O médico diante da morte na urgência e emergência:reflexões sobre o ser médico

The literature pointed that the way which people deal with death have been changing along centuries, and nowadays what is realized it is that, each time more, the human being have difficulties to deal with death. Due to the fact that the main function of the physician is to save their patients lives; responsibility that is aggravated by the necessity of to take decisions quickly, once he need to deal with the unexpected situations of the urgency and emergency, many times these professional have to face of impotency and fail situations, when he lose a patient. The main goal of this study was to understand the experience of physicians that work in the urgency and emergency, in front of death. These questioning it justified by the fact of the physicians do not have, many times, a space to express their suffering and anguish about the issues related to death in their work routine, despite lifedeath question to be often present their everyday. It is still possible to verify in the literature, an appointment of the necessity of to include in the curriculum of Medicine courses, subjects that approach such questions. The method used was based on the existential-phenomenological perspective, using as instrument the participant observation, to the intent of understand the routine in the urgency and emergency context, and semi-structured interview. It was interviewed six physicians that work in the urgency and emergency of the most important hospital of public health system of Natal-RN. The results showed that the physicians reported pleasure in work in the urgency and emergency, despite of they presented stress and the difficulties that they deal with in the public system. Despite of the fact that the death to be considered as a phenomenon that make part of the physician s routine, sometimes, deals with these one is more difficult. Many times losses generate an impotency and guilty feeling, as well as questionings about their performance during the attempts to save lives. We verified, from this study, the importance of the existence of some kind of intervention in the emergency, in order to the physicians can elaborate the questions about death and die emerged in their work. We consider yet that this study corroborates and reiterates the discussions concerning the importance of this thematic to be approached in a more effective way, during the academic formation of these professionals, as well as, the importance of a larger investment from the part of Government in the urgency and emergency sector, in order to propitiate to these professionals a work that brings less harmful for their health

O oncologista clínico diante da morte: implicações para a produção do cuidado

It is undeniable that all the extraordinary technological advances in contemporary society have increased the severe patients expectation and quality of life, especially cancer patients. On the other hand, it is easily verifiable by many researches that it was not possible to advance in the same proportion in caring for the human experience of death. Much is said about the anguish of a man facing death, of cancer patients in terminal stage, about their families, and very little about the feelings, anxieties and ways of coping with the medical professional who deals with this situation, specifically the clinical oncologist. Little is known about the experience of the doctor who has learned to take death as an enemy to be defeated, and increasingly is compelled to live at length with his advertisement. However, we started to watch in recent years a growing interest of researchers in this issue. This study seeks to add to this interest in order to understand the experience of clinical oncologists that accompany dying patients, the meanings they attach to death, ways of coping and the implications for providing care. This is a qualitative study in which was used as a tool for data collection an in-depth interview with the projective using script and scenes. Gadameriana Hermeneutics was used for analysis and interpretation of narratives. The subjects were 10 clinical oncologists who work at two institutions from cancer treatments in the state of Rio Grande do Norte, chosen from a variation in the time working in the specialty (minimum of one year, even old ones). However, you can bring some initial results for the dialogue. It was found that the death is still a topic that causes many difficulties in the daily lives of these professionals, the choice for oncology involves dealing with death without preparation in medical education; being close to the patient in the final moment, supporting the family, coping with own pain of loss and the inability to heal. These are central elements of the narratives. We also have investment in medical training and continuing education in setting up a demand that permeates the discourse of participants. Being able to listen to the subjective world of clinical oncologists will support the work not only for them as other professionals who deal with patients with advanced cancer, providing evidence to understand to what extent the meanings attributed to its know-how before patients on the verge of death interfere with the production of care and allow identify coping strategies in everyday life of these professionals that hinder or facilitate coping with death, promote or preclude the care with others and with themselves. It is hoped that research can contribute to the field of knowledge about the know-how in clinical oncology and their terminal-care-death oncologist-patient relationships, bringing runways capable of promoting a better quality of care in the production of all involved in this process: professionals, patients and families

Os agentes funerários e a morte: o cuidado presente diante da vida ausente

The present time is marked by the art of escape from death, which has become synonymous with failure, its exposure has become intolerable and the care of the dead body were assigned to third parties who market this practice through services and products that shape the market undertaker. In this context, in which death is an object of study, has arisen funeral officers, as professionals dealing with a dead body, with the pain of relatives and their reactions, often being the first to have contact with the death scene. As professionals in the health area, the morticians also deal with death. The first attempt to prevent the arrival of death, funeral officers already has begun their work routine from there. Death and its surrounding part of their profession. What about those professionals whose work demands as a feared and denied by society? This study aims to understand the intents, meanings and implications for the mortician to deal with death in their daily work in order to focus renewed attention to the care of these professionals. To this end, it was carried out a qualitative research grounded in the theoretical framework of Gadamerian hermeneutics for production and interpretation of narratives. It was used two methodological strategies for data collection: in-depth interview with script and workshop with the use of "scenes". Research participants were nine morticians funeral of two funeral agencies of the city of Natal. It was possible to detect the presence of the social imaginary of interdiction on the theme of death from living with feelings of his presence daily, from the need of respondents to naturalize their contacts with death, a requirement of their office to deal with the difficulties of manipulating body fluids and odors, sometimes in a state of decomposition; allied to wishes to achieve the goal of delivering to family-customers a "embellished" body for the final farewell. Being a mortician, in addition to not being a professional motivation, involves facing difficulties related to heavy routine work, low salaries, unprofitable work materials and equipments, besides having to deal with the social gaze that devalues the profession. In turn, they also deal with the pain coming especially from contact with family members, either when they are targets of these feelings of anger, whether they identify with the pain of the bereaved ones. On the other hand, when the recognition and gratitude of the families occur, they find meaning and beauty in their profession of caring for the dead body. The present study by giving voice to morticians has become possible to understand better their profession, the pain that surrounds and care needs of these workers. Finally, it has argued that the mortician may be recognized as a care professional for the way exercising caution with the dead body and their families.

Cuidados paliativos e ser-para-morte: reflexões sobre um atendimento psicológico

Death is a theme that fascinates, though at the same time, frightens and uneasy the human being, despite the finitude being present at our daily lives. In each historical time, death has been represented in a peculiar way, from familiar death (at Middle Ages), to interdicted death (at contemporary times). Through this path it‟s possible to recognize several attitudes and stages front of death and the process of dying as possibilities of coping and the understanding of these occurrences. In other hand, the palliative care proposal came as a humanized attention, front of the human finitude, recognizing death as a part of the vital cycle. The Brazilian reality, in this context, still faces a lot of political, economic and social barriers that makes difficult the consolidation of palliative care at the death process in the Brazilian Health Care policies. Currently, according to the Brazilian Palliative Care Association, Brazil presents an average of 40 services with this proposal. Such data portray our inexpressive condition in relation to these cares when considering the territorial extension and population of our country. Considering this scenario is relevant think about death and the process of dying at contemporary times, at a health context in which palliative care, when trying to humanize the process of dying, bring to light the issue of human finitude and the beingtowards- death, as thought by the philosopher Martin Heidegger. According to him, the human being (Dasein) is constituted as a being-towards-death, once death is its most own potentiality-for-bein and its last possibility to be lived. In view of the ideas presented, the proposed study appears as a qualitative research of existential-phenomenological inspiration and aims to understand the experience of being-toward-death from the psychological care to a person out of possibilities of cure living on palliative cares. The psychological care happened at the patient‟s home, understanding the clinical process of being-with-the-other from the written reports of the psychology/researcher, by the accompanying sessions, configured as an experience report. These reports are focused on the experiences lived by the patient, as well as apprehended by the psychologist at the intersubjectivity relation and its own experience with Dasein and, therefore, being-toward-death. The reports were hermeneutically interpreted, from the senses that emerged in this process, considering the notion of being-toward-death proposed by Heidegger. Furthermore, it was important to dialogue with other authors that approached the studied theme. It is perceived, through brief and meaningful reflections about the clinical treatments started, that the experience of illness with no possibilities of cure makes the Dasein revises feelings and experiences that were marked at the temporality and historicity of existence. It is a stage of life in which the cultural dimension and the common sense of finitude, often gains ground in the human condition, taken in its ordinary sense, unlike the way it has been thought from an ontological and existential perspective of death. Thus, there are singulars and revealing paths in the palliative care scenery as possible ways for authenticity of being-toward-death

Morte e filosofia: sobre o desejo de imortalidade entre os gregos

Enfoca-se aqui a vinculação íntima entre a exaustiva busca empreendida pelo espírito grego para edificar em terreno sólido as colossais fundações de uma ciência dos primeiros princípios, e o que supõe-se ser sua motivação secreta e última, a aspiração pela eternidade, o mais universal e genuíno desejo presente em todo ser humano, não ser obliterado pelo tempo.

Síndrome de Berardinelli :territorialidade e imaginário

The Syndrome of Berardinelli or Congenital Generalized Lipodystrophy, known popularly in Seridó as "The Magicians", it is considered in the world as a rare syndrome and of few studies. In Rio Grande do Norte, specifically, in the Area of Seridó, an important incidence of bearers was verified. Face to present subject, this work describes in beginning the origin and evolution of the referred syndrome, standing out the genealogy of the families of the bearers in the temporary cutting that dates of the beginning of the century XIX to the current days and, later, it s has as purpose to justify the territorialities and the imaginary of the Syndrome and Berardinelli starting from the lived experiences, of the conidian and of the social practices. That implicates to verify as those people they fragmented certain places, like them they noticed her and they were noticed by the society. The methodological approach for the accomplishment of that research is of qualitative order in a perspective phenomenological, ethnography and historical, once the analysis is not just ruled in the product, but it takes in consideration the life history. The analysis presents the way as the depositions they make sense in the context of the study of the genealogy, of the perception imagery of the society before them and the image constituted by them, of himself and of the other. The data, still, demonstrate that the a lot of people's existence with to Syndrome in Seridó happens due to the consanguinities among the families

A televisão e a (re)construção do imaginário : as telenovelas e sua ifluência socioespacial em Caicó-RN

Under the perspective of the Cultural Geografhy, this dissetation thoretically discusses about the socio-spatial interference that the Rede Globo's soapoperas have in the construction of the collective imagination of the people who lines in the city of Caicó - RN. Here the social and spatial impacts produced by Rede Globo's main fiction program, the soapoperas, on the collective imagination of the inhabitants of Caicó are the main interest. The main argument here is that this TV program has an anormons influence on the evereday life of the people who live in Caicó and this influence ends up modifying their social, spatial and cultural pratices. This influence has been also working as the main force producing a real spatial impact. In this sense "new spaces of dialogue" are constructed through the influence of television. The main understandig is then that the soapoperas, at least within the context of Caicó, are a great force constructing social and spatial collective imagination of this city's inhabitants.

Monitorização da pressão intracraniana como exame complementar no diagnóstico de morte encefálica: observação preliminar através do registro de dois casos

Estudou-se retrospectivamente a evolução clínica de dois pacientes, até sua falência cardíaca irreversível (FCI), submetidos à monitorização contínua da pressão intracraniana (PIC). O estudo detalhado desses traçados mostrou que, nos dois casos a PIC atingiu valores máximos 5 e 12 h antes de ocorrer diminuição na amplitude das ondas, observada 47 e 60 h pré-FCI. Essa diminução foi progressiva e tornou-se linear cerca de 30 h antes da FCI, em ambos os casos. O diagnóstico clínico de morte encefálica (ME) foi obtido 3 e 28 hs após a linearidade do traçado. Os autores sugerem que o diagnóstico de ME pode ser definido mais precocemente com o uso da monitorização da PIC desde que o paciente não esteja sob sedação, e salientam a necessidade de mais observações, em número maior de pacientes.

A ficção científica e o ensino de ciências: o imaginário como formador do real e do racional

Este artigo apresenta uma reflexão sobre a inserção da ficção científica no ensino de Ciências, no qual buscamos identificar como a ficção científica incorpora elementos na estrutura conceitual dos educandos partindo do pressuposto de que teria um papel de desencadeadora e/ou organizadora da aprendizagem. O filme Jurassic Park foi estudado como constitutivo do conhecimento, transmutando o ficcional no real/racional, possibilitando a organização hierárquica dos conceitos, acrescendo novos elementos na estrutura conceitual dos educandos e atuando, também, na mediação do conhecimento - ora organizando, ora desencadeando.

Cisto coloide no terceiro ventrículo e morte súbita em jovem

Morte súbita de jovem, sexo masculino, 23 anos, assintomático, suscitou verificação de óbito. Antes queixou-se de cefaleia excruciante, em sala de aula, caindo sobre o computador. Encéfalo apresentou edema e congestão vascular. Sem herniações. Cortes coronais evidenciaram dilatação dos ventrículos laterais e nódulo aderido ao teto do terceiro ventrículo. À microscopia o diagnóstico foi cisto coloide do terceiro ventrículo. A ameaça de morte súbita em portadores de cisto coloide é sério problema diagnóstico na emergência médica. A relevância deste caso está em lembrar aos médicos que esta entidade deve permanecer como diagnóstico diferencial nas cefaleias em crianças, adolescentes e adultos jovens.

Os convivas da morte no banquete das almas: presença de eguns em um conto de João Antônio

A literatura escrita tem sido um espaço privilegiado para a representação e, consequentemente, para o registro e divulgação dos valores e costumes de variados grupos e segmentos sociais. No conto analisado neste ensaio – Eguns –, o escritor paulistano João Antônio (1937-1996) traz um narrador que descreve com detalhes uma rara festa religiosa ocorrida na Bahia, destinada ao culto dos ancestrais. Contemplativo e respeitoso, limita-se a contar o que a tradição religiosa permite. O contato com a alteridade ganha foros de rito iniciático e a experiência – em sentido forte – é transferida ao leitor.

Desenvolvimento, produtividade e sobrevivência de maracujazeiro-amarelo enxertado e cultivado em área com histórico de morte prematura de plantas

O objetivo deste trabalho foi avaliar o desenvolvimento vegetativo, a produtividade e a sobrevivência do maracujazeiro-amarelo (Passiflora edulis Sims) enxertado sobre três porta-enxertos, em área com histórico de morte prematura de plantas. O experimento foi conduzido no município de Adamantina-SP, no período de maio de 2006 a fevereiro de 2007, adotando-se o delineamento de blocos ao acaso, com três tratamentos e sete repetições. Os porta-enxertos avaliados foram Passiflora edulis, P. alata e P. gibertii, utilizando-se da enxertia convencional por garfagem tipo fenda cheia. Avaliaram-se o diâmetro do caule do porta-enxerto e do enxerto, o comprimento do entrenó e dos ramos secundários, o número de ramos terciários e o de frutos, a massa média, o diâmetro e o comprimento médio dos frutos, a produtividade e a sobrevivência de plantas. Os resultados demonstraram que o uso da enxertia no maracujazeiro é uma opção viável como meio de propagação vegetativa, assim como forma de controle de alguns patógenos habitantes do solo, um dos problemas que têm limitado a expansão da cultura. As plantas enxertadas sobre P. edulis apresentaram melhor desenvolvimento inicial, seguido de P. gibertii e de P. alata. A menor produtividade ocorrreu em plantas sobre P. alata. Mesmo com a presença de Fusarium solani e Rotylenchulus reniformis nos solos, 91% das plantas enxertadas sobre P. gibertii sobreviveram após 12 meses de plantio no campo, enquanto em P. alata e P. edulis, esses índices foram de 60% e 8,6%, respectivamente, mostrando assim a maior tolerância às doenças causadas por patógenos habitantes do solo por P. gibertii.

Influência do momento da cobrição, em relação à ovulação, na fertilidade e na ocorrência de morte embrionária precoce em eqüinos

Verificou-se a influência do momento da cobrição, em relação à ovulação, na fertilidade e na ocorrência de morte embrionária precoce (MEP) em 405 éguas da raça Puro Sangue Inglês, acompanhadas por 629 ciclos estrais. As éguas foram divididas em cinco grupos, de acordo com o momento da cobrição: grupo I, composto por 79 éguas cobertas entre 48 e 36 horas antes da ovulação; grupo II, com 102 éguas cobertas 36 a 24 horas antes da ovulação; grupo III, com 166 éguas cobertas 24 a 12 horas antes da ovulação; grupo IV, com 185 éguas cobertas até 12 horas antes da ovulação; e grupo V, formado por 97 éguas cobertas até 12 horas após a ovulação. As ovulações foram determinadas por palpação retal e ultra-sonografia, realizadas a cada 12 horas. O diagnóstico de gestação foi feito 14 dias após a cobrição com auxílio de ultra-sonografia. Novo exame foi realizado aos 60 dias para verificar ocorrência de MEP. Maiores índices de prenhez foram observados nos grupos III e IV (P<0,06). Verificou-se comportamento quadrático da taxa de prenhez em função do momento da cobrição aos 14 dias (R²= 91,0%; P<0,05) e aos 60 dias de prenhez (R²= 89,2%; P<0,05). Não foi observada diferença entre os grupos para MEP pelo qui-quadrado, mas a análise de regressão revelou comportamento quadrático da variável (R²= 92,4%; P<0,05). O melhor momento para cobrição foram as 24 horas que antecederam a ovulação.