先哲の智恵に学ぶ

　　　　　　　　　（Timeless Truth）

■いろは歌　　色は匂えど散りぬるを　～　我々の生活に欠くべからざる思想

■平家物語　　祇園精舎の鐘の声　　～　The bell of the Gion Temple tolls into every man's heart

■歎異抄　空事 たわごと まことあることなきに　～　決して苦しむために生まれてきたのではない

■徒然草　　望月の円かなる事は、暫くも住せず、やがて欠けぬ　～　いつの時代になっても・・・

■白骨の御文章　朝には紅顔ありて　夕には白骨となれる身なり　～　人の心に深くしみわたる

■人生の短さについて　（セネカ）　～　やめる土壇場になって、やっと始めようとしていないか

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K-PAX 光の旅人 [DVD]/ケビン・スペイシー,ジェフ・ブリッジズ

￥3,990

Amazon.co.jp

What about societal structure?　Government?

No, there's no need for one.

No laws?

No laws, no lawers.

How do you know right from wrong?

Every being in the universe knows right from wrong.

But what if some one did do something wrong?
Committed murder, or a rape?
How would you punish them?

Let me tell you something.
You humans, most of you,
subscribe to this policy of an eye for an eye, a life for a life.
It's known throughout the universe for its stupidity.

Even your Buddha and Christ saw it quite differently,
but nobody really cares, not even Buddhists or Christians.

You humans.
Sometimes it's hard to imagine how you've made it this far.

・・・・

It's fine to show interest in your fellow patients,
but it's quite another telling them you can cure them.

You seem overly upset, Mark.
To borrow a phrase from Navarro, "You need to chill."
For your information,

all beings have the capacity to cure themselves.
This is something that K-PAXians have known this

for millions of years.

Listen to me.
On this planet, I'm a doctor, you're a patient.

Doctor...patient.
Curious human distinction.

It's not your job.
To cure Howie, Ernie, Maria or anyone else,
It's mine.

Then why haven't you cured them yet?

・・・・

Do you know waht a family is?
you worry,

They don't tell you that.

You don't have a family?

No.
We don't have families on K-PAX.

Well, you don't know what you're missing.

・・・

I want to tell you something you don't yet know.

We K-PAXsians have lived long enough to have learned it.

The universe will expand
the it'll collapse back on itself.

Then it'll expand again.

It'll repeat this process forever.

What you don't know is when the iniverse expands again,
everything will be as it is now.

Whatever mistakes you make this time around,
you'll live through again.

Every mistake you make,
you'll live thruogh again and again, forever.

So my advice to you is to get it right this time.

Because this time is all you have.

■関連記事

・生きて死ぬ私　(茂木健一郎)　～

　　　　私の心の中には、まさに「今」の現在に加えて、

　　　　　　　少し前の、過ぎ去った「今」の名残と、少し後のこれから来る「今」の予感が混在している。

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MedicineWorld.Org
Your gateway to the world of medicine

What Are The Qualities Of A Good Physician?

http://medicineworld.org/cancer/lead/3-2006/what-are-the-qualities-of-a-good-physician.html

A study of Mayo Clinic patients

has found seven behaviors define the 'ideal' doctor

and supports an Institute of Medicine recommendation that

quality medical care should include a patient-centered approach.

The Mayo Clinic-led study was designed to develop
a comprehensive set of ideal doctor behaviors.

Telephone interviews were conducted in 2001 and 2002 with 192 patients
who were seen in 14 medical specialties of Mayo Clinic
in Scottsdale, Ariz., and Rochester.

Reported in the recent issue of Mayo Clinic Proceedings,
the article was based on transcripts of patients
detailing their best and worst experiences with a Mayo Clinic physician.

From the transcripts, study authors identified seven behaviors that
describe the ideal doctor
-- confident, empathetic, humane, personal,

forthright, respectful and thorough.

Conversely, patients who described a "worst physician"
experience focused on traits reflecting opposites of desired doctor behaviors,
particularly perceived insensitive or disrespectful behavior.

The study suggests that training new and practicing physicians
about interpersonal skills could have far-reaching effects for patients.

The quality of a patient's relationship with a doctor can affect
not only a patient's emotional responses,
but also behavioral and medical outcomes

such as compliance and recovery.

An editorial in the same issue expands on the patient-doctor relationship,
saying health institutions ought to follow the recommendations of
the Institute of Medicine to improve quality by
fostering a patient-centeredness approach to medicine.

James Li, M.D., Ph.D., Mayo Clinic Division of Allergic Diseases,
writes in an editorial that health care can't meet a standard of quality
if the patient-doctor interaction is hurried, disrespectful, cold or callous.

Dr. Li has been involved with developing programs and curricula
for teaching new and practicing physicians at Mayo Clinic
about how to strengthen their interactions with patients.

Mayo's structure of focusing on the patient also helps
nurture strong relationships between doctor and patient, he says.

"A doctor who pays personal attention to the patient,

who is respectful, compassionate and competent,

that's what every patient wants,"

Dr. Li says.

"It's really the duty and obligation of the medical community

to design a health care system so that

physicians are best able to exhibit those qualities

for the good of the patient during the clinical encounter."

Dr. Li notes the seven behavioral traits identified by scientists

as ideal for physicians can be taught in various settings,

such as having medical residents witness positive interactions

which they can model.

Of the seven behavior traits, "thorough" was named most often by patients.

Patients can sense if a doctor is rushed or preoccupied,

the study's authors say,

just as they can sense a physician's genuine interest.

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Crush/Bon Jovi

￥1,233

Amazon.co.jp

It's My Life



This ain't a song for the broken-hearted
No silent prayer for the faith-departed
I ain't gonna be just a face in the crowd
You're gonna hear my voice
When I shout it out loud


It's my life
It's now or never
I ain't gonna live forever
I just want to live while I'm alive
(It's my life)
My heart is like an open highway
Like Frankie said
I did it my way
I just wanna live while I'm alive
It's my life


This is for the ones who stood their ground
For Tommy and Gina who never backed down
Tomorrow's getting harder make no mistake
Luck ain't even lucky
Got to make your own breaks

It's my life
And it's now or never
I ain't gonna live forever
I just want to live while I'm alive
(It's my life)
My heart is like an open highway
Like Frankie said
I did it my way
I just want to live while I'm alive
'Cause it's my life


Better stand tall when they're calling you out
Don't bend, don't break, baby, don't back down


It's my life
And it's now or never
'Cause I ain't gonna live forever
I just want to live while I'm alive
(It's my life)
My heart is like an open highway
Like Frankie said
I did it my way
I just want to live while I'm alive
'Cause it's my life!

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アバウト・シュミット [DVD]/ジャック・ニコルソン,キャシー・ベイツ

￥3,990

Amazon.co.jp

About Schmidt

I know we're all pretty small

in the big scheme of things.

And I suppose the most you can hope for

is to make some kind of difference.

But what kind of difference have I made?

What in the world is better because of me?

I am weak, and I am a faiure.

There's just no getting around it.

Relatively soon, I will die.

Maybe in twenty years, maybe tomorrow.

It doesn't matter.

Once I am dead and everyone who knew me dies too,
　it will be as though I never even existed.

What difference has my life made to anyone?

None that I can think of.

None at all.

http://www.youtube.com/watch?v=rahgBbi4cRE

■関連記事

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Palliat Support Care. 2008 Sep;6(3):231-8.

The meaning of quality of life:

narrations by patients with incurable cancer

　　 in palliative home care.

Melin-Johansson C, Odling G, Axelsson B, Danielson E.

The Sahlgrenska Academy at Goteborgs

University, Institute of Health and Care Sciences, Goteborg Sweden.

titti.melinjohansson@miun.se

http://www.ncbi.nlm.nih.gov/pubmed/18662416?dopt=Abstract

Abstract

OBJECTIVE: The objective of this qualitative study was to elucidate the meaning of quality of life as narrated by patients with incurable cancer approaching death in palliative home care in Sweden.

METHODS:

To gain a deeper understanding of what quality of life means for dying patients,

data were collected from narrative interviews with eight patients in their homes in 2004-2006.

Qualitative content analysis was used to interpret the meaning regarding quality of life.

RESULTS:

Three main themes were found: being in intense suffering, having breathing space in suffering, and being at home.

Living with incurable cancer at the end of life was experienced as living in physical distress as the body became incapacitated by unexpected physical complications.

This incapacity had consequences on patients' psychological, social, and existential well-being.

As the complication phase abated, the patients experienced that they regained hopefulness and had time to reflect on existential issues.

Patients were provided affirmative care at home from family caregivers and the palliative home care team.

SIGNIFICANCE OF RESULTS:

This study shows that it is feasible to perform individual interviews with patients approaching death and elucidate the meaning of patients' quality of life in palliative home care.

Patients oscillate between being in intense suffering and having breathing space in this suffering, which somewhat opposes the traditional picture of a continuous linear deterioration.

Being cared for at home by family caregivers and health care professionals provided a sense of independency and security.

Being at home safeguards patients' entire life situation and increases quality of life.

PMID: 18662416 [PubMed - indexed for MEDLINE]

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Expert On Death Faces Her Own Death

　　 Kubler-Ross now questions her life's work

May 31, 1997|By Don Lattin, Chronicle Religion Writer

http://articles.sfgate.com/1997-05-31/news/17749844_1_elisabeth-kubler-ross-terminally-dying

Kubler-Ross revolutionized the way Americans look at death and dying,
but decades of work with the terminally ill
has done little to ease her own transition into the great beyond.

Two years of medical problems and existential angst
have forced the Swiss-born psychiatrist and spiritualist
to question her own legacy and to reconsider her ideas about life,
death and "the other side."

"For 15 hours a day, I sit in this same chair, totally dependent on someone else coming in here to make me a cup of tea," she says.

"It's neither living nor dying. It's stuck in the middle."

"My only regret is that for 40 years I spoke of a good God who helps people,

who knows what you need and how all you have to do is ask for it.

Well, that's baloney. I want to tell the world that it's a bunch of bull.

Don't believe a word of it."

・・・

"When I came to this country in 1958,
to be a dying patient in a medical hospital was a nightmare,"
Kubler-Ross said in an interview at her home last week.

"You were put in the last room,
furthest away from the nurses' station.
You were full of pain, but they wouldn't give you morphine.
Nobody told you that you were full of cancer
and that it was understandable that

you had pain and needed medication.
But the doctors were afraid of making their patients drug addicts.
It was so stupid."

In 1969, Kubler-Ross published "On Death and Dying,"
a trail-blazing book that made her famous
and helped launch the hospice movement in the United States.

"She was the first to break the taboo about death
-- to get physicians and nurses to realize that death is a part of life,"
said David Kessler, a hospice movement leader and author of the new book

"There is nowhere on Earth now where they don't know
Elisabeth Kubler-Ross and the five stages of death and dying,"
Kessler said.

According to the Kubler-Ross model,
dying patients often go through five emotional stages
-- denial, anger, bargaining, depression and acceptance.
Just let dying patients express these emotions, she said.
Make doctors listen to their patients
and give them enough medication to control the pain.

Today, Kubler-Ross is not optimistic about her effect
on the American medical establishment.

"Even now, when we have 2,700 hospices in America,
80 percent of our doctors try not to refer patients to hospice,"

she said.
"They see death as their failure."

But what really makes Kubler- Ross question her legacy
is her own encounter with medicine in the 1990s
after suffering a major stroke two years ago.

"After teaching doctors and nurses for decades,
I was in the hospital after my stroke,
and it was like my work was nonexistent," she said.

"The nurses never came to see their patients.
They would just sit out there in front of their computers."

"I had this frozen arm and incredible pain.
If you blew on my left arm, I would scream.
The nurse told me I was holding my hand in a funny way
-- which is typical of stroke patients -- and she sat on my arm!
I slugged her with my good arm and yelled,
'That hurts like hell!'
She said, 'Oh, you're becoming combative,'
and brought in two fat nurses who tried to sit on it again.
If I had a pistol, I would have shot them."

"When I left the hospital, I was so depressed," she said.
"It was like my work for four decades had gone down the drain.
Nobody learned anything.
I only had one good nurse in six weeks in the hospital.
It's a disgrace."

Shortly after moving into her new home in the desert outside Scottsdale,
Kubler-Ross suffered a major brain stem stroke.

"It's a lousy retirement," she said. "I can't wait to die."

While her current spiritual vision contains more gloom and doom,
Kubler-Ross continues to believe in the afterlife and spirit guides,
whom she affectionately calls "my spooks."

"I only believe in what I see and hear with my own eyes and ears,"
said Kubler-Ross, who reports two near-death experiences of her own.

As for skeptics who claim these visions are mere hallucinations
caused by a lack of oxygen to the brain,
Kubler-Ross replies, "Let them wait until they experience it themselves."

Until recently, Kubler-Ross said her belief in
reincarnation inspired her opposition to euthanasia.
There are always lessons left to be learned in life, she said.

Today, Kubler-Ross is not so sure.
While she still opposes physician-assisted suicide
and has nothing but disdain for Dr. Jack Kervorkian,
she has come to see suicide as a legitimate option.

"If it were not for Kervorkian,
I would have done it a long time ago.
I can't stand this Kervorkian," she said.

"When I've had enough of this, I'll do it myself.
I don't give a hoot about the afterlife,
reincarnation or anything. I'm finished, and I'm not coming back."

Kubler-Ross doesn't miss a beat when asked
which of the five stages of death she finds herself in at the moment.

"Anger," she yells. "I'm pissed!"

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なぜ生きる/明橋 大二

￥1,575

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「死んだらどうなるか」
　何かでごまかさなくては生きていけない不安だ。
　しかし、ごまかしはつづかない


どうして「後生暗い心」が苦悩の根元なのか、
疑問に思う人が多いだろう。

だが、未来暗いと、どうなるか。
例えれば、こうもいえよう。

三日後の大事な試験が、学生の今の心を暗くする。

五日後に大手術をひかえた患者に、
「今日だけでも楽しくやろうじゃないか」といってもムリだろう。

未来が暗いと現在が暗くなる。
墜落を知った飛行機の乗客を考えれば、よくわかろう。

どんな食事もおいしくないし、コメディ映画もおもしろくなくなる。
快適な旅どころではない。

不安におびえ、狼狽し、泣き叫ぶ者も出てくるだろう。
乗客の苦悩の元はこの場合、やがておきる墜落なのだが、
墜死だけが恐怖なのではない。

悲劇に近づくフライトそのものが、地獄なのである。

未来が暗いと、現在が暗くなる。
現在が暗いのは、未来が暗いからである。
死後の不安と現在の不安は、切り離せないものであることがわかる。
後生暗いままで明るい現在を築こうとしても、できる道理がないのである。

五十歳近くになったトルストイが、気づいたのもこのことだった。
今日や明日にも死がやって来るかもしれないのにどうして、安楽に生きられるのか。
それに驚いた彼は、仕事も手につかなくなっている。

こんなことがよくも当初において理解できずにいられたものだ、
とただそれに呆れるばかりだった。

こんなことはいずれもとうの昔から誰にでも分かりきった話ではないか。

きょうあすにも病気か死が愛する人たちや私の上に訪れれば
（すでにいままでもあったことだが）
死臭と蛆虫のほか何ひとつ残らなくなってしまうのだ。

私の仕事などは、たとえどんなものであろうと
すべて早晩わすれさられてしまうだろうし、
私もなくなってしまうのだ。

とすれば、なにをあくせくすることがあろう？

よくも人間はこれが目に入らずに生きられるものだ
──これこそまさに驚くべきことではないか！

生に酔いしれている間だけは生きてもいけよう、

が、さめてみれば、これらの一切がごまかしであり、
それも愚かしいごまかしであることに

気づかぬわけにはいかないはずだ！

　　　　（トルストイ著、中村白葉・中村融訳　『懺悔』）

愛する家族もいつか、この暗い死にぶつかるのだ。
そう思うと、生き甲斐であった家族や芸術の蜜も、もう甘くはなかった。

作家活動は順調だったが、確実な未来を凝視した彼の世界は、
無数の破片にひびわれ一切が光を失った。

「われわれは断崖（危険）が見えないように、
　何か目かくしをして平気でそのなかへ飛びこむ」

とパスカルはあやぶむ。

思えば私たちは、真っ暗がりの中を、突っ走っているようなもの。

「死んだらどうなるか」未知の世界に入ってゆく底知れぬ不安を、
何かでごまかさなくては生きてはゆけない。

文明文化の進歩といっても、後生暗い心が晴れない限り、
このごまかし方の変化に過ぎないといえよう。

しかし、ごまかしは続かないし、なんら問題の解決にはならない。

何を手に入れても束の間で、心からの安心も満足もない、
火宅のような人生にならざるをえないのである。

http://ameblo.jp/the-path/entry-10431594780.html

ーーーーーーーーーーーーーーーーーーーーーーー

ごまかし、目隠し、現実逃避。。。

自分の人生は、そんな人生ではない！

と胸を張って言えるかというと、とてもそんな自信は・・・。

何となく生きてきたするのは、誤魔化して生きてきたからなのかもしれない。

そう、自分で認めるのも、なかなか厳しいものがありますが。

現在が暗いのは、未来が暗いから

お先真っ暗な未来を抱えていることに気づいてしまったら、

確かに今から、うつになってしまいそう。

期末試験のオンパレード、とかでさえ。。。

死を見つめるためには、

まずは、自分は誤魔化していないかと、自問するところからですかね。

■関連記事

こころのサイエンス：幸せになるためのウソ　～　うつ病患者は自分に嘘をつかない

死を見つめる心（岸本英夫）　～　人間の日常生活は、一つのごまかしの上に営まれている

金持ち父さん　貧乏父さん（R.　キヨサキ）　～　忙しい人が、一番の怠け者

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国際的に通用する医療人を目指して ｢知っている知識｣から「使える知識」へ

――　日本では、法律上できないことになっていますが、早いうちからのペーシェントタッチは必要だと思いますか？

天満

どこの国でも学生のペーシェントタッチが当たり前というわけではないけれど、

他国の医学生と比べて、学んでいることはほとんど同じですし、

日本の医学生の知識が劣っているとは、僕は思いません。

ただ、知っているという意味においては劣っているとは思わないけれど、

できるという部分に関しては、そうは言い切れない。

というのは、「知ってる」を「できる」に変える教育が、日本では徹底されていないから。

テストの知識でしかない。

それが実際に現場に出て、患者さんを診る段階で活かされるかというのは別問題です。

たまに、患者さんの了解を得て、問診をとらせてもらったり、聴診器を当てさせてもらったりすることがあります。

もちろん、担当医師の監督下においてですが。

そういう時、例えば、聴診器に関していうと、クリック音が聞かれるとか、

いろいろ教科書で異常音を学んだり、コンピューターではっきりと聞き取れるような音よりも、

実際にあてさせてもらうと、「ああ、なるほど」。

すると、もう忘れないですよね。

そういうことが、知識を実際に使えるものとして根づかせる段階では必要だと思います。

（中略）

――　今の医学生たちが、共通して抱えている不安とか悩みはありますか？

天満

　まず、打たれ弱くなっているという気はします。

周りの学生を見ていて思うのは、不安というより、

モチベーションが１年生のときから、どんどん下がっていくこと。

安定を求めて、堅い職業だからとか（今は、必ずしもそうではないとしても）、偏差値がよかったからとか、

そういう理由で医学部に入ってくる学生もけっこういることはたしかですが、

それでも１年生のときは、やはり医者になりたいというモチベーションが、まだ高い。

先生が呼びかければ、１年生から積極的に研究室にも行ってみたり、

どんどん先のことを勉強してみたり、そういう学生は多いのに、

学年が上がるにつれて、テストテストで追いまくられ、「最低限の合格点を取ればいい」となってくる。

途上国では、医学部に行くのは社会的な地位が高い人の子弟が多くて、

小さいときから国を背負うくらいのモチベーションをもって育てられ、またそういう教育を受けてきています。

だから英語を使わない国でも英語はネイティブ並みにしゃべるし、

国際的な感覚も身につけている人が多いと感じます。

ヨーロッパでは、もとから階級社会というのがベースにあって、

「ノーブレス・オブリージ」、つまり、「富める者は、果たす義務がある」という意識を

文化的に持っているという印象を受けます。

その点、日本の医学生は、社会に対する責任というか、社会貢献意識は、まだ低いと感じます。

――　モチベーションが落ちていくことに対する打開策など、

　　　　これからの医学生にとって、どんな工夫が必要だと思いますか？

天満

　例えば、ペーシェントタッチは、モチベーションを落とさないための一つのキーだと思います。

やはり現場を見て勉強すると、頭に残ります。

実際の病気を、ただ教科書で読むだけでは、単に「知っている」で終わってしまいますが、

その患者さんを診ると、「使える知識」として、残り方が全然違います。

（中略）

ブラジルに行ってたときに、ちょっとおもしろい話があって、

スウェーデンから研究のために来ていた30歳くらいのスーパーバイザーが、

いつも白衣を着たまま、外のカフェにご飯を食べに行くんですね。

「どうして、脱がないんですか？」と聞いたら、「これを着てるとかっこいい」。

昔は、たしかに“お医者さま”だったと思いますが、

今は患者さんたちもいろいろな情報を得て、不都合があったら訴えられる時代です。

でも、僕は今、IFMSA-Japanの代表として、いろいろな人と出会わせてもらって、しゃべらせてもらって、

医学教育だけではなく、医療を含むさまざまな問題に対して意識的に働きかけていける立場にあります。

なり手が少ない立場ではありますが、おもしろい。

自分が楽しんでやれる、それが一番のモチベーションになっています。

授業だけでも忙しいけれども、「やれと言われたことだけをやる」教育を受けていると、

モチベーションが下がってしまうので、

何事も学びたいことを自ら発見して、積極的に首を突っ込んでいこうと思っています。

ーーーーーーーーーーーーーーーーーーーーーーーー

言われたことだけやってても、面白くないですからね。

僕も、何か公けの講演会とかにも参加してみようかな。

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