A Lotus Flower

In Buddhist symbolism, the lotus flower represents the purity of the body and mind, as it is born in mud, floats above murky waters and always remains clean and pure.

Tibetan mantra "om mani padme hum" 

Robert's clinical report

(Fictional narrative)*

This is the story of Robert, a 23-year-old boy who arrives at the emergency room of the University Hospital with complaints of dyspnea, pain in the left hemithorax and fever. Preliminary clinical investigation revealed a large left pleural effusion with ipsilateral pulmonary collapse. Further investigation showed it to be associated with lung and mediastinal metastases secondary to a testicular tumor. From the first contact, Robert revealed a resilient behavior, related to early coping with adversities in life. He received intensive curative chemotherapy and cooperated in all treatment recommendations, while smoothing out conflicts in his affective life.

Abstract

Overview of the emotional flow and decisive moments in the clinical care of a very young man who arrived alone at the University Hospital emergency room complaining of severe shortness of breath. Overcoming all patient limitations, the doctor had to find a quick and effective way to stabilize the patient. Here you will find the plot segmentation, describing how the doctor coped with the challenges presented by Robert's clinical case: The exposition (PLOT 1) took place in the emergency room of the University Hospital, where Robert was received in a threatening clinical situation. He arrived alone and could barely express his symptoms. The raising action (PLOT 2) occurred when Robert was informed about the testicular tumor and its spread to lymph nodes and lung. After draining the pleural effusion, he became less symptomatic, better understanding the physician's rational approach, which improved treatment adherence. The conflict (PLOT 3) was revealed by the family history. Robert lived alone. He never met his father and his mother died after long suffering from drug abuse and AIDS. The climax (PLOT 4) occurred when Robert revealed a double love affair. He was bisexual and emotionally attached to Lisa and Alan. They didn't know about each other and Robert didn't express any preference. The ambivalence was resolved naturally, as Lisa gave up and Alan became his caregiver. In the falling action (PLOT 5), Robert faced four cycles of chemotherapy and a surgery to remove a residual mediastinal teratoma. Gradually, his life returned to normal and he felt strengthened, improving his professional performance and building a stable affective relationship. The resolution (PLOT 6) will be presented by the storyteller in a comprehensive biopsychosocial approach.

Emotional flow

The graph presented below is a simplified depiction of the Robert's emotional flow. In each PLOT element, the patient-physician relationship leads to emotions that occur along distinct time intervals (△t). The interventions are responsible for the emotional flow, which is unique to each story. The continuous sinuous blue wave represents the oscillating patient’s emotional status, with the larger inflections representing the “turning points”.

Author's perception of the patient's emotional flow and turning points 

*James Fleck, MD, PhD is a full professor of medicine at UFRGS, Brazil

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