Bibliografías temáticas / Saikaya

Literatura académica sobre el tema "Saikaya"

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Publicado: 26 de julio de 2024

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Artículos de revistas sobre el tema "Saikaya"

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Drake, Christopher, Ihara Saikaku y Paul Gordon Schalow. "Mirroring Saikaku". Monumenta Nipponica 46, n.º 4 (1991): 513. http://dx.doi.org/10.2307/2385190.

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Saikawa, Makoto, Takashi Nakamura, Junji Uchida, Masaki Yamamura y Tatsuya Nabeshima. "Correction: Synthesis of figure-of-eight helical bisBODIPY macrocycles and their chiroptical properties". Chemical Communications 54, n.º 73 (2018): 10379–80. http://dx.doi.org/10.1039/c8cc90385a.

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Suseno, Edy. "ANALYZING FOUR IDENTITY STATUS ON SAIKAKU’S SHORT STORY “TWO OLD CHERRY TREES STILL IN BLOOM” TO ENHANCE CRITICAL READINGIN". CaLLs (Journal of Culture, Arts, Literature, and Linguistics) 7, n.º 1 (30 de junio de 2021): 39. http://dx.doi.org/10.30872/calls.v7i1.4746.

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The short story could be the media to teach something to the readers. “Two old cherry trees still in bloom” for example, is written by Saikaku. Through his work, Saikaku would like to show the readers the implementation of 4 identity-statuses. He brought the readers into critical reading to help them find the identity. To analyze the 4 identity status content in his short story, the coding analysis was used. By analyzing, it could be seen that 4 identity-status categories comprise identity diffusion, identity foreclosure, identity moratorium, and identity achievement. Each status has two codes like uncertainty and unknown in identity diffusion, admiration and sympathy in identity foreclosure, struggle and chasing in identity moratorium, and settle and completion in identity achievement. Through the analysis, Saikaku shows the readers that to harmonize oneself as an individual and community member, someone needs to develop his curiosity through implementing identity moratorium to satisfy his lacking of background knowledge. Moreover, developing a sense of love is very essential to keep someone digging something out sufficiently through identity foreclosure to reach the ultimate goal of life.
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Qosimova, Gulnorakhon Bakhtiyorjon qizi. "Artistic language of ihara saikaku". International journal of linguistics, literature and culture 7, n.º 3 (5 de mayo de 2021): 180–87. http://dx.doi.org/10.21744/ijllc.v7n3.1623.

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The paper is devoted to the analysis of Ihara Saikaku’s artistic language as a novelist of the Japanese literature of Genroku period. Through the lingvo-poetic analysis the author illustrates characteristic features of Saikaku’s unique language.
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Johnson, Jeffrey. "Saikaku and the Narrative Turnabout". Journal of Japanese Studies 27, n.º 2 (2001): 323. http://dx.doi.org/10.2307/3591969.

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Mayemerova, Ainur. "The meaning and origin of the name Saikal in the Turkic languages". Turkic Studies Journal 5, n.º 1 (2019): 119–30. http://dx.doi.org/10.32523/2664-5157-2023-1-119-130.

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The proper name of a person among the Turkic peoples has a special meaning. There is a belief that the name directly affects the future of a person. Therefore, choosing a name for a newborn baby is a big responsibility for the family. Each onymic unit in the language is a reflection of the national consciousness. Onymic units play an important role in intercultural communication. The meaning of anthroponyms in one language may be different in another related language. This article defines the meaning of the name ‘Saikal’ in the Turkic languages, identifies and compares the anthroponymic and appellative meanings underlying this name. The peculiarities of the use, meaning and origin of the anthroponym «Saykal» in other Turkic languages are differentiated. On the basis of modern and historical linguistic data, the transformation of the word «Saikal» into an anthroponym and its use in positive and negative meanings is determined. The word ‘Saikal’ in the modern Kazakh language has a negative meaning. In the Kyrgyz language, the name Saikal is one of the most common names for girls, because Saikal is a heroine who was a fighting girlfriend of Manas Batyr, who was revered by the Kyrgyz people. In the literary heritage of the Kyrgyz people, the image of a woman named Saikal is a symbol of an intelligent, prudent, brave and courageous woman. Various historical and cultural factors may influence the use of the same word in Turkic languages with opposite meanings. Comparing the use of anthroponyms of one language in other related languages, it is possible to to restore new data on the system of common Turkic anthroponyms, their history and the function of individual words as anthroponyms. The data presented in the article will make it possible to understand the peculiarities of the appellative vocabulary underlying anthroponyms, and can also be used in the etymological dictionary of personal names of the Turkic peoples.
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OKITSU, Kaori. "The Saikyo-ji Collection:". Journal of Indian and Buddhist Studies (Indogaku Bukkyogaku Kenkyu) 60, n.º 2 (2012): 626–29. http://dx.doi.org/10.4259/ibk.60.2_626.

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Cordaro, Madalena N. Hashimoto. "A Retórica da persuasão em Saikaku". Estudos Japoneses, n.º 20 (10 de abril de 2000): 55–68. http://dx.doi.org/10.11606/issn.2447-7125.v0i20p55-68.

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Centralizando-se em tradução de trecho inicial de Nanshoku Õkagami (O Grande Espelho do Amor de Homens), analisam-se recursos poéticos da tradição do período Heian utilizados por Ihara Saikaku no Primeiro Período Edo (1600-1750) no sentido de uma construção de um discurso persuasivo do narrador, especialmente através de mitate e mono-awase.
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Das, Banani. "Body Image and Identity: A look into select short stories of Bhabendra Nath Saikia". International Journal of English Literature and Social Sciences 8, n.º 4 (2023): 178–85. http://dx.doi.org/10.22161/ijels.84.29.

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The human body has been theorized in many ways, including the entire notion of the woman as a human creation. It is generally agreed that this concept refers to our perceptions, thoughts, and feelings about our bodies, which influence our behaviour about our bodies. The article examines numerous authors whose individual genealogies meet on the common ground of identity theory and women's lives and is supported by a theoretical framework based on conceptions of identity, body-image and self-image in women and feminist discourse. This paper probes into the concepts of identity in women through the literary canvas of Dr. Bhabendra Nath Saikia and demonstrates the effects of body image and self-image on the development of identity. Of course, an extensive discussion of the short stories of Dr. Saikia is beyond the scope of this paper. The aim of this paper is to analyse the concepts through the two short stories short titled "Dhura Xaap" (ঢোৰা সাপ 1958) and "Sringkhol" (শৃংখল, 1970) by Dr, Bhabendra Nath Saikia. The paper seeks to explore the concepts of self-image, identity and body image through three female characters ‘Chandrika’, ‘Janeki’ and ‘Ambika’.
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Struve, Daniel. "Saikaku, romancier du monde flottant (note d'information)". Comptes-rendus des séances de l année - Académie des inscriptions et belles-lettres 148, n.º 4 (2004): 1479–83. http://dx.doi.org/10.3406/crai.2004.22801.

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Tesis sobre el tema "Saikaya"

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Struve, Daniel. "Ihara Saikaku, un romancier japonais du XVIIème siècle : essai d'étude poétique". Paris 7, 1995. http://www.theses.fr/1995PA070035.

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Johnson, Jeffrey. "Novelness in comical Edo fiction : a carnivalesque reading of Ihara Saikaku's Koshoku Ichidai Otoko /". Thesis, Connect to this title online; UW restricted, 1994. http://hdl.handle.net/1773/6656.

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Mukora, Wanjiku Beatrice. "Disrupting binary divisions : representation of identity in Saikati and Battle of the sacred tree". Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape7/PQDD_0016/MQ55002.pdf.

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Walter, Alain. "Autour de Saikaku et Chikamatsu : 1642-1724 : essai d'érotique comparée des littératures japonaise et occidentale". Bordeaux 3, 1989. http://www.theses.fr/1989BOR30053.

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Saikaku - romancier - (1642-1693) et chikamatsu - dramaturge - (1653-1724) sont deux des plus grands ecrivains de l'ancien japon. Issus de la classe montante des chonin (commercants, artisans), ils representent l'aspiration au bonheur, a la reussite economique, a l'egalite et s'opposent aux valeurs des militaires au pouvoir. Mais ils subissent aussi l'influence des cultures dominantes precedentes. Par ailleurs, l'amour chez saikaku est tourne vers la vie, alors que chez chikamatsu il choisit la mort. Dans la premiere partie, koshoku ichidai otoko de saikaku conduit a comparer les figures de seducteurs dans les litteratures japonaise (ariwara, heichu, le genji, yono- suke) et occidentale (don juan, casanova) par rapport a la beaute, au temps, au sacre, a l'etre. . . Dans la seconde partie, l'auteur examine en quoi les recits d'amour tragique de koshoku gonin onna et la description de la carriere d'une prostituee dans koshoku ichidai onna revendiquent la liberte pour les femmes. Le parallele avec bocacce et m. De navarre permet de preciser les rapports du christianisme et du bouddhisme avec l'amour. La prostitution decrite par saikaku invite a une comparaison avec moll flanders de defoe et nana de zola. Dans la troisieme partie, est etudiee l'attitude de chikamatsu a l'egard du double suicide d'amour, et divers paralleles sont esquisses avec werther, romeo et juliette, carmen, othello
Saikaku - a novelist - (1642-1693) and chikamatsu - a dramatist - (1653-1724) are two of the greatest writers in ancient japan. Belonging to the rising class of the chonin (merchants, handy-craftsmen), they embody their aspirations for happiness, economic success, equality and stand against the values of the ruling military. But they are also under the influence of previously dominant cultures. Besides, for saikaku, love is turned towards life whereas, for chikamatsu, it chooses death. In the first part, saikaku's koshoku ichidai otoko leads to compare the character of the seducer in the japanese (ariwara, heichu, the genji, yonosuke) and in the western (don juan, casanova) literatures regarding beauty, time, the sacred and the being. . . In the second part, the author will examine what, in the tales of tragic love from koshoku gonin onna and the description of a prostitute's career in koshoku ichidai onna, is a demand for the liberation of women. The parallel with boccaccio and m. De navarre will enable to clarify the attitude of christianity and buddhism towards love. Prostitution, as it is described by saikaku, induces a comparison with defoe's moll flanders and zola's nana. In the third part, chikamatsu's position concer- ning love double suicide is being studied and diverse parallels with werther, romeo and juliet, carmen, othello are sketched
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Sengupta, Saikata [Verfasser], Julian [Gutachter] Großkreutz, Otto W. [Gutachter] Witte y Andreas [Gutachter] Hermann. "Non-canonical neuron-specific interferon-gamma pathway in the hSOD1G93A mouse model of amyotrophic lateral sclerosis / Saikata Sengupta ; Gutachter: Julian Großkreutz, Otto W. Witte, Andreas Hermann". Jena : Friedrich-Schiller-Universität Jena, 2019. http://d-nb.info/1205885269/34.

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Ray, Saikat [Verfasser], Michael [Gutachter] Brecht, Imre [Gutachter] Vida y James [Gutachter] Poulet. "Functional architecture of the medial entorhinal cortex / Saikat Ray ; Gutachter: Michael Brecht, Imre Vida, James Poulet". Berlin : Lebenswissenschaftliche Fakultät, 2016. http://d-nb.info/1115767534/34.

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Ghosh, Saikat [Verfasser] y Hans-Günther [Akademischer Betreuer] Roßbach. "Unequal Opportunities in Early Childhood Education in India: A Demand Side Perspective / Saikat Ghosh ; Betreuer: Hans-Günther Roßbach". Bamberg : Otto-Friedrich-Universität Bamberg, 2018. http://d-nb.info/1160938822/34.

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Saikawa, Takashi [Verfasser] y Madeleine [Akademischer Betreuer] Herren-Oesch. "From Intellectual Co-operation to International Cultural Exchange: Japan and China in the International Committee on Intellectual Co-operation of the League of Nations, 1922-1939 / Takashi Saikawa ; Betreuer: Madeleine Herren-Oesch". Heidelberg : Universitätsbibliothek Heidelberg, 2016. http://d-nb.info/1180610695/34.

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Boro, Saikia Sudeshna [Verfasser], Sandra V. [Akademischer Betreuer] [Gutachter] Jeffers, Stefan [Gutachter] Dreizler y Jürgen [Gutachter] Schmitt. "Magnetic and activity cycles of cool stars / Sudeshna Boro Saikia ; Gutachter: Sandra V. Jeffers, Stefan Dreizler, Jürgen Schmitt ; Betreuer: Sandra V. Jeffers". Göttingen : Niedersächsische Staats- und Universitätsbibliothek Göttingen, 2017. http://d-nb.info/1142001598/34.

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Lastivková, Jana. "Ihara Saikaku a jeho povídky z vojenského a měšťanského prostředí". Master's thesis, 2008. http://www.nusl.cz/ntk/nusl-293968.

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Tématem diplomové práce jsou povídky Ihary Saikakua z měšťanského a vojenského prostředí. V úvodu je nastíněn vývoj japonské společnosti období Genroku a literárního díla Ihary Saikakua, básníka a prozaika. Jádrem práce je analýza a interpretace povídek z jazykového, stylistického a narativního hlediska.
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Libros sobre el tema "Saikaya"

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"Saikaku shokokubanashi" no kenkyū. Ōsaka-shi: Izumi Shoin, 2015.

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Saikata Āsagarera kabitā. Ḍhākā: Asṭrika Pābaliśārsa, 1990.

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Hinotani, Teruhiko. Saikaku. Tōkyō: Kokusho Kankōkai, 1989.

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Saïkali, Nadia. Saikali. Paris: Somogy, 2011.

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Nihon Bungaku Kenkyū Taisei Kankōkai. Saikaku. Tōkyō: Kokusho Kankōkai, 1989.

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Morita, Yoshio. Seikō no saikaku: Saikaku no chiebukuro. Tōkyō: Ōzorasha, 1996.

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Yomikaerareru Saikaku. Tōkyō: Perikansha, 2001.

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Saikaku tenbō. Tōkyō: Bensei Shuppan, 2000.

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Saikaku, Ihara. Saikaku shokokubanashi. Tōkyō: Miyai Shoten, 2009.

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Emoto, Hiroshi. Saikaku kenkyū. Tōkyō: Shintensha, 2005.

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Capítulos de libros sobre el tema "Saikaya"

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Königsberg, Matthew. "Ihara Saikaku". En Kindlers Literatur Lexikon (KLL), 1. Stuttgart: J.B. Metzler, 2020. http://dx.doi.org/10.1007/978-3-476-05728-0_2158-1.

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Königsberg, Matthew. "Ihara Saikaku: Nanshoku ōkagami". En Kindlers Literatur Lexikon (KLL), 1–2. Stuttgart: J.B. Metzler, 2020. http://dx.doi.org/10.1007/978-3-476-05728-0_2162-1.

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Hammitzsch, Horst. "Ihara Saikaku: Nippon eitaigura". En Kindlers Literatur Lexikon (KLL), 1. Stuttgart: J.B. Metzler, 2020. http://dx.doi.org/10.1007/978-3-476-05728-0_2163-1.

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Königsberg, Matthew. "Ihara Saikaku (1642–1693)". En Frauenliebe Männerliebe, 386–91. Stuttgart: J.B. Metzler, 1997. http://dx.doi.org/10.1007/978-3-476-03666-7_86.

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Hammitzsch, Horst. "Ihara Saikaku: Kōshoku ichidai otoko". En Kindlers Literatur Lexikon (KLL), 1–2. Stuttgart: J.B. Metzler, 2020. http://dx.doi.org/10.1007/978-3-476-05728-0_2159-1.

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Hammitzsch, Horst. "Ihara Saikaku: Kōshoku gonin onna". En Kindlers Literatur Lexikon (KLL), 1. Stuttgart: J.B. Metzler, 2020. http://dx.doi.org/10.1007/978-3-476-05728-0_2160-1.

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Hammitzsch, Horst. "Ihara Saikaku: Kōshoku ichidai onna". En Kindlers Literatur Lexikon (KLL), 1–2. Stuttgart: J.B. Metzler, 2020. http://dx.doi.org/10.1007/978-3-476-05728-0_2161-1.

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Hammitzsch, Horst. "Ihara Saikaku: Seken mune zanyō". En Kindlers Literatur Lexikon (KLL), 1–2. Stuttgart: J.B. Metzler, 2020. http://dx.doi.org/10.1007/978-3-476-05728-0_2164-1.

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Konno, Atsushi, Koichi Nishiwaki, Ryo Furukawa, Mitsunori Tada, Koichi Nagashima, Masayuki Inaba y Hirochika Inoue. "Dexterous manipulations of humanoid Robot Saika". En Experimental Robotics V, 79–90. Berlin, Heidelberg: Springer Berlin Heidelberg, 1998. http://dx.doi.org/10.1007/bfb0112952.

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Gundry, David. "The two paths of love in the fiction of Ihara Saikaku". En The Tokugawa World, 668–84. London: Routledge, 2021. http://dx.doi.org/10.4324/9781003198888-46.

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Actas de conferencias sobre el tema "Saikaya"

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Rancane, Sarmite, Ivo Vezis, Dzidra Kreismane, Aija Rebane y Aldis Jansons. "Assessment of perennial ryegrass (Lolium perenne L.) genotypes under Latvia agro-ecological conditions". En Research for Rural Development 2021 : annual 27th International scientific conference proceedings. Latvia University of Life Sciences and Technologies, 2021. http://dx.doi.org/10.22616/rrd.27.2021.001.

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Within the frame of the Nordic/Baltic public-private partnership ’PPP for pre-breeding in perennial ryegrass’ various activities were performed, including assessment of L. perenne (Lp) genotypes under agro-ecological conditions of Latvia. This article summarizes the data obtained in two harvest years for 19 intermediate tetraploid (4x) Lp genotypes. In order to compare the results obtained in ryegrass with performance of grass interspecies hybrids (Fl), which become especially relevant in the recent years, two varieties, developed in Latvia – Lolium × boucheanum Kunth. ‘Saikava’ and × Festulolium ‘Vizule’ were included in the experiment. Various scores were performed, including evaluation of regrowth, intensity of culm development, sward cover, crown rust (Puccinia coronata) susceptibility, etc. The dry matter yield (DMY) and fodder quality were also determined. It can be concluded that the genotypes showed relatively good results in the first two harvest years. Wintering conditions were favourable. Despite the intensified drought and heat in the 1st ley year, relatively high DMY, which ranged from 9.30 to 12.15 t ha-1, for Lp were harvested in three cuts. In the 2nd ley year, under more favourable humidity conditions, Lp in four cuts provided similar DMY, which ranged from 8.81 to 11.50 t ha-1. If we compare the average DMY of Lp and Fl genotypes, it can be concluded that in the first two harvest years no significant differences were found, the average DMY was 10.30 and 10.64 t ha-1, respectively. No significant differences were found between Lp and Fl in terms of forage quality.
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Al Mamun, Khandakar Abdulla, Md Akram Hossan, Md Yasin Arafat y Shafait Ahmed. "Feasibility assessment of wind energy prospect in Bangladesh and a proposal of 2MW wind power plant at ‘Parky Saikat, Chittagong’". En 2015 International Conference on Advances in Electrical Engineering (ICAEE). IEEE, 2015. http://dx.doi.org/10.1109/icaee.2015.7506800.

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Sakamoto, Ryo, Ryo Sakamoto, Satoquo Seino, Satoquo Seino, Hirokazu Suzaki y Hirokazu Suzaki. "COASTAL ALTERATION AND CHANGES IN SHORELINE MORPHOLOGY DUE TO ARTIFICIAL STRUCTURES IN MIIRAKU TOWN ON FUKUE IS. IN THE GOTO ARCHIPELAGO". En Managing risks to coastal regions and communities in a changing world. Academus Publishing, 2017. http://dx.doi.org/10.31519/conferencearticle_5b1b9405463da4.93038143.

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A construction of breakwaters and other shoreline structures on part of a coast influences drift sand transport in the bay, and causes comprehensive topographic changes on the beach. This study investigated shoreline and coastal changes, taking as an example of Shiraragahama Beach in Miiraku on the northwestern end of Fukue Island, Nagasaki Prefecture (Kyushu, Japan). Miiraku, adjacent to Saikai National Park, appears in the revered 8th century poetry collection “Manyoshu” and served as a port for a ship taken by the Japanese envoy to China during the Tang Dynasty (618-709). Because of the recent development of breakwaters for a fishing harbor, the shore environments of this beach have changed significantly. In this study, the status of silt deposits and topographic changes on this beach arising from the construction of a harbor breakwater were evaluated by comparing aerial photographs taken in different years. Next, the changes in the shoreline visible from aerial photographs from 1947 to 2014 were analyzed. Lastly, the altitude of the beaches was measured using accurate survey methods. The following results were obtained: 1) coastal erosion made rock cliffs to fall off along the shore and deposited sand on this beach; 2) the more serious advances or retreats of the shoreline took place around shoreline structures; 3) sandbars and beach cliffs were formed.
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Sakamoto, Ryo, Ryo Sakamoto, Satoquo Seino, Satoquo Seino, Hirokazu Suzaki y Hirokazu Suzaki. "COASTAL ALTERATION AND CHANGES IN SHORELINE MORPHOLOGY DUE TO ARTIFICIAL STRUCTURES IN MIIRAKU TOWN ON FUKUE IS. IN THE GOTO ARCHIPELAGO". En Managing risks to coastal regions and communities in a changing world. Academus Publishing, 2017. http://dx.doi.org/10.21610/conferencearticle_58b4315256b56.

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A construction of breakwaters and other shoreline structures on part of a coast influences drift sand transport in the bay, and causes comprehensive topographic changes on the beach. This study investigated shoreline and coastal changes, taking as an example of Shiraragahama Beach in Miiraku on the northwestern end of Fukue Island, Nagasaki Prefecture (Kyushu, Japan). Miiraku, adjacent to Saikai National Park, appears in the revered 8th century poetry collection “Manyoshu” and served as a port for a ship taken by the Japanese envoy to China during the Tang Dynasty (618-709). Because of the recent development of breakwaters for a fishing harbor, the shore environments of this beach have changed significantly. In this study, the status of silt deposits and topographic changes on this beach arising from the construction of a harbor breakwater were evaluated by comparing aerial photographs taken in different years. Next, the changes in the shoreline visible from aerial photographs from 1947 to 2014 were analyzed. Lastly, the altitude of the beaches was measured using accurate survey methods. The following results were obtained: 1) coastal erosion made rock cliffs to fall off along the shore and deposited sand on this beach; 2) the more serious advances or retreats of the shoreline took place around shoreline structures; 3) sandbars and beach cliffs were formed.
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Lokajícek, T., A. Aminzadeh, T. Svitek, M. Petružálek y R. Prikryl. "Amphibolites Study from Various Borehole Depth". En 57th U.S. Rock Mechanics/Geomechanics Symposium. ARMA, 2023. http://dx.doi.org/10.56952/arma-2023-0379.

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ABSTRACT In this study the elastic properties of crystalline rocks – amphibolites from different boreholes were studied. We studied the depth effect on the elastic properties of mineralogically quite homogenous rocks – amphibolites. The samples were taken from three different crustal levels – shallow (tens of meters) Stařechov (Czech Republic), medium deep (first thousands of meters) KTB (Germany), and deep crustal depths (up to 12 km) KSDB3 (Russia). The elastic properties were first determined experimentally using high-pressure apparatus and 3D ultrasonic testing. The effect of main rock fabric components were evaluated using the method of inverse calculation from experimental data. There was found an increase of P-wave velocity, P-wave stiffness elastic constants with the depth for 19 samples, collected from different depth, and all loaded to 400 MPa of hydrostatic pressure. This fact can be explained by the stress memory effect. Stiffness constants and Young modulus were determined for primary material orientation INTRODUCTION Elastic anisotropy is a crucial physical property of crustal rocks namely when reflecting deformational history of the rock. Knowledge of the anisotropy of deep crustal rocks (e.g., Kern et al. 1991) is of special interest for studies focused on the evolution of the crust. The relationship between amphibolite elastic properties and mineral composition and/or rock fabric has been extensively studied in the past (Siegesmund et al. 1989). The influence of microcracks on the elastic wave velocity and its anisotropy has been noted in many previous studies (Crampin 1977, Babuška and Pros 1984 among others). Numerous studies are focused on the systematic study of elastic properties of rocks extracted from boreholes e.g., KTB (Berckhemer et al. 1997) or KSDB3 (Nikitin et al., 2001, Saikia et al. 2021). In all of these studies, there is missing comparative research concentrated on the relationship between the actual depth of rock occurrence and its elastic properties.
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Informes sobre el tema "Saikaya"

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MacFarlane, Andrew. 2021 medical student essay prize winner - A case of grief. Society for Academic Primary Care, julio de 2021. http://dx.doi.org/10.37361/medstudessay.2021.1.1.

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As a student undertaking a Longitudinal Integrated Clerkship (LIC)1 based in a GP practice in a rural community in the North of Scotland, I have been lucky to be given responsibility and my own clinic lists. Every day I conduct consultations that change my practice: the challenge of clinically applying the theory I have studied, controlling a consultation and efficiently exploring a patient's problems, empathising with and empowering them to play a part in their own care2 – and most difficult I feel – dealing with the vast amount of uncertainty that medicine, and particularly primary care, presents to both clinician and patient. I initially consulted with a lady in her 60s who attended with her husband, complaining of severe lower back pain who was very difficult to assess due to her pain level. Her husband was understandably concerned about the degree of pain she was in. After assessment and discussion with one of the GPs, we agreed some pain relief and a physio assessment in the next few days would be a practical plan. The patient had one red flag, some leg weakness and numbness, which was her ‘normal’ on account of her multiple sclerosis. At the physio assessment a few days later, the physio felt things were worse and some urgent bloods were ordered, unfortunately finding raised cancer and inflammatory markers. A CT scan of the lung found widespread cancer, a later CT of the head after some developing some acute confusion found brain metastases, and a week and a half after presenting to me, the patient sadly died in hospital. While that was all impactful enough on me, it was the follow-up appointment with the husband who attended on the last triage slot of the evening two weeks later that I found completely altered my understanding of grief and the mourning of a loved one. The husband had asked to speak to a Andrew MacFarlane Year 3 ScotGEM Medical Student 2 doctor just to talk about what had happened to his wife. The GP decided that it would be better if he came into the practice - strictly he probably should have been consulted with over the phone due to coronavirus restrictions - but he was asked what he would prefer and he opted to come in. I sat in on the consultation, I had been helping with any examinations the triage doctor needed and I recognised that this was the husband of the lady I had seen a few weeks earlier. He came in and sat down, head lowered, hands fiddling with the zip on his jacket, trying to find what to say. The GP sat, turned so that they were opposite each other with no desk between them - I was seated off to the side, an onlooker, but acknowledged by the patient with a kind nod when he entered the room. The GP asked gently, “How are you doing?” and roughly 30 seconds passed (a long time in a conversation) before the patient spoke. “I just really miss her…” he whispered with great effort, “I don’t understand how this all happened.” Over the next 45 minutes, he spoke about his wife, how much pain she had been in, the rapid deterioration he witnessed, the cancer being found, and cruelly how she had passed away after he had gone home to get some rest after being by her bedside all day in the hospital. He talked about how they had met, how much he missed her, how empty the house felt without her, and asking himself and us how he was meant to move forward with his life. He had a lot of questions for us, and for himself. Had we missed anything – had he missed anything? The GP really just listened for almost the whole consultation, speaking to him gently, reassuring him that this wasn’t his or anyone’s fault. She stated that this was an awful time for him and that what he was feeling was entirely normal and something we will all universally go through. She emphasised that while it wasn’t helpful at the moment, that things would get better over time.3 He was really glad I was there – having shared a consultation with his wife and I – he thanked me emphatically even though I felt like I hadn’t really helped at all. After some tears, frequent moments of silence and a lot of questions, he left having gotten a lot off his chest. “You just have to listen to people, be there for them as they go through things, and answer their questions as best you can” urged my GP as we discussed the case when the patient left. Almost all family caregivers contact their GP with regards to grief and this consultation really made me realise how important an aspect of my practice it will be in the future.4 It has also made me reflect on the emphasis on undergraduate teaching around ‘breaking bad news’ to patients, but nothing taught about when patients are in the process of grieving further down the line.5 The skill Andrew MacFarlane Year 3 ScotGEM Medical Student 3 required to manage a grieving patient is not one limited to general practice. Patients may grieve the loss of function from acute trauma through to chronic illness in all specialties of medicine - in addition to ‘traditional’ grief from loss of family or friends.6 There wasn’t anything ‘medical’ in the consultation, but I came away from it with a real sense of purpose as to why this career is such a privilege. We look after patients so they can spend as much quality time as they are given with their loved ones, and their loved ones are the ones we care for after they are gone. We as doctors are the constant, and we have to meet patients with compassion at their most difficult times – because it is as much a part of the job as the knowledge and the science – and it is the part of us that patients will remember long after they leave our clinic room. Word Count: 993 words References 1. ScotGEM MBChB - Subjects - University of St Andrews [Internet]. [cited 2021 Mar 27]. Available from: https://www.st-andrews.ac.uk/subjects/medicine/scotgem-mbchb/ 2. Shared decision making in realistic medicine: what works - gov.scot [Internet]. [cited 2021 Mar 27]. Available from: https://www.gov.scot/publications/works-support-promote-shared-decisionmaking-synthesis-recent-evidence/pages/1/ 3. Ghesquiere AR, Patel SR, Kaplan DB, Bruce ML. Primary care providers’ bereavement care practices: Recommendations for research directions. Int J Geriatr Psychiatry. 2014 Dec;29(12):1221–9. 4. Nielsen MK, Christensen K, Neergaard MA, Bidstrup PE, Guldin M-B. Grief symptoms and primary care use: a prospective study of family caregivers. BJGP Open [Internet]. 2020 Aug 1 [cited 2021 Mar 27];4(3). Available from: https://bjgpopen.org/content/4/3/bjgpopen20X101063 5. O’Connor M, Breen LJ. General Practitioners’ experiences of bereavement care and their educational support needs: a qualitative study. BMC Medical Education. 2014 Mar 27;14(1):59. 6. Sikstrom L, Saikaly R, Ferguson G, Mosher PJ, Bonato S, Soklaridis S. Being there: A scoping review of grief support training in medical education. PLOS ONE. 2019 Nov 27;14(11):e0224325.
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