WEBVTT

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In the name of Allah, glory to him
who has subjected this to our use.

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For without him, we would
never be able to do it.

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[music]

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What\'s the story?

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Mr. Kochi is a 60-year-old
fellow with a history of locally

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advanced gastric cancer.

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Surgery was September of 2000,
had a partial gastrectomy.

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At that time, you met with
him and recommended chemo.

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He is eating more.

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His weight\'s down about seven pounds
since you saw him three months ago,

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although he says it\'s a weight
loss from the last two weeks.

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After this, he hasn\'t been interested
in chemotherapy or anything else?

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No.

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Let\'s just take this in with
me in case he wants to see.

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What worries me is that the CT
scan from March shows that there

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is a little bit more disease
than there was even in January.

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I\'m worried that the cancer
here is a little bit worse,

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even though he\'s feeling well.

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It bothers him that the part of
the stomach he has seen on the.

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X-ray has increased since January.

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Just as when we talked last fall,
I think that it is reasonable

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to try some chemotherapy.

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My recommendation would be to try
some chemotherapy to try to make these

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tumor nodules smaller in the abdomen.

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What is the percentage
of benefit and cost?

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It\'s always hard to get
to know percentages, but

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I can show him a picture.

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You see the place he circled?

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This is where the darkness is, and where
you had your problem on January four.

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But now, the same area
has gotten bigger.

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If this chemotherapy is not a complete
cure, and it causes other problems and

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makes me weak, how does it help me?

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It\'s a very good question.

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The truth is that no one can guarantee
the benefit, but I think that if we

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were successful in getting shrinkage
of the disease with a relatively mild

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chemotherapy, he may feel well longer.

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It\'s hard to put a number of months
on that or a number of years.

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Tell him that we believe that our
day has been chosen for us, and it

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cannot be pushed up or forced back.

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I think that our goal then in Medicine
is to help you feel as well as

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you can feel until that day comes.

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[reciting of prayers]

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His family agreed to undergo the
surgery, and I don\'t actually know

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what the patient himself knew at
the time of surgery, but nonetheless

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when through a gastrectomy.

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At the conclusion of the procedure,
which he fortunately tolerated

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well, was told that we got it all.

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A comment that we interns hear
from surgeons all the time.

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We got it all, but why don\'t you go
see my friend downstairs [chuckles]

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to talk about chemotherapy.

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The last issue is when
there\'s a language issue.

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I do not operate on somebody that
has not had an opportunity to

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talk to me through a translator.

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Yes, a hospital translator.

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Rather than the family.

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Not the family.

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We don\'t know what they\'re telling.

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[laughter]

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We get caught in that
bind fairly frequently.

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You know you\'re in trouble when
you give a long paragraph...

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[laughter]

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They say two words.

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It\'s like, \"Wait a minute.

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Are you telling them what I said?\"

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I don\'t know how much of it relied
on his religion or his background or

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his sense of logic or sense of health
or fear of chemotherapy or how much

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may have been a miscommunication
that maybe he would\'ve accepted

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chemotherapy had I been more convincing.

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Why don\'t you relax there.

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I\'m going to lift your leg.

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I want you to tell me
if this causes any pain.

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[foreign language]

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Very flexible.

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Much more flexible than I am.

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[laughter]

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Let me help you sit up.

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Well, I\'m sorry you\'re
having discomfort here.

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I don\'t know exactly what\'s causing
that discomfort though it always

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concerns me that it could be the tumor.

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We know that the cancer or
the tumor is in this vicinity.

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It\'s in this area of the body.

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He still has it.

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He still has it, and it may
very well be that the cancer

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is contributing to that pain.

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Even the pain in the back.

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You\'re basically telling me my dad
still has the cancer, because I know

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when I talked to Bandara on the phone

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I think he\'s always had the cancer.

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I don\'t think we\'ve... I\'ve always
felt that he\'s had this cancer.

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Why don\'t you have a seat down here.

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We\'ll talk a little bit more about this.

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I know that this is the
first time we\'ve met.

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You have not been able to participate
in some of the other conversations.

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When I first met your father, it
was more a question of whether he

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would agree to try some chemotherapy
to try to control the growth of

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the cancer in those lymph nodes.

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He chose not to have the chemotherapy.

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We talked about chemotherapy options.

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I have a question.

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When you were giving him
that options, were there a

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translator or just my sisters?

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I don\'t remember.

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I\'m sorry.

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I honestly don\'t remember.

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When I asked my dad why he refused
chemotherapy, he told me because

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there was one that-they were just
going to put a pipe through his arm.

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Yes.

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One of the drugs we give
as a continuous infusion.

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That is we put a long catheter
in the arm, and then we hook that

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catheter up to a small pump, and
then you carry around a pump.

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The pump slowly drips in the
chemotherapy 24 hours a day.

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Curiously, even though that sounds
horrible, it actually turns out that

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chemotherapy is easier that way.

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One sad confession that I have to make
to you for the first time, but I\'ve

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already spoken with him and other family
members, is that we don\'t have any

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treatments that will cure this disease.

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His disease is incurable.

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His is incurable.

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Incurable.

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Which means that I don\'t have a drug
that will make it go away forever.

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I know it doesn\'t,
but will it slow down?

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Well, that\'s what we hope.

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If he can live one minute longer
for us, it means a lot to me.

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I know he\'s a religious person.

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He accepts his fate.

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I believe that if there\'s a
disease, there has to be something

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to either kill it or slow it down.

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I don\'t want to lose my dad,
just because he decided not to.

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I think there was no
translator at that minute.

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Right now if [crosstalk]

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That was the first visit where
I met his daughter, who was a

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little bit outraged that we had
not offered him treatment before.

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Of course, we had offered him
treatment, but he had chosen

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not to receive treatment.

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I told him that if there\'s
an injection or tablet I can

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take, that would be fine.

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They said, \"No.

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We have chemotherapy.\"

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When I asked
Dr. Fisher, he says,

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\"Well, I did tell your dad, but
your dad never agreed to it.\"

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When I ask my dad, my dad
says he never told me.

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I don\'t know who to
believe or what to believe.

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I told them that very first day,
that I would take pills and shots.

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The only thing I would not agree
to was to carry around that pump.

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I only said no to the pump.

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I agreed to everything else, because
I know that the disease is very

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difficult to treat if you wait.

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Every time you\'ve come here,
they\'ve told you about chemotherapy.

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Yes, the pump.

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That was up to the
translator to tell you.

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No one told me anything else.

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They\'re telling me that, every time they
saw you, they recommended chemotherapy.

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Dad, I\'m not saying that
anyone is right or wrong.

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But maybe someone didn\'t tell you
or maybe they forgot to translate.

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. It\'s okay.

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No, I blame myself.

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I should have come with you from
the beginning, and you would have

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started this treatment six months ago.

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Well, when I look at what Fisher
told me it\'s like, \"Well, I always\"

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offered chemotherapy to your dad,\",
but... Yes, you will keep on offering

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the same thing over and over, and
my dad would keep on refusing that.

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Right now, I actually understand my dad.

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I think how my sister explained
it to them, every time Fisher

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would say chemotherapy, my
dad was like, \"The pump.\"

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[foreign language]

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[foreign language]

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Before praying, you have to be clean.

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You wash your hands, your
arms, your face, your feet.

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You cannot allow yourself
to bleed or you cannot have

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something injected to your body.

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That\'s why my dad couldn\'t do
it, because he couldn\'t pray.

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[foreign language]

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[music]

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Your days are always interrupted.

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You know, at a certain time, for
four and a half, five hours you\'re

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just not going to be doing anything.

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Hey.

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Hey.

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How you doing?

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I\'m going out.

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I\'ll be back around 4:30.

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Okay.

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Well, go ahead and take this with you.

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This form?

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Yes.

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When you come back, you still have
10 other things that you still need

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to complete, so you\'re always behind.

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You can say, I have
to carry my ambition.

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When you do public service and you want
to move up quickly, people ask you to do

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a lot of things that if you tell them,
no, they won\'t ask you to do anymore.

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I just had to reconcile the fact
that there\'s just certain things

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I won\'t get a chance to do.

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Hey, [?]?

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[?] Wow.

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What\'s going on?

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I\'ve been on dialysis
for two and a half years.

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Two and a half years.

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Imagine yourself sitting in that
chair for four hours and then

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parts of your body, you can\'t move,
and then you get uncomfortable

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towards the end of that four hours.

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Things start to happen to you
that you can\'t really explain,

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but you still can\'t get up.

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You still have to stay there.

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One of the realities of being
on dialysis is it kills you.

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It wears your body out.

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The longer you\'re on
it, the weaker you get.

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At some point, if something
goes wrong, you may not make it.

00:16:04.343 --> 00:16:11.685
[background noise]

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I wish the doctors are more
concerned about how we cope.

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The staff here is great, and
that\'s what balances it out for me.

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That the nurses and the techs
here have been very, very helpful.

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The doctors on the other hand, and
maybe that\'s just not their role in

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the medical system to be that person,
but you would assume it would be.

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Because at least in terms of
preparation and ability to cope,

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they have the most
specialized training.

00:16:48.520 --> 00:16:53.010
I have an uncle, he\'s very aggressive
to his doctor, because he feels like

00:16:53.420 --> 00:16:57.819
over the years, his doctor hasn\'t
given him the best care possible.

00:16:59.910 --> 00:17:04.339
You can see the response from the
doctor with him is like, \"Well, goddamn.\"

00:17:05.329 --> 00:17:06.329
What?

00:17:06.359 --> 00:17:08.839
I\'m trying to help this person
and he\'s coming at me like that.

00:17:09.240 --> 00:17:13.930
Why is he so hostile, and he\'s
not doing what I\'m telling him?

00:17:14.880 --> 00:17:17.290
\"He\'s beating me up and
he\'s not doing what I say.\"

00:17:18.200 --> 00:17:19.200
He got two strikes.

00:17:25.379 --> 00:17:29.850
In the African-American community,
Tuskegee is a big part of our experience.

00:17:30.850 --> 00:17:38.169
It\'s a number of things, but it is a
more recent and poignant experience that

00:17:38.900 --> 00:17:42.696
a large segment of the African-American
community is familiar with, and has

00:17:42.720 --> 00:17:45.556
colored-particularly for a generation
of African-Americans, has colored their

00:17:45.580 --> 00:17:46.980
behavior when it comes to medicine.

00:17:49.500 --> 00:17:52.749
That generation just implicitly
doesn\'t trust doctors

00:18:08.939 --> 00:18:16.939
[music]

00:18:19.691 --> 00:18:22.836
I\'ve been on the list two
and a half years, and I got

00:18:22.860 --> 00:18:25.257
to tell you, it\'s a beast.

00:18:25.910 --> 00:18:29.209
Even checking up on it or trying to
rush the process just doesn\'t work.

00:18:30.860 --> 00:18:31.575
They don\'t want you to call.

00:18:31.599 --> 00:18:33.199
They get annoyed when you call too much.

00:18:34.158 --> 00:18:38.366
They\'re like, \"Man, I told your
blood type is this, and this is

00:18:38.390 --> 00:18:41.676
where you are on the list, and when
you rise to the top, I\'ll call you.

00:18:41.700 --> 00:18:42.760
Don\'t call me no more.\"

00:18:44.010 --> 00:18:45.250
That\'s how they respond to you.

00:18:45.360 --> 00:18:46.736
They\'re like, \"Man, I
got a lot of patients.\"

00:18:46.760 --> 00:18:47.760
Why are you calling me?

00:18:48.820 --> 00:18:49.916
I\'m trying to manage this.

00:18:49.940 --> 00:18:51.180
You\'re making my job harder.

00:18:51.240 --> 00:18:51.997
Leave me alone.

00:18:52.021 --> 00:18:54.021
\"I\'ll get in touch with you
when you\'re all right.\"

00:18:56.189 --> 00:18:56.866
That\'s what I\'m saying.

00:18:56.890 --> 00:18:57.729
It\'s more like a bureaucracy.

00:18:57.790 --> 00:19:00.266
It\'s like, \"Damn, why
keep calling over here?

00:19:00.290 --> 00:19:03.040
I told you last week,
you got three years.

00:19:03.120 --> 00:19:04.440
Call me when you got two years.\"

00:19:07.960 --> 00:19:08.960
How often do you call?

00:19:09.540 --> 00:19:10.540
Every month.

00:19:13.320 --> 00:19:14.320
Every month.

00:19:16.380 --> 00:19:19.410
They suggested to me that I call
them every week just to bug them,

00:19:22.330 --> 00:19:23.940
but shoot, I want to know.

00:19:24.429 --> 00:19:26.169
You ain\'t the one that
need a kidney, I do.

00:19:26.309 --> 00:19:27.309
Help me out.

00:19:27.630 --> 00:19:28.630
Shit.

00:19:28.750 --> 00:19:29.760
Come on.

00:19:30.209 --> 00:19:31.546
I\'m not calling just to bug you.

00:19:31.570 --> 00:19:34.860
I\'m calling, because if I don\'t
have it, I\'ll have problems.

00:19:37.430 --> 00:19:38.546
Respond to me accordingly.

00:19:38.570 --> 00:19:41.256
Don\'t respond to me like I\'m
another file that you got to

00:19:41.280 --> 00:19:42.520
pull out every time I call you.

00:19:46.563 --> 00:19:54.563
[background noise]

00:19:58.805 --> 00:20:02.650
There is a big attitude like, \"He\'s
not going to take care of himself.

00:20:02.820 --> 00:20:05.906
Why give me kidney now, when I
can get someone else who\'s a more

00:20:05.930 --> 00:20:08.889
productive member of society a kidney.\"

00:20:10.270 --> 00:20:12.386
There\'s also this perception
that if an African-American

00:20:12.410 --> 00:20:15.725
man who has hypertension and
diabetes is just going to ruin it anyway,

00:20:16.995 --> 00:20:18.020
why give him a kidney.

00:20:19.670 --> 00:20:22.989
When all these other folks who
are more deserving should get it?

00:20:25.449 --> 00:20:26.449
Which is nonsense.

00:20:26.849 --> 00:20:27.849
Nonsense.

00:20:31.030 --> 00:20:39.030
[background noise]

00:20:51.999 --> 00:20:55.429
Most of the White patients here
either have had transplants

00:20:55.770 --> 00:20:56.930
or going to have transplants.

00:20:58.330 --> 00:21:00.579
Most of the African-American
men here, aren\'t.

00:21:01.659 --> 00:21:02.939
They\'re in it for the long haul.

00:21:05.500 --> 00:21:08.989
I know there\'s research to back that up, a
lot of quantitative research to back that up,

00:21:09.028 --> 00:21:11.550
but anecdotally, it just
seems there\'s a big disparity.

00:21:12.469 --> 00:21:13.469
A big, big disparity.

00:21:15.323 --> 00:21:18.626
A lot of folks voice it,
particularly in their disparity.

00:21:18.650 --> 00:21:19.139
You can hear it.

00:21:19.440 --> 00:21:21.366
When they talk to the nephrologist,
they don\'t like talking to

00:21:21.390 --> 00:21:23.630
nephrologist, because the
nephrologist only has bad news.

00:21:30.160 --> 00:21:31.160
Is that 114 me?

00:21:32.340 --> 00:21:33.340
No.

00:21:35.199 --> 00:21:39.656
There\'s this implicit belief that
genetically you can\'t really match up

00:21:39.680 --> 00:21:44.260
an African-American with a White or an
Asian or even someone who\'s Hispanic.

00:21:46.770 --> 00:21:54.000
Anecdotally, I know of a lot of
interracial donor relationships.

00:21:54.860 --> 00:21:58.793
If that can work, and it\'s not few and
far between, there a number of them,

00:22:00.181 --> 00:22:02.710
why is it the system
can\'t support that as well?

00:22:06.870 --> 00:22:07.870
[?] 112.

00:22:09.492 --> 00:22:10.625
Similar to 110s.

00:22:10.976 --> 00:22:14.891
[background noise]

00:22:17.223 --> 00:22:18.223
110s.

00:22:19.394 --> 00:22:20.394
110s.

00:22:21.408 --> 00:22:21.993
What is it?

00:22:22.133 --> 00:22:23.551
[background noise]

00:22:24.286 --> 00:22:25.686
95 over 42.

00:22:27.136 --> 00:22:28.274
All right. Hold on.

00:22:34.769 --> 00:22:40.086
Being able to stand at the
end, some days it\'s a chore.

00:22:40.110 --> 00:22:41.723
You got to will yourself to do it.

00:22:42.536 --> 00:22:46.562
[background noise]

00:22:46.757 --> 00:22:47.734
Are you ready?

00:22:47.758 --> 00:22:51.063
[background noise]

00:23:27.854 --> 00:23:35.854
[music]

00:24:47.003 --> 00:24:49.003
Again.

00:24:50.396 --> 00:24:54.501
[babbles]

00:25:07.693 --> 00:25:08.693
Do you say \"tutu\"?

00:25:09.518 --> 00:25:10.518
[gaggles]

00:25:10.897 --> 00:25:14.647
Justine has a hole in the
muscle wall of her heart.

00:25:17.068 --> 00:25:19.256
Her grandmother just flatly
refused to believe that.

00:25:19.280 --> 00:25:20.416
She just said, \"She looks great.

00:25:20.440 --> 00:25:21.277
There\'s no problem here.

00:25:21.301 --> 00:25:22.901
I don\'t know what you\'re talking about.\"

00:25:25.820 --> 00:25:28.999
We initially started talking
with them about the repair.

00:25:29.590 --> 00:25:32.176
We were talking about a surgical
intervention where we would go

00:25:32.200 --> 00:25:36.250
in through the chest and repair
the muscle wall, and that was

00:25:36.670 --> 00:25:38.706
really an obstacle for grandma.

00:25:38.730 --> 00:25:40.250
[background noise]

00:25:52.171 --> 00:25:53.171
Okay, you\'re all done.

00:25:53.791 --> 00:25:57.261
For example, when you die, if
there is a mark on your body,

00:25:58.809 --> 00:26:03.321
whether from a pen or charcoal or
a scar from surgery, it stays with

00:26:03.817 --> 00:26:09.138
you into the next and scars you.

00:26:13.142 --> 00:26:16.966
She said that this was a mutilating
type of procedure and that.

00:26:16.990 --> 00:26:18.729
Justine would have this forever.

00:26:18.909 --> 00:26:21.825
The implication was not just
in this life, but forever.

00:26:21.849 --> 00:26:28.266
That it was almost... I don\'t really
know exactly what their belief system

00:26:28.290 --> 00:26:33.356
is, but it\'s almost it\'s a mutilation
of whatever her soul or body was

00:26:33.380 --> 00:26:35.770
that would go on after this life.

00:26:38.750 --> 00:26:41.769
She had very clear and
strong objections to that.

00:26:42.800 --> 00:26:44.370
It was an, \"Absolutely not.\"

00:26:44.610 --> 00:26:49.510
I did say that not doing the surgery
would probably shorten her life.

00:26:50.210 --> 00:26:53.996
She said something to the effect that
better to live a shorter period of

00:26:54.020 --> 00:26:56.832
time than to be mutilated for all time.

00:26:57.353 --> 00:27:05.353
[music]

00:27:06.115 --> 00:27:12.161
[foreign language]

00:27:41.393 --> 00:27:46.546
The string-tying ceremony
is for the ancestors for the

00:27:47.647 --> 00:27:48.712
family, and for the doctors.

00:27:48.736 --> 00:27:51.375
The ceremony allows
the miracle to happen.

00:27:51.400 --> 00:27:53.745
This stuff mean be good,
don\'t be bad, grow up good.

00:27:59.568 --> 00:28:06.041
When grown up, stay with your
family and with your life.

00:28:14.017 --> 00:28:15.479
[chuckles]

00:28:17.079 --> 00:28:18.079
It\'s not funny.

00:28:18.219 --> 00:28:19.380
That\'s all I know.

00:28:19.670 --> 00:28:22.500
Okay, I know a lot.

00:28:23.288 --> 00:28:25.155
You know [?]

00:28:25.330 --> 00:28:29.010
The reason that we\'d like to take
care of this is mainly long-term

00:28:29.190 --> 00:28:35.210
consideration that over many years,
having chronic enlargement of the heart

00:28:35.470 --> 00:28:37.220
can lead to weakness of the heart.

00:28:38.000 --> 00:28:40.800
Sometimes people can have
what we call heart failure.

00:28:41.240 --> 00:28:44.250
At that point, you can\'t really fix it.

00:28:45.309 --> 00:28:49.926
What I recall is that you were
concerned primarily about the incision.

00:28:50.150 --> 00:28:51.826
Can you tell me a little bit about...

00:28:51.850 --> 00:28:53.256
Well, my mom, she\'s scared.

00:28:53.280 --> 00:28:57.320
If you cut, she\'ll see the scar on her.

00:28:57.780 --> 00:29:03.933
My mom, she want to wait until we
go to the Lao temple, and they say...

00:29:03.971 --> 00:29:04.610
Go to the temple?

00:29:04.650 --> 00:29:04.867
Yes.

00:29:04.891 --> 00:29:09.720
They have some medicine for her,
and she wants to wait for that.

00:29:09.780 --> 00:29:11.640
When are you doing that?

00:29:12.510 --> 00:29:13.197
I don\'t know.

00:29:13.221 --> 00:29:14.270
Maybe next week.

00:29:15.941 --> 00:29:17.851
What would be the
purpose of this medicine?

00:29:18.070 --> 00:29:19.155
What do they say the medicine was?

00:29:19.179 --> 00:29:21.346
They say when take
medicine, the hole close.

00:29:23.211 --> 00:29:23.968
They say that.

00:29:24.152 --> 00:29:25.152
I want to try it.

00:29:25.200 --> 00:29:25.552
Traditional healing?

00:29:25.577 --> 00:29:25.974
Okay.

00:29:25.999 --> 00:29:26.267
Yes.

00:29:26.393 --> 00:29:29.322
I want to try everything, work or not.

00:29:29.704 --> 00:29:30.704
Okay.

00:29:30.910 --> 00:29:34.389
Then after that, give
it some time to work?

00:29:36.639 --> 00:29:37.639
Okay.

00:29:37.749 --> 00:29:39.419
[laughs] Then we can have her check.

00:29:39.559 --> 00:29:40.279
We can check again.

00:29:40.549 --> 00:29:40.619
Yes.

00:29:40.699 --> 00:29:41.149
Okay.

00:29:41.570 --> 00:29:46.246
There are some holes that can close,
and certainly we have a lot of children

00:29:46.270 --> 00:29:48.170
whose holes have closed without surgery.

00:29:48.940 --> 00:29:54.106
From our standpoint, we don\'t see a
lot of them close at this age after

00:29:54.130 --> 00:29:58.540
a year or two of age, but I think if
that\'s something that makes everybody

00:29:58.779 --> 00:30:02.440
feel like they\'ve done everything
short of an affirmation to help her,

00:30:02.720 --> 00:30:04.130
then I think that\'s appropriate.

00:30:05.610 --> 00:30:10.898
It was my own decision.

00:30:13.632 --> 00:30:15.581
My family was against me.

00:31:05.247 --> 00:31:10.239
[background noise]

00:31:12.803 --> 00:31:20.803
[foreign language]

00:32:14.660 --> 00:32:18.439
The traditional way of
doing it after recently was

00:32:18.700 --> 00:32:20.000
doing an open heart surgery.

00:32:20.464 --> 00:32:22.470
[foreign language]

00:32:23.350 --> 00:32:28.156
Nowadays, there\'s another option
rather coming from the outside and to

00:32:28.180 --> 00:32:34.557
close it, is to go within the vessel
itself and just go inside the heart.

00:32:34.582 --> 00:32:38.701
[foreign language]

00:32:38.790 --> 00:32:41.430
You would achieve the same result,
but with much less invasiveness.

00:32:41.870 --> 00:32:45.450
There is a device that\'s been
approved in November last year.

00:32:45.910 --> 00:32:49.167
This is the first time
the FDA has approved it.

00:32:49.700 --> 00:32:52.886
Anytime you have an invasive
procedure, there\'s a life-threatening

00:32:52.910 --> 00:32:53.910
risk that comes with it.

00:32:54.269 --> 00:32:59.045
There\'s a risk of
infection, which is common.

00:32:59.069 --> 00:33:00.069
[foreign language]

00:33:00.325 --> 00:33:02.645
There\'s a risk of blood loss
requiring a blood transfusion.

00:33:02.780 --> 00:33:07.614
[foreign language]

00:33:07.639 --> 00:33:11.027
There\'s a risk of blood clots
forming as we put the catheters in.

00:33:11.543 --> 00:33:13.746
[foreign language]

00:33:13.770 --> 00:33:16.799
These blood clots can go and cause
problems in the heart or in the

00:33:16.824 --> 00:33:22.057
[?] [foreign language]

00:33:22.572 --> 00:33:24.156
These are the common
risks that come to mind.

00:33:24.180 --> 00:33:26.380
There are other risks
that we cannot anticipate.

00:33:26.809 --> 00:33:30.110
Again, we need to compare it to
the risk of doing nothing, and we

00:33:30.169 --> 00:33:32.799
know if we don\'t do anything that
she\'s going to get into trouble.

00:33:32.921 --> 00:33:33.921
[foreign language]

00:34:19.496 --> 00:34:27.496
[music]

00:35:49.464 --> 00:35:57.464
[music]

00:36:44.326 --> 00:36:46.895
This is what she would tell my mother.

00:36:46.920 --> 00:36:51.200
That she was going to do everything in
her power to make her leave this place.

00:36:52.231 --> 00:37:00.231
[music]

00:37:02.109 --> 00:37:06.150
It basically caused
her to get depressed.

00:37:08.559 --> 00:37:10.468
She did not care whether she
took her medications or not.

00:37:10.492 --> 00:37:17.709
She did not care what
her blood sugar was.

00:37:17.770 --> 00:37:19.310
She did not test herself.

00:37:20.030 --> 00:37:22.009
She just wanted to die, basically.

00:37:33.210 --> 00:37:36.439
They sent me to a psychologist, a
psychiatrist, because I felt like I was

00:37:38.487 --> 00:37:43.582
suffocating, drowning, crying all day.

00:37:45.328 --> 00:37:46.558
I didn\'t know what to do.

00:37:49.710 --> 00:37:50.710
Good morning.

00:37:50.861 --> 00:37:53.890
[?] how are you doing?

00:37:54.110 --> 00:37:56.340
How are you?

00:37:58.080 --> 00:37:59.080
Where have you been?

00:38:01.099 --> 00:38:03.610
You\'ve missed quite a
few of your appointments.

00:38:04.010 --> 00:38:10.827
I\'ve told her that she needs to keep
them, but sometimes she\'s like

00:38:11.462 --> 00:38:16.129
she doesn\'t feel well, and she just wants
to stay home and she won\'t go anywhere.

00:38:18.000 --> 00:38:22.290
Can you can you tell me why in essence,
you haven\'t made your appointments

00:38:22.340 --> 00:38:25.096
or could you tell me why it\'s been
difficult for you to come to the office?

00:38:25.120 --> 00:38:29.195
They told me to call for an
appointment, but other issues

00:38:30.363 --> 00:38:38.363
came up, so I had to take care of
those other things, not my health.

00:38:41.279 --> 00:38:46.546
I was told to call for an appointment
and since other problems came up,

00:38:46.725 --> 00:38:51.020
I decided not to take care of my
health, but to take care of my problems.

00:38:52.800 --> 00:38:55.370
Do you feel comfortable talking
about the problems or the

00:38:55.410 --> 00:38:58.129
distractions that have been going
on since we last saw each other?

00:39:00.784 --> 00:39:03.456
I\'ve had a lot of problems.

00:39:03.481 --> 00:39:11.401
My phone number has changed too, and
I had to move out of my apartment.

00:39:11.929 --> 00:39:14.420
How often have you been checking
your sugars or have you been?

00:39:15.424 --> 00:39:16.965
My sugar, in the mornings.

00:39:17.937 --> 00:39:18.879
In the mornings.

00:39:18.903 --> 00:39:21.565
Although I\'m not convinced, because
my sugar is always low in the

00:39:21.589 --> 00:39:24.425
morning and later in the day, I\'ll
eat something and my sugar rises.

00:39:25.041 --> 00:39:27.601
It affected me greatly when they
told me I had diabetes, because.

00:40:03.679 --> 00:40:07.046
My impression, basically, you\'re
a post-menopausal woman with a

00:40:07.070 --> 00:40:11.115
history of diabetes, which sounds
rather uncontrolled history of

00:40:11.139 --> 00:40:18.136
hypertension, which is controlled, and
a history of depression in the past.

00:40:18.160 --> 00:40:21.060
As well as asthma, which also
appears to be controlled since

00:40:21.440 --> 00:40:22.440
she\'s been on the Advair.

00:40:27.280 --> 00:40:31.970
Relatively noncompliant with care, more
is undergoing disjointed type of care.

00:40:35.672 --> 00:40:39.301
Sometimes my feet feel
numb, and my toes.

00:40:39.659 --> 00:40:40.678
In your toes.

00:40:42.554 --> 00:40:43.554
Is that new?

00:40:44.104 --> 00:40:44.354
Yes.

00:40:44.740 --> 00:40:48.895
I need to get a
peripheral neuropathy pen.

00:40:48.919 --> 00:40:50.187
A needle?

00:40:53.528 --> 00:40:55.662
No, just a little stick to see...

00:40:56.754 --> 00:40:58.931
To se of they are numb?

00:40:58.955 --> 00:41:00.715
It\'s better to use a
toothpick than a needle.

00:41:01.239 --> 00:41:03.730
She\'s afraid of anything that\'s sharp.

00:41:04.149 --> 00:41:05.977
[laughter]

00:41:08.360 --> 00:41:08.750
Feel it.

00:41:09.250 --> 00:41:10.250
It\'s soft.

00:41:10.390 --> 00:41:10.980
Does that hurt?

00:41:11.110 --> 00:41:13.654
I promise, I won\'t draw blood.

00:41:14.407 --> 00:41:14.804
[laughs]

00:41:15.063 --> 00:41:16.063
[foreign language]

00:41:16.349 --> 00:41:16.899
Okay.

00:41:17.250 --> 00:41:19.396
Just close your eyes for me and
just tell me whether you feel this.

00:41:19.420 --> 00:41:20.420
Close your eyes.

00:41:20.498 --> 00:41:22.295
[foreign language]

00:41:22.320 --> 00:41:23.376
Do you feel this?

00:41:25.529 --> 00:41:25.779
[foreign language]

00:41:26.439 --> 00:41:26.695
Si.

00:41:26.719 --> 00:41:26.726
Yes.

00:41:26.750 --> 00:41:27.750
Do you feel this?

00:41:28.165 --> 00:41:29.165
[foreign language]

00:41:31.360 --> 00:41:31.570
No.

00:41:31.750 --> 00:41:32.036
Good.

00:41:32.060 --> 00:41:33.060
I didn\'t touch you.

00:41:33.155 --> 00:41:41.155
[foreign language]

00:42:31.409 --> 00:42:33.009
I need both to control
my blood pressure.

00:42:37.046 --> 00:42:40.187
This is for the [?]

00:42:40.270 --> 00:42:44.200
My mother, she uses what
we call home remedies.

00:42:44.910 --> 00:42:48.369
I know people who try certain
remedies, and they work.

00:42:48.809 --> 00:42:53.259
For some people, it doesn\'t, but they
should be encouraged to try them.

00:42:54.650 --> 00:42:58.136
My general view on medicine is
that if we\'re going to really make

00:42:58.160 --> 00:43:02.096
progress, we need to take into
consideration and consider all

00:43:02.120 --> 00:43:06.090
other forms of treatments, other
therapies, all the forms of medicine.

00:43:07.219 --> 00:43:09.105
You have all these different
medicines out there.

00:43:09.129 --> 00:43:12.105
You have the Western medicine, but
you also have Ayurvedic medicines,

00:43:12.129 --> 00:43:18.359
you have Oriental medicine, and
there\'s a lot of things out there

00:43:18.730 --> 00:43:22.950
that maybe using combination can
really make a bigger difference.

00:43:24.849 --> 00:43:28.184
In the past, they gave me Glucophage.

00:43:28.418 --> 00:43:30.086
Okay, and you stopped that, because

00:43:30.185 --> 00:43:35.949
I stopped, because my hair fell out
in clumps and it upset my stomach.

00:43:37.446 --> 00:43:39.206
I worry about side
effects from the medicine.

00:43:39.249 --> 00:43:41.569
You can tell when your health
is affected by the medicines.

00:43:42.244 --> 00:43:47.187
I think that my mom became
sick from too much medicine.

00:43:49.108 --> 00:43:50.719
She died of cancer too.

00:43:51.002 --> 00:43:54.050
Below the duodenum, under
the stomach, she had a mass.

00:43:59.231 --> 00:44:04.226
A doctor in Peurto Rico told me that,
possibly, all of the medicine she had

00:44:04.251 --> 00:44:08.819
taken had accumulated, rather than
going where it was supposed to go.

00:44:25.897 --> 00:44:28.690
[?], to be honest with you, we have
a lot of things to talk about

00:44:28.715 --> 00:44:30.330
and one visit isn\'t enough.

00:44:30.420 --> 00:44:30.900
Okay.

00:44:31.180 --> 00:44:34.056
One thing is I\'d like to first talk
about what we\'re going to do about your

00:44:34.080 --> 00:44:36.489
diabetes, because it could be a lot.

00:44:37.469 --> 00:44:38.930
The control could be a lot better.

00:44:39.480 --> 00:44:41.150
I have here a book.

00:44:42.170 --> 00:44:45.016
What I would like you to do for the
next two weeks, because I would like

00:44:45.040 --> 00:44:51.080
to see you in at least two weeks, is
to check your sugar in the morning.

00:44:52.049 --> 00:44:55.899
Both actually, before each meal and
also after she\'s finished eating,

00:44:56.520 --> 00:44:57.896
she can take her sugar again.

00:44:57.920 --> 00:45:00.339
Just to see how high her
sugar goes after her food.

00:45:01.991 --> 00:45:05.250
For the Glipizide, I know you\'re
taking the 10 milligrams twice a day.

00:45:06.000 --> 00:45:10.026
I really would like to see what your
values are before I start increasing

00:45:10.050 --> 00:45:11.699
or decreasing the dosage for you.

00:45:12.170 --> 00:45:14.290
I also will see what your
sugars have been doing here.

00:45:15.229 --> 00:45:18.387
That\'s why it\'s important I see
you in the next one to two weeks.

00:45:20.225 --> 00:45:21.602
I\'ll do that, and.

00:45:41.262 --> 00:45:42.534
I\'m going back to my home.

00:45:47.475 --> 00:45:52.321
Now, I think I\'m getting better.

00:45:53.048 --> 00:45:56.607
My sugar is not like it was
before, and I only use the

00:45:57.459 --> 00:46:00.396
asthma inhaler once a day.

00:46:00.560 --> 00:46:03.174
Because I feel relaxed, having
recovered what I thought I\'d lost.

00:46:06.170 --> 00:46:08.646
A lot of times we don\'t ask why
they\'re non-compliant or why

00:46:08.670 --> 00:46:10.309
they\'re not coming to their visits.

00:46:10.789 --> 00:46:12.756
We just put in the note,
\"Noncompliant with care.

00:46:12.780 --> 00:46:15.266
\"Just not interested,\" and usually there
are other things that are going on,

00:46:15.290 --> 00:46:17.500
dynamics that we need to understand.

00:46:18.680 --> 00:46:22.016
Provided that there\'s nothing acute
going on a physician shouldn\'t feel

00:46:22.040 --> 00:46:24.816
that fault if honestly they-all
they\'ve done on that one visit is just

00:46:24.840 --> 00:46:28.335
talk and figure out why troubleshoot
why things aren\'t working out.

00:46:28.359 --> 00:46:31.186
As opposed to just making sure that
note is done and making sure that you

00:46:31.210 --> 00:46:34.056
know our Ts are crossed and our Is are
dotted with respect to the medications.

00:46:34.080 --> 00:46:34.980
Take your time.

00:46:35.010 --> 00:46:38.330
It\'s okay to just sit there and talk and
figure out why things aren\'t working.

00:46:48.943 --> 00:46:53.051
I have so many memories here, because
I came when my children were so little.

00:46:54.005 --> 00:46:56.326
We\'ve had suffering and happiness.

00:46:57.279 --> 00:46:59.854
We\'ve lived through many things
here, so I don\'t want to leave and

00:46:59.878 --> 00:47:01.849
they won\'t take me away from here.

00:47:02.060 --> 00:47:05.315
This is what is important.

00:47:05.907 --> 00:47:13.907
To be consistent, and
to care for a home.

00:47:16.081 --> 00:47:24.081
That is how I am, with my
children, and with with my home.

00:47:30.774 --> 00:47:38.774
[music]