Impact of Chemotherapy Induced Diarrhoea (CID)

Impact of Chemotherapy Induced Diarrhoea (CID) This assignment will critically explore one impact of cancer treatment, examining the physiological nature of the impact. I will analyse strategies for alleviating the impact, considering the contribution of the multi-disciplinary team. I will discuss the contribution of healthcare professionals to holistic care analysing the professional and ethical dimensions of practice. Finally I will evaluate the effectiveness of the current management of the identified impact. The one impact of cancer treatment which I have chosen to look at is chemotherapy induced diarrhoea (CID). The London Cancer Alliance (2013) reports that patients receiving chemotherapy are at risk of developing severe diarrhoea, and the prevalence has been reported to be as high as 50–80%. Sherman (2008) explains that diarrhoea has a significant impact on quality of life and can contribute to malnutrition, weight loss, immunosuppression, and mortality. I have personally encountered CID in my practice and have seen how debilitating it can be for service users both physiologically and psychologically. According to Stein (2010) the pathophysiology of chemotherapy induced diarrhoea is multifaceted, complex and still undergoing further investigation. This is also acknowledged by Gibson and Keefe (2006) who believe that CID is likely to be caused by combinations of varying factors which include, altered gut motility; colonic crypt damage, impairing water absorption in the colon, changes to intestinal microflora, affecting absorption and altered fluid transport in the colon. Robinson and Dobish (2007) believe that the absorptive and secretory capacity within the gut is altered during chemotherapy due to the toxicity damaging the intestinal epithelium, inflammation of the bowel wall and superficial necrosis. Which according to Stringer (2009) causes a difference between secretion and absorption in the small bowel resulting in diarrhoea. Viele (2003) suggests that there are two mechanisms by which chemotherapy may induce this. First, the diarrhoea is caused by changes in intestinal absorption which may or may not be accompanied by excessive electrolyte and fluid secretion. Second, the diarrhoea may be a consequence of a combination of mechanical and biochemical changes caused by the chemotherapy. These intestinal functional changes are thought to be a result of direct toxicity of the chemotherapy on the colonic crypt stem cells. Death of these cells leads to a cascading effect where immature crypt cells attempt to compensate by releasing more secretory compounds (Viele, 2003). The small intestine is also thought to play a role whereby the villi are unable to absorb fluids correctly, leading to a skewed ratio of fluid absorption and secretion. In addition, chemotherapy is reported to destroy the brush border enzymes, which are responsible for the digestion of both carbohydrates and proteins, and this causes more gut-wall secretions to occur (Rutledge and Engelking, 2008). Sharma (2005) informs us that if CID is uncontrolled the consequences can be devastating both physically and psychologically. According to Cherny (2008) diarrhoea can lead to, dehydration, electrolyte imbalance, renal issues and even death. Viele (2003) reminds us that the impact if CID is not just physiological, the psychological effects of diarrhoea include depression, social isolation and anxiety. Patients suffering from CID will often require additional healthcare resources, such as admission, which will raise the cost of the patients care for the healthcare service (Dranitsaris et al 2005). Arnold (2005) explains that CID can interfere with cancer treatments affecting scheduled treatment plans, dose reductions ultimately leading to a worse outcome. In a reflective study of cancer patients who acquired CID, Arnold et al (2005) discovered that 65% of patients experienced a decrease in dose intensity, a dose reduction was required in 45%, a delay in treatment was experienced in 71%, and 3% had their therapy discontinued. Maroun et al (2007) conclude that treatment delays, discontinuation and dose reductions have a direct adverse effect on patient mortality and morbidity. Therefore clear objectives must be in place in order to manage chemotherapy induced diarrhoea effectively. According to Skelley (2005), healthcare professionals must promptly diagnose and treat patients with CID, minimise treatment delays, maximise chemo intensity and therefore maximise the patients’ quality of life whilst undertaking treatment. Skelley (2005) states that to manage diarrhoea in an acute setting effectively healthcare staff need to maintain an accurate stool chart and should grade diarrhoea using the National Cancer Institute Common Toxicity Criteria for Diarrhoea. The London Cancer Alliance (2013) supports the use of a grading system and shows one in their management literature and has added symptoms into the table to help aid in grading diarrhoea more effectively. The LCA (2013) add that mucositis and neutropenia from the chemotherapy treatment can also significantly increase complications associated with CID. Prompt recognition and swift appropriate treatment are essential. Therefore by completing the aforementioned measures, medical staff are enabled to choose the correct treatment options and it also helps to monitor the effectiveness of the treatment. Also we must ensure that a stool culture taken, so as to rule out any infections or other causes which could further prolong or alter treatment plans. It is important for healthcare professionals to actively encourage patients to report their bowel movements, because patients can fear that reporting diarrhoea will delay their treatment (Maroun, 2007). As a healthcare professional we should aim to reassure patients that prompt diagnosis and early treatment can prevent delays to their chemotherapy. According to Cherny (2008) patients with CID should have a full assessment including medical history, dietary history and medication review. Before treating CID other common causes of diarrhoea should be considered and excluded. These could include, adverse medication effects, concurrent Disease such as, Crohn’s disease, diverticulitis and ulcerative colitis, viral Infection, bacterial Infection, faecal Impaction, diet and psychological Factors (LSA, 2013). Benson (2004) believes that patient education is the vital underpinning to the management of CID and before commencing chemotherapy, patients must be fully informed of the potential risks and what actions to take, if they develop diarrhoea. Patients will require nutritional advice and the LCA (2013) guides us by showing the initial management for CID which we can in turn offer to patients. This includes drinking 8–10 large glasses of clear fluids per day to prevent dehydration and stopping lactose-containing products since lactose intolerance can develop when the mucosa is damaged. Patients need to avoid spices, high-fibre foods, high-fat foods, caffeine, alcohol and fruit juices. Small frequent meals such as bananas, toast and plain pasta are also recommended. There are many more aspects to dietary advice therefore input from a dietician would be beneficial. Benson et al (2004) show that in diarrhoea grades 1–2 Loperamide is the recommended medication, 4mg followed by 2mg after every loose stool up to 16mg daily. If diarrhoea persists, high dose Loperamide should be used and Codeine Phosphate 30–60mg QDS can be added, also a stool culture needs to be taken if not previously done. The patient will need to be admitted to hospital if not already an inpatient if the diarrhoea persists or becomes grade 3-4 after 24-48 hours. At this point Octreotide is the recommended treatment as a sub-cutaneous injection, 300mcg/24hr for 5 days, increasing to 600mcg/24hr if not effective (LCA, 2013). According to Barbounis et al (2001) Octreotide has a 60% 90% success rate in resolving persistent diarrhoea. Zidane (2001) explains that although Octreotide has proven to be more successful than Loperamide, it still remains as a second line treatment due to its high cost. Chemotherapy induced diarrhoea has tremendous effects on patients’ quality of life, the management of cancer patients requires increased attention to this side effect from nurses. Targeted education is needed to help nurses implement systematic assessment and documentation. Nurses must ensure to communicate effectively with patients and caregivers in every setting about the nature of diarrhoea and its causes, as well as develop appropriate interventions for each individual. As such, nurses need to maintain current knowledge of the causes and available treatment strategies for CID. It is also imperative to remember the beneficial effect that diet may play in alleviating diarrhoea symptoms. Reference List Arnold, R. J. Gabrail, N. Raut, M. Kim, R. Sung, J. C. Zhou, Y. (2005) ‘Clinical implications of chemotherapy-induced diarrhea in patients with cancer’. The Journal of Supportive Oncology, 3(3), pp. 227-232. Available at: http://www.oncologypractice.com/jso/journal/articles/0303227.pdf (Accessed: 22 March 2014). Benson, A.B. Ajani, J.A. Catalano, R.B. Engelking, C. Kornblau, S.M. Martenson, J.A. (2004) ‘Recommended guidelines for the treatment of cancer treatment-induced diarrhea’. Journal of Clinical Oncology, 22, pp. 2918–2926. Available at: http://jco.ascopubs.org/content/22/14/2918.long (Accessed: 30 March 2014). Cherny, N. I. (2008). ‘Evaluation and management of treatment-related diarrhea in patients with advanced cancer: A review’. Journal of Pain Symptom Management, 36(4), pp. 413-423. Available at: http://download.journals.elsevierhealth.com/pdfs/journals/0885-3924/PIIS088539240800111 5.pdf (Accessed: 8 April 2014). Dranitsaris, G. Maroun, J. Shah, A. (2005) ‘Severe chemotherapy-induced diarrhea in patients with colorectal cancer: A cost of illness analysis’. Supportive Care in Cancer, 13(5), pp. 318-324. Available at: http://www.ncbi.nlm.nih.gov/pubmed/15614493 (Accessed: 01 April 2014). Gibson, R J. Keefe, D M. (2006) Cancer chemotherapy-induced diarrhoea and constipation: mechanisms of damage and prevention strategies. Support Care Cancer. 14, pp 890–900. Available at: http://link.springer.com/article/10.1007/s00520-006-0040-y (Accessed: 01 April 2014). Hogan, C M. (1998) The nurses role in diarrhea management. Oncology Nurses Forum. 25 (5), pp879-86. Available at: http://www.ncbi.nlm.nih.gov/pubmed/9644704 (Accessed: 23 March 2014). London Cancer Alliance (2013) LCA Acute Oncology Clinical Guidelines. Available at: http://www.londoncanceralliance.nhs.uk/media/56533/FINAL LCA Acute Oncology Clinical Guidelines September 2013.pdf (Accessed: 9 March 2011). Maroun, J.A. Anthony, L.B. Blais, N. Burkes, R. Dowden, S.D. Dranitsaris, G. (2007) ‘Prevention and management of chemotherapy-induced diarrhea in patients with colorectal cancer: a consensus statement by the Canadian working group on chemotherapy-induced diarrhea’. Current Oncology, 14, pp. 13–20. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1891194/ (Accessed : 10 March 2014). Rutledge, D N. Engelking, C. (2008) Cancer-related diarrhea: selected findings of a national survey of oncology nurse experiences. Oncology Nurses Forum. 25, pp 861–873. Available at: http://www.ncbi.nlm.nih.gov/pubmed/9644704 (Accessed 01 September 2012). Sharma, R. Tobin, P. Clarke, SJ. (2005) ‘Management of chemotherapy-induced nausea, vomiting, oral mucositis, and diarrhoea’. Oncology. 6, pp. 93–102. Available at: http://www.sciencedirect.com/science/article/pii/S1470204505017353# (Accessed: 5 April 2014). Sherman, D S. Fish, D N. (2008). Management of protease inhibitor associated diarrhea. Clinical Infectious Diseases. 30, pp 908–914. Available at: http://cid.oxfordjournals.org/content/30/6/908.long (Accessed 01 April 2014). Skelley, K. (2005) ‘Management of chemotherapy induced diarrhoea in adults with cancer’ (Online). Available at: http://www.ruh.nhs.uk/about/policies/documents/clinical_policies/ local/405%202006 %20Management%20of%20Chemotherapy%20Induced% 20Diarrhoea.pdf (Accessed: 22 March 2014). Stein, A. Voigt, W. Jordan, K. (2010) ‘Review: Chemotherapy-induced diarrhea: pathophysiology, frequency and guideline-based management’. Therapeutic Advances in Medical Oncology. 2 (51). Available at: http://www.ncbi.nlm.nih.gov/pmc/articles /PMC3126005/pdf/10.1177_1758834009355164.pdf (Accessed: 28 March 2014). Stringer, A.M. Gibson, R.J. Logan, R.M. Bowen, J.M. Yeoh, A.S. Laurence, J. (2009) ‘Irinotecan-induced mucositis is associated with changes in intestinal mucins’. Cancer Chemotherapy Pharmacology, 64, pp. 123–132. Available at: http://www.springerlink.com/content/d45k70508772318j (Accessed: 3 April 2014). Viele, C. S. (2003) ‘Overview of chemotherapy-induced diarrhea’. Oncology Nursing, 19(4 Suppl 3), pp. 2-5. Available at: http://www.sciencedirect.com/science/article/pii/ S074920810300114 (Accessed: 23 March 2014). Zidan, J. Haim, N. Beny, A. Stein, M. Gez, E. Kuten, A. (2001) ‘Octreotide in the treatment of severe chemotherapy-induced diarrhea’. Annual Oncology, 12, pp. 227–229. Available at: http://annonc.oxfordjournals.org/content/12/2/227.long (Accessed 22 March 2014).

How does Fitzgerald’s variety of language techniques illustrate his views on the lifestyle of the era, here and in the novel as a whole

With reference to at least two passages, show how Fitzgerald's variety of language techniques illustrate his views on the lifestyle of the era, here and in the novel as a whole. Fitzgerald uses many different literary techniques to portray his opinion of the lifestyle during the 1920's. The use of Nick Carraway as narrator continually exposes the readers to both the positives, and negatives of this era. Throughout â€Å"The Great Gatsby† Fitzgerald explores key issues of â€Å"The jazz age†. The role of women and the hierarchy of society are two of the main issues which Fitzgerald explores. Throughout passage one there is a big divide of social status and it is clear that the differences within the class hierarchy are profound: â€Å"He's so dumb he doesn't know he's alive.† Fitzgerald uses the brutal character of Tom Buchanan to portray the divide and disapproval of working class citizens like Wilson. The use of strong adjectives portrays the maltreatment of the working class. In passage two Fitzgerald presents the opposite end of the hierarchy to the readers. The readers are therefore exposed to a world of wealth: â€Å"†¦superior couples holding each other tortuously, fashionably, and keeping to the corners†¦Ã¢â‚¬  The continued use of adjectives by Fitzgerald this time creates a different image. He creates a disjointed atmosphere which is contrasted by wealth. The negative imagery that is created challenges the idea of The American Dream and the fallible belief of characters like Wilson that success and therefore wealth is essential. This contrasts the first passage where Fitzgerald portrays the negatives of poverty. Fitzgerald suggests that there was no equilibrium of success and wealth in that society. However, Fitzgerald was in fact part of the higher social class who contributed to these parties. Infidelity is a key issue that Fitzgerald exposes in this novel and this is especially true for passage one: â€Å"She smiled slowly and, walking through her husband as if he were a ghost, shook hands with Tom, looking him flush in the eye.† Fitzgerald uses his narrator Nick to observe the desperate actions of a typical working class woman of the 1920's. Fitzgerald's provocative language, â€Å"looking him flush in the eye,† portrays Myrtle's obsessive pursuit of wealth and supposed happiness. The idea of The American Dream is once again divulged, as Myrtle's quest for wealth sacrifices her marriage. The comparison of Wilson to a ghost is important because it shows that Fitzgerald disapproves of Myrtle's actions and is trying to portray her callous behaviour. The technique of formal, introductory action, â€Å"shook hands with Tom† is used by Fitzgerald in contrast to the deeper more intimate relationship beneath the superficial appearance. This represents Fitzgerald and his sympathy in this instance for the poor, hardworking citizens; even though he was himself part of this wealthy lifestyle. In passage two no direct infidelity is explored by Fitzgerald; however the idea of frivolity amongst couples is: â€Å"There was dancing now on the canvas in the garden; old men pushing young girls backward in eternal graceless circles†¦Ã¢â‚¬  Fitzgerald's use of â€Å"pushing† and â€Å"graceless† suggests that there is no connection or intensity in relationships. Similarly to the worthless marriage of Wilson and Myrtle, these couples are awkward and without attachment. The role of women is a major flaw of society within this time period. Fitzgerald suggests mistreatment in his description of, â€Å"†¦old men pushing young girls†¦Ã¢â‚¬  He emphasises the lack of connection amongst couples and presence of control over women. He disapproves of the treatment of women; however he does not defend the women or even approve of their actions, â€Å"single girls dancing individualistically†¦Ã¢â‚¬  His language is sarcastic and mocking towards the drunken women at Gatsby's party. Both sides of Fitzgerald's arguments are made more significant by the location, representing the treatment in public situations. Fitzgerald is portraying the lack of reaction amongst citizens of the 1920's. Similarly to when Tom broke Daisy's nose. Although the action was recognised by Nick it was not dwelled upon. This domination is re-emphasised later in the novel at another public party location: â€Å"Whenever he sees I'm having a good time he wants to go home.† Fitzgerald repeatedly features dominating, bullying husbands who control their wives and restrict their lives. However, some would argue that the control is to stop inappropriate behaviour of the typically drunk women of the era. This control over women is paralleled in passage one by the dominating male character of Tom: â€Å"I want to see you†¦Get on the next train.† Fitzgerald uses Tom's brutal nature and blunt direct speech to portray the worthlessness of women. Fitzgerald's language is domineering and controlling, which suggests that he has unfaithful motives for his arrangements with â€Å"his girl†. Fitzgerald portrays an entirely different character to the readers after Myrtle's death: â€Å"Tom drove slowly†¦In a little while I heard a low husky sob, and saw that the tears were overflowing down his face.† Fitzgerald show's the readers that this lifestyle can be fragile and vulnerable at times. The readers see a new side of Tom and it proves that although he was a domineering character he did have true feelings for Myrtle. Fitzgerald still represents the era by using bold and masculine adjectives, â€Å"†¦low husky sob†¦Ã¢â‚¬  This description of Tom portrays the idea that people could not show fragility without trying to be superficially strong. The male domination of characters like Tom is similar to the behaviour of Mink in â€Å"Postcards† by Annie Proulx. Mink is a very possessive and restricting character, he controls his wife Jewell: â€Å"†¦Mink wouldn't hear of it. Had a fit every time I wanted to go somewhere†¦Ã¢â‚¬  This possession is very similar to Tom and his control that he needs over Daisy. However there is a difference, Mink and Jewell are very poor farmers which are directly contrasted by the wealth of Tom and Daisy. The American Dream that so many people went in search of, hoping that money meant happiness, is proved false. Two completely different male characters from different wealth background are still dominating and controlling. Therefore, American Dream seekers like Wilson, Myrtle, The Joad family from â€Å"The Grapes of Wrath†, Lenny and George from â€Å"Of mice and Men† are blinded by a dream. Excess is an issue of the 1920's among successful wealthy people similar to those of Gatsby, Daisy and Tom. Fitzgerald displays initial disapproval of this gluttony: â€Å"†¦Champagne was served in glasses bigger than finger-bowls.† The use of an upper class comparison makes this sentence more powerful. Fitzgerald compares excess with more flamboyant objects. This is effective in the portrayal of the lavishness of parties. However, his possible disapproval is soon altered by the effects of alcohol and the narrator is soon engulfed in a wealthy society: â€Å"I had taken two finger-bowls of champagne, and the scene has changed before my eyes into something significant, elemental, and profound.† Fitzgerald condemns the consumption of alcohol and displays its dangers perfectly through the transformation of his narrator and his observations. He suggests that society's vision is clouded by alcohol and excessiveness rendering it impossible to possess educated and sensible opinions of the extravagant lifestyle. The excess of a public environment is directly contrasted with the poverty of a private location in passage one: â€Å"†¦a grey, scrawny Italian child was setting torpedoes in a row along the railroad track.† This observation made by Tom is purposefully displaying Fitzgerald's disapproval of the excess of the Buchanon's lifestyle. He shows readers that poverty was ignored by the upper class. Instead of helping the area characters similar to Tom want to ignore them and return to their luxurious lifestyles. The private location is essential in the portrayal of the ignorance to poverty and the lack of connection with menial workers like Wilson. The entire novel displays one of the biggest flaws of 1920's society, superficiality. Passage two contains the superficiality of parties and public events: â€Å"†¦Vacuous bursts of laughter rose toward the summer sky.† Fitzgerald uses a powerful adjective to describe the laughter as being fake. Imagery is created of clouds floating into the sky; this is created by Fitzgerald to display the superficial atmosphere. Everyone at the party is contributing to the hollow laughter and taking advantage of Gatsby and his hospitality. Fitzgerald is showing the readers a lack of genuine care or enjoyment, it is a superficial persona. Fitzgerald continues to show the readers that superficiality is present in private scenes like passage one: â€Å"Get some chairs†¦his wife moved close to Tom.† Fitzgerald portrays how a relationship can be superficial. Myrtle's order is brazen in order to spend time with Tom. He shows the readers that people of this era were superficial, for public show and private gain. This is similar behaviour to that of Daisy later on in the novel: â€Å"Make us a cold drink†¦As he left the room again she got up and went over to Gatsby and pulled his face down, kissing him in the mouth.† This behaviour is paralleled to Myrtle's; they are both very cold and daring in these cases. Fitzgerald believes this is wrong and he displays this by the quick pace of the sentence, it shows a rush to end the action. The behaviour is similar to that of Tom and his affair with Myrtle, which shows a strength emerging for women. Daisy is now entering into an affair just as Tom is. Fitzgerald represents a clear disapproval of the unfaithful nature of society. I think Fitzgerald uses lots of literary techniques to cover all the key issues of the 1920's. He successfully describes situations vividly and encourages the reader using Nick as narrator. The readers are encouraged to believe that the â€Å"Jazz age† was excessive, superficial, wealth obsessed and unfaithful. However, as Fitzgerald shows using Nick, it was a very attractive era which captured people and engulfed them in money.

Fallout Book Report Essay

P.S. I am sorry the summary is so long but I wanted to make sure everything in the book was covered and there being 3 people makes it 2 times longer. The novel is a memoir of the lives of three children of a meth-addicted mother, Kristina, and how her addiction affected their lives. They now live in different homes, with different parents, as well as different last names. Each of them has a different story, some more fortunate than others. Hunter knows about his sisters and new younger brothers, while Summer knows about her brothers and Autumn knows nothing. It starts with Hunter’s story; adopted and raised by his biological mom’s mother and stepfather. He refers to his adoptive parents as â€Å"Mom and Dad.† He works at a radio station in Reno, Nevada. His girlfriend, Nikki, supports him in everything he does. As Christmas approaches, he is living with Nikki and having relationship troubles. Hunter is doing drugs more frequently, and cheats on Nikki with a persi stent radio groupie. All the while, Hunter is feeling like a piece of him is missing because of the lack of knowledge about his father. When he sees him, he knows, but his father is the date of his coworker, Montana. Hunter then gets drunk and calls Brendan (his father) out on his actions about how him raping Kristina produced Hunter. Once that situation is in the past, another problem occurs, as Hunter is approached by Nikki, who hears a voicemail left by Leah on Hunter’s phone about the cheating incident. He is kicked out of Nikki’s house and takes the guestroom in his parents’ house because, thanks to Kristina, his two younger brothers, David and Donald, have moved in and taken his room. Shortly after Hunter has moved back in, he is notified that Kristina will be spending Christmas with them. Autumn’s story takes place at her grandfather’s house in Texas. Her OCD (obsessive-compulsive disorder) and frequent panic attacks make her a loner at school, so her best friend is her Aunt Cora. Although she promises Autumn they will always be friends, she is wooed by her massage therapist professor and taken away from her. A new boy comes to her school and is immediately taken with her. She has a hard time opening up to him and even tells him her parents are dead. His name is Bryce and he ends up being Autumn’s first boyfriend, first kiss and first time. When her aunt announces her engagement, the happiness she gets from her new boyfriend fades and she feels alone. Desperate to make sure he stays with her, she has sex with him without protection. Realizing that being drunk makes everything easier to deal with, she begins drinking to make herself feel better. Her father’s and grandmother’s interruption at Aunt Cora’s wedding only makes things worse, bringing her past to her present; then, Bryce finds out her parents aren’t dead. Devastated about the lying, Bryce leaves Autumn, and to make matters worse her drinking has gotten out of hand and she is almost raped by the groom’s cousin, Micah. The wedding ends when Autumn realizes how lonely she is and begins to wish she is pregnant, and her father finds her and tells her how she came to be. In the process, he convinces her to go to Reno for Christmas to see the mother she never knew. The California foster system took Summer away shortly after living wi th her father when they were abandoned by Kristina. She knows everyone in her family except for Autumn. Her father’s ex-girlfriends have molested and used her, causing her to be thrown in different homes with different problems. Her life is pretty stable in one home until one of the meth-using girls that also lives there molests one of the younger girls; it hits close to home and she is unable to control her anger. She gets in a fight with the meth girl and ends up getting sent to live back with her father and his girlfriend of the moment. The day after the fight, her boyfriend, Matt, saw her face and offered no sympathy, so she ran to his best friend, Kyle, who always showed interest. She ends up cheating on her boyfriend with Kyle by having sex with him. She knows that Kyle uses meth and other drugs but his loving nature has drawn her in. When he and Summer confront Matt about their newfound relationship, she sees the side of Kyle she never wanted to and realizes his addiction and anger may cause problems. The living conditions at her father’s house aren’t the be st; the constant smoking irritates her asthma and as Thanksgiving approaches, she starts to miss Kristina. She calls her, but can’t remember why; she was blown away by her mother’s selfishness and when her father is drunk later that night, he reveals that Kristina only cares about herself. Her father being drunk proves to be a much worse situation than just spilling the truth; his drinking costs him a DUI and he loses Summer. She is sent to another home in Fresno. Leaving her boyfriend and life behind, she is unwilling to move far away. When she gets to her new home, she is immediately taken aback by her new foster father. His demeanor worries her and makes her wonder what secrets the other girls in the house might have. She knows from experience not to get close to the other girls in the house, but one of the girls tells Summer her secrets and becomes attached to her. During the few days Summer is there, she hides her cell phone and planned to meet Kyle. When she sneaks from under her foster sister’s watch long enough to escape, she ends up running away with Kyle for Christmas—he is so in love with her that he even attempts to stop using meth for her, which means suffering through withdrawal. She and Kyle save up money and live out of his car while they head to a ski lodge, where Kyle plans to work. The stories collide when Kyle and Summer get in a car accident and the closest place to them is Reno, Nevada. Summer ends up calling her grandfather to pick her up from the hospital the morning after the blizzard hit and the accident happened. Hunter is out picking up Kristina and his grandfather from the airport after spending the early morning making up with Nikki. He knows that things won’t quite be merry and joyful Christmas morning with the whole family being together. Autumn and Trey show up before Summer gets there and when Trey sees Kristina, they are immediately drawn to each other and spend most of the day before dinner talking to each other. Summer tries to be sisterly to Autumn and Autumn doesn’t know what to make of all of it. When dinner starts, David asks when he’ll be going home and Kristina says she doesn’t know; Donald gets angry and tells her he never wants to go back—that he never wants to be with her again. Hunter is the first one to jump up when Kristina acts offended and he yells at her, telling her the only person responsible for what happened to her was her. Summer jumps in the argument too when Kristina begins to complain that she doesn’t have the resources to take care of her kids or give them a good life. The book ends with a newspaper article saying Marie Haskins has put her new book ‘Monster’, on indefinite hold while Kristina is undergoing chemotherapy for cancer. At this point, Kristina has reunited with her husband, Trey, and with her resources, she is trying to make her life better so she can be the mother she has never been. I can’t personally connect to this book but I can emotionally connect to this book. I have a friend in my life that I like a brother to me and he has parents just like hunter, autumn and summer. Drugs are a very personal matter and mess up your life more than anyone can know until it happens to you. I felt what he felt becaus e he is such a dear friend that all I could do was worry about him and wonder how he was doing in that new foster home he was moved to. I always heard all about the stories and the way he was in the foster home. He said it wasn’t easy and it was painful to know that everyone he loved had bailed out on him. He soon developed many of the problems these kids experienced with drinking and doing other drugs. This life isn’t easy from what I have heard. This book is very easy to relate other books by Ellen Hopkins because all of the books I have read by her seem to be about drugs and complications in life including hardships and suffering. I don’t really watch movies in this type of subject but I did hear that there is supposed to be a movie coming out based on the crank series by Ellen. I’m not sure whether it’s out or not but the books are great and movies tend to ruin the reading of the book. Both crank and glass led up to this point in the book series and was consistent throughout the storyline of all three books. There is so much drug abuse in the books and making right decisions is not one of Kristina’s strong points. I believe that the theme of this book is that drugs can ruin lives especially to the young girls out there. The plot of this story is to tell a story from the perspective from the 3 abandoned children that Kristina left behind. There storied tell about the hardships they went through and how life was for them during this painful teenage years. Even though the plot wasn’t very funny, it is very intriguing and interesting to find out what makes people do this to their own children and why they do the things they do. This story is told from the three kids point of view. And it switched off every so often so it was very suspenseful. The setting of this book is in three different places considering the three different points of view. Hunters’ setting was in Reno while Autumn’s setting was in Texas and Summer’s setting was anywhere the foster system took her. In my personal view the climax of the story was when all three of the children met for the first time and got to be a family together. In conclusion, I would recommend this book to anyone that enjoys reading this type of book seeing as how it has sex and drugs in it. I would definitely restrict this book to anyone under the age of 15 or 16. This book is a lot more profane then the others and I feel that you should be at least old enough to understand the meaning and why the book is how it is. Not many people judge books but I would definitely recommend this book to anyone who wants a good read and interesting enough to make it to when you put the book down you can’t wait to pick it back up. I truly feel her books are amazing and make you see how messed up some situations are.

The Phone -Memory Snapshot - Free Essay Example

Sample details Pages: 4 Words: 1118 Downloads: 1 Date added: 2017/09/21 Category Advertising Essay Type Narrative essay Tags: My Neighborhood Essay Did you like this example? The Phone While I was a kid, my father got one of the first phones in the neighborhood. I can perfectly remember that wooden crates lacquered, mounted on the wall. The bright receiver was hanging on a side. I was still too small to reach the phone but I was always listening, fascinated, as my mother spoke to him. Then I discovered that somewhere inside this device lived an amazing person. Her name was Hello Central and there was no one thing in this world, which she would not know. Hello Central can tell you anybodys phone number and also the exact time . My experience with this spirit closed in a bottle came one day when, while my mother was visiting a neighbor and I was playing whit the tool bench in the cellar,I hit my finger with a hammer. The pain was terrible and there was no one around me to show any compassion. I walked around the house sucking on my sore finger until I reached the ladder. The phone! I quickly dragged up a chair from the living room in the lobby. I stepped on it, I forked out the telephone receiver and I put it to my ear. Hello, Central! , I shouted into the microphone which was just above my head. A click or two and then a low and clear voice answered me back. Ive hurt my finger , I whimper on the phone and tears overcame me soon, now that I had an audience. Your mommy is not home? , the question followed. Theres nobody home but me I stammered. . Are you bleeding? , the voice asked me and I answered that i am not. I hit myself with the hammer and now it hurts so bad. Can you open the cooler? she asked me again and I said I can. Then get over there and get a piece of ice and keep it glued to your thumb said the voice. Then I started to call Hello Central for anything. I asked help for my geography lessons and she told me where Bucharest was. She even helped me with my math . She told me that the squirrel that I trapped in a park the day before, eats fruits and nuts. Then came a day when Figaro, our canary, died. I c alled Hello Central and I told her the sad news. She listened to me and then started to tell me things that parents usually tell their children to calm them. I asked her, What happens to birds who are singing so beautifull and bring so much joy to people,why do they have o end in a pile of feathers on the bottom of a cage? . I think she understood my feelings,because she slowly answered back,Doru always remeber that there may be other worlds in which they can sing. Another time on the phone,Hello Central and the Central answered with a well known voice. How do you spell the word price? I asked. All this happens in a small town in Romania. When I was nine, we moved to the other end of the country, from Ploiesti. I missed a lot my friend . I leftHello Central in that box of mahogany wood from our old house. I never tried to do the same thing with our new modern and bright phone,in the new house. I had become a teenager but the memories of my childhood followed me everywhere. Often , in moments of uncertainty and helplessness I remembered that feeling of serenity and security, which we had at that time. I appreciated now how patient and sympathetic and good hearted she must have been for her to lose so much of her time with a little boy like me. After several years, I did go to Ploiesti again, this time to continue my college studies. I took the train there but we had to stop in Sibiu first. I had a half an hour between trains. I spent about 15 minutes on the phone with my sister, who lived there for a while. Then, without thinking, I dialed the number of operators in our native town and said: Hello Central! . Miraculously, I heard the same low and clear voice, that i knew so well saying this is the central. I didnt plan this but I heard myself saying: Can you tell me how to spell the word price? A long pause. Then, that soft voice answered me, I guess your finger has healed by now. I laughed, So you are, indeed ,I said. I wonder if you know how much you meant to me at that time . And I wonder, she said, if you realize how much your call meant for me. I have never had any children and i was really happy to get your calls, every day . I told her how much I thought of it along the years and I asked if I could call her again in May when I come back to visit my sister. With pleasure ,she told me, just ask for Anca. I returned to Ploiesti after three months and for my surprize another voice answered me . I asked for Anca. Are you a friend? she asked me back. Yes, a very old friend , Doru its my name. Sorry to tell you this Doru she told me but Anca had worked only part time in the last years, because she was sick ,and unfortunetlly she died five weeks ago. I was frozen for a second and then right before i was about to end the conversation she said, One minute, you say your name is Doru? My heart jumped and i quickly answered yes it is. Well,Anca left a message for you sir,she wrote it on a piece of paper in case that you would call. Ill read it to you. Her message was: tell him that they are other worlds in which you can sing. He will know what I mean . I thanked the operator and i hung up. I knew what Anca meant. Never underestimate the impression you did on someone. All this came back to me from an old photo that i have in one of the drawers. I realize now ,how much people can help each other,how much we can change if we just open our hearts. Its hard to acomplish that ,specially with the busy life we all have everyday,but a reflection always makes us think twice. I wish that all the people to be like Anca and even if i never met her in person she is always gonna be in my heart. The more years pass the more value she has for me. Don’t waste time! Our writers will create an original "The Phone -Memory Snapshot" essay for you Create order