ASM Final Exam

Find the true statement

- ***the single most serious threat for the elderly is stroke. - 25% of medical students take no course in geriatrics (its 97%) - the single most serious threat for elderly is falling. (not the single most) - after a significant impact on the lives of elderly research participants at the Univ of Minn, where half were less likely to get depressed and 1/4 we less likely to become disabled, the government began creating programs just like it. (no it was shut down)

Barnard (1922-2001)

- 1st human heart transplant - defined ethical definition of death - heart-lung bypass invented in 1953 - challenges included immune system, long surgery, blood, ethics, rejection, repairing blood vessels - not first human transplant (kidneys and nose done) - confident, driven, determined - patient: Louis Washkansky - poor results of initial transplants drove surgeries down (immunosuppresant) - 25,000 transplants per year

TED Talk by Jill Bolte Taylor "My Stroke of Insight"

- Brother with schizophrenia - Dedicated research to understanding the disorder/brain disfunction - What are the biological differences between the brains of normal control compared to brains of schizophrenia or bipolar disorders - Microcircuitry of the brain - Traveled as advocate for NAMI - Woke up and discovered brain disorder - completely deteriorated in 4 hours - Could not walk, talk, read, remember - Two hemispheres completely separate and process info differently - Right hemisphere about present moment, thinks in pictures, learns kinesthetically - Left hemisphere thinks linearly and methodically, about past and future, picks out details, categorizes and organizes, projects future possibilities, thinks in language, connect internal to external world - Little voice - I am, I am - separate individual Lost on morning of stroke - Stroke: gripping and release of pain, witnessed herself having experience of exercise, body slowed way down, rigid and constricted movement, heard dialogue inside body, couldn't define boundaries of body, Total silence, Back on - there's a problem, La la Land, Right arm paralyzed - having a stroke, This is so cool (back and forth, consciousness and reality), Seeing pixels, Couldn't speak or understand language, Nirvana - 8 years to completely recover - We choose moment by moment how we want to be in the world - I am - The "we" inside of me - The more time we spend choosing to run the deep inner-peace circuitry of our right hemispheres, the more peace we will project into the world, and the more peaceful our planet will be

TED Talk by Lise Worthen-Chaudhari "The Body Knows More Than We Think"

- Embed arts to promote movement that is the medicine - Interactive art technology - Applies principles from dance and emerging digital technologies to evoke creative process during activity-based prescription performance - Tactical emersion - Insights on bridging disciplines of rehabilitation science and creative arts - No one likes to be told what to do implicit learning - body has to figure out movement for themselves, Like learning to ride a bike, Implicit techniques used in dance like improvisation and analogy learning - Our bodies know more than we think Neuroplasticity - rerouting of neurons, Works through sensation, Neurons remember - You can bridge the disciplines, Persevere

Describe some underlying personal motivations for Sigmund Freud that you read?

- His mother adored him and gave him the sense that "he was born to achieve something great" which gave him the confidence to succeed later in life. - His father, on the other hand, said the he would "never amount to anything" and Freud still had dreams decades later of proving his father wrong by speaking his accomplishments.

TED Talk by Anne Marie Albano (my choosing) "How to raise kids who can overcome anxiety"

- I have always found that discussing the struggles of anxiety and learning coping mechanisms to be of value for situations I find myself in, whether that be with my own anxious thoughts or in helping others deal with theirs. - I also have thought to myself before about the growing awareness of anxiety and other mental health illnesses and how they are becoming more prevalent in my generation and those after me - I have even asked myself this exact question of "how will I raise my kids to minimize and overcome their anxiety." - Anne discussed the science aspect of medicine when talking about her trial experiments for treating children using anxiety medication and exposure therapy. - She discussed the art aspect as well with a focus on how parents can help to prevent a long-term anxiety illness and teach coping mechanisms when their child is anxious.

The Diving Bell and the Butterfly movie

- I think the movie showed the science and art of medicine in an effective way. - We clearly saw the science of medicine in the measures the healthcare professionals took to sew his eye, work on his mouth movement, and other forms of physical therapy. - I think the movie did an especially brilliant job of depicting the art of medicine though. Henriette, the speech therapist, demonstrated a level of patience with Jean-Do that was incredibly remarkable and one that few people could exemplify in this situation. - Her focus on finding an effective communication method for Jean-Do showed her care for him and for his ability to express his thoughts, even in a nonverbal and nongestural way. - I think a movie can certainly convey ideas in a way other art forms can't, and I think this movie proved that. Having the combined efforts of a visual and auditory form where I can put a face to the patient and physicians brought me deeper into the story than reading an anecdotal essay. - The movie format also allowed me to see the different roles, actions, and thoughts of each person affected by the medical situation, opposed to a TED Talk which only allows for one point of view. - This movie in particular allowed me to sympathize with the patient on another level because of the choice to film the majority of the movie as if we are looking through Jean-Do's eyes and experiencing his life. - I think for communicating across language barriers, if the patient has the ability to move any limb, there is potential to create a method of communication using arm, leg, hand gestures. In the case of Jean-Do, I think the strategy choice of his caretakers was effective and would be the way I would communicate.

The Power to Heal Article by Smolan, Moffitt, Naythons

- On pages 18-19, the photo features a woman selling various herbs and charms from her merchandise stand in Mexico City. Objects to improve people's overall health, their financial status, and their relationships in love are displayed at the shop such as incense, dried flowers, candles, powders, and shark jaws. On pages 24-25, the photo displays a spiritual shrine that has been set up for people to visit who are searching for cures for illnesses including rheumatism, cancer, paralysis, blindness, and arthritis. At the site of the shrine, the faithful consume dirt, rub it on themselves, or bring it home to aid the work of the cures (Smolan et al.). - In "The Hero in the White Coat" included on pages 57-61, the story of Dr. Grossman recounts the courageous, heroic work of doctors as they are simply doing their job daily. The job of doctors is to save lives, perform what might seem like the impossible, and pull off what feels like a miracle to their patients. We as patients put all our faith into doctors to heal humankind from physical wounds, and doctors risk and sacrifice their lives while embracing the role of a healer and doing so with humility and courage (Smolan et al.). - he message of doctors as healers and heroes from the prose in the book was more of a modern view on healing and more relevant to the world of medicine today. The photo of the herb and charm merchandise stand, on the other hand, represented a more historical and traditional view of medicine when potions and natural objects were used. When comparing the two artistic examples, the prose represented the power of healing more to me. Personally, - I did not grow up using natural remedies but instead would be taken to doctors and look to them for healing remedies. I have always trusted doctors and admired their dedication to helping people, including long work hours and constantly learning or researching on their off time. Doctors work with patients and families during what may be some of the most dark, scary, uncertain times and have the power to heal these people who are suffering. I am also a concrete thinker, so the proven evidence of science brings ease to my mental wounds while healing my physical wounds. I find comfort in knowing the facts rather than trusting in the power of unknown and uncertain ancient remedies.

Reading chapter 8 closely, Gawande chronicles for us the life and passage of his own father and essentially we learn how a human being lives a good life. In the end, we see the chronicle of what was most important as the senior Gawande drew closer to death which included:

- Physical suffering was not exactly prominent as the drugs were helpful to minimize it. - The shifting tide of consciousness made him realize his death was not over. - Anxieties of enduring what he hoped would be gone, were still evident. - Anxieties about problems with his body, confusion, worries about unfinished work and caring for those he was leaving were prominent as his consciousness surfaced. - In the end a desire for peacefulness was prominent.

TED Talk by Guy Winch "Why we all need to practice emotional first aid"

- Twin - Psychologist - Body valued over mind - We don't teach emotional/psychological hygiene like we do physical hygiene - We could treat psychological injuries like we do with physical but we don't - Make physical and psychological health equal - Take action when lonely - Loneliness creates deep psychological wound - distorts our thinking - Pay attention to emotional pain - Failure - we convince ourselves we are incapable - Stop emotional bleeding/change responses to failure - Rejection - we think of our faults, blame ourselves - We make psychological injuries deeper by hurting our self-esteem even more, we would never do that to a physical injury - Protect your self-esteem - Ruminating - focusing on negative thoughts, replaying bad things - Battle negative thinking

Dr. Gawande summarizes that to treat serious sickness or injury, clinicians and patients would be wise to consider these 3 vital questions BEFORE deciding on a course of action:

- What is your understanding of the situation and its potential outcomes? - What are your fears and what are your hopes? - What are the trade-offs that you are willing or NOT willing to make?

The Wit movie

- What resonated with me the most throughout the movie were the short monologues the patient, Vivian, gave directly to the camera. I felt like I was the caretaker sitting next to her bed and experiencing the pain with her. - She chose to only say certain things to the camera/audience rather than to her doctors and that gave an example of a poor patient-physician connection. - This movie has commonality with Gawande's book regarding the discussion of the life of a person who is close to death. - Being Mortal talks about how in the last stages of a person's life when they are approaching death, they focus more on the present and what makes life worth living when they have to depend on other people. - In the movie, Vivian suddenly learns of her stage four cancer and her perspectives shift when her health, dependence, and ability to teach are taken. She reflects deeply on her passion for teaching and the importance of treating others with kindness and compassion the way her nurse Susie did.

Sanger (1879-1966)

- birth control pill (coined the term in 1914) - social activist trained as nurse - was jailed for distributing info in BC clinic - had a newspaper called "The Woman Rebel" which was banned under the Comstock Act - awakening from Freud's lectures - McCormick provided $2M in financials - Pincus and Rock scientifically developed the pill and it was legalized in 1960 and 30x effective - progesterone and estrogen discovered

Anthropologists discover diseases

- cannibals, Kuru, Mad Cow - prion protein - Kuru: brains exhibited amyloid plaques, similar to Alzheimer's and CJD - anthros studied Fore habits and traced all deaths from Kuru to cannibalism in women and children - two chimps injected with Kuru - sick youths traced to British cattle

Ivanovsky (1864-1920)

- discovered viruses (were molecular) - tobacco plants/tobacco mosaic disease, used filter and contaminate was still coming though so had to be something smaller than bacteria - found that the filtrate contained the disease - Beijerinck worked with this and found its not bacterial spore

Roentgen (1845-1923)

- discovered xrays by accident - study of bacteria and how they polarize light - the use of xrays was embraced immediately - rigid, meticulous, stubborn, passionate - spent much time alone in lab - turned lights off, lucky to stumble upon what others should've - first Nobel Prize in physics - disobeyed authority - xray discovery led to 3D CT/CAT scans - findings were published within 7 weeks - xrays moved in straight lines, not reflected by lenses, not deflected by prisms/magnet - "shadow pictures" of hand

Jenner/Henderson/Foege

- eradication of disease (smallpox) - cowpox inoculation/vaccine - last known case of smallpox in 1977 - Soviet Union asked WHO to organize world vaccination and donated 140M doses - two pronged vaccination needle (Henderson) and eradication escalation (E2) approach (Dr. Foege: go to outbreak spots and vaccinate country by country) contributed by US to speed efforts

Freud (1856-1939)

- exploration of unconscious mind (did not discover) - psychoanalysis dream interpretation and sexual theories - mental health viewed as religious punishment/possessed/fake - forced world to recognize the importance of the unconscious - perceptions, motives, dreams, thoughts, actions - id, conscious ego, unconscious superego - unconscious sexual drives, inner conflicts - cocaine for pain, hysteria, first to use couch in therapy - diligent, intelligent, observant - libido: mind is system of psychic energy - free association

What personal attributes or capabilities enhance Roentgen's chances of his scientific discoveries?

- good with his hands - meticulous experimenter - rigid and stubborn, although not lacking imagination or daring - spent endless hours in the lab

Ventor and Collins

- human genome - mapping of viruses, parasites, mycobacteria, and new targets - Mendel father of genetics, Watson and Crick fathers of DNA - Human Genome Project (Sinsheimer) map and sequence - initial government funding in 1987 - DOE and NIH - 1990 international project began with plan to sequence entire genome in 15 years - Ventor: categorized human gene function and with Hunkapiller (designed fastest sequencing machine - 100M bases a day) - Collins and Vector led projects that tied in race to sequence human genome - genome is an incomplete list of parts

Edwards (1925-2013) and Steptoe (1913-1988)

- in vitro fertilization - published in 1969 - Louise Joy Brown was first in vitro infant - control number of eggs fertilized; Edwards influenced stem cell work in 1980 and won Nobel Peace Prize in 2010 - challenges = fertilization, dose, hormones, timing, culture, implantation, money - catholic church condemned ivf

Fleming (1881-1955)

- remove dead tissue and flush with saline - discovered that mucous destroyed bacteria - penicillin (mold juice) - reducing infection, discoveries ignored by colleagues - modest, reticent, self-effacing, hid his brilliance and drive - hard worker, nimble mind, prepared, shy, inscrutable as a child - lysozymes from blood, tears, saliva kill bacteria - treated battle wounds in WWI

Future

- sensing, proteomic, nanotech, bioinformatics, imaging, computing - application of medical knowledge to individuals = humanity's finest and most difficult skills - final frontier = aging - technology extending life, molecular/genetic sciences

immunity

- specificity, memory, diversity - 1st theory: Behring - blood of immunized animals carried a protective substance (antitoxin) - 2nd theory: Metchnikoff - cellular immunity, white blood cells, "phagocytes" attacked infectious microbes - 3rd theory: Ehrlich - reactions of antigens and antibodies (lock and key) - Wright bridged gap of blood and cellular - opsonins whet appetite of phagocytes - Lederberg: self and nonself - memory cells, NK cells, T/B cells

The discovery of IVF was first published in the scientific journal Nature in what year?

1969

The last case of smallpox in our world occurred in:

1977

In the final pages of this chapter, Gawande implied that what happens in the end to people in these nursing homes and assisted living facilities is:

A life designed to be safe becomes devoid of what matters to the patient; These facilities are not built for the sake of the elderly but for the satisfaction of a child who leaves them there; The children leaving the elderly at these facilities want safety first and autonomy for their parents much later.

The aging process of the human body provides for all BUT one of the following:

An increase in the thenar muscles and a decrease in the thickness of the cardiac muscle.

It was not medical researchers who figured out how Kuru was transmitted within the Fore people. Instead it was:

Anthropologists

the idea about autonomy that Gawande suggests is most useful and realistic to elderly in Chapter 5

Autonomy is where we are permitted, insofar as possible, to shape the story of our lives in our world of choices and connections to others and where debility and dependence do not rule out or overrule our autonomy

How does the work of Freud and Weyer connect? Is there a difference in cultural response between these two time periods?

Both Freud and Weyer's work was focused on human's mental state and brain function. Specifically, they both focused on psychiatric problems, such as hysteria, to explain the very real symptoms of mental illness. In Weyer's time, people and women specifically were seen as crazy and tortured for their mental condition. In Freud's time though, these problems were legitimized and became proper subjects in medical study.

The first surgeon to transplant a human heart successfully was:

Christaan Barnard

Who led the projects that tied in the race to sequence the human genome?

Craig Ventor & Francis Collins

Contribution of Dr. Rosalind Franklin to the discovery of DNA's structure

Dr. Rosalind Franklin's scientific work was used, but not credited, by Watson and Crick. Franklin designed and conducted the imaging experiment that produced "Photo 51", the first imaging evidence that DNA was structured as a double-helix. Her colleague, Maurice Wilkins, took a copy of the photo to Crick and Watson's lab, without Franklin's knowledge or permission. Once Watson saw Franklin's experimental data, he realized that DNA had to be structured as a double-helix. He and Crick subsequently announced over lunch in their local pub that they had decoded the structure of DNA. They made this announcement only 1 month before Franklin's publication about the structure came out in March 1953, but it was enough for them to be able to claim public disclosure of the discovery for themselves. None of the three revealed that they used Franklin's work to "crack the code" until after her death in 1958.

Who won the Nobel Prize for discovering the double-helix structure of DNA?

Francis Crick & James Watson

Who is considered the founder of genetics as a field of study?

Gregor Mendel

In 3-4 sentences, describe Fleming's "firsts"--his advances and discoveries.

His first discovery was that by surgically removing as much dead tissue as possible and flushing the wounds of soldiers with sterile saline solution, infection was greatly minimized and the production of white blood cells was stimulated. His second discovery was that droplets of nasal mucus were destroying a yellowish bacterial colony in some contaminated culture plates and identified the substance killing the bacteria as a protein called lysozyme. His other discovery was of the powerful broad-spectrum antibacterial substance penicillin, which he came across in his lab when he noticed on a petri dish that the staph colonies close to mold had dissolved. He discovered the mold was secreting something that killed many of the disease-causing bacteria even as it was diluted, now known as penicillin.

In 3-4 sentences, give your impression of Ivanovsky as a scientist and as a person. Address a different impression or character trait of Ivanovsky per sentence (no repetition of information between sentences.

Ivanovsky seemed like he was methodical in the steps of his experiment: recognizing the tobacco disease, pumping the juice through the filter, and used his findings to make assumptions based on what was known in the world of medicine. He also seemed territorial of his findings: he wrote to claim priority for the discovery that the agent could pass through the filter and criticized Beijerinck's agar experiment. He was also open and imaginative to this new disease-causing agent: it was too small to see with the naked eye and not a known bacteria or toxin that caused the disease.

In 3-4 sentences, tell the story of how Ivanovsky figured out this innovation.

Ivanovsky was analyzing stunted, discolored tobacco plants that he recognized were infected by tobacco mosaic disease. He set out to isolate the microbe that he assumed was causing the disease, but when juice from the infected leaves was put into a filter for bacteria, the agent that spread the disease slipped through the filter which meant the microbe had to be something he couldn't see. After reading Beijerink's discoveries that ruled out bacterial spores, toxins, or particles, Ivanovsky believed that the most likely explanation for these filterable viruses was that "the contagium is contained in the sap in the form of solid particles."

As we read the book and especially in this chapter, we realize that Gawande is edging us toward a view for how to live a happy fulfilled and meaningful life. For instance, a Harvard philosopher writes about loyalty and an intrinsic human need that we all have to 'seek a cause beyond ourselves.' Who is that philosopher:

Josiah Royce

Which of the following statements about the charts in the beginning of Chapter 2 is FALSE?

Modern medicine helps to create an upward trajectory and a continual climb.

In 3-4 sentences, talk about your impressions of Fleming as a scientist and a person

My impressions were that Fleming was a quiet and modest yet driven and brilliant man who was confident in his remarkable discoveries. He seemed as though he had conflicting personalities as a scientist and as a person. As a scientist, he was said to be a leader, always at the top of his class, observant, and experimental. As a person, he was said to be a sports lover, as well as modest, shy, and inscrutable.

A researcher and a doctor created in vitro fertilization (IVF). Their names were

Robert Edwards and Patrick Steptoe

Select 1 other medical first we've discussed that involved controversy. Compare/contrast the controversy around IVF and the other medical first you've chosen

The creation of IVF was controversial as well as the creation of the Pill, two firsts that deal with the creation of life. The topic of reproduction is subject to criticism by both the science and religious community on the morality of the particular medical advancement. Both Edwards and Sanger were rebuked by the scientific experts and religious leaders. Sanger's distribution of contraceptive information, however, caught the attention of law enforcement, legally was banned, and caused her to be sentenced to jail. The controversy of IVF did not uproar this kind of chaos to the public. It is also noteworthy that Sanger is the first woman to be focused on in this book as a medical "first," which may have contributed to the controversy of the Pill over the already controversial topic.

The United States contributed these 2 innovations that sped the WHO's worldwide vaccination efforts:

Two-pronged vaccination needle & Eradication Escalation (E-squared) approach

By reviewing Maslow's theory around motivations for living, Gawande contrasts the desires of young versus old versus older old. He suggests that as we age:

We interact with fewer people and concentrate on spending time with family and established friends

In a 3-4 sentences, describe the cultural and historical context of Fleming's life and work.

When World War I broke out, Fleming went to France to treat wounded soldiers where he discovered antisepsis methods were not working for sever wounds of the soldiers. Thousands of soldiers were dying of tetanus, blood poisoning, and gangrene. Flemings approach to surgically remove dead tissue and flush the wound with saline was resisted within the army. His discovery of lysozyme and penicillin were both ignored and dismissed by his colleagues.

As Dr Gawande begins his book, he describes the intention of the lessons given when he was in medical school and said that he learned one of the following

about saving lives only

Gawande begins this chapter by showing us how doctors from other countries might view a patient's experiences as we witnessed in Chapter 6 with the patient Sara Monopoli. Gawande references scholars who have studied progression of medical developments in developing countries and how it is tied to economic development so that:

as countries become more developed they experience 3 stages of medical development and yet death and dying occur in the patient's home in the 1st and 3rd stage

One technique that Freud and colleague Breuer became known for is "catharsis", which refers to the process of "tracing [hysterical symptoms back to their] first appearance and re-experiencing the associated thoughts and feelings" that were experienced the first time. Through catharsis, many clients were able to stop the symptoms from occurring ever again, essentially curing the "hysteria". This process was given a different name by "Anna O.", the first patient who Breuer tried it with. What did she call it?

chimney sweeping

Roentgen shares part of his academic path with Albert Einstein: they each won entrance to Zurich Polytechnical School by examination. What disqualified both of these scientists from the traditional enrollment path?

disobeyed the authority of educators

It seems Gawande found more about fixing medicine by witnessing the interactions of his father with the two surgeons discussing his father's case. The surgeon who finally proved to be the right one, in Gawande's father's view, was all but one of the descriptors below:

exuding confidence but also authoritative, self-certain, and busy with things to do.

T or F: Gawande wonders: how did we wind up in a world where the only choices for the very old seem to be either going down with the volcano or yielding all control over on our lives. Ironically what he tells us is that the story of the poorhouse is vital to understand but that it is NOT a medical story.

false

T or F: The difference between standard medical care and hospice IS the difference between treating a patient for a disease and doing nothing for the patient.

false

T or F: Your chances of avoiding the nursing home are directly related to the number of children you have and having at least one daughter-in-law is crucial to the amount of help you receive.

false

T or F: Magaret Sanger created the birth control pill (The Pill).

false - Sanger was a leading advocate for birth control. Katherine Dexter McCormick provided the financial backing. Sanger recruited Gregory Pincus and John Rock, experimental scientists, to developed the product.

T or F: Roentgen discovered X-rays on Nov 8, 1895. For the subsequent 6 weeks, he performed a series of experiments to characterize the distance that, and substances through which, X-rays traveled, skipping meals to focus on documenting the novel discovery. His findings were published within 7 weeks and a day by the physical and Medicine Society of Wurzberg. However, it took several years, still, for clinicians to start using the technology.

false - xrays were embraced immediately

Chapter 5 tells a story about a physician who just knew how to sell his ideas and who was not afraid of rejection (this is an interesting quality or character trait when you really are passionate about making some change in life). He decided to make a change to the Nursing Home environment because:

it was a lonely place for most residents; it was a boring environment for residents; there were often feelings of helpless ness among the residents; he felt he knew that the residents needed a reason to live

In America in the early 1900's, about 60% of our elderly lived with one of their children, whereas in the latter 1900's (~1975) that percentage moved to:

less than 15%

It is NOT death that the very old tell Gawande that they fear, it's

losing their way of life, their hearing, and their memories and best friends

These days, in the US alone, organ transplantation occurs for

more than 25,000 Americans per year

A more ideal description of nursing homes is considered by Gawande in this chapter and it should be a place where:

one where the representatives of the institution sat down with the person to figure out 'what living a meaningful life' really means to them.

The following text described what protein: "...bits of infectious, self-replicating protein that can jump from cell to cell, animal to animal, and species to species"

prions

Human beings, as it was found and demonstrated at communities like New Bridge in Boston, had a need for

privacy, the possibility of forming caring relationships with those around them, flexible daily rhythms and patterns, community

The main issue causing organ transplantation failure is

rejection

Now that the human genome has been sequenced, Adler names these fields as the newest frontiers of medicine:

sensing, proteomics, nanotechnology, bioinformatics, imaging, computing

A monumental lesson is learned and embedded in the author about our medicine's approach when his family engages with the hospice nurse. Choose the correct statement:

the intention of hospice (as they use their arsenal of tools and meds) is to be clear they attend to what matters to the patient, to attend to obtaining clarity and communication from the patient, and to guide family in the many aspects of creating the ability of living for the best possible day instead of sacrificing time 'now' for time 'later.'

What was the result of the experimental 'assisted living facility' that Karen Wilson and her husband created?

the opposite of: the inhabitants ended up doing poorly because their diets and lifestyles declined with all that freedom, the government shut them down due to concerns over safety, incidence of depression rose in the inhabitants

Gawande characterizes the 'poorhouse' of the early 1900's and eventually compares them to the current poorhouses in India which he visited. One major adjustment in the U.S. in 1935 provided the means to allow many of the middle class to avoid the destitution of the poorhouse. It was:

the passage of the Social Security Act

Once Lou Sanders moved in with his daughter, "everyone discovered the reasons that generations live apart." Choose the one that does not apply:

the relationship with grandchildren is related to how long the grandparent lives

Insurance companies, like Aetna, decided to run an experiment to determine how to negotiate the delicate situation of whether they should support the use of experimental drugs to extend life in their claimants (patients who were insured by them).

they found that combining hospice care with experimental drugs was less costly than just the experimental drugs

T or F: A most fundamental difference for being treated for a disease or condition now is that we go to the doctors office; it used to be fundamental that the doctor traveled to the patient and this one difference offers a substantial change to healthcare.

true

T or F: Adler states that the final frontier of medicine is Aging.

true

T or F: Adler states: "...the application of medical knowledge to individuals like you and me will inevitably remain one of humanity's finest and most difficult arts."

true

T or F: Dr. Gawande says that we've been wrong in Western medicine because: "We think our job is to ensure health and survival. But really it is larger than that. It is to enable well-being."

true

T or F: Gawande asserts that now-a-days independence is highly revered for and by all people and that modernization did this. In doing so, it (modernization) did not demote the elderly, per se, but demoted the family.

true

T or F: Gawande becomes aware of the profound implications that the transformation of elder care has for medicine: "....as people's capacities wane, whether through age or illness, making their lives better often requires curbing our purely medical imperatives--resisting the urge to fiddle and fix and control."

true

T or F: Genetic inheritance significantly influences longevity of life

true

T or F: In Chapter 6, appropriately named, Letting Go, Gawande cites and describes many examples of patients and doctors deciding what Swedish doctors call the 'breakpoint discussion.' This is a series of conversations to sort out when we need to switch from fighting for time to fighting for the other things that people value.

true

T or F: The Soviet Union asked the World Health Organization (WHO) to organize worldwide vaccination for smallpox and donated a lot of vaccine doses to achieve this goal.

true

T or F: This chapter on new plagues discusses disease related to the prion protein.

true

T or F: This statement drives home the point that this book is showing that our medicine needs fixed: 'You agree to become a patient, and I, the clinician, agree to try to fix you, whatever the improbability, the misery, the damage, or the cost.'

true

T or F: The difference between aging in the American culture versus in the Asian culture, for Gawande, was that dignity was a natural feeling paid to elderly and felt by elderly Asians.

true - Our culture slowly turned a blind eye to a very valuable resource and in doing so, we eventually lose out on a HUGE depth and breadth of knowledge but we also end up costing ourselves a great deal of money since we eventually create a whole system of nursing homes and facilities that are ill-equipped to help humans live a meaningful life. Think about how this concept fits into the course objectives to understand how our medicine evolved.

T or F: Sanger, who was a practicing nurse, was jailed for distributing information about birth control to her clients.

true - Sanger was sentenced to 30 days in jail for providing information about birth control because it was illegal in her time.

T or F: Margaret Sanger coined the term "birth control"

true - She first used the term in the June 1914 issue of a newspaper she founded: called "The Woman Rebel".

T or F: A very poignant message in this book is that healthcare professionals should make an effort to understand what the patient cares about and what matters to the patient as they engage in diagnosis and treatment and should also use the WHOLE 'ask-tell-ask' strategy when engaged with and talking with a patient.

true - This way of talking with another human being about their health, life, and decisions can guide them to really cement their own ideas for how to live a most meaningful life.

T or F: An assertion made by Gawande is that...the problem with medicine and the institutions it has spawned for the care of the sick and the elderly is not that it has an incorrect view but that it has almost NO view and that medical professionals concentrate on repair of the body and not on the sustenance of the soul.

true - We often are seen as ones who are just correcting the problem with the body and that's it.

T or F: As Gawande witnesses Juergen Bludau MD, the chief geriatrician at the Center for Older Adult Health, who completes an exam of a patient, he hears and sees the 'job-of-a- geriatrician-in-action' (as Bludau puts it): to create the highest quality of life for the patient so that they have optimized 'freedom from the ravages of disease and the retention of enough function for active engagement.'

true - not quite what Descartes would have wanted, since he wanted us to master nature and become immortal, but closer than we were even 50 years earlier.

People with serious illness have priorities besides simply prolonging their lives. Surveys of these people suggest all but ONE of the following:

use any and all medical technologies to prolong life regardless of pain or suffering

In one word, what scientific/medical first is attributed to Ivanovsky? The discovery of:

viruses

Dr Gawande says that this book, Being Mortal, is about

what it is like to be creatures who age and die, how medicine may have gotten it wrong as it evolved and that it forces the wrong ideas and experiences of life on patients by prolonging their lives and often ignoring the quality of their lives and what matters to them, the modern experiences of mortality