Media and Human Suffering: Foundations, Ruptures, and Continuities

Why do we suffer? Is suffering inevitable? And what does it mean to suffer? The answers to these questions are very difficult and lie at the heart of the human experience. One author most interested in these questions is Bernard Malamud. In almost all of Bernard Malamud's works suffering is a major theme. In all of his novels and short stories his characters suffer and some are redeemed and some are not. This paper will investigate how the themes of suffering operate within the works of Malamud and in the process seek to obtain a greater understanding of where suffering fits in to Malamud's view of life and human experience. A common feature of suffering in Malamud's stories is that of the suffering Jew. As Malamud himself is Jewish it is not surprising that a vast majority of his characters are as well. It is equally understandable that the Jewish view of suffering is prevalent in his writing. This, however, is not the only view of suffering that Malamud offers the reader. He also points to suffering as a form of imprisonment, a warped feature of the American dream and, encouragingly, a state that for some offers the hope of redemption. This view is not completely Jewish centered as he also explores other Western traditions of how suffering can be viewed, particularly that of Christian and Greek forms. In conclusion Malamud's works take us into a world of suffering characters, usually Jews that must face the dilemma of their state of suffering. For those who can accept this state and make morally appropriate choices redemption is available, however those who can not are doomed to continue their suffering without hope.

Researchers need to stand amidst traumatized people to learn from them to begin to understand the meaning of their suffering. Distance is lessened and listening intensified as researchers ask the question of what it means to suffer. Through this paper, we explore as compassionate researchers, the meaning of suffering, its language and consequence with the intention to understand, inform, enlighten and challenge ourselves to learn from each other. We offer a perspective for human science research created through a hermeneutic consciousness about suffering where understanding takes its form analytically as an interpretation, of an interpretation. This unquiet understanding, a chaotic bricolage of suffering was brought together hermeneutically to unify a diversity of suffering narratives within the context of honoring personal narratives, while confronting the challenges of academic writing. “I do not think realizing that we who [suffer] are utterly lost and broken, necessarily causes despair. What breaks us is the impression that everyone else isn't”. Our work as researchers, writers and teachers then becomes bringing the meaning of suffering into language and understanding what challenges us to confront and humanize research beyond academic expectations of “…clean and reasonable scholarship about messy, unreasonable experiences”. The hermeneutics of suffering prevents personal narratives from becoming “an exercise in alienation”, but rather as an invitation for humanizing conversations about suffering, where their unique qualities and characteristics are brought back interpretively into the world. We belong to our suffering; it humanizes all worldly activities through a common ‘rough-ground’ from which we can become more compassionate, generous and open to the experiences of others. A committed engagement between the researcher and the people who suffer, together becoming experienced about the many faces of suffering, deconstructing its complexity and thus co-creating a deeper understanding how to communicate, respond, share language, and learn from each other.

Cultural practices and anecdotal accounts suggest that people expect suffering to lead to fortuitous rewards. To shed light on this illusory ‘suffering – reward’ association, we tested why and when this effect manifests. Across three vignette studies in which we manipulated the degree of suffering experienced by the protagonist, we tested a ‘just world maintenance’ explanation (suffering deserves to be compensated) and a ‘virtuous suffering’ explanation (suffering indicates virtues, which will be rewarded). Our findings revealed that the illusory ‘suffering – reward’ association (i) could serve as a way for people to cope with just world threats posed by the suffering of innocent victims, and (ii) manifested when the suffering was not caused by the victim’s own behavior and not readily attributable to bad luck. Taken together, these findings not only provide evidence for the existence of the illusory ‘suffering – reward’ association but also elucidate its psychological underpinnings.

Suffering can be made to serve us. Suffering instructs us, we can learn from it; suffering humbles us, we realize how futile it is to try and manipulate life to get out of it what we want, no matter what it does to others; suffering confronts us, it is not what we expect from life but what life expects from us; suffering shapes us, we lose our hardness of heart, we become caring and compassionate; suffering commissions us, commands us to take up our cross and live life the way it is meant to be lived; suffering inspires us, we begin to have a zeal for life; suffering empowers us, we more courageously take a stand against what is wrong in the world as we reach out to all those who suffer; suffering leads us to our destinies in life, in the area in which we suffered, we have gained an expertise, an in-depth understanding of the kind of suffering we suffered and a desire to help those in similar need: suffering frees us, we are no longer victimized by tragic events but have risen to a position where we can face and overcome those events triumphantly; suffering makes us witnesses for life, we bear powerful and inspiring witness to the fact that suffering can be triumphantly overcome, that life is and remains precious and is to be lived appreciatively and to the full.

Objective To discuss the need for performing intravenous urography(IVU) in patients with non-muscle invasive bladder cancer before surgery. Methods From 1997 to 2008,1968patients were diagnosed as non-muscle invasive carcinoma of the bladder with pathological confirmation. All patients underwent ultrasonography, cystoscopy and IVU prior to surgrey. The x2 test was used for statistical analysis. Results The incidence of upper urinary tract urothelial tumors (UUTUT) was 11. 0% (216 cases). Two hundred and fifteen (13. 6%) suffered simultaneous UUTUT detected by IVU in 1528 patients with bladder cancer who had intermittent painless gross hematuria, while only 1 (0.3 %) suffered simultaneous UUTUT in 386 non-symptomatic patients (P＜0.01). Among 120 patients with bladder cancer whose upper tract was abnormal detected by ultrasonography,120 (100. 0%) suffered simultaneous UUTUT detected by IVU, and of 1848 patients who were normal in upper tract by ultrasonography, 96 (5. 2%) suffered simultaneous UUTUT detected by IVU (P＜0. 01). Of the patients with no abnormalities in upper tract by ultrasound, 37(3. 0%) suffered simultaneous UUTUT detcted by 1VU in 1247 patients with single bladder tumor,and 59 (9.8%) suffered simultaneous UUTUT in 601 patients with multiple bladder tumors (P＜0.01). Of the patients with single bladder tumor who had no abnormalities in upper tract by ultrasonography, 2 (0.2%) suffered simultaneous UUTUT detected by IVU in 822 patients with the diameter of the tumor＜1.0 cm, and 35 (8. 2 %) suffered simultaneous UUTUT in 425 patients with the diameter≥1. 0 cm (P＜0.01). Of the 1541 patients with histological G1, 48 (3.1%) suffered simultaneous UUTUT detected by IVU, and of the 427 patients with histological G2- G3, 168 (39. 3%)suffered simultaneous UUTUT (P ＜ 0. 01 ). Conclusion Patients with the following characters should undergo IVU before surgery: hematuria, abnormal upper urinary tract by ultrasonography,multifocal tumours, the diameter of the single bladder tumor≥1. 0 cm and high gradc tumors. Key words: Urinary bladder neoplasms; Urography; Hematuria; Cystoscopy; Ultrasonography

Background : Burden countries toward Pulmonary TBC, one of them is Indonesia. Data of WHO shows that Indonesia, every years is found 580.000 the new sufferers of Pulmonary TBC and the number of death because of Pulmonary TBC reaches 140.000 per year. The large number of sickness placed Indonesia as a country that has the most Third Pulmonary TBC sufferers in the world, after China and India, the prevalence reaches up to 225/100.000 inhabitant. In Pekalongan, according to the Puskesmas report shows there is an increase Pulmonary TBC case year by year, we can find it in a range of sufferers BTA tuberculosis positive findings or Case Detection Rate (CDR) in 2009 registered 88,7% in prevalence is 81,43%, in 2010 is 97,81% in prevalence is 78,73%, in 2011 there is 132, 78% in prevalence 92,79%. This case shows that in Pekalongan, the Pulmonary TBC disease case is still high. Some BTA pulmonary tuberculosis positive cases that be found and cured in Pekalongan in 2011 is 229 sufferers. This number is categorized as high, and the majority sufferers are from the incapable socioeconomic family, so that they have malnutrition tendency. The aim of this research is to know the influence of behavior and nutrient status toward the case of Pulmonary TBC in Pekalongan. This research is a kind of case control research. The independent variable that being researched are behavior and nutrient status, and the sufferers’ contact are as confounding variable. Methods : This research wad done to 70 respondents’ sufferers of TBC with BTA (+) as case and 70 respondents not sufferers as a control to the same characteristics. Results : The result of the finding is that there is no influence between behavior influence toward Pulmonary TBC and the percentage is p= 0,285. Then, there is an influence of nutrient status toward case of Pulmonary TBC and the percentage is p= 0,000 and OR= 7.583 and also there is an influence of sufferers’ contact toward the case of Pulmonary TBC and the percentage is p= 0,049 and OR= 4,387. The researcher suggests doing the effort to increase the crawl of sufferers Pulmonary TBC to increase the new case of finding, increase the hygienic and healthy behavior and increase the citizens’ nutrient status. Key words: behavior, nutrient status, Pulmonary TBC.

The relief of suffering is at the heart of palliative care practice. Yet there has been little exploration of how palliative care doctors, working in different countries and cultures, recognise and respond to their patients’ suffering. This research sought to develop a deeper understanding of suffering in the palliative care context, as witnessed by doctors in India and Australia. Through narrative interviews, 18 doctors spoke of how they recognised suffering, and what it meant to them to respond to suffering. The narratives chosen for analysis spoke to the dialogical encounter in which doctors sought to connect with their patients in common humanity, to recognise the particular nature of suffering and to meet in an intersubjective, relational space. The concept of intersubjectivity provided a lens for analysis of these narratives. Here, ‘intersubjective’ is used to describe the interhuman experience in which the subjectivities of ‘I’ and ‘Thou’, described in Martin Buber’s dialogical ontology, are brought to the encounter. I use the term ‘dialogical encounter’ to describe the meaningful connection between doctor and patient, as experienced by the doctor, where there is a sense of recognition of the ‘other’ and possible emergence of the ‘in-between’ realm (Buber, 1970). A key finding is that the relief of suffering in palliative care involves dialogical encounter between doctor and patient. In this in-between realm of interhuman encounter, suffering is transformed or relieved through the recognition and confirmation of the person who is suffering. Rather than being unidirectional, dialogical encounter is mutual, with the doctor also receiving from the patient, within the normative limits of the therapeutic relationship. The cultural differences apparent in suffering between India and Australia were unified in the experience of dialogical encounter by doctors in both countries. This thesis reinforces the primacy of the doctor–patient relationship in the relief of suffering and encourages renewed attention to preserving the conditions for the flourishing of this relationship in modern medical practice. Key words: narrative, palliative care, suffering, physician-patient relationship, encounter, intersubjective

Awareness of others' suffering is a key issue within interpersonal helping process. Potential helpers must have recognized the person in need and his/her distress so as to initiate helping behaviors. Suffering is a primary and essential concept in the domain of medical care and especially with terminally ill patients. This study introduces the concept of suffering as a frame of investigation to examine how hospice volunteers witness and perceive the suffering of terminally ill patients. Conceptualizations and methods of Personal Construct Psychology are applied in the present study. All three Christian volunteers in one hospice ward in central Taiwan were contacted and recruited to participate in this study. With the triadic elicitation technique, the interviewees gave responses based on their perceptions of the suffering of terminally ill patients they had served. It was found that motivation based on and in order to fulfill one's faith is essential for the research participants to volunteer for the services in hospice ward. Seven construct domains were identified as; ”physical pain”, ”hardship over loss and separation from family”, ”total pain-death anxiety and unfinished business”, ”lack of interpersonal support and interpersonal betrayal”, ”effects of character”, and ”unrealistic hope”. The interviewed hospice volunteers did not attribute the patients' suffering toward their mis-deeds and sins. However, there is a lack of respect and sharing of the patients' subjectivity, hope and the ”co-presence” with the terminally ill patients. It is recommended the above issues should be dealt with in hospice volunteers' in-service trainings.

To review the experience of reoperative valve replacement for 104 patients. From January 2002 to December 2009, 104 patients underwent heart valve replacement in reoperations, accounting for 2.92% of the total patient population (3557 cases) who had valve replacement during this period. In this group, 53 male and 51 female patients were included with a median age of 46 years (ranged from 13 to 72 years). The reasons of reoperation included 28 cases suffered from another valve lesion after valve replacement, 10 cases suffered from valve lesion after mitral valvuloplasty, 19 cases suffered from perivalvular leakage after valve replacement, 18 cases suffered from valve lesion after previous correction of congenital heart defect, 7 cases suffered from bioprosthetic valve decline, 10 cases suffered from prosthetic valve endocarditis, 9 cases suffered from dysfunction of machine valve, and 3 cases suffered from other causes. The re-operations were mitral and aortic valve replacement in 2 cases, mitral valve replacement in 59 cases, aortic valve replacement in 24 cases, tricuspid valve replacement in 16 cases, and Bentall's operation in 3 cases. The interval from first operation to next operation was 1 month-19 years. There were 8 early deaths from heart failure, renal failure and multiple organ failure (early mortality 7.69%). Major complications were intraoperative hemorrhage in 2 cases, re-exploration for mediastinal bleeding in 2 cases and sternotomy surgical site infection in 1 case. Complete follow-up (3 months-7 years and 2 months) was available for all patients. Two patients died, one patient died of intracranial hemorrhage, and another cause was unknown. Satisfactory short-term and long-term results can be obtained in reoperative valve replacement with appropriate timing of operation control, satisfactory myocardial protection, accurate surgical procedure and suitable perioperative treatment.

To retrospectively review the experience of reoperation after closed mitral commissurotomy, valvuloplasty, perivalvular leakage and dysfunction of bioprosthetic valve in 221 cases. Two hundred and twenty-one patients underwent heart valve reoperation from January 1998 to August 2005. Among them, 8 cases was emergency operation. The reasons of reoperation included 105 cases suffered from mitral valve restenosis after closed mitral commisurotomy, 37 cases suffered from valve lesion after mitral or aortic valvuloplasty, 29 cases suffered from perivalvular leakage after valve replacement. Eighteen cases suffered from bioprosthetic valve decline, 9 cases suffered from dysfunction of machine valve, 7 cases suffered from tricuspid insufficiency of Ebstein, 5 cases suffered from prosthetic valve endocarditis and 11 cases suffered from other valve disease. The re-operations were mitral valve replacement, mitral and aortic valve replacement, aortic valve replacement and tricuspid valve replacement. The interval from first operation to next operation was 1 - 21 years. The early-stage postoperative mortality was 8.6% (19/221). And the reasons were low cardiac output syndrome, arrhythmia, multiple organ dysfunction failure (MODF) and renal failure. Among these the emergency operative mortality was 3/8. And the mortality was 14.5% (9/62) in class IV of cardiac function (NYHA). The risk factors of reoperation about heart valve disease include emergency operation, low preoperative cardiac function, MODF, long time of cardiopulmonary bypass and aortic blocking. Therefore it is emphasized that mastering and treating the risk factors promptly, which could decrease the mortality and incidence of complication.

Although we sometimes praise a person who suffers for not sinking under his suffering, we still suppose that the sufferer is to be ranked more among life’s losers than among life’s winners. And, in general, we are inclined to find perverse anything that values suffering itself. On the contrary, anything that undermines physical or mental thriving strikes us as lamentable. The current disability rights movement is an exception to this general attitude. It wants others to see that those with disabilities are not among life’s losers, or even among life’s heroic overcomers of the tragic, but are instead people to celebrate. From the Patristic period onward, the Christian tradition has held a roughly analogous position not as regards disability but rather as regards suffering in general. It has supposed that those who endure serious suffering are not the pitiable losers of life or even the heroic overcomers of tragedy but rather are those specially loved by God. In this paper, I want to look closely at the relevant Christian doctrines to see what can be said to explain this attitude towards suffering and to distinguish it from the neighboring perverse attitude that sees suffering as an intrinsic good.

Objective To describe the general condition of workplace violence against emergency department nurses in five hospitals of Guangzhou;to investigate the status of the post-traumatic stress disorder in the emergency department nurses after suffering from workplace violence;to analyze the relative factors of post-traumatic stress disorder.Methods 143 emergency department nurses from 5 hospitals in Guangzhou were investigated by general information questionnaire,workplace violence questionnaire,PCLC and SSRS.The investigation data were analyzed.Results 86.7％ of emergency department nurses suffered from workplace violence during the past 1 year;the most popular style was non-physical violence.The emergency department nurses suffered from negative emotional experience,such as grievance,chagrin,low work passion,not focused spirit.The scores of PCL-C of emergency department nurses who had suffered from workplace violence were obviously higher than those who hadn't.21.8％ of the emergency department nurses who suffered from workplace violence in the past one year had certain degree of the signs of PTSD,12.1％ had obvious signs of PTSD.The influencing factors of PTSD:degree of hurt,objective support and availability of social support.Conclusions The situation of workplace violence which the emergency department nurses were faced with was more and more grave.The emergency department nurses who had suffered from workplace violence were in different degree of PTSD.The more social supports the nurses get,the better mental health status they will possess. Key words: Emergency department nurse; Workplace violence; Post-traumatic stress disorder

Spirituality, Suffering, and Illness in Everyday Life / Suffering and Illness in Professional Literature / Spirituality and Illness in Professional Literature / The Trinity Model: Spirituality, Suffering, and Beliefs / Clinical Nursing Practices that Create a Context for Conversations of Suffering and Spirituality / Clinical Practices that Invite Healing: From Suffering by Connecting to the Spiritual in Conversations about Illness / Educating Ourselves as Persons and Nurses to Provide Compassionate Care / Connecting the Personal and the Professional in Matters of Suffering and Spirituality

In tutte le civilta umane, il dolore, pur con le implicazioni negative che esso sembra comportare dal punto di vista concettuale, soprattutto per il suo legame con la morte, e sempre stato visto – piu o meno implicitamente – come un’esperienza educativa in grado di potenziare lo sviluppo umano in una situazione di limite o di eventuale “fine” dell’esistenza (Mantegazza, 2002). Il riconoscimento che il dolore e la sofferenza implicita in esso “modificano” l’essere umano sia nella sua dimensione fisica che mentale e preludono ad una sua trasformazione che avviene sotto il segno dell’ermeneutica che permette la comprensione dei significati della vita della persona e della sua relazione con il mondo circostante e con gli altri, e stata ed e il punto di partenze di molte pedagogie antiche e moderne (Garelli, 2001). Il potere di modifica/trasformazione e il potenziale educativo del dolore – concetto centrale, ad esempio, nelle teorie del filosofo e psichiatra Viktor Frankl [1905-1997] – e stato intuito dalla civilta greca. I Greci hanno compreso l’universalita dell’esperienza del dolore umano e hanno assegnato ad essa un posto rilevante nella loro paideia quale sistema etico, religioso ed educativo finalizzato alla formazione delle nuove generazioni. Il pathos e un nucleo di emozioni e sentimenti nel quale trovano posto le esperienze che l’essere umano come soggetto individuale, essere comunitario e membro di una specie, sperimenta nell’arco della sua esistenza: il dolore, il male, la morte, la sofferenza, la gioia. Tutti concetti che, oltre a rimandare ad una gamma emozionale studiata da specifiche pedagogie nella loro forma di tecniche dell’anima e del corpo, sembrano spesso restare inspiegabili allo sguardo del pensiero razionale. Il pathos rimanda all’“oscurita”, da intendersi come quel coacervo di emozioni che sembra impenetrabile allo sguardo della ragione. In questo articolo metteremo in evidenza, attraverso un approccio di ricerca di tipo ermeneutico, come il pathos rappresenti, di fatto, il nucleo etico ed educativo del concetto di finitezza umana e come da esso si possa partire per delineare una pedagogia nichilistica attiva della finitezza in grado di disvelare nella sfida alla morte, al dolore e alla sofferenza, il senso e il significato profondo della vita umana dinanzi ai suoi limiti estremi.

Objective To evaluate the effects of proton and heavy ion therapy on weight loss and nutritional problems in patients with head and neck (HN) cancer during radiotherapy. Methods Totally 109 patients with HN cancer who received proton and heavy ion radiation therapy from May 2015 to June 2016 were retrospectively analysed. Results During radiotherapy, 58.72% of the patients had a weight loss. Among them, 52.29% of the patients had a weight loss of less than 5 kg, 6.42% of the patients experienced a weight loss of more than 5 kg, and 12.84% of the patients had a weight loss of more than 5%. Grade I or grade II dry mouth was reported in 6 (5.50%) patients; 9 (8.26%) patients suffered from grade I oral mucositis; 20 (18.35%) patients suffered from grade II oral mucositis; and 7 (6.42%) patients suffered from grade III oral mucositis. There were 4 (3.67%) patients suffered from grade I or grade II nausea, and 3 (2.75%) patients suffered from grade I or grade II vomiting. Besides, only one patient (0.92%) suffered grade I loss of appetite, and none patients suffered from difficulty of swallowing. Conclusions Proton and heavy ion radiation therapy is associated with lower rates of weight loss and fewer nutritional problems related to radiotherapy among patients with HN cancer. Key words: Head and neck neoplasms; Protons; Heavy irons; Body weight changes; Adverse reaction