Oź FGFD ź NGI.

ISH FOR C,4REEFS

Student’s Book

NIVBRSITY PEESS
Contents
It’s myjob / Patient care/ Project Listening Reading Speaking Language spot Vocabulary Pronunciation
Body blts Signs and
symptoms
1 ?he hospital team p.4
!NurSingintheUK Ta!k ng per‹cnally Prof.Ie afa student ve.lbs for
nurse descr1h.ngjcbs

2 In .a nd around the hospital p.10

William O Neill Wheelchairs On the ward Giv1 ng clime tons Preposit'onsof Pssgital Where is the
— head porter v!a cmail placeeld departments stress7
movement

3 Hospital admissions p"6

Carmen Dornañ A g-‹tient record Bad handwriting Admitting z .atensummary Past Simple v Past D tion{ erord
— hospital pati*n* Continuou s
4 re:eptiooist
Accidents and emergencies p.22
Jeff Olive•— Shock Instructions A surprise Emergency Infnrmatlon poster lnstr actions Fi st aid
paramedic passenger helpline
S Pain p. 28
A*easofreferfed Que2lonsto Pain Describing pain is:/, /,a/. /•v
pan asesspMn

6 Symptoms p.34
Sandy McGuire - Night cough Ing kesearch1ng
helpline nurse symptoms Symptoms Mvstery Asking questions Symptom report Questlon forms
A helpline cal, syndromes on a ne!pl’ne
”ongue diagnosis
7 Caring for the elderly p.40
The effects of AI7he'mer’s A care home OI:J age and the Transfe° to a care Letter of will Piohlems and adds
ageing disease Assessing a pat’ent b* ill home intraouc-on to a
are home
8 Nutrition and obesity p.46
Nutrition ltam ns and A diabetic patient Eat yourself to Calculating BMI Advice to a friend should ’shoulan’t Diabetes
minerals death via email
An eating disorder
Food Intake
fleadlng bank p.s2
1 Pet vislt› 5 Chran ic pair. 8 C ÙOCOlôt ^ 11 Typhoid Mary 14 The return of Thalidomide
2 ,Vlobile veJlca unité 6 Improving patient care 12 Myths and facts 1S The be5t medicine f
-lospital error 7 Secrets ofa long life 10 Death and dying custom s 13 Anaesthesia Reading bank key p. 67
4 accidents in tñe hnme
9 Blood p.68
The henrt
Forensi- anaIy,!s B ood ypes 81o3J g8Hem BI0o¢l in h i$tD Describiñg blood Zerc anô First Te<ting blood
A blood test ans ly$\s Making difficuit cr'.Ils Conditianal
decisioos
10 Death and dying ç.74
The body after Breaking bad news eepon ofa d°ath Thr Hope Preparing a body Death certificats
death txpiessiq 8 TaIking abcut
Children › Hcsplce for relatives dying
EuthanaQe
11 Hygiene p.gO
Hsrt'iet Banks- MRSS A hygiène Hygiène
Ahygienelepol A5fthenurse- NOtiC£ Talking z bout
b inpedion obligation
Testresults
12 IVlental health nursing p.86
'uIiet Francisco - Tourette syndrome Famaus p=opIe A case conference CCII iZGÇhFE niB A patient’s Ille cmail job O:esentPeŒec Mental illness Stress Patterns
mental health s uffering'from -th.°.. facts history Implication
nurse mental illness
13 Monitorlng the patient ; 92
Takip g read.'ngs A coma patient General Vital signs D•scribing a Th.°. Pa ssive Describing Taking readings
Hypotne mia naesthetic Anaesthetic procède e rC3dings
A stan
procdue
J4 Medicat\on p.98
Dosages Patl.°nz medication Pandemics and P tientmeö+czton Whiting up an be poing to v Typs and Noms
Tamiflu exper:•ment Fresent of medkaion
Cnntinuous for
future
15 Alternative treat ments p.T04
Mind and body Medicina! plarrts Wild treatments Two healer5 Advice to a friend Giving reasons Types af therapy
therapies vin email

Speaklng actlvlties p i.0 Grammar reference p.1î6 Listening strlpts p.125 Glossary p.132
4 Unit J

Scrub up
Work with a partner tomatch each job with a person in
the picture.
13 anaesthetist pharmacist
cardiologist physiothempist
consultant porter
lab technician radiologist
midwife receptionist
paediatrician scrut nurse
paramedic surgeon
Match each phonetic spelling to one of the jobs.
Try to say them with your partner.
u /‘ski ab fl3:s/ e /,ieidi‘ulodgisL/
b /ri'sepJanisl/ 12 f /kan'saliant/
c /‘sa:dren/ g /o'ni:x£lotist/
d /, fiziau'0eropist/ . _ . h /,pi:dia'ti ion/

Listen and repeat. How is stress mmked in phonetic

spelling?

Listening 1
An admission
Mrs Benson is admitted to hospital Listen to the
five short conversations, and decide who is speaking to
her in ench one. Write 1-S.
a a recepfionist d a sister
b a consultant e a radiologist
c a paramedic
Listen again and decide if these sentences are
true
(T) or false(F). Vocabulary
1 Mrs Benson has had alalL. Verbs for describingjobs
2 This is not/vIrs Benson's first x-lay.
Complete these descriptions of jobs with the verbs
3 Mrs Benson can’t find the toilet. below, and match each one with a job from Scmb up.
4 She has a heart problem.
moves performs specializes
S The consultant sends her home. gives examines prepares
6 Mrs Benson’s appointment is next week. supports ta'kes
delivers
 The hospital team 5

In this unit
O hospitaljobs
a describing what people in a hospital do
O describing routines and current activities
bthe nursing profession

1 A paediatrician ireo Is children.

6 A surgeons in the
2 A attends births and operating theatre.
babies.
7 A medicines to give to
3 A in illnesses of the heart medical staff or patents.
and blood vessels.
8 A responds toemergencies and
4 A equipment, furniture, first aid.
patients, etc, around the hospital. 9 A operations.
S A x-rays and other images. 10 A samples and tissues
under a rrucroscope.
Unit 1

Listening 2 e Language spot

Ajob interview
Present Simple v Present Continuous
Before you listen, answer the questions.
We use the Present Simple 1.o talk ahout routines,
How do you feel about interviews? Are you good duties, and things that happen all the time.
at them? f prepare the instruments for surgery orid help wi’th
When was your last interview? What was it for? the operations.
How did it go? A midwife delivers babies.
Look at the listening script of Rachel’s interview on
p.125, and underline all examples of the Present SimpJe.
\/\fe use the Present Continuous to talk about
things we are doing at the moment, or things that
are happening now.
At the momen I I’m doing a part-lime course.
Look at the listening script of Rachel's interview, and
circle all examples of the Present Continuous.
We can use ccrtnin vcrbs in the Present Simple
(for example like) with an -ing form.
I like watchiriq operotions.
Some verbs, such as like, worit, Snow, etc , are not used
Listen to Pachel having a job interview, and answer in the Present Continuous.
the questions. I file my word ot the moment!
dere is Rachel working now?
2 wNch pan of the hospital does she work in?
The Present Continuous is also used to talk about
3 by is she looking for a new job?
future schedules (see Unit 14)
Corr iplete tÏ ie 3ei tiet ice3 uiiiig l)ie vvoi’ds belovr. I’m working nighls ne›rt weekend
Then listen again and check » G tu Gzarnmaz reference {› \16
applying for features night shift lead this student nurse’s email home to her friend. Choose the corr
fully-qualified part-time rewarding complete it.
Are you a scrub nurse?
2
At t.he moment lam doing a course and
work ing at the same hme.
3
It’s hard, especinlly when I’rn working a
and going to next day
4
... it's the contact with the patients that’g most

S Why are you üflCVUjUÜ}


Hi lvana
I/ ‘m wrrfinq' to say thank you for the birthday card, and to tell you how I get on / ’m getting on’. l’cJ
On fhe geriatric word I m moking /moke’ beds and checking
/ r£erV patirnls'blood pressure and temperature. I in
learning /Ieci‘i›* a lot, •nJ \he experience is very useful.
I ’m going out /go out' most Saturday nights, but stay in and study on other days. tomorrow iyo/ myo/ng"to a restaurant for my birthd
love
Maria Carmen
" Profile of a student nurse
2 Choose three jobs from Scrub up. Write a sentence to
describe what the person does,and a sentence to describe
what the person is doing in the picture on p.4 and p. S.
Then read you sentences to your partner.They must
name thejob.
A he moves potients from one port of the hospital Io
another In I he pit ure. he’s pushing a trolley.
B Is it o f›oner?
A Ves.
Speaking
Work in pairs. Take turns to choose one of the sentence
heads in the box for your partner to talk about. Ask
questions to make them talk as much as possible, arid
note down the main information. Keep going unfi you
have both used all the sentence heads.
A One day, I hojse to work ‹n gnqfher county.
B Peals? Where?
The hospital team
A Maybe Australia.
B Why dpyou wont to worh in Australia!
A It’s on interesting place and nurse’syoy is nol boil!
B /Yow such...
I’VC WOf # '/ . . .
I'velike
course is hard
to 'von . . work, but I ’m enjoying /
I i i nay free time, I . . .
I really e isjoy
I'i i i s Iu L)yI r i @ . . . I ‹cally ‹lori’t like . . .
I’m goocl at
Nt’xt year, I
Read this profile of a student nurse. Do you have
anything in common with her?
llossitza Bontchcva is nineteeri years old. She‘s
studying too a diploma in nursing at Vazov Nursing
CoI lege. She has exams next rr.onth, so at the
rrioment she’s Studying hard. She wants to be a nurse
because she likes working with F•• ple rind £he's
interested in
science, but she really doesn’t like doing paperwork.
She'd like to be a paediatric iiuise because she really
en)oys working with children. She's worked on a
children's warrl f‹‘ir I hree months as a work placement,
One day, she hopes to work in a children‘s hospital in
India, which she saw on television.
She’s goud at talking to people and making them feel
com.fortahIe, : nrl she’s wry organized. In her See time
she plays the guitar, and goes out dancing most
weekends.
2 Write, a te›r1 ment your po rtner, using the information
you got in S peaking.
 8

Norer›ze Nlgfitb›gaIa(1820—1910) was the founderof

modern nursing.ShedramaticaIly improved conditions
for soldiers in field hospitals, and educated peoplc about
the importance ofhygiene.She saved thousands oflives
and bccame very famous.She later started her own
trainingcollege fbr nurses, and wrote many books on
nursing.

Reading I Number these jobs from the highest grade(1) to

the lowest (4). Two of them are equal.
Read the article and decide if these sentences are true
(T) or false(E). a charge nurse
1 The more responsibility you have, the higher b nursing officer
your grade. c auxiliary nurse
2 Nursing officers are the same as auxiliary nurses. d sister
3 Students are paid less than auxiliary nurses. e staff nurse
4 A charge nurse is a man.
S There are not many opportunities for British nurses
to specialize.
6 Many nurses say that the job is rewarding. but
the pay islow.

zuzpaid, uYttYiâfllcd,
but
ntmñog iok•a{›rofessio1›. The- mrtIz‹•ds
carrer Cth a three- nr four-mar tr-mining,
grude dtptnds rim e4q›erieiice and ckills,
and each grade W different
respr osibilities and Joy. On the boii‹sii
gradrs are unqualified an.xilinry nurscx
who do th routine xsork on hospital
wnrds. O›t the topgmdes an' tuusii g (iirll+erstu‹Jy rind liccornc spueiisl
oBicccs, who are usually adtriinistratozs. Nurses can specialize in marry cliffercnt
hrkts time arc tringc nurses working in
Auxiliary t cu'scs nzY'ott the bounty
Camiult); arid psy•cliiatrit nurses svlic› tnmi.
grades, butaaidcrit nurses gci the l‹rwvst
tbr inciiinlly ill. There are llcnldi visitors
pay: H‹nsmer, signsdon’t stay ai the
bottom of tlir pay serie forcvw4Yhen xvlio visil patients in dieir osvu hornes,
‹I•••y qu«tify, thcyuan ‹vnzkiay nna
•«iñdlc x*dc. As they get mper et>ce,
cl oy rar› gec promufiott and rrtovc ftp dye 8'L ny of lu sny they do not get cuntigli
rnnLs tu liccunie siaff nurse, then aétcr Jiay arKl respect f‹ir the svurk tile)' d‹r.
a n au), aixt perka§s "lTieysay tlint the wnrk is pliyzirally mid
mentally haril, thai. thex• svork long fronts
Maay nurses work slzilis. a»t1 ultcn tlwy
heir traittiog, t1›any nui'sc“s chuosc to dt›
 The hospital team

Checklist
Assess your progress in this un-rt.Mick (W) the
statements which are true.
I can name and describe hospitaljobs
I can talk about duties and regular activities
I can describe what is happening at the
Find words in the article with these meanings. moment with these meanings.
1 exams and courses that you have tâken I can understand an article about nursing
I can talk about my work and training
2 money that you will receive when you are old

3 similar work that you hnve done before

e Key words
4 special abilities Work and training
s apply for a job
S levels of pay fully—qualified
P s lecture
6 extra hours you can work to earn more money night shift
part-time
promotion
7 study and practice to learn how to do a job
qualifications
b c rank
8 more advanced learnt ng responsibility
, ¡„
specialize
Project Jobs
auxiliary nurse
1 Goonline and try to find the answers to the questions.
consultant
1 Whnt is the NHS? nursing officer
2 that's the starting salary for a qualified nurse physiotherapist
in the UK?
3 How much nnnua) leave does a grade B nurse get? Look back through this unit. Find five more
4 How many hours a week does a nurse work? words or expressions that you think are useful
s \n/hat Enghsh language exam do you need to piss to
work in the UK?
6 What grades can a staff no rse be?
7 What is the salary range for a staff nurse in the UK?
8 Semch the word‘nursing' at the bookstore
wwvr.amazon.co.wk. What's the first book that
comes up?
Find a site thnt advertises nursing jobs. Find a job that
would interest you in the fiiture and find these details
if possible.
job title Salary and benefits
grade qualifications and expefience
location how to apply
duties closing dnte for applications
In the next clnss, compare your answers.
10

V\/otk with a partner Look at these pieces of equipment Do you know, or can you guess, what they are:for?

I fhinA this one is/or meosunng n/›afient‘s Pearl rate.

Or mnybe it’s/or monitoring brnin cictivity.

Vocabulary
Hospital departments
¡
Wh Ich of lhe departments nltown opposite
1 dispenses medicines› e
2 treats kidney diseases? ,
3 specializes in pregnancy and birth? i
I
S heats diseases of the skin?
6 performs opeiabons on patients?
7 designs special exercises for patients?
8 studies blood disorders? i
9 treats bones? Dermatology j
10 specializes in the heart?
11 deals with sick children? Haematology
12 treats disorders of the nervous system! Obstetrics ,
2 batch each department to one oilhe pieces of Surgery ,
equipment in fcrub up
 In and around the hospital

In this unit
e describing what different hospital departments do
e giving directions in a hospital
e prepositions of place and of movement
e describing where things are

Pronunciation Complete the sentences with the prepositions below.

at by in next to rin outside over under
Where is the stress?
1 The toilets area the ground floor,
1 Match each of t,he words below to a stress pattern. reception.
1 Cardiology 2 I always keep a pen _ . my pocket,
2 Pharmacy 3 Press the button ynI›r Hed if you neetl
3 Gynaecology the nurse.

4 Neurology a •e•O•• 4 I'll put your bag yOUI @€‘@, OUt OF

S Obstetrics the way.
b oe••
5 The restaurant’s the top of the
6 Orthopaedics c M•• building so take the lift!
7 Paediatrics --— d ecGee 6 Reception is _ the main entrance,
8 Pathology e •M•a the left.
9 Dermatology 7 See that door over there? The car park is just
f ••G•
10 Physiotherapy
8 He's Ward 3, the end of this
11 Renal Unit corridor.
12 Surgery
Underline the correct prepositions in these sentences.
Z Listen and check, then listen again and repeat. I Walk throuqh / neor reception, and take the lift to I
of / in the third floor
3 Work in small groups. Tell the group what department
you would like to work in, V\fhich ones would you not 2 Goaround I along / past this corridor, and it’s the
like to work in? third door or / nt the left.
3 If you goport / through / behind the swing doors,
you'll see the waiting room
e Language spot 4 The toilets are at the bottom o / over the stairs.
Prepositions of place and movement S Physiotherapy is in front of/opporitethis
To describe the place where something is, we use department, so just go across I out o/the corfidor.
prepositions such as in, or, on top of, ct the top 1 hot 6 Gopost / down the restaurant, take the stairs upto I
tom o/ inside / outside, near, next to.by. in front along I on the second floor, and the ward is out off
of,behind, oppos/te, under, over, at,on the lefl 9ht . o Site the1ift.
Th# shops near the entrance, on the riqhf oyrecepl ion.
Choose five prepositions, and write five sentences with
The toilets are at the bottom of the stairs, on fire left.
them about the building you are in now
To talk about movement, we use prepositions such as
up. down, into, out of, away, from, to, through, across, Cardiology is on the first floor, ileM to Neurology
atono.past, bnc# to, around, leftl right.
to through the swing doors. fern left atong the corridor,
and Use mffee bar’s in front of you. Speaking
Prepositions of movement are used with verbs of Work in pairs. Student A go to p.J4. Student B goto
movement such as go, come, take,push, carry. p.J12.
Can you take there/les bacle Io the once, please?
To get from here to surgery. you hnve to wheel the
trolley through three wards
IZ Unit 2

Listening 1 4 Work in pairs. Study the picture on p. 4 and p.S for one
minute, then Student B closes the book. Student A asks
Directions for directions from reception, and B tr ies to give them
I Listen to these people giving directions. Look at the " O‘" €•'- 'y
picture on p, 4 and p.S at the same time. Match each i xAMPiE
dialogue with a prelude. A How do you get from Physiotherapy to Su rqery?
1 g y B ?ou go o/ony the com for, and

Writing
Giving directions via email
I Use the map and complete the spaces in the emaiL

Dear Mr Keane
Here are the directions you ›'sked for from the rails 6y sfafieo to th
L rave the railway station ai lhe main entrance. Turn
' and walk along Sfetion Streel for aboul 100 metres Go° the road f0

>b

2 Dsten again. Where is the person gnring

directions to?
0 _ 2 3 Alicia Marcos
3 Try to fill in the missing words. Thenljsten again
45 BUS STOP
O
out of here and the door you wont is
just opposite. 4 S BUS STOP
2 Soifs outside ?
STAT ION STIt tET
3 Go . the hospital . these
swing doors.
4 the first right, and it’s the second door

S . take the second left and go along that 2

l/Vrite an email giving a friend directions to where you
corridor. work or study from the bus or railway staVon.
 In and around the hospital

It’s my job 3 Try to remember the verbs in the text about William
1 Before you read, make a list with a partner of the things o'Neill and complete these sentences.
you think a hospital porter does. Read about William 1 We I patients by wheelchair or
O’Neill does he mention any of the same things as stretcher . .
Y° 2 be 1 andc.. heavy
equipment . .
3 .. and we d of all the waste
William O’Neill 4 We c it each day and t it
away for recycling.
I’m the Head Porter iii this hospital. What do I do? Well, S Each hospital bed p 4.5 kilos of waste
1 run the place. every day
Porters do more than just push food trolleys around the 6 be d the posl .. . and b
hospital. We transport patients by wk.ee1chaii or letters for patients ...
stretcher from the warrls t‹› 8atliology or Physiotherapy
and back again. We ieiiiove dead booties to the 4 Now read the text again and check your answers.
mortuary, we lift and carry heavy equipment and
furniture, and we rlispose of all the waste. Each.
hospital bed provinces 4.5 kilos of waste every may. We Listening 3
collect it rarh day and take it away for recycliiig. The porter*s office
We deliver the pcist all over the hospital and bring
Listen to William O’Neill answering telephone calls
letters for patients -that's avery important thing. As
and direct mg operahons. Complete these notes that he
we move around the place, we take lies, samples, and
makes of the phone calls.
specimens from here to there and back agairc Last year
I wiilker1l,800 kilometres!
To dr› all these things a porter
must \›e fit, he nLle to IN.ink
rlrarly in an emergency,

Next time you are waiting

for a porter to answer yeur
call, please be patient. He
will be with you as soon as
he can.

2 9p¿idp i{these sentences are true (T) or false(F)

I Porters only push food trolleys around.
2 They move patients around tke hospital
3 Porters take dead patients from the wards
4 fach nd makes 4.5 kilos oJwastc a day.
S TO.e porters destroy all the waste.
6 Porters give the patients their mail
14 Unit 2

Jedrzej Jaxa-Rozen from Poland

has designed a flying wheelchair.

• -” ". “ “ ‹ ’°‘ -'‹

"n=" /'°*tv ”"**“"-“*.
Speaking
Student A(Speaking p.11)
describe your picture, and I›sten to student B describe theh picture
Without looking at each other’s pictures, find ten differences between them.

Reading Read the text again and answer the questions.

Wheelchairs 1 What material was the first wheelchair made of?
2 V\that are modern wheelchairs made of?
head the article on p.1S quiclily. Ticlc the things that arc 3 V\fhnt difference does an electric engine mule i
menfioned. 4 Apart from your arms, what can you use to control a
O computer programs wheelcl iaii?
2 O hospitals S What three things can an iBOT do that an ordinary
wheelchair can’t1
3 O problems getting around buildings
4 O sport Find words in the text with these meanings.
5 O what wheelchairs are made of 1 the place you put your arms
6 O children 2 orders
7 O history of wheelchairs 3 not disabled
8 O high—speed wheelchairs 4 Grieved by II ie usel’s own power
S hovr easy it is to move around
6 that does everything
 In and around thehospital T5

Checklist
Assess your progress in this unit.TlCk (J) the
statements whlch are true.
I can name the mai n departments in a
hospital
I can describe what deparłments do
I can understand and give directions
I can clescribe where things are
I can understand an article about
whCelchairs

Key words
Parts ofa hospital
corridor

mortuary
reception
Modern wheelchairs are a big improvement on the first wheelchairs, which were just wheelbarrows like fhe ones we use in t
ward century. It had the latest
The first real wheelchair was owned by King Philip of Spain in the sixteenth
technology — removable arm rests and leg rests —and was made of wood Modern vvheelChaiis are made from the sam
Nouns
disorder
nervous system
sample
specimen
stretcher
waste

arms or have soi»eone to push Verbs

dispense
Wheelcha r design made a big jump forward with the invention of a
computer program that responds to voice commands. For users who dispose of
cannot speak, corr'pute‹ technology also makes it possible to Adject’›ve
manoeuvre a mach› e by small movemenb of the head. hung, tongue. disaDlcd
and breath.
Somethngsthatablrboiedpeopledowthoutf Lngcanbea Looł‹ back through this unit. Fi nd five more
major problem for disabled people, for example rlir’ bing stairs, words or expressions that you thi nk are useful.
enlering and leaving buildings, and using toilets A •heeIchair
can eifher help or make the problems worse So betore
choosing a wheelchair there are r’ my questions
you have to ask Will the wheelch›iir be self-
propelled or manual+ Which is more
imponant, manoeuvrabiłity or stabiliy?
Ho ' do you get in and oot of it?
The i8OT claims to sołve many of the
problems of stanriarrJ a•heelchaiis II is
a highly advanced. all purpose
wheelchair that can travel up stairs.
raise Ihe user to reach h›gh shelves.

“ and balance on tvvo wheels in the

shower. ft is greai fun to use, but
beware the pnce — the iBOT costs as r!
°ucI' as a luxt ry car.
 16 Unit

S«rub up ]rJCI3P ITAL

\/Vork in pairs. These patients have ofived inhospital \ZV’A ITING
and are waiting in reception. Discuss why you think
each one is there. A6EA

I. isten to the patients describe their problem, and Tal‹e a seat in the
decide which one is speaking.
2 The first nurse you meet will be a specialist caJled
1 3
2 4 3 This nurse will make of your problem.
3 Decide the order, 1—S, in which the patients should be 4 This helps decide who is
S A patient with a _. condition will see a
doctor immediately.

Vocabulary 6 A nurse will get personal details from you and fill in
a hospital form.
The admissions procedure
7 When these is a free a doctor will see
Complete the sentences with the words below. you
a tiiage nurse treatment 8 The doctor will decide on thc.
an initial assessment a priority
Have you ever been admitted to hospital* Do you have
life-threatening waiting room
any stories of unusual hospital admissions? Describe
registration cubicle
exactly what happened.
 Hospital admissions

In this unit
e describing the hospital admission procedure
e describing what happened
e Past Simple v Past Continuous
e filling in a patient record card
e writing a summary ofa patient

Vocabulary
I Work in pairs. Discuss the question. Patient record
What are the main responsibilities of a hospital J Which Scrub up patient is ecocded on this form?
receptionist?
Z kead about Canven and answer the questions
1 Whnt qualities does Carmen need in her job? PATIENT RECORD
2 How do medical staff cause Carmen problems?
3 What does she know about medicine? Srirnaizie G ra.Q¿
DOB 7. 0
Occupation
Carmen Dornan Marital status
I’m a hospital receptionist. If you need to find
somebody, or if you need to know anything about the Contact no.
hospital - ask me. If you want new paper towels, or you SrT1Ol‹in¿ iiltake
need to speak to a surgeon — ask me.
Alcohol irrtake
I often meet people when they are tightened, angry, or
drunk, so it’s important to be diplomaNc and strong. I F\easoi for adrnissior
often need to reassure people, soit’s important to be Meclical histoi y ñl¿hLloodprossurc
calm
Allergies
My normal work is to greet and assist patients when
Dr Parkinson.
they arrive, make appointments for patients, record
patients" information, and organize and file patient
records. I also keep the accounts. You need to be very
organized to dothis job
z Find words and abbreviations in the patient record
Of course, I have to operate a computer, a fax machine,
with these meanings.
and other office equipment, but I also have to know
first a1d,and understand medical terminology and I )ob OCCU@Q t iOTt

abbreviations.i\Ay biggest problems are with the 2 bad reactions, for example to
handwriting of medical staff. It certain medications
wastes a lOt of time when I doi‘i't family doctor
understand reports and forms
4 closest relative
because of handwfiting or
abbreviations. " the amount of something you eat,
drink. etc. regularly
I believe that without me
and the other receptionists 6 date of birth
the whole hospital would 7 male / female
come to a stop. past illnesses and injuries
married / single / divorced / widowed
10 not applicable(= not a question
for this patient)
11 ineach (day, week, etc.)
12 number
18 Unit

Research shows that hospital admissions increase when lhere is a full moon, and in the two days following a World Cup defe»t.

Listening 4 married?
A patient record form S smoke?
Listen to the i iuise get persona) details from a 6 do you smoke a
patient As you listen, complete thefor 7 ahergicto
8 Do day cif yciur. family
from any of the following . .. ?
PATIENT RECORD
Speaking
Student As work together in pairs. Student Ds work
together in pairs. You are going to play the role of a
DOB patient admitted to hospital Invent the following
Place of birth details.
full name date and place of birth
Occr‹patioi
allergies smoking and alcohol i ittake
Marital status occupation marital status
Next of kin next of kin reason for admission
Contact no. family history medical history
SnJcking i nt.Ake 2 Student A— you are the nurse. Ask Student B, the
Alcohol int.Ake patient, questions to complete the patient record
Reason foi r/rr ission below,
FaiJnily history Now chaztge roles.
r1›ei tal illness
diabetes
PATIENT RECORD
S\.ii iJarrie

listen again and complete these questions that the

nurse asks.
1 What you?
dateofbidh?
3 .youbornl
 Hospital admissions

In oneyear in the UK, 0, people

were admitted to hospital because of
accidents with socks and tights.

Language spot Z Write atleast three sentences about these people,

inventing details about what happened to there.
Past Simple v Past Continuous
We use the Paul S›imp1e totalk about things which
happened in the past.
I felt terrible when I got home last niqht.
I slipped on ice and hurt my tnee.
Snme verbs have a regular Past Simple, ending in -ed.
ask — asbed arrive — arrived
The Past Simple of some verbs is irregular.
go- sent come — came take- took
find examples of the Past Simple in the Ustening
script for Scrub up on p.l2s. Wnle the base form for
each one.

When we are telling a story we of'ten use a verb in

the Pnst Continuous to give a background to what
happened.
I was ridiny my hibe. A cat run in/ront of me and I
fell off.
She cut her finger whe» she wet preparinq/ood.
Underline examples of thePast Continuous in the
[isteningscrtptfoiScruhuponyJ2S,
›1 Cio to Grammar reference p› 117
Complete the sentences using the verbs in brackets in
the Past Simple and Past Continuous tenses, Decide the
order of the verbs first
1 When he wpr working. he p_mke his aTm.
(break, work)
2 My son _ a firework when it
and. his hand. (explode, hold, burn)
3 I ofthc can. My dad .the
door and my fingers.(get out, break,
close)
4 My mum . in the bathroom, She
and her head,(1t,faIl,
get dressed)
5 I to music, when suddenly I
a whistling in my ear and I
deal. (hear, go, listen) 3 Describe an accident that happened to you. that were
you doing and what happened?
6 I in the park, and a man me
and. me. (punch, chase, run)
lQ Unit 3

Every minute spent filling in

forms is a minute spent nor
with patients.
Elcna kneip
Nurse

Reading S Researchers could understand 849» of doctors' notes.

Bad handwr*rting
flat do people say about your liandxvrifing? Is it
clear and easy to read?
As fast as you can. write down three types of medicine
and three diseases. Show it to your partner Can they
read what you have written? Have you made any
mistakes?
Read the article and decide if these sentences are true
(T) or false (F).
1 Nurses study doctors’ handwriting at school.
2 Doctors generally write numbers more carefully
than words.
3 Methimazole and Metolazone are used for different
conditions.
4 Ramachandra Kolluru is a pharmacist.
6 Many hospitals use abbreviations in order to avoid
mistakes. .
7 At Charing Cross hospita). staff carry computers
around.
4 Find words in the article to match these definitions.
1 non-medical people who work in hospital offices
2 written instructions on what drug to give a patient
3 made somebody pay money as a punishment
4 to cut off part of the body
S an arm or let
6 mistakes that result in death

Thei‘e is air old johe lliat duclors i;u lo bad liuildwt”itii ul al bi ’iatiu is wi linii i¢›IJudy uilLlcr>lai1dS.
school t‹› Ieai-i hOw \r› \vritu bade' and Barl I›a‹›cłtvriliiig alsc causea ‹lelays, •I ich aie expensive cnd
nurses go lo school to learn how to tead wasteful.
do lors’ hai dwntii g. Theie is ti-‹ith in lhc•
ioke - c‹›mputei a»r.I cis ‹›f lfas There are many technological
handwriting of meriicrl staff shows thal solt run ns fur the prol›lem,a n‹l ihoi Uh
‹1octoi ' vi iling in a lr›t n'r›rse than lha\ o( digital technolo can’t ii»pioi’e
nurses and adminish‘até'e staff. Maybe it's handwriting, it can improve 11 ie
L›ecause Jr›ctoi“s are always ui rler siluatioi . At Lai don's Charing C›oss
pressure of rinse rhat ltJey \vi‘ite very fast. hospital, for exai 1{›Ie. {›afienIs vea› hai-
The habit stans whci› lhey a c n edi«aI c‹›des fihe same as in a stipei n›arki•l}
students anrl gels worse as time {›asses. on lheii‘ v›1sfs ur and(es. Siaff use the
bar codos alr›i g with hand-held
computers tu ger acc iralu. clear, and
careful vilh i\uinbeis. I-to\vevei:they lend to fui‘m letcers of the easy-i‹ read info›c ation.
alphabet L adl ‹ When dmg names look ’ei \ similar, bad
handw›1tiiz¿ can »ean patients gel the wiong medicii›e A
young girl neai ly Ji€ I \vhc \ she was gh en Mefhimazote instead
of Mctolazone (one is for h s h blood pleasure and rlie uther is
ter thywid pmUle»s . Ai›d in US, an Amencan cardiulogist.
RanJachandm Kolluru, tvrole a yrcsci iption so hcdly that the
/›hai n a«isI ga›'e a j atieiai the wrong naedi«ine. This time the
patient dirt die and a ccurt fined the dociur225,tXI0 dullaru.
R ‹°r›ilj‹ resear«hexs studied SO patient pi'ogress nores They
found lhat they could noi read 16° ol the ^’onJs. The
inisui dental ding that this causes can \neac ihai a patient is
gi en the wrong hlood, or thai asurgeon an pufales lhe wicng
limb. Fofal ei ion. of course. make news. h‹it studie show that
every yeai hundreds of thousands uf mistakes ale rn‹›de in
hospitals aiouiJd lhe world, and a lot r›f llzcm are because of
 Hospital admissions

Checklist
Assess your progress in this unit.Tick ( the
statements which are true.
I can describe fhe admissions procedure
I can understand and complete patient
records
I can ask somebody for their personal details
I can describe events in the past
Patient summary
I r.an understand ar article obcut
Read this summary about Mustapha Hussein. the
haridvvriting
pañ ent N Listening 1. Find three mistakes in it.

Mustapha Hussein was admitted with possible

concussion afler falling from a ladder and hitting his
head. Mr Hussein was born in 1982.1-Ie is divorced, and Keywords
works as a painter. Hi.s next of kin is his brother, Yusuf. Adjectives
He can be contacted on O7709-40J229. Mr Hussein allergie
smokes 40 cigarettes a day. He does not drink alcohol. fatal
He is not allergic to anyhing. There is a family history
Nouns
of diabetes on his father’s side.
accounts
appointment
Write a sirnilar summary about sarah Bebr using the cubicle
information on the patient ieco id dclClvv.
first aid
initial assessment
life threatening condition
PATIENT RECORD limb
pre5CFiption
First name S arah priority
Genc!ei O F progress notes
registration
teacher
trcahrient
married triage nurse
father Ian
Look back through this unit.Find five more
OH 9R—"/ Ci5456
words or expressions thatyou think are usef‹vI
n,’a
10 url1 ts per weelr
suspected fractured

Farr il', history heart É tisease

t fit.hcrus side‘)
 I-lospital admissions

Chwklist
Assess your progress in this unit.Tick(s•'*}the
statememswhich are true.
I can describe the admissions procedure
lean understand and complete patient
records
I can ask somebody for their personal details

Patient summary I can describe events in the past

Read this summary about Mustapha Hussein, the I can understand an article about
patient in£istenirip J. Find three mistakes in it. handwriting

Mustapha Hussein was admitted with possible

concussion after falling from a ladder and hitting his
head.Mr Hussein was born in 1982. He is divorced, and
works as a painter. His next of kin is his brother, Yusuf.
Adjectives
He can be contacted on 07709-401229. Mr Hussein
allergic
smokes 40cigarettes a day. He does not drink alcohol
fatal
Heisnot allergic to anyt 8 There is a family history
of diabetes on his father’s side Nouns
accounts
Write a similar summary about Sarah Behr using the appointment
information on the patient record below. cubicle
first aid
initial assessment
PATIENT RECORD life-threateningcondition
limb
prescription
Surname Eehr First name Sarah yj y¡
DOB 3/1/B4 deader D F progress notes
registration
Occupation teacher
treatment
Marital status married triage nurse
Next of kin father_Ian
Contact no. OI79R—7954£I8 Look back through this unit. Find five more
Smoking intahe words or expressions that you think are useful.
ri,'a
Alcohol intake 10 units per week
Reason for admission suspected fractured

Family history hea.rt diaeaae

(father’s side)
Allergies nuts
22

Scrub up
Vocabulary
You are in a light aircraft when it crashes into the First aid
jungle. Your radio is broken so you can’t call for help
There are two of you and you must get ready to walk 1 Work iii paiis. Discuss the tjuestioiis.
100 kilometres to safety. You already have clothes, food, Have you ever experienced a patient with
and water. blisters?
third degree bums?
severe bleeÖrrtg?
How should you treat them?
2 Complete each sentence with a word from the box.
apply keep squeeze
check for make sure sterilise
immerse puncture swab
immobilise remove treat
1 a clean, sharp needle with alcohol.
2 there is no glass or other foreign
body in the wound.
3 Use the needle to the bltster.
4 Don‘t burnt clothing.
ma main artery if necessary
the injured person lying down.
the injured body part once the bleeding
has stopped.
. the person for shock.
9 Don't severe large burns in cold water.
10 signs of circulation.
with lodine or rubbing alcohol.
You can take only ten rrioie things With you
12 antibiotic ointment and cover with a
from each hst Discuss what to take with your
bandage.
partner and explain your reasons.
3 Compare your answers Cth a partner. Working
Medical General together, decide vvl ucl i of tl ie above irish uctiQnS
bandages a torch belong with each of these condiUons.
a scalpel a box of matches
a snake bite kit soap a blisters
Morphine a mirror b tlü rd degree burns
Aspirin a compass c bleeding
disposable gloves a knife
a thermometer scissors 4 Add an instruction of your oen for each condition.
tweezers fish hooks
a first aid manua) large plastic bags
hypodermic needles a cooling pot
adhesive tape a mosquito i iet
 Accidents and emergencies

Ir› this rinit

e talking about first aid
o understanding and giving instrunions
o the symptoms of shock
e describing how to deal with an emergency

mLanguagespot
1 nstructinns
Speaking
To tell somebody what to do, you can use the
Imperative.
Checkforsigns o/circulation.
Apply thepads to/iïs chest.
To tell somebcdy what not fo do, add Don’f ...
Don’t remove burnt clothing.
To emphasize what is important, you can use
Make sure ...
Mate sure ltte sound is clean.
Mate sure you don t forfffl his body,
Work in pairs. Student A look at this page. Student B go
then asking for instructions, you can use the to p.lâ 2.
Present Simple, time to. shrill, and should.
Student A
What do I do now!
DoJhave to immobilise Its leg? You are a parent. Five minutes ago a poisonous snake
Shall/ to/'e o//f/te dressing rtow7 bit your child. You phone an emergency helpline.
What dosage should/give mirn? Explain the situation to the helpline nurse, then listen
and use these notes to find out what to do. Note down
J Match the begtnnlngs and endings of the sentences. the instructions that you are grven
E XA M P LE
l Check that a I count up to between
breaths? What sholl I do with the sound?
2 Make sure you b 1 give her? Should Ipu t it on ire+ Should I.. ?
3 What do c have to apply the pads wound — ice? bandage?
4 Don’t let d the paü ent is breathing. child thirsty - milk OK?
s Should I e the patient try to stai id up. vvalkaround?
6 Shall I bandage f put the bumt area under dcctor'
running water?
2 You nre a nurse wnrking en a telephone helpline. Lis†en
7 Don’t g the patient’s pulse again.
to your ca1)er explain the emergency, then use these
8 What dosage shall h tie the bandage too tightl
notes to tell the caller what to do and to answer any
9 Take i the wound now?
questions.
IO Where do I j use a sterile needle.
Z Work in pairs. Think of three emergencies a member of Mate sure he gets fresh air! Open windows and doors,
the public riiigli[ have t‹r den u til i. FCli each uitg, van te
anR
three instructions to help them. Tell your instructlons
to anothcr pair. They must guess thc cmergency. fresh air JZ (windows / doors /, carry if necessary
£ XC M PLE
(a patient is unconscious) mouth — wash out J(water)
Don’t move the person. milkJ(alcohol Z)
Mabe sure they are sM// breathing. skin — remove clothes if covered in pestIicide
Keep f/ieper5on warm unfi/ medical help arrives. — wash I(running water, soap)
eyes - wash J(running water, 1s minutes+,
chemicals A)
touch pesficide lx(gloves 77)
 24

the heart Start beating correctly

after It has stopped or become
irregular. It words by sending an
electric shock through paddles
or electrodes placed on the
" patient's chest,

Listening Listen to the student nurse receiving instructions

Instructions from a paramedic, and check your order,

I Work with a partner to put these pictures in a logical ' Listen again. Underline the correct option in italics.
order. Describe what is happening in each one. E XA M PLE
The patient has yad a strobe 7 a cardiac arrest
2 l The nurse gives two? three breaths into the
3 patient's mouth.
2 The paramedic courts up to three? four after each
push dovrn on the chest.
3 The nurse pushes down on the chest een 7sixreen
times.
4 They set the charge on the deCbrillator at 1007 2OD.
b
S The nurse applies the pads on each side off ahave
and the/oivthe heart,
6 The patient starts to respond after theJrst second
charge from the defibrillator.
7 The patient is evenLidocaine / Atropine.
B The rlnsage is 20h ml over one minute/I00 ml over
two minutes.
4 Complete each sentence with a verb front the list,
then hsten again to check.
check hold repeat stand
give press set up support
give put
him CPR.
him mouth—to—mouth first.
3 his head.
d
4 Right, his nose c)osed,then .. .
S your hand on lus chest.
e
6 clear of his body,
7 .,then. . the buttons and hold for tvro
seconds
8 his pulse again.
, 9 OK — the procedure.
30 \nfel) done. Now an IV and give .
 Accidents and emergencies

Taxi drivers in 8angi‹ok are now being trained to help women give birth An estimated
#* // women in the
ciry give birth in taxis or tuk-tuks on the way to hospital each year.

Reading 2 \/\fho gave instructions to Clive?

1 Look at the pictiires. What do you think the article is '3 \f\f1 iu ii Mol iait u ited Clive?
about/ 4 How is the baby now?

2 Discuss lhese questions with a partner. 4 Work in pairs. Cover the article. Can you remember the
Have you ever helped with a birth? Hovr was it? midwife's instructions. Look at the words below to hel p
Were you born in hospital, at home, or somewhere you remember
else?
Have you heard of any births that happened in an Ill a r›kct motl her's chest
unusual place?
nose and n›oi th
3 Read the text and answer the questions. hncL towcl
‹› mhilical cord
1 Was this Clive's first experience of a birth?

British tax i driver, Clive Lawrence, became a midwife for an

hour when z p‹*ssenqer gave birth to a baby in fhe back of his
taxi.
Asha Gemechu's baby was due in a month, but when her
conl’racI ions slarted she called for a I’axi to take her to
hospital. MF Lawr€'ncr answered fhe call,
The expectant rr›‹ir › was in fhe taxi for ten minutes when
she realized that things were happening too fast. I he baby
was not going lo wait. Its head appeared, and F’r Lawrence
slopperf lhe taxi In help with the birth.
Mr Lawrence said ‘I was there when my kids were born, so
fhis was not completely new for me. I spoke to a nurse on the
faxi radio and she gave me instruCt ions - I only dld what she
fold me. There's ncthinq spec ial zbout that. One minute I had
one passenger, then I h6d two, bul I here’s no r*xtia charge!’
A midwife at the hospita1 Sdid. ‘Givinq birlh or I he way to
hospital doesn't happen otten, but if you're there when it
does, just support the Party’s head and guide it uut - dun't
pull. Then clean fhc baby's nose and. mouth, but don't cut the
umbilical cord - just lay the baby of I I e molher’s chest, cord
and all. Dry I he baby with a
clean towel or cloth,
gently rub its back, then
cover mum and baby with a
dry blanket to keep them
both warm. and wait for
medical help to arrive.'
‘Cli •e was wonderful.' the
mother said later, ’he did
everyEhiilq riqht.‘
Asha is naming lhe
baby Mohammed
Olive. Mofher and
baby are both
doinq well.
 26

Worldwide. somebody is k‹IIed in a car

accident every Ü /* seconrts g.
(World Hee Ith OrganiSation statistics)

It’s myjob Signs and symptoms

l Read about Jetf Oliver and answer the questions. Shock
I When did leff decide to become a paramedic? Paramedics often have to deal with shock, a condition
2 How long did he train for the job?
that is often caused by major trauma such as a traffic
3 What things do you have to be good at do Jeff's job? accident Shock occiirs w'henthe heart is unable to
4 Who makes Jefi‘s job diffi.cults supply enough blood to the organs This result5 iria
slowing-down of the vital fonctions, and can cause
death. Shock is tiifficult to diagnose in ïts early Stages.
Jeff Oliver vrhich rriakes it hard to treat. Read aö out the slgns and
symptoms of shock, and complete them with wo rd5
I‘m Jeff Oliver, I’m 24 years old.1decided to become a below
paramedic when I saw two of them treating a driver at dangerously blood pressiire
the sceneof an accident when I was a boy. abdominal cardiovascular
I started as a trainee ambulance technician, and respiratory intestines
trained for two and a half years to become a qualified abnormally coma
paramedic. Now I administer life-saving procediiros gastrointestinal central nervous system
myself, It’s part of my everyday work todefibrillate the
heart of a cardiac arrest, to apply splints to Iimb5 and T he IS
dress wounds, and to set up drips. affected. This can problems may
I have to make quick decisions —it’s as important part cause changes in develop. The patient's
of giving emergency treatment. So is personality, and heart often beats
restlessness. In abnormally fast. bt›t
communicating clearly and
advanced stages, heavy bleeding may
keeping a clear head in some
confusion and Cause It to beat too
difficult situaü ons. And situations ultimately slowly.
are often very difficult, especJally can
when we have to deal with people result.
under the influence of drugs
and alcohol. But paramedics
don't tfdrd‹twice— we are
a)ways first at the scene
when there is a suicide,
a read accident, or a fire.
When you save a life, it’s
the best job in the
world.

2 Join these word combinations used in the text.

1 become a a life Their temperature
may be
with b as a trainee
J give c a qualified paraniedic
*
4 make d treatment low (hypothermia) or
5 save e people high (hyperthermia).
6 start f decisions
$ Would you like to do Jeff’s job?
 Accidents and emergencies

Checklist
Assess your progress inthis unit.Tick ( the
statements which are true.
I can talk about first aid procedures
I can understand instructions for CPR
I can instruct somebody how to give first aid
Writing I can understand a description of the
symptoms of shock
Information poster
I can write instructions tor dealing with an
You have been asked to produce a poster telling
emer enc
motorists what to do in an emergency. Write a list of
in trtir1inn fnr f he tnllnvving sit iatinn. Ctve ren nn
where it will help people to understand.
Key words
Medical problems
FIRST AIB FOB uOTORISTB blister
cardiac arrest
circulation
A car has crashed. You are the first to arrive on foreign body
the scene. The driver is unconscious. stroke
What do you do? trauma
wound
Treatment
CPR
. An abnormaJ disposable
increase in breathing
dressing
rate can lead to
hypodermic needle
'distress
sterile
sterilise
swab
tweezers

Look back through this unit.Find five more

words or cxprcssions that you thinl‹ arc useful.

probIerz›s arise from

alack ofblood supply.
The
c
can can stop working and
be can start to die.This
- '‘ ’ ftigh in tne early can cause
‹. stages, but then
'.- '.’ hypotension is nausea, vomiting, or
common as It falls rIiarrhnr‘a
t"i
 28

Scrub up Vocabulary
Work vrith a partner. Which of these parts of the body Describing pain
do you think is the most sensitive to pain? Number
them from 1 (the most sensitive) to10 (the least Discuss these questions with a partner
sensitive). Are you good at dealing with pain?
back of hand _ forehead Do you have any special techniques to help you deal
cheek nose with pain?
What is your experience of looking after people in
fingertip palm
severe pain?
foot upper arm
Match these words for types of pain with their
forearm upper tip
descriptions.
You need a paperclip and a ruler. Bend the paperclip
into a U shape. \Vith the points rif I he I I a hniit 1 Omm
apatt, touch your partner on the back of the hand with
both points at the same time. Can they feel one ortvro
points? Adjust the distance between the points and do
the test again until you find the shortest distance
where they can feel two points.Write down the result
and repeat on the other parts of the body listed in1. To
make it more difficult, sometimes touch your partner
with just one point.

l a throbbing pain a feels like it is eating you

2 a sharp pain b travels fast along part of
your body
3 a burning pain c is steady and not too painful
4 a stabbing pain d feels like a muscle is being
squeezed
S a shooting pain e feels like something sharp is
stuck into you
6 a dull ache comes and goes
rhythmically
7 a gnawing pain g feels like fire
8 a cramping pain h is wrong and sudden
faces like these are used to help children and people
who cannot speak a language say how much pain they
feel. Join each adjective to the face it belongs with best.

3 Look at your answers for J.Did the experiment give the agonizing modei•at6 quite bud slight
same results? mild not bad severe unbearable
 Pain 29

In this unit
• describing types of pain
G describing degrees of pain
e comparing things
e asking about pain
N referred pain

Listening 1 3 What kind of pain do you think these conditions might

A pain chart cause. Discuss your thoughts with a partner.
a deep cut a stomach ulcer
I Listen to four patents describing their pain.
migraine kidney stones
Tick (I) the boxes that describe the pain, and mail the
a tumour a broken ankle
position on the body
labour a severed finger
Patient Patient Patient Patient

burning
1
O
2 3
M
4
e Language spot
stabbing Making comparisons
throbbing I Match these examples with the rules below.
shooting O O M O a ft's much less sore than yesterday, thanbs.
constant O O O b they hnve more beds in fhp C.ily HrisyiMl.
frequent c This is the st longest paintillet variable without
occasional n prescripl ion.
mild 0 0 d Ivlost women choose to hove pain relief when
moderate giving birt'h.
severe e fzisf niqñ t thepnin was more severe than
O 0 0 0
getting better
getting worse \n/e use comparatives to say how things are different.
Stayingthesame 0 0 0 These painkillers are milder than those

To make a comparative stronger, we often use touch

or a lot.
You Pooh much better today.
The opposite of more is less.

We can use inore and less with a noun to talk a bout

quanUty.
3
We use superlatives to compare something to all
other tlungs of the same type.
Work with a partner Try to complete these phrases,
then listen again mid check. 4
1 Are youstiE pain? The opposite of the most is the leosl.
2 Well, pain around my stomach. This is the least serious t ype of ftacl:ure.
3 I a slight pain, just here We can use most with a noun to talk about a large
my right side. proportion of something.
4 I’ve. this throbbing pain s
my head. G o to Gramin at reJeienc e } ›.11 8
S 1 getting this teirible pain
my left arm
30 Unit S

Look at the information about these three painkillers. 1 Theé babies are clifferenl sexes 7 the so me sex
Complete the sentences, then write three more of your 2 Mrcn started with Nos and air/T'ethidine.
0
3 Gas and air made ? didn’1 mo be her feel good.
4 The epidural ieheved o// 7 some of the pain
5 Janice had 7 didn’t have gas and a ii.
6 Janice lost no7sit feeling during her previous birth
Complete these sentences Cth verbs below, then
listen again tocheck.
became got tookaway
copewith losing wears off
feel relieve
I It does the pain a bit
2 ... the effect very quickly.
Effective Cost SiJe effects
3 It made me sick too.
Nuradeine JJJ7 €€ 7 4 . . . when the _ unbearable, I had an
I broxen /// main
epidural
S Did that help you. . the pain?
6 It the pain completely!
I Niirademe is much (eflecdw)than 7 I decided to have gas and air if the pain
Ibroxen. worse .
2 Ibroxen is (cheap) than Nuradeine. g i didn't like all sensation.
3 Ibroxen has (side effects) than
Muradeine.
4 Niiradeine is (effective).
la .“I, /ea/ , la/
Work in pairs. Put each word below into one of the
three colsi ii is accoidirty to the str in id of tlte
undeiJined vowel. Look at the pronunciation guide on
» p.J32 to helm you. 7ry to pronounce the words.

Listening 2 /3:/ /eo/

Pain relief ulcer

Listen to Janice and

Karentalking about their
expefiences of pain relief in
labour. Underline the nart apr hurt doctor
of the sentence in italics care nurse appointment
that 1s trite first hnir tumour
worse where
I.isten to tne words and repeat them.
Reading 3 Complete the gaps using veibs from the article. You
Before you read the article, discuss these questions may need to change thetensc.
Nth a partner. 1 She wears a mask to p . the area of
Canyon give a definition of’pam’? bu rit skin.
Whydo we feel pam 2 The pain in your legs should go when we
What would happen if you could feel no pain? t your back problem.
3 She used bieathing exeicises and gas and air to
Read the article, and decide if these statements are true
(T) or faTse (£). m the main of childbirtR
I People who are boro unable to feel pain are unlucky. 4 A local anaesthetic will p you feeling
any pain ó ming the operaü om
2 Pain starts in the brain. 5 Breathing exercises help c 1:he main to
3 Chronic pain lasts longer than acute pain. some extent.
4 All drugs which stop pain work directly on the 6 When you s a sefious injury, you
brain. may not feel main immediately.
S ’Phantom limb'pain is felt by people who have lost
an arm or leg.
 referred pain (n)
pain that is felt in a different
part of the body from where the
pain is caused

Patient care
Questions to assess pain 1 2 3 4

Here are some basic questions to ask a patient when burning EJ 00 0

assessingpain.thatch the beginning of each sentence stabbing 0 00 0
to the end. throbbing 0 0 0 0
1 Where does a worse? shooting M LI M M
2 Ooesit b it hurt? constant G 0 EJ
3 When did it start c does it hurts frequent 0 0M
4 Does the pain d describe the pain? occasional 0 0 0
S How much e hurting? mild O O
6 Can you f hurt all the time? mcJerate 0 G 0 M
7 Does anything make g stay in one place or
severe 0 0 EJ EJ
move around?
getting better 0E3 G 0
8 What makes it h the pain feel better?
getting worse 0 GE3
staying the 0 0 0
Speaking
Work in pairs. Student A look at this page. Student B Writing
Pain report
Read this report on a patient's pairL Can you find and
go
correct five rrristakes in it?
You have a problem with your liver which is causing
you pain. Imagine the pain you might feel, and be The patient has abdominal pain. It begin suddenly last
ready to answer the nurse’s questions. Think about the
following details. night as mild but constant pain all over abdomen. Now
where? it is more bad, and is on the right hand side to the
when/ abrlomen. The pain has worse when he coughs.
liuw find?
type of pain?
Wrlte a report about the pain your partiierdescrit›ed in
same place or moving7
Speaking. Use the chart you filled in to help you
getting better / worse?
i’ernember the details.
what helps / makes it worse7
You are the nurse. Ask Student B about the pain they
are experiencing, and fill in the chart at the top of the Body bits
next column Areas of referred pain
Change roles. Answer the nurse’s questions. Look at the diagrams showing areas of referred pain
Work with a partner. Discuss which colour you think
refers to each of the following parts of the body.
a kidney g stomach
b appendix h colon
t ovary i bladder
d liver and gallbladder j lung and diaphragm
e small intestine k heart
I pancreas
 Pain 33

Checklist
Assess your progress in this unit.Tick(w*) the
statements which are true.
I can understand a patient ciescribing pain
I can ask a patient ahc\zt their pain

”"” I can understand an article about pain

I t:an write a report on a patient’s pain
I can name the main internal organs

Key words
Adjectives
agonizing
cough
mild
severe
severed
slight sore
unbearable
Nouns
gas and air
labcrir
local ai aesthetic
migraine
pain relief
stomach ulcer
tumour

Look back through this unit. F-ind five more

Words nr expressions that you thinL are useful.

2 8 =

TO
11 =
'
34 Unit

Scrub up Listening 1

1 Listen lo these patients describe their symptoms,

and match each one with theii condition.

Work with a partner. ivlatch each phonetic spelling to

one of the words on the list. How do you say those
seven words?
1
bruJslng _ 2
constipatinn_
a cough 3

deformity 2 Listen again and tick the words you hear from this
dizziness. list.
3 /ko£/ feve
itchtng Nouns Adjectives
diarriioea deformity 0 0 deformed
a tump .
nausea a lump 0 0 lumpy
nuinbness bruising 0 0 bruised
vomitlng
a runnynpse swelling 0 0 swollen
sičlmess pain C3 Ed painful
sneezing
a sobe throat nurnbness £J O nunl b
spols feve 0 feveish
sweTfing

7 /'tazdnas/ tlzedness redness 0 red

ac}\ujg tiredness Tl tired
Listen and repeat the seven words. 0 tiring
Decide if each of the symptoms on the list affect the ache aChy
inside of the body, the outside of the body, or both.
dizziness 0 0 dizzy
Write I(-— ins0ide), (= outside), or B (= both) next to
eachone Say the w rds as you decidetogeth9r (the sickness 0 sick
bold parts of the words are stressed).
constipation CJ El constipated
 Symptoms

In this unit
e describing symptoms
e asking about symptoms
e how to form questions
e syndromes
e tongue diagnosis

3 Can you remember the questions that the nurse 1 Match the beginnings of the questions with the
asked? Woil in pairs to try to complete them from endings.
memory, then listen again to check.
1 a it hurt
I How it feel? h /VLrs Hales?
2 Ahtdedeformed, ? 3 Where does c are you?
4 What about d broken?
3 it pairifu) when you move it?
S Set’s have a took — swollen, e happened to you?
4 move your toes 6 You've had an x-ray, f haven‘t you?
S How feeling! 7 Anything g your shoulder?
6 a sore throat 7 8 You aren't on any other h isn‘t it
“i redness? medicafion,
8 going? Listen and check your answers.
9 dizzy at all? Work in oairs. Close your
10 When sick mostly? books and try to remember
11 pain? as much of the conversation
as you can.
4 Write questions
e Language spot to go with these
Question forms answers.
We change the word order to form a Question with
be, with tenses lhat are formed with be and hnve, end
with model verbs such as con, wilf, st pufd, etc.
Are you off riqhf? (now You-are eIQ)
What is she doing? Nurse
Where hove they put thct vrheelchairf Patient Not bad, thanks — a bit sore.
Can you move your toes? Nurse
We use tlte ver b Hi› to i‘iiuke questions Frith the Patient I lelJ off my bike
l'resent and Past Simple
Nurse
Patient Here, around my wrist.
Did you labe your med ination lasl night?
Nurse
V who I, who, eI c asks about the subject of the uerb.
do is not necessary. Patient Yes, I can, slowly.
Whnt happened? (not .) Nurse
Who said that?(not Why.) Patient Yes, very! I‘ve also got u cut on my leg - looL
We often use question tags to check information, Nurse
to express surprise, to be friendly. etc. Patient Yes, it is deep. \Afitl I need stitches?
This is yoar first lime on this word, isn’t it?
Nurse
now don’t enf meat, do you ?
Patient No. never — and J don’t want any!
vre sometimes Jeave out the verb, if it is easily
Nurse
i indersl r›nd.
Any painI (-— Do you have any pain?) Patient No, I haven't seen him yet.
Comfortoble! (-— Pte you comforta ble?) 5 Now listen to the conversation. Were any of you
questions exactly the same?
 36 Unit

In the UK, the most common reason

given for taking time off wor)‹ is
‘flu-like symptoms’, which are typically
afeverandachesand painsinthebody.

It’s my job Signs and symptoms

Read about Sandy i\McGuire and decide if these Night coughing
sentences are true (T) or fake (F).
1 Sandy works at night.
2 Her shift is a quiet one.
3 Some people phone because they are lonely.
4 Sandy only gives information —not advice
S Helpline nurses have to speak foreign
languages.

Sandy McGuire
Ioperate the telephone helpline on the graveyard shift
- thot’s the one from riridniglit through to the morning,
Although it’s quiet and still in the streets otitside, it‘s
not so quiet in the office The early hours of the
morning are sometimes the busiest time, vrhen the here are descriptions of four pGs sible conditions that
telephones.ever stops ringing. can cause a child to cough in the night Complete them
People call the helpline for information or advice, or with the words below.
sometimes they just need to hear a friendly voice. We coiighingup occurs make sounds
talk to people who are depressed alid worried, anal accompanied get are wheeze
sometimes in pain. Sometimes we get some funny breathe hue
enquiries —yesterday, a teenager phoned because he
had swallowed some chewing guru arid he was afraid Asthma
he was going to clie! Chiltlren with astl.ma cotiph, null ' vrlien
We can't see our patients, so we halve to be very good on they bre-utlie out. They become very short of breath
the phone. We hnve to learn how to do it, because it wi en an -uttack '.
doesn't coiiie i t»tuially. We have to Arrow I row to ask A cold
the right questions so that we get clear and accurate
Scmettrnes a chiltJ a cough and a fever
answers, aniJ we have to be with a rnlrl A fiaJ rat:gf rn ri
able to speak iri “*
vorriit
language anyone con
tindersta nd.
Cluldren under three years old sometirties
s croup. They leave o soie throat and they

wheeze when they t

in. Wheii lhey cotig,la
7
it often like u clog b»rl‹in¿,
Pneumonia
The symptoms of pneumonia a
temperature of over 1O2‘F (39“C), fast breathing,
sometirries ' by vomiting and sometimes
'* blend.
 Symptoms

Listening 2 3 Now change roles You are the paUent. Call the helpline
A helpline call ano tell the nurse about your injuieo mist.

Listen to Sandy McCiuire taking a call on the

helpline.As you listen, fill in the information about the Writing
patient.
Symptom report
1 age of patient
1 Read this repoi t about a patient with appendicitis and
2 wheezes breathing in breatlung out O
find three mistakes.
3 coughs up blood yes O no
4 vomits yes no
5 aü ergies yes no
6 lever yes & rto &

Which of the conditions in Signs nn£fsyrnpto›rs do you

think the end has7 Diseuss your idea mth a partner.

Speaking
St udent A look at this page Student B go to p.112.
Student A
2 Wi ite u iepoi’t on tliis paüeiit vrho les foed p isoiurig
You have hurt your wrist. Memofizethese symptoms. using these notes.
You will describe them to the helpline nose later.

You fell off your bicycle. It happened Ave days ago.

Your right wrist is very painfu). The skin feels hot, and
is reel arid sore.’l’lie slinpe of the wrist sec me nor ma1,
but it’s a bit swollen, mid it hurts when you toiirh it.
You can move it without making the pnin worse. You
can a lso hold heavy bags, a rid put weight on it

2. 1 You are the helpline nurse. Ask the caller questions

to find out exactly what the problem is, Use the
notes belovr to limb you, u i d mukc iiotes us you
listen to the answers.
aches?
nausea? Proje«t
vori\itirib (lrlood?)
Research the symptoms o1 one these illnesses and give
fever?
a short presentañon describing them to the class.
diarrhoea? (blood?)
cramps? AIDS gangrene
bloating? tuberculosis iabies
malaria lepiosy
2 When you haue all the answers you need.look at the
diagnosis table on p 111. What do you think Student
B's problem is?
3B Unit

I used to have compIr:tr' faith In

doctors Now I’m \ fighting to make
them understand that they don’t
have sIl the answers.
Uave Hart ies
Cu/1or Veteran

Reading
Discuss the question with a partner
Have you ever had symptoms with an unknown
cause? What did the doctor say?
Read the article and decide if the sentences are true (T)
or false (F}.
1 CFS is caused by a virus.
2 CFS sufferers cannot lead a normal life.
3 Some doctors believe they are not really ill.
4 Gulf \A/ar Syndrome sufferers were attacked with
chemicals.
S They were vaccinated against the syndrome.
6 The army officially says that stress car reed their
illness.

Tick (I) the things that each syndrome affects.

Chronic Gulf
Fatigue War
Syndrome Syndrome

muscles
nerk
“
sklfJ

sleep
throat
\n/ork with a Partner. Try to match the words without
looking back at the text, then look back und check.
1 a recurrent a sleep
2 an overwhelming b glands
3 chronic c swings
4 loss of d nches nnb pains
S mood e appetite
6 muscle f sore throat
7 poor g feeling of tiredness
8 swollen h iJlnesses
 Symptoms

t7hecktist
Assess your progress in this unit.Tick (W) the
statements which are true.
I can rlcscribe symptoms
I can a5k a patient about their symptoms
I can form questions in »Il main tenses
Body bits I can understai›d an article ahout
syndromes
Tongue diagnosis
Zetsu shin is used in traditional
Chinese medicine. Practitioners
examine the tongue in order to Key words
diagnose illness and to find out act ing
about the personality of the iFtJ iS i 0g
patient. Complete the text about
cramp
zelsu shin us ing, the words below
deformity
disorder balance sign state dizziness
condition problems effectively indicates itching
thinlong aggressive lump
mooc! swings
nat sc*a
Blood 'are associated with a white numbness
tongue. Yellow .'a disordererl liver and rash
gallbladder. Blue or purple shows up a ' spot
in the digestive system. Purple on the underside stitcl c“s
shows the immune system is not working
•.
A dark red tongue can be a '
of inCammation oT ulcers in the body. Look hack thfOLl@IJ this unit. Fini4 ñ v‹“ more
words or expressions that you thiiik arc useful.
Movement
"f'he flexibility of the tongu‹• shows th‹• genriral
6
of the digestive system.

Width
A wide.tongue is gr›od f‹›r it show:s a Jsliysical indd
psychological _.'. A narrow tongue
indicates sharp . •
Tip
A rotuided tip shows a .p._....•of goc›r1 physiral
arid oriental health. People whose tongues have a
printed tip have '° persui refit ies.

2 Examine your partner's tongue and make notes. Tell

them what their tongue indicates about them
according to zetsu shin
Discuss what you told each other. Do you think there is
any truth in retsii Sh in!
40 Unit

Scrub up
Listening 1
A care home
Discuss the Questions with a partner.
Would you like tolive in a care home when you are
old7 Why / Why not?
In your notebook, make a list of the advantages and
disadvantages of care homes.
B XAM PL £

You always have compony. You don’t live with your

Listen to two elderly people in a care home talking.

Do they mention any of the points in your list?

1 ’hunts of an elderly person you know well and hovr

ageing has affected them. Think about the answers to
these questions Then talk to your partner about the
person
What daily tasks does he / she need help with?
How does he / she keep mentally fit?
Hovr does he / she keep phys›cal1y fit*
What worrii:s hii•i / her?
How happy is he / shed 3 Listen again and tick (I) the things that Edith (the
How healthy is he / she? first speaker) mentions
Z Discuss what special difficulfies are faced by elderly Edith doesn’t like ... Edith wants ...
patients and the calf who are caring for them Use the O the staff O respect
words below tohelp you, and write sentences. M Barbara O friends
I XAM P LE her owr name O privacy
ha ve more sude e ects from drugs. O bingo O to play bingo
O coach trips O more stimulation
O her our horne O less stimulation
gctti rig a role ntl
O her old life O to go to the seaside
O the food M independence
O washing up U more food
O to go home
hni1-›r- attifi iclc of staff
rucovciy
 Caring for the elderly

In this unit
e rare homes
o the ageing brain
a Alzheimer’s disease
a will
e describing the problems of the elderly
q aids used by the elderly

Reading 3 Find words in the text with these meanings

Write yotir name as fast as you can with your right
hand, thendo the same with your left hand. Was one
easier? Does it look better? Discuss the reason why
with a partner.
Read the amcle. and decide ilthese sentences are
true (T) or false {F).
1 You can learn to write with the wrong hand.
2 Learning makes new nerve cells grow
3 As we get older.large numbers of brain
cells die
1 to make things happen at the same time
C
2 tochange the electrical connections
3 conditions that kill brain cells
4 loss of the ability to use your brain
vrell S connected to getting old
a . -r

4 It our brain is healthy, it continues 6 the ability to control your body’s movement
to develop when we are old. l't I .S

5 Mental stimulation keeps your 4 Try these brain exercises, Do you know any others?
memory good. Name the colours o1 the following words as fast as
you can. Don't read the words but say what colour
they are.

MULTICOLOURED ORANGE
“,. , RED BLACK PINK WHITE GREY
Read a page of writing upside-dowr
42 Unit

AoLs (n) If you see a l‹ttlc less spring in

Activities of Daily Living.These i nclude my step. if your name fails to
ealing. bathing, dressing, toileting, and leap to my lips. you'll know why
wal king. A person’s ability to perform And if I tell you a funny story
these activ ties without help is used for the second tir ‹ . please
when assessing how much care they laugh anyway.
need. Charlton Heston
Film slor and Alzheimer’s su ever

Signs and symptoms e Language spot

Alzheimer’s disease will
1 Discuss with a partner what you knovr about We use will
Alzheimer’s disease. Hovr does it affect the to talk about future facts.
fr›flr›wing things?
In twent y years' time, i here urill be more old people and
the memory /etveryourip people.
behaviour daily like
speech to ma1‹e predictions and express hopes about the
future. We often use words such as I i h/itb... ,
Z Read the text. Which effects did you mention? I hope. . and proba bly when vre do this.
3 Decide it each symptom is more connected with I thinit Inf die when I’m 90!
movement (M}, thought (T), or behaviour (B). Then I don’t this b141p/ay sport when I’m BD.
compare your ideas with your partner. I hope I Mon’1 liUe in a care home.
wittyamilf around, you’ll probably hoveo long and
her/tfiyo/c/age.
Alzlieirrier’sdisease damages the brain, destroying
memory arid reason. People with Alzheimer’s disc•ase vrhen we decide what to do, have, etc
suffer confusion and less of cognitive function. They reo or coffee! Er.. f’Jf have Coffee, please.
neecl more and more nursing care as th.ey hecorne
to make offers, requests, and promises. We can also
progressively more helpless, and Cnally die.’Fire illness
use Shall I, , , ? for offers.
has three stages:
I’ll get you o drrn#.
early stage Shall I get you sonnet hint to eat?
forgetting recent conversations or events T lVill you do me a fovour!
minor changes in abilities and behaviour I won’t be bact Jote, so don’t worry.
repetition 13 €ii› *o Grammar reference .119
middle stage 1 Complete the sentences with. the words below. Then
needing sonnet help vrith ADCs decide if each one is a future fact (I’-), a prediction (P), or
wandering a decision you’re making (D).
loss of intert.St ]yi Other p‹•op1e
unusual behaviour '11 be able ’11 have ‘11 probably
shuffling gait ’11 s)eep Shall 1 will open
later stage 1 The new hospitn in 2010.
nec•ding constant help with. ADLs 2 I don’t the you_ tonJght
forgetting names if you have a nap now
complete loss of memory
3 goout tonight? Er . . no, I think
inability to recognize familiar people,
IN stay at home.
objects, or places
getting easily upset or aggressive 4 You togo home a week after
confrtsing night and day your operation.
confinement to bell or a wheelchair S I chicken ciirry wrth flee, please.
ilifficulty ii‘i swallovriiig a i’m working tonight, so I
loss of xpeech be tired tomorrow.
 Caring for the elderly

geriatrlcs (n) ’Elderly‘and’oIder'are

the medical care of old acceptable words to use about
people gerontolog y (n) the elderly.‘Old‘is considere‹J
the scientific study ofold age rude by many people.
and ageing

Complete this dialogue of of’fers and requests. Use ’If, 2

Match each vocabulary item with a picture. | c”
will, or won"f and one of the verbs below
tall paes stand do see
A Will • you pays me my glasses? Then I
2

be able to thetelevirinn.
B Here you are.
A Thanks. Oh and_______________'/OU ’me
another favour?
B What now›
e
you help knew •up? I want to
switch it on.
B You ." probably !°over.
I _" do it.
A Thank you I '° trouble you again.
Listen and check. Then practise the dialogue with
youi’partiier.
4 How do youimagine yourself at7S years old? Discuss it
with your partner. Talk about these topics.
family home friends health
sport hobbies routine travel

A Where do N thint' u’///fye w'hen you’re 7S?

B I hope I’ll live nt horne with my family.

Vocabulary
Problems and aids
1 Work in pairs. Match the adjectives with the cases.
Say the adjectives as you do the exercise. The 1 herring aid 7 power chair
stressed part of each word is ini›olA 2 walking stick 8 helping hand
Aneiderlypersonvvho... 3 glasses 9 false teeth
4 pressure pad 10 artificial hip
I cannot leave her bed a frail S incontinence pad 11 walking frame _
2 often wets himself b immobile 6 bath lift 12 commode
3 breaks a bone easily c 1›edridden
4 can‘t hear very well d confused Work in pairs. Take turns to choose a vocabulary item
fomaboveandexplwnvvhaWtiusedfoz,Theother
S cannot move around freely e independent
t› often can’t remember things f forgetful studentrnurtguesstfieitem
7 wears his pyjamas in the street g incontinent 8YAMPLD
8 can’t see very weh li sliortsighted A ft’s/or helping people who are immobile to
9 likes to be thee i deaf get around.
B Is it a power rlioir?
A No. try again.
44 Unit

If I'd known how old I was

going to be, I’d I av2 taken
better Ca eof myself.
Adoph Ztikor
i-rim producer
USt before his 100th birthday)

Listening 2 Now work with a different partner to exchange

Assessing a patient
An elderly patient is admitted to hospital after a
fall Listen as a nurse talks to the patient's daughter,
and complete the table.
information
Student A— You are the patient“s nurse. Teli Student 8, a
hospital transfer specialist. about your patient
Student 8 — You are the hospital transfer specialist Find
out as many details as possible about the patient, and
make notes.
Now change roles.

Writing
LeNer of introduction to a care home
You are a hospital transfer specialist. Using the notes
you made when listening to the patient’s nurse in the
Speobinq exercise, write a letter of introduction to the
care home.
0 = none = mild // - moderate /// - severe
deafness /// Body bits
loss of sight The effects of ageing
restricted movement
Complete the labels using the wcrfis Helnw.
sleep disorders
tinkled focus constipation
problems feeding self
growth rate impairment sensitivity
incontinence fragile discoloured leakage
signs of confusion restrict grey
a Hair loses pigmentafion and turns _ . ’ It
Sistem again and make notes. becomes thinner and its stows doc
EXAMPLE
b The lenses of the eyes become stiffer and thicker It
becomes harder to ' on near objects.
Deterioration of the inner ear causes hearing
Speaking
Teeth become ' and fragile, and fal) out
An elderly patient vrho you are nursing 1s golng to be
e Skin loses elasticity and becomes dry and
transferred from your ward to a care home. With a 6
, It also becomes thinner, causing
pai’tnei, invent details about the pat›ent and make increased 'to the cold.
notes. Include details about these topics.
Digestion slovrs dOwn, causin8 —
state of health hearing and slght
medication merlta) state Fatty deposits "the blood
otliertreatitient mobility flow and cause high blood pressure.
help needed personality h The bladder can’t hold as much urine, and there is
surrie '°
i Box\es become “
 Caring for the elderly

Checklist
Assess your progress in this unit.Tick (tz') the
statements which are true.
Ican talk about some of the main issues of
geriatric care
I can understand an article aborJt the brain
I can use w'i// to talk about the future
I can use vvi//to express decisions, nnd to
make ufiers af\d rec,meets
I can talk abnut the physical problems anet
aids of the clclerIy
I can understand a dekcription of the
physical effects of aseing

Key words
Nouns
rarr h0mr
cognitive function
confinement
confusion
gait
independence
mobility aid
nap
shuffling
stimulation
Adjectives
deaf
degenerative
frail
imrnobiltt
incontinent

Look back through this unit. I inrt five more

words or expressions that you th.ii-.k are r›scful.
 46 Unit

Z Look at the lists, and answer the

1 Work with a partner. How many of these foods can you
name. can you vivo inem mime iisis Dew'
3 With your partner, use the lists tocreate
questions.
Find two good sources of protein.
Find two good sources of carbohydrate
Pind two dairy products.
Find two pulses
find seven ways of cooking food
Which foods on the list are high in fat?
Which foods contain high levels of vitamin C?
Which Goods are low in vitamins?
hich items on the list are junk foods?
\A/I1ich food doyou think iS highest in calories?
the most nutritious meal possible
the most unhealthy meal
a meal for an atNete
a menl fnr a ñ iahetir
a meal for somebody who needs
to lose weight.

DeB
ohoc j
O' bH,na na
to sauce voghuo
q egg @€{6

a
tofti
O1
IT1b trebab
°* w›ne
 Nutrition and obesity

In this unit
o nutritional value of different foods
a vitamins and minerals
e diabetes
e giving advice
e body meas‹Jrements and bmi
e eating disorders

Body bits
Nutrition

1 Work in pairs. Look at the pictures above. Talk about Zinc makes your • stronger sothat you can
why our body needs the things shown. What does it fight colds and infections. It is found in shellfish, nuts,
contain? VVhich part of the body ›s it especially good and seeds.
for?
Omega-3 is an essential fatty acid which helps yotir
2 Complete the descriptions of vitamins, minerals, and * function well It is tound in oily fish J ike
oils with the words belovr, and match each one to a mackerc!, sardines, salmon, and tuna.
picture. Some words are used more than once.
Protein builds tip, maintains, and replaces I h‹• tissues in
teeth organs enzymes nervous system your body. Yc›tzi ' , your ' , and
brain eyes skin immune system your immune system are made up mostly of protein
blood muscles bones cardiovascular system
cells Carbolrydzates are sugars which are broken doc by
' 2 then stored in the '• as a
Vitamin Cis needed to help the ' repair itself source of energy. Grain products such as rice,
when it is cut or damaged.lt is found in fruit, especially bread, and pasta are sources of carbohydrate.
citms fruit like oranges and grapefruit
Pats fuel the body and help absorb some vitamins, They
TheB-vitamins keep the ' Fealthy and h0lQ are aisothe building blocks of hormones, and they
rediire stress. They are found infoods lfke wholegrain insulate nervous system tissue in the body.
break, and cereals. Unsaturated fats, found in oils and nuts, for example,
Vitamin A keeps tht ' healthy and is are believed to protect the '*
irrlportant for good vis’iozi. It is found in fatty foods like
butter, cheese, whole milk, and yoghtirL
Project
Vitamin D is needed for healthy bones and
because it helps the body absorb calcium. Our body Research two of the following substances, and write
makes Vitamin D when our ' is exposed to about why our body needs them, and what they are
sunlight. fotind in. Try to use some of the language in Body bits.
Vitamin E
Calcium is needed for children’s ° and teeth
Vitamin K
to grovr.lt isfound in foods like milk, cheese, and
Potassium
yoghurt.
Selenium
Iron helps your carry oxygen. I/you do not Folic acid
get enough iron, you vrill be pale and tired and you
may J7et anaemia. Iron is found in red meats, especially
livt•r.
194 T I I( IO t1 people
worldwide suffer from diabetes.
In the USA it is the sixth most
common cauw r death.

Vocabulary Listening 1
Diabetes A diabetic patient
1 £isten to a student nurse discussing a patient with a
hospitalniitritionist, and answer the questions
I How long has the patient had diabetes?
2 Which type of diabetes does the patient have?
3 Is the patient obese?
4 \?Vhat does the patient’s ‘special machine' do?
S Can the patient eat sugar?
6 Why should the patient not have big meals?
7 What is hypoglycaemia?

Discuss with a partner what you knowabout diabetes. '

Try to complete the missing verbs. Then fisten again
Match these woids with their definitions. to check.
4 Does he i himself with insulin?
l balance a takrng rcgular cxercise 2 He‘s o . a special diet, is he?
2 childhood b small amounts of food that you 3 Type one diabetes is not lv _to obesity.
eat between meals 4 i his patient has a specia) machine to ch
3 cbet sugar that the body uses for levels of glucose ...
energy
4 glucose the time of your life when you S He needs to c the calories in his meals...
are a child 6 ... lie should lix _ snacks, riot big meals ...
S active e the correct amount of different
tfü ngs
6 obesity the type of foods that you usually Reading
eat Do you like fast food? How often do you eat it? Do you
7 overweight g the condition of being very fat, in tliink it is addictrre?
a way that is not healthy
8 snacks h too heavy and fat Read the article and decide if these sentences aretiue
Put the words into the spaces in this text about (T) or false (F).
diabetes. 1 The two girls in the article said fast food is
'nutritious and good for you'.
Diabetes occurs when your body does not produc.e 2 fast food changed Morgan Spurlock
enough insulin, a hormone that controls the level of psychologically.
'in the blood. One type of diabetes
appears 3 The finn proved that fast food is
good for you.
i.n ', rind the other type appears after the
age ofeigh.teeri. 4 fvloigan Spurlock was overweight when
It is very common for very he started filming,
" P°°P
° ° 8t•t diabetes, so tb.e illness is 1.inked to $ Morgan Spurlock became a fast food addict
For this reason, it is important to g‹•t the right 6 n/iorgan Spurlock died from liver failure.
' between food arid exercise.lt is
important t‹› be *, and to eat a
healthy
', containing
plenty offr‘uit and vegetables. Nutritionists say
"are better
Nutrition and obesity
 Nutrition and obesity

BMI (n) BMI means Body Mass index. It is

used to assess whether a person*s weight Is 0 RMI of . to //. i5the right weight
healthy or not.To raIculate a patient's BMI » RMI of below 1 S. i underweight
you use the formula: o BMI of ! to 29. iS overweight
weight in kilograms
o Bfv\1 of at 0 is obese
hejght in metres+

3 Discuss these questions with a partner or in a group

Is obesity a choice or an illness?
Do you think fast foods should be limited like
cigarettes (for example health warnings, high price,
special places for eating, etc.)?
Should overweight people pay more for health care,
plane tickets, etc

In 2003, American film maker Morrj»r S{›lJrlc›ck marJe a fills about the effects of eatir›‹j c›nly
hamburgers, pizzas, and fries for a month. Th‹' iden r:arr›e tr› fairs when two overweight
American girls took legal action against a famous fast-food company. J he girls a‹.«used time
company of making tf›err far. Tf›e company said that i£ was n‹›t the hon U at mane them
fat, buE eating toe much The r.c›rT›pany alsn saitJ t eir food was ’riLitritious ancl jnnd for

The girls' legal action failed, but Morgan St›url‹›ck ‹Dec ideJ to mest what the company said
abor I I ooh For a mor›tI fy‹ ate only last food, three limes a day, and took the daily
exercise of an average American. Hr filmed himself during Lhis rr ‹›nth and the film he made
re‹nrr 5 tf e r I\nnges tba/ I apprner\ tc him
When Spurlor:k startecJ waking the film, he was health y and slim. On the second day, he had
his first ’fast-food stomach ache', and volT\ited. Over the follnwinq thirty days, he gained 2•1.S lb
(11.1 kg). lie also had otter [Problems depressi‹›n, heurIacf›es, and lethargy ie harJ cravings for
a fa.st-fuorJ meal — only this would relieve the symptoms A doctr›r tolrJ st›i›rlock f›e was addicted
Towards the end nf the month, do cm warncrJ fHn hat the food was causii›q lifo-threatenin{j
liver damage, and said he sl uuid stop. It took five months nn a vegetarian diet to get back to a
nom›aI weight.
Tf›e film he mnde is called Super size me. It was nominated for an A‹:arJet»y Award for best
doc‹ mentary in 2005. The film’s message was that the fast fc›urJ industry was probably
as bad as the tobacco industry — it made a lot of moriey by encouraging ilInes.s

Speaking
Work in pairs Whlch of the
people on the right do you
think these statistics refer to?
1 I 8O m
2 95.7 kg
3 S 11
4 211 lbs
S 1.8 x 1.8 3.24
6 95.7 + 3.24 29 54
W»lter FTudsun
@ I3ovr do you say them?
Listen and check
3 \/Vork in pairs. You are going to exchange information
about the other three pictured people Student A go
to p 110. Stude ct B go to p. 13.
Calculate the BMI of the three people Heidi klurn
Robert Wadlow
George Clooney
SO Unit8

The idea of human beauty Obesity now contributes to the

changes over time.At the death of more than
beginning of the 2Oth century, @ , /) Americans a
Lillian Russell, a Hollywood star, year The incidence of childhood
weighed over // O L/ IN S obesity i4 now at epidemic levels
(91 l‹ilos) To‹1J Harki n
American politician

Language spot
should Z shouldn’t
;. We use sheu/d f shouldn'I to give advice and to say
what would be correct.
You should qive up smoking
Your blood sugar shauldn’t go over 240 mg?dl
c Should is weaker than must.
J should stop eofinp swaa/s — but I’m not going†o!
': Here are some other ways of giviog advice.
and that’s terribie becau e I shou d be o y 65 i s
It would be o good idea to Jose some weight. t’m really shocked. Every time I look in a mirror I
I’d see o riuf ritiontsp, ifI were you ’, but that just makes me eat more. I
G‹° t‹? Gzammax reference p.12NJ am so busy these days, and I don’t have any time for
x i'«ise. Ofcuursc, I know bask food is ',
Complete these sentences using should or shouldn’t + but every time I stop eating it I for a
burger. I suppose I m‹›st he °fast foocls.
Nothing in the same way.
You should drink lots of water before you run a
marathon. I ant ti'ying l›arJ tc lose a kilo a week. Soi‹iotiirie!> I
6
I’m getting fat I , but it doesn’t work. I just feel hungry
more exercise. and then I give in and have spaghetti or a steak -
they’re better for me than burgers, aren’t they? \ will
You _ breakfast —it wakes up stop eating fast foods, I promise — but don’t say I
the body and provides fuel for the day. should do without cola,because I have
People with high blood pressure on chocolate and even ^ sugar from hot
drinLs Completely.
too much salt on their food.
p y _ plenty of vitamin C I thought, being a nurse, you should know aboul
in your died ° and diet, and you could give me some
advice. love
6 People with diabetes _ Hmta
large meals.
7 A person with an eating disorder
helphomapsychologist
8 Children too many sweets.

Writing
Advice to a friend via email Disruss with n partner whnt 8dt ice to give Hesta to
help her lose weight successfully and in a healthy way
A close I fiend has written you an email asking Think about these topics.
for
advice. She is worried about her eating
habits. exercise what not to eat
Complete the email with the words below how much weight to lose when to eat
how quickly to lose weight vrhat to drink
addicted to feel depressed what to eat other good habits
bad for you fills my stomach
cut down get cravings 3 Write an email replying to Hesta.
cut out losing weight
skip meals
 Nofrition and obesity

Checklist
Assess your progress in this unit. Tick (w) the
statements which are true.
I Ca r› ta I k a hOut fC›Orl gKnLJ pS

I can describe the nr tritiorial value uffnot4

I can talk al›out diabetes
Listening 2 I can use should/shouIdn’l to give arlvice
An eating disorder I can understand a tCxt about the effects of
fast food
1:ating too much is not the only eafing disorder, What
other kinds do you know? I cun wake cnIct›latinns ahout people's size
2 @ Listen to a staff nurse pass on informaUon about a
new patient at a shift handover. A nswei the Questions
about the patient.
Key words
Adjectives
addicted
rliahetic
ohese
overweight
Nouns
calorie
1 How old is the patient? Craving
2 flow long is she in for observations diet
3 What is her weight? intake
4 What illness does her mother thlrtk Am ta has? jt.ink Scud
S What is Anita obsessed With? rr›irieral
rlutritiur ist
Complete these symptoms that the staff nurse protein
mentions.
1 abnormal a changes
2 attaclcs of b constipation vitamin
3 difficulty c dizziness
4 feeling d loss Lcok hacL through this nit. Find five rr›ore
S frequent e miserable words ur expressions that you think arc uscf I
6 has I weight loss
7 ii road g periods
8 personality h sleeping
9 stomach i swings
10 stopped havi eg j pains

Project
Inter view a person about their food intake, and vrrite a
report.Include information about these topics.
what they typically eat in a day
their cilUiic ii it be
how active they we
how balanced their diet is
their bad habits
their general health
your recommendations
52 Reading

Reading ban
Read the arö cle and decide if the
sentences are true (T) or false (F).
l Pet visits can help patients in
hospital feel better.
Pets are nervous when they see
their owners in hospital.
Pet visits help children make a
link with theiz life outside the
hospitaL
4 Pets often transmit diseases to
patients.
It 1s easy toset up a pet visiting
programme in a hospital.
What guidelines or rules would
you make for a pet visiting
programme in a hospital? Make a
list.
¥¥’lien Patricia S revens, a nurse,
was in houpital for’ the tairtli ‹if laer
l wii uw, she u'u• scurtxl hud
uncomfortable. She didn’t want
i‹› see her Iä mily or Friends, h‹ t
slee aanted to see leer dog. ‘I
p›ersu‹ideci my’ doctor to let rue
see m\ dog, 1 iv.is taken in a
u'heelchair io tlac loos pital
enrmnce, x Herr ivw- hustannd wus
w'aiting. 1 u.-as so excited and
1s.oppy wh-en na dog ran toxx“ards
nie, xiugging leer t.ai1,’ said
S icvens. ‘It was etter than tiny
mecü catioii.’
Pet pozuer
In recent ycurs, more and mc›re improve pntieni and parent
laospttuls heie found th.it tact morale. I'et vlsits are also allowed
•isirs mn help co calm, ivassuro, on the paediatric word at Sutter
end mut ix-etc tstitienis. S rudies Mec4icnI Center in Sacramct to,
slaoxv Uiat t›euing iinimals can Calif‹rm ia. ‘Rtalay children lassie n
reduce nnxieiy, lower (blood strong connection to their pets,
pressure, and !ielp p›aticnis to heel explains Arn; Nlcdovo»-. child like
fa.‹ter. Patients are sometimes prugmn me co-ordin.atoi’. ‘Il‘ the
liatotoicr to see their pets t)ian they tiers can s isit them on the xs'8rci,
are tO see pet›plc — dieir dog xs e can tiring the child’s normal.
doesn't care if ilaey smell fonny or everyday’ lile Intel Lhe hosptuil,
look een iLIe. and wt Fcel This l1e(| s the child te

fn›pressire results
Leo Ann Matura, an adx'nnced
yracEi«e nurse at d e Mtlhoc1i.sf
Hosp›ii.al in I-luuston,flCxas,
re men(aers Use time a pet vi.‹iied
Her ‹nvner, a svomsn wide 1 ttng
cancer. ‘This patient hard I y ex'er
wol‹e up or Spoke. She nex-er got
out of tied ancl she rarely ate
o iydiiiig,’ say Mdtura, ‘tout aficr
a visii from her dog, she sat up,
lcioked happier, and started
mlking. She xv'a.s a different
person.’
Nut:ilI results arc as imprcssiv-e
as Matura’s, but pet x'isits can
nial‹e e difference. Wlier 31 pet
s’isits wcre ol›ser ved at’ l”he
Hospital for Sick Children in
Toronto, Caiudn, researchers
f‹›urtd that poet visits hel pec4 to
Breahing dou n
barriers
Peop›le may be concerned daat
the5‘ have load no cases of pat ients
tieing hifected by animals. Some
laosp›iial sialf may feel that tact
i isiiing is not a good idea. Lea
Ann Mature comments, ‘I
h‹›ught d e doctcrs u'ouIdn'£
agree, hut all €i£our cloclors think
it’s a good id. s. Ho«’ cr, ic is
important to hax e a cleai‘ policy
snd a list of rules or guidelines
before pets nre aÍlou. cd to 'isit. It
con tnl‹e n lor of time anti cflort to
nin1‹e sure that die prog rnmrne is
successful.“

2Mobile medical
units
Before you read thetext, answer
the question.
After a natural disaster
(earthqu•«kc, flood.\ urricane,etc.)
what klnds of problems might
affcct hospitals and hospital staff?
Now read the text and answer the
questions.
1 Apart from its use in disasters,
in what two other situations
can NorHosp be used?
2 Describe two ways in which
NorHosp isflexible.
3 does the surgical module
contain lighting equipment?
4 How many weeks'supply of
disposables does the rinsing
module have?
S Which module provides
outpatient servicrs?
6 Are disinfectant or insecticides
supplied with the hygiene
module?
Match the green words intlietext
with the meanings below.
J expefienced or suffeied
2 Lkely to last foi a long time
3 ieady to use
4 mačhines for sterifizirtg
equipment
5 items tlwt arethrown
away after use
6 a system of assessing illness or
injury and treating the most
serious cases first
Reading bank
„ ”
NorHosp •
The Norwegian Mohile
Huspital and Disaster Uilit
(NorHosp) is a flexible
medical emergency unit .
composed of different
modules. It is specialty
designed for the surgical
treatment of injLlfies
sustained in natural
disasters and wars. But it can also be used for other purposes, such as the
introduction of health ser’zices to rural areas.
the NorHosp modula can be used in one place. packed up, and used
again in other places. Most of the equipment can be pacl‹.ed in
lightweight, durable cases. It can therefore easily be transported on jeeps,
trucks, boaD. and aircraft.
The module system makes it possible to split up the complete r r it and
use the various rriodriles in different combinations. In this way, NorFlosp
can be tailored to meet particular needs. NorHosp contains all the
instruments and equipment necessary for the treatment ol adults and
children.
NorHosp modules can be Iransporled quickly and efficiently to the site,
and facilities can be operational within 72 hours.
Each surgical module contains sufficient medical equipment to establish
an operating theatre with two operating tables. Theo operation and
examina(ion lamps are included. Two autoclaves allow for continuous
sterilization of instruments nnd textiles.
Each nursing module contains all the necessary nursin9 equipment to
establish and maintain a surgical warrJ wilh 50 inpatients, and has
sufficient disposables for fourteen days.
The x-ray module coi itains a cu‹ripIcte x-lay depai liiieiit iiicludirirj x-lay
machine, manual developing eqLiipmenl, darkroom equipment.
chemicals, films, light boxes, and protection equipment.
The medicament module contains medicines and infusion fluids
sufiicient for the treatment of YOU surgical patients (intravenously and
orally), half of them with abdomen/chest injuries.
Each Medical Officer module contains cquipmcnt for establishing a
simple outpatient department for cliagnosis, and where triage and
emergency treatment can be provicled.
The hygiene module contains equipment for gathering, heating. storing,
testing, and distributing water. Disinfectants or insecticides must be
ordered separately.
54 Reading
Read the text and decide If the
sentences are true(T} or false(r).
1 The pañ ent was admitted with
an injured foot.
2 The patient was admitted to
the surgical ward.
3 The patient diJ nnt e•‹ ‹*•
correct medication.
4 The patient died before he
could beoperated on.
5 The patient dled of brain
damage.
6 It was decided that the patient’s
death had been an accident.
Match the words(1-6) from the
text with the correct definitions
(a—fj.
1 inquest
2 coroner
3 lawyer
4 counter
5 vascular
6 pulmonary
a of the blood vessels
b to act against something
c of the lung
d a person trained in the law who
does legal work for other
people
e a person who investigates the
causes of death
f an inquiry to find out the facts
Inquest told of
hospital error
A FIO.SPITAI . error tell a dying rnao on ihe tvroi›g
tvartJ lor tsvo days a6 deep rein tl1rombosi,a{DVT)
ravaged his hody, ai› inqc›esi heard. S‹epheiz Melx-in
Nenboltt s it'fcrcd mxssix'e brain rtanJage u'hen a
hlood clot formed in hi* veins. Now his family ale
considering legal action against York Hospital.
saying that his tte9th was ‘untii›Jely anti
unnecessary".
Mr Newbold. a 52-yeztr-old maintenance worker,
went to York Hospital on November 3 complainiag
ohm s\x'ollen rigl1t foot. He should ha 'e heels seal to
u surgical u'arJ v here he «oc Idhave heel› created
with Fmym . ndFLlg WhiCh counters the ei”fects of
D¥’T. However, hospital stafl”\vrotigIy admitted
bim to cn orthopaedic ward. where he slayerl for
two days. bslore Fitiall\' heing transferred io the care
ofa con.sultans vmcular surgeon. Ta’eniy-four hours
later. on November 6. doctors decJde‹l they would
have to opemte to remove hir leg heloy the ktiee.
The oj›e a‹ion went aheaJ on November 10, but
two days later Mr Ne 'holtl sulTcred a cardiac
arre.st. A scan rex’eaIc0 he had had a pulmonary
emhoiism, a condition related to DVT. Mr Newbolcl
siif’l’ere‹l basis damage arid died in the hospital on
November IG.
Givinb evi‹lence, the surgeon said he could not
expliiin ss'hy Mr Nexvbcld Ind beeti admitted to an
orthopaedic w‘ard where ii was riot policy tc›
actn inister •'raymin. I-ie did hot kl›ow \thy his
me‹licaI team had not given Mr Ncwbcl‹l t) e c4rug
York ‹x›roner Donald Coverdale said, ‘From
November 3 until the dny of‘the operation. no
Fragmiii wa.s gis'en io Mr Nesvhold. If he had been
admitterl to a consultant ocular sutpeou’s care
from ‹lny one. it is clear thai Fragmin would hiive
heen prescribed. Frugmiti reduces the risk of‘DVT,
but does trot eli@nate it. Ii is iinpossihle io sn;'
whether Mr Nexit›old would has e suffered thi.s
DV’I’ il he hacl receiverl the Fragmin.’ He recorded a
verdict nf death by @isadveiiturc.
K inn Daniglls. Mr Neu bold’s family’s lawyer.
said, ‘Tire family hope that the ho:spitaI w'ill learn
from the errors, atid that mo other families will htn'e
to suffer in flue 1‘uiure.’
A spoke svoiliati l‘t›r Yui k Hospital’s I iHS Trust
sai‹l. ‘We would like to extend cur sincere
sympathies io the family of Stephen Newbold
diii‘iiig this diffictil r time.’
 Reading bank

4Accidentsin
the home
Which oft.he categories in the text
do these home accidents belong

1 liicy Mann left a candle

burning when she went to bed.

2 Two-year-oldTobySmithfell
into a neighbour’s swimming

3 76-year-old Eric Baker sllpped

on a wet bathroom floor.

4 One-year-old Ben Brown put a

small toy in his mouth and it
lodged in his throat.

S Jasvinder Singh cut his hand In the UK, about 2.b million people evei y year seek treaonciit at ap
badly while opening a tin of Accident .ind Emergency department after an accident in the
peaches. home. More than 3,fltltl people die every year *s a result of lsr›nie
6 Ten-year-old Jason Gold accidents, .incl rhe total c-ost of home accident injuries has f›een
swallowed some of his father's estimated at J2S billi‹›n per- year.
medicine.
7 82-year-old Iris Watts dropped a
pan of boiling water on her Reseiirch shows thud mo.‹I home amidents
foot. ecu ii itt the follnieing cate$orins.
8 Nick Young suffered cuts, falls
bmises, and a broken arm when
/O OIIJ
he was putting up some shelves
In his home. fires
9 Lee Fenton was hit bya DIY accidents
falling tree which he was choir in{;
cutting down.
pnckaginp accidents
Join these word combinañ ons taunts and scalds
used in the text.
gnrclcn accidents
1 safety a resources
tlrowning
2 total b leaflets
3 simple c cost
4 limited d services Many of these accidents could (›e prevented L›y following simple
S advice e guidelines guidelines. With this in Samuel, the government produce.s a rangr of
6 emergency f campaigns saiéty cairipaigns .and advice leafier to warn people ai›out dangers
;iroiincl the house.This xs*ould clearly reduce the load rin Accident

police, fire :ind aint›ularice, allowing theiri t‹i use their liliiited
resources for other work.
56 Reading
5Chronicpain
Read the text quickly and choose
a A curetor chronlcpain
b Managing chronic pain
c Hew treatments for chronic
pain
Readthetextagain.Choosethe
cozrectwords to complete the
sentences.
l Chronic pain lastsfor a limited I
ionq period of time.
2 Chronic pain sometimes f never
only exists in people’s minds.
3 The causes ofchzonicpatn aze
simpJé /compiimted.
4 Chronic pain chin /c nnofbe
S The programme helps patients
use their mind f mind and body
tomanage their pain.
6 Patients nFe/ nre not given
medication as part of the
Try to remember the verb used in
these expressions. Then read the
article again and check.
t continue yy extended
periods
2
m a big difference
3
f better about
4
w towardsa
mearñngfuL active and
satisfying fife
tv doselywitha
tearnofphysothnapWm
6a your fears
7 d stretching and
exercise sessions
8 ch negative ways of
thinking
9a deptesston
10 f ourprogramme
......................................................... .. ................... ........... ..
. Wkat is chronic pain?
. There are twokinds of pain, acute and chronic.
, Ac‹›te pain lasts fnr a limited time.and is usually
. the result of an injury, surgery,or medical illness.
” Chronic pain continues for extended periods of
time, sometimes even after the original problem
- has healed.Treatments for acute and chronic pain
are often quite dtfferenL
. Is the pain all in my mind?
t: Many people ask this question when they can’t
. understand wiry they have chronic pain, or because
t they feel that heaith professionals.famiIy,and
, friends don't believe them.But pain is either
present or absent —you can’t imagine it. And we
t know that pain is caused by a mix of physical.
psychological,social, and emotional factors.
•'''”''”' "”'o"ou"""”u”ww”wo" "“w“"“”“"“" "-" "•"
, Will my pain go away7
! At present there is no known cure for chronic pain.
t Many patients say that their pain reduces during
. treatment on our programme, but only a few
people find that it makes a Fig difference on its
t own. However, we aim to help you manage your
day-to-day mood and outlook on life, and generalI}•
to feel better about yourself.
: Advances in our understanding of pain are
t happening all the†ime, anrl whn knnws what the
t future may bring? However, it is more helpful to
foCus an working towards a meaningful,active,and
satisfying life today, rather than on the possibility
t ofa cure In the future.
-
What happens on the programmed
You will work closely with a team of
physiotherapists, psychologists,nurses. doctors,
. and occupational therapists.We will teach you
skills to help you address the challenge of living
' with chronic pain. We help you to understand your
. pain, and overcome your fears about it. We help
you
' to reduce tablets that don’t work.We do stretching
and exercise sessions.And we help you to learn
" ways of relaxing and challenging negative ways of
t thinking; arid so avoid depression.
. Will this programme really help me to improve my
Ilfe,eventhoughmy pain hasn’t gone away?'
Yes, it is possible.Many people who follow our
programme,and similar programmes around the
- world,report that they have achieved a more
' balanced and fulfilling life.Theyachieve this
. despite their chronic pain. _
 Iteading bank 57

patientara lktPROVlNG l'ATltiNT CARE

Before you iead the text below,

look at these words and phiases
from the text and usethem to
predict what you think it is about.
Use a dicttonaiy to help you, if
necessary.
misdlagnosis
diagnosÖ ctool
informaö on database
quality of care
Read the text. lu which paragraph A J+99,jas‹›n and Clzarlorre M.Jude*s three-year-nld daughter,
dc•rIops chickeitp‹›x. The illtzcss folI‹»vcd rhe it‹›rma) pat‹cn›s
will you find information about at fiisr. hut then her syniptoiiis g‹ir u'‹›rse. Dc›ctors told her parents it w'ax
thefollowing. all normal, but Isahcl had tti he rushed to the Accident fi Emergency
t howthe diagnostictoolworks departilient of their locril hospital. Here her condition continued tt›
deieri‹›rule. She uncut into multiple ‹irgan failurc:is .n result uf a

2 whot hoppened to Isabel 1sal›e1 is'as tal‹en to .iii‹›thcr li‹›spital, where she spenr two months
Maude at the local hospital suffering front ic›xñ i shock syndrome and necrotiziiig fusciitis (als‹›
kiHiwii us 't‘hc flesh-eariug hug’}. FCirtuiantcly, lsshrl cvcritu:thy i›iade a
3 how the diagnostic tool can be full recovery. But her parents were devast‘ated by rlie expeneuce — their
need famil3' tluctur mid her local A fi E departineiN had not diagnosed her
sytnpttiiri?s ‹iorrecqly, and their slaughter hurl :iIiiu›st dick.
4 who developed the idea foi the
g diagnostictool Duriny rlic riitie haal rl1cir ‹1arighrer u’as i» I’ c’ SI*ica’• rl›e M.tc›‹Ics and
paediafrici.tn Dr |ose§›l l4i-irt‹›, whu l›rlped to rreat is.zhel, can e up with
S who the system is for rhe idea of a diagnustic t‹›‹›i to rry r‹› stop the kincl of nzisdiag»osis rhat
h:id caused then› and tl›cir dsuyI›rer su muct suffering. The Maudrs left
loin thèse word comblnations their jol>s t‹› sct up ‹y nïc‹Iical charil v f‹› pursuc tlJeii ide. .
used in thetext
Tkr co1i1/.ink' s ii›ission st.atenaeiit is ‘Our mission is ro help reduce
1 clinical a slfills diagnosis mid decision error, and provicle clinician.s xx'itli relevant
2 diagnostic b recovery k Oowledge in their u'orkfl‹nv t‹› help them iinpr‹›ve the cjuulity of care.’
3 secondary c failure The pr‹›duct the htaudes deveI‹›ycd, called lsaheJ, uses seW'are t‹› search
4 full d error n eclit.ml taxes. It all‹›\\’h n cdit:tl htaff t‹› key ia syi»pt‹›nJs, signs, resume uf
S decision e characteristics rests ai›d invesligt1ric›ns, etc. The d:It:hose then ‹leli -ers n lirt of p‹ siblr t!
6 organ f infection iagnt›scs. The tiscr can clicL ui› e‹tcI› diagnosis tt› acccss it›furniation and
ii\wages. The s‹›hware is acccxsil›lc vi.a II+c Wah, ‹ inrrgrnr«rl i tn ‹nJ
elecn”onic r»edic. I records system.
initially, the systri» was deslgncd f‹›r paediatric patients, but it n‹›w
includes ndults : s well. It cc›x'ers all th mator syecialtier, i»clu‹Jing
i»rernal »acdicii c, surger}‘, gynaccolugy and obstcrrice, geriatrics, and

1s l cl is beint; usccl in tl›c UK, USA, Ireland, and India. At ‹›ne li‹›spiral in
the USA, a paedi:itrician listed the niniii clinical chnmcterisi ics of every'
medical admission l‘‹i thr paedi.irric intensive care unit for ture tn‹inth,
alld I5fl)3c inc)ttdrc) the ctIt’l’etit diagfil‹›â i6 ill cvCr}' case. I‘ her llttspili3ls
who lisv-e usecl it say it is especially' useful for crises u'hidi are difficult to
diagnose. For experienced physicians, it can serv’c a,s a renaiiider. For less
experienced physicians, it ceu help t‹› huild t‘heir diagnostic sl‹ill.s.
SB Reading

7Secratsof a
longlife
Read the article and decide if the
sentences arebue(T) or false(F).
Genetic factors expr&in thelong
life of Okinawans.
2 Elderly people in Okinawa
usually eat large meals.
3 Elderly Okinawans are
physically active.
4 Elderly Olfinawans are usually
cheerful and relaxed.
$ On Okinawa, elderlypeople are
often Involved ln group
activlñ es.
6 Young Okinawans follow the
same lifestyle astheir
grandparents. ‹I
Add these sentences to the end of
the paragraphs(A—G) wheze they
fit best.
AU of these factors give
Okinawans ibigai, or’a reason
for living'which makes their
lives happier and more fulfilled.

2 The lifeexpectancy of Brazilian

Okinawans is17 years lower
than that on Okinawa itself.

3 Rates of osteoporosis, heart

disease, strokes, cancer, and
dementia are all low on I›
Okinawa. )i

4 Oklnawans under the age of 50

have Japan’s highest rates of
obesity, heart disease, and
premature death
 Reading bank

8chocolate
Read the text quickly.Who is this
information fork
yañ ’
a doctors
b nutriñ onists
¢0ñâ
c the general public
Chocolate is madefrom the beans oyi CaCao trp.e, and teas Been flopulorfor
Read the text again and complete thousands ofyears. The Aztecs in butt America used cocoa beans to make a
it using words from below. chocolate drink which was refi'eshing and nourishing, but bitter to taste. In
Europe,sweeteners were added, and modem chocolate contains cocoa butter,
mifortur ately afiei tooth sugar, and cream or milk.
decreases slowly full
hungry mood same But is chocolate good for yznJ? Flrst, the good news•
improves before risk Research at Harvard University suggests that people who eat chocolate three
because lower high times a month will IIv2.almost a year longer than people who don't.
quickly
Chocolate contains flavenoids— substances that can reduce the
Match these words from the fext of coronary artery disease. Chocolate also contains small amounts of
Frith the correct definitions. caffeine, which can be beneficial as it. ' your endurance and .. ’
a pros and cons feelings of fatigue.
b fañ gue Eating choco|atc mzkes yoti feel good. I ikc other sweet food,chocolate
c sensation stimulates the release ofeiJdorphins—natural body hormones that produce!
d addicted to (ee|iI1g$ pf pleas use and help to liftyoq *, And because chocolate
e contribute to melts in themouth at body temperature, it produces a wonderful, silky
sensation that people love. According topsychologists, this is one of the
f clog up
main reasons why people can become addicted to chocolate.
1 to helpcause something But it’s not all good news. ',chocolate contains a lot of calories —
2 feeling justlO0 gof milk chocolate contains 520 kcals, while dark chocolate contains
3 tiredness 510 kcals.That's about the “ number of calories as 2.S kg of
4 to block grapes oi 300 g ofgriile0 chickc›.
S good points and bad points The Harvard researchalso suggests that people who eat too much chocolate
6 can't stop doing something, have a life expectancy. Chocolate is. " in saturated
eating something, etc. fats and sugar, so eating too much can contribute to obesity and related
health problems. And the sugar in chocolate can cause .*decay.
But if you reaIIycan’t resist Aocolate, eat dark chocolate— it’s higher in
cocoa than milk chocolate and helps to increase levels oJHDL,a type of
cholesterol that helps prevent fat clogging up arteries.
60 Reading
9 Leeches
Read the text.Match each topic
below with a paragraph (A—G}.
1 Problems with leech therapy
2 Flowleechtherapy works
3 Patient reactionto leeches
4 History of leech therapy
S Benefits of uslng leeches
Find words inthe text with the
following meanings.
1 to make something become
bigger or wider
2 cut off
3 dangeis
4 outer openings in the body
S a state of being blocked or too
full
6 having a feeling Jextreiiie
dislike
ln your owri words, explain
the Job that leeches do
- some tenefits and dangers of
using leeches.
A Imagine having a blr›r›cisucking worm attachcc4 io your holly - by a dr›ctor! lt
may sound incredible. but it liap[oens. and it's known a.s beech therapy.
Lccclic.s are ii t3 J›c i›l‘carthsv‹›rrri, and their use in tnciJicirm diues. L›tick 2,500
years. In Europe. the surgical remove of a patient’s blood u.sing leeches was
prnciised u'idely u iilil lhe I 'Lili cenl ury.They w'erc thought in cime many
âñogs, including headaches, olwsity, eye di.sorders, and mental illness. P'or
most ol’ the 2Oh century the use elf leeches went own of fasluon, but since
dcx'elr›tanienLs in niicrusurgery in ihc 19SCs. ilicy fuive been rpakii a
conielaack.
Leeches are often used today in p1a.stic or reconstructive .surgery, especially
where a part uf the body, such as s finger, liend, tuc, or car hus become
sex'ered and h•is to lv re-iittachcd.This is how’ it works: scnietinacs a
j,aticnt”s s‘cins arc unable to take blood away from the t›c›d3• part anc4 so die
blood builds up, causing ‘venous congestion'.When thi.s iuippen.s, rite re-
aitaclaed }iart ‹if dcc ht›t)y lurns blue and lifeless, and is at risk of being lost.
Leeches attached to the budy wilt suck the blood axvav. allowing the re-
attached b›‹uiv part to sure i•'e until the x'eins begin to w'cirk nc›rnNly.
’late Jccch Birr di›c5n’t hurt because leech saliva contains a natural
anaesthetic. 1 Fch smis-a also contains suhsiances u hich present ilae blood
from alerting, and dilute the blt›c›d vessels to increase blood how fi'hen a
leech is liitl ot‘blood, ii simpl3 fall.s off.
beeches arc inexpmiasive ti› buy, and easy io look alter. And studies have
slaown dear leech therapy can double the success rate of tm»*i•J»od tissue
flaps — for example, w'liere a flap ol‘skin is taken fTOna one area oI‘ the body io
clever •e dcli:ct or inyury in another erea, as in facial reconstruction following
cancer.Tiiis is a nuich higher success rate than that acluex-ed though drugs
r›r lurtlier surgery.
As you niiglit iinuginc. t*aticnts are ufien
t4fSgUlitcCl at the tlaiirighl ol‘having slirny
wcirms attaclicd to their wounds. ftut
«'hen die henefits are explained io diem
they ususlly nccopt the trcaniaeui -
_ mmt ivould rathei hax'e leech therapy
than losc a par t i›f their L y.
Hosvever, thcrc can he t;rot›Ícms.
Flazards associated with leecla
dietapy iticlude inlècü on,
excessise blcod less thst may
retjuire blocd transfusion, and
allcrgic reaciic›ns. St›mciirnvs the
lcvches slif° off pacients and rc-
£yt‘the hotly tljat urc nOt in need
of treatment. Once they are Rill,
leaches xml It it›k ft›r a wnrrn, dark
j;l:ice In digest their meal, antl may
burrow inter wounds or enter the
j,afieni’s naoinh or other •
orifices.To prcxznt escapes, ,
nurses niusi keep careful
cotini ol’the leeches.

10 Death and dying
customs
Reafi the text quickly and nnswer
the questions below
1 Who is this inforrwatit›n for’?
a patients
b healthcare professionals
c religious leaders
2 Wliat ii tltc vv i itci’s if tin ihim i?
a to desrribe the process of
dying and death
b to help people from
different
relic ions doa1 with grief
c to explain how different
religions view dying and
death
Read the text again. raecide
whether each statement relates to
Buddhism, l3lairi. Or Judaism, and
write d, i, ord. There rnay be more
I The clyiii¿7 pprson shoulcl be
krpt qiiiot and calrri.
2 Tlie dying person shoiild not be
len alone.
3 I‘hc body is washecl my fami)y
members.
4 Amy open wounds shoiild bc
S Ourial should take place vrithir
24 łioiirs.
6 Grcmation is not are cptable.
7 Buiial nr crernation are
ar ‹:eptable.
Reading bank
Desth and dying Customs
Death is a cullvrol os well as a biofogica1 agent.It is important for you
to be awore of the cult ural ourt rPliyir›i i helirfs curl ridstomb oj your
dyiny portents and their families these guidelines will help you to
respond in on oppropriate wo)/ in order to provide a culturally-owore
servfce.
When a Muslim dies in hospital, the family may experience a great
de al of anxiety if they feel that healthcare s’taff a re unfami(iar with
Muslim traditions. Firstly, it is important to put on some gloves so
If at yuu edu not touch the body oirectly. The face of the person who
has died should be turned towards Mecca. Straighten the arms and
legs and close the mouth and eyes. After death, the body is washed
by family members of the same sex and is wrappeo in whit:e linen
cloth. According to Islamic tradition, a dead person should be buried
as soon as possible, preferably within 24 hours A Muslim is always
buried, never cremated. Post-mortem examinations are discouraged.
unless they are required by I aw.
According to 6uddhist beliefs, in death the consciousness departs
from one lif’e and begins the journey into another new life. Eor
Buddhists, death is a process in which the consciousness gradually
scp»r»tcs from thc body. This can takc up to three days, wI1icl is
when death occurs. II is very important to provide as much peace and
quiet for the dying person as possihle.The more composed ano calm
the mind is at death, the greater the opportunity for a better rebirth.
Immediately following signs of physical death, Buddhists believe
that rt is bes’t to keep fhe body in a peaceful state.Tra drtionaIly, the
body is taken to the home. and for a period of three days or so
prayers are said ańd the body is not touched. The decea sed may be
cremated or bur!ed, depending on the wishes of the family. Generally
speaking, pcist mortems are acceptable as the body is consioered
tess important after death.
By rel'8'^ °' law, someone should stay with the dyi ng person so that
the soul does not feel alone. The body should also not be left alone
after death. It is important to leave in place any catheters, drains,
and
tubes, as the fluid in them is considered to be part of the body, and
must be buried with it. Cover them with gauze or bandages. Any
wound dressings that have body fluios on them must also be left on
the body. Any incisions or cuts must be covered.The body is prepared
for buri0l as soon as possiblc after death, preferably within 24 hours.
The body is prepared by members of the chevra kaddisha, or burial
society, and the body is covered with a sheet. Post-mortem
examinations are discouraged, unless they are required by law.
62 Readirig bank

IJ ¥ÿphuid Lary
1 head the,textand complète it their rented summer liousé. W"hei1 six of the eleven
iisingwords from below. outbr ak,s, tu look fö r the s‹›iirce. Aftrr sorte month
co-operate disease cured
quarantine forcibly samples
confirmed examples .freely
transrnittecl discuss sent
develo d infection causes
pioNded infected heÎped
investigation lsôlated C eorge Super was certain tÎ\st rhe VVRn the camsC
R Decide ifthese sentences are true lO’rk.A l at
(T) oi falsü (F):
Ma born in the
United States.
2 Maiywas often ill.
George Soper discoeered that
mary was ä typhoid carriêr,
Irish imlTligrdnt whu wäs the first frÔ rn .hcàlih öflicials, shoü iiiiJ; ä rid
Mary wanted to help tÙ e
ä uthorities, ihè. ISA. She probably.:cnniractsd a Mary vins a strong-ininded woman;
5 fer T91O Mary did not worf
l’rightening for her to lie confrc nted
With food agä ln
in: this way. Eventi:elly the NewYork
6 Mä ry iras kept.irihö spital for she beca.nie'ü carter, and sprëad t_h.ë City Health Dep›arirneni seni five
a total of26 years. disease. pcilice ofticers and an arnhulä nce
Typht›id is:BFl infecties. of the and * tool her to
7 Marydied of typhoid.. éiigestive system camsed hy a h,›rp¡ta1,
bacterium, fhiiottella lyptli. Amori g 'Fhe NewYork Ciiy heälth
OtlJCY SyFtip[CJïTg{'5, il' ° inspectö r carried our some rest.« and
ueä kn s:s, high fe'vër, „ä rash of red • that LtBry wes s
sposs, chills, nveaiing,Ü artd seri£iUS cä rrier. !n 1910 she wss tïansferred
«•u• in 1 finn:nl m«rpleen to ari isia 3d »Car Ncwsork City,
and ben.is. deliriu.m:. end eroiion of vhêFe slie livèJ irr isolation f9r thirè
the intestinal wall tea‹iing tô years. the was then releasë‹i but told
liaernorrhùge. Il is ' thai she should not work w4ib feod
through con:tsyiinated food or again.'Hotvevêr, îrr 1:915 she iook a

ü uthreä Ls Of typhoid in the Neiv an‹1 t›ther h°oGpiial itaff - rwo:c›f

Ycrk.City ares betu'een 190fi and them die . Mark.wa:s the ici.zed

on ‹zach occ-nsion, members of the .cottage.

f.prhily or:o:ther serveurs. In December 1. 932; h4ary suflèred
typhoid, 22 people a massive stroke, ivhich left h’er
became ill, and t›ne died. At thC paralysed. She died in 1938 of
timle, typiliciid wan u-mei ions pic uL:lciti, ptjeun onia.

0% Of,suf rc . ttsed to c4escrib›e e carrier of a

In the summer of J9Ii ,Nefi'York dangerous "who
franker Charles. Henry Darren fiired refuses to take precaution or
Clary to be a cook for lu.s.faintly at • with the authorities.
 Reãding bank 63

IZ Hpłhsand ćacts
A myth is Something that isnot
true. Theinformation hëre th Feople with mental illness are viotenl and tipp edičtabla
examiñ ê smyths about mentai
Mentä l ilIri+‘. «”is a figrriertt ofi i›n.
illness and the facts behind therń .
Mentã l illness cań nö t ă fłect me.
Match the myths with the facts. Therapy and séff-help are a waste of tirne.
Mental illness only:affects people in.nch countries.
1

4 If I have a.mental illness,it’s a sign ol wèakńëss ìtś ïny fault.

Most people with meiuaI illness live on”the sheets or areIn îiïèû tá l
5
iospi
6
7
8
Identify three things in this
informatiionthat have improved
your understanding of mèntäl
ißneis.

c Fact Mental i[li éss ïsrt’t your I.áu\t .aw ïîierè than Iïearț dîsëase or diabetes
is your laulț. Marital illnesśis a product ö t biological,psychological.
and social tàclors: Rèseaii:żi shot lhal sć4izophrenia,depression;
änd alcohiilism can be linJted to géù eiić and biol(›gićal tacloni:
SncTal iztlluences, st ch as ü ë lc nf ä I ved’nne nr a ¡nb,can aLs‹›
contrïbuiú to rich ò Nełopiiień t of inéntal illness.
d Fact Mental iiliiess iisorpri.singly corn.nion,and can ailect anyone. A 20tH
survey @› ihe World Health Ò rjjanizatìon õ f 50,00t›adults in fourteen
tountńœńweälëdthaTaÜgni5cantnuihbétofthe’püöp(e:

e Fact’ Menial and brain ò iśordeisare țound among peoplé in dèveloped

cö uń friëš as well aśiû detèloping’t›atiuos. In a study of 27 countrï”es
carried out @• itie1t'‹›ń d Hëalilj Organization, no c‹ninny.ozs lound
to be lrée of schimphrenia. Alcohol abuse is another coiÏuocn
disorõerafotiùd the acrid.
I Fact Most people wiÏIJ mental Ïlln.ess liye in the coinmuțjity” Most peopl’e
wliu need hoșpilaÏization âre omy Ïhere for briùf peŁiods›Łc /qet
trčatmeni änd then rétum hćme. You probably kń ow.som èò në with a
mental il.lness and do‹1’t evP.‹n... r. ealize ii. ”
g Fate ’Menial illness îs”ieaI.!t caik s sü fferiń ğ a”nd disahiIity,and «ah even
słic›rten lile. Thesymptom a’re a șign of real illt essWhicb needs
ireziiineü c”’and diagnosis’.
łi. Fact Tl1ere.is a wicle mnge c›f lrealmenłs,. Iheiapj, and conulautJìty support
toi’tqentaI iliness Must people with i»eń tal i!"'• Ğ get better. Many.
e ã ã
rhä: ::åT ä .ape dn p*tt’rtt t rin’ dt'idt I t ”
C
reco ery *
64 Reading
13 Anaesthesia
Choose the best headings (1—6) to
match the sections of the tcxt
(A-D). There are two
more headings thnn you
need.
1 Some types of anaesthesia
2 Death on the operating table
3 A short history of anaesthesia
4 Anaesthetic nurses
S What is ’anaesthesia’?
6 Anaesthesia Islay
2 Answer these questions about the
text.
l How do anaesthetic drugs
work?
2 Why do you think patients
were field or strapped down
before anaesthetic drugs were
available?
3 What difference ditl
anaesthetic disjgs rnalre tc› the
work of surgeons 7
4 Which was safer to use — ether
OT CTI IOTO OTfH
S Which was easier to use — ether
or chloroform?
6 Do patients lose consciousness
during regional anaesthesia?
7 Is death resulting from
anaesthesia common?
Find words or phrases in the t£:xt
with these meanings
a having a strong effect
b loses the power to feel
c disappear gradually
ANAESTHESIA
‘Anaesthesia' means ‘fuss ‹›f sensation'. Drugs that cause anaesthesia
work by blocking the signals thai pass along your nerves to your brain.
This st‹›ps you feeling pain. When the drt/gs wear uff. you start to feel
nurmal sensations again.
The development of effective anaesthetics in the 19th century was an
important factur in suc«essf ›l surgery. Before this time, few operations
were possible, and surgec›ns were jur'ged t›y tFieir speed. 5orr›e doct‹›rs
used alcohol or morphine to redt.ce the pain. but patients were usually
held or strapped down. Many ‹died on the operating table. Anaesthesia
mcant thnt curgcons could tal‹c rr›‹›rc timc and perform morc complex
procedures.
Ether was one of earliest anaesthetics. but it I ad some drawbacks — for
example. it oould cause vomiting. It was Cjuickly replaced by chl‹›r‹›f‹›rm,
which 'van mr›re potenf and eacier to ‹ ne tip.ot› ether. H‹›wever, it wac
not as safe to use as ether. anrJ coulcl cause st dren death. By the
1 920s, it›traveno 's ir.ducfion agents were introd ,ced. They enabled
patients to fall asleep quickly ai ‹J pleasantly. In the 1940s muscle
relaxants became available.
Anaesthcsia can be given in rJifferent ways, ant4 idol all anaesthesia
' make's yr›u U‹icur'sciOus.
* Local anaest.hesia numbs a small part ‹›f your body. Vou
stay conscious hut free from pair .
^ Regional anaesthesia can be usecl f‹›r operations ‹›i larger or deeper
parts Cl f tt›e body. The most oommon re8'on£Il anaesthetics (als‹›
known as regional ‘bl‹mks') are spinal and epidural anaesthetic:s.
These «an l›e used fur uperati‹›ns on the lower heady. such as
Caesarean secti‹›ns. bladder ‹operations. cr hip replacements. Y‹›u
stay ‹zunsciuus f›tzt free mom pain.
* General anaesthesia is a state of ‹:‹›ntroIIed unc‹›nsciousness. and
you feel nothing. It is essential for some operations stir £\ as
abdominal surgery. Ac the anaesthetic dry g woar off, your
ccnsci‹›usness starts tu return.
o Modern monitoring
systems and a greater
unJerstanding elf the
functions oi the bcdy
mean that
at›aesthesia is now
very safe. Fewer than
1 in YOU.UtXJ deaths
durit g operali‹›t s arE
directly related to
anaesthesia.

14Thareturn of
Thalidomide
Read the artide and decide ifthe
sentences are true (T) or false (5).
1 One of the slde effects of
Thalidomide was nausea.
2 60a of mothers who took
Thalidomide had normal
children.
3 The tests carried out on
Thalidomide were not strict
enough.
4 Thalidomide can cure leprosy.
S Thalidomide can damage the
autoimmune system.
6 We still don’t know exactly how
Thalidomide works.
Add these sentences to the end of
the paragraphs (A—E) where they
fit best.
1 lt has been so successful in
many cases, that it is seen by
some as a'wonder drug'
2 At least now this drup, which
caused such tragedy when
introduced, can now offer hope
to sufferers of conditions that
are otherwise incurable.
3 Investigations began
immediately into what had
gnne wrnng.
4 However, Garry does suffer
from side effects of the drug
such as muscle pain, and
numbness in the hands and
feet.
S Drugs must now undergo
thorough testing on human
subjects before being made
available for general use.
Reading bank
A
In 1961 an Australian doctor, William McBride, noticed
a sudden increase in the number of babies bcing horn
with one or more limbs missing. He realized that all
thoir mothers had taken the same drug dur¡ng
pregnancy, and he alerted the medical world. The drug,
Thalidomide, had heen used since the late 50s I.o
combat nausea during pregnancy. When its
catastrophic effects were realized — 40’/» of aHected
children died in their fii st year — it was withdrawn from
B
Thc drug hod been hclicvcd cafe, as it had been
(horoughly tested on animals. Tests had shown that
rats could be given massive doses without any ill-
effects. Today’s strict rules for drup-testing owe a
tjreat meal tn ThalirJnmirle.
The diug remained out of use until 1964. when Dr
Jacoh Sl›eskin foUnd some old boxes of it in his French
clinic, and decided to tip it as a sedative to relieve the
suffenng of a patient with leprosy, a disease that eats
away at the flcsh and hones. Within three days. lesions
had healed and the leprosy disappeared. Since then.
the drug has cautiously been triaJled as a treatment for
a wide range of conditions.
D The powerful anti-inflammatory properties of the drug
rrjake it effective at tro<itif itj nrtl›iili . AIDS, i'‹'iuILiplc
sclerosis and over 100 other conditions. including
many autoimmune disorders. It is also believed to
restrict the growth of hlood vessels in cancerous
tumours. Garry Edlin. a patient whose rare form of
cancer. n antJe cell lymphoma. has been successfully
treated by Thalidomide at Derriford Hospital in the UK,
said ‘Within ten days the huge lumps had gone — it’s
like a miracle cure.’
Although Thalidorryde is known to be elf tive. wo do
not fully understand how it works. For this reason. and
because of the memories of its devasteting
introduction, it will take sorr e time before Thalidomide
is widely accepted as a treatment.
 66 Reading
15The best
medicine7
Find the answers to these
questions in the text below.
1 in what two ways is laughter
good for patents, accosting to
Dr TiTIl Ciick7
2 Where were the first laughter
therapy sessions held?
3 Why might laughter help
diabetics?
4 How does laughter help fight
infection. according to some
studiesi
S According to Dr Crick, why is
laughter a powerful healer?
Match t)ie highlighted words ln
the text with the meanings below.
1 the effect that you are trying to
achieve
2 recovery after illness or injury
3 designed to help treat illness
or to help you relax
4 makes something begin to
happen
S to increase something
6 hormones produced in the
brainthat reduce pain
It’s not a noise that yOU Usually hear comiMg from a f›nspitaI rnnm ‘Ha he
haa! Hee IJee!’ You oper the door to see twelve patients - all sir:k, several in
wheelchairs — tickling eacl other with long balloons and laughing es I oFd dS
it‘s possible to laugl .
Joii'ing in with lhe fun is Dr Tim Crick, and tL›is is his weekly session of
la ghter therapy at Leeds City Hospital. The aim of these 30-minLite sessions
is not only to help patients forget that they are sick. accorriir g to Dr Crick:
’Laughter gives the lungs and the mf›scles a good workout, which is
important in long-term patients. But more than this, I bed eve that laughter
can actually speed up recuperation from sickness..'
Laughter therapy’s recent history begins in the 1980s, when writer
Norman Cousins clescribed in Anatomy of an Illness t›ovv he used comecly
films to successfully give himself some relief frum a painf ›l medical
condilion. This prompted academis tn l›egin looking a+ the ; hysinlnrjirnl
effects of laughler. The spread of therapeutic ’law glster clubs‘ Uegi» in lr rlia
in the 199Os with Dr Madan Kataria, who hegan taking patients for sessions
in a public park.
So is there any science behind the claims that lauqhter speeds recovery?
Certainly, it triggers a range of reactier s in the hociy. Some str dies have
shown that the ability to use and respond to humo‹ r may raise the level uf
infection-fighting antibodies. and boost the level of immune cells. A recent
study with diabetics showed ttlat laughter helped control Llccd sugar levels.
And research at the University cf Maryland st owed thot LaugfHr g helped
blood flow fry keeping blood vessels relayed.
For Dr Crick, it is in Iaughter’s auility to relax us that its Ole.aling power lies.
’Aftur a good laugh, orir tTlLiscles relax, or r mir d stops fcLLsir’q on pain or
negativa thoughts. and endnrphins start to flnw in mm hmins It pcits the
body iv a situatior where it can hecgin to I eal itself When we are healtT°.y we
can ar:hieve lleis state througf physical exercise, sccial cantant, and so on —
thir›gs that al-e more diflicult wheii ycu aie ii› t›ospit‹al. Laughter, in the .Dame
way as music, cara hrin9 •!• xntiOi intU the wards.‘
While many are dos I tful ahGLJt the sever tÍfic hasis uf IaugL›ter tlierapy, it
woulrl L e impossible for even the rcost extreme sceptic to watLl Il ese
twelve patier ts in Leeds laugh L Dtil tears rur› dcwn (heir faces withor t
thinking, ’Tl sis is dolrig tf›em gucd.‘
 Reading bank

Reading bank key

I Pet vlshs (p.S2) 5 Chronic pain (p.56)' 1F 2 F- 3T 4F SF 6T
7F
1 z z r 3 T 4T •r zr
Z Possible answers 2 1 long 2 neuer 12 Myths and facts (p.63}
The pet should be in gcod health. / clean 3 Complicated 4 cannot Ib 2g 3d 4a Se 6 h 7c 8 f
/ stay witfi the family or patient al, all 5 rtiind and body 6 are not
‘ e
3 2 rriake 3 feel Students’own answers
The hospit‹al should check that patients 4 work S work
in herts nearhy nre not nfraid ofU€ 6 uverccme 7 do Anaesthefia (x64)
allergic to the animal The doctor should TE 2C 3 A 4P
8 challenge 9 avoid
approve. every v'sit. The family must sign ’1 They hlr›rk the signals passing
a consent f orm releasing the hospital 10 follow
f'om !iab'l tyi
from nerves to the brain,
a •eem«.gpatfe..tcare(p.m 2 Because operations were very
Mobl!|e mpdica] ugtit$ (p„y3) 1 Students'owri answers painful before anaesthesia.
3 They could take more time
Pos,sible answers 1 1£: 2A 3G 4C 5F and peift›rrn rnore complex
The hospital has noeleCtri£ity or running 3 Je 2a 3f 4b 5d 6c procedures,
water. Hospital buildings / equipment 4 Ether
are dam›aged.The h›uspital runs out of/ 7 Secrets ofa long life (pt) S Chloroform
cannot get supplies. The hosp•ital staff
1 1F 2F 3T 4T 5T 6 6 No
are k:il!ed. irjlured, or cannot get tc•work.
The number of patients Increases. F 7 No, it is rare,

1 wars, health services for rural Z ID 2G 3A 4_ F a potent b numbs c wear off

areas
2 Possible answexs 8 Chocolate(p.s9) 14 7he return ofThalidomide(p.65)
1 c
It can be used in different places. It is 1T 2F 3T 4T 5F 6T
easy to pack / transport. The modules
2 1 risk 2 improves '
can be used ini different com›b•iiJations. 3 decreases 4 mood 1 IC 2E 3A 4D 5B
S Unfortunately 6 same
3 yer 7 lower 8 high IS The best madi‹i•se?(p.66.)
4 twc
9 tooth 10 full I It exercises the lungs and
5 Medical Officer mcd\Ie 11 after 12 slowly muscles, and it speeds up
6 no
3 aS b3 c2 d6 e1 f4 recovery from illness.
1 sustained 2 durable
3 operational fl :autoclaves 9 beeches(p.d0) 3 It helps control blood sugar
5 disposables 6 triage levels.
IG 2C 31 4B SE
4 it may increase the number of
Hospital enor{p.S4) 2 l dilate 2 severed antibodiesarid immune cells
IT 2F 3T 4F 5T 6F 3 hazards 4 orifices S Because it relaxes us
S congestion 6 disgusted
11 2e 3d 4b Sa 6c 1 aim 2 rccupeiation
3 Students’ own answers 3 therapeutic 4 trigger
4 Accidents In the home(p.5Sj S raise / boost 6 endorphine
30 Death and dying customs(p.6t)
1 fires
2 drowning ¥1 b 2 c
3 f’a1ls Z I Buddhism 2 judaism
4 choking 3 Islam 4 Judaism
S packaging accidents S Islam, Judaism 6 Isle.m
6 poisoning
7 burns and scolds
8 DIY accidents 11 typhoid Katy(p.52)
p garden accidents T 1 cured 2 causes
2
5 invesfigation 6 samples
7 forcibly 8 confirmed
9 infected IO quarantine
11 disease 12 cooperate
68 Unit

ScruB up
There are four main blood groups: A, B, AB, and0. $ach Z Not all blood types con be mixed together. Stead the
type can befollowed by + or-. Do you knowyour blood information below, and work with a partner to solve
group? the puzzle.

DONOA

ven the other women. R

hJadcly ’s blofJd Ca» t he gi
t m Kalie and Alex.
blood tO Freya. C
Oly Katir could donate ‹ve blow to Maddy. E
o\ the omen could g
Your w blood y Of the others.
{VCn
Alex can’t be g
„ A+ - +"
A6— = E
AB
' 0+

Vocabulary Listaning1
Testing blood Blood types
Completelhetext using the words below. Use your 8 Listen to some student nurses learning aboulhow
dictionary tohelp you. different hlrinri types rrtixtogether. Which two blood
types are mixed together in each pictiue?
slide drop microscope syringe
vein test tube pipette

Use a 'to take some blood from a

'in the patient’s arrm Put the blood into a
'.Then, use a •to put a
'of the blood oato a *.
=type +type b= type +type
Examine it under a ‘'.Whatdoyousee?
2 Which blood type is most useful for emergencies?
 Blood

In this unit
e talking about blood types
e describing blood samples
e doing a blood test and giving the results
e desrri bing logical sequences using i/ and when
e the heart

Speaking
Describing blood cells
Identify each type of blood cell in the picture below.
C platelets
white blood cells
bJood cellsa | b | C

*'ce
ee' e* epp' s ', e * ee{
e
* ' »‘ 11
Find three more mistakes in this description.

r.irr./JInr
There are many red blood cells moving
freely in the plasma. The centres of the red hlood cells
are a light colour and the cells are all the same size. You are going to read about our knowledge of
There are three white blood cells in the diagram. blood. Work in pair s. Studsnt A be to p.110. St eduit B
They go to p.113
are more regular in shape thru the larger red blood
cells. There are many platelets in this drop of bloom. About SOO BC Alcmaeon
They are the small, dark, oval-shaped I odies. About 200 BC Chinese scientists
J492 doctors in Rome
This blood has cancer. Write a description of what
1658 Jan Swammerdam
you
see in the diagram. 1818 James Blundell
1874 William Ostler

e 1901 Carl Landsteiner

a * ee e 1912
1917
Rogrr ice
Oswald Robertson
1940 Karl Landsteiner
t3 1948 Dr Carl Walter
1962 Max Perutz
 70 Unit

The -i r›r - sign after a person’s r'‹›t have it to produce

blood proup sl ows whether or
not the hlood has tf›fi Rhesus
factor ci› the surface of their
blood cells.-This is ar: antigeti,
whiCh causes people who do
ant ibocties When their blood
comes iriio contact with it,Thjs
causes their blood to become
too thick.

Listening 1
A blood test Language spot
Zero and First Conditional
We use the 2ero Conditional to talk about what
always happens in a par ticular situatiorc It is often
used to talk about scientific facts.
If you heat water to 1OO°C, it boils.
fatten you get pregnont, you put on weight.
’I’he Present Simple tense is used in both parts of the
sentence.
that happens to the blood when you take aspirin7
Glisten, complete this description of a Complete blood
Count (CBC) with the words below. We use the First Conditional to tñ k about possible
future actions or situations
infection platelets If you remind mc Infer, f’fl come and help you
haemoglobin oxygen You won’t get I here on I ime if fiou don’t he rry.
clot red brood cells Von won’t get there or I ime unless you hung.
white blood cells
be don‘t use riff Z won’t after if/ when 7 unless.
be use the Present Simple.
A C8C rne›isiircs the number of different cells that If you go through the suing doors, you’ll see the oJre on
mule tip the blood. It look.s at: the J@.
' — these take . 2 from the Underline examples of the 2ero and the F•irst
lungs to the body’s tissues, aIld take carbon dioxins Conditional in the Listening script for listening I on
p 129
away at the same time ’fhe C.bC also measures the
amount or ' {r. protein in the cells that
»
carries the cx ygon), u.nd looks at the sixe arid shape of Complete these six t‹n ices usñ ib the 2ci ci C›i Lite lii Lt
Conditional
the cells.
1 If you explain the problem to Sister, she
—these l•rot‹•. I tl it: l›o‹ly at;iiii isI (tell) you what to do
2 When you have an anaesthetic. it (stop)
’— you feeling pain
thcne make the blood .
3 R I have time this evening, I .(help) you
vnth your homework.
2 Linen tot he dialogue and answer the questions. 4 You (have) a fever if your temperature
I How dOeS the patient feel? Elbe) over 37.S‘C.
2 How much blood is the nurse going to take? S If a person's brain _{not get) oxygen, they
3 Whnt problem does the test result show?
4 i-tow many million red blood cells per microlitre
6 Jf you (take) a sleeping pill before you
does it show?
goto bed, you {sleep) well tonight.
S How can the patient correct the problem?
C Hnvvithestapeoftfie edcells# 2 With a partner, write three scientific facts using the
7 Howisthepatientswh2eMoodcehcount Zero Conltional, two true and one faise. Read tnern to
8 how are her platelets? the class. They have to guess which one is false.
 6lood

3 finish these sentences with true in,formation, then

discuss them Cth a partner. The heart is a muscle as big as youx fist in the centre
1 When I get home tonight. I’ll ... of your chest. It is an efficient ' that can get
2 If the weather's good at the weeliend, ... blood to the furthest cell in your body within sixty
3 I'll be very happy if... seconds.
4 IN be very disappointed if... On its circular journey around the body, blood
° the heart twire, lure wdh oxygen o
nrl once without oxygen
Body bits
The heart
£ook at the diagram and complete aorta
the descripñ ons with the
words below.
pump
pulmonary artery
leaves
valve
enters
nitery ”
flows -
atrium ’‘ ,
" Bloodcariyingoxygen
aorta comes into the left side
of the heart. The left
opens
closing ^ Ms, the
mitral valve opens and
beat
the blood °
intn the left ventride.
‹ The aortic valve opens
_ and the blood leaves
” through the
Blood without oxygen
comes into the right side When you listen to a
of the heart. It heart ' you
' the right hear‘lub dub, lub dub'
atrium. Then the This is the sound of the
tricuspid valve
•and the
blood goes into the
right ventricle. Then the
pulmonary ' mitral valve
opens and the blood
* through
the pulmonary

tricuspid valve
 72

Solve this ‹time

”the investig›‹tnr knows the
Oate:123§ r:›urderer useJ a sickle.Bot he
Place: China can't find the murdgr weapon
A man is murdered in a village because all the sickles in the
village are clean. He I ays them
a(I out in the sun and watches.
Soon he knows which sickle was

Reading › ›md words in the text Cth these meanings.

Do you know of any murders where blood analysis has 1 (used about a thick liquid) to
helped the police to catch the killer? Tell the class. IT1TUe S l Ciwly 0

2 Read the aTticle, and decide if these sentences are 2 a knife, gun, or other thing used to
true (T) or false (F). hurt people
i Blood from a cut artery drips out. 3 salrva, semen, and other liquids
2 Blood pattern analysis looks at the shape of tops of in the body b
blood.
4 people who the police believe
3 Luminol tells you the blood type..
committed a crime
4 1\nale blood is dix terent irom female blood.
5 Graham Backhouse’s neighbour shot himself. S hurt by a weapon
6 responsible for a crime 8

81OOO PA77ERK ANALYSIS

Even a tiny drop of blood at Ehe scene of a violent crime
‹:an give important information tn thr policr. Bloom in
there either because it has dripped out of a s‹iiall
wound, sprayed out from an artury, oozed out throurjh
d ldrCje wuur›d, cr fluwri off a wuagur›. Usirlg blood
pattern analysis, poIi‹:e can learn a lot about what
f\d|D}›t fJucJ fr€JtTi \lie sl d|Do uf the L›lucx) cJr ups.
In 19d4 a man, Ciraham› BaCkf ouse, was found
injured near his hume with drop ‹:uts across his fa‹:e
anrl r:hcst. A neighhcur lay duad nearby. Backhouse
sairl the neighho‹ir attacked him, arid sc ho shot the
riuiqhbcur to clr:frnd himself. But the shapr of the
blood drops showrcJ rhat Backhouse was star›dir›g still
wht‘i i I \L' wd5 wuur idnd, or ml II ›uru wdx ulau i its LiloucJ

Sometimes a murderer cleans the crimu scum very from Backhoi sr cm his gun or near Ehe victim. Police
rare.fully, and if detectives cannot see any blood they were sure Backhouse shot his victim and then wuur ded
spray a chcmical called Lumirlol acros.s Ehe sc.ene. This himself. He was fuurJd quilty of murdrr.
makes it possible to see the blood ir the dark. I uminol
can show up very small drops of hloocl.
From bluud at the scene of a crime, police can learn
abouE the person the blood came from. They can tell
the person’s blood typr and, because male and frrnalr
blooct cclls are different, they can alsc work ouL if the
bluud comes from a mari or wuman. Also, 80% of us
are ’sec.reEurs’, which rlleans our blood ty|ue is
contained in other bodily fluids. this can also help
identify suspects.

Project
Research one of these topics, and present what you find
out to other students.
Forensic analysis of hair, DNA, and fingerprints
a crime that was solved using forensic analysis
 Blood

€hecklist
Assess yo‹ir progress in this unit.Tick (w) thr
statetnents which are true.
I can describe a blood sample under a
m.icroscope
I can talk about blood tests and their results

Speaking I can use sentences to talk about general

or future situations
1 Have you ever been in a car accident? Have you
I can understand a description of how the
ever seen one? Describe what happened.
heart works
I can understand an article about forensic
analysis of blood

Keywords
Blood artery
bodily fluids
cell
clot
2 Read about the results of a car accident. Then close drip
drop
your book and check you have understood the same
forensic analysis
details as your partner.
haemoglobin
platelets
Three people have been seriously injured in a road
vein
accident, and brought to hospital. In ono car was
twelve-year-old Sally Cook arid her 70-year old Fqiiipment
grandfather William Cook Sally has lost a lot of blood, microscope
and needs a transfusion. i-ter grandfather is pipette
unconscious. and needs a bed on ICU and a ventilator slide
(= a breathing machine} to keep him alive. syringe
£red Ellis is 21 years old, and vras driving the second test tube
vehicle. Police say Fred caused the accident. Lie has
severe injuries. and he wil.1 need a ventilator and a bed Look back through this unit. F-irid five more
on ICU words or expressions that you think are useful.

3 Discuss the following problems in small groups.

1 Sally’s parents belong to a religious group which is
against organ and blood donation. They do up{ want
their daughter to have someone else’s blood. Should
the hospital respect their wishes, or should they
glve her a Uansfusion?
2 There is only one bed available on ICU. Who
should have the bed, William Cook or Feed Ellis?
74 Unit

Scrub up
Work in pmirs Discuss the questions
Wnich is more common in your culture, bui’ia1or cremation 7
What is atypical funeralIi1‹e?

Vocabulary Complete th csc sentences list ng the words in I

Talking about dying I This boy has serious head injuries. He has been in a
for a week.
Match these worcts wiLh a Llcñn Lion. The patient stopped breathing, and is now on a
1 termini a (of an accident or illness} that machine.
causes death We need a porter to take the body to the.
4 I‘m afraid your father in his sleep last
2 fatal b to become more and more
night.
week
3 go 8owr\hiII c There was a accident outside the
an examination of a body to find
out how the person died hospital —both drivers vrerc killed.
4 coma
the use of machines to keep a 6 The showed that the old lady died of a
d person nlive stroke.
S mm support e (of an dlness) that cannot be 7 After a bad falL Mr Deans _ very last and
cured, and ca uses death died the following week.
6 pass away f a room in a hospital where dead
This gentleman has _ cancer. With
bodies are taken and stored
treatment, he may live another year
7 mortuary g an unconscious state that a
person cannot wee from Choose one of the words. Tell a true slory which
8 post—mortem a polite word meaning ’to die' includes it
h
 Death and dying 75

In this unit
e talking about dying
o the body after death
e expressing possibility
e discussing euthanasia

Listening
Report of a death
I A nurse visited Henry Jacobs in the days beTore he
die‹L Listen to him reporting to his supervisor, and
answer the questions.
1 When did the nurse first visit Mr Jacobs7
2 What happened at four on Monday7
3 When did Mr Jacobs die?
2 These ore snme nf the thin g.s thot run happen
when a person is dying. Listen again and tick
(J)thethings that the nurse mentions.
1 O The patient’s hands, arms, and feet become cool.
2 O They become incontinent.
3 O They hallucinate (see people or things
that are not really there).
4 0 They want to sleep all the time. 7
S 0 They have difficulty breathing.
6 0 They become restless (unable to resl).
They lose consciousness.
8 0 They become confused about ttme.place, and
who people are.
9 The colour of their skin changes.
0 Their breathing becomes irregular
10
0
11 £J They don’t want to eat or drink.

Body bits
The body after death
1 What happens to the d ferent parts of the body when
we die? Discuss it Cth a partner.
2 Look at the diagram and complete the labels vrith the
words below.
beating breathing slightly cools stops
rigid release ceases open enlarge
1 Brain activity
2 The skin
6 stops.
3 The eyelids slightly and the pupils
7 The heart stops
4 The pulse 8 The bowel and bladder. their contents.
I Thejaw relaxes and opens 9 The limbs become
76 Unit
hospice (n) a hospital íor people who are dying
Reading
Read the article about a children's hospice. anyd m
i
each of these headings to a paragraph
1 Saying goodbye
Z Using the senses
3 A home from home
4 Personal care
5 Helping the family
7ńe $ope Čhi’l(ren’x Hoxp›če
* the Hope Childrens Hospice pruvid s
free specialist care lor children wilh tile-
Iir»itiMs • *łdilions who are not expecte¢l to
live into adullhood. It cares for up t‹›eighi
terminally-ill children at one time,and aius
tu care for them in lhesame way their
łamiń es would cam for them at home.lVhen
families prefer to do the caring tIzemsel\es,a
hospice carer will go to their huine and help
them .
Life4imitirig condiüons prmnt many
long-term nJemica1 and emotional prol›Iems
— not only łor the chiId,but for parents and
siblings too. So łhc hcspìce oiled respite
care —st on stays (or (he child alone or for the
xvI1ole family together. At these tímes,parents
hand over resjJonsibilìtîes lo the siaff and
leave a‘holiday'. SI ortstays give terminally-ill
children an op/›onunity lo meet others with
similar conditions
Each child at the hus\vi«e has their own
carer and their own caie plan. A normal day
+ 'shf start with a jacuzzi balls followed Dy a
massage from a
complen ’nlary
therapist.5onie
rlailrlren gn lo
school,wliíle others
play with hospice
play specialists.
Ż Read the article again and answer the questions.
l Do children have to stay at the hospice all the tìmel
2 How does the hospice help the children’s families?
3 How many children does each carer look after?
4 What can chiltlren do in the mu)ti-sensory room?
S How is music used at the hospices
6 How arethe special quiet rooms used?
“
D I I ie hospice hasa mułtï-sensary zoarn›@' ’I z'
This isa special ruorn which stimulatestțje
childienssenseswith lights. mus}j;,JqØi,
arid smell. lt has touch+cieeo cofdtJtitørs,
video gumes, paddllng pix›ls, andspace for
wheelchair dancing. Children have music
thera 'and can recorcł theíroum music,not“""
unI;'as away to express theiz feelings, but to
leave something for their family and Irlènds w• la
łÎsíen to In thejæazsto conta -^
the hospice Isa numbet of quiet rooms
where we care forchildren during and after
death. lÏiese are placeswheze families and
friends can say yoodl,ye. Dir support does
not etxÏ with death.We help not just gń eving
parents,but ako siUlïngs who are
experiencing bereavement. We give
everyone opportunities to discu stłieir
tears aUuul ¢leath and dying.
Patient care
Breaking bad news
3 Medical staff sometlmes need to grve sad news, fOf
example that an illness is terminal, or that a relative
has died. Here are sonic tips for brealang bad news.
Discuss the reasons for each one with your partner.
allow a lot of time
find a private
place express sy ii
ipatl iy
use simple and honest language
2 Add three more tips.
 Death and dyi»g

Language spot 2 Work with a partner. Discuss what these symptoms

Expressing possibility could indicate in a patient.

When you are not sure about something, you can a fever tliarrhoea
use the modal verbs moy, might, or could. The a rash sleeplessness
verbs all have a similar meaning. stomach ache crying (in a baby)
They“re going to try a new drug. it might work ond it extreme tiredness painfulfingers
E XA M P LE
1-ie’s been diagnosed with concer. 1-ie may hove only A A/erer m!9ht ind/cnfe ‹in infer i ion.
weeks to live. B Or it could be flu.
Mrs Carr has developed a rash. She could be allergic fa A Or muybe the person has.
Penimllin.
Spend five minutes thinking about your plans for your
You can use these verbs to talk about possible future free time in the next week Note down your definite
plans or schedules schedule, your possible schedule, and things you
I'm tired, so I might nOt 9^ ^•! • g* haven’t decided yet.
Imag be worfi'ing nights nextFriday— I’ll have to check
E XA M PLE S
Here are some other ways to express possibility. I‘m working tomorrow night.
He soys his ear hurts. Perhaps he has a• i•yection. I could be meeRng my ynend or Sundoy morning - I’ll
Mrs Ferreira is tolling to herself, Maybe she’s having check my diary.
hallucinations.
* !9^‹ :iO Shopp!^9 Of I mny stay in and study.
It’s possible fhof the growth is cancers us, so we’ J/ need
to 4 Work in pairs. Talk about your plans and schedule.
do tests.
» Speaking
Complete these sentences using an iterllfrom the top
When a patient dies in hospital. a nurse null prepare
group, and a verb from the bottom group.
the body if relatives want to see it. Discuss with a
may might could partner what you need to do to the body. Think
maybe perhaps It’s possible that about thefollowing.
left 's has gone be go have to eyes position
1 I can’t find my phone. I mouth jewellery
buy another one. hair lines (N, catheters. etc)
washing the room
a little late for my shift—
rnybus isn’t here yet.
3 T to the cinema tonight — I
haven’t decided yet.
4 Marie isn't herei she

S Thobed'seip\¿ Mrs Lewis

home.
6 You've lost your notebook? you
it at reception.

Student A go to p.78. Student B goto p.113.

 78 Unil

In the UK, before a body can be buried euthanasia (n) tt^e practice
or cremated, a ductor must issue o (illegal in most countries) of
death certificate stating the cause of killing without pain a person
death. If there is doubt abooL how a who is suffering and cannot
person dies, Lhe doctor reports the be cured
death to the coroner, an official who
investigates causes of death.

Student A
Pead these guidelines for preparing a body, and draw
simple pictures in your notebook to help you
remember them.Then close this book and exchange
information with Student B. Ask questions, for
example What do you do with the month who I obout
washing? etr. Make notes as you listen to Student B.

eyes
Close the eyes if you can. It is not
always Death certificate
possible.

comb the hair. You may needlo use a

washing wet comb to make it tidy.
Pleose lich one of the lâllou›iny.
— There will / M will not be a post-mortem
0 — The death will be reported to a coroner
Cause nfdeoih
I n Primary cause of deoth stroke 4 days before
dealh

o
jeweUezy Other importoni conrliiions
Diat›et.e°: t IO years)
If there is going io be an auiopsy, Demcnti a (O monLhs)
)ines leave all fVs and catheters in. If there
is no autopsy, you can remove them.
But remember that the sile can bleed Complete this su mmary Cth the prepositions below.
post mortem, so cover these with
for with by for in from for
gauze

the room ’Tariq Khamina suffered ' diabetes

' ten years. and was diagnosed
* dementia six months ago. He started to
receive treatment ' heart disease five years
EIt I¥*8
Death certificate ngo, and has also been treated ' high blood

Work with a partner. Close your books and write down pressure. He suffered a stroke caused ..•
vrhat information you would expect to find on a death hear disease and died ' hospital.
certificate Then open your books and look at the
certificate tocompare.
 Death and dying

Checklist
Assess your progress in this unit. Tick ( ) the
statements which are true.
I can tnlk at›‹›ut what happer s f›ef‹›re anJ
after a {›erson's death
I can t›nrJe.rstand a text about what happens
tu tlle f›udy after Jeath
S @ Listen to two doctor’s talking about a paüerit who
has died, Marün Webb. Make notes as you listen. I can understand an article aL›uut hospices

4 Write about Martin Webb's medical history and dead I can express possibility in dil-ferent ways
Use your notes and the text about Tariq Kharnina to I can air dcrstarid a death certificate
help you.
I can write a report about a patient’s death

Speaking
d!gr› Keywords
www -. ice4Dia r›org.u Norm
body
bereavement
htJrial
carer
cremation
dementia
funeral
life-limiting condition›
siblings
stroke
sympathy
Work in small groups. Discuss the questions. therapy
Do you know of any cases of euthanasia that have Verbs
been in the new? diagnose
Ir' your opinion, do wehave the right to choose lose consciousness
when we are going to die?
’”b!**'°’
Do we have the right to choose when another
person is going to die? Adjectives
grieving
Z Read the true story below. multi sensory
A dnctnr, seeing his R7-year-old better s\Ilf”erii\g fi'om
f.ock back through this r nit. F-ind five more
telw ii al cancer, ii tected him w i¢h emu s, cn\lsin¿L his
words or expressi‹›ns that you thin k are useftal.
cleath immediately The trld°ed decided thnt the doctor

3 Discuss the questions.

It your opinion, is the doctor guilty of
murder? If you were the judge, wnuld you
send him to pi ison? If so, for how low g?
4 Your teacher will tell you what the judge said.
80 Unit

Scrub up
Test your knowledge of hygiene by doing this
quiz

1 What is MRSA?
a a virus
b a Dncteriuni
¢: an antibiotic
2 How do you catch
MRSA?
a by eatirig from dirty
plates
h from pcoi t›ospitaI
hygiene
c by drinking lJąd wator
3 Which of these things
has nothing to do
with bacteria?
a wine mak ir g
b yoghurt
c the common cold
d bad smells
‘f Where do
staphylococcus bacteria
hot live?
8 How long should you
wash your hands in
water to be sure they
a it F\ oses arc clean?
b in soil a fifteen seconds
c in toilets Li half a rrinrite
4 In an operating C one minute
theatre, which of these 7 When F-lorence
tl łir I\§S Ćf€'dkS l1y\git2i it° Nigl ifii‹g<sIo, fuuiider
rules? of modern nursing,
a w ring you rnmk worked in a hospital
over your r ose during the Crimean
b wearing your ham loose war (1854-1856), the
c we0rinq make up death rate dropped
from 60% to 2.2°4. ’”
Which of these thinps is Why?
most important in a She made nurses wash
stopping the spread of their hands
MRSA? b She gave her patients
a hospital staff should fruit and vegetables to
wash their har›ds uat
between patients c The ’eiltilation was
h cleaners mhm Id in protect
disinfect door handles
c visitors sho Id wear
masks

Vocabulary
Hygiene equipment d

1 Match each of theae iterns od hygiene equipment

to a picture. . x
bin clinical waste disposal bag yg
“N,
bucket
detergent
cloth
disposable gloves
mop- paper towels
sił scaprllspr’ er

f
 Hygiene

In this unit
o hospital hygiene quiz
e talking about the spread of infections
G understanding a hygiene inspection report
• talking about obligation
• MRSA
e cCimpleting a Pathology lah report

2 Complete the sentences with the words below.

contamination disinfectant
antimicrobial agent susceptible DeVore you read, discuss these quesUoiu with a
pathogens resistant partne›.
scab spotless In the hospitals and clinln you know, how much
1 An wilt lriT1 microorganisms. time do nurses spend cleaning?
2 Use a sterile to get a sample mom Wl rat ix tl i8 b83I why tii i t iakcñ • em s l<iff follow
the back of the throat. hygiene procedures?
3 Our birdies have ways to ii 2 Read about Harriet Banks and answer the questions.
such as
viruses and bacteria. 1 What is the Ward Matron's rank?
4 The old,the young, and the very iJl are most 2 What type of hygiene is Harriet Banks especially
to hospital infection. strict about*
5 Staphylococcus is to most antibiotics. b 3 y does Harriet have real power in the hospital?
6 There is a risk of from urine and blood. 4 How does Harriet encourage nurses to folios
7 Wash floors and door handles with hygiene procedures?
8 A home doesn’t have to be , but it does
have to be clean.
HanetBaiAs
Listening 1 I wear a blue uniform because I arri a Sister, arid I am
A hygiene report responsible for ward hygiene arid the quality of
patients’food.
Listen to a hospital administrator talk ing to the My job is to do everything necessary to prevent and
Ward Sister about the hygiene report for her ward, and control infection. Because a lot of infection spreads by
answer the questions. hand, I make sure that everyone follows the clean.liness
1 Did the ward get a good or a bad score? procedures. For example, hands must be washed f›efore
2 What reasons does the Sister give for the and after patient contact, before and af'er taking off
ward’s score? gloves, an.d after helping a patient use the toilet.
2 Read through the sentences from the report. Then I amin charge of ward budgets, and
liste n again and underline the correct version controlling the money means I
have real power. Sometimes I
1 The door handles ate / aie not regularly cleaned
refuse to pay cleaning arid
2 Beds ore 7 ore not always cleaned between patients catering companies if I’rn not
3 The toilets are cleaned three times 7 twice 7 once happy with standards.
daily. But I don’t like to be
4 Floors are cleaned/our times7 twice Z once daily. strip all the time. I like
S The average time for cleaning up spillages of bodily to encourage staff to
fluids is s Z IO Z IO-30 7 more than 30 minutes. think about intection
and the spread of
6 Nurses’ knowledge of MRSA is gOOd7 air/ poor.
disease, and to lead
7 Nurses olwoys Z do not always wear gloves. by settir:g a good
r us t Ie.
 82 Unit

A sUrvey was done in 2004 to Hungarian Ignaz Semmelwels (1818-65),

find the cleanest country In the the father of hand hygiene, died from an
world.Can you guess which infection that spreud from a small cut on
country It was? his finger.

Language spot Complete the sentences Frith need to, must, need(s),
âon’t hnve to, m‹irtn’t, Aris to Use the verbs below
Talking about obligation
use cutting cut order
Match these examples with the rules.
a Sorry, I have to ga I’m on dut y in ten minutes. complete e+ep change emptying
b You mustn“t forqel to put gloves or. I You’ll need o m p_ the floor— there’s been a
c tVe need to clean ltte floors more oflen. spillage.
d You don’t have to wash mrs shoh‘s/oce. She con do 2 You g!oves after contact
it hersei/. with each patient.
e f'wo beds need changing. 3 The bins —they‘re all fu)l.
I All visitors must wash their hands.
4 You Mr Mills's nails — t’ve
must
We use must in rules, and to say when things 5 You your mobile phozte
are
ii•idethebudding.
necessary.
6 The Ward Sister a hygiene
report every month.
rocedures more care 7 My hair — 1 can’t keep it alJ
NOTE: lt can sound very strong to say non must. .. under my hat.
hove to 8 I sozrte zrtore paper towels
We use have to Io talk about things that other people — they've nearly all gozte.
oblige us to do.
2 Speaking
Student A, working in pairs with another Student A, go
to p.HO. Student B, working in pairs with another
We use n ustn’I to say it is necessary that you do now Student B, go to p.114.
do something.
3
don’t hnve to
Writing
V\fe use don’t have to Io say something is not
Notice
necessaq. Work in pairs. Following the hygiene inspection, the
4 Ward Sistem has asked you to make a notice reminding
nurses about good hygiene practice. Write a list of rules
more: Use must + verb NOT and instmctions for the nurses.
need to
We use need to to say it is necessary to do HYGIENE REMINDER!
something

1 You must report all spillages immediately.

2 All visitors should ...
We use need + ing to say whatjobs it 1s necessary to

6
» Gc› tc› Grammar reference }› 121
 Hygiene

Between 1994 and 2004, deaths

in the Uh from MRSA infection
‹s›4OO%

Signs and symptoms

NtRSA
T woz1 rvttha garner. yead about the symptoms of
\R5A.Tick tL‹ symptoms that affecl the skin.
The newspaF s Call MRSA ’the Mesh-eating siiperhig’.
This is because sy rriptoms are nasty, and include
intectionuMet the s¥ iri (nsiwhy run UP aTiTis or lf•ps}.
Some peoyl e are carriers - they have MRSA but dtin't
show any of tire symptoms.
MRSA cxn cousei

boils
redress
bone irJections
sep'tir wounds
Sever swelling .
septicaemia
tenderness
toxic shock syndrome iin tigo
u.ri wary tract infections headache.
heat I-vulvc ii.fccticlris
 84

Research done at a New York

A species of Lree in Brazil known
hospital found that the ties as Pau d’Arco or the Inca tree of
that doctors wCai‘ are a naajo life (Tabebuia avellanedac)
source of dangerous bacteria contains substances 'vhich kill
Staphylorocc‹›s at›reus.This trf•p
could he our next weapon against
MkSA.

Listening 2 Now complete this summary of the report by choosing

Test results the correct word in italics.

A nurse on Ward S gets a phone call from the

Pathology lab. Listen and complete this report. When medical staff suspicion /.suspect' that Mrs
Browning has MRSA, they send blood samples and
swabs to the Pathology lab for tests. The test results
show that she has infected 7 an infection 7 infect* from
the bacterium Staphylococcus aureus. This bacterium
has resistant? resistance/ esists' to some antibiotics, it
is susceptible/ susceptibitity•to one antihiotic. and
there are two antibiotic it c;+nnot resistant 7 resistance
? resist*.
Mrs Browning will be isolated in a separate room
and,to avoid any confniiii›infioia Zcontoiiii›iate• by
pathogens, the ward will be thoroughly disin/ected Z
Patient’s Name .............................. disiri ectant”'.
IrlentifiPrl harterilirn °
PlacC of infectiota
Reading
Read the questions to Nurse Anthea anal her answers,
and decide If these sentences are true (T) or false (F).
1 Dlit can be good for you,
2 Children who live with pets are more suscept'ible to
Tests done" allergies.
urine M blood O throat O nose O skin O 3 AnUbiotics klJl all bacteria.
White bIn‹xI cell co‹›nt ° 4 Vancomycin will always be LOOP» effective.
Test for Escherichia c }G S VRSA is a stronger bacterium than MRSA
negative 0 positive 6 We are losing our protection from bacteria.
Test for Staphyloccocus aureus’
2 Find words in the text Cth these mearñngs.
negative 0 /›os0ifive
I moving around on your hands
Pesistanre tn antimirrohinl agents ^
Resistant Susceptible Non-resistant 2 regular contact with something
Penicillin O E; O 3 particles of solid waste from the body
Cefazolin O O O 4 completely without dat
vechicillin LJ M O
Erythromycin O O O S to not be filled by something
Clindamycin 0 0 6 somethjng that you use to fight with
Tetracyclinc O 7 not at aI1 effective
Mtzpirncin0 0 O
Vancomycin EJ
Oxacylln O o
 Hygiene

Checklist
Assess your progress in this unit.Tick (W) the
statements which are true.

I ran talk about good hospital hygiene

practices
I can understand a hygiene inspection
repur'.
I can talk about obligation

Ask Lhe Nurse — I understand the syrnptoms and causes of

MkSA

Ican understand a Pathology lab repcrt

Key words
Nouns antin\
Don’t z'orry. Children who ljvc in spodcssJ j- c}ean hoube5 icrobiaI agent
do not have much exposure io bacteria, so their immune Uacteria
system don’t get the practice of figliring bacteria. Research bin
shows that cluldren tiving in houses £ ar are not spotlcssly ratering
clean, w'ho leave contact is4th animals and faecal matter, get
fw'er illnesses than children living in spotless homes. And «›ritamirintiun
there’s evidence thai children who live with pcrs get fewer disinfectant
imr›une system
infect ion
pathugen
¿roredure
virU5
AdJt•ctlvcs
resistant
spillage
spotless
susceptible

Look bacl‹ through this unit. Find live rr›ore

words or expressions thatyou think nre riseful.

Antibiotics Uh the weak bacte ria buL allow tnc smong ones
to survive and get stronger. This me.errs that there arr moi c:
and more bacteria around that arc resistant to antit›iotics.

Therr’s an antibiotic called Vancomycin."Chi.s is our Jasi

weapon against MRSA, but in time it well be useless no
One type of Sraptaylococcus aureus is now resistant to
Vancomycin — so ii isVRSA —Vancomycin resistant. t herr
is a possibility of a t›acteriurn u.hic1a w;li be resistant to o//
aniibiocics.
We ha 'e t›een winn irlg Lhc war against bacieria for about
AGW \ csrs. butsoon I tcteria eit] mal e a c‹›mehoc)c and v e
will be where we ivcrc in the rü netccnth cenniry — with no
pnatection from bacteriß.
86

Scrub up z w:th your partner. try to explain what’mentally ill’

1 Which of these people do you think may have a menta› means. Finish this sentence in your own work.
illness? Discuss each one with your pm tner. A person is mentally ill if he / she...

Stephen Gough has vralked oaked ßy the time Salma Perrin goes to bed, David Geary is seventeen. lie sleeps
across Briiairi, ‘Nukedrie› s is natur mal,’ she will have washed her hands over all day. and at iugltt)ie si to iii lum
he says every time he is arrestetL a hundred times. She says,‘I know room playing his guitar. He says,’Life
t1aey‘re clean, but I can’t stop myself.’ sucksl’

Barbara Scctt believes she is in danger. Andy Park has celebrated Christmas Every time Diego Fetri gets into a car,
and never leaves her house. 5hetalks every day for the last twelve years. He he becomes a monster ’Other drivers
to the people on the television and lives alone and says,’Every day I give we mad, he says
says,’They‘re my realfriends.’ presents to myself’.
 Mental healt h nursing 87

In this unit
e describing the symptoms of mental illness
œacaseconference
o Present Perfect
e schizophrenia
e writing a job application
e Tourette syndrome

when a past action has a iesDlt in the present

Vocabulary He's had his medica fion and 1s feeling sleepy.
Mental illness when we give news or recent, finished events
1 Match each wood with its ü efîzù tion. Thepsychiatrist has just spots to the patien1’s fornily
1 posture a the false belief that when we say how much we have completed, how
somebody is trying to harm many times we have done somethi rig, etc.
you, or that you are f have told him six t imes to take his medi‘cnfion
sornebody very Important
with yet. to talk about whether or not tasks have
2 unemotional b not suce where you are
been completed
3 hallucinations c not wanting to talk to
I’ve taben Mr Pool’s lemperoture. but I hnven't checked
peop1e
his blood pressure yet.
4 manic d not logical, not making
sense Sth/or and since to talk about when a present
S paranoia e behaving in an abnormally situaUon started.
l’ve worbed at this hospital for six months.
6 disoriented f not showing your feelings
Wc use the Past Simple, not the Present Perfect
7 uncommunicaü ve g a way of standing or sitting
8 delusions h fee1irtgs of extreme, when wetalk about a finished time in the past,
uncontrollable sadness especially with time expressions such as ago, last week,
9 irrationaJ i strange and false ideas that g yyyy
somebody believes are true Igraduatedfrom college /woyeors ogo,
IO depression occasions when you » G tel Grammar reference |-›.J .7.)
il11"tgif1e yOU s ee (1 iE1 1gi•
that are not real ly there 1 Complete each sentence usi ng one of the verbs below.
Use the Preset it Per(eat Whéi’8 possibly. In othcr
sentences, use the Past Simple
Pronunciation attend go see study
Stress patterns be have start write
fuush reply
Match thèse stress patterns to the ten woids above
1 We the assessment. You’I1 getthe
a •••• e ••••• report tomorrow.
b •4a• f •4a•• 2 The doctor the patient three ö mes
today.
d •»•Ro h Ro• 3 I worlring here a year ago.
2 Listen and check. 4 Mrs Linton is no longer in hospital. She
home,
e Dnguage spot S I three letters to the consultant, but he
Present Perfect yet.
g T untiJ 11 o'clock last night
We use the Present Perfect
7 The patient. the clinic since January.
fri talk a bout past actions in an unfirushed period of
time, for example‘in my whole life’, or‘today’. 8 The patient in hospital for a vreek now.
I’ve never done this before. 9 you ever a general
have you seen Ana this morning! anaesthetic?
 8B

The novelist André' Malrat x

Thr novelist Viry,inia Woolf
suffered from Tourette synclrorne,
suffered from bipolar disorder She
which showed in a nervous facial
had her first mental breakdown
tic and muscular and vocal
‹when she was II'it tecu. and made
activity. He was ‹well-krown for
several suicide attempts She killed
his energetic sfyle of public
herself whei s\ e was 59 by
speaking
walking into z rivrr

2 N Paula is a nursing assistant. She is finishing her

shift, and Jack is sts ting his.Jack is checking the list of Listening
things to do. Listen to the conversation. and write a A case conference
tick (/) or a cross (X) next to each job on the list to
show if Paula has done it yet.

Write five sentences in your notebook about what

Paula has do ne and hasn’t done yet Listen to the psychiatric cue come rence discussing
a pat rent, De)roy Moselu Tick (/) the symptoms of
4 Write the past parti ciple of these verbs schizophrenia that they say De)roy has.
be . &*< give a D strange posture
watch work b O confused and disoriented
forget talk c ci ies a lot
take try d D unclear speech
Write questions using Hovr you ever ... and the verbs e D uncommunicative
above to find out about your partner’s experience as a I O make irrational statements
student nurse. g O unable to sleep
E KA M PLES h ma sic
Have you ever been laie for ClOSs?
i D hear voices in the head
I-tovr you evrr we Icheél on operotion?
j O unable to retain information
Ask your questions. Each time they ansvreryes to your
first question, use questions in the Past Simple to get
more information. Speaking
tXAMPL4 Work in pairs. You are going to read about Del roy
A Hoveyou even been late for class? Moseki's life Student A goto p.110 Student B goto p.114.
B No, I haven’t.
A Hove you ever watched on operation?
B Yes, I have. It was lost week, Project
A LVhot was if? Many talented painters, writers, actors, etc. suffer from
B It wos an appendectomy. mental illnesses I‘ird out about two famous people and
A Peo//y!/-low long did write about how mental illness affected their life
 Mental healt h nursing 89

Mental illness is far i nore

common than cancer, diabetes,
he:irt disease, or arthritis. Clne
}ieisoil in thru suffers some sort
cut iirental illness at some time in
their 1ivrs.

Reading Join lhese word combinations wit hout looking at the

lext, then look at tne text to check your answers
1 head this article about schizophrenia and decide if Choose some of the combinations to learn.
these sentences are true (T) or false {£).
l changes a relatively normal life
I There arc 1.S million sufferers of 2 facial b completely
schizopf:rent a 3 the onset of c side effects
2 A psychotic episode is a symptom of 4 think d su›cide
schizophrenia. S com rnit e expressions
3 People with schi2ophrenia are usually not 6 reduce t he f treatment
violent and dangerous 7 have bad g the illness
4 Suicide is not cornered with scfuzopluenia. . 8 lead a h in behaviour
9 recover logically
S We understand what causes schizophrenia. JO long-ter rn j symptoms
 9O Unit

It’s my job Writing

1 Work in pairs.Discuss the questions. Email job application
Have you done any work placements Read this advertisement for a job, then put the
How did you feel when you started7 expressions in tne correct places in Julie's emaiL
\/Vhat difficult situations did you have to deal with?
skills arid qualifications to meet with you
Z Read about Juliet Francisco and answer the questions i believe relevant work experience
I How did she feel when she started her placement 1 1 am attaching to apply for
2 What two activities does she talk about from her
placement?
Job title: mental health nurse
3 What went wrong each time?
City Hospital
CITY I-iOfi PITAL PSYL F- lA F PIC I, NI I

Juliet Francisco Psychiatric Unit

I've]iist fi.n1sherl my training and am now a qualified

mental health nurse. The rourse was in two parts, half
general nursing and half riaoritul health musing. I’ve Eat y•• i”<• r>“ \ca«

stutlied a lot of t hefty, but the it•al learning has come

I row my placements iri psychiatric wards,
My first placement was on a ward for elderly people.
TH* F•tients were £l1l very quiet, tout I was still terrified •• o e a hea lurse
wh.en I started. I thought some of the things the
Dear Mr Till
patients said and did were really strange.
One day 1 took a relaxation group. But no one told me I am wrilir'g . ' Ihe job
that doing relaxation can start a psychotic episode. We a‹Jvertised on the City Hospñal •'ebsiIe. I am 22 years
old, 'nd I have jusl qualified as a mental her Ilh nurse. I
were all lying clown on tht fl‹ior — all nicely relaxed.
also have I have done
Suddenly a woman in the group started screaming. I pIa‹:emen1s on a germlric w‹iid, at ‹J in a prison unit.
wiis so shocked that 1a1most screamed too. I ast summor I worked as a volunteer on a camp for
Another time, I took a patient out for a h11 ‹Jre n wi h I earning difficulties.
walk round the town. Suddt•nly he
ran off down the street. V\fhat necessary • for working
on your unit.
/ sh‹›uld I do? Run after him? No, I I would welcome an opportunity
tool a rh nce. Ijust stncrt arid! My phone number is
watched trim. He stopped and 01632.960061.
looked back. Ismiled and gavt• a a copy of my C\/.
friendly wave, then turned around
and walked slowly back towards Yours sincerely
the hospital. A minute Juliel Francisco
later he joined rue.
He was laughing. 1
was quite proud of
myself that day!
 Mental health nursing

Checklist
Asses.s your progress in this unit. Tick ( the
statements which are true.
I can talk about the symptoms of mcr tnl
Illness
I can understand an article about
schizophr+•nia
Signs and symptoms I can use the Present Perfect
Tourette syndrome I can write a job applicntior\
1 Read about the condition and answer the questions.
1 then does Tourette syndrome first appear?
2 What makes i he sympioms worse?
3 What four categories of I:ie are there? Key words
Verbs
7’ourette syndrome is a nervous disorder which first concentrate
appears iri childhood. A person with Tourette swear
syndrome has frequent, repetitive motor and vocal tics
Adjectives
(repeated movements or sounds that you cannot distressing
control). f‹›rJg-term
Vocal tics may consist of repeating somebodyelse‘s psychiatric
words, or sudden outbursts of swear words. psychotic
Tourette tics are often worse when a sufferer is tired or traumatic
under stress. Sufferers can hold back their tics for
Nouns
hours, though this leads tu a strong outburst of tics
bipolar disorder
later.
onset
Motor and vocal tics are classified as either ‘simple’ or placement
’complex’. Simple tics are sudden, short rn.overnents, qualified
and complex tics are movements or speech.that use side effects
more than r›nc set nf muscles. suicide
threat
2 This is a list of some tics. Work with a partner Using tic
your dictionaries to help you, write N (for motor) or
V(for vocal) next to each one Look back through this unit. Find five more
clapping making faces words ur expressions that you think a‹e useful.
kicking scratching
muttering smelling things
spitting belching
hiccuping stuttering
swearing shivering
blinking shouting
chewing clothes snifhng
licking things throwing things
offensive sticking the tongue
gestures out
3 Write down the verbs that are newto you.
92 Unit

Scrub up i Listen and check.

1 Look at the pictures below. Descfibe what the nurse is 4 Can you answer these questions?
doing in each one
1 What two things does bpm mean?
Work with a partner. Match each reading 1-4 with a 2 What do 150 and 90 refer to?
3 Are these readings normal? What isthe normal
1 120 bpm range for each?
a temperature
2 38.S°C Take your partner’s pulse. What should their maximum
b blood pTessure
3 150/90 heart rate be when tney exercised
c heart rate
4 18 bpm
d respiration .

Pronunciation Patient care

Taking readings Taking vital signs
Which words or expressions from Scrub up do these 1
Put these words in order to make sentences in your
phonetics represent 7 notebook. Which vital signis the nurse tabing in each
/’I a:I “ciL/ case?
2 /' tcnaprot(a/ I tongue pop your under just this
3 /pals/ 2 roll your can up you sleeve?
4 /rc'spiroti’i i’cit ' 3 cold a feel bit your may on chest this.
S /‘blad ,preJa/ 4 and out in just normally breathe
6 /, vaill ‘saint S relax mc for your nrm.
@ Listen and check 6 shirt you undo please your , me for could?
Listen and check.
 Monitoring the patient

In this unit
e s.aying measurements
e describing changes in measurements
G r‹*cording vital signs
e hypothermia
m using the Passive to describe procedures
m general anaesthetics

Vocabulary
Describing readings b
Complete the se t¢nces with I ne wpids below, and
match each one to a graph.
’» up risuig felt
stable up and down went us
varies back to
1 h His temperature was all
night, but now :it’s . at
3?.S.
Her heart rate . to2O
bpm, but now it’s agan.
His blood pressure flOIM
120/80 to 160/TOO.
4 Her pulse rate was extremely low, e
but now it to 7o.
5 His respiratory rate
between 10 and 2S bp m
6 He was runn ing a fever, but his
ternperat are’s . .normal
now.

Listening 1
A coma patient
patient's progress to the doctor on call. Listen and
1 The patient, Grant Forrester, is sufiéring from a
decide if these sentences are true (T) or false (F).
Traumatic hrain Injury (TBA) and is in an Intensive Care
Unit (ICU), It is J4 p.m and the nurse is reporting the The patient is awake..
2 The patient is getting worse._ _
3 An ICP of twenty isOK.
4 The doctor is going to go to the hospital.
@ Listen again and complete this table

Time
8P ICP
2000
21OO

22P)O

2300
94 Unit

Signs and symptoms e Language spot

Hypothermia The Passive
Before reading, discuss with a partner what you know Passive verb forms are very common in medical
about hypothermia. English, We use Passive verbs to say what is done to
people and things,
The patient’s progress is monitored every hour.
IVir West was treat dyor multiple injuries.
Often, you can choose whether to use an Active form
or a mssivelorm. Compare these sentences.
(Actiue) Paramedics treated the mm for hypothermia,
(Passive) The man was treated for hypothermia.
The Passive form focuses on the action, not on the
person or tlfing that does the action. If you want to say
who does the aclion, use by.
The man was treated)or hypothermia bypoiamedics.
v$ C! c› to Grammar reference { i.12'1

3 Underline the correct form of the verbs in italics.

Make a list of the symptoms of hypothermia by joining
the two halves of these phrases. Was Rn nvne mrnii:ted / woe adrr, itte‹f' to hospital too
an operation. She JiJn’Igive 7 wosn’I yiven tool for
Moderate hypothermia (JS—S4“fi) eight hours. She bi ougl‹t / wcs brought' to theatre at
sixteen hundred hours
lack of speech
She was f›repared 7 yreJnred* for the:itie. The nurse wa.s
violent hehuviour
shaved / shaved• the area which wire going to ut/ be
SlUFTed co-cirdination cut, and Mrs Rnmorie put on Zwas yuf on" a theatre
irrational shivering gown 1-Ier clentrires removerl 7 were removerI•, and her
Severe hypothermia (a3—30"C} wedding ring titp‹x1 to her wrist.
shivering skin
2 Ken Miah was woken up one night by severe
inabilityt‹› walk abdominal pains. kead the notes, and vrrite sentences
riyid breathing in your notebook to describe his experience using the
shallow pulse rate Passive, You can say who did each action if you want
to.
pale muscles
DXAMPLD
fallin{j stops
admit / nospital
He was odmiRed Io hospital.
Speaking J I giue / general anaesthetic
A man has been rescued from the sea, and has 2 perform / appendectomy
hypothermia. In pairs, you are going toexchange 3 Insert / stitches / wound
information about his vital signs, Student A goto p.TH. 4 prescribe / painlollers
Student B go to p.114.
5 discharge from hospital
 Monitoring the patient

A preparation that is c‹›rcr›ionly

used in general anaesthetics
comes from the drug curare. It

* is the paralysing poison Sou th

American Indians use on the . ’
tips of their arrows. ,

Reading 3 Work in pairs W) thout looki g back at the text, try to

4 Liiscuss these questions with a partner. femembei tne missing verbs, Then look back and
cneck
Have you ever had a general anaesthetics Describe
what happened. 1 The anaesthetist's job is to p tnis from
here you / \/\fould you be nervous of having one? happening .
2 The patient is a general anaestlii tic in
2 Read tne article and answer the questions.
t knee parts.
1 How many Iypes of drugs make up a general
3 . an electroencephalogram (£EG), v niCh will
anaestneUc?
w_ if you are waking up.
2 What are theyi
4 The second drug p the muscles .
3 What tells an anaesthetist if a patient is waking up? s An alarm will s if it drops too low.
4 by bo patients under general anaesthetic need a 6 Despite the effects of the paralysing drug, tne brain
ventilator? a)so still f
S What two organs are not paralysed by general
anaesthetic?
 96 Unit

The scientist Sii Humphrey Davy (J778— One of the first women to
1829) discovered tile ar'aesthetic give hirth pa nlessly using
properties of nitrous oxide When he chlcrofurr•i nani‹ d her new
breathed in the gas. he began laughing bab}’ Anaesthesia
uncontrollably before losing
consciousness He named it“Iaughing gas‘

Speaking 2
Work with a pmtner Decide what the logical order for
the pictures is.
I 2 3 4
S 6 7 8 _
\/\fork in pairs. Use the notes in the Speaking oct ivifies
section to describe half of the anaesthetic procedure.
Use the Passive where possible. Make notes while
listening to you partner. Student A go to p.111.
Student B goto p.114.

Writing
Describing a procedure
Use your notes from Speak'ing to write a description of
what happens when a patient has a general
anaesthmic. Add dmails of your ovrn

/irst, the patieW is os'#‘ed quesfions to assess their Health

and history. Then, lie is given a. pre-med and...
 Monitoring the patient

Checklist
Assess your progress in thi.s unit. Tiek (W) the
statements which are true.
I carl express the results ofthe ma in
methocls of monitoring
t ‹:an tvncit°rstarid and rerord a patient’s vital
si§'ns
Listening 2 l ran use the Passiva
A scan
Look at the picture. Talk
with your partner about
w’1mt's happening.

Key words
Monitoring
bpm
Listen to the dialogue between Mrs Murphy and the Urain Wavcs
nurse, and decide rf thes‹• sentences are Tue(T) or false ECG
(F). f›eurt rato
I Mrs Murphy dranl‹ nothing before the scan. oximet«r
s‹:ar
2 Before the scan, Mrs Murphy was worried about the ‹Jltrusoririd
baby. vital signs
3 Mrs Murp s pregnancy has just started. .
Nout s
4 Mrs Murphy’s scan shows abnormalities. al›r ormality
S She doesn't wsint to 1‹now the sex of the baby. r:c›urdinatiurJ
6 ’Al c liccrtbeat is very weak. pre-med
sl ivrrin¿
Complete the sentences with tne verbs below. Then transduc‹‘r
listen again and checlc vc°ntilatr›r
Jooks putting rnakes shows up
lie back passing work stopped Verh
paralyse
1 . , . just on this examination table.
2 I’m some gel onto yOilf Bbdomen. Look jack throrsyh this unit Fir cl five more wor
3 Thut helps the ultrasound vrell ¢ls or exprussir›ns that yr›u thir›k are riseful
4 Your notes say the baby has moving.
S ... and it a pict tire here on the rnonitoi.
6 lt any abnormnliües.
7 t’m the trnnsdurer over your abdomen
now.
8 So the baby’s Olive and good
4 Discuss these questions with your partner.
Do you know any traditional ways of testing if the
baby is a boy or a girl?
Are there any advantages in knowing ila baby is
going to be born a girl or a boy?
Would you want to lcnow l
98 Unit

Scrub up
2 Tell your partner about a time when you had one of
Work in pairs. Match these pictures with the medical
these condit ions. What treatment did you have? Did it
problems.
work?
1 an infection
2 a cut
3 an insect bite
4 constipation
S obesit’y
6 vitamin deficiency
7 an infectious disease
8 an allergy

Vo«abulary
encourages bowel movements.
Types and forms of medication
6 . provides a substance that the body
Complete each sentence with a type of medicine
A painkiller An anti histamine 7 _ treats allergies.
A sedative A stimulant 8 increases activity in the body.
An anti-inflaru/uatury Ari antidepressant
9 . reduces feelings of extreme sadness.
An inoculation A laxative
An nntibintic A supplement IO . makes you rela xed and sleepy.
4 kills bacteria rind other germs. Z Work in pairs. Look at the list of words in 4. Circle the
2 protects you against infectious syllable that you think is stressed in each word.
d seasev EXAM PLE

relieves pain. jitter

4 reduces swelling. 3 i i Listen and check
4 Discuss with a partner which type of medicine you
coiñ d use to t reat the people in Scrub up.
 Medication 99

In this unit
e types of medication
e methods of giving medication
e understanding instructions for giving medication
a hegoing to v Present Continuous for future
e writing up an experiment

S Match the pictures with these names. Listening

1 syi inge . 6 supposltory Patient medication
2 inhaler 7 adhesive patch
3 ointment 8 tablespoon
4 capsules 9 dropper

é Listen to the nurse give information about patients'

medication. Match each patient Cth the problem they
have and with a medication type.

patient problem medication

Mr Gupta allergy antibiotic
Mr Bill constipation painkiller
Mr Sawyer skin infection laxative
Mr Thomas respiratory tract infection antibiotic
/VIr Cheong abdominal pain antihistamine

N £isten again and write down the dosage for each

pafient.
1 Nlr Gupta mg of Morphine every
hours
2 Mr Gill a. mg infusion of
Clindamycin over a hour
period
3 /Vfr Sawyer one _ mg tablespoon of
Metamucil, . times a day
4 Mr Thomas . mg of Cephalexin every
houfs
S Mr Cheong as injection of rug of
De otane every hourr
100 Unit

Patient care Language spot

Dosages
Put the words in the right order to make sentences.
Then listen and check.
1 day needs take a to week two for twice she tablets a.
2 Oliver what is on Penicillin dosage of Mr?
3 medicine he often need does his how?
4 four drop Mrs 0.s every each hours ml one eye give
in Mubew
S with mealtimes on day two water times he's a three
tablets at.
Speaking
Work in pairs. You are going to exchange details about
patients'medication.Student A look at this page.
Student B go to p.IU.
Student A
be going to v Present Continuous for future
We can use be going to
to make a prediction about thefuture, based on signs
we can see now.
The scan is very cleot -you‘re going to have twins!
to talk about your next action.
f’m just going to take your lempero lvie.
to talk about something you have decided to do.
I’m going to apply fora job in New Vorb
We use the Present Continuous to talk about things
we have scheduled in the future.
I’m seeinp my bo tend toniqht.
VZbat shifts are you worbinq next week?
We often use the Present Continuous with
expressions like next weeb, in May,tomorrow. etc
I’m fnbiriq n week’s holiday in April.

Ask Student B questions to complete this information

» 1r› tr› Gxammaz reference |a. 123

about patients’medication Complete these sentences using be going to or the

Present Continuous and the verb in brackets.
2 teaspoon 3/ day at } J ’ffi QOIHQ TO DSP (ask) you a few questions and fill tn
Dupont mealtimes this form.
fVlrS painkiller 2 Here's your appointment —you .(see)
Francis the doctor at JI 4S tomorrow.
Miss SOO * 8 1 7 day x
3 Your temperature’s falling —you . (feel)
much better tomorrow.
w 8 2days
4 What time (start) work tonight?
Mtss antihistamines
Ekobu S The consultant (talk) to you later today.
6 [ (visit) some friends next weekend, so
17 day on . ,J pJJ
Strauss an empty
7 J (ask) the doctor if you can
stomach
have stronger painkillers.
/Vtr 75mg 8 (you, have) your operation tomorrow
Rossi capsule Tamiflu morning, or tomorrow afternoons
Mz laxative
Work inpairs. Ask each other about your future
Metcalf
schedule, and about things you have decided to do in
Mr injection 1 7 3 hours the future. Ask about tonight, next weekend, next
Takahashi 30 mg summer, when you finish studying, etc.

A Whal ore you doing tomorrow nig/jf?

B f’m worming until seven,†hen I’m going lo go home
andjust relax.
 Medication

Apandemk canstart when these three conditions are met:

0 a new disease appears
0 the agent infects humans,causing serious illness
0 the agent spreads easily among humans

3 Write sentences making predictions about people in ' Read the sentences and decide if they are true T
your class. Give a reason for each one. or false (I).
1 A pandemic is a type of virus.
Grace is yen my I u fall oslccy I lits off ei’i1oOt1 — site throbs 2 Viruses reproduce outside your body.
vrry I ired! 3 More people died thorn Spanish flu than were kifled
in the First World War.

Reading 4 HIN1 is the name of a pandernic

S H5N1 is an antiviral drug.
I Can you name any deadly infectious diseases that have 6 Tarniflu is made by Roche.
spread around the world?
7 Tamiflu stops HSNI spreading.
3 What is the latest news on bird flu?

When someone who has flu sneezes nearDy you take tiny Since I’7lg rhe HtNl virus Nos mutated Now thme is a
droplets nf their ‹livri into yL/r ksr›gs. ? he cfroplc’ts mt tatinn called HSNI . ten this mutation trst appear‹xJ
cowaln viruses that are lteklng f‹ r a new home. They get
lntcyo‹›r lungs und tfx'n Intc› ycurDloW. ai‘id cm c|tJickly
take rx/et yotJr whole budy. uslng mms a factory in which
rhcy can reproduce
W any rime. a deadly bacterium or ‹a virus can Decomo
very succmsful .and spread aeros the world. killing
millions uf hiJman beings. then rhis happens it Is cullecl n
“pandomic"
here was a pnndemic in 1918 V inf/uenru virca cated
HINI, or ’Sp«rrsh flu. Nlled between 50 and l00 million
pccpfo. More people died from MINI them wcTۥ killed in the Flu Wbrld for
A let ta from ao‹iuc in a miller‹• F› !*l @ Cle SC FlDW

\\ r- I iIi \u‹imr
102 Unit

Writing up an experiment
In an expei iment, a stimulant called Isoprenaline is
given to a rat to see what happens to heart rate and
blood pressure. Look at the data, and use the words and
expressions below to complete the report.
dose intravenous infusion
the effect of returned
nnaesthetized administered
dropped recorded

Experiment report
Aim To test 'Isoprenabne onan
rat.
Method I ' a small 4
of
Isoprenaline by 'to a rat and
6
the rat’s heart rate and blood
pressure.
Results The rat’s heart rate went upto SOO and then
'slowly to normal after three
minutes.
TheraCs blood pressure •after one
minute.After two minutes the rat’s blood Z These two charts show what happened when an
pressure returned to130. anaesthetic (Cocmne) was given to the rat. Look at the
data carefully, then write up tne report using the report
above to help you.

time in minutes time in minutes

Isoprenaline effect on blood pressure Cocaine effect on blood pressure

m

time in minutes tiiTie in minutes

H
 Medication

Checklist
Assess your progress in this unit.Tick(+*') the
statements which are true.
I can understand instructions forgiving
medication
I can use be going to and the Present
Continuous to talk about the future
Project I ran unclerstnnd an article ahniil”
I Do you know who the man giving the injection is? Do pandemics
you recognize the disease? Read the story.
I can write up an experiment

Keywords
Adjectives
antiviral
immune
Verbs
prescribe
mutate
spread
Nouns
bowel movement
constipation
deficiency
diagnosis
dose
droplet
germ
infusion
saliva
stimulant
suppository
The Crifish scientist Edward Jenner (1749—1823) found a
cure forsmallpox when he noted that rnilkrnaids did Look back through this unit. Find five more
not catch the disease because they already had a mild wot”ds or expt”essions that you think are useful
form of smallpox from milking cows. This made them
Immune —their bodies could resist the disease. Jenner
invented vaccination -the in)ecting of a mild iorm or a
disease into patients to make them immune. His
discovery came at a time when smallpox was killing
millions.

Z Research one of these drugs which has also changed

history and prepare a mini-presentation for the clues,
Talk about its nistoiy. what it's used for. how it’s taken,
and any possible side effects
Penicillin
Aspl in
the pi\I (o a\ contraceptives)
104

Scrub up
Work in pairs. Discuss the questions.
What treatment is being performed in each picture? Wliat do you know about it?
Have you tried it? / Would you try it?

Vocabulary
Types of therapy 3 Massaging hands and feet to unblock energy
Complete the descriptions with the words below, and
match each desci iptionto a tnerapy. 4 Inserting needles into on the body to
control the energy called qi(/iJi:d
cncrgy herbs channels pressu re points S Using sound to help patients conool pain and
stimulate heal tneiapist functioning improve physical and mental_.
u had i tiCii ial Chinese medicine
6 Using prayer to ask a god or spirit to tne
b acupunctu re patient
c music therapy
7 Using Chinese knowledge of to balance
d cupping
yin n:nd yang
e reflexology
f faitn nealing 8 Laying of the. .’s hands on the patient
g ieiki to bring energy into the body
h hyd rotherapy
2 Discuss these questions Auth your partner.
1 Putting heated cups or the skin to suck bad What alternative therapies do you believe in?
whom tne body d Which are you most sceptical about?
2 '1‘he use of hot and cold water and u ncierwater
exercise to the immune system
 Alternative treatments 105

In this unit
O describing alternative treatments
O natural medicines

o giving reasons
G healers
o arguing for and against something

Reading 3 YVork vrith a partner. Try to remember the verbs used

Discuss these questions in pairs. in tlte at ticle. Then read the article again to
check.
Do you know any examples of animals using
natural medicines tokeep themselves healthy? 1 Grass m cuts sick and cl
What medicine) plants or other natural medicines their stomach of worms.
do you know? Chimpanzees eat certain leaves toc
stomach aches and r tiredness.
Guess which natural medicine (I-S) animals use to
treat which condition (a—I). Then read the article rind 3 Bears ch ligusticum roots arid
find out if you guessed correctly. a the juice to wounds.
1 aromatic plants a labour 4 Eephants eat certain leaves before they
2 clay b skin conditions g b to n them
3 grass c stomach problems with labour.
4 leaves d wounds S Many animals eat clay to b
S roots e tiredness d poisons in their stomach.

A lot ofknowttdge which we call ’alternative medicine' has come

from thatching animals, because rit›t every pharmacist is a human
being —aniutaLs freat themselves will medicines too.Yr› may ha 'c
aecn a dog ter a cat eat grass, for example.They do this because it
rngkes they .sick, and clears their stomachs t›f worms.
InTanzania, lcaxzs from a tree which local WaTongwe penple call
‘the bitter lent tree’, are eaten by chimpanzees. Both the
WaTongwe arid the chimpanzees knows- ihat the leaves can cure
stomach aches and relieve tiredness.
Bears know about the meilicirial properties of the rc‹›t of a plant
called Ligtisticurn.’Fliey chew its root, and apply the juice to
we@nls as uu antiseptic. I.igtisticuni is fiscal by Navajo Indians
ten. A folk story says they were told attain the plaoi by hears.
Wfieti ican elephants arc going io git'e birth, ihey u'itl walk
many kilometres to eat tbe leav'es from a certain tree thai will help
labour.The leaves are used hy Kenyan women ftir the same thing.
Gay is eaten by many animals, from con's to rhinoceroses, because
ii breaks down pciisons in the stomach. It is also the main
ingredient of kaolin› which is used in irratments for stomach
illnesses in humans.
When some birds build their nests, they choose aromatic plants
thai will keep their babies healthy.The plants chosen b}' the birds
are also uscrl by herbalists for skin problems such as ulcers, sores,
and eczema.
Because bacteria are becoming resistant to antibiotics, it is
becoming more and more important to find aliemati•'es, and
z‹xipharniacc›gnris5' - u wc›cd fri›iii Greek meaning’animals’
knowledge of medicine’, - ma3 give us important new information
about very old w'ajs of dealing with illness.
 106 Unit

tfa patient believes that a drug

will cure them, it often will,
even if it is just a tablet with no
active ingredient. This is known
as the placebo effect.

Listening . .. so thot ...

Eley/ianta cut leoves so thot their labour will be easier.
. because...
Animatspu†anlson their shin becozzse they produce
formic acid.
.. fO . . .
The juice is anti‘septic, so bears pm I it on their wounds.

I useonly herbof medicines - tho1’s whj/ lam so healthy'.

O Lister to this radio programme about an alternative J batch the begiruaings and the endings o1 the
treatment called qiyonq (/t |â:‘pull), and decide ifthese sentences.
statements we true (T) or false (£). 1 Homeopatny Works that’s why i
a feel so good now.
1 icausesiUness.. onnrhmals. for swellings.
2 @i is a treatment 2 Acupuncture
3 A holistic‘ Oeatmer›t deals with the patient‘s mind, unblocks qi c so it cannot be a placebo.
not the body 3 We need a lot of d to make a diagnosis.
4 O_iyonq corrects the body’s energy balance. informafion e for relaxing the body and
S External qigong nealers pass their hands OVflr the 4 They use massage mind.
patient’s body. s use an ice pack f because your yin and
b Professor Silver 1s sceptical about qiponq. 6 I gave up yang are not balanced.
7
Professor Silver believes in the placebo eNect. smoking — g sothat il can flow around
8
Professor Silver thinks that belief is the most 7 You are ill the body.
important part of Oeatment
2 Complete the sentences using for,†o, so thot, because,
What is your opinion of qigong healing? Put ariX so, and Thof’s why
somewhere on this line to show your opinion › i have music therapy _ improve my
X - -X memory.
I strongly believe I am extremely 1 W mot net doesn't believe in modern medicine,
in it sceptical about it
she will oot see a GP
3 Lie in the water yUu get the fu1) benefit
Language spot of the treatment.

Giving reasons 4 Ciarlic has antibactei ial properties. . it‘s

good for the immune system.
We can give reasons for things in a number of S I take vitamin C every day it stops you
ways.
getting colds.
for + noun 6 Peop)e use this herb _ burns.
People take herbal medicines for good heoltL.
I see o reflexolog •t yor my bocb pain. 7 She believes in liomeopathy healing
/OT + - ing and relaxation.
Bifds use these plants/or building nests.
3 Do you use supplements, therapy, etc. to help you stay
to + infinitive healthy? Tell your partner what you use, and vrhy.
Chimpanzees eat these leaves to treol stomach aches.
/ visited o dealer la pet relieffrom the pain.
 Alternative meat ments JO7

Project Student As questions:

Medicinal plants
Do some research on the Internet about a plant that is
used as a medicine. £ind out information such as
what it looks like
where it grows
Speaking
Student A —read about Pak Haji
Haron on this page. Student 8 - read
about Alma Gluck on p.HS. Then
cover the infoi motion and ask your
partner the questions that follow
the text.
what it is used for
how it is prepared for use.
How did Alma lean to be a healer?
How do Christian Scientists believe illness is erred?
How does Alma give consultationsl
Does this form of healing rea)lywork?
1 With your partner, read the two texts again and
translate the following key terms into yooro
language. If necessary, use a dictionary
1 superstition
2 to consult
3 a fee
4 a course
S give a consultation
6 to charge

L-:ir ut-‹1 h is c‘i”4tt liter ii li is I.ither xv Iin, i n ttn n.lr’Ji’or it fi teni

filt lM8
Advice to a friend via email
1 This is part of an email which you have received from a
friend who is ill with a dangerous tumour. What is she
thinlring of doing

and the situ ‹ ffects nf tI’e i ›c shrines are hombIe."

Nothing seems lo work, s‹› lha huspila/ I ias arranged an op ralion. II's in lwo
Well, lhen I read a magazine article about a fa ilh healer
who Steals Hollywood stars, a nd I went lo see him. There was a big audience
I am seeing him lwice ‹c week. He says I mr.st stop taking the medicine, a
All the besl
Alex

2 Write an email in reply. Ask questions about the faith

healer. You can either encourage your friend to seethe
Iueter, or argue against the healer anJ try to persuaJe
her to have the operation.
108 Unit

Body bits Hypnotherapy

FJypnosis is uscd to change the subconscious mind.
Mind and body therapies Behaviour and are changerl through
head the descriptions of alternative treatments and hypnotherapy, resrJlting inbetter '^
and physical health.
complete them using the words below.
scalp scertt habits mental
Indian head massage
beneficial herbs wrinkles hair Then ’1 is squeezed,
contact operafion pressure fingers rubbed, tapped, and prodded. J”he
concentrate properties adjustments pressure "is then combed.
practitioner posture - Pressure points arc wurLed on,and
the ears are gently pulI«d and
Aromatherapy ,” pressed.
Thernindandhodyareinfluencedbythc 'of
:›romatic plants arid oils. People are invigorated or calmed Chlropractice
by tht tit'at merit, helpirig lherri either Lu sluup ot' Lo !* are mnrlr‘ In
2 better. thP spine.TI\rcugh massage
and stretcning, the ”'
of the joints and muscles is
Ayurvedic medicine normalized, anrl pain relievet4.
T”he tor\gtie Is‘re‹a‹!‘. anrl pr0hlr'ms with rlifferent
organs of the budy are identified. Lines and ““
on the face are also used in thC Sun soup
diagnosis. 7\ scup made ofa rnixture
of and
vegetables with anti-
Biofeedback “ cancer ’^
Electrodes are placed on the is given to patients
Perspiration, temperature, and blood with cancer.
are munitored,and the x
information is fed back topatients, who
learn f›ow toccntrol their own body
functions.

Reflexology
Points on the feel(reflex
zones) are stimulated, which
has a ^ effect on
other parts of the body.

Alexanrlertechniqrie Shiatsu
Light hanrJ is made bythe‘teacher.andharmful Clients remain fully «lothed while f7 is
tension remc›v’ed by Improving *.‘Student5’are applied to certain parts of he body by
the
shown how tochange ways ofthinking and using their bodies. .’^ using thumbs, paIms,and fingers.
 Alternative treatmen’Ls J09

Checklist
Assess your progress in this unit.Tick (W) thc
statements which are true.
I can tJrscribe alternative treatments
I can give reasons in different ways
can understand nn alice about
Speaking zuopf arrnocognnsy
I can express air opinion for or against
something

Key words
Adjectives
holistic
medicinal
sceptical
Nouns
consultation
conventiur al rneJicinc

fee

You are going to debate whether conventional gray:Li[ionrr

medicine or homeopathy is better for a particular
root
patient. First, prepare your ideas in groups. Copy the
SOfP
table below and note down your ideas. superstition
Group A You are in favour of conventional medicine, supplrmerit
and against homeopathy worms
Group B You are in favour of homeopathy, and
against conventional medici ne I cok back tf›rougl this unit. Final five moru
G ou A ! Group B words or exgressiur s h at you think are useful.
in favour of ! against in favour of against
conventional homeopathy ' homeopathy | conventional
medicine medicine
Are the
practitioners
qualified?
He does
it works
tments
ested

A patient has a number of problems. Her symptoms

include diarrhoea, pal r.s in the joints, and loss of
has Should she see a nomor or a homeopath?
Each indent from group A now talks with a per tnei
Tom group B.Discuss the patirrt, and try to persuade
the other person ahoi it your poi nt of view
 110 Speaking
Speating activities
Student A
Unit 8 p.49
1 Ask and answer questions until you both have al) the
information, for example What's Heidi Klum’s height in
feel?
Robert Wadlow 2.72 m 223 kg
Walter Hudson 6'1"
1402 lb
Unit 9 p.69
Read the information below, and draw very simple
pictures to help you remember it in the grid on p.69.
Do not write words.
Ask your partner questions tocomplete the grid, for
example What happened in about 200 B€? that did
Chinese scientists do? Write notes as you listen
About 500 BC Tne Greek scientist Acrnaeon saw that
arteries antJ veins were different.
1658 In HoIland,Jan Svvammerdam used one
of the first microscopes, and saw that
there are different types of cells in the
blood.
1874 William Ostler identiL1ed platelets.
19J2 Roger Lee demonstrated that it is safe to
give gro‹›p O blood tc patients of any
blood group, and that blood from all
groups can be given tcA0 palier›ts.
19J7 An American army doctcr, Oswald
Robertson, set up the first bloom bank.
1948 Dr Carl Walter designed plastic bags for
coller.ting and storing blood.
Unit IN p.82
You are nurses on Ltte ward pictured on p,83 There is
going to be a hygiene inspection. Look around the
ward, and find as marry problems as you can. Decide
what action to take about each problem
EXAMP OF
The bin needs emptying.!‘llfind a cleaner.
Now each work with a Student B, the Hygiene
Inspector. They will tell you what problems they have
found. Tell them what action you have taken, or what
action you’re going to take, for example:
B You need to emptythe bin
A Yes, I told a cleaner, and he emptied it. I'm going to
check them every morning in future.
Unit J2 p.88
Here is Delroy Moseki talking about his life, a few years
after the case conference you listened to. Ask your
partner questions to get the missing information, for
example how Jonq has Delroy been ill?
I’ve been ill since . That’s when I
started to get the voice in my head.
I’ve seen doctors, psychologists, psychiatrists, and
psychotherapists,and I’ve been in hospital seven
times.
The first time I went into hospital, I was
years old. They just put me on
medication. Now I‘ve stopped
because it made me feel like I was dead.
I left thp knsp\tnI. Then. T got into serious trouble with
the police and they sent me to .I’ve
spent three years in prison iri my l›fe. It wasn't a nice
experience, but I learned to there.
Since then I've read about my illness and I started to
understand it.
When I got out of prison I met a group of travellers.1
travelled all over Britain with them.’that changed my
life.
I’ve been off medication now for
years. Am I winning the fight? Well, my life has heen
hard. but now 1 have friends I can talk to. I'm not
isolated any more, an.d i’ve jUst got
 Speaking activities 115

Unit J3 Speaking 1 p.94 Student B

Describe the patient's temperature and heart rate for
Student B to record.Then listen to the information Unit 5 p 32
about the patient’s respiration and blood pressure and i You are in pain after a fall the other day. Imagine the
record the information in the graphs.
pain you might feel, and be ready to answer the nurse's
temperature
heart rate questions in a lot of detail. Think about the following
details.
where? same place or moving?
when? getting better worse?
how bad? what helps / makes it worse?
type of pain?
Answer the nurse’s questions.
respiratio+s blxs•d pressure

1 2 3 4
burning O G CJ O
stabbing m m M lxl
throbbing O M O D
shooting O Cl D
constant O O O O
Unit 13 Speaking 2 p.96
frequent £J EJ D
Describe each stage in the anaesthetic process by occasional O O O O
making full sentences using the words given Use the mild O CJ M O
Passive for You begin with picture 1, then Student B moderate O O O O
describes picture 2, and so on
SéVere O U O
EXA M PLE
gettingbetter O O O O
The patient is given a pre-med to make him s/eej?y and gettlngworse O O O O
relaxed stayingthesame O O O D

Change roles. Now you are the nurse. Ask Student A

about the pain they are experiencing, and fill in the
chart.
• give / pre-med / sIi‘‹:[›y and relaxed • insert cannula / hand
Unit 6 Diagnosis table
- administer / injection of by mouth • añr»iri ei general anaesthetic /
lose consciousness gastroenteritis E.coli infection
• record / type and amount / drugs
aches
nausea yes yes
vomiting maybe no
blood Jn vomit maybe no
fever QS nO
blood in stools no yes
• insert / tube / atrway yes yes
cramps diarrh
• connect / tu be / ventilator / help / ¢›ea bloating
breathe
- delluer / anaesthetic gas / lungs / • disconnect / equipmenL /
keep / uncons¢Jous transfer / recovery room
1J2 Speaking

Unit 2 p.114
Describe your picture, and listen to Student A describe their picture.
Without looking at each other’s pict’ures, find ten diNerences between them.

Unit 4 p.23 instructions. Explain the situation to the helpPne

You are a nurse working on a telephone helper ne. Listen
to your caller explain the emergency, then use these
notes to tell the caller what to do and to answer any
wash the wound vil h soap and wa let. Don
" T“""
wound — wash I (soap and water)
— ice X
-bandage I(not too tight)
immobilise the leg Jdower than the heart)
stand up. move x
food, drink A
hospital! J/
A man you work with has spill pesticide on his face,
eyes, and mouth. Phone the emergency helpline for
nurse, then listen and use these notes to find out what
to do. Note down the i nstructions that you are given.
difficulty breathing — walk around/
Aink?
mouth? eyes? situ?
Unit 6 p.37
I You have a very bad stomach and decide to call a
helpline nurse. Memorize these symptoms then close
your book.
You have bad cramps in your stomach, and you feel
really bloated. you have had diarrhoea, and there is
Glued iii it. Yoin’whole i›cdy aches. You feel a liHle sick,
but you haven't vomited. Your temperature is normal.
 Speaking activities

2 Call the helpline and tell the nurse about your problem.
3 I You are the helpline nurse. Ask the caller questions 190J At›strian Karl Landsteiner discovered three main
to find out exactly what the problem is. Use the human blooLl groups — A, B, and O.
notes below to help you, and make notes as you 1940 Karl LanJsłeiner tJiscovererł the Rhes‹›s factor
listen tothe answer.
J962 Max Perutz was awarrJed the Nobel prize for his
What happened? slÓ n pairtful?
niscovery of haemoglobin.
pain? whcrc? redness?
swelling? deformed?
tender? hold weight?
bruising move it?
2 When you have allthe answers you need, look at the Read these guidelines for preparing a body, and draw
diagnosis table on p.lIS. What do you think SŁudent simple pictures in your notebook to help you
A‘s problem is? remember them. Then close this book and exchange
information with Student A Ask questions, for
Unit 8 p.49 example tVhat do you do wit h the eyes? What about the
hair? etc take notes as you listen to Student A‘s
Ask and answer questions until you both have allthe
information.
iitfontiutivn e.g. IMhat’sHeidi Klum's heighf ix mef res?
eyes

height height weight weight moufh

Put dentures in if worn. These vrill be
Heidi Klum 5’9’o" 119 Ib difficult to put in later, Try to close the
mouth if possible. Putting petroleum
Robert Wadlow 810“ 4921b
jelly on the lips may help.
Walter Hudson I.64 m 636 kg
hab
Unit 9 p.69
Wash the whnle hofly. Mnke sure that
Read the informafion be)ow, and draw very simple
the face and hands ale perfectly clean
pictures to help you remember it in the grid on p.69.
Do not write words. before the family sees the body.

Ask and answer questions to complete the grid e.g. position

tVhnt happened in obout 200 BC? What did tsreeb
scientists do? Write notes as you listen,
about 200 BC Chinese scientists learnecl ahout the
ci ulation of blood.
J492 Doctors in Rome performeri the first blood
transfusion. They gave hlood from three boys to
the Pme The L›oys and the Pope all died.
1818 dritish dortor James 8IundelI made the first
succ«ssful human blood transfusion.
jewelłery Put this in a bag marked with the
patient's same to give to the family.
hnes
the room Put chairs in the room for relatives tosit
on. Put one or two boxes of tissues in
the room. Cleo away dirty
linen.rubbish, and medical equipment
that is no longer needed. Put on gentle
music if appropriate.
114 Speaking

Unit11 p.82 Unit13 Speaking 1 p.94

You are hygiene inspectors, inspecting the ward Describe the patient‘s respiration and blood pressure
pictured on p 83. Look around the ward, and find as for Student A to record. Then listen to the
information many problems as you can. Discuss what action needs aboul the patient's temperat‘ure and heart
rate and to be taken to correct each problem record the information in the graphs.
2 X A M PLE

the bin’sfuIl. They need to empt)/ bins regulars. blood pressure

Now each worlt with a 5tudent A, a nurse on the ward

Tell them what problems you have found, and find out
what action they intend to take.

Unit J2 p.88
Here is Delroy Moseki tailing about his life, a few years typ e gupe
after the case conference you listened to. Ash you r
partner quesfioris to get the rrtissing information. ior
example How many limes has DeJrojZ been in hospital? "C

I’ve been ill since I was at school. That‘s when I

started to get t)ie voice in. my head.
I’ve seen doctors, psychologists, psychiatrists, and
psychotherapists, and I've been in hospital
times. Unit J3 Speaking 2 p.96
The first time I went into hospital, I was 2S yeais Describe each stage in the anaesthetic process by
old. They just put me on medication. Now I’ve making full sentences using the words grren. Use the
stopped taking the rriedicaUori because Passive form. Student A begi us with picture 1, then you
I left the hospital. Then I got into serious trouble with describe picture 2, and so on.
the police and they sent me to prison. I've spent
in prison in my life. It wasn’t a nice
experience. but i learned to read there. Since then I’ve
and I started to understand it.
When I got out of prison I rriet .I
travelled with them. That changed
my life.
I‘ve been off medication now for three years. Am I
wiring the fight? Well, my life has been
,but now I have friends 1 can talk to.
I‘m not isolated any more, and I’ve just got my own flat.

• patient y Oru gs/ help/

waLc up • care fnr / specialist staff
• monitor / level of consCiousneSS
• give / medication / pan n
 Speaking activities

Unitl4 p.JO0
Ask Student A questions to complete this information
about patients‘medication, for example lVhaf dosage
should I give Mrs Oupont/ does AJrs Dupont need? Vt at The Christian Scientist
medical’ion is Mrs Francis on?
Mrs antibiotic
faith healer
Dupont
Alina €›lti‹'k feluri to art A iiierivaii n'li}tinus p•n›op call‹ d
Mrs infusion 4 mg/ The t0iristinn Science €ihun:h. Slsv tom a rwu creek courxc
Francis to maul ‹o b* . he.i]cr.
minute A«cc›t‹Ii»¿ t‹› fhc' Wl›risTiJH c”tvnr?su, illness i> i›‹’›t ntJc\c
Miss iron b\' T‹›cI [›tlt fry rhc lit\’iI, 4‹› I\ruling I\:itpens I›}' bLen¿ clt›h‹r
Wang supplement
Miss 2capsules antihistamines one / 4
Ekobu
hou‹s (with water)

Mr tii:it. iii a rest, a gmtip of patieiics n rrc pr4ved fi›r ariel anot lui
1 capsule vitamin
{trotip uirr unt pr.iyt€ for. Piuyer iu.afle iso difltrrucc.
supplement
Mr 2/dayx
Rossi Student B’s questions:
Sdays
• How did Pak Haji Haron learn to be a healer?
1 teaspoon when
• What does Pak Haji believe causes illness?
Metcalf
** • How does Pak Haji care ill ness?
Mr painLiller » Does everyone believe in Pak Haji's povrer?
Takahashi needed

Unit6 Diagnosis table

bad strain fracture infection
swelling yes yes yes
tenderness yes yes yes
brulslng yes yes no
skinhurt no nO yes
redness yes no yes
deformity no yes no
movement yes yes no
pain
hold weight no OO yes
116 Grammar

rammar reference
1 Present Simple v Present Questions Short answers

Continuous Am I working bard? Ves, I am

Present Simple Are you/wc/ working hard? yott/we/

they they are.
Is he/s1ae/it working hard? lie/she it is
I/You/We/T)ey work inatuam.
No, I’m not.
T9e/She/It works in atearn. you/we/ they
aren't.
= subject + irJinitive lir/she/it isn’t.
Negative
—— Am / are Us + subject + -ing form
l/You/We/They don’t rnakebeds ie my job. We use the Present Continuous to talk about things that
lie/She/It doesn't make bedsinmy job. are happening now, or around now. We often use a
time expression such as of fhe momen I or this week.
= subject + do not(don’t J7 does not (doesn’t) +
At the moment. I’m doing a part-time course.
inñnitive
Which department are you wor#inq in this week?
Ouestions Short answers
Note that there are some verbs which cannot be used
Do 1/you/we/they want a job? Yes,I/you/we/ they in the Present Continuous. These are hnve (— possess),
do. and thinking and feeling verbs such as dislike, he te,
he/she does. knaw, like, love, remember and want.
Does lie/she want a job? No, I/you/we/they I want a new job xOT
don't.
he/she doesn’t.
Prepositions of place and
-- Do/Does + subject + infinitive
movement
We use the Present Simple to describe routines and
duties, and to talk about things that arc true at any Prepositions of place
time. We use the following prepositions to describe where
A ward orderly helps around the wards. something or someone is: in, on, on top of, at the top 7
A surgeon doesn’t âHve an ambulance. bottom of, inside, outside. neon, next to. in out of,
Do anaesthel ists deliver babiesl behind, opposite, under, over, at, on the left? right (of}
Present Continuous The stairs are near the reception.
You’llflnd†he reMaurant on ltte ground floor.
Posiñve
Prepositions of movement
I am working.
We use the following prepositions to describe
You/We/Tliey are working. movement: along, up, down, info, ouf of, away,from, to.
1-ie/She/It is working. throuqb, across, along, past, back to, oround, left 1 rigW

= subject + am / are / is+ -ing form With prepositsons of movement,we use verbs such as
bring, carry come, gel, go, j?ush, run, late, and walk.
negative
You w‹r/4throuqh Orthopaedics to get to the exit,
I am not (’m not) studying. The porter brought the wheelchair up to the ward.
You /We/They are not (aren't} studying. up to the fhird/oor. Ward 6 is opposite the lift,
movement place
He/She/It is not (isn’t) studying.
= Subject +’m not / aren’t/ isn’t + -ing form
 Grammar reference

3 Past Simple v Past Continuous Past Continuous

Past Simple Positive
Positive You/We/They were waiting for the doctor.
I/You/WefFliey/He/She slipped on sorrie ice. = subject + wcs / were + -inq form
= subject + Past Simple Negative
Negative 1/He/She was not (wasn’tl working here then.
I/You/WefThey/He/She didn't break any Jones. = subject + was 7 were + not + -ink form
= subject + did + not didn’t) + infinitive Ouestions
Questions Short answers Were you listening to him?
Did I/you/we/they/ Yes, I/you/we/they/ —— has 7 here + subject + -ing(orm
lie/she fall? he/she did.
We use the Past Continuous to talk about an action that
No, 1/you Owe/they/ was happening in the background when another event
she didn’t. happened. It is often used in a sentence vrith when +
Past Simple.
-- Did + subject + infinitive
Tie was getting off the bus when he slipped.
Note that the hcZsheZlt form does not change at all in
Lhe positive andnegative of in questions. We can change the order oT the sentence.
Spelling rules for Past Simple He slipped when he was petting off I he bus.
then he was getting off the bus, he
slipped
Infinitive Past Simple
most verbs infinitive wait waited 4 Instructions
Giving instructions
verbs ending in.finitivc arrive arrived
There are several ways of telling someone what to do
in -e + -d
The Imperative is the most direct type of comman‹1
verbs ending in y -i
consonant + -y + -ed I ry tried Positive
verbs ending in double the stop H stoppr d Check the patient’s temperature.
vowel + corisoriarit
cement iairt -ed = infirñ five
NegaUve
except if final delc)/ delayed
consonant Do not / Don’t move him.
is -w, -x, or -y
- Do+ nof(Don’t)+ infiiztiLive
Many verbs have anirregu)ar Past Simple form, which
We can use the Imperative form mode sure to
has to be learned separately. These include:
emphasize the Importance of aninstrucRon.
be - was break - broke have - had A4ake sure you dispose o/y1oves s yely.
jam -yell go - wen I take -tool Make sure the dosage doeso‘I exceed 2OOm I.
we use the Past Simple to ta)k about an action that
happened at a particular point in the past, be often use
past time expressions such asjZesterday, last week, and
in + month / season 7 year.
The doctor examined my leg yesterday.
118 C›rsmmar

Asking for instructions Adjective type £xample Superlative

\n/e car. use the Present Simple, dave to. shaft. and
one syllable the niilél the milélest
shoulrJ to ash foi instnictions.
est
How do I net the rhargc on the defibrillator?
crie syllable + the -st su/e the s‹fest
Where exnctly do I have to apply the pads? cndirig in
Shall I tie the lao r AnMr ti}jhtly* two syllabl os the
endir(i ir y yD test
Should 1 remove the burnt clothing?
two or mois the most yrin/i l the most
= (question word +) do/ sha///sfiou/d + T+ infirù tive syllables paiRfi 1
irregulur good the best
hud the worst
5 Makêng Comparisons
Comparative adjectives this is the safest treatment available.
He haä th e most serions t ype of fracture.
be use comparative adjectives to make a comparison
bmween two things or situations The opposite of the mest is fhe Jeost.
Adjective type Exemple Compmative T !!S äMQ has the fenst severe si de jects.

one sylluble i -er mild mil0er We can use more, tess and most + noun to talk about
relative amounts.
ore syllable +r e er
Corr wornr.n rhnnse to yivr hirtfi hy Caesnreon secfiort
ondir.g i n -e
nowadays. (more —— a higher number than before)
two syllables y -§ -ier e•usy casier Yon will feel lerr pniri ïj you usedes and air.
endiiig in y (ess -- a reduced amos nt)
fwn oi mow + more çain/u/ more painfu) Most people aren’t ver'y good at dealing will- goi›i.
syllablos (most —- the rnajority)
irro(*ular good better
Sud ivorse ö Question forms
the pain is milder now. There are several ways of aslcing a question These are
freatrnents today are more e ertive. generñ ly divided into those that iequñ e only ages / no
a nswer. and wk- questions, vrhich ask for specific
When we compare two thtngs or situations direoly, we
information
use the comparative + thori
The ncture is more serious than we realized. yes 'no questions
The opposite of more is fexs. Thèse be@n with an auxiliaty verb, such as do / did,
am / is/ore, dave / bas, con, cou/d, roll. must, oc.
The tinai:men I was less successful than we lied hoyed
mesertsimple
To make a comparison stronger, we use much before
the comparative. Doyouhavtasuretùroat?
J’m feeling much better lodo/. -— Do/Does + subject + infirut›ve
My leg is much Jess painfu I than it wias yesterdoy Past Simple

Superlative adjectives Did she see the doctor yesterday?

\1 e use superlative adjectives to rrtake a comparison —— Did + subjecl + irfinitive

between more than two third's. Present Perfect
Have you been sirk?
= ffnve 7 I-bas + subjeci + past participle

The verb 6e and modal verbs such as can /could/ must/
should / why are not formed Cth do / does /did
Present Simple
1s the hospital near here?
= Present S riple of be + subject
Present CozttTrtuous
bthepangetdngvvorse?
= Present Simple of be + subject + -irig form
Modals
Could you give me your name?
- Modal verb + subject + infi riibve
wIi- questions
Sometunes it is necessary to begin a Question Cth a
Question word when we want specific information
Question words include what. who, when, whete, why,
which, and how. be can use how Ln other combinati ons,
such as how much, how mony,
IOW O3@, OA e, etc. The question words
whot. which. how much, how many can be followed
by a noun.
What does my x-ray show?
How much pain can you feel?
In the two sentences above, the question word is the
ob)ect of the main veTb. Notr that what, who, Yl/hich,
how much, how many can also be the subjeo of a
Question In this case, the word order is the same as in a
positive sentence
Who told you that?
= question word (+ subject) -i- verb
O_uestion tags
A question tag is a short Question that we add at the
end of a natement We use question tags when we
want someone to confirm irJormation. The vbtb used
in a question tag depends on wla ich verb is used in the
statement
In a positive Question, the question tag is usuaJly
negative.
You II tell me yOM’re uncom/or fable. won tyou?
In a negative question, the quesñ on tag is usually
posits ve
My/nce is less swollen todoy, *sn’t il?
Grammar reference
Ouestions without a verb
In conversation. we can make a question wit host using
a verb if we think the meaning is clear enough.
Sure? (= Are you sure*)
Any questions* (- Do you have any qucs tic›ms?}
will
The new hospital will open in 2012.
= subject + with (’II) + infini0ve
Negative
Your aunt will not / won’t be able to walk.
- subject + will + not (won’f) + irdiniove
Ouestions
Which care horne vviU I go into*
Will you come with me?
—— q uestion word -i- ) mill + subject + infi nitive
Short answers
Yes, 17 you/he/she/it/we/they will
No, 1/you/he/she/it/we/they won’t.
The short form '11 is found roost commonly after a
pronoun.
I’ll get you some water.
We use will in a varied of contexts, for example to talk
about things that we how ate definitely going to
happen in the future
YOU r mOt h e r’S lv em O ry wi I I get wO rse aS Sh e Qets O IN e r
to make predictions and to expi ess expectations about
the future
Prediction / thrub most people will live to 100.
I don“t thinb II! enjoy beiny old.
NOr being old
Exyectation I I oye I’II he alole to enjoy rug owl oge.
to express a decision that we have made suddenly
You loom tired I II getyoM a coffee.
Lo make yi”onuses aJad i”equests
Don’t worry — I won’t be awo'y too Ioncj.
Will ou come to the restaurant with met
l2O Grannnnarreference

h'me that we can offer to do something by using the

form Sta II J + irdinitive. Zero and First Conditional
Shall I call the doctorforyou7 Zero Conditional
Remember that we can use will / won’t in first We use the Zero Conditional to talk about fans that are
Conditionai sentences. generally true, especially in a scientific context
IJ my cold gets worse, l’ll go to the doctor. JI ynH expose a wound to air, it heals more quick ly.
We uzon'f Jzove the nzeeting ifnobody is/›ere.
-- I/+ Present Simple + Present Simple
i/c1ause main clause
shouldXshouldi›’t We can use when i nstead of J.
We use should and should nol (shou!dn’t) to@ve advice hen you expose o wound Io ata, iI heols more quic#Iy.
and to oder an op niow
First Conditional
Posittve
be use the First Conditional to talk about possi ble
A čiahrt.ic shoutd cat ‹a tla\mrtev.d rlict, tuture sit ations
= subject + shoufd + infinitive It yOu don’t eat less, you'11gct fat.
Negative -- If+ Present Simple + will ’IU + infinitive
An oliese l-,erson shouldn't eat sug;iry fooA i/c1ause znam c1ause

=subjct+shO 1d+not@fioudn’t+inflniUve be can also use when + Resent Simple instead ot In

Oueshons Shodansves First Conditional sentences, when is slightly stronge r
thou if, and means only when or once
Sliould I eat a lot of bread? Yes, you shoultL PatiPnt r.r/re will imyrnve whenthere nre enot/§h nurs.es
No, you When there are enough nMrses, potient core will improve.
shouldn’t. We use uri less + Present Simple to mean i/not
Unless we act quicbly, he will die
What should I do to im}›rovc niy diot?
He’ll Oie Mn/ess we ocf \M1C/r/J.
- ShouId + subject + infinitive
Remember that, in Cond\tJoria1 se'ntences, y, when, and
= QueWon word + should + subject
un/ess are not fohowed by wf//
We do not use the auxiliary do /éloes I o form the
negative and questions.
NoT ent o lot OJ b end? Expres»ing possibility
SLot2id is much weaker th an must.
kOLf must ta k'e some exercise. (= or your health will We use muy, might, and could when we are not certain
suffer) about future situatior\s, sučh as plans and schedrtles.
don sh OuJd tobe some exetcise. (- it is a good idea)
Positive
Giving advice
The hear' • •y / might / could clnse next yo.7r.
We can offer adwce by usirg ofher expressions.
subject -i- may/ migTit + infinitlve
/f WOM/d be a good idea fa see a nMtritionist
Negative
iyi were you, I’d tot’e a multivilomin loblet
I’d take a rnnltivitamin table, iyi were you The patierit may not / might not wnnl tn eat.
- subject + may/ might + nof + inffruLivr
 Grammar reference

D_uestions
have to
What symptoms might / could he have /
POSiÔve
Might / coidd she lose consciousness?
Visitois have to leave the ward by 20.00.
= (question word -i-) might + subject + infiritrve
= ni ihject + hpve /h as to + infinitive
Other ways of expressing possibil‘ity Negative
We can express possibility in other ways.
Nurses don't have to wear gloves all the time
Perhof›s, maybe, it's p ss/tile thnt are used at the
= sub ect + don’t / doesn’t have to + infinitive
beginning of a sentence or clause.
O_uestions Short answers
Perhaps and mnybe have the same rnearung, while it’s
possible thot is sü ghtly more formé Do I have to wash my hands? Yes, ynii do.
His bteathiny has slowed üown. perhaps 7 Maybe I Does he have to have surgery? No, he doesn’t,
should call the nurse.
= Do ZDoes + subject + bove to +infinitive
f/she’s asleep whenever you visit, its possible that she’s
not sleeping at night We use drive / has to -i- infirutive in positive sentences
and questions totalk about things that we are obliged
to do because or the circumstances, or because
13 Obligation someone tells us to
We use must? mustn’t and have to/ don’l have to lo We use don’t have to Zdoesn‘f have to+ infinitrve to talk
Talk about obhgafion about actions that are not necessaiy.
Nurses don’t ht2ve to clean theJoor. Thof is the job of the
must cfeaflers.
Positive need to
Wc mu.st stop the spread of MRSA Positive
= sub)ect + must + infinitive You need to follow procedures.
Negative
= sub ect + need to+ infiniUve
Theatre staff znust not (mustzt't) wear rrmke-up ï'4egative
= subject + must + viol + înfiniÔ ve Mrs Hassan doesn’t need to be in a separate rooi»
/I/ÏMSt is not followeLi by to. = subject + doxi’I/ doesn’t need to+ infLrtttive
You mLiSt Mme sterile instruments. no+ Your Ouestions Short answers
We do not form the negative vritl the aiixü iai y Un blocs. Docs this patient need to Yes, she docs.
Visitors mustn’† smote in the hospital. he moved to another ward?
uo r Visitors
Do I need towear a mask? h'o, you don’t.
The question form of must is not frequently used.lt is
-- Do / Does + si i hjem + ri reâ to +infiniü ve
more common to use the question form of have to.
Need is formed in the same way as a regular verb, with
We use must / mustn’( when giving ruJcs or tefllg
-i added to the he/sheiit forms in the positive, and the
sorneo'ne what to üo or what not to do.
auxiliary ‹Jo used in negatrre sentences and
Nurses must use ai› antiiiiiciohial cigei I. questions.
You mustn’t leave spillages unrepoHed.
We use ri eed(s} to + infiniö ve to say that au action is
necessary. We use don't /doesn’t ri ced to ir a simJlar
way to don’t doesn’t have No.
 122 ‹ rammar

need+ -ing ever and never

We use need + -ing to say what tasks it is necessary £ver is used in questions to mean’at some time in a
todo.
person’s life'.
The floor needs cleaning. Never is used in negative statements tomean’not at
= subject + neeâ /zi eeâs +verb + -/zig any time in a person's life’.
The ber/s Jon’f need chongiztg. Slave you ever hod on operation?
She hos never worted in this hospital.

12 Present Perfect v Past Simple /or,since, and yet

We can use both the Past Simple and the Present
Present Perfect
Perfect with/or and the Present Perfect with since to
Pos1tive answer the question How long?
There have been many changes in this hospital over /or + peñ od of time, tosay how long a period of time
th.e past year. lasted.
= subject + have I has+ past participle for eight monlhs, for two hours
fegatixre since + point in time to say When a period of time
started.
Mrs Shaw hasn't taken her medication.
since 2 o’clock, since 1993, since yesterday
— subject + have Whos + not(haven’t/ hnsx’t} + past
participle Present Perfect. f’ve worbeñl here for a few months.
Ouestions Short answers Past Simple: f was on the Chitdren’s Wold for six weebs.
Have you had any visitors? Yes, we have. Present Perfect: I’ve worted here since1was eighteen.
he/she/it has, pg)
No, we haven’t.
We useget in negative Present Perfect sentences and
he/she/it hasn't.
question\s to talL about th1ngs that we expect to
-— I:-Iave bias + subject + past partieiple happen.
We use the Present Perfect to talk about an action that They hoven’t arrived at wort yet.
happened dufing a period of time from the past to the Has she talked to the consultant yet?
present. It is not important exactly when they Set always appears at the end of the sentence.
occurred. We often use time expressions such as this
year/ month 7 week, today, or hefore. Past Simple
Dr 8nght hasn’t carried out this type ofsurqery before. Positive
Have you seen Sister tones today?
I failed the exam twice.
It is also used It› give iicw› Uf a recent, fii tisl red event.
= subject +Past Simple
Mrs Linton has had a baloy girl. (= This happened
recently but we do not know when. It is the event that Negatixre
is more important) We didn’t understand what the psychiatrist said.
It also describes a past action that has a result in the subject + did + not (didn’t] + ir fir ui ve
present, Questions Short answers
He hos had the operation, and is in the recovery room. Did you have a local anaesthetic? Yes, I/he/she/it/we/

No, 1/he/she/it/we/
they didn't.
= Did + subject + infinitive
 Grammar rr frrrnce 123

Note that the he/sh e/it form does not change at all in
the positive and negative or in queJons.
Past Passive
We use the Past Simple to talk about on action or event Positive
that happened at a particular point in the pan. ‘•• r•ticrt was prepared for theat re
My second placement was in Casually. = su bject + was / were + past part iciple
With the Past Simple we can use expressions such Negative
as i’ri + year / i i wit tl i / scasui i, fist, I eJure, UI er, or id
‹its. She wasn‘t diagnosed until this w.orrung.
Note thai ogo comes at the end o{th etime = subject + nos Z were -i- not (wasn’t / weren't} + past
py, g
pardciple
She first saw o psycñ intfist Ino yeors ago. Ouest\ons Sltort answers
V\/e can use both the Past Simple and Present Perfect to Were the correct {Procedures Yes, they were.
talk about an action that happened today However. followed? No, they weren’t.
when used with a Present Perfect verb, todny means
that the action may continue or be repeated, but the —— tVas / lVere + subject + past participle
Past Simple suggests that the achon is finished, or that We use the Past Passive to talk about procedures that
the day is nearly over. happened at a specific point in the past. As Cth the
Present Perfect I’ve seen the doctor twice lodoy. (= it is Present Passrre, we use the Past Passive when the
possible I may see him / her again) action is more important than the agent, or where the
agent is not known.
Past Simple 1 saw the doctor twice today. (-- it is
unlikely that I will see him / her Active or Passive
again today) It is ofien possible to use an AcLive form of the Present
Simple or Past Simple instead of a Passive form, with
The Passive little tlifference in meaning. However, with an Active
verb it is necessary to say who performed the action.
The Passive is used when it is not important or relevant
Passive The ventfJntor is monitored.
to mention who per'nrms / performed an action (the
Active Someone monitors lhe venlila for
‘agent’). ft is often used when we describe medical and
other procedures. lf we want to say vrho performs an action in a Passive
sentence, we can use by.
Present Passive
the ventilator is mo nitoreâ by lhe onoesthelisl.
Positive

Ter i ipe'mi u r i' u i id 1 i i ii i! rate are x nas i Le recL

14 be going fov Present Continuous
=subject -s am / is / nre + past participle
for future
Negative
be going to
The heart is not paralysed by the anaesthetic.
Positive
=subject + am / is / are + not + past participle
I am going to change my clothes.
Questions Short answers
= su bject + am / is / are going to+ infinitive
Are der itures remt›ved Yes, key are.
before an operation? h'o, they aren’t, Negative

--Am /Is 7 Are -i- subject -i- past participle He is not (isn't) goiftQ tO CU ii f'b• his i mind

We use the Present Passive to talk about procedures in = subject + o›n / is /a re + i not going to - intuitive
general.
 124 Grammar

Questions Short answers We use so to talk about the result of an action or

is the operation going to be cancelled? Yes, it is. decision.
No, it isn’t. so + clause I Jelt fired. so i bouqhf some
vilomins.
—— Am lbs Are + subject +going to + i r\fiinitive
We use because to inl roduce a reason for an action.
We use he going to i nfinitive to talk about general because clause /”ni in London because I’ve got an
intentions and plans. appointment with nay
She isn'I going to apply for lha I job. chiropracter.
We also use beqoinq to+ infinitive to predict the future We use lha I’s why at the beginning of a sentence or
based on information that we have now. clause, alter a dash, full stop, or semi-colon, to explain
That’s a biq needle. The injection’s going to hurt, isn’t it? the result of an action or decision It has a similar
meaning to so.
To talk about actions that we are about to perform.
that’s why + clause I’ve got an appointment with my
km going to check your blood pressure naw, so try to relax. chiropractor — fhot‘s why I’m in
We often use future time expressions with be going to. London.
These include- tomorrow, this afternoon / week, next
Priday 7 month7 year, on Thursday. at 3.00.
Are you going to visit the hospital tomo rrow?
Present Continuous
for information on how toform the Present
Continuous, see p.1J6.
As well as using the Present Continuous for current
actions. we can also use the Present Continuous to talk
about future arrangements and schedules.
It› avoid ctn if minii, it is curt ui iui i tu use future liiiie
expressions, such as tomorrow, ne›‹tweeb, in two hours.
at three o“clocb, later toélay.
I’m seeing the consultant this afternoon.
Because the Present Continuous relates to
appointments, it is generally used for the near future.

IS Giving reasons
’there are several ways of giving a reason for
something, for example/or, to, so that, because. so,
thol’s why.
We use/or and to to talk about the purpose of an
object,
i.e to say what we use it for.
for + now r Plants are often used for pain relief.
for + -iny Plarile are often usedJor relieving pain
to + infinitive Plonl s are oflen i2se‹J to relieve poin.
We use so that to talk about I he purpose of an action
so fhot +clause Many people tahe vitamins so that
they can slay healthy.

Unit 1
Scrub up
1 scmb nurse 6 radiologist
7 cardiologist 7 consultant
3 receptionist 8 anaesthetist
4 surgeon 9 paediatrician
S physiotherapist 10 porter
Listening J - An admission
P=paramedic, B=MrS Benson
P Can you henr me? Mrs Benson?
B Yes. Where am 1? What happened?
P You're in my ambulance. Vou’ve had a
fall and we’re taking you tohospital
B Yes, now I remember.
B=iadiologist, B=MrS Benson
R Right. Mrs Benson We’re gomg to have
a closer look at your heart. Have you
had an x-ray before?
B Yes, I broke my leg once.
S=sister, B=Mrs Benson
S Hello Mrs Bensor. How do you feel?
B Terrible. t’ve got aterrible headache arid
1 need to use the toilet.
S OF IU draw the curtains and you can
use a bedpan. Doctor Bright is coming
to have a l‹x›k at you in amoment.
4 B Where are they'
C=consultant, B=Mrs Benson
C Mrs Benson. We‘ve been wor/ieJ about
you hutlvcgotgoodnews thex-ray
shows your heart is clear and Sist er says
your blood pressure is brick to normal.
HuW ai‘C you fcclti tg?
B ! reel tine now.
fi €ior›rl.I’m going to prescribe some
medic:ne and I'm discharging you.
R=receptionlst, B-Mrs Bersor
R light Mrs Benson, so you want to make
an outpatient’s appointment for next
week?
B Yes please.
R Thursday at fool
B rine.
R GoocL Next Thursday at four o’clock to
see Doctor Lee in Outpaaents.
Listening scripts
Listening 2—A job interview
I=Iritervievrer,R=Rachel
I OKBachel,let's start the interview with
a few questions. You CV says thnt
you‘re working at Crty Hospital
R Yes,in the upeiatn ig theories.
I Are you a fully-qualified scrub nurse?
R Nnt yet, At the moment I‘m ?lo ng a part-
time course and work ing at the same
time. I’m preparing for the exams,
which are next month. It's hard,
especially when I‘m working a night
shift and going to lectures next day.
I TeE us about your job. v\/hat do you do
every day!
R Well, I assist ltte surgeons I prepare the
instniments for surgery andI help with
the operations.
I What do you like best about being a
scrub nurse /
R Well, [ like watching operations, but it’s
the contact with the patierrtsthat‘s
most rewarding.
I So, why arc you applying for a new job°
R We1ll‘rn very happy in my)Ob. but I
want more responsibility.
Pronunciation
1 Cardiology 7 Paediatrics
2 Pharmacy 8 Pathology
3 Gynaecology 9 Dermatology
4 Neurology 10 Physiotherapy
S Obstetrics 11 Penal Unit
6 Orthopaed:cs 12 Surgery
Listening1— Directions
P=physiotherapist, i\A=man
P Goout of here and thedoor you want is
just opposite Go in l\uough the door
and give your prescription to the man
behind the counter.
M So it's just outside 1 ierc?
P Yes, just across the corridor.
2 it was. It made me feel,like, reafly
P=porter, M=rnan
P Go into the hospital through thrsr
swing doors. Go along the corridor,
take the €rsi rtght, audit’s the second
dour on your left.
Listening scripts 1ts
MThrough the so ing doors, down the
corridor, lust righl. second left.
P That’s it.
M Than As
R-receptionist, V=visitoi
R Go aJong this corridoi and tum lett at
the ent Go along the next corridoi. take
the second left and go all the way along
that corridor The ward you want is
right at the end, soaight m front of you.
V Thartk you.
Listening 2— The porter*s office
H=head porter, W=porter Wahid,
8=porter Bris
H Sure, right away Hello, Wahidi Are you
there›
W yes,
H there are you?
W I‘m at the top of the stairs outside
Physiotherapy.
H OK. Can you go across the hospital to
the stores and collect a box of
disposable syringes and takethem to
the Path labs And also. a wheelchair.
W Box of syringes and a wheelchair. OK.
H Porters’ office ... Yes, Dmtor Sayed, UI
do that . . Hello. Brian i
8 I’m here.
H faoctor Sayed from cardiology wznts a
porter. They’ve got a lot of empty
bottles — can you take them to the hins /
H Outside Cardiology near the soring
doors on the main corridor .. and then
take a stretcher to Ward four, collect a
patient and take him toRadiology .. ,
Hello. Porter’s office ...
Scrub up
l I was at a party, and one of my ft tends
gave me a lrttle white tablet, I’d had a
few d finks und I was feeling good, andf
took it, even though 1 didn‘t know what
weird.1 could see and hear really
strangethings, and it scared me.1still
don‘t feel normal today. and I'm very
worried.
2 ft’s not due until next month, but when
I uvas washing up this morning there
 4 26 tistening
was a little hlood.lt worried rue. Then1
got thèse pains.
3 1 was working high up on a ladder. My
fcet slipped and I fell.I hit my head but
there’s no blood and 1 don’t feeltoo bad.
4 I was walking by the river, and 1 think l
stepped on it and it bit me.I don’t know
what type it was but it was long and
silver with a black head.
5 Iwas looking in the mirror and lsaw
this big spot on my faœ.I chec1‹ed it on
theInternet and l‘m suce l've got
cancer. Do you think I’m going to die?
Ustening — A patient record
form
M=Mustapka, N—nizrse
N Mustapha, isn’t rt?
M Ves, that‘s right
N So, what happened to your
M I wns working on a Jadder. It was
rairü ng and1 slipped and tell
N Did you hit your headZ
M Yes.1 saw stars and fell sick at Mst.
But now it‘s OK.
N Isee. You may have concussion.
first, I’ll take down your details and
fil1 in this form. So, what‘s your
surnamel
M It's Htisseiw
N Can you spell tltut fui itici
M 1-I-U-double S-£-l-N.
N What's your occupation? 1\
A I‘m a printer.
N RighL What‘s your date of birth*
M First of the ninth, eighty-two
N One, nine. eighty two .. and where
weic you horn?
M Kaiachi, Pakistan
N What’s your marrtal status i
M Sorry?
N Are you carried?
i\ANo, l’rn single.
N And do you have a contaft telephone
nurnbefforyournextofkinZ
M 07709-401229 - it’s my brother. Yusuf.
N Ö O ÿOU £1T1Okg I
N How many do you smoke a days
MTwenty a day.
N Uh huh. Do you ô rînk/
hfi No.
N right. Are you allergic to anything?
M No
N Now, famiiy history. Do any of your
close family suffer from any of the
following - mental illness?
1\A No.
N Diabetes?
M My mother‘s parents are both diabet ie
N Maternal grandparents .. diabetes.
Tuberculosis?
M No,
N HIV / AIDSI
M No.
Listenlng - Instructions
P=paramedic,N=n.. .
P Roger. Oscar Lima Charlie, we’re with
the patient now. Possible cardiac arrest.
Stand by, over. Nurse, check his pulse.
N There’s no pulse.
P OK.
N He‘s not breathing.
P tt’s acardiac arrcst Give htm CPR lu
it! lalk you through it. OK?
NOK.
P Give him mouth-to-mouthñrst.Support
his head That‘s it,lift it back Pight. hold
his nose cIosed,then open his mouth
and breathe strongly into rt. Give two
full breaths into his mouth. OK/
N Rfi lâ1.
P let his chest fall again, Nothing°
N Nothing.
P Tum his head. That‘s righL Pul your
hand on his chest. Now put your other
hand on top of your first hand. OK?
N OK
P Pusl t down a little ... and release ... Doit
again. One .. two. . three ... four
N How many times shouid I doit7
P Repeat the procedure fifteen times . ..
OK. Check his pulse again. Anythingi
N No. Still no piilsc.
P OX. Don't wail. Use the A£D. Set it at a
charge of two he ndred.
N Bight. It‘s two hundred.
P Apply the pads to his chest.
N there doI put them?
P Put one above the heaft and one below.
Stand ciear of his body. Make sure you
don‘t touch him. Call’everybody clear’
and then press the buttons and hold for
two seconds. OKi
N OK. Everybody clenrl
P Check his pulse again,
N Nothing.
P Are you sure?
N Yes. There’s no pulse.
P OK- repeat the procedure. Same charge
— two hundred
N Bight. Everybody clear! Ah hahl There’s
a pulse.
P Good. Well done. Now set up an lV and
give him lidocaine
N How much shall I give him?
P One hundred millities over two
mi nutes.
Llstening 1—A pain chart
N=riurse, P=patient
1
N How are you today, Kathy Are you still
in pain?
P Well. there‘s pain around my stomach.
It’s quite bañ
N What kind of pain is
P lt’ a burn ing paie.
N DoyouMwayshaveit*
P It never goes away- Never,
N 1s it getting worsen
P No. it’s staying about the same.
2
N How’s the pain today, Emin
P lt's much hetter, thanks. I have a slighl
pain, just here in my right side, but it’s a
lot less painful than yesterday.
N How oHen do you get the pain?
r only every now and again — it cornes
;jjjd g pç
3
N Do you still have a headache°
P Yes. I’ve got this throbbing pain in my
head
N Whereabouts'
P In the forehead right betweeilllly eyes.
N Does it feel the same all the t›me°
P No, it changes. Sometimes it‘s not trio
bad, but it gets a bit worse at night.
If And it’s getting more seve ie now, is it°
P A little bit, yes.
N I’ll get you some painkillers
4
N So, you're having pains in yoM arm.
P Yes. I keep getting this terrible pair i
down my left arm. lt starts at the
shoulder and shoots down to my hanfl
N 1s thts all the time›
 Lnteni0gscdpts lD7

P No, but most of the time. but it’s

agonizing when it happens. Listening 1— Symptoms
N You've6ad an x-ray. haven't you+
N When did this starts
P Yes, 1 have.
P ltsta tedytate‹Jay,Du itsinufii +tu‹e N=nurse, P=patient
severe today. N flow does it feel? A littie deformed.
P No, just bruising.
N Mm, we’re hetter take a Innk . . isn‘t it?
N You aren‘t on any other mcdiration, arr
P Yes, Ihere’s a huge rump jusl above the
you?
ankle. And there‘s quite a lot of
Listening 2 - Paln rallaf bruising. And just here, it‘s very
P hto,I’m not.
J=Janice, K=Karen swollen. 2
J Hello, my name‘s Janice. N Is it pamfu) when you move it? N HOvV arc you feelings
K Hello, Janice.I’m Karen. P Yes. very. P Not bad. thanks — n bit sore
I Hi,Karen. Boy or girl? Al Can you move your toes? N What happened to you?
K A boy. And yours? P It’s difficult, they’re numb - 1 can‘t feel P 1 fell off my bike
I A girl them at all. N Where does it hurt?
P Here, around my west.
x Lnvely. 1 think we gave birth at the same 2 N Can you move your fingers/
time last night, didn‘t wet N How are youfeeling? P Yes, I can, slowly.
J Yes.1 heard you. P 1 feel so hot. Whal does I he N Is it painful i
K Was 1making somuch noise? Welt it thermometer says P Yes, v I’ve also got a cut on my leg —
was the pain. N Yes, you do have fever. Your
J Didn‘t you have any pain relief ? temperature is a lrttle over 38. Have you N Oh. that’s deep, isn’t itl
K Oh yes.I hadjust gas and air at first. lt got a sore throat / P Yes, it is deep. Willi need stitchesi
does relieve the pain a bit, but the effect P YeS, it him IS When 1 talL N Maybe. Have you had stitches before?
wears off very quickly.lt ma kes you teel N 1 can see spots. Any redness i P No, never - and 1 don’t want any!
so light-headed if you have too much.It Ves. my chest wñ d track me a£ N You’ve seen the doctor, haven’t you?
red made me feel sick too. Anyway, when N And do you feel tired? P No. I haven't seen him yet.
the pain became unbearable. I had an P Yes. rorst‹a nt tiredness. And my legs
epidurai feel achy. too.
J Did that help you cope with the paln? 3 Listening 2 — A helpline call
x It took away the pain completely! MJ N How’s it going? N=nurse, M=mother o1 child
whole lever half went numb! It wk P I'll be glad when this is over. Doing N National Health line. How can 1 help?
great. How about you? anything is really tiring. M Oh, hello It’s my little boy - he‘s sevrn.
T
J his was my third, so the pain was n Oh dear. Do you feel dizZy at all? I'm worfled, because he’s got a terrible
easier to bear. Idid breathing exercises. P Yes, some days 1 feel dizzy and pptjgtt
1 decided tohave gns and air if the pain «i i« i‹r N OK. So,can you describe the cough* I
gol worse, but I didn’t need it.1 had an N when do you feel sick, mostly? rue» n. dues he wheeze when he
epidural last time. but 1 didn’t like P In the mornings. And I'm very coughsi
losing all sensation. This time 1 wanted constipated — haven‘t been to the toilet 1V1 Yes he does.
tO IDel the birth. for three days. Sorry to moan. N Does he wheeze when he breathes in or
R f'm sorry, Jan ice — I the nk you must be p i all right, We all need a good when he breathes out?
° moan sometimes. What nbout paln i M Mr .. . when he breathes In. Yes, not
P No. No pain. when he breathes out.
Pronunciation N When he coughs, does he cough up any
blood?
air hurt cloctoi Language spot M loo, but sometimes when hecoughs. he
care nurse appointment u - nurse , P=patient q y¡y
first halr tumour j
N I see. Does he have any allergiesi
ulcer worse where x of, IVLrs HaJes7 M No. I don‘t Lhink so.
P Not too bad. thanks. N light. Docs he have a fever? Have you
Al What happened to your taken his temperntvtre?
Unit 6 P 1 had afall. M Yes, he's burn ing.The thermometer
ii Where does it html says 37degrees.
P from my wrist to my elbow.
Scrub up II Whnt about your shoulder ?
diarrhoea numbness bruising
nausea aching tiredness N i«’s h.ve a look — swollen isn’t it!
cough
 1 28 Listening
Listening J - A care home
£=EMtĘB=BeMy
E ... and that nurse — Barbara— I don’t like
her.
B Sssh, Edith, she’ll hear youI
R I don’t care if she hears me, Betty.
She speaks torue like a child —‘That's a
lovely jumper you're wearing, Edith.
Don’t you look pretty ' She should call
me'Mrs Taylor’, thank you very muchl
Norespect, you sect And she comes into
my r‹x›in wiIhe›ut knocking. You’ve got
no privacy. no self-respect.
B Oh, cheer up. Let's goovrr and play
some bingo.
E Bingo? I‘m not interested in playing
bingo witfi a group ot old ladies! lt‘s not
very stimulafing, is it! C#'It#)SO
slow because they‘ve got nothing lo
keep their minds busy, and their
medication slows them up some more.
They just sit in front of the television all
B Arc you coming on the trip to the
seaside next week?
Ii No, I don’t lilic coach trips.1 just want to
go horne.1 miss my independence.1
miss my Łitchen. And that's anothe
thing — I don’t lilte the food here.
C Yes, but we don’t have to cook or do the
washing ourselves. 1 like this care home.
lt‘s clean. The staff are very
professional, and it‘s nice toknow
there's someone near in un emergency.
And thae's always someove to talk to.
I'm never lonely.
s w‹ 1, I don't want some young nurse
telling me what I can and cannot do.1
want children around me. It‘s not
natural livuig like this — evciybcxly here
is old!
Language spot
2 3 five feet elercn
A Will you pass me my glasses? Then UI
be able to see the television.
B Here you are.
A Thanks. Oh and will you dome another
favour?
B What nowt
A Will youhelp me stand up? I warrt to
switch it or.
B Vou'll probably fallover. f’ll do it.
A Thank you.I won’t trouble you again
Llstening 2 — Assessing a
patlent
N-nurse,o=daughtez of eIder1y patient
N Vout mum‘s going to be fine. There are
no bones broken.
D Oh, that‘s good news 1 was worrie‹t
because she’s n bit /rall.
N Is that the €rst time she’s had a fall?
D Yes, it is.
N I am doing an assessment of her. so I’ve
got some questions. Can you help me
urith them?
D Of course, go ahea‹L
N Right. Number one. How‘s your
mother‘s hearings Docs she wear a
hearing aids
D Ves, she is very deaf. Without her
hearing nid she hears nothing at all.
IJ OF. Can she see OF?
D With glasses, yes —very well for her age,
N Right. Mobihty? Are her movements
very restricted?
D Well, she needs help getting dressed
and getting in and out of the bath. She
has a walking stick rind she's very
independent. But some days she gets
dizzy and can be tinste ady on her feet.
She uses ascooter for shopping.
N The next question is about sleeping
habits. Does she have any sleep
disorders?
D She hns a lot of problems. She often
wakes up in the middle o/ the night.
Sometimes she can‘t sleep at all. She
lakes sleeping pills, and of course she
has a nap every now and then during
II c day.
N OD.AnyprobIems eating* Can your
molhr r ferd herself?
D Oh yrs, she’s fine at the table.
N Right Continence is next. Ooes she ever
wet herself/
D Well that happens quite often. Probably
because she doesn’t like usn ig a bedpai
and she ran‘t get to the bathroom. We
have to mnke sure she hns an
incontinence pad
N Does she ever show signs of corfusion/
D Occasionally, yes. Sometimes she thinks
I'm her sister. Lasl nighl I heard
someone moving around downstairs,
and when 1 went down, [ found Mem
in
the kitchen. She didn'l know whcre she
was We laughed aboiit it afterwards.
N Does this often happen?
D No. Very rarcly.
Listening1— A diabetic patlent
s=studnnt nursc, N-nuŁritinnist
s The new patient has had diabctes since
childhood. his notes wy.
N Uh huh. He hos type one, then ?
S What's that?
N There's type one diabetes and there's
type two. Type one usuaity appears
before the age of eighteen. Does he
inject himself with insulin?
S Yes, daily-
N Uh huh. OK. He’s on a special diet, is hc?
S Yes, but he's not overweight.
D No. Type one diabetes is not linked to
obesity.
S Soobesity is linked to type two, is it?
N Yes. Type tvvo is the common one.
S Thi.s patierrt has a spetial machine to
check levels of glucose in his blood. And
he shoiildn‘t eat sugar, right?
N Well, no. it’s not true that diabetics
Shouldn‘t eat sweet things. Actually,
what’s impoi taitt is balaric‘e. A diabctic'
like your patient should eat the same
amount of food at the same time of day
He necds tocount the calories in his
meals, and he shouid have snacks, not
big meaJs — especially befoie heA
S Oh, Why is that i
R 1“o avold hypoglycacmla.
S Hypoglycaemia — not enough glucose
inthcMoalńght
NRghL
Speaklng
l core metre cighty
2 ninety-five point seven kilos
4 two hundred and eleven pounds
S one point eight tirnns one poirrt eight
equals three point two four
6 ninety-five point seven divided by
three ptnt tt ftxai t we equals I vveiity
nine point five four

Listening 2 - An eatlng dlsorder
S=staffmirse, N=nurse
S The new patient's name is Anita
Josephs. Anita is sixteen. She fainted
and an ambulance brought her ln, so
we are keeping her ln for a forty-
elght- hour observation. Anita is very
underweight. She weighs 38.8 kilos.
NJ That puts her BMI in the danger zone,
s Yes, her mother believes she has
anore›0a. She told me about Anita's
personality changes and mood sings
N2 A typical teenager?
S To a point, yes But Aiuta Is obsessed
with diet:eg. She doesn’t eal. so she
gets stomach pains, frequent
constipation, and attacks of dizziness.
What does Anita say?
S Sfie says she feels miserable all the
tirnc, but she doesn’t know why,
However, she doesn‘t believe she hBs a
weight problem. She told rue that she
eats the same as everyone else, and
she doesn‘t think her ivelght loss is
abnormal. However. shedoes say she
has difficulty sleeping. and is losing
her hair, and she has also slopped
having periods.
Listening 1 — Blood types
I=instructor.,SI / S2= students land 2
I I want to show you what happens if you
mix the wrong types of blood.Now, in
front of you. you’ve got test tubes vnth
different types of blood in them. The
blood in one test tni be is type A. Now
who can receiv U1r›od type A?
S1 A paLiertt with. blood type AB.
I Right. So Aß can receive type A.ßut can
B iece ive A7 What happens if you give
i ype A to type B* Now there's some type
B blood in t he second test tube If you
add adrop of type A. you’ll see how they
react together. Now put a drop of the
blood on a sllde and look at lt through
the mlcroscope.
S2The red blood cells ore olning
togethei. I Yes, that’s Tight. We call that
’clumping‘,
Now the blood stops mooring if the red
cells clump. And of course, if the
blood stops moving. the patient dies.
NoVv, if
we put a little of block type O into more
type A, we'll see thed:fference
SIThe red blood cells are moving. The
blood looks OK.
I Right. You can give type O blood to all
the other blood types. So, if we have an
emergency, we usuNly use type 0. It’s
the universal donor
Listenlng 2— A blood test
N=nurse, P=patient
u H‹mvdoyouftt1?
P Tired all the time, really — I never have
any energy
N Have you had a blood test before?
P No,l haven‘t, no, How much blood will
you take?
N Oh, just enough to fill the syringe - just
five millilitres ... Well we’ve got tlic
results of your blood test. As 1 thought,
you're a little bit anaemic.
' es that bad*
u No, not necessarily It just means that
your rod blood cell count is a litt)e on
the low side A normal count ls about
4.2 to S.4 million red blood cells per
miCrolitre of blood, and yours was 3.9.
P Oh dear— what does that mean?
N Don’t worry- anaemia’s very com mon
in women.If you take iron
supplements, your red cell count should
soon go up. The cells are normal in size
and shape, so that looks good. Your
uvhite cells are a lithe high. but you’ve
just had a sore throat, haven’t you*
P Yes.
n Well. that’s just a sign that your body’s
been fighting the infection, so that's
fine And platelets were normal
Unit 10
Listening — Report of a death
n=nvrse, S=supervisor
N When I visited Mr Jacobs on Monday he
wcs golng downhill last. He was
conscious most of the time. His hands
and feet were cool. His aims were pale
grey. He spoke. but not tous—to people
we couldn‘tscc, At about four o‘clock he
tried toget out of bed and fell to the
flour. His breathing was restricted rind
Listcning scripts
noisy.so 1 gave oxygen to help mm
breathe.
S And you saw him on Tuesday, too,
didn‘t you›
N Yes. By Tuesday he was unconscious all
the time. Irregular breathing —
sometimes o pause of aminute or more
He took no fiuids and nofood. so there
was no urine Mrs Jacobs and Iturned
him regularly
S And when did the end come?
N The end came on Wednesday morning
Mr Jacobs was no longer breathing.
I called Doctor Simpson and he
pronounced Mr Jacobs dead at
ten o’clock. the seventh of July.
Writing
A Did you hear Mr Webb died last night?
B Did Se? OF dear. He got a lung infection,
didn't he?
A Yes, two weeks ago. He was receiviftg
treatment for that. bul he actually di ed
of a helf attack.
B Rea1Iy7 Wkat caused ti2
A A blood cJot.
B light. He had AIDS, of course, didn’t he.
When was he diagnosed with that?
A Six months ago. And he was I HV-
positive forfive years. He started
suffering from depression at about the
same tune
Listening1-A hygiene report
H=hospital administrator,S-sister
H Ah.Sister. [ need to talk to you about the
hygiene inspeciion
S OK. How was our score?
H Mm. Three out of ten
S Oh dear. Sell, they come at a very bad
t:me. Mid-morrü ng.
H I have their report here Er . .. I'll just run
through the important things ... under
’Ward hyg rene’—’Door handjes are not
regula rly cleaned. Beds are not ahvays
cleaned between patients. ToiJets must
be cleaned three times a day but they
are Only cleaned‹mee a day Floois must
be cleaned four tunes a day but they are
only cleaned once a day.'
Under‘Spillages of bodlly flulds’. the
report says that the average time was
 130 Listenlng
thirty-five minutes to clean op a
spiJJage of urine. Anü it says ‘Nunes’
knowledge of MRSA is good, but .
S They always wear gloves.
H Not good enough.It says here,’No rses
must wash hands be(ore putting on
gloves and after removing gloves ‘
S Well. We certainly need to improve. but
we are very short staffed.
H Mm.
Listening 2 —Test results
was.
r-ward nurse, P=Path lab t i J It says here that somebody spilt their
W Hello. Ward S.
P Hello, this is Peter tories from the Path
lab. l‘m phoning with Sandra
Browning's results
W Hi. Peter. Good neus?
P I'm afraid not. I can confirm it in v8sA.
We have identified the bacterium — it'
M RSA clone lS. OK. Now›, Mrs Browning
has an infectlon in her fight hip.
Correct?
W Yes,
P Well, we tested her urine and blood, and
took tluoat and nasal swabs. First
things first.Blood — high white cell
count.
w OK.
P Negatlve for L coli. But positive for
Staphylococcus aureus. We tested tlUs
Staphylococcus for resistance to
antibiotics. These are the results.
It is resistant to: Cefazolin, Penicillin,
and V ethirlllin. We ako tested for
resistance to firythTOmycin,
Clindainyciti, and Tetizcychne — all
goSttiv6. HO\^/oVef, I u>” I S S) iOw U ie
bacteriurn has a susceptibi lity to
Mi›girr›r1n Also, rhe harteririm is nnt
resistant to Vancornycin and Oxacyllin.
WOK. I've got thnt Peter — tha nks very
posture disoriei ted
unemotional uncommunicative
hallucinations deli isions
man Ie irrational
paranoia depression
Language spot
J=Jack, P=Paula
J Have you changed the patients‘
diessings' That’s the first thing on
my Hst.
P No, l haven’t done them yet.
J Mrs Eriksson’s blood pressiire needs to
2
be talu•n Have you done that yet?
P Yes, that was the first t.hing I did.
i What about Mr Sissoko‘s temperatuie?
Haveyou|akenit?
P Yes, I've done that. It's lower thanit
orange julce. Have you cleaned the
' ° O"
P That‘s the nexl thing on my list. so no,
1 haven’t done that yet.
And Mrs Wong needs some tests. Have
you taken a urine specimen from her*
P She’s having a shower at the moment.
SO I haven't had a chwce yec
Listening -A case conference
P=psychlahstN=nutsethma it
P . . so let's move on. Next on the list is
new patient Delioy Moseki. for those of
you who don't know him, he is SI,
admitt ed on Tuesday. Who is Mr
Moseki’s nurse therapist+
N It’s me doctor.
P Paul. Thank you. Can you take over*
N Yes Er . . Delroy ... The notes say that
when he was admitted last Tuesday he
ei . . oppea red normnl in h1s
movements and posture. However. he
didn’t know where he was and what
was happcning. He avoids eye contact,
and has spoken to none of the other
patients, as far as I know. The night staff
report that he has some sleepless
nighfs. He shouts out in thc night and
sales other patients. 1tl-ink lie has
auditory hallucinations.
P Yes, tnat‘s in the notes. He hears voices.
Have you done any tests ?
N Yes, the charge nurse on nigh I shift
has tested him.He names objects
correctly, but forgets them almost
immediat cly.
cries. It‘s also very hard tounderstand
what he says
P Thank you Paul. Now l’d like to est
some questlons . ..
Scrub up
1 Yoiternpe*atureis .letssee. rty-
eightpointüve.
NOW relax while 1 measure your het rt
rate .
3 Your blood piessure 1s a hu ndred and
/ifiy over nincty
4 The patient’s respiratory rate is around
eighteen bpm.
1 heart rate 4 respiratory rate
2 terri peizture s blood pressuie
6 vitaJ sign
Patient care
I Just pop this under your tongue.
2 Can you roll up your sleeve?
3 This may feel a brt cold on your chest.
4 Just breathe:n and out normally.
'i Relax your arm for me
6 Could you undo your shirt for me.
please?
Listening 1 — AComa patient
l=1CU nuise, D=doctor
1 ICU*
D Hi. Doctor 6Aichaels here.
I mood even ing, doctor.
D stood evening now’s our ’rBi patient*
I Mr Forrester/ Mm. It’s not looking good.
H6‘s still unconscious, doctor
D Whnt‘s the blood pressure reading°
1 BP is one sevenly over one twenty.
D Mmm, Much too high And what Ans it
at twenty hundred hours 7
i One fifty over ninety. It started rising an
hour later — at twenty-two hundred
hours it was one sixty over one ten.
D So, rlsing all the time. What about his
lCP?
1 ICP was stable at twenty at twenty
hundred hours. But it rose to twenty
five at twenty-one hundred At twenty-
two hundred it was t vrenty six Now it’s
twenty seven.
D Right. We mu st get his ICP back to
below twenty. Twenty and over is too
high On. I’ll be there in ten minutes.

Listening 2— A scan
N=nurse, M=Mrs Murphy
N OK, his Murphy, just lie back Qn this
examination table. Are you
comfortable7
M Yes, thank you.
n Have you had plenty of water todrink?
M Yes —three glasses
N Good. we need your bladder full I'm
putting some gel onto your uhrlomen
That helps the ultrasound work well.
M OK
N Your notes say the baby has stopped
°*'•8 + a •'g* '
MYes,I‘m a bit worried.
N And you’re in the twenty-second week
of your pregnancy?
M Yes.
N Right. Well the ultrasound scan is very
simple. When 1 pass the t ransducer over
yoox abdomen, it bounces sound waves
of the baby‘S body and it makes a
picture here on the monitor. Then we
S 10 mllllgrams of Dimotane each llme.
can see if there is anything wrong. It
shows up anyabnormalltfes. A scan can
usually Show if the baby is a boy or a
girl. Do you want to know me baby’s
sex?
M Yes please.
N OK. I’m passing the f ransducer over
your abdomen now. Ah, here we arc
There’s the baby. Ca n you see It?
M It's not very clear.
N weir, here’s the head. Can you see that'
N And there's a hasa. rive fingers. And
there’s a foot — can you seek
M Ves
N Can yOu see the heel beat B'
The bab alive and looks good. Yes,
everyth ing is normal And look —a
penis.lt’s a boy.
M Really7 1 wanl ed a girl.
N You dld? Just a moment ! Well you're not
going to be dlsappointed — you’re going
tohave twins - a icy md a girl.
Vocabulary
A painkiller An antihistamine
A sedative A stimulant
An anti-inflammatory An antidepressant
As inoculation A laxative
An antlblotic A supplement
Listening scripts
Listening - Patierrt medication T' Hello.
I But to start us ofT, Amber Can you tell
1 Let‘sstaitwith Mr Gupta. He's had pain
us about qi9oiip heating*
all right in the lower alxiomPn The
A oipong is holistic. It sees illness as a
doctor says he needs stronger pain
problem of mind, spirit. and body, so the
relief, so he has prescribed thirty
whole person is treated. not just the
milligrams of Morphine every four
illness.
hours.
I Rlght. And qi is important isn't it? \V1iat
2 We have nraved Mr Gill to an lsolat ton
exactly is Qi?
room, as he has an infection in his
A @i is energy. Oi is part of everything
respiratory tract. A new antibiotic may
that exists. fitness, you see, is caused by
work, so we are givtng h tm a 600
an imbalance of 9i, and a qigo•9 *£•2tle r
mllligiarn infusion of Cllndamycin over restores energy balance so that healing
a period of four hours,
can happen.
3 Now, Mr Sawyer. We have to encourage
i And you heal from a distance, don‘t
bowel movement, so a laxative could be
you? Over the telephone?
usefu] He has one tablespoon of
A That's co7rect. 1 practice external qi
Metamucil - that‘s 15 mill:grams - three
healing. I speak to my patients by
times a day.
telephone.
4 Right. 1\Ar Thomas is on antibiotics for
I And you unblock their qf?
his skin infecilon. Cephalexin is in
A Put simply, yes.
tablet form, to be taken Cth food. 2S0
I Thank you. Profesxnr Silver — you don’t
rrulligrams every slx hours. believe in qi, do to u
lastly, Mr Cheong referees an injection
P No. I have found no evidence for qi, no.
of an antihistamine every elght hours i And yet energy healing does work,
don‘t you agree?
Maybe th1s drill control his allergies.
P It docs wui sometimes, yes.
I So how do you explain IU
Patient care P We find a lot of evidence for a placebo
1 She needs to take two tablets twice effect. Belief is seventy per cent of any
treatment.ln other vrords, my hands
a day for a week.
can’t heal you. but if you believe I have
2 What dosage of Penicillin is MrOI ver
healing hands. then I can heal yOu by
on?
moveeg my hands over you.
3 How often does he need his medicines
i So. what‘s really going on here?
4 Give Mrs Muben one 0.S mil eye drop
P Well. we do k now that being completely
in
each eye every four hours. relaxed helps us recover more quickly.
1 So, you are saytng that all I need is to
S He’s on two tablets three times a dny
with water at mealtimes. relax and believe that you have the
power toheal me?
P inactly. by explanation iS not as
interesting as Amber‘s, but we live in
the twenty first century and ..
Listening1-Chgozig
I=izttezviewer, A=Amher, P=Prnferrnr
I Can you cure Illness without medicine
or surgeryi Energy healers say yes.
Energy healers soy they can heal
witl lost ttiucl tii ig the patient. In the
studio, to tell us about energy healing,
i.s Amber Chesterman, who is a qiqon9
healer.
A Hello.
I Also with us is Professor Julius Sllver
who is sceptical about Qigong.
132

Glossary
tweezers ‹› fully-qualified .‹i side effects
artery u: junk food thu ultrasound
bin u usual .ai appointment
e dressing x lump io bacte a
SCOF\ a firstaid c, care home
cardiac arrest disorder ‹›o cure
body ci fdtal
sore ‹› diagnosis

Consonants
drop I” fee
b obese vein
tic 0 therapy
dose ct the immune system
k clot r sample
gait ‹ sterilise
stretcher / shift
d5 allergic ¿ infusion

abnormality *,*hnn: ’n›‹cliti/ n something
that is not normal
accuunI» h›'ku c›i itx/ /› a iecoid of honey
received and spent
achlng ”cikiij/ n a continuous, steady pain
addicted /a'diktid/ adj having a physical
and mental need to consume a
substance,especialIya harmful drug
agonizlng / ‹cgan«tzirj/ adj extremely
painful
allergic /.a'I:‹:d¿iU adj having a condition
that causes a bad reaction on contact
with acertain substance
antimicrobial agent /,aaimaik,ra‹›hi I ’ct
¢l-with n a substance that kills bacteria
and other micro-organisms
antiviral /,ni›t›’ :‹mol adj used to describe
a drug that stops a virus from copying
itself,and therefore prevents infection
from spreading
apply for a job /o,pIai l“*r .e 'c1¿nh/ vtO
make a formal written request for ajob
appointment /. 'p.ait›tma M/ n a formal
arrangement to see a doctor, etc.at
a pat ticular time
artery ' 'u:t.mil n any of the blood vessels
which carry blood away from the heart
auxiliary nurse /nq‘ziliai”i n:‹:s/ n a nurse
with basic qualifications who helps with
the care of pztienLs
bpm ‘,Hi: pi: 'en»’ n \ beats per minute
used to measure heart rate
2 breaths per minute used to measure
respiratory rate
bacteria /h;ck’it.Sri,/ n small organisms
withou† a nucleus, that can sometimes
cause infection
bereavement /bi’rvn›niiU’ nthe death of3
loved one
bin ,‘Min/ n a container for throwing waste
into
bipolar disorder /hat,par›l0 clis‘a.do(r)/ n a
mental illness that causes somebody to
change suddenly from being very happy
to very sad
blister *' hlt.sto‹ rl/ n a closed shell of skin
containing liquid. that is caused. for
example, fry a htirn or nther injury
bodily fluids /,l txlili 'I1H:idy/ n the liquids
inside the body fhat allow it to function
body ‘t›od n a dead person
bowel movement /'brtuI ,n u.x Iljnnt/ n the
release of sulid waste matter from the
body
brain waves "hi c›n 'clvz. n electrical
signal» in the hrain
bruising /'hi u:zi‹j n blue or purple marks
on the body, caused by bleeding under
the skin
burial /’hcriaI/ n o ceremonywhcre a dead
person is put in a box under the ground
calorie ."k:cLni-i/ n a unit for measuring how
much energy food will produce
cardiac arrest /,ku.disk o'iest. n an
occasion where somebody‘s heart stops
beating
care home "kev ho‹›m/ n a home that
prnvirles accommodation. food. and ca‹e
for elderly people
carer /'kcai’ati )/ na person who is trained
to take care ofIII or elderly people
catering *'kcitarnj/ n the work of preparing
food for a hospital, schooI,etc
cell /scI/ n the smallest unit Of IivinB • altet
circulation ’,s:‹:k}»'lct}tj/ n the movement
of illsLI0o‹J through theheai‘t and hlood
vessels
clot /kIot/ n (of blood) to form thick lumps
cognitive function /,kogmtiv ’fu k|‘oir* n
the ability to useyour brain effectively to
think, recognize, remember, etc.
concentrate /'k otis,inreit/ v to focus
attention on one thing
confinement /kan'f.m rrioi t/ nthe
condition of being unable to leave.your
bed, 3 room, etc.
confusion /k.on' ti:-y / n a state of not
being certain about what is happening,
what you should do, what something
means, etc.

constipation 1. n «i :-' | i ’ n the
condition of being ‹ ‹'able to I ave
a bowel moverrierit easily
consultant .’”I o i i t.» i i n a hospital
dcctor of high rank who has special
knowledge in a particular area of
medicine and advises the patient‘s doctor
consultation l.i ›N•,.›! ' .' t › na meeting
with an experi, especi.ally » dnrtnr. In gel
aclvice or treatment
contamination l. i ! l. u c ‹IIi n the
process by whlcf. a place, su(›stance, etc.
is affected bya sobstance that iS
dangerous or carries disease
con 'entionaI medicine ! .^i •”u | o»I
‹ ir‘‹ls/ i i n the ‹›sual, tmditicnal form of
medical treats cnt useJ in the West
co-ordination I., . ‘‹! ‘ w« | » n the ability
tocontrol y‹›ur movements well
corrldor I. i i /‹l. ( i › na long narrow
passage in a balding, with boors that
open Into rooms on either side
cough l.i ›l n a sudrtei! noise produced
when air is suddenly furced out of the
throat, for example when you have a cold
CPR (cardiopulmonary resuscitation) ‹i
p›i ’‹i I i ), n 3n emergency procedure
used to keep a persor! ‹alive who has
stopped breathing or wf os I calI f'as
stoppcrl heating
cramp '’l.' .c›”› t• na squeezing pain n a
muscle
cravlng l.i c‘i i i na sudden strong desire
for sor”ietfing
cremation r i i m‹ t i na ceremony where
the body ofa dead person Is burnt in a
special I»iiiIding
cubicle I i \ i\ I na small room that is
made by separating off part of a larger
room
deaf ‹!c I adj u nable to f ear
deficiency ‹.I i ' I |. i ›s! r: the state of not
having, or not having enough of.
something that is essential
der ‹inity ’ ‹ L' ‹ I i› a cr '‹l‹t «›‹ ii i
which a part or of the body iS not the
normal shape
degenerative v.I i c!-,c’i .›i i ’ adj (of an
Illness) getting or likely to get worse as
lime passes
diabetic ‹1. 1 ‹ i l. md; being unable to
produce enough insulin
diagnose. ‹’..‹ i ›o‹ vto say what
disease or cor diti‹›n a person is suffering
from, based on tests, exar if ation*. and
SQL gtOrf\ S
diet °].t i.: i n1 the food fhat you eat and
dring regularly
2 a limrted variety or amount of food thaf
you eat for medical reasons or because
you want ro lose welght, a tir ‹‘when
yr'r only eat this limited variety or
am‹›cJl \t
disabled ‹I iI:.J‹! ody having a phys ical or
mental problem wh‹rh mr nS you are
unable to do some tl^ings
dislnfectant ,‹I ^//› I film \ n a substance
that kills bacteria
disorder rl ‘. ^. ‹!o‹ i n an illness that
causes ‹i part nf the body to stop
functirining correctly
dispense i t c i!› vto prepare medicine
and give it to people
disposable ‹ ^:›‹ ./cl°l adj make to be
throw n ‹away after use
dispose of ‹Ji• ’ t •.^‹ .* » ' vto throw away
something that is no longer needed
dlstressing ,!/• i s/ q ad/ something thai
makes people feel xtreme)y upset
dizziness ›!›x .-’. n a confused feeling
that you are turning or spinning, or that
everything else is
dose ‹’ * » the amount ofa drug that is
given at one time
dressing I ‹‘“.i n a piece of soft material
placed over a wound in order to protect It
drip r’. v(of a liquid) to fall in small
drop ’‹!i r›t- n a very small amount uf lio,uid
that form sa round shape
droplet ’ ‹h i Ioi n I i. extreriiely small
drop of.a liquid
ECG (electro¢ardiogram) . i » v! I ’’ n a
medical test used to measure electrical
activity in the heart to diagnose heart
disorders or blockagcs In the arteries
eczema ’ !. i i o n a sl‹in condition that
causes redness and itching, and sores
that seers.te fluid and become dry
and scaly
fatal t‹› ï I en} causing, or capa6l«of
causii g, death
lee i ’ n an amount of money that you pay
fGr pr‹›fessional advice or services
first aid f.‹ •f ‹‘i‹! e emergency treatment
that is glvc‘n to somcLody before
professional mediCal help ls available
floor . II i i › n1 o‹'e levcl ofa buiIdI•B
2 the bottom sur f’ace ofa room
foreign body i .: i I’ .’. i n a substance
or object that iS found in the body, but
should not be there
foret1sic analysis I’.^ I r‘t !-. * i 1 :* i‘.’ r
scicntific study that is dore to tryto
help police solve a crime
frall ’i› iI nx/j phys‹raIIy weak and easily
injured
fully-qualified t ‹ .1 i I. '. oll I:\ /‹! adj havlng
passed all necessary exzms in order to do
a particular job
funeral I t . r . l.‘ n 8 ceremony et wNch a
dead çcrsoi* is buried or cremated
Glossary
gait ‹\r i‹ n the way ir which a person
walks
gas and alr ‹;.'. : i '‹! . i › n a gas that is
given to ¿atiei’ts to r«Iicv« pain, thaf is
made up of SO% oxygen and 509 nitrous
oxirte
germ ‹I ,.• i› i n a m‹cro-organism that can
cause Infection and disease
grieving ‹\ i i i i ndj fr'elii'g great sarlness
after a loved one has died
haemoglobin ” i ›i. i ‹ i I n a
substance ir red blood cells that marries
oxygen nro‹ r'd the body
healer ‘ I Isl › i i a person who cures
people of llli!esses and dlsease using
natural powers rather than medicine
heart rate I ‹ I i ‹ ii n the speed at wI ich
the heart beats
herballst I! I ..‹ i n a person who use8
herb» (-plants) to treat patlenls
holistic 1 1 !I adj used to describe
medical care that looks at all aspects
ofa person's body, mind,and enviror
mertt
hypodermic needle !i'. ‹| nc!.' i i| ' UJ ‹',I
n a device with a sharp point «sed for
injecting a °,uhstanre through the skin
immobile i ri : o‹ 1 .! i l adj uno ble to vvoll‹
around
immune system ‹^/ i ii I i.i /-i sisiii » n the
system m the borty thdt rnrluces
substz i ces to help it figf I dB a IRSI
infection anJ disease
immune » ri odj not affected by and
not able to catch a particular disease or
il mess
incontinent ii i t. i 'i \ i i i '. u i.' adj’ unable to
control the mhase t›f ‹ rlne and faeces
independence •• !" ‹'c .• n freedom
to do what you wanI to do, without
being cortrnlled by others
fnfectlon M i ' ‹ 1. t i' na condition caused by
baCterla i‹JvadIng ‹ r1d multiplying in a
bodily part or tissue. resulting in disease
infusion ,’/ I” i - i ! ” n a method for slowly
pul!ir°g a drug ur uther sulJstancu intu u
person's vein; the brug that is used in
this way
initial assessment i ni|I . ’sr'•lv i i ’ I 'H a
judgement r ade about I ow serious a
patient‘s coi•dition is when they first
arrive at hospital
intake » iut t• n the amount of something
that a person vats. drinks, takes. etc., ‹n a
particular period of time
itching ‹I t n an irrilting feeling on the
skin that car‹scs a desire to scratch
junk food ‹I „.•. L t\i,‹ n food, for example
burgers and fries, that isquick and easy
to prep• re and cat. but is badfor your
 134
labour "leiH.1r I/ r the process cf
childbirth.from thC start of contractions
of the uEerus to the birth of the baby
lecture "I kt|'.1 i )/ i› a talk that is yiven to a
group of people to teach them about a
particular subject. often as part of 2
college course
life-llmltingcondition ,I:ut” linen up
Loi›‘ch}n n an illness that prevents a
person from living a normal life
life-threatening condition ,I. ii” Nrr't.»mi1
k. t1’c1›,[n‹ n an illness that could kill the
person that has it
lift ‘!iIi/ rl a machine that carries people or
goods up and down to differed levels
in a building
limb lin› ri an arm or a leg
local ar¥desthetic I.a‹. kl :ci1as’l1c4ik. n a
drug that makes you unable to feel
anything in one part of the bcdy
long-term ‘,Ing 't.‹mjz. odjlasting for a Ion8
time.often many years
lose‹onsciousness ,lu:z k nijjgirl as vto
become unconscious
lump ’fa,mp/ n any kind of abnormal mass
that can be felt in or on the body
medklnal /f1io’cIisinI/ ad) I elpful in the
process ofhealing illness or infection
microscope ‘m:uk rank. ‹q» n an
Instrt›ment used in scientific study for
making very small things look larger so
that youcan examine their carefully
migraine ’maiqicin n a severe headache
that may be accompanied by nausea.
vomiting, or sensitivity to light
mild n1:nld/ obj not strong
mineral ”ri\ini ot/ n a substance that is
naturally present in the earth and in the
human body, and is essential for good
health
mobility lms‘ h‹lo ti/ n used to describe
how easy or difficult it is for a person to
walk around
mood swings 'n›u:‹1 xw‹qtjx/ n periods
during which a person changes quickly
from feeling very happy tofeeling very
unhappy
mortuary ’’ tna:i”l }.art.' na room ina
hospital where dead bodfes are taken
multi-sensory ‘,multi ¢i›sait/ odd
lnvolvtng all or several of the senses
of touch,sight. hearing. and smell
mutate ''n›iu:'teit/ vtodevelop into a new
form because ofa genetic change
nap /ntep/ n a short sleep taken during tht
day
nasal /‘Ijefrl/ adj of or relating to the nose
nausea ’no:zJa/ n the unpleasant feeling
that you are goings to vomit
»ewous systel» /6o n.z. x’.>» ,sist3zn/ n the
system of all the nerves in the body
nigM shiR 'n:iiI /llI nthE period of work
that takes plan.e during the night
numbness '‹›•i»n.•» n a IacL of feeling in a
part of the body
nursing officer 'it:‹:sl/1 ,mis.›f i ) n a senior
nurse who is responsible for managing a
ward and the people who work on It
nutritionist i› ju: tri|';ni•t n a person who
studies the effects of food on thp body
obese o‹ 'hi's. a very fat in a way that is
not healthy
onset onset n the time when a disease or
condition starts to affect a person
overweight ,ñ‹ ›v» ›+ cil adj too heavy and
fat
oximeter nk ’Mali-t.aI i ) r› a machine for
measuring the amount of oxygen in the
blood
pain relief jam ri,Ii.I*‘ n drugs or
treatment given to a patient to take
away pain
paralyse '‘ p:t'raI‹iiz v to make all or a part
of the baby unable to move
part-time pu:t ‘laim adj(of a job,course
of study, etc.) occupying only part of
the normal week
pathogen ’‘p:ctlM¿a›t r/ a liarrriful r »cia-
organism capable of causing disease,
Such as a virus, bacterium, or
fungus physiotherapist ,Iizis
'tM,t›ist/ n a
person who is trained to treat disease.
in|ury.or weakness in the joints or
muscles by exercises. massage, and the
use oflight and heat
pipette ’(x‘t,ct n a narrow tube used in a
laboratory for measuring or transferring
small amounts of liquids
placement ”plcis‹riont/ n ajob. oRen as
part ofa course of study.where you get
some experience of a particular kind of
work
platelet• ‘r!• ‹!3ts/ n small discs in the
blooJ, that help to clot the blood from a
cut or wound
practitioner /pra'k’tt.|.•i1atr)/ n a medical
professional who is licensed totreat
patients
pre-med ’pri: med/ n drugs given to
somebody in preparation for an
operation or other medical treatment
prescribe /pr»’skraib/ v(ofa doctor) ro
authorize a patignt t receive a
particular drug or treatment
prescription /pzo'.sknpJiJ n amedicine ur
tredtrricnt uutliur iz 'd Ivy â JOctO‹. II -v
written order that authorizes this
treatment
priority /pi.i i' nnti / n a thing or person that
you think you need to deal with first
pix›cedure *pro'si-d-y r)/ » the usual or
correct way of doing something
pr0g7eSS ¥¥€lteS ‘’[II .1c iL|l‘L”x \34‹•lw IT a
written record ofa patient‘s condition
ove«a pericd of time
promotion /p4 .›* m.nt [It n a move toa more
importantjob or rank
protein pr; t .l‹ n na natural substance
found in meat. eg8s. fi5h, some
vegetables. etc., which we need in order
to grow and stay healthy
psychiatric :iiL i':v1r L adj relating to
mental illness or to the treatment of it
psychotic •‹ti'k tllik, odj relating to. sex•ere
mental illt ess
puncture "p.‹ ilk i (.w r) r‘to make a hole in
something
quallFuations ,L ›‹ t›liI“i'Lr'i]'nx n exams
that you have taken and courses of Study
that you have completed
qualified 'fiv »Iil:t i‹t ufJ) havlng passed
the exams necessary to do a particular
tob
rank i:tijk n the level of job that a person
has in a particular area ot wo«k, such as
nursing
rash r:c(+ r› an area of red SpOt5 on a
person's skin, C»used by an illness or
a f'u6Lti¢JI1 tO SGITIetl1iflg
reception /i i'sc)›[n n the area inside the
entrance of ahospital, where patients
and visitors go when they first arrive
registration , a‹l¿i'st i‹ iJi›. n the official
recording of something in writing
resistant /l i'xistonl• adj not affected by
something: able to resht something
responsibility itis,{›c›i›s.a* L il»t i n duty to
do something important
rewarding /i i’v a.dll› aclj(of a job or
activity) that makes you happy because
it is useful or important
root /ru:t/ n the part ofa plant that grows
under the ground
saliva ’sa'l:Hx’6 ri the llquid that is
produced in your mouth that helps you
swallow food
sample 'sa:inpI/ n a small amount ofa
substance, for example blood or bcdy
fissile.that is tested in order to obtain
information
scan mkni› n a medical test for pregnant
women In which a machlne uses
ultrasound toproduce a picture ofa baby
inside its mother‘s body
sceptical ”'skcptik I' ad) not believing
completely in something
>e•e‹e Ill's i.4 i jl adj (olzn illness, ifljUr}/,
etc.) serious, very bad
severed / .mad/ odj (of part of the body)
cut off in an accident
shivering /’(iv»riq/ n slight shivering of the
body caused by cold,Illness, etc.
shuffling *'{allNl/ adj used to describe a
 /lOSSdF'/ J35

may of walking with short steps, with the biood vessel, that cc n cause loss o1
feet not leaving thcfloor tumour ’ I u »oi i ›. n an abnormal growth
muscle control, speech difficulties, etc. of tissue caused by an uncontrolled
siblings ." + l ^hi z n brothers and sisters
suicide ’ ii i :i /‹! n the act ofkilling increase in cells
side effects •› i‹l i L I. t n an extra and
yourself tweezers " I› i.z.nz n a metal tool for
usually bad effect that a drug has on you,
superstition ›«.j ..›’>‹i \ i n a belief that picking up or removing very small
as well as curing illness or pain
cannot be explained by reason or science objects, consisting of two arms that you
skip ',I.q: v to not do *omething that you
supplement '..•.|°l n i›i n something that pii\ch tugtñher
usually do or should do.such as have a
you eat in addition to your normal food ultrasound ’ . .It i .^,. ‹› i ‹-! n the use of hlgh-
meal or take medicine
to maintain or improve your health frequency sound waves to make an
sllde ’ s t.'.i‹I ‘’ na small piece of glass that
suppository so gi›xi! i ›. n a medication in image of a part inside the body: the
something is placed on so that it can be I
tablet form which is inserted into the image produced
¢oLed at under a microscope
rectum, where it melts unbearable ’.. l,c, . I .I adj toohad or
slight ‘›l.i ‹ i. adj nQ great, a small degree of
susceptible s* sr gliI°I adj likely to be extreme tocope with
snack , <›:r'L n a small meal or amount of
affected fry something vein ’\ ‹ ' n any of the blood vessels that
food
swab ‹ ›l-• vtoclean someth ng using a carry blood back to the heart
sore .’r. (r).‘’ odj (of part of the body) painful
piece of soft material ventilator ’ \ uI Citi \ { i I ‘ n a pleCe Of
anrl possibly swollen. for example
because of infection or being used too swear r ( i j vto say bad words medical equipment used to allow
much swelling ‹ Im n an increase in size of somebody to breathe who cannot do so
an injured or diseased area of the body without help
sore '’sn ‹ i )'’ n a painful, often red, place
as a result of fluid build-up •irus ’› , ‹i os n a micro-organlsm that
on your body where there is a wound
swollen , '•› ; ‹›loJi odj(used ahout palI of causes infection and disease and that
or an infection
the body) ircreased in size as a result of spreads by copying itselr
source <^ •,’ /? a place or thing that you can
fluid build-up •ital sigos \r n 1 ' u uiz ' n a patient's pulse
get som‹ thing from
sympathy ‘›/ i i]»(Iz.’ xi a feeling of rBte.temperature, respiratory (=
s{+e*'lalize ’ ' >{ 'c nl.i ix ’ v tuhecurrie an
understanding and carlng between breathing) rate, and blood pressure
expert in a particular area of work people
specimen •\›o ii c.,i na sample of blood, vit3f¥tlr\ ’ \ i I 0l ilii n dny0fd group Of
syringe si’r /M‹J-, i a medical instrument organic compounrls that are needer\ in
urine.tissue. etc..collected for lakoiatory used to remove fluids from the bDdy small amounts but cannot be made
analysis or inject them irrto it using a needle within the body
splllage . s t ul rl ,. o an occasion when
test tube ’icsr rju L•. n a glass or clear ward . \•..›.‹1 n any of the rooms in a
liquid is dropped by accident; the liquid
plastic tube used In laboratories for hospital which has beds for patients
that is dropped
holding a liquid or other substance to be waste ›. ci i. n materials that are no
spot ›i›t n a smafl.often red. mark or
tesled longer needed and are thrown away
lump on a person‘s skin. sometimes with
therapy fioi .nt i nthe treatment ofa worms › :. r ‹x ’ n long thin crea(ures that
a ycllow head to it
physical problem or an illness live 1nsicIe tf!e body and can cause Illness
spotless ‘ ;› ! Io adj completely clean
threat l”h I n a bad thing that somebody wound ›•. r: u‹! n an injury that involves
spread ›\ ‹‹! v(ofa disease,an infeCfion,
says they will do to another person the skln being cut or broken
etc.) to move from one person or place
tic t L n a fast, uncontrollable muscle
to
movemer't, ofien occurring in the face
cover a wider area
transducer t i .' i .• ’‹li i •,.°‹ i › ’ n a device
sterlle .’"›i« uiI.‘’ cdj that has been heated
that is passed over a patient inan
to kill microorganisms
ultrasound examination in order to
sterilize ' glen /1» ix’ vto heat something ln
produce an image
order to kill mlcro-organisms on it
trauma . I i o u o n a serious shock to the
stimulant u n} ,I o» i .' n a drug that makes
hody cr mii d, for ex•nmpIe causer\ by a
ynu fPPl iT\nrr awal‹P.ancl that mnkes the
violent event
body work faster
tra vmatic i i .n « i:i.' i i \., adj 1 extremely
stimulatlon m to lcij». n acllvity that
unpleasant and causing you to feel upset
makes the mind more active
and / or anxious
stitches ’•i ‹I|iz n short pieces of thread,
etc. that doctors use t Sew the cdges of 2 (of an injury.etc.) sudden and violent
treatment i i i \› ,i i /? the medication,
a wound together
surgery,therapy, etc. that is given o‹
stomach ulcer •’ ’ <,‘•. i i.nl‹ ,I . t i ) n a sore
Area oM tito Ouf»dt- Of flio \›utJy uf un the
done In urder to cure or Improve a
surface of an organ inside the body condition or injury
which is painful and may blecd or triage nurse i i i ‹! i›:‹ n a pc‹son
produce a poisor ous substance whosejob is to decide how urgently
stretcher ' I i ct|,nt i î, n a piece of patients need to be treated, according to
equipment that allows two people to how serious their condiLioi, is
carrya sick or injured person who is lying
down
stroke < r ‹›I.. n damage to part of the
brain caused by a blocked or broken
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