A Collection of Clinical Case Stories as Emotional Landscapes of The General Physician Desert

Review Article

A Collection of Clinical Case Stories as Emotional Landscapes of The General Physician Desert

Jose Luis Turabian ^*

Specialist in Family and Community Medicine, Health Center Santa Maria de Benquerencia. Regional Health Service of Castilla la Mancha (SESCAM), Toledo, Spain.

*Corresponding Author: Jose Luis Turabian, Specialist in Family and Community Medicine, Health Center Santa Maria de Benquerencia. Regional Health Service of Castilla la Mancha (SESCAM), Toledo, Spain.

Citation: Jose L. Turabian. (2025). A Collection of Clinical Case Stories as Emotional Landscapes of The General Physician. Desert, International Clinical and Medical Case Reports, BioRes Scientia Publishers. 4(2):1-6. DOI: 10.59657/2837-5998.brs.25.055

Copyright: © 2025 Jose Luis Turabian, this is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Received: September 01, 2025 | Accepted: September 15, 2025 | Published: September 22, 2025

Abstract

This International Clinical and Medical Case Reports section is a collection of descriptive clinical vignettes, "like the plates in a geography atlas" that will present the emotional situations (empathy, frustration, sadness, joy, exhaustion, etc.) metaphorically described as emotional landscapes (which can have emotional, cultural and spiritual significance for people, evoking feelings of peace, beauty, nostalgia or belonging): mountains, volcanoes, rivers, valleys, islands, waterfalls, glaciers, fjords, estuaries, etc, and who are experienced by general practitioners, when they dealing with different clinical cases and patients, with the aim of achieving a greater understanding of what we are and what we do as doctors in relation to patients. This case presents a case of Parkinson's disease with progressive deterioration, difficulties with daily life and work, family problems, and stigma. This landscape emotionally suggests to the general practitioner a solitary, hostile, inhospitable, unpopulated, arid, desolate desert, devoid of any possible support; devoid of living beings, without rain, with dry soil and rocks exposed to decay and erosion.

Keywords: parkinson’s disease; emotions; metaphor; general practitioner; cultural landscape

Introduction

Clinical Vignette/Emotional Landscape: Desert

Mark, 57, presents with Idiopathic Parkinson's disease with difficult-to-control motor fluctuations and painful dystonia that interferes with gait [1, 2]. The disease was diagnosed 11 years ago. Initially, a right-sided asymmetric rigid-akinetic syndrome was detected, with some improvement after starting rasagiline. Three or four years later, he reported increased clumsiness with right-sided and the left side manipulation. Retigabine was added, which was initially well tolerated. However, a year later, there was slight worsening of his manipulations. He began dragging his right leg and had difficulty starting to walk, along with tachyphemia and a mild resting tremor of his bilateral hands and postural tremor when stressed. He was started on levodopa/carbidopa, requiring a dose increase, and opicapone. Later, he developed non-disruptive delayed morning ON periods, occasional oral dyskinesias, and mixed insomnia with episodes of hyperhidrosis. ReadiLine was switched to safinamide. In subsequent follow-ups, he reported increasingly frequent OFF episodes and morning akinesia, and the levodopa/carbidopa dose was increased and adjusted according to his work schedule. Subsequently, toxin injections were started in his lower limb for dystonia in his right foot, which interfered with his walking. A year ago, he started foslevodopa and foscarbidopa but immediately experienced a skin reaction that disappeared upon discontinuation of the infusion. He was placed on the surgical waiting list for Deep Brain Stimulation. Over the past year, Mark has been experiencing episodes of anxiety, a feeling of shortness of breath, irritability, and discouragement. He sleeps very little and is hyperalert.

Mark usually visits his GP's office alone

There are some difficulties understanding him well, and Mark also seems to have trouble organizing his thoughts while speaking: his speech is excessively rapid, his rhythm is disordered, and his articulation is slurred, with words and sounds mispronounced, shortened, or omitted...

“Doctor, I need sick leave… As you know, I work in a pharmaceutical laboratory and I can no longer perform my normal job duties… I am ashamed of my colleagues and bosses seeing me in this situation… I see negative attitudes toward me for having the disease… as if I were being discriminated against or rejected… I know that in my current situation, I feel defective or inferior… but all of that hurts so much… and seeing myself as disabled…”

The GP observes Mark’s motor symptoms such as tremors, slowness, and rigidity. He is aware of his advanced Parkinson’s disease, which does not respond adequately to medication, presenting motor fluctuations or dyskinesias despite medication.

Mark is now on disability. His wife currently has an adjustment disorder, and his daughter has learning difficulties [3].

Physicians may be well equipped to address the biological aspects of the disease, but not for its psychosocial dimensions. Illness as a personal condition often has repercussions in two directions: on the one hand, patients' illness influences the behavior of the societies in which they live, but the rejection or acceptance of these conditions also modulates the personal experience of the disease.

The general practitioner (GP) treating Mark has witnessed the initial shock of the diagnosis and the patient's progressive deterioration, his symptoms, his stigma, and his loneliness. His Parkinson's disease affects social aspects: loss of lifelong identity, and social roles are forgotten or abolished; difficulties in the ability to manage and control activities of daily living; dependency, marginalization, exclusion, or social harm; emotional aspects: disregard, stigma; and behavioral and cognitive aspects: loss of a sense of control over one's life; It is associated with disability and death. In addition, other aspects (beliefs, family, health services): Family dynamics change, unusual reactions arise, while anxiety and rejection are often disguised as overprotection [4].

The GP believes that metaphors structure our understanding of the world. Metaphors are not only present in language but also structure human thought and cultural values. The landscape can be seen as a metaphorical model that organizes cultural concepts. The landscape metaphor manifests itself in everyday expressions that link geographical features with human qualities [5].

In the case of Mark, this patient is a "desert"; a lonely, unpopulated, arid, desolate place, without any possible support; inhospitable and shunned by civilizations, uninhabited by humans or hardly any living beings. Plants and animals that live in the desert need special adaptations to survive in a hostile environment. In the desert, there is a lack of regular rainfall. This means that dry ground and rock are exposed to forms of breakdown and erosion [6].

Mark feels helpless, isolated, disoriented, empty, alone, uncertain, without resources, and lacking control…

As Mark leaves the office, a blast of dry, warm, dusty air hits the GP, who thinks:

"I hope Mark finds an oasis of hope."

References

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Turabián, J. L., & Pérez-Franco, B. (2014). Journey to what is essentially invisible: Psychosocial aspects of disease [Viaje a lo esencialmente invisible: Aspectos psicosociales de la enfermedad]. Medicina de Familia-SEMERGEN, 40(2):65–72.
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