Instructions to the actor
- You are going to play the role of Eva, a 42 year old woman, divorced and working at the local library. You have an avoidant personality structure and you look pale and exhausted when you enter the office, sitting down in the chair you are offered with a heavy sigh as it is good to be seated.
The most typical characteristics of avoidance are:
- A pervasive pattern of social inhibition
- Feelings of inadequacy
- Hypersensitivity to negative evaluations
- Avoiding working situations involving cooperation with others due to fear of critics
- Restraint within intimate situations due to fear of being shamed or ridiculed
- Views self as socially inept, personally unappealing, or inferior to others
Complaints – Illness
To the doctor's initial question, you tell that the reason for coming is irregular menstrual bleedings. When the doctor asks you to tell more about it, you start with telling about a duration of half a year with irregular intervals and stronger, more lasting bleedings than before. On this background you asked for a consultation, and got one in two weeks.
If the doctor asks you about your own opinion of the condition, you may disclose your feeling of exhaustion and thoughts about an approaching menopause. But you have been increasingly worried about something serious turning up. Up till the last year, you have had regular menstrual bleedings with 29 days between each starting point.
But the last half of a year, bleedings have appeared with form 10 to 34 days intervals, lasted for eight to nine days (earlier five to six days). Now you have to use double menstrual pads to avoid bleeding through, but yesterday it happened and last night you had to rise from bed in order to change pads due to fresh red blood with cloths appearing.
Your first menstrual bleeding occurred when you were 12 years old. You have had four pregnancies, given birth to three children. The fourth pregnancy terminated in a spontaneous abortion two years after your second child was born.15 years ago. All labours were uncomplicated. After the divorce one year ago, you have not established any new intimate relationship due to fear of one more failure. Therefore, you have stopped using prevention.
You smoke 10 cigarettes a day and use no medication except some occasional Aspirin due to headache with some relief.
You have up to now had a good health with no need for consulting a doctor after you moved to this new place, where you now live, one year ago.
If and when the doctor asks whether you need a sick-leave, you respond that it could be good for you, but you are not sure if you are ill enough and therefore have to give a self-report instead.
If the doctor asks more about your life situation, you may tell (not necessarily disclose all of it immediately) that you have moved from your earlier living place into a new flat as the only provider for your three children because of the divorce from your husband one year ago. Your economy is strict as you have to pay high interest on your loan, but you are in balance.
Your three children are: Nils 18 years (high school), Trine 15 years (junior high school) and Peter 5 years (day-care centre). Your ex-husband, working on an oil-drilling platform met another woman and moved together with her far away.
You have no contact with him, he calls once in a while the children. They have adapted pretty well to the new surroundings. You have not been able to establish a social network in your new living place, are afraid of taking initiative as others may think you are silly and uninteresting to join with.
You are educated as a librarian and got the job with only a 15 min. walk from home.
In the beginning you liked it, but he last months you have dreaded going to work feeling insufficient. Your new boss demands everyone to be creative and starting new projects thus, favouring your peers doing this, while the more withdrawn, like yourself, become scapegoats.
You try to avoid conflicts with your boss, but she is more and more critical towards you. If the doctor asks you explicitly about your real situation, you disclose your feeling of increasing bad temper, exhaustion, and problems with insomnia leading to tiredness in the morning. Your appetite is reduced, but you have not lost weight.
If depressions in the family, especially mother, are explored by the doctor, you answer "not as far as I know".
The last couple of months you have had some headache, had vertigo and had problems with reading as the letters have merged together.
You have less energy to mobilize and have thought a lot about your mother who died only 52 years old from "cancer in her belly" some 10 years ago.
With hesitation, you disclose fear of the same faith hitting you after you have got these menstrual problems. Uterine cervix smear two years ago was normal.
If you have the opportunity you may disclose your concern about reduced ability to care for your children. Your two teen-agers are in opposition to and criticize you. You feel it as a burden when they quarrel a lot and it is difficult for you to intervene in their expanding activities. It is a lot more drugs and alcohol abuse among young people here than where you came from and you feel uncomfortable with Trine's dating a 10 year older truck driver.
Results from the investigation (to be informed about on the student's request):
At the gynaecological investigation, abundant blood with some cloths occurs. The uterine body is enlarged as with eight weeks pregnancy. The consistency is flexible with a bulky surface. Both ovarian are normal. Blood pressure 135/80, hearth rate 72, regular, Hb.10.5. Additional clinical investigations are normal.