This chapter introduces the reader to a world of clinical problem solving in blood disorders as presented in hematology lectures. These lectures encompass multiple perspectives, the patient, his/her relatives, healthcare students, consultant health professionals and society. This style of lecture aims to enable these key stakeholders in the health care system to utilize the continued learning derived from sharing their narratives toward attaining the goal of improved healthcare outcomes. The chapter has three narratives which are intertwined – the patient narratives of their experiences with disturbances in their blood stream, the blood system disease narratives of the medical professionals and the stream of consciousness expressed in poetry evoked by the first two narratives.
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“I am all impatience to be off...I dream of rocky cliffs that border this river, the endless bendings and turnings, the lakes and sloughs along its length, little riverside towns and villages, fishing boats, freighters, new faces, squatters, bottomland folks, birds, animals, trees, and wild fruit. But, most of all, I dream of great freedoms to come where the living is quiet, where the struggle to survive is less.”
River Journey by Clarence Jonk Published by Minnesota Historical Society Press, 2003
This chapter on blood disorders begins from a very simple biological perspective with a human context that may be relevant to a person trying to understand and cope with his/her blood disorder or a student of health sciences beginning his or her journey into the topic of hematology. The material presented in this chapter was originally developed by author RB to remove the tedium of his Medicine lecture classes. RB began introducing his students to the patients’ world, through their personal narratives, that otherwise remain unexplored in conventional approaches to disease in mainstream medical texts.
Although RB initially utilized his own experience of narrative encounters with patients he found that the Internet was a treasure house of rich narratives, written to share, thus waiting to be understood from a health professional learner’s perspective. Although RB found the length and detail of patients’ experiences sometimes quite difficult being unnecessarily lengthy and somewhat dense, he realized that once these narratives were adequately explored and relevant portions selected for quoting and discussion, they could serve as powerful learning material, particularly to hold student interest. (Biswas 2009)
This chapter reads as if RB was giving his lecture. That is, this is the lecturer’s narrative journey through the river of blood with learner/reader. The poetry around the river metaphor has been inserted to remind readers of the many layers of meaning we humans attach to rivers, both those inside of us and in the world around us. The narrative snippets have been taken from Web-based discussion forums, articles, and blogs to illustrate non-linear narrative with the usual linear lecture session.
Questions about Blood at an Elementary Level
The following questions are invariably asked by medical learners ranging from students to those with medical conditions.
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What does blood look like under a microscope?
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What are the cellular elements of blood?
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How does the river of blood run?
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How and why does the river of blood fail sometimes?