Women

Anorexia

• http://www.bing.com/images/search?q=Pro+Ana+Quotes&Form=IQFRDR

Inspirational Materials from the Pro-Ana website

Maladaptive perception

Katrina Project: Application of Writing Meaning Onto Bodies

• "To save as many lives as possible while adhering to an ethical framework. To do everything possible to save each and every life."

•

The Circumstances• # of patients exceed the capacity of the medical system in place to care

for them• All of the patients left at Memorial are the ones with critical needs for

dialysis, oxygen, round the clock monitoring, not to mention clean beds, food, and fresh water.

• Machines depend on electricity to drive them; during the storm, all electricity shuts down, which means

• Oxygen delivery systems shut down• Drips, which regulate such things as heartbeat and blood

pressure, and run on electric motors, cannot function properly• Hospital relies on generators, but water rushing into the basement

where the generators are housed means many of these are damaged• It is very hot, which means blood supplies which are normally frozen are

compromised in the heat• Heat stresses patients and slows the recuperation process

The Patients and the Dilemma

• The decisions of who should be saved and in what order is one that has to be written on the spot, under conditions no hospital policy could ever anticipate. Questions arise as to whom to save:

• the sickest • the ones with the greatest chance to survive• the younger (middle aged and under) patients• those with the greatest social worth

Unpacking Meaning to Free Up Action

• How do you "unpack" those terms? What does greatest chance to survive mean? Is it the same for everyone? What do you mean by social worth? Does education enter into the equation here? Does money?

• What data do you use to identify populations with a greater likelihood of recovery and what problems might you encounter with this research?

• data on recovery rates of African American patients is complicated by quality of care they can access and the point at which they seek it out

• AND HERE'S YOUR CHALLENGE: THERE ARE FIVE OUTLETS FOR ONE GENERATOR AND in this exercise SIX ACUTELY SICK PATIENTS WHO DEPEND ON RESOURCES THAT ARE FUELED BY THIS GENERATOR. WHO WILL YOU CHOOSE AND WHAT WILL DRIVE YOUR CHOICES?

•

Jeremy• Twenty eight years old• Computer repair technician, currently unemployed because of a

glutted market• No children, but after many years of desperately trying to

conceive, his wife is currently expecting • Diagnosed with failing kidneys• Has been undergoing daily dialysis for two weeks now, but the

extent of his condition is such that even though acute, there is a chance of improvement with use of dialysis for a short time

• Occasional smoker, with a string of youthful misdemeanors• Overcame serious addition to drugs and alcohol as a teenager• Active in his Pentecostal church

Ali• Fifty something married grandmother and mother of one child• Currently acting as guardian of two young (three and five yrs.old)

grandkids while her daughter undergoes another run at drug rehab treatment (her fourth)

• Works 30 hours per week on second shift at Chucky Cheese as part of the clean-up crew

• Husband is on disability • Lives in an aging trailer park • Smokes two packs of cigarettes a day, self medication to deal with

unremitting stresses in her life• Currently recovering from heart surgery to correct an aortic aneurism• Since the surgery has occurred in the past 48 hours, the patient needs

careful monitoring

Emily• Thirty something• Hard working teacher and mother of three young children, ages 13 to

two years • Happily married; husband is engineer with a good job• Injured in serious car accident • Accident was caused by dwi driver• Right leg and right arm were broken and require that she be in traction

for significant period (six weeks)• A newspaper story reveals her husband is visiting a remote area of

Kenya as part of an investigation into clinical trials conducted on Gikuyu tribe

• Recently voided her previous medical directive and was in process of rewriting it when this medical event occurred

Katherine• Much loved grandmother of 23• 97 years old• Diagnosed with terminal cancer• Specific time remaining for her is uncertain• Cheerful, helpful; she is seen by the staff as the First Lady in

the ward; everyone loves her• Closely connected with her family, she asks—and they agree--

that everything should be done to keep her alive• Katherine’s nine children all work at low paying jobs and have

families of their own• She is a widow who lives on disability

Stacey• Thirty years old• A life long political activist dedicated to eradicating poverty in the world• Lives modest lifestyle: one room in a rooming house, simple meals shared with

the food pantry he works at • Has no history of drug or alcohol use• Had three years of college training in a Jesuit Seminary• Currently diagnosed with fast spreading cancer, which, if treated with a regimen

of rather costly drugs, can extend his life out by several decades• Given the competition for scarce resources, Stacey offers to give up his bed and to

gut his way through the pain without drugs or any other resources• He says he is ready and eager to end his journey on earth and to meet his maker • His prognosis without treatment is limited to a week at best, however his modest

lifestyle--he eats mostly vegetables and little meat--does put his survival rate at above the average

Kelly• Middle aged forty something• Lawyer married to another lawyer • Very affluent couple, with multiple homes• Give back a lot to the community; extensive pro bono work

in addition to executive roles in two charities • No children or immediate relatives• Has long history of successfully arguing—along with her

husband-- for clients in malpractice suits• TSI, transient ischemic stroke, has since caused subsequent

stroking, resulting in partial paralysis of right side of body• She seems very confused and uncertain and currently cannot

communicate her wishes or desires

Thanks for coming!

• No answers, just questions. • Let’s continue• the conversation!