Rewrite the case study from the Mr. Jones's point of view. Repeat the exercise from other viewpoints: those of a family member, the physician, and you. A short story, such as "The Jilting of Granny Weatherall" by Katherine Ann Porter (1930) or "The Interior Castle" by Jean Stafford (1953), may be substituted for a case study.

Health History and Range of Symptoms

Mr. Jones is a 45-year-old, married man, employed as a supervisor with Parrish Construction Company. He is accompanied by his wife to the same-day surgery unit for preoperative assessment the day before his scheduled operation. His breath smells of alcohol.

Chief Concern: "I need to get this surgery over with. We have a big job to do at work, and it will be my butt if it is not completed on schedule. I plan to cut down on my drinking. I know I drink too much sometimes, but it's because of the pain from this thing." (Patient points to area of hernia.)

History of Present Illness: Mr. Jones was referred to Dr. Judge, a surgeon, by the nurse employed by the construction company. Mr. Jones had experienced periodic pain and swelling in his right groin area for at least 5 years and several times has seen the employee health physician, who told him he had a right inguinal hernia that should be repaired. He admits to experiencing decreased appetite and insomnia for the past ten days.

Social and Family History

Mr. Jones's father died of cirrhosis at the age of 52 years. His mother is 80 years old and has a history of diabetes. Mr. Jones is the youngest of six children. One brother died at birth, another died at age 6 of a tumor, and a third brother was a heavy drinker. Two sisters are alive and well.

Mr. Jones has been married to his second wife for 9 years; they have no children. His second wife has three boys, aged 12, 14, and 16 years, who live with her first husband and have no contact with Mr. and Mrs. Jones.

Mr. Jones has five children by his first marriage; all are alive and well, living with his first wife. He pays $50.00 a week for child support for each child. The children visit him every other weekend.

There is no family history of tuberculosis, hypertension, epilepsy, or emotional illness.

Review of Systems

General: No current change in weight and usually feels good, except when the hernia acts up.
Skin: No symptoms.
Eyes: He wears glasses for reading.
Ears: No symptoms.
Nose: No symptoms.
Mouth and Throat: Experiences recurrent episodes of hoarseness. Denies dysphagia.
Neck: No symptoms.
Respiratory System: Denies pain, dyspnea, palpitations, syncope, and edema.
Gastrointestinal System: Reports eating only three "good meals" during the past 10 days. Appetite is good when not drinking. Denies food intolerance, emesis, jaundice, flatulence, diarrhea, constipation, and melena.
Genitourinary System: No symptoms.
Neurologic: See "History" and "Interview with Significant Other."

Physical Examination

Mr. Jones is a 45-year-old white man with dark complexion and a ruddy face who appears chronically ill. He is mildly intoxicated and appears anxious. Weight is 136 lbs; height is 59110 ; temperature is 98.8ºF, pulse is 92, and regular respirations are 20 and unlabored; blood pressure is 160/90.

Skin: Well hydrated and without lesions.
Head: Normocephalic.
Eyes: PERRLA. Vision corrected with glasses. Visual acuity decreased to 3-mm print at 18 in. on the left and 4-mm print at 18 in. on the right. Extraocular movements full; no nystagmus is noted. Visual fields are intact as tested per confrontation. Conjunctivae are slightly injected. Sclerae clear. Lenses are without opacities bilaterally. Funduscopic examination reveals the discs normally cupped, and no vascular changes bilaterally.
Ears: External ears symmetrical, without lesions. Otic canal is clear. Tympanic membrane pearly gray bilaterally. Hearing is within normal limits per watch tick at 6 in. Mouth and Throat: Lips, tongue, and buccal mucosa are pink and moist. Teeth are brown, crooked. Gingivae are atrophic. No inflammation of posterior nasopharynx.
Nose: Nasal septum in the midline. Nares are patent bilaterally. Sinuses not tender.
Neck: Full mobility and no significant lymphadenopathy. Thyroid not enlarged, without nodules.
Chest: Bony thorax is without deformity or tenderness. Respiratory movement is full, and diaphragmatic excursion is adequate bilaterally. Lungs are clear to percussion and auscultation.
Cardiovascular: The PMI is in the fifth intercostal space of the LMCL. NSR without murmurs or gallops.
Abdomen: Abdomen is soft and flat. Bowel sounds are heard in four quadrants. Liver is descended 5 cm below the costal margin. No splenomegaly, tenderness, or mass. Surgical scar present in right lower quadrant.
Genitourinary: Normal male genitalia. No hernia palpated. Rectal: Internal and external hemorrhoids noted at 5 and 7o'clock. Normal sphincter tone. Anal canal free of tenderness. Prostate is in the midline, firm without nodules, not enlarged.
Extremities and Back: Muscular development symmetrical. Normal in appearance, color, and temperature. Peripheral pulses palpable and symmetrical. Free of varicosities or edema.
Neurologic: Speech is slurred, sensorium somewhat cloudy. Cranial nerves II through XII are intact as tested per gross screen. Moderately tremulous. Biceps, triceps, brachioradialis, patellar, and Achilles reflexes are symmetrical but brisk. Babinski's are down bilaterally.

Significant Laboratory Findings

Blood alcohol level: 0.29 U/L. Stool guiac: negative.
ECG: sinus tachycardia, otherwise WNL.
Chest x-ray: no active chest disease.
Coulter-S: Hgb 16.0 g/dL (H), HCT 48.2% (H), MCV 101 m³ (H); CL 92 mEq/L (L); uric acid 8.04 mg/dL (H), SGOT 90 U/L (H); Liver panel: GGT 66 IU/L (H); and urine: bacteria 21, WBC 8-12

Interview with Significant Other

1. Mr. Jones's Viewpoint:

Health History and Range of Symptoms

Mr. Jones is a 45-year-old, married man, employed as a supervisor with Parrish Construction Company. He is accompanied by his wife to the same-day surgery unit for preoperativeassessment the day before his scheduled operation.

Chief Concern:

History of Present Illness:

Social and Family History

Review of Systems

General:

Skin:

Eyes:

Ears:

Nose:

Mouth and Throat:

Neck:

Respiratory System:

Gastrointestinal System:

Genitourinary System:

Neurologic:

2. Mrs. Jones's Viewpoint:

Health History and Range of Symptoms

Mr. Jones is a 45-year-old, married man, employed as a supervisor with Parrish Construction Company. He is accompanied by his wife to the same-day surgery unit for preoperative assessment the day before his scheduled operation.

Chief Concern:

History of Present Illness:

Social and Family History

Interview with Significant Other

3. The Physician's Viewpoint:

Health History and Range of Symptoms

Mr. Jones is a 45-year-old, married man, employed as a supervisor with Parrish Construction Company. He is accompanied by his wife to the same-day surgery unit for preoperative assessment the day before his scheduled operation.

Chief Concern:

History of Present Illness

Social and Family History

Interview with Significant Other

4. Your Viewpoint:

Health History and Range of Symptoms

Mr. Jones is a 45-year-old, married man, employed as a supervisor with Parrish Construction Company. He is accompanied by his wife to the same-day surgery unit for preoperative assessment the day before his scheduled operation.

Social and Family History

Interview with Significant Other