CLASS ASSIGNMENT

Faculty of Medicine UPH, batch 2014

1. Angelina Pramusinta
2. Chitra Asfrita
3. Devita Widjaja
4. Gita Permatasari
5. Jessica Aprilia
6. Putri Paramitha
7. Reynalda Valyn
8. Yunisa Iren Sinaga

Lecture 1 : The Nine Needs of the Dying

Caring for people who are close to death demands compassion, kindness and a skilled
application of knowledge. “The Nine Needs of the Dying” sets out for care in the last
few days and hours of life, those are;
1. Expressing feeling, means the need to express emotions
2. The overcoming of loneliness
3. The one’s life has been meaningful
4. To find meaning in the present moment
5. To continue to feel useful
6. The need to maintain some control over one’s life
7. The need for consistent message, means the need for honesty
8. Spiritual needs, such as the need for hope and spirituality
9. Letting go

Answering to the first question “which of the above nine needs of the dying do
you feel will be most relevant for you?” is first, to continue to feel useful. The reason
I chose this was because most of the time when someone has been diagnosed with
such as inoperable cancer, people surround you will treat you differently because now
they know you are sick, and the disease weakens your body and limits your ability to
do everything. But in other hand, the fact is that I have the thought that I still have
enough energy in my youth, that it will be nice if I’m treated like a living human
being because I am not dead yet and I know I’m still needed will make me better and
give me back my confident. Although I have a disease that will affect every aspects of
my life, but I want to live the rest of my life filled with good memory like I still have
strength and I can use it to help myself and others, and the thought of not being a
burden others should bear to keep in my mind.
If the diagnosis is for an older person, or for example my mom or dad, the most
difficult nine needs of the dying for them is expressing the feeling. It is their job to
protect and to always be there for their children. Knowing that they have uncured
disease means their life expectancy will shorten, and the possibility to live as long as
they hope to be with their children also reduced. Most of the time parents don’t want
their diseases to be a pain memory and experience to children and the idea of not
always be able for the children is also frighten them, thus they come up with white
lies such as telling their children not to be worried too much and telling them they are
okay. While the most relevant nine needs of the dying for them is spiritual needs,
because from my opinion spirituality is the deep inner essence of who we are it is
related to our soul, spirituality comes from the unique qualities of each individual.
Not only does this provide an opportunity for the individual to grow, find peace,
patience and, hope, but these issues may influence the behavior and decisions of both
the dying person and family members. Serious illness may cause one to reflect on
what it is that really matters in life and can result in changed priorities. At the end of
life, when the physical body becomes frailer, the individual’s inner being can become
stronger as spirituality is awakened.

Lecture 2 : The Six Dramas Lecture

Patients usually display 6 dramas when doctors tell them that his/her cancer is
not curable. There are positive and negative reactions in each drama. Every negative
reaction will lead to another negative reaction in the next drama. If patient display
positive reactions in every drama, he/she will feel peace even when dying.  
First, patient play the drama of shock. They will try to deny the reality of their
cancer disease. The positive reaction in this drama is partial denial. Patients
acknowledge their disease intelectually, but not consciously. They usually do not
express their true feelings and remain calm in order to look strong. The negative side
in this drama is a panic reaction. Patient totally deny the reality and cannot think
clearly. In extreme cases, patient will try to commit suicide.
Next, patient play the drama of emotion. The positive response in this drama is
catharsis, where the patient will not believe what has happened to them, and they will
ask “why me? what did I do wrong?” . If patient keep all their feelings to themselves,
they will develop negative response which is depression. All of the negative thoughts
will gather inside their head and will be resulting a negative mind.
The third drama is the drama of negotiation. After patient ask “why me?” in
the catharsis stage, they try to reasonate with their disease. If they come up with
positive response, they will try to bargain “maybe it’s not me!”, “maybe the doctors
have not try the best”, or “maybe there is a new drug”. It is very normal for patient to
hope for a miracle and negotiate to God or to the doctors or to their close persons.
But, if patient cannot express their feelings and hope, they will swallow the angry and
desperate feelings and eventually selling out their hopes and spiritual faith.
The fourth drama is the drama of cognition. where the positive response is
realistic hope, the patient will accept what will happen to them, they will be as real as
possible to the current situation that she/he is facing. They will ask about the disease
progress and prepare death by asking about their purpose and meaning in life.
However, it could be the other way around, they will feel like there is no hope for
them to live because there is no such thing as miracle. The patient will sink in doom
and hopelessness.
The fifth drama is the drama of commitment. After patient truly accept their
cancer disease and know the possibility that it will make them die, patient  is faced to
the commitment of cancer patient. Patient have to choose whether to accept the
commitment or deny it. If they show positive response and accept it, they will make
effort to fulfil the commitment and use their precious time wisely. But if the patient
have fallen in despair, they see their own life is meaningless and resign from life.
The last drama is completion. If patient displayed positive response in all
previous dramas, patient will likely reach fulfillment drama. Patient is able to embrace
his/her death in peace. In contrast, negative reactions in previous dramas lead patient
to forlornness which is shown as withdrawal and depression. It is the completion of
resignation. Abandoned, forsaken and despairing, the patient forlornly welcomes
death as an end to the living hell which remains.
The six dramas lecture teach us very important lesson for our personal life and
life as a doctor. Every human being may die from cancer disease, thus we can apply
this six dramas knowledge to help our relatives, friend, or even ourselves dealing with
cancer death. We can give them comfort, accompany them, listen to their inner
battles, and support them to find peace. As future doctors, this lecture help us know
better how to treat cancer patient. We can apply this knowledge and assess patient’s
reaction toward their disease, then maybe provide external help if they stuck on
certain negative responses.

Lecture 3 : The Four Tasks of Mourning Lecture

Each person have people they loved, people who share the same happiness and
sadness. Thing to remember, human are not immortal. No one can escape the death.
Include the ones we loved. There will be someday we lost those people who are really
important for us. Although it's not easy, there are four task of mourning we should
learnt.
First , people must accepting the reality of loss, the reality that the dead person
has gone forever. They will not come back and we cannot meet them anymore. We
just can let them go and pray . At the first phase of loss, usually people still sad, cry or
sleep in their room try to flashback all of beautiful memory with them. its being
normal if that condition happen just for a short term like a week until a month, but
becomes denial if it goes on for years . Day by day, people must change, dont stuck,
they must move on , no matter how hard and pain it is. Because the show of life must
go on.
The second one, people must can escape from experience the pain of grief.
Anger, guilt, loneliness, anxiety, and depression are among the feelings and
experiences that are normal during this time. But, there so many ways that people can
do to avoid that painfull feelings, such as being strong, not trying to flash back,
moving away, keeping busy, take a holiday, meet the new person, etc. Moreover,
people also can ask their friend to give them support and consolation. Support from
closest friend or another family really can help reduce that painfull feelings. You just
need to open your heart and mind and tell them what do you need from them in this
hard situation . Usually they will give you grief counselling. One of the aims of this
grief counselling is to help facilitate and accompany people through this difficult
phase so they don’t carry this pain throughout their life .
Third, It’s hard to adjust to an environment after the death of our loved one.
For many wifes who lost their husbands or children who lost their parents, there will
be a big change in their life. A woman who used to has her husband as a head of the
family, now has to take his role. Maybe she used to spend her time at home but now
she has to get a job so she can continue her family life. Same goes to children who
lost their parents. They have to start to learn how to have an independent life without
their parents. It’s hard for the them to develop and fight their fear. But, to have a
better life, they should try to move on.
The last, is withdrawal from emotional energy and reinvest it in other
relationship. This does not necessarily mean finding a new spouse, surrogate mother,
etc. but re-entering new life without memory of deceased loved one. It doesn't mean
you don't love the deceased one anymore, but it simply recognized that you ae not
alone. There are other things and people to be loved and you are capable of loving.
As a doctor, we should have an empathy. We know how hard it is for them to
get use to live without their deceased loved one. Don’t judge them. Give them time.
Until they can arrange their feelings and can accept the reality.

Lecture 4 : The Movie “Wit”

In the last class with Mr. Morris, we watched a movie called Wit. Wit is a 2001
American television movie directed by Mike Nicholas and starring Emma Thompson,
tells the story of Dr. Vivian Bearing’s final weeks of life when she is diagnosed with
metastatic Stage IV ovarian cancer.
In the movie, Dr. Vivian Bearing (Emma Thompson) is a professor and
scholar of seventeenth century poetry. Despite her success, she has lived a life of
isolation. During the movie, she continually breaks the fourth wall by looking into the
camera and expressing her feeling, confessing, reflecting and even bantering to the
viewer behind the lens.
The movie’s opening scene, Dr. Harvey Kelekian diagnosed Professor Bearing
with metastatic stage IV ovarian cancer, and after that, the doctor explained an
experimental research protocol to treat her disease. Dr. Bearing agrees to participate
the experimental reasearch and she suffers through the various effects. After the
diagnosing scene, the movie is introduced to contrasin primary care providers such as
research-minded resident, awkward and the patient-focused nurse Susie Monahan.
The movie also tells a series of flashbacks. The flashback Professors Bearing
returns to her time as an undergraduate being chastised by her professors, Dr. E.M.
Ashford. The scenes described various aspects of clinical evaluations, medical test
and cancer treatment. As she grows increasingly ill, Dr. Bearing agrees to undergo
more test and experimental treatments, even thouh she realized the doctors treating
her less as someone to save. As she nears the end of her life, she regrets her
intensivity and realizes she should have been kinder to more people. At the end she
learns that human compassion is more profound importance than intellectual.
As a group, we all like this movie because this movie is unique and gives us
many good lessons as medical students and future doctors. It tells us a story about a
cancer patient who is not giving up her life just like that. She even agreed to be an
experiment for the doctors, because she knew that eventhough she was diagnosed
with cancer and will be having a hard time, her illness can be a good experiment for
the doctors that will hopefully result in a new light for future cancer cases. But after
that we can see that Vivian is being treated like some kind of an experimental
mannequin. One thing we sure learn from the class and from the movie is that we as
doctors have to treat the patient, not the illness. Eventhough we know that a disease
can not be treated well, eventhough that a patient will die anyway, we still have to
give a patient some kind of hopes. Not a false hope like “No, you will not die, you
will live I promise”. But a hope for them to live the rest of their life happily. To assure
them that it’s okay, to let them do good deeds, do the things they want to do before
they die, do the things that makes them happy.
In the movie, Vivian did not have anyone to come and see her, any family
members or any family. It was just her close teacher in the very end of the movie
before she died. I believe there are probably many patients who don’t want to let
anyone know that they are sick so they don’t want to call them. Or there are probably
many patients who don’t even have any family members left, who don’t have any
friends or relatives to call. That is a part of our job again, as a medical worker at the
hospital to befriend them. No we don’t have to be their best friend or anything but at
least have a good relationship with them, make them feel that someone still care for
them.