Skin - Background to audio case story

This story is about Beatrice, a refugee from Chile who witnessed violence and was tortured before she came to the UK in the late 1970s. She has cancer of the bladder and was a hospice in-patient. In the last two weeks of her life, Beatrice became more sensitized and unsettled. She was given new drugs to relieve her increasing pain and symptoms.

Hypersensitivity, agitation and paranoia are not uncommon with advanced disease, when patients can have complex physical and psychological symptoms and can be on several drugs which carry the increased risk of adverse reactions.

Skin can be used to think about and discuss the intermixing of biographical experience and disease at the end of life.

You can download the text of Skin here that includes an activity.



This can be done alone and/or as part of a group discussion.

(i) Read the case story and identify Beatriz’s symptoms. The symptoms include:
• hypersensitivity to touch, smell and sound
• agitation and irritability
• a retreat from language, beginning with English, Beatriz’s second language
• a refusal of hands-on care
(ii) In thinking about the relationships between social and physical pain for Beatriz, there is a layering
and intermixing of possible causes to consider:
• the biochemical changes brought on by advancing disease and adverse reactions to her drugs
• her past biographical experience in Chile and then as a refugee in the UK
• individual characteristics and habits (has Beatriz always been a person who becomes easily irritated by
(iii) Think about the team’s decision not to wash Beatriz. Why might a decision to respect patient
‘choice’ be problematic in this case? What care alternatives might there be?

Fields - Background to case story

Harshini is a migrant from Kerala, South India. She is 34 and cares for her 76-yearold mother who has dementia. Dementia is a non-specific syndrome with varying effects upon memory and sensory motor
control, depending upon which part of the brain has been affected. The disease has taken away Harshini’s mother’s memories,her awareness of the religious prescriptions that she lived by and her self-consciousness.

The text and tutor guide to support Fields can be downloaded here. A dramatisation of Fields is the first story on the Two Sighs film.


Think about and/or discuss two main questions:
• What are some of the relationships between disease and cultural difference in Harshini’s story?
• In what ways might social pain be a part of the story?