The Most Traumatic Night of My Life :: essays papers

The Most Traumatic Night of My Life It happened about a month ago on a warm Tuesday night in august. Nothing seemed out of the ordinary, but I was soon to find out differently. I was about to experience the most traumatic event of my life. I was at my boyfriend Will’s band practice in downtown with him and his three friends. We decided to go check out some abandoned rooms in the old, run down three-story apartment building in the search of cool stuff for their practice spot. We walked into one room that turned out to be an old after hours club that was no longer in use. There were some useful things, someone grabbed a couple chairs, someone else took a couple speakers that looked like they would still work, and I carried a full-length mirror. As we proceeded into the hallway, I led followed by the rest of the crew and we headed back to their room. When we were about ten feet from where I was going to put the mirror down, for some reason the mirror just broke in half in my hand. I tried saving the other half from smashing on the ground and a jagged piece sliced deep into my wrist. Everyone saw the mirror smash but didn’t realize what had happened to me. I could barely speak. I was so shocked I just pointed down to my wrist. It all happened so quick probably in a matter of about 5 seconds. Every time my heart beat, blood would gush out of the wound. Everyone was talking to me but their words were sort of blurred together. My boyfriend took his shirt off and wrapped it tightly around my wrist. He said to hold my arm above my heart to slow the bleeding. Luckily we were only about five minutes away from Mercy Hospital. So we got in the car I was feeling really light headed and was afraid I would pass out. My mother used to work in the emergency room so I got in pretty quickly. I was still in horrible pain though. Then a nurse came in and put an antiseptic liquid on my wrist I asked her what it was for and she said â€Å"the doctors going to be in soon to stitch you up.

The Human Genome Project Essay -- Science Scientific Research Papers

The Human Genome Project Introduction The Human Genome Project (HGP) is a plan to develop a detailed genetic and physical map of the human genome. As a result of this project, it is predicted that vast increases in technology and biological approaches to the molecular world will occur. It was speculated that this project would take two decades. Some scientist did not even think it could be done because the technology was not ready for this kind of project. Multiple issues have arisen since the original concept for this genome project was introduced. Never before had mankind faced such issues in one project. These issues include such topics as biotechnology, ethical dilemmas, social and individual implications, health and medical care, and scientific research. When the project was started in 1990, technology could only sequence 300 base pairs at a time. This made mapping (location of genes) and sequencing (the number and pattern of "letters") of the entire 3 billion base pairs seems like an insurmountable task (Collins & Jegalian, 1999). Limited technology drew critics of the project with doubt that a complete map could be accomplished. Development of technology proved to be the least controversial issue. Ethical issues often became the center of concern. Also, the fear of attempting to clone a genetically superior race became a key issue. Many of the other issues stemmed from ethical concerns. Health and medical care implications could have a profound effect on society and individuals through prevention, diagnosis, and treatment of genetic diseases. Thanks to the HGP things like insight into basic biology, development of new technology, and medicine may be increased drastically. History The official start of t... ...Human Genome Project: where did it come from, where is it going? American Journal of Human Genetics, 51, 1-6. - Spengler, S. (1997). Emerging technologies from the Human Genome Project for understanding susceptibility and risk. Environmental Toxicology and Pharmacology, 4, 235-238 - van Ommen, G., Bakker, E., & den Dunnen, J. (1999). The human genome project and the future of diagnostics, treatment, and prevention. The Lancet, 354 (suppl 1), 5-10. - Young, D. & Leonard, D. (1999). Issues in genetic testing. Clinical Chemistry, 45(6), 915-926. Websites - http://www.cnn.com/SPECIALS/2000/genome/ - http://www.celera.com/ - http://www.nih.gov/ - http://www.nhgri.nih.gov/NEWS/about_HGP.html - http://www.nhgri.nih.gov/HGP/ - http://www.ornl.gov/TechResources/Human_Genome/home.html - http://www.sciencemag.org

Institutional Racism and Racial Discrimination in the U.S. Health Care System Essay

Institutional racism and racial discrimination in the U.S. health care system has been part of a long continuum dating back over 400 years. After hundreds of years of active discrimination, efforts were made to admit minorities into the â€Å"mainstream† health system but these efforts were flawed. Colin Gordon in his book Dead on Arrival portrays a very strong stance towards this issue when he states, â€Å"The American welfare state has always been, at root, a Jim Crow welfare state – disdainful of citizenship claims of racial minorities, deferential to a southern-controlled Congress, and leery of the racial implications of universal social programs† (172). It is evident that throughout the history of U.S. health care that race has shaped health provisions in a number of ways, most noticeably in private and public health care institutions. Gordon throughout his books discusses the ways in which institutional racism, specifically in the field of healthcare, has manifested itself throughout history. One of the most prominent manifestations of institutional racism in the healthcare field comes to light when examining past (and sometimes present) policies regarding admission (to healthcare facilities) and discrimination of minorities. It is evident when observing the adoption, administration, and implementation of these policies in the past that they were purposefully constructed to be exclusive of minority citizens (specifically African Americans and Latinos). Gordon gives an example of such policies in 1939 under the Social Security reforms. In the formative years of the New Deal southerners in Congress pushed for and won for the exclusion of agricultural and domestic labor from coverage under the National Recovery, Agricultural Adjustment, Social Security, National Labor Relations, and Fair Labor Standards act, this affectively excluded 90 percent of the southern black workforce (185). The implications of this act of agricultural exclusion are most clearly evident in the South and Southwest—regions whose economies were dominated by agriculture, who agriculture systems were peculiarly labor intensive, and whose agricultural labor markets were organized around low wages, tenancy, harsh legal controls, and violence. Gordon argues that segregation  persisted in medicine and hospitals longer than in any other public institution or facility partly due to the fact that Southern Congressmen pushed for local control of any federal expenditure; and later on this pushed Southern and Southwestern leaders into a partnership with doctors, employers, and insurers to keep racial minorities excluded from the health system. Southern interests led to a push for job-based private insurance, locally administered subsidies for hospital construction, and penurious charitable programs for those left behind, â€Å"southerners persistently worked to exclude African Americans from coverage, tap into federal funds without sacrificing local practices, and ensure that charity programs remained under local control† (174). Employment-based benefits, initially developed as a surrogate for national policy, was successful in leaving behind the majority of African Americans and Latinos due to the fact that they were grossly underrepresented in the unionized industrial economy, and in part because benefits such as these did not extend to casual or domestic or agricultural workers. Private health benefits came to be looked upon by many Americans as a â€Å"wage of white-ness† (176). Federal agencies, both out of practical and political necessity, consistently surrendered control over federal funds and standards over to state and local administration, â€Å"states set their own standards for care and eligibility and controlled the pace and scope of federal matching funds. Local political and medical authorities wielded considerable informal power and discretion† (187). In 1948 the Brookings Institution published a book-length assault on health reform. The conclusion of this publication was that higher black mortality rates are â€Å"predominately the result of economic, cultural and social differences† although, the research for this publication based cost estimates off of the ordinary expenditures of white families and confined comparative mortality rates to the white population, this led to them to conclude that the United States was among one of the most healthful nations in the world (188). Seconding this conclusion and also asserting that higher rates of non-white mortality were due to such things as poor sanitation, housing, education, and the lack of ordinary individual and community common sense was the AMA. The partnership between these two organizations is evident. At the root of the hospital issue in the South was not only professional and patient segregation but also the way in which it was countenanced by federal efforts  to address the region’s dearth of facilities. What is shown here is the long-standing political strategy to try and appease reformers by granting federal funds but to simultaneously placate opponents by relinquishing control to local or private interests; federal aid to hospitals both in 1940 and under the 1946 Hill-Burton Act â€Å"avoided any commitment to maintenance: once built, hospitals would reflect local control and local custom† (193). This however did nothing to prevent segregation seeing as in order to be considered nondiscriminatory a hospital was only required to grant equal access to the portion of the hospital that was built with federal funds. Perhaps the most compelling public health issue during the formative years of the American welfare state was the dismal status of rural services. In places in the South and Southwest and the nation’s inner cities basic services such as a hospital, public health clinic, and a doctor accepting Medicaid patients did not even exist. Gordon offers the example in Mississippi in 1948, there were only five general hospital beds for every 100,000 blacks in the state—at a time when four beds for every 1,000 citizens was considered adequate (175). It is evident that health care in the twentieth century has been shaped by a myriad of â€Å"direct and indirect discrimination, strong southern interests and local administration, the uneasy intersection of public and private (job-based) benefits, and the sharp political distinctions routinely drawn between contributory and charitable programs† (209). According to the U.S. Commission on Civil Rights, â€Å"Despite the existence of civil rights legislation equal treatment and equal access are not a reality for racial/ethnic minorities and women in the current climate of the health care industry. Many barriers limit both the quality of health care and utilization for these groups, including †¦ discrimination.† Importance of Health Care Access to comprehensive, quality health care services is important for the achievement of health equity and for increasing the quality of a healthy life for everyone. Access to health services entails the timely utilization of personal health services in an effort to achieve the best possible health outcomes. The utilization of and access to health care has many substantial impacts on a person’s life. A person’s overall physical, social and mental health statuses are all impacted by the ability to be examined and treated by a medical professional. Health care also plays a significant role in the prevention of disease and disability, the detection and treatment of health conditions and a person’s quality of life. A structured healthcare system assists in providing a foundation for a healthy lifestyle for both individuals and their families. Without access to healthcare, minor health issues have the potential to escalate either permanently affecting living standards or worse resulting in death. The health care sector also has an impact on the local economy. Health care facilities such as hospitals and nursing homes provide jobs and income to people in the community. As these employees spend their income in the community, a ripple spreads throughout the economy, creating additional jobs and income in other economic sectors. Also, providing healthcare may also be a business incentive to companies. Healthy employees can mean a healthier, happier, more productive workplace. A company’s decision to invest in and offer health care to their employees not only filters back into the economy but also may help them to recruit and retain quality employees, improve employee satisfaction, and reduce absenteeism due to sickness. Business that offer health insurance as part of their employee benefits package are probably better able to attract more qualified applicants than those who don’t. Also, offering health insurance coverage is a way of keeping operating costs low, because employees are generally more apt to take a position at a lower salary when health insurance benefits are provided. This is because it generally costs more for someone to obtain an individual or family health insurance policy than to get employer-sponsored coverage, making the difference of a lower salary negotiable. Businesses offering health insurance can deduct their portion of the contribution toward their employee plan as a business expense and get a tax advantage. If the business is incorporated, the business owner’s insurance and the coverage paid for employees are deductible. Access to health care services and insurance plays a vital role in individual and families lives along side society as a whole.

Methods in Identifying Business Process Essay

Abstract This paper will discuss which information gathering methods can be used in analyzing requirements, identify which business process mapping methods should be used in analysis activities, discuss which business process mapping tools should be used in documenting analysis, indicate how the analyst would know if these methods and tools were effective in understanding the requirements, and explain how prototyping tools could be used to confirm these requirements. Assessment of Enterprise Level Business Systems Information gathering used in analyzing the requirements of a business are essential to ensure that the customer is getting the best possible product for their needs. It is important for the consulting team to know different methods of information gathering to obtain the best possible information they can as this will help to ensure a higher success rate for the overall implementation of the product. In today’s world, it is very easy for a customer to comparison shop the different products available to them. Browsing online and clicking a mouse is all it takes to move from one company to the next. The process starts when a customer starts narrowing down what they are looking for and begins to choose a few systems to have personally demonstrated to the company. Best practices would state that the consultant in charge of providing the demonstration of the software would do some homework on the company to find out what they do, start speaking with some of the stake holders to see what they expect from a new system (HR may not have the same requirements as IT, who may not have the same requirements as management or production). Meeting with a number of stakeholders within the different departments of a business will help the consultant narrow down the needs of the organization. This gives the consultant an edge and can help the consultant provide a customized demonstration of the software for the company. Digging deeper, the consultant should also have a team of experts on his or her side as well, someone that may be a subject matter expert, and a technical expert  will help as well. This is to ensure that input is taken from users and from IT and can be used to ensure the best possible user interface for those using the system and what resources are already in place vs. what is needed on the technical side. Every avenue available to the consultant should be examined to ensure the best system fit for the business. The business process mapping methods that should be used in analysis activities should be determined by what the business is doing. There are four main steps of process mapping that are needed. They are: * Process identification or attaining a comprehensive and well-rounded understanding of all the steps of a process. * Information gathering, or identifying objectives, risks and key controls in a process. * Interviewing and mapping or gaining the perspective of individuals in the process and designing actual maps to be used in the process. * Analysis or utilizing the tools and approaches used to make the process run in the most efficient and effective way possible. (Jacka, J. Mike) First, the process or processes used by the business must be identified so the consultant may gain a full understanding of what is to be expected in the new system. Without process identification, the project would be at a standstill. Gathering information around the processes helps identify what the objectives of a process might be, what risks might be involved within a process and what is needed to control the process from beginning to end. For example, if a company that makes fiberglass bathtubs were to put a process in place for the gel coating or painting procedure of a tub project, the process might show that the mold is to be positioned in the paint booth, dust and debris is to be removed from the mold using a wipe down cloth and air hose, the paint has to be a certain thickness, so one of the risks involved would be paint that is too thick or thin in spots. Finally we have the controls that maintain the process from beginning to end which may be manual or robotic. Other things could also come into play such as paint levels, catalyst and dry time, so it is important to obtain all information surrounding the process as possible. Interviewing individuals who currently run a process is important to ensuring that nothing is left out of the process. If it is possible, the consultant should interview a few different  people that perform the same function to obtain an objective look at the overall process and cover different ways of doing the same thing. From these interviews the process map could be created. Finally, we would analyze the process map and ensure that each step of the process is accounted for and is conducted in the efficient and effective way. The consultant may ask additional questions at this point to see if something within the current process is wasteful, and what may be done to improve on the process. Documenting the process of the analysis should be done meticulously as well. This can be done in a report fashion or in a flow chart fashion. Both have their merits, however, a flow chart can make a very complicated process seem very simple by breaking it down into steps and utilizing different shapes for these steps. A flowchart is a primary type of business process mapping the shapes or symbols used such as arrows, circles, diamonds, boxes, ovals or rectangles will mean something different for each step. Though a flowchart simplifies a process, it can detail the inputs, activities, decision points, and outputs of any process. An analyst could know that this type of documentation and mapping has shown its worth by the understanding and acceptance of those he has interviewed to understand the process in the first place. If the analyst allows the users to review the flowcharts and they understand each step of the process, then the documentation has done what was intended. Additionally, the users may be able to point out additional ways to make a process better at that time if they had not done so before. Prototyping tools allow the analyst to create a mockup of what the documented process may look like and how it may actually work in simulated real time. The prototype can show users what a version of the finished product may look like and how it will function. This is yet another failsafe built into the overall assessment process and may give the analyst another area to make process improvements based on the input of users, management and project stakeholders. The assessment of an enterprise level business system is lengthy and can be complicated if the right people are not included in the process. However, if the analyst follows time proven techniques to identify what is needed, gather information, document and map out the processes and use the analysis of the mapped out processes to create a good prototype, the analyst should be better able to create what is needed for the business. References Jacka, J. Mike & Paulette J. Keller (2011), Business Process Mapping: Improving Customer Satisfaction, Second Edition(6-10)

Create and maintain a safe environment Essay

It is utmost importance for learners to feel physically and emotionally safe in order for learning to take place. Safe in terms of physical safety but emotional safety too in order for them to feel emotionally safe enough to engage in the classroom. It is important to understand that the learning establishing a safe learning environment provides the key to the success of the teaching/training process. This environment should be a place that puts learners at ease from anxiety, prejudice, and fear of criticism. The role of the teacher is to create an environment where everyone is accepted and learning can take place freely with mistakes happening as well. Although the trainer/teacher has the lead role it is accepted that there are no experts and good valid contributions can be made by participants. This creates a good learning environment where learning can take place. Laying down ground rules at the start of each session helps to establish expected behaviour from the participants and helps the m feel safe. Any adverse behaviour/ disruptive behaviour should be dealt with swiftly in a way that makes everyone feel safe and respected. The learning environment should be physically safe and health and safety procedures need to be adhered to. Trailing wires should be clipped appropriately and trailed appropriately avoiding trip hazards. If physical active exercise consists of the course then appropriate mats /flooring should be made available Assessment Criteria 1.2.2 – EXPLAIN why it is important to promote appropriate behaviour and respect for others. EXPLAIN 3 types of learner behaviour that may hinder learning and suggest ways of overcoming these. Learner Behaviour How I could overcome this A learner may have a strong opinion about a subject matter and this might start to affect others who may not agree with him/her I would thank the learner for taking time to bring this up. Validate their point by saying it was an issue that was very debatable and I would invite them on a 1 to one session to discuss the issue further in order for the rest of work we need to cover on the session to progress. A learner may become very chatty with others. This distracts other learners and they miss important parts of the session. A learner may use inappropriate language. Other learners may find this offensive. I would use an activity that would engage the leaner as it may be possible that they may start getting bored. In the process I may mix groups and shuffle people about so people get to share different ideas and try and see things from different points of view. It would be important to address this by saying â€Å"We agreed not to use inappropriate language in this session, let’s all be respectful of each other† If the behaviour persisted I would request to have a word with the offender in private and explain that his behaviour was disruptive and how it was affecting others. If this failed I may have to follow policy and procedure and ask them to leave the course to avoid further disruption. A learner has disrupted my lesson when we were doing a needs assessment where all the participants say what they would like to gain/learn on the day. He said he wasn’t here to learn anything and didn’t want to be on the course. He said he was only here because his manager had told him to. His tone was harsh and quite aggressive. I arrived on to the next person and called a  quick coffee break for 10 minutes. During the break I spoke to Tony who became very tearful and explained to me that he was agro phobic and did not like to be in large groups of people. He also explained that he suffered from depression and although it was currently under control with his medication he had relapsed. He also explained to me that he had been threatened with a disciplinary and had come on to the course under duress. I then explained that he was free to go home and I was going to have a meeting with his manager to try and rectify the situation. When I spoke to the manager we arranged to facilitate the same training for this individual in a smaller session where he felt more comfortable and at a time when he felt his mental state was better. I carried on with the rest of the learners and apologised for the disruption earlier in the session. Reference list Gravells, A (2013) The Award in Education and Training Exeter: Learning Matters

Summary and critique of Stanley Milgram

The experiment on â€Å"Behavioral Study of Obedience† was conducted by Stanley Milgram in July 1961. It was barely three months after Adolf Eichmann had been tried over the criminal activities committed during the Nazi war. The research was designed to address the questions about the peoples who were the masterminds of the infamous Nazi torturing ordeal that were responsible for the deaths of millions of the innocent people. It was intended to find out the people who would prefer to be submissive to the authority at the expense of human life. The experiment also sought to measure the willingness of individuals to obey an authority figure who instructs them to do certain things that are against their personal conscience. The question that the researchers were asking was, â€Å"Could it be that Eichmann and his million accomplices in the Holocaust were just following orders? Could we call them all accomplices?† The hypothesis was that there was likelihood that that during the Nazi war it might have been that Adolf Eichmann and his accomplices were just being submissive to the orders from higher authority (against their will) to murder the innocent people. The research question was very instrumental in helping to unveil how one can alter another person’s behavior, beliefs and mind-set. Before giving the results of the experiment the researcher predicted that only a negligible number of the participants would obey the orders and persist on to administer maximum shock. The range was 0 – 3%. That meant that out of 100 participants only 3 would administer the 450 volt shock. Method The people who participate in the experiment (subjects) were drawn from different social status background within New Haven area. They comprised people from a wide range occupation with characteristic characters include clerical officers, teachers, salespersons, engineers and drudges. The group was a representative of all educational levels; from elementary school to doctorate and other professional degrees and aged between 20 – 50 years in their right state of mind (Milgram, S., 1963). The dependable variable in this experiment was the maximum shock that the subject, S, was willing to administer to the victim L up to that point when he resist to follow the instructions given to him by the experimenter. The independent variables were the learner (an experimental confederate) and the experimenter’s orders. There were two participants in each case. They were; a naà ¯ve subject who played the role of a â€Å"teacher† and was provided with a 450 volt electric shock generator and the second one a confederate who played the role of a â€Å"learner.† The task of the â€Å"teacher† was to read to the â€Å"learner† a list of word pairs. The â€Å"learner† on the other hand was to respond correctly to these pairs of words by pressing the button as an indicator of his response. In case of a wrong answer the â€Å"teacher† was to administer an electric shock to the â€Å"learner†. For each subsequent wrong answer, the â€Å"teacher† would increase the voltage. Even though the subject believed that the learner was receiving the actual shock, the learner, being in a separate room, sets up a tape recorder which had been incorporated to the electric shock generator. This tape played sounds which had been pre-recorded to march each shock level. The presupposed victim (â€Å"learner†) would start to bang the wall separating him from the subject at given numbers of voltage increase. He would continue banging on the wall and complaining of heart condition until all the responses from him ceased. The data collected was based on how much electric shock the subjects were willing to inflict on the victim. This was to indicate their level of obedience and to see their willingness to obey the orders; if it they were doing it deliberately or did it against their will. Results Eventually it was discovered that out of the 40 participants 14 subjects showed explicit signs of nervous laughter and smiling which were inapt and weird. Three of the subjects developed irrepressible convulsions. According to the results obtained, it is evident that while responding to the demands prompted by the appraisals, 40 themes exceed the projected break-off point. None of them administered the electric shock below 300 volts, a point when the victim starts to kick the wall and provided no answers to the teacher’s questions. 5 of them stops at the 300 volt level; 4 of them proceeds to 315 volt level; 2 breaks of at 330 volt level; 3 others drop off at 345, 360 and 375 volts respectively. These 14 subjects were defiant to the experimenter’s instructions. They were recurrently in a frantic and enraged condition. However 26 of the 40 subjects were obedient enough to proceed on to punish the victim till they attain the shock of 450 volts. But they do this against their will. They could be observed to be in consternation once the experiment was brought to a halt. Discussion The results obtained imply that there are people who, despite receiving orders from authority, would choose to defy and stick to what they believe is morally acceptable. In this case the 14 subjects held this belief and would not inflict pain on another person against his/her will. It was however observed that some people would choose to act against their conscience and submit to authority even if what they are ordered to do is against moral principles. This what the 26 subjects did; despite expressing some signs of displeasure in shocking an innocent person, they still go on to obey the commands to the end. This implies that obedience to authority can cause harmless and non-hostile individuals to turn inhuman. The results seems to be in contrast to those predicted in the questionnaire where only 3 out of 100 respondents said they would proceed to administer electric shock to their victim up to the most maximum and risky shock of 450 volts. In this case however, the figure was surprisingly high; 26 out of 40. It had also been expected that a subjected would basically terminate or proceed as dictated by his conscience. However the subjects exhibited tension and emotional strain in their response to the commands. Critique The experiment was well conducted and its objective was attained. The volunteers were got through a New Have (Connecticut) daily newspaper advert and direct mail to some informing them take part in the study of reminiscence as well as the learning designate conducted in a laboratory at Yale University. The real purpose of the experiment was hidden from the subjects until the experiment was over; they knew that the experiment was a study of memory and learning yet it was about study of obedience to authority. Another thing was that the entire volunteers were to play the role of the teacher while that of the student was played by an experimental confederate. In addition, the generator that the teacher used was just but of 45 volts sample shock with the generator not wired to shock the learner. Lastly, the kicking of the wall by the learner, screams and his rejection to proceed and the commands/orders of the experimenter to the teacher were all skillfully fabricated. These indicate the researchers’ thoroughness in the design of the experiment to answer their specific research question. Most importantly, at the end of the experiment subjects underwent some procedures to assist them go back to normal well being. The researchers did not however deal with any feasible alternative explanation for their results. This might be attributes to the fact that they expected the subjects to show some level of obedience. Also, the subjects might have been expected to act accordingly and participate fully to make the research successfully bearing in mind that the real objective of the experiment was hidden from them. It should be stated here that there are some people who will not, at any cost, accept to administer any level of electric shock to another person. The research was also not well represented in terms of gender or the researchers did not specify the sex of the participants. This raises the question about the criteria that was used in selecting the subjects. But all in all the experiment was quite essential as it the positive and the negative nature of human beings. Reference: Milgram. S. (1969); Study on behavioral obedience, Journal of Abnormal and social psychology; 371-378. http://www.wadsworth.com/psychology_d/templates/student_resources/0155060678_rathus/ps/index.html

Challenges And Frustrations In A Country Doctor English Literature Essay

Challenges And Frustrations In A Country Doctor English Literature Essay Franz Kafka’s, â€Å"A country doctor† is a story that narrates the experiences and challenges a country doctor faces as he tries to carry out his duties as the doctor. He goes through various obstacles which he has no solution to, but has to face them just as they are. He clings to the idea of being a helper, wards of resignation, is ready to sacrifice his private life for his professional ethics and is forced in the cruelest way to recognize the vanity of his effort (Samon 2002). In this essay, am going to identify four challenges and frustrations that accompany each that confront the doctor. I will also explain why the story may be called a nightmare then lastly highlight the themes that revealed from the story. The weather is very unfavourable. It is this period that the doctor struggles to attend to an emergency ten miles away during a snowstorm. It is this bad weather and exhaustion that led to the death of his horse. The death of the horse greatly frustrates the doctor as he is unable to attend to the alarm because of lack of a horse. At the end as he goes back home, he is still greatly affected by the snow. The perspective of the patient about his sickness is also a big challenge to the doctor. The patient has given up on life. When the doctor arrives and looks at the patient, the young man says, â€Å"doctor, let me die!† This is a total loss of hope. The young man knows that the presence of the doctor will not bring any improvement to his health status. The young man later asks, â€Å"Will you save me?† At the end the young man tells the doctor that he had very little confidence in him. This is a major challenge to the doctor as the sick young man has already given up. The doctor is frustrated because he can do nothing to the state of the young man (John stone 2008). The emerging of the groom from the pigsty is one great challenge the doctor faces. The groom is a stranger but very willing to assist by lending his horse. In stead of accompanying the doctor, he refuses to go with him. In fact just the first time he handles Rosa is very suspicious. He scratches her cheek with his teeth. The groom’s actions after the doctor leaves are also mysterious (Cuizon 2008). The torment the doctor feels about Rosa is also a great challenge. Rosa was left with a stranger whom she was not willing to stay with. The doctor had to make a choice between saving Rosa and attending to the patient. He decides to attend to the patient but is frequently disturbed mentally about the state of Rosa and the stranger. The frustrations go further as he has left Rosa in a vulnerable state yet his mission is not successful (Cuizon 2008). The story might be called a nightmare because of the happenings that take place. The emerging of the groom and the horses from the pigsty is frightening. The doctor, who is the owner of the pigsty thinks it is abandoned, in fact Rosa’s comment is satirical; â€Å"one doesn’t know the things one has in one’s own house.† The groom is too willing to help. The description of the horses is not normal; in fact the doctor admits that he had never used such horses. The speed the horses run and the time taken for the ten miles is very short. The way the patient’s family handles the doctor is also frightening. They take off his clothes, and then force him to lie in the same bed with the patient. They then close the door and leave. In addition, the song sung by the school children and the teacher is frightening, â€Å"take his clothes off, then he will heal, and if he does not cure, kill him. It’s only a doctor, it’s only a doctor.†(Cuizon 2008).