Carolyn E. Fiorillo
The goal of this unit is to encourage students to think and to focus that thinking on the future of their health and that of their loved ones. Most of the students we come in contact with have had nothing more serious health-wise to contend with than a sprained ankle or a bout with the flu. They consider themselves to be invincible. But, if you probe, they will recall an aunt with cancer or a cousin with sickle cell anemia, and they can be slowly brought around to seeing the relevancy of health care concerns. In your discussion of these issues, ask them to relate their experiences and those of family members and friends to help them to associate themselves with the subject. This unit is based primarily on discussion and on activities designed to keep them personally involved. These are serious issues that will at some time in their lives affect every single student.
Activity One
Early in the unit, I would suggest a field trip to the children's ward at one of the local hospitals. They will see children their own age and the age of their siblings, battling serious injuries and life-threatening illnesses. This will help to "make it real" and it will also prove invaluable in writing their feelings in the journals you will be asking them to keep throughout this unit. Note: You will need to closely monitor any remarks made to or about the patients by the students. Have them save up their questions for your guide.
Activity Two
Along with other briefer activities, I am going to suggest that you break your class up into groups of five students each and provide each with a small journal. Ahead of time, make up a series of 3x5 cards. Assign each student a disease/condition/problem that you are aware of and he is not. Each day he is given a new card with a continuing serial of symptoms/problems for him to react to and record in his journal. Some suggestions might be:
Condition 1)
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Card A: You have just been in an automobile accident (driving drunk after a party), broken your neck, rushed to the hospital.
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Card B: Paralyzed from the neck downwait to see if it is permanent. Doctor is too busy to answer questions.
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Card C: In ICU; specialist says maybe surgery would relieve pressure on the spine or it could make it worse. Second opinion?
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Card D: Informed consent for surgerydo you have enough information? Should you sign?
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Card E: Surgery didn't workparalyzedwhat is going to happen to you? Nursing home? Do you bother with rehab? Who's going to pay for it?
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Condition 2)
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Card A: Symptomsfatigue, vague aches and pains, want to sleep all the time, pale and rundown.
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Card B: Go to the doctorflu. Seems worse than that to youcan't get well.
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Card C: To another doctorsays you need tests. Will insurance cover them? He's scaring you, but you're afraid to ask what you might have.
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Card D: Doctor says you have leukemia. He explained chemotherapy, but you were too upset to understand what he was talking about. You hate needles and don't know what to do. You're too young to die.
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Card E: You started chemo and threw up for three days. Nothing tastes right and you feel sick all the time.
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Card F: Your hair is starting to come out in clumps. You don't want to go out of the house where anybody will see you. You want to know if you're ever going to get well, but nobody will say.
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Condition 3)
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Card A: You and your friends were snorting coke and the couch caught on fire. You went up like a human torch and were burned over 70% of your body. You were taken to a burn unit.
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Card B: You are in constant, terrible pain. Your whole body is bandaged, including your face. You can't see, but you can feel the bandages being removed and replaced and you know there is very little area not affected. You ask questions, but you keep being put off.
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Card C: You must be dipped every day into a tub of disinfectant to kill the bacteria which would otherwise kill you. It is extremely painful and you must be sedated in order to endure it. You wonderwhy bother?
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Card D: You know now that you will be blind and that you will require years of treatments and multiple surgeries to regain even partial use of your hands and feet. You will never be able to resume the active, athletic life you once had. You sink into a deep depression.
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Card E:
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You demand that the treatments be stoppedyou just want to go home and die with your family in peace.
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Condition 4)
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Card A: You are African American and kidney function problems run in your family. You begin to experience symptoms of renal dysfunction.
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Card B: Tests reveal that both of your kidneys are malfunctioning and you must go on a dialysis machine three times a week.
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Card C: You have asked to be put on a waiting list for a kidney trans-plant, but you are told that you probably will not get one because you are black and there are very few black organs donated. Experience has shown that there is a better rate of compatibility and success if a black person receives a donated organ from another black person.
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Card D: You are angry that you may very well die because you are black and can't get a transplantwhat can you do about it?
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Condition 5)
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Card A: Your father lives alone; he has chronic bronchitis, which is not covered by insurance. He is unable to work and can't pay his bills. Are you going to let him starve and/or cough himself to death?
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Card B: You feel obligated to take your father in to live with you-your brother has moved to California and your sister has four children and no room.
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Card C: Your father's condition is worsening. He's very forgetfulleaves the gas on, the front door open, wanders off in the street and gets lost. He gets angry when you try to talk to him about it.
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Card D: Doctor says your father may have Alzheimer's Disease and there is very little he can do about it. The medicine is expensive and Medicare does not cover it. What are you going to do?
These are only suggestions for the cards to get you started. Use your imagination and make the unit last as long as you want. The unit itself will be taught a little each day and the students will write in their journals, based on what they have heard taught and on what they are personally experiencing through the cards. At some point, switch the groups so that all the leukemia patients are together, all the burn victims together, etc., allowing them to compare notes. Assign one group member to be the doctor. The others will ask him questions about their treatment, his attitude/attention, etc., and he will defend his busy schedule, financial pressures, need to distance himself from his patients and whatever he feels will alleviate the patients' fears and concerns. This will give everyone a chance to hear both sides. You might also invite a doctor to join the class and field questions. Conclusions from these discussions should be noted in their journals. At the end of the unit, have a general discussion on patients' rights and responsibilities and doctor/patient relationships, with each telling what he has learned and how it will affect his future health care.
