“Good night, sweet prince”: Saying goodbye to the dead in shakespeare's plays

Themes of death and loss have often been treated with greater eloquence in literature than in psychology and the helping professions. This article explores the treatment of bereavment and mortality in some of Shakespeare's tragedies and comedies, illustrating his deep understanding of the place of loss in human life.     

Terminology Matters: Patient Understanding of “Opioids” and “Narcotics”

Background: The terms “opioid” and “narcotic” are often used interchangeably by healthcare providers. The purpose of this study was to compare understanding “narcotics” vs. “opioids.” Methods: A convenience sample of English‐speaking women (n = 188), aged 21–45 years, seeking care at a primary care clinic were asked (1) “What is an opioid/narcotic?” (2) “Give an example of an opioid/narcotic?” (3) “Why does someone take an opioid/narcotic?” and (4) “What happens when someone takes an opioid/narcotic for a long time?” Responses were recorded verbatim by a research assistant and then coded independently by two investigators. Results: More than half of respondents (55.9%) responded “don’t know” to all 4 opioid questions, while just 3.2% responded “don’t know” to all 4 narcotic questions (P < 0.01). Most women were unfamiliar with the term opioid (76.3%) and did not know why someone would take an opioid (68.8%). About two‐thirds of respondents were able to give an example of a narcotic (64.2%) and knew the consequences of long‐term narcotic use (63.2%). Conclusions: While more women were more familiar with narcotic, many identified negative connotations with this term. Future research should explore how to improve patient understanding and attitudes regarding both the terms opioids and narcotics.     

Adenomyomatosis of the Gallbladder: The “Good Omen” Comet

Background: As emergency physicians perform bedside ultrasound with greater frequency, greater numbers of incidental and potentially unfamiliar sonographic findings will be encountered. Objectives: Illustrate, discuss, and briefly review literature regarding one such finding and diagnosis in right upper quadrant sonography. Case Report: A middle-aged woman was evaluated in the Emergency Department for abdominal pain. Limited bedside sonography of the gallbladder revealed mural thickening and comet-tailing. A diagnosis of adenomyomatosis was made. Conclusion: Gallbladder adenomyomatosis can produce ultrasound findings similar to those of more serious and emergent gallbladder diseases. Cognizance of the sonographic details and typical clinical characteristics will allow the emergency physician to appropriately assess and disposition patients with this condition.     

Is Consent “Informed” When Patients Receive Care from Medical Trainees?

Objectives: Medical care requires consent and consent requires information. Prior studies have shown that patients are poorly informed about the medical training hierarchy. The authors assessed the impact of “informed” on “consent,” by assessing willingness to be seen by trainees before and after information about trainee’s credentials. Methods: A convenience sample of patients in an urban emergency department (ED) waiting room was surveyed, ascertaining willingness to be seen before and after information about trainees credentials, using Likert scales. McNemar’s test, linear regression, and mixed models were used to assess statistical significance of information in changing preferences and patient characteristics predicting knowledge, willingness, and change in willingness to be seen with more information. Results: The authors approached 397 patients, and 199 (50%) English speakers participated. Initially, 45% of subjects knew the meaning of “medical student,” and 35%“intern” and “resident.” In a controlled multivariate linear regression, educational attainment (p < 0.0001) predicted more knowledge, Hispanic ethnicity predicted less (p = 0.03). Subjects were less willing to be seen by lower‐ranking trainees (p < 0.001). Information about trainees caused a significant increase in unwillingness to be seen by medical students (17% to 28%, p = 0.004) and interns (8% to 13%, p = 0.029). Conclusions: Substantial numbers of ED patients would prefer not to be seen by trainees. When patients are informed about trainees’ credentials, they become less willing to be seen by more junior trainees. Further research should clarify informed consent for care among non–English speakers and should address these issues in other medical settings.     

The “Filarial Dance” Is Not Characteristic of Filariasis

The objective of this series was to show that the sonographic appearance described as the “filarial dance” is not characteristic of filariasis but occurs in nonendemic areas as a manifestation of epididymal obstruction. An experienced observer documented cases after initial observation of the filarial dance in routine clinical practice using high‐frequency linear array transducers. The filarial dance was described as excessive to‐and‐fro movement of echogenic particles within a prominent epididymis and graded 1 to 4 according to the extent and distribution of the abnormality. The country of birth, exposure to filarial infection or travel to a filarial‐endemic area, previous scrotal surgery including vasectomy, any previous or current scrotal inflammatory disease, and any congenital testicular abnormalities were recorded. Over a 10‐year period, sonographic appearances consistent with the filarial dance were observed in 18 patients (bilateral in 6). The mean patient age was 47.7 (range, 28–91) years. The abnormality was graded in the 24 affected testes as follows: grade 1, n = 3; grade 2, n = 8; grade 3, n = 8; and grade 4, n = 5. No patient had a history of filariasis or travel to an endemic area. Six of 18 patients (33.3%) had bilateral vasectomies; 5 (27.8%) had a history of epididymo‐orchitis in the ipsilateral testis; 3 (16.7%) had previous scrotal surgery; and 4 (22.2%) had no relevant urologic history. We have described a sonographic appearance identical to the filarial dance in men with no history of filarial infection. Most had previous scrotal surgery or infection, suggesting that the filarial dance may not always be due to movement of filarial worms. The unifying condition in patients with filariasis and our patients is lymphatic obstruction, likely the underlying cause of the appearance in both groups.     

“When It's More Than the Blues”: A Collaborative Response to Postpartum Depression

ABSTRACT Postpartum depression (PPD) affects 13% of new mothers. The consequences for a woman diagnosed with PPD, her new infant, and her family can be serious and long‐lasting. This article describes an innovative consultation‐liaison service between 1 community mental health clinic and public health centers specializing in the early detection and treatment of PPD. The benefits of the consultation‐liaison model are presented, including: (1) data from a chart review describing client demographics, diagnostic, and treatment information and (2) results of a satisfaction survey completed by public health staff, including modifications made to the service in response to the satisfaction survey. The implications of the consultation‐liaison PPD treatment model as a practice concept significant to the emerging trend of Primary Care Networking are outlined and emphasized, in the light of the study results.     

Spiritual side of “Good grief”: What happened to holy Saturday?

Pastoral and other caregivers of the recently bereaved offering spiritual counseling are urged to be mindful of the human element. Immediate and even mid-term responses to loss will and must be experienced, even in the face of the consolations offered by religious belief. To suggest that faith itself can drive out the pain of bereavement is to counsel badly. Instead, the author conceptualizes the process of grief “in a way that links the human processes of working through grief to growth with the spiritual resources of the Judeo-Christian tradition”; then he applies his model to particular counseling situations, emphasizing the benefits of his approach.