Example of How to Mark a Textbook
Marking your text involves making note of your "prior knowledge." These notes are best written in the margin. "Prior knowledge" is any knowledge which you have read, seen, or heard from another source that is relevant to the text material. Using "p.k." helps you learn and understand the text material by putting it in the context of something you know.
On Death and Dying
Examples which show that death is a fearful, universal happening |
The ancient 1Hebrews regarded the body of a dead person as something unclean and not to be touched. The early 2American Indians talked about the evil spirits and shot arrows in the air to drive the spirits away. 3Many other cultures have rituals to take care of the "bad" dead person, and they all originate in this feeling of anger which still exists in all of us, though we dislike admitting it. The 4tradition of the tombstone may originate in this wish to keep the bad spirits deep in the ground, and the pebbles that many mourners put on the grave are left-over symbols of the same wish. Though we call the firing of guns at 5military funerals a last salute, it is the same symbolic ritual as the Indian used when he shot his spears and arrows into the skies. I give these examples to emphasize that man has not basically changed. Death is still a fearful, frightening happening, and the fear of death is a universal fear even if we think we have mastered it on many levels. What has changed is our ways of coping and dealing with death and dying and our dying patients. Having been raised in a country in Europe where science is not so advanced, where modern techniques have just started to find their way into medicine, and where people still live as they did in this country half a century ago, I may have had an opportunity to study a part of the evolution of mankind in a shorter period. I remember as a child the death of a farmer. He fell from a tree and was not expected to live. He asked simply to die at home, a wish that was granted without questioning. He called his daughters into the bedroom and spoke with each one of them alone for a few moments. He arranged his affairs quietly, though he was in great pain, and distributed his belongings and his land, none of which was to be split until his wife should following him death. He also asked each of his children to share in the work, duties, and tasks that he had carried on until the time of the accident. He asked his friends to visit him once more, to bid good-bye to them. Although I was a small child at the time, he did not exclude me or my siblings. We were allowed to share in the preparations of the family just as we were permitted to grieve with them until he died. When he did die, he was left at home, in his own beloved home which he had built, and among his friends and neighbors who went to take a last look at him where he lay in the midst of flowers in the place he had lived in and loved so much. In that country today there is still no make-believe slumber room, no embalming, no false makeup to pretend sleep. Only the signs of very disfiguring illnesses are covered up with bandages and only infectious cases are removed from the home prior to the burial. |
Reasons why dying at home is better for both patient and family. Include prior knowledge:
2 - my father died in a hospital but his death did not seem to be as bad to me as portrayed here. |
Why do I describe such "old fashioned" customs? I think they are an indication of our acceptance of a fatal outcome, and they help the dying patient as well as his family to accept the loss of a loved one. If a patient is allowed to terminate his life in the familiar and beloved environment, it requires less adjustment for him. His own family knows him well enough to replace a sedative with a glass of his favorite wine; or the smell of a home-cooked soup may give him the appetite to sip a few spoons of fluid which, I think, is still more enjoyable than an infusion. I will not minimize the need for sedatives and infusions and realize full well from my own experiences as a country doctor that they are sometimes life-saving and often unavoidable. But I also know that patience and familiar people and foods could replace many a bottle of intravenous fluids given for the simple reason that it fulfills the physiological need without involving too many people and/or individual nursing care. |
| old days |
The fact that children are allowed to stay at home where a fatality has stricken and are included in the talk, discussions, and fears gives them the feeling that they are not alone in the grief and gives them the comfort of shared responsibility and shared mourning. It prepares them gradually and helps them view death as part of life, an experience which may help them grow and mature. |
| today |
This is in great contrast to a society in which death is viewed as taboo, discussion of it is regarded as morbid, and children are excluded with the presumption and pretext that it would be "too much" for them. They are then sent off to relatives, often accompanied with some unconvincing lies of "Mother has gone on a long trip" or other unbelievable stories. The child senses that something is wrong, and his distrust in adults will only multiply if other relatives add new variations of the story, avoid his questions or suspicions, shower him with gifts as a meager substitute for a loss he is not permitted to deal with. Sooner or later the child will become aware of the changed family situation and, depending on the age and personality of the child, will have an unresolved grief and regard this incident as a frightening, mysterious, in any case very traumatic experience with untrustworthy grownups, which he has no way to cope with. It is equally unwise to tell a little child who has lost her brother that God loved little boys so much that he took little Johnny to heaven. When this little girl grew up to be a woman she never solved her anger at God, which resulted in a psychotic depression when she lost her own little son three decades later. We would think that our great emancipation, our knowledge of science and of man, has given us better ways and means to prepare ourselves and our families for this inevitable happening. Instead the days are gone when a man was allowed to die in peace and dignity in his own home. |
This sums up main idea of this article which is based on compare-contrast organization. |
[The more we are making advancements in science, the more we seem to fear and deny the reality of death.] How is this possible? We use euphemisms, we make the dead look as if they were asleep, we ship the children off to protect them from the anxiety and turmoil around the house if the patient is fortunate enough to die at home, we don't allow children to visit their dying parents in the hospital, we have long and controversial discussions about whether patients should be told the truth-a question that rarely arises when the dying person is tended by the family physician who knows him from delivery to death, and who knows the weaknesses and strengths of each member of the family, I think there are many reasons for this flight away from facing death calmly. One1 of the most important facts is that dying nowadays is more gruesome in many ways, namely, more lonely, mechanical, and dehumanized; 2at times it is even difficult to determine technically when the time of death has occurred. 3Dying becomes lonely and impersonal because the patient is often taken out of his familiar environment and rushed to an emergency room. Whoever has been very sick and has required rest and comfort especially may recall his experience of being put on a stretcher and enduring the noise of the ambulance siren and hectic rush until the hospital gates open. Only those who have lived through this may appreciate the discomfort and cold necessity of such transportation which is only the beginning of a long ordeal-hard to endure when you are well, difficult to express in words when noise, light, pumps, and voices are all too much to put up with. It may well be that we might consider more the patient under the sheets and blankets and perhaps stop our well-meant efficiency and rush in order to hold the patient's hand, to smile, or to listen to a question. I include the trip to the hospital as the first episode in dying, as it is for many. I am putting it exaggeratedly in contrast to the sick man who is left at home-not to say that lives should not be saved if they can be saved by a hospitalization but to keep the focus on the patient's experience, his needs, and his reactions. When a patient is severely ill, he is often treated like a person with no right to an opinion. It is often someone else who makes the decision if and when and where a patient should be hospitalized. It would take so little to remember that the sick person too has feelings, has wishes and opinions, and has-most important of all-the right to be heard. Well, our presumed patient has now reached the emergency room. He will be surrounded by busy nurses, orderlies, interns, residents, a lab technician perhaps who will take some blood, an electrocardiogram technician who takes the cardiogram. He may be moved to x-ray and he will overhear opinions of his condition and questions to members of the family. He slowly but surely is beginning to be treated like a thing. He is no longer a person. Decisions are made often without his opinion. If he tries to rebel he will be sedated and after hours of waiting and wondering whether he has the strength, he will be wheeled into the operating room or intensive treatment unit and become an object of great concern and great financial investment. He may cry for rest, peace, and dignity, but he will get infusions, transfusions, a heart machine, or tracheotomy if necessary. He may want one single person to stop for one single minute so that he can ask one single questions-but he will get a dozen people around the clock, all busily preoccupied with his heart rate, pulse, electrocardiogram or pulmonary functions, his secretions or excretions, but not with him as a human being. He may wish to fight it all but it is going to be a useless fight since all this is done in the fight for his life, and if they can save his life they can consider the person afterwards. Those who consider the person first may lose precious time to save his life! At least this seems to be the rationale or justification behind all this-or is it? Is the reason for this increasingly mechanical, depersonalized approach our own defensiveness? Is this approach our own way to cope with and repress the anxieties that a terminally or critically ill patient evokes in us? Is our concentration on equipment, on blood pressure, our desperate attempt to deny the impending death which is so frightening and discomforting to us that we displace all our knowledge onto machines, since they are less close to us than the suffering face of another human being which would remind us once more of our lack of omnipotence, our own limits and failures, and last but not least perhaps our own mortality? Maybe the question has to be raised: Are we becoming less human or more human? (Kübler-Ross, On Death and Dying.) |
Materials from Flemming, Reading for Results, 4ed 1990 315920^
Developmental English. Displayed with special permission of
Houghton Mifflin Company. All Rights Reserved.
"Read, mark, learn, and inwardly digest.
- Book of Common Prayer
