L’impact du suicide sur l’aidant

Le suicide (« meurtre de soi-même ») pose à tous une question essentielle: qu'est-ce que l'expression manifeste du désir de mort mobilise en soi et chez les autres? Cette interrogation s'avère particulièrement difficile à soulever pour l'aidant ou le soignant confronté à la mort volontaire d'un client ou d'un patient. À travers l'histoire d'un suicide en institution, les auteurs évoquent la nature des mécanismes défensifs mis enjeu par l'équipe soignante. Sidération traumatique, dénégation, déni, culpabilité, mouvements dépressifs sont autant de réactions individuelles et collectives qui s'opposent au travail du deuil, et menacent la cohésion institutionnelle. Les membres de l'« institution en crise » ont à réguler leurs tensions, en évitant de répondre par le retrait, la banalisation, la hantise du suicide, ou l'instauration de pseudo-solutions « pragmatiques ». Il s'agit d'éviter en particulier l'annulation ou le déplacement d'une nécessaire reflexion de tous sur la genèse, les implications et les conséquences du suicide intra-institutionnel. Les auteurs rappellent les principaux fondements et les modalités d'une exploration en équipe de ces phénomènes qui - en l'absence de « travail de la crise » - risquent de situer l'institution dans l'impasse d'un questionnement consistant seulement à savoir à quel moment, faute de s'être retournée, elle se serait détournée de son patient en souffrance.Suicide ("the killing of one's self) raises one crucial question: what does the manifest desire of death bring out in oneself and in others? For those providing care and support who are confronted with the voluntary death of a client or patient, the question is particularly difficult to address. Using the story of a suicide in an institution, the authors reveal the nature of defense mechanisms at play within the group of caregivers. Whether it be a traumatic daze, denial, guilt or depression, these individual and collective reactions to the event hinder the mourning process and threaten cohesion within the institution. Members of an "institution in crisis" must try to relieve their tensions by refraining from withdrawal, banalities, being haunted by suicide and implementing pseudo-solutions. The purpose of such an exercise is especially to avoid the cancellation or displacement of necessary thougt process about the origins, implications and consequences of a suicide taking place within an institution. The authors discuss the founding principles and guidelines for group exploration of these phenomena. Without this coming-to-terms with the crisis, the authors point out that the institution could find itself in a rut where discussion focuses only on when and where things went wrong, and how it turned its back on a suffering patient

Analyzing Longitudinal wb-MRI Data and Clinical Course in a Cohort of Former Smoldering Multiple Myeloma Patients: Connections between MRI Findings and Clinical Progression Patterns

The purpose of this study was to analyze size and growth dynamics of focal lesions (FL) as well as to quantify diffuse infiltration (DI) in untreated smoldering multiple myeloma (SMM) patients and correlate those MRI features with timepoint and cause of progression. We investigated 199 whole-body magnetic resonance imaging (wb-MRI) scans originating from longitudinal imaging of 60 SMM patients and 39 computed tomography (CT) scans for corresponding osteolytic lesions (OL) in 17 patients. All FLs >5 mm were manually segmented to quantify volume and growth dynamics, and DI was scored, rating four compartments separately in T1- and fat-saturated T2-weighted images. The majority of patients with at least two FLs showed substantial spatial heterogeneity in growth dynamics. The volume of the largest FL (p = 0.001, c-index 0.72), the speed of growth of the fastest growing FL (p = 0.003, c-index 0.75), the DI score (DIS, p = 0.014, c-index 0.67), and its dynamic over time (DIS dynamic, p < 0.001, c-index 0.67) all significantly correlated with the time to progression. Size and growth dynamics of FLs correlated significantly with presence/appearance of OL in CT within 2 years after the respective MRI assessment (p = 0.016 and p = 0.022). DIS correlated with decrease of hemoglobin (p < 0.001). In conclusion, size and growth dynamics of FLs correlate with prognosis and local bone destruction. Connections between MRI findings and progression patterns (fast growing FL—OL; DIS—hemoglobin decrease) might enable more precise diagnostic and therapeutic approaches for SMM patients in the future