Hiroshima

In April, I went to Japan for three weeks for vacation. I chose a handful of cities to visit and spent few days in each. One of these was Hiroshima, where I visited the Peace Memorial dedicated to the people who were killed in the atomic bombing on August 6, 1945.

Before I went to the memorial, I don’t think that I understood the devastation of nuclear weapons. I knew that the bombs released enormous amounts of heat and radiation, and that the aftereffects of radiation exposure such as cancer were horrible. Knowing wasn’t the same as seeing photographs of the sick and dying, or the ragged, blood-stained uniforms the schoolchildren had worn, or hearing the stories narrated by survivors, most of whom had been children and are now old men and women.

The exhibit is constantly changing, especially as society changes and living memory fades. At the time, the main museum was undergoing renovation, but there were others nearby, including a special exhibit titled “The Twinkling Stars Know Everything,” after a collection of stories by the mothers and fathers of first-year students of Hiroshima Itchu Junior High School. The school was located only a kilometer away from the hypocenter of the bomb, and nearly the entire class died. They were only thirteen years old.

I learned about another collection of stories at the memorial and decided to read it: Hiroshima, by John Hersey. Originally published in The New Yorker, this book follows the lives of six people who were present in the bombing.

Genbaku “A-bomb” Dome © Jennifer Hsu

Of the six, the individual who most caught my interest was Dr. Terufumi Sasaki, a 25-year-old surgeon who had just completed his training at the Eastern Medical University in China. I felt great empathy with this young physician, as I am similar in age and stage of training. Dr. Sasaki was working in the Red Cross Hospital in Hiroshima. When the bomb fell, he found himself to be one of the few uninjured physicians on staff, and soon he and the other physicians were overwhelmed by the thousands of injured who came to the hospital for help.

Quote from the book:

“By three o’clock the next morning, after nineteen straight hours of his gruesome work, Dr. Sasaki was incapable of dressing another wound. He and some other survivors of the hospital staff got straw mats and went outdoors — thousands of patients and hundreds of dead were in the yard and on the driveway — and hurried around behind the hospital and lay down in hiding to snatch some sleep. But within an hour wounded people had found them; a complaining circle formed around them: “Doctors! Help us! How can you sleep?” Dr. Sasaki got up again and went back to work. Early in the day, he thought for the first time of his mother, at their country home in Mukaihara, thirty miles from town. He usually went home every night. He was afraid she would think he was dead.” – Hersey, J. Page 25

I can hardly imagine how exhausted and terrified he must have been.

Hiroshima is one of the most striking and terrifying proofs of the horrors of war. But my visit there also showed me the greatness of the human spirit and the possibility of forgiveness and healing. At the memorial, I stopped to listen to a student choir – one of many which take place throughout the year, dedicated to the children killed in the bombing – when a Japanese man turned to me and attempted to give me a pamphlet. When I indicated that I could not read Japanese, he used broken English to tell me about why the students were singing. Then he asked where I came from. When I said that I came from America, he smiled broadly and said that he loved Americans, and that he hoped to travel across the world to visit our country one day, too.

More Information

Hersey, J. Hiroshima. Vintage Books, NY. Reprint edition, 1989.

Ikegami, N. The Twinkling Stars Know Everything. First English Edition edition, 1984.

I Am Not Sick, I Don’t Need Help

Have you ever been in denial?

Recently I have been pinching myself in disbelief. Am I really graduated from medical school? Are people actually going to start calling me “doctor?” Wow! It is terrifying, yet exciting. As a fresh graduate, I know that I still have a long road ahead of me before becoming a board-certified physician, but right now I have been feeling so incredibly blessed.

This period of time between graduation and the beginning of residency has been incredibly relaxing. I spent most of it vacationing. In April, I traveled throughout Japan for three blissful weeks. Then, I went on a scenic car trip from Texas and all the way up through New Mexico, Nevada, and Idaho to Washington State. Beautiful, isn’t it?

Driving by the Sierra Nevada © Jennifer Hsu

During these trips, I also read several books. One of these is “I Am Not Sick, I Don’t Need Help” by Xavier Amador, Ph.D., a clinical psychologist. I found it to be a quick, pleasurable read, because of the author’s concise and clear writing style. He also does a spectacular job of evoking empathy and understanding through clinical vignettes and personal stories.

If you know somebody with serious mental illness who is in “denial” and refuses to seek treatment or take medication, then this book is for you.

Dr. Amador divides this book into five parts. The first part provides information about mental illness, particularly schizophrenia. The second part describes the LEAP (listen, empathize, agree, partner) methodology that Dr. Amador developed, which has shown positive results in his work with patients and their families. The third part focuses on the feelings of betrayal and guilt that a patient and their family may feel when the patient is taken against their will to the hospital, and how to re-build trust. The fourth part discusses the value of assessing a person’s awareness of their illness and its purpose in formulating a cooperative treatment plan.

The fifth section is the most memorable of all. In it, Dr. Amador tells us about his brother Henry, who was diagnosed with schizophrenia. I could feel the love and care between the brothers, nearly palpable from the page, and I admired that he shared his brother’s story with us. It is a poignant reminder that every patient, no matter how “crazy” or psychotic, is loved by somebody. I admit that I shed some tears reading Henry’s story.

I highly recommend this book for anyone with a family member with mental illness. It is also a wonderful read for any health professionals.

Key Takeaways
  • “Denial” is the wrong term for poor insight in a person with mental illness. In patients with schizophrenia, the executive (frontal) part of the brain is often dysfunctional, resulting in a symptom called anosognosia, which is the condition in which a person with a disability seems unaware of its existence.
  • Reflective listening is listening with only one goal: to understand. It is not commenting, disagreeing, judging, or reacting in any way.
  • It is not necessary for the patient to believe that they have a mental illness. But, it is necessary for the patient and their support network (family, health provider) to work together for success. Prioritize finding common ground and collaboration, not arguing over who is “right.”
Quotes

“I can’t guarantee that LEAP will definitely eliminate medication and service refusal in the person you’re trying to help, but I can promise that if you faithfully follow the guidelines I give, they will help lower tension, increase trust, and greatly increase the likelihood that the person you are trying to help will follow your advice.” – Amador, X. Page 3.

“I have never talked anyone out of a delusion and, to my knowledge, I have never talked anyone into one either. The point is, when you’re facing someone who rigidly holds irrational beliefs, you gain nothing by disagreeing.” – Amador, X. Page 84.

“I loved Henry, and when someone you love is in pain, it is hard not to empathize. Learning to listen lead to empathy. And my empathy ultimately resulted in my brother showing a real interest in my thoughts about the illness he felt he did not have and the medications he was sure he did not need.” – Amador, X. Page 113.

More Information

Amador, X. I Am Not Sick I Don’t Need Help! How to Help Someone with Mental Illness Accept Treatment. Vida Press. Kindle Edition. 2012.

“LEAP®”; “L.E.A.P.®“;“Listen-Empathize-Agree-Partner®”; “Listen, Empathize, Agree, Partner®” and all similarly punctuated versions are registered trademarks of the LEAP Institute, are protected under the laws of the United States Patent and Trademark Office (USPTO), and may not be used without express license of the LEAP Institute.

Learn more at https://leapinstitute.org

Ten Minutes

“It’s amazing how much you can learn about someone in ten minutes of casual conversation.”

The doors swing open. I bustle through, the tails of my short white coat fluttering behind me. It is my first day as a medical student in this hospital and I’ve been sent to see Mrs. “W”. I look around, a little lost, and hope that I’ve finally found the right floor. The nurse sitting at the desk looks up. Her eyes are very large and very blue.

“Welcome to the floor!” she says, with amazing cheer for seven o’clock in the morning.

I freeze in my tracks.

“Thank you,” I say.

Her wide, blue eyes continue to stare at me. Her lips are smiling, curved in a pink, plastic smile like a Barbie doll. I feel like an unwelcome intruder, a lost third-year medical student playing doctor and invading the daily churn and flow of the unit. And so I continue, stuttering nervously over my words.

“I-I’m here to see a patient.”

“Thank you for coming to see our patient!” she says.

Her enthusiasm remains unflagging. I introduce myself and mumble a few somewhat coherent sentences like Where-Is-Room-12? and something about the weather and Have-A-Nice-Day! Eventually I find my way to the patient.

Mrs. W is a thin 60-something-year-old woman with COPD (causing shortness of breath) and venous insufficiency (which causes severe pain in her legs) who, well, also does a bit of cocaine every now and then. While she came to the hospital for breathing problems, her primary complaint is her leg pain. She has been scheduled for an outpatient vascular surgery clinic. But until then, she must live with the pain. We discuss the benefits of walking.

“I know it’s hard to exercise in the hospital, but walking would really help,” I tell her.

“Maybe if I had someone to walk with,” she says.

And so that’s how it began. In the afternoon after rounds, I return to her room. We walk two laps around the unit together. She is surprisingly steady on her feet, requiring no assistance, though occasionally she leans against the wall and stops due to pain. And in those ten short minutes, I learn about her. She tells me about her children, two of whom live hundreds of miles away and are too busy to see her. The third is jobless and lives with her at home and helps her “sometimes” around the house. She tells me of how she used to work long days as a single mother to support the family. And how she struggled to quit smoking and finally stopped a few years ago, but hasn’t been able to quit the cocaine.

“I tell myself it’s the last time every time,” she says. “Then I have a bad day and I just do it. I know I gotta stop ’cause it’s bad for my heart, but deep down, I guess I’m not ready yet.”

It’s amazing how much you can learn about someone in ten minutes of casual conversation.

The next day, I am unable to return to her room until much later in the day. She nearly tumbles out of bed when she sees me.

“I thought you forgot about me,” she says.

“Of course not!” I reply.

After I ask about her day, she asks about mine. I share a little about my life. The astounding (but ever shrinking!) number of years of future education that I had yet to traverse. That no, I am not married, but I am in a long-term relationship with my boyfriend. And I tell her some silly things, like how I had ran through the pounding rain that morning and dropped my phone in a puddle. And somehow, it still works!

The nurses notice. They exclaim over how great Mrs. W looks. The exercise put some color in her cheeks, they say. And she is walking so well and so steady on her feet! They dote on her with genuine affection and when they turn to look at me, I can see their gratitude.

We manage to walk three laps.

“Maybe tomorrow we can walk four,” Mrs. W says with a smile.

When I leave that day, the blue-eyed nurse stops me in the hall.

“Thank you for walking with our patient!” she says, with her ever-present cheer.

This time, I smile back.

Today’s Daily Post Writing Prompt: Ten