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10th Edition
Understanding
Human Behavior
A Guide for Health Care Professionals
Alyson Honeycutt, M.A., N.C.C.
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Printed in the United States of America

Print Number: 01 Print Year: 2023
Contents
Preface �� vii
Section I Becoming a Health Care Professional. . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Chapter 1 Challenges and Responsibilities of Health Care Professionals . . . . . . . . 3

Challenges and Satisfactions in Health Care. . . . . . . . . . . . . . . . . . . . . . . . . .4
Providing Client-Centered Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
Practicing Habits That Lead to Success. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
Practicing Empowerment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
Chapter 2 The Philosophy of Individual Worth and Equitable Care. . . . . . . . . . . . 13

The Meaning of Individual Worth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
What Is Bias? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Promoting Equity in Health Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Practicing Cultural Awareness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Cultural Competence and Health Care Outcomes. . . . . . . . . . . . . . . . . . . . . 18
Chapter 3 Self-Awareness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Understanding Learning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Developing a Growth Mindset. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Your Role As a Health Care Professional . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Your Life Roles. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Managing Your Time. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Section II Understanding Human Behavior. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Chapter 4 Influences on Behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

The Basis of Human Behavior. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
How People are Alike and Different . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Genetic Influences on Behavior. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
The Developmental Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
How Physical and Social Environments Shape Behavior. . . . . . . . . . . . . . . . 38
Assuming Responsibility for Behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
iii
iv Contents
Chapter 5 Physical Needs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Maslow’s Hierarchy of Needs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Importance of the Hierarchy of Needs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Physical Needs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Comfort and Safety Needs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
Physical Needs and Behavior. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Chapter 6 Social and Emotional Needs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

Social Needs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Self Esteem, Self-Concept, and Self-Awareness. . . . . . . . . . . . . . . . . . . . . . . 63
Self-Actualization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Environmental and Cultural Influences on Social/Emotional Needs. . . . . . . . 71
Social/Emotional Competence for Health Care Professionals. . . . . . . . . . . . . 73
Chapter 7 Emotions and Behavior. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75

Meaning, Importance, and Physiological Effects of Emotions. . . . . . . . . . . . . 76
Stress. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Positive and Negative Emotions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Formation of Emotional Patterns. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
Using Emotions Constructively . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
Chapter 8 Adjustment and Patterns of Behavior. . . . . . . . . . . . . . . . . . . . . . . . . . 93

Understanding Adjustment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
Emotions and Adjustment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Frustrations and Satisfactions in Daily Life. . . . . . . . . . . . . . . . . . . . . . . . . . 97
Improving Adjustment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Adapting to the Role of Health Care Professional. . . . . . . . . . . . . . . . . . . . 103
Section III Behavior and Problems in Living. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Chapter 9 Common Threats to Adjustment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107

Adjustment Through Stages of Life. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
Adjusting to Life Changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Social and Cultural Stressors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Chronic Stressors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Coping Skills and Resilience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Chapter 10 Effects of Trauma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .123

What Is Trauma?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
Traumatic Experiences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
Domestic Violence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Reactions to Trauma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
Trauma-Informed Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
Contents v
Chapter 11 Defense Mechanisms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141

The Purpose of Defense Mechanisms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
Common Defense Mechanisms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
Substance Abuse and Dependency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
Defense Mechanisms and Adjustment . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152
Chapter 12 Frustration and Inner Conflict. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157

Understanding Frustration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
Effects of Frustration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Coping with Frustration and Inner Conflict. . . . . . . . . . . . . . . . . . . . . . . . 165
Frustration, Inner Conflict, and the Health Care Professional. . . . . . . . . . . . 171
Section IV Effective Human Relations and Communication. . . . . . . . . . . . . . . . . 175
Chapter 13 Effects of Illness on Behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177

Physical Effects of Illness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178
Emotional Effects of Illness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178
Effects of Serious Illness on Behavior. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
The Challenge for Health Care Professionals . . . . . . . . . . . . . . . . . . . . . . . 184
Chapter 14 Human Relations and Coping with Patient Behavior. . . . . . . . . . . . . . 187

Practicing Effective Patient Relations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188
Helping Patients Adjust to Illness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188
Guidelines for Interacting with Patients and Clients . . . . . . . . . . . . . . . . . . 190
Common Behavior Patterns of Patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
Chapter 15 Practicing Effective Communication. . . . . . . . . . . . . . . . . . . . . . . . . . 203

Observing and Interpreting Nonverbal Behavior. . . . . . . . . . . . . . . . . . . . . 204
Verbal Communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208
Paraverbal Communication. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
Effective Listening. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212
Improving Communication Skills. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
Section V Death and Loss. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
Chapter 16 Grief and Loss Throughout Life. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219

Coping with Change and Loss. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220
Losses Throughout Life. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
Losses due to Death. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 226
Understanding Grief. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
Role of Health Care Professionals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234
vi Contents
Chapter 17 Death: Attitudes and Practices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237

Changing Attitudes and Practices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238
The Meaning of Death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240
Death with Dignity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241
Issues Related to Care of the Dying. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243
Legal Aspects of the Right to Die. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 246
A Challenge for Health Care Professionals. . . . . . . . . . . . . . . . . . . . . . . . . 249
Chapter 18 Caring for the Dying Person. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255

Reactions to Diagnosis of a Terminal Illness. . . . . . . . . . . . . . . . . . . . . . . . 256
Dying as a Growth Process. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 258
Personal and Family Issues Related to Care of the Dying . . . . . . . . . . . . . . 259
Medical Issues Related to Care of the Dying. . . . . . . . . . . . . . . . . . . . . . . . 262
Rights of the Dying Person . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 264
Roles of Health Care Professionals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265
Section VI Trends in Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269
Chapter 19 Health Care Through the Ages. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271

Healing in Early Civilizations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 272
Evolution of Modern Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
Allopathic Medicine and Alternative Approaches . . . . . . . . . . . . . . . . . . . . 278
Innovations in Modern Medicine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 280
Issues in Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285
Staying Informed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 288
Chapter 20 What Is Healing? Who Is the Healer?. . . . . . . . . . . . . . . . . . . . . . . . . 291

Factors That Affect Healing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 292
Who Gets Sick? Who Gets Well?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293
The Holistic Approach to Health Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . 297
What Is Legitimate Therapy?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 300
Role of the Health Care Professional. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 304
Chapter 21 Managing Stress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307

Understanding Stress. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 308
Managing Stress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 309
Reducing Physiological Effects of Stress. . . . . . . . . . . . . . . . . . . . . . . . . . . 310
Glossary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315
Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319
Preface
Introduction
Understanding Human Behavior: A Guide for Health Care Professionals is designed to assist
students in health care education programs to learn basic principles of human behavior.
These principles provide a basis for increased self-understanding and improved interpersonal
relationships. With technological advances in diagnostic and therapeutic procedures, it is
easy for a health care professional to focus on procedures and routines. Patients, however,
want personalized care that conveys respect for the patient as a person.
Patients’ expectations are more likely to be met when health care professionals aim for
effective interaction with each patient. By consciously attending to each interaction with
patients, the health care professional will experience greater job satisfaction.
Organization
Understanding Human Behavior: A Guide for Health Care Professionals, Tenth Edition, is
organized to proceed from relatively simple information to more complex concepts, from the
known to the unknown, and from application to self to application in a variety of interper-
sonal situations. For that reason, Chapters 1 through 18 are designed for sequential study.
Chapters 19-21 do not follow the sequential pattern. Chapter 19 describes historical con-
tent and current developments in health care; Chapter 20 explores the nature of healing and
suggests guidelines for evaluating the legitimacy of various therapies. Each of these chapters
can be studied independently at any point in the course. Chapter 21 introduces the impor-
tance of managing stress and can potentially be assigned early in the program, so students
can start practicing stress management. Undertaking the role of a student, introduction to the
clinical setting, and care of the sick all include stressful experiences. Preparing to become
a health care professional includes learning the importance of self-care, and stress manage-
ment is an essential component of self-care.
Section I (chapters 1-3) provides an orientation to the role of health care professional, the
importance of accepting each patient as a worthwhile human being, the challenge of striv-
ing for self-understanding, and guidelines for personal and professional growth. Section II
(chapters 4-8) presents information about various influences on human behavior: the role
of heredity, basic physical and psychological needs, developmental factors, role of the social
environment, emotions and their power to influence behavior, and adjustment as a compos-
ite of all these factors. Section III (chapters 9-12) presents more complex concepts related to
human behavior: stressful events that occur in the lives of most people, domestic violence
and bullying, and the mental and emotional effects of traumatic experiences. Many victims
of a traumatic event subsequently require health care. For both personal and professional
reasons, health care professionals need to be aware of the mental/emotional and physical
effects of these traumatic experiences, as well as the potential for long-term adverse effects
on the victim. The remainder of Section III covers other factors related to one’s adjustment:
common defense mechanisms, inner conflict, and frustration.
vii
viii Preface
Section IV (chapters 13-15) explores the components of effective communication. Practice

exercises are designed to help students become better communicators by improving their
skills in sending, receiving, and observing verbal and nonverbal exchanges. These exer-
cises can involve all students and be accommodated readily within a class period. Section V
(chapters 16-18) provides an overview of practices in relation to death and dying and legis-
lation related to the rights of patients to participate in health care decisions, especially those
related to end-of-life care. The grief process is discussed in detail, with guidelines for assist-
ing the bereaved.
Section VI (chapters 19-22) is designed to encourage students to accept the changes that
inevitably will occur in the dynamic health care system. Chapter 19 provides a historical
overview that reflects the roots of current practices, including holistic health care. Chapter 20
describes the emergence of the holistic emphasis and spotlights several complementary
healing modalities that have gained widespread acceptance with the public. The reader is
encouraged to maintain an open mind in conjunction with a healthy skepticism in evaluating
various treatment modalities. Chapter 21 addresses stress management.
Changes to the Tenth Edition

Understanding Human Behavior, Tenth Edition, includes the following updates and additions:
●● In Section I: Becoming a Health Care Professional, Chapter 3 includes an expanded
discussion of growth mindset.
●● In Section II, Understanding Human Behavior, Chapter 5 describes the connection
between nutrition and resistance to illness, and Chapter 6 contains an exploration of the
need for balance between independence and interdependence. Chapter 8 provides an
expanded discussion of positive emotions, including gratitude and joy, and addresses
the influence of culture on the expression of emotion. Chapter 8 includes a discussion
of how social media can impact adjustment, and Chapter 9 addresses the influence of
national and world events, including the COVID-19 pandemic, on adjustment.
●● In Section III: Behavior and Problems in Living, Chapter 10 describes the traumatic impact
of the COVID-19 pandemic. Chapter 11 includes updated information about substance
use in the US, and Chapter 12 now includes a discussion of discrimination can be a
source of frustration.
●● In Section IV: Effective Human Relations and Communication, Chapter 13 now includes
a discussion of how financial concerns and cultural background impact behavior of
patients and their families. Chapter 14 provides practical strategies for setting personal
matters aside while at work. Chapter 16 discusses cultural differences in how individuals
express grief.
●● In Section V: Death and Loss, Chapter 18 discusses how financial concerns impact family
decisions about end-of-life care.
●● Section VI: Trends in Health Care, Chapter 20 is streamlined, providing guidelines for
evaluating the validity of alternative and complementary treatments. Chapter 21 explores
the connection between stress and health.
Preface ix
Instructor & Student Resources

Additional instructor and student resources for this product are available online. Instructor
assets include an Instructor’s Manual, Educator’s Guide, PowerPoint ® slides, Solution and
Answer Guide, and a test bank powered by Cognero®. Student assets include PowerPoint®
slides. Sign up or sign in at www.cengage.com to search for and access this product and its
online resources.
MindTap
MindTap is a fully online, interactive learning experience built upon authoritative Cengage
Learning content. By combining readings, multimedia, activities, and assessments into a sin-
gular learning path, MindTap elevates learning by providing real-world application to bet-
ter engage students. Instructors customize the learning path by selecting Cengage Learning
resources and adding their own content via apps that integrate into the MindTap framework
seamlessly with many learning management systems.
To learn more, visit www.cengage.com/training/mindtap.
Using Understanding Human Behavior

The effectiveness of Understanding Human Behavior depends on the instructor’s choice of
activities: class time to clarify various concepts and specific activities to encourage student
participation, especially the sharing of experiences, discussion of problem situations, and
selection of effective behavior for real and hypothetical situations. The instructor’s own cre-
ative use of the text material is the key to students’ achievement.
No one ever completely masters human relations skills. Those who sincerely want to
relate effectively to others must become lifelong students of human behavior. They must con-
sciously practice human relations skills in order to improve their sensitivity to the possible
meaning of observed behavior and select appropriate responses. The immediate challenge
is to gain as much as possible from this course, as a foundation for the lifelong challenge of
developing a high level of skill in human relations.
About the Author

Alyson Honeycutt, M.A., N.C.C., is a National Certified Counselor, holds a License in School
Counseling from the North Carolina Department of Public Instruction, and has advanced
degrees from North Carolina State University at Raleigh and Appalachian State University.
She has taught parenting and literacy classes, has been an instructor in English at the col-
lege level, has taught students with emotional and behavioral disabilities, has served as a
district-level behavior support coordinator in the public schools, and has worked as a health
and wellness coach and yoga instructor.
x Preface
Reviewers of the Tenth Edition

Brett Brandon, RMA, AA, BS, MPAS Kat Slusser, PhD, RN
Allied Health Instructor Falculty, Program Coordinator
Sarasota, FL Santa Rosa, CA
Elizabeth MacQuillan, PhD, RDN, CHSE Joshua Snyder, MBA, EMT-P
Program Director and Assistant Professor Clinical Coordinator
Grand Rapids, MI McKinney, TX
Beverly Marquez, M.S., RHIA
Director
Sedalia, MO
Section I
Becoming a Health Care

Professional
T
his section introduces some of the challenges, responsibilities,
and satisfactions of being a health care professional. People
from all walks of life require health care. As a health care professional,
you will be challenged to serve each person effectively. Section I is
designed to help you become aware of the realities of a health career
and to help you learn strategies to succeed as both a student and a
health care professional.
1
Chapter
Challenges and Responsibilities

of Health Care Professionals
Objectives
After completing this chapter, you should be able to:
●● Describe the challenges and satisfactions of working in health care.
●● Explain the importance of client-centered care for health care professionals.
●● Explain how your study habits as a student relate to your future work habits as a health
care professional.
●● Explain the meaning of empowerment and apply the concept of empowerment to
real-life situations.
Key Terms
Client-centered care Self-confidence Standards of
Empowerment Self-reliance performance
4 Section I: Becoming a Health Care Professional
Congratulations! You have decided to become a health care professional. During your edu-
cational program, you will have the satisfaction of learning new information and developing
new skills. As a health care professional, you will be able to make a significant contribution
to your community. This chapter introduces some of the challenges, responsibilities, and
satisfactions of being a health care professional.
Challenges and Satisfactions in Health Care

Your career choice indicates that you like people and have a strong desire to help others.
Although you could possibly make more money in some other field, a career that provides
opportunities to help others may be very rewarding. You will also be part of one of the largest
and fastest growing industries in the world. As you gain skills and experience, you will have
opportunities to work in many different locations and different types of facilities. Qualified
health care professionals are expected to be in high demand in the future.
Challenges
Health care providers have always faced challenges, including long work hours, staff
shortages, and potential job burnout. In recent years, events such as changes in the health
insurance system and the COVID-19 pandemic have increased these challenges. Many
health care facilities experience high turnover, and health care professionals often cite
stress, burnout, and long hours as factors in their decision to leave their jobs. Yet many
health care professionals also report finding great satisfaction in their work. The habits
and attitudes you practice now as a student will impact your effectiveness and your satis-
faction in your work later.
© Gorodenkoff/Shutterstock.com
FIGURE 1-1 Qualified health care professionals are expected to be in high demand in the future.
Chapter 1: Challenges and Responsibilities of Health Care Professionals 5
Approval versus Inner Satisfaction

We all admire those who can do something extremely well; each of us would like to be
admired by others. We enjoy receiving approval from others, yet this good feeling is only
temporary. Athletes may enjoy hearing the cheers of the crowd, but the deepest satisfaction
comes from knowing that they performed with great skill. True satisfaction is an inner feeling of
pride in doing something well, regardless of whether the performance is applauded by others.
As a health care professional, you will find your greatest satisfaction in trying to give each
patient appropriate care. By meeting each patient’s needs to the best of your ability, you will
complete the day with an inner feeling of pride. The opposite approach—to view your work
as a series of assignments to be completed so that you can get off work or go on break—
results in finishing the day by saying, “Whew, I’m glad that’s over!” Stop now and consider
this very important question: How will you approach your work? As a challenge that provides
satisfaction and a sense of accomplishment? Or as work you must do to get a paycheck?
Setting Goals for Inner Satisfaction

Performing your work well can provide self-confidence and a deep sense of satisfaction
that is not dependent on praise from others. By working to improve your performance each
day, you will increase your level of skill. Excellence lies in that little bit of extra effort given
to achieve a superior performance. In the health field, that little bit of extra effort may make
the difference between safe and unsafe practice.
The habits you form as a student carry over into your performance as a health care
professional. Now is the time to develop habits that will lead to skillful performance,
self-confidence, and pride in your work.
Setting Standards of Performance

Only you can set the standards that will guide your performance over the coming years.
At times, you may be tempted to take a shortcut. Sometimes a piece of equipment will be
contaminated and obtaining sterile materials to complete the procedure will require extra
effort and time. Only you will know whether or not sterile technique was violated and the
contaminated equipment was used—unless, of course, the patient develops an infection as
a result. Your own standards should include accuracy in measurements, observations, and
reporting. Your standards of performance determine whether you experience the inner
satisfaction that comes from knowing the job was well done.
One key skill that will serve you well as a student and as a professional is the ability
to focus your full attention on the task at hand. Modern life is full of distractions, and
most of us are accustomed to multitasking.
Many students complete assignments while
having a conversation, watching a video,
or texting a friend. Consider this now: For Discussion and Reflection
Would an effective health care provider be Do you often multitask, for example, by
distracted while checking a patient’s vital completing assignments while checking
signs or administering medication? If you social media or texting friends? In the
make it a habit to set study goals and give future, what types of tasks might need
each task your full attention, you will be your full attention, without distractions?
better equipped to perform your job duties
effectively in the future.
When making that little bit of extra effort to do tasks well has become a habit, it becomes
an essential part of your performance. Thus, excellence as a health care professional will
depend upon setting high standards of performance for yourself now.
Excellence and Patient Safety

In the health field, all professionals should strive for excellence. Anything less than excel-
lence can endanger the patient. The nurse should give the correct medicine to each patient.
The medical assistant should use correct technique in all situations that require asepsis. The
laboratory assistant should report test results correctly; the dental assistant should sterilize
instruments correctly; the ambulance attendant should move the accident victim correctly.
Careless or incorrect performance can have disastrous effects for the patient.
Providing Client-Centered Care

As a health care professional, you will work with many different people, each of whom is a
unique individual—a physical, emotional, mental, and spiritual being. Each has a history of
experiences, a life within the context of a specific family and community, beliefs and values,
and a unique genetic makeup. To provide the best possible care, you will need to show con-
cern about the patient as a person rather than as someone for whom a specified procedure
must be carried out (“the knee replacement”).
As a Student
Your commitment to providing quality, client-centered care begins now, while you are a
student. Your first responsibility as a student is to take full advantage of every opportunity to
learn. Try to see the purpose in each assignment; look at it as an opportunity to learn, rather
than as a chore to complete. With this attitude toward learning, you will not be tempted to
skip class without good reason.
Your second responsibility is to decide what standards will guide your performance as
a student. Imagine that your school has set a certain grade, such as 70, as passing in your
program. Now imagine yourself saying, “I’ll study this material until I know it well enough to
make 75.” In many courses of study, a grade of 75 is acceptable; a deficiency in the student’s
knowledge of subject matter is unlikely to cause harm to someone else.
In an allied health course, however, the
implications of “just passing” are much more
serious. Any gaps in your knowledge and
For Discussion and Reflection performance of skills can affect every patient
1. Explain the importance of setting high served. Do you want your future services to
standards for yourself as a student and patients to be of “just passing” quality? Or do
as a health care professional. you wish to give the very best service you can
2. Tell about a time you felt proud of give? If your educational program is prepar-
something you worked hard to ing you to provide health services, can you
accomplish. What made your be content to learn only 70 percent of what
accomplishment so satisfying? your teachers expect you to learn? Can you
be content to develop your skills just enough
to get a passing grade in a laboratory course?
Chapter 1: Challenges and Responsibilities of Health Care Professionals 7
Of course, you won’t earn perfect scores on every assignment or test, nor should you
expect to. Grades can be viewed as feedback from your instructor about what material
you have mastered and what you need to review. Make it a habit to look back over your
graded tests and assignments to see which topics you need to revisit. If you are uncertain,
ask your instructor to discuss the test or assignment with you, not in an effort to raise your
grade, but in order to increase your understanding and skills. The mark of a good student
is not someone who receives a high score every time, but rather someone who uses each
assignment, especially difficult ones, as an opportunity to learn more.
Practicing Habits That Lead to Success

In setting standards for achievement, plan to do your best, rather than trying to be the best
student in the class. How can you do your best? Develop a study routine and establish the
habits that work best for you. To get started, consider the following guidelines:
●● Tell family and friends that you have set aside a certain time of day as your study period.
Do not allow them to violate your schedule by interrupting you unless there is an
emergency.
●● At the beginning of each study period, write out a list of specific things you need to
complete; then rank the items in order of importance. Complete task #1 (most important)
first, and then move on to task #2. If one of the tasks is something you dislike but must
get done, let it be task #1 so that you get it out of the way.
●● If your list of study assignments is too long to complete today, set up tomorrow’s list
so today’s remaining assignments come first; then put the items on that list out of your
mind until tomorrow and give your full
attention to today’s list.
●● Set up a calendar or special notebook For Discussion and Reflection
for assignments, due dates for projects What study techniques have been most
or reports, and test dates. Note on your effective for you in the past? What
calendar the dates/times you will work on challenges do you foresee in creating a
specific assignments or study for a test. study routine?
By planning, you can avoid last-minute
rushes to meet a deadline.
Practicing Empowerment
Adults should control most aspects of their lives. During adolescence, learning to make deci-
sions is an important developmental task. If you entered adulthood with a tendency to let
your parents, spouse, friends, or anyone else make decisions for you, it is time to recognize
that you are giving away your power—the power to be a self-reliant, responsible adult.
When you are planning to eat out with a friend, who decides which restaurant? Do you
usually say, “Oh, I don’t care—you choose”? Does your significant other give you a choice?
If you do not participate in small decisions that affect you, how can you expect others to
include you in big decisions?
How does empowerment affect you? Suppose you have informed the family that your
study hour will begin at 9:00 each evening. During the second day of this plan, your
teenager calls you to the phone at 9:15; the caller is a relative, who talks about their prob-
lems for a full half hour. Two days later, your 10-year-old opens the door at 9:30 and says,
“I need a note for my teacher about the field trip next Monday.” Each time you permit
these violations of your study hour, you are giving away your power. You gave your two
children the power to interrupt your study hour. You gave your relative the power to use
30 minutes of your study time for their own purposes. You probably responded to these
requests because you are accustomed to meeting the needs of others, even if doing so
interferes with your own needs.
When you take an active role in making decisions, you are taking responsibility for your
life. If you have not been in the habit of making your own decisions, you can start claim-
ing your power by requiring others to respect your needs. For example, after informing all
members of your family that a certain time is your study time, do not permit any violations to
occur. Remind those who interrupt you that you are not available during study hour. If you
are consistent, the interruptions will eventually stop.
Then you can use the same approach with another of your needs. You may choose
to make the next decision about where to eat or which movie to see, instead of allowing
someone else to make that decision. You may wish to inform your partner or friend that
you want to be involved in any decisions that affect you. This change will not occur rapidly;
be content with small changes initially. By persisting, you will eventually gain more control
over your life. Do not be surprised if others resist your decision, especially if you are just
beginning to participate in making decisions. Give your family and friends time to accept
your change in behavior. Ideally, decision making is a give-and-take situation. Sometimes
your decision is accepted, whereas at other times another person’s decision prevails.
© areetham/Shutterstock.com
FIGURE 1-2 Empowerment contributes to patients’ self-esteem and sense of well-being.
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'C'est entendu, Monseigneur,' replied Jacqueline softly. 'I'll come to your
living-room as usual and bid you good-night after all our guests have
departed.'
Far be it from me even to hint that, as she said this, Jacqueline threw
more than a cursory glance on Gilles or on M. de Landas, for nothing could
have looked more demure, more dignified and aloof than she did at this
moment, when, having spoken, she bowed with stiff grace to the group of
gentlemen before her. And even Maître Calviac would have felt that he was
a mere bungler in the matter of bowings and scrapings if he could have seen
these gallants responding to Madame's salute; the right leg outstretched, the
left foot kept back, the hand almost touching the floor with a wide sweep of
the arm, then brought back to the lips as for an imaginary kiss.
The next moment Jacqueline had turned and presently could be seen,
still with that same stiff grace, receiving the adieux of her guardian's guests.
She held her small head very erect and with one hand plied her fan with
lazy nonchalance, whilst the other was perpetually being extended to those
whose privilege it was to kiss it.
As for the group of young gallants—well! they had the immediate future
to look forward to. True, that for the nonce they were forbidden to continue
the quarrel for fear of incurring their host's displeasure; but it was only a
matter of putting off the happy hour when one could be even with that
insolent stranger. De Landas turned with a significant gesture and a
knowing wink to his friends. After that, the small group dispersed and
ostentatiously mingled with the rest of the departing crowd.
D'Inchy, before he left Gilles' side, managed to murmur fulsome

apologies.
'I do assure Monseigneur,' he whispered earnestly in Gilles' ear, 'that

these young jackanapes will not be tempted to repeat their impudence, and
that I...'
'And that you, Messire,' broke in Gilles a little impatiently, 'are entirely
innocent of any intention of offending me. That is, of course, understood.
Believe me,' he added gaily, 'that the little incident was more than welcome
as far as I am concerned. Your lavish hospitality had made us all drowsy. M.
de Landas' aggressive temper brought life and animation into the
entertainment. I, for one, am grateful to him for the episode.'
Five minutes later he too had taken leave of his host. Jacqueline he did
not see again. She was entirely surrounded by friends. Nevertheless, he left
the banqueting hall in a state of exhilaration, and as he passed through the
doors between the rows of Monseigneur's obsequious serving-men, they all
remarked that Monsieur le Prince de Froidmont was humming a lively tune,
the words of which appeared to be:
'Les plis de sa robe pourprée

Et son teint au vostre pareil!'
CHAPTER XI
AND HOW IT ENDED
When Gilles de Crohin found himself alone with Maître Jehan in the
corridor which led straight to the main entrance hall, he paused for a
moment, irresolute, wondering what he had best do. That there had been
murder in the eyes of that gallant Marquis de Landas no one could doubt for
a moment, and there lay a long stretch of dark streets and narrow lanes
between the Archiepiscopal Palace and the safe shelter of 'Les Trois Rois.'
But you cannot imagine Messire Gilles de Crohin quaking even for a
moment at the thought.
'Careful we must be,' he said in a whisper to his faithful alter ego; 'for
my choleric friend will not, I imagine, be above lying in wait for us within
the shelter of a convenient doorway, and I should ill serve the cause of the
Queen of Navarre by getting spiked between the shoulders at such an early
stage of the proceedings. But between that and showing that gallant
Spaniard a clean pair of heels and foregoing the pleasure of threading his
mask on my blade, there is a world of difference; eh, my good Jehan?'
'Above all things,' he added to himself, under his breath, so that even
Jehan could not hear, 'I must find out whether a certain provoking glance,
which flashed from out a pair of the most adorable blue eyes I have ever
seen, were intended for me or not.'
And his thoughts flew riotously back to Jacqueline—Jacqueline, his

dream, his tantalizing, exquisite dream—Jacqueline of the blue eyes and the
captivating mole—Jacqueline of the roguish smile and the demure glance.
'I wonder, now!' he murmured softly. Had she perchance meant to give
him a hint? Had she thrown him a warning glance? Gilles just then could
have sworn that she had done both when she spoke of Monseigneur's living-
room, where she would sit prattling after the last of the guests had departed.
'Did she mean me to take refuge there against de Landas' murderous

intentions?' he asked himself. But the supposition did not appear likely.
Gilles was no coxcomb and had not had many dealings with women during
the course of his chequered career; but he had an innate respect for them,
and would not credit Jacqueline—proud, demure, stately Jacqueline—with
the intention of offering a gratuitous rendezvous to an unknown gallant.
Rather was her glance intended for de Landas—the assignation was for
him: 'perhaps,' thought Messire Gilles with a vague stirring of hope in his
heart, 'perhaps with a view to keeping that fiery lover of hers out of harm's
way, till I myself was safely abed.'
Be that as it may, the most elementary dictates of prudence demanded

that he should go back to his hostelry before his enemies had time to
concoct any definite plans for his undoing. So, calling to Jehan to follow
him, he found his way quickly out of the Palace.
It was raining heavily just then; the streets were dark and, after a while,
quite deserted. Gilles and Jehan, keeping a sharp look-out around them,
walked rapidly and kept to the middle of the streets. Fortunately for them
both, they had had plenty of leisure in the last four days to wander through
the intricate by-ways of the Flemish city. They knew the lay of the land
pretty well by now, and at this moment when the thought of a possible guet-
apens was foremost in their minds, they were able to outwit any potential
assassin who might be lurking on the direct route by going to the hostelry
along devious ways usually unfrequented by strangers.
Thus it took them nearly half an hour to reach 'Les Trois Rois,' and
Jehan, for one, was heartily congratulating himself that those murderous
gentlemen had been comfortably thrown off the scent and were mayhap
cooling their tempers somewhere in the cold and the wet, when, just as they
entered the porch of the hostelry, a shadowy figure detached itself from out
the gloom.
Gilles was already prepared with a quick, 'Qui va là?' but the figure
proved inoffensive-looking enough: a woman, wrapped in a mantle and
hood from head to foot. She had a small roll of paper in her hand, and this
she held out timidly to Gilles.
'Monseigneur le Prince de Froidmont?' she inquired under her breath.
'Myself,' replied Gilles curtly. 'What is it?'
He took the paper and unrolled it. By the light of a small lanthorn which
hung just inside the porch he saw that it was a letter—just a few lines—
written in a small, pointed hand, and signed with the letter 'J.'
'Jacqueline!' he murmured, bewildered—so dazed that it took him some

time before he was able to read. At last he deciphered the brief message.
'I do entreat you, Mesire,' it ran, 'to return to the palace within the
hour. Nay! I do not entreat, I command! Go to the postern Gate: you
will find it unlatched. Then cross the Courtyard till you come to a
door on the left of the main Perron—this will be unlocked. You will
find yourself in one of the chief Corridors which give on the grand
Staircase. Remain there concealed, and await further Orders.'
A strange enough missive, of a truth, and one, no doubt, which would

have made an older and more prudent man pause ere he embarked on so
dubious an adventure. But Gilles de Crohin was neither old nor prudent,
and he was already up to his neck in a sea of adventure which had begun to
submerge his reason. Even before he had folded up the paper again and
slipped it into the inner pocket of his doublet, he had made up his mind that
no power on earth, no wisdom or warning, would deter him from keeping
the tryst. Did I think to remind you that he was no coxcomb? Well! he
certainly was absolutely free from personal vanity, and it was not his self-
conceit which was stimulated by the mysterious message; rather was it his
passion for adventure, his love for the unforeseen, the unexpected, the
exhilarating. The paper which he hid so tenderly inside his doublet had a
delicious crisp sound about it, which seemed to promise something
stimulating and exciting to come.
'Run up, Jehan,' he called to his man. 'I follow you. Let me get out of
these damnable slashed and puffed rags—these velvet shoes and futile
furbelows. Up, man! I follow in a trice! We have not done with adventure
yet to-night.'
Then he turned, with a piece of silver in his hand ready to reward the
bearer of such joyful tidings. But the messenger had disappeared into the
night as quietly, as mysteriously as she had come.
II
Less than half an hour later, Gilles de Crohin once more found himself
within the precincts of the Archiepiscopal Palace. He had been so quick in
changing his clothes and so quick in covering the distance which separated
him from the trysting place, that he had no occasion to use the postern gate
or the small door which had been indicated to him. The great entrance
portals were still wide open when he arrived; some of the corridors still
thronged with people—guests of Monseigneur and their servants on the
point of departure—whilst others appeared entirely deserted. At one point,
Gilles caught sight of M. de Landas taking elaborate leave of a group of
ladies. He had his usual circle of friends around him, who—a moment or
two later—followed him out of the Palace.
Gilles, with Jehan close behind him, kept well within the shadows, away
from the throng. He had exchanged his elaborate and rich costume for a suit
that was both plain and sombre; he had washed the perfume out of his hair
and the cosmetics from off his hands. He felt unfettered in his movements
now and in rare good humour. The only thing which he had borrowed from
his former accoutrement was the magnificent Toledo rapier, which, after a
moment's hesitation, he had buckled into his own sword-belt. It had been a
parting gift from Madame la Reyne de Navarre and was a miracle of the
steel-worker's art; supple as velvet, it would bend point to hilt like a
gleaming arc and when it caught a ray of light upon its perfect edge, it
flashed a thousand coloured rays like a streak of vivid lightning in a storm-
laden sky.
Jehan, on the other hand, was not altogether at his ease. Having less
cause to feel exhilarated, he had a greater mistrust of the mysterious
missive, had vainly tried to argue prudence where his master would only
hearken to folly. But he had never succeeded in getting beyond a laboured:
'I th-th-th-think——' Upon which, he was peremptorily ordered to hold his
tongue, even while Messire went merrily singing to face this questionable
adventure.
At one point Gilles stopped in order to speak to a serving-man, asked

him to tell him where was Monseigneur's private apartments, and when the
man appeared to hesitate—for indeed he did not like to give this
information to a stranger—Messire had seemingly lost his temper, and the
man, trembling in his shoes, had stammered out the necessary directions.
Monseigneur's private apartments and those of the household were in the
right wing of the Palace. This was reached by mounting the grand staircase,
then continuing along the main corridor which connected the different
portions of the vast building, until the wing containing the living-rooms was
reached. No one, the man went on to explain, slept in this portion of the
Palace, which held only the reception rooms and one of the chapels; but
there were always night-watchmen about the place to see that no
malefactors were about.
Whilst the man spoke, Jehan felt as if his eyes were searching him
through and through. The worthy soul was liking this adventure less and
less every moment.
Indeed, very soon after this all the corridors became deserted. Singly, in
pairs, or in groups, all Monseigneur's guests and their servants had taken
their departure. For awhile the varlets and wenches belonging to the
household were busy clearing up the disorder and the débris attendant on so
large a gathering and on so copious a supper, and one could hear them
jabbering and laughing in the distant dining hall or in the offices down
below. Then that noise, too, became stilled, and one felt that this portion of
the vast Palace was indeed completely uninhabited.
Up at the Town Hall, the belfry of Martin et Martine had just chimed the
midnight hour. Messire Gilles and his faithful Jehan found themselves in
the vast hall at the foot of the grand staircase, and the main entrance with its
monumental gates was then immediately behind them. A strange stillness
reigned all around: the great Palace seemed here like a city of the dead.
Jehan vainly tried to protest once more. For what was Messire waiting,
he wondered. Surely it was unwise and worse to linger here now, when
every one had gone and all servants were abed. Presently, of course, the
night-watchmen would be making their rounds. Jehan had a swift and
exceedingly unpleasant foreboding that he and his master would be
ignominiously turned out! and then God alone knew in what rows and
quarrels they would be involved, or how hopelessly they would jeopardize
their own position; not to speak of the Queen of Navarre's cherished
scheme. Poor Jehan would have given five years of his life and half his
savings for five minutes' glib speech with his master.
III
Even at this very moment, Jehan's vague terrors took on a definite form.
Footsteps and voices raised in merry converse were heard, resounding from
the distance, and the next instant two serving-men carrying torches came
leisurely down the corridor in the direction of the hall. Immediately behind
them walked Monseigneur the Governor, who had Madame Jacqueline on
his arm. Jehan felt as if his heart had stopped its beating; his knees shook
under him, whilst tiny drops of perspiration rose at the roots of his hair.
Ye gods! if they were discovered now! They would be under grave

suspicion of evil intent ... burglary ... assassination.... There had been talk at
the banquet of 'spy' and 'Spaniard.' Jehan's scanty hair stood up on end with
horror.
Fortunately, Messire was equally aware of danger, gave a quick glance

round, and perceived a door close beside him on the right. This part of the
hall was, equally luckily, in shadow. There was also just sufficient time to
reach the door, to open it, and to step incontinently behind it, closing it
again noiselessly. Phew! it had been a narrow escape!
The footsteps and the voices came rapidly nearer; a minute or two later
they passed within a foot of the door behind which Gilles and Jehan were
crouching, hardly daring to breathe. The glint of the torches could be
distinctly seen through a narrow chink between two panels, as well as the
shimmer of Madame's white satin gown. There were but a few inches of
wood and a foot of floor-space between Messire and shameful discovery,
and Maître Jehan fell to wondering what particular form of torture would be
applicable to a man who was found lurking at dead of night in the dark, and
with obviously evil designs on the life or property of the governor of a
Flemish province.
Thank Heaven and all the protecting angels, however, the footsteps
passed by, and presently were heard ascending the main staircase, and
whilst Maître Jehan was feeling as if his whole body would melt in a sea of
cold perspiration, Madame Jacqueline's rippling laughter came only as an
echo from a considerable and comparatively safe distance.
After awhile Gilles ventured to open the door very cautiously. A faint
murmur of people stirring came from very far away; the shuffling footsteps
of the torch-bearers died away in the distant corridors.
And once more all was still.
IV
Gilles gave vent to his feelings by a long-drawn-out 'Phew!' of obvious

relief; but the next moment he said, quite coolly:
'Pardi, my good Jehan! but we did not want to be caught hiding in this
place like a couple of malefactors, did we?' and made straightway to re-
open the door. Jehan seized him by the arm and clung to him with all his
might.
'Why shouldn't we st-st-st-stay here?' he urged almost glibly.
Gilles shrugged his shoulders. 'Why not, indeed?' he retorted. 'Something

has got to happen presently,' he added carelessly. 'Somebody has got to
come. If it is not Madame Jacqueline—and, honestly, my good Jehan, I
have small hopes of that—If it is not Madame, then——'
He paused and frowned. For the first time a sharp suspicion had crossed
his mind. Had he proved himself to be a vanity-ridden coxcomb after all?
Should not the most elementary prudence have dictated....? Bah! whatever
prudence had dictated, Gilles would not have listened. He was out for
adventure! Whether gallant or dangerous he did not care! Once more he
shrugged his broad shoulders and unconsciously his slender hand gripped
the hilt of his splendid Spanish sword.
He threw a quick glance around him. Through the open door, the huge
metal lamps which illumined the hall beyond threw a wide shaft of golden
light into the room where he and Jehan had found such welcome refuge. It
appeared to be something of a boudoir or library, for the shaft of light
revealed rows of books, which lined the walls all round. There was a
window at the far end of the room, and that was closely curtained, and there
was no other door save the one through which the two men had entered.
The fire in the large open hearth had been allowed to die down. A massive
desk stood not far from the window, and there were a few chairs about and a
small, iron-bound coffer. Papers littered the desk and a finely wrought
candelabra hung from the ceiling.
'The room,' said Gilles lightly, 'looks as if it had been closed for the
night. There is no reason why we should not await here the future course of
events.' He drew one of the chairs into a comfortable position and sat down,
then added: 'I do not know, of course, how long we may have to cool our
heels in this place, until the writer of the mysterious epistle chooses to
explain his or her commands. I am beginning to think, as you do, my friend,
that the missive should have been signed with an "L" rather than with a "J".
What say you?'
'Aye! Aye!' muttered Jehan.
'Well, 'tis no matter! I'd as soon meet mine ebullient friend of the
languorous eyes to-night as to-morrow, and inside this deserted Palace as
out there in the rain. And a little sword-play would be very stimulating after
the sentimental dalliance of the last few days.'
'H'm!' murmured Jehan equivocally.
'In the meanwhile, there is no reason why we should not have a rest. I
confess to feeling rather sleepy. Just take a last look at the corridor,'
concluded Gilles, as he stretched his long limbs out before him. 'And if you
are satisfied that all is well, come and join me in an excursion to the land of
Nod.'
Jehan went to the door as he was told and peered cautiously to right and
left of him. Seeing nothing suspicious, he went as far as the great hall to
listen if all was clear and still. It was whilst he was gone that something
arrested Gilles' attention. Furtive footsteps this time—a number of them—
moving stealthily along the corridor. With a quick gesture, he adjusted the
mask over his face—instinct led him to do that first and foremost; then he
jumped to his feet and went to the door, but had no time to step across the
threshold, for the next instant a compact group of moving figures emerged
straight in front of him out of the gloom, intercepting him and barring the
way.
'À moi, Jehan!' he called aloud.
But it was too late. From the hall beyond there came the sound of a
vigorous scuffle. Jehan, caught unawares, was putting up a good fight
seemingly against heavy odds; but he could no longer reach his master—
whilst some half-dozen gentlemen, all wearing masks, were pushing their
way into the room.
'We've run our fox to earth at last, Messeigneurs,' came with a mocking
laugh from out this dense and aggressive-looking group. 'And without
cooling our heels in the wet—what? I told you that this would be the better
plan. His own egregious vanity hath led him straight into our trap and 'tis
mighty fine sport that we'll have with this abominable spy, without fear of
interruption.'
It was the voice of M. de Landas, unmistakable owing to the slight

guttural pronunciation of the French language peculiar to his Spanish blood.
Before Gilles could forestall him, he and his friends were all around him:
six of them, fine young gallants—those who had supported de Landas in the
quarrel after the banquet.
Gilles surveyed them all with a rapid glance, measured his own position,
which of a truth was not an advantageous one. The light from the lamps in
the hall fell, through the open doorway, full upon him, whilst his aggressors
appeared only like a dense mass in the heart of the shadow. They were
evidently intent on forcing him back into the room; their movements
appeared like part of a concerted plan of action, to get him into a corner
where they could more comfortably hold him at their mercy.
Gilles realized his position, the danger in which he stood and his best
chance of defence, with the unerring rapidity of a born soldier.
'It must have taken a huge effort of intelligence, Messire,' he said

ironically, 'to concoct this pretty plan. What was there in an open challenge
to frighten so many stalwart gallants?'
He gave ground, retreated into the room while he spoke. De Landas and
his friends pressed in closely after him.
'I have yet to learn,' retorted the young Spaniard with a sneer, 'that you
are worthy of crossing swords with one of us. You may draw, an' you have a
mind; but you cannot escape the lesson which I and my friends have vowed
to administer to you, and which, forsooth, you have so richly deserved.'
''Tis no use,' he added with an intaking of the breath like an angry snake,
''Tis no use calling for help. The night-watchmen are in my pay: my own
men have settled with your servant, and no sound short of an earthquake
could reach the distant wing of the Palace where Monseigneur and his
household are abed.'
He drew his sword, and his friends immediately did likewise. Still they
advanced, the solid phalanx of them, and so cunningly that Gilles was kept
in the shaft of light whilst they remained under cover of the shadow.
'A murder!' said Gilles quietly.
'A lesson, first and foremost,' was de Landas' curt reply. 'After that, we
shall see.'
'What shall we see, Messire?' riposted Gilles with a mocking laugh. 'A
Spanish cavalier stooping to assassination——?'
'Who spoke of assassination?' queried one of the gallants.
'Why else are you here?' retorted Gilles, 'the six of you, whilst half a
dozen or more of your varlets are overpowering my man outside, after ye
have bribed or threatened the watchmen into silence? Methinks it looks
uncommonly like projected murder.'
'Whatever it is,' broke in de Landas savagely, 'it will be a lesson which

you are not like to forget.'
'The lesson of how to lay an ignoble trap for an unsuspecting foe? A
lesson, indeed, in which the teacher is well-versed in infamy. The
assignation; the forged signature! The watchmen bribed, a dozen of you to
attack two men, and, as you say, the wings of the Palace where our host and
his servants lie abed, well out of earshot. My compliments, M. de Landas! I
have met much knavery in my time, but none, I think, quite so cleverly
devised. France, it seems, hath still a great deal to learn from Spain, and
——'
He had not yet drawn in response to the other's challenge, but stepped
back and back until he was almost up against the desk at the far end of the
room. Then, suddenly, with a movement so swift that his antagonists were
taken completely unawares, he skipped behind the desk and with a push of
his strong arms threw it down straight at his assailants, forcing them in their
turn to give ground or the massive piece of furniture would have fallen on
the top of them. As it was, it came to the ground with a crash, the noise as it
fell being to a certain extent subdued by the thickness of the matting which
covered the floor.
When de Landas and his friends recovered from the suddenness of this
unexpected shock, positions for them were unpleasantly reversed. They
were now in full light, a good target for an experienced swordsman, whilst
Messire le Prince de Froidmont lurked somewhere in the shadow.
Fortunately he was comfortably outnumbered, and his henchman quite
helpless by now; to disarm him and give him the long promised
chastisement was only a question of time.
'And I have sworn,' cried de Landas spitefully, 'to deposit at Madame

Jacqueline's feet the mask which still hides his impudent face.'
Gilles, however, was determined to sell his life or his discomfiture

dearly. He had not been slow in consolidating his new position. Losing not
one second of precious time, he drew the overthrown desk close to him,
picked up a couple of chairs that were close by, then reached out for two or
three more, piled these up over and around the desk, and by the time de
Landas and his crowd had recovered their bearings and returned to the
attack, he was magnificently ensconced behind a barricade of heaped-up
furniture, and, having drawn his sword, was ready for defence.
'Now, Messeigneurs,' he said with those same mocking tones which had
already exasperated de Landas beyond endurance, 'see to it that you escape
well-merited chastisement; for, on my oath, I swear that 'tis I who will
deposit half a dozen masks at Madame Jacqueline's feet ere I give you a
chance of carrying out that nice little murder plot which was destined to
cover six stalwart seigneurs with glory.'
De Landas gave a harsh laugh.
'Your ruse will not protect you,' he said, 'though I confess 'twas well
manoeuvred. À moi, friends! 'Twill not be the first time that you have aided
me in extirpating noisome vermin from its hidden burrow. You, La Broye,
and du Prêt, hold the right; Herlaer and Maarege the left; de Borel, you and
I wherever we are needed, and en avant. At him, friends! No barricade on
earth nor protecting darkness shall save him from the punishment which he
hath so richly deserved. At him, and unmask the rogue, so that I can at last
smite the impudent spy in the face!'
De Borel, young, impetuous, a fiery nincompoop, easily led by the nose

by his more brilliant friend, was not slow in following the lead given him.
He and Herlaer made a swift rush for the improvised barricade whilst de
Landas attacked in the centre and the others, with equal vigour, both on
right and left. They thrust their swords somewhat wildly through the
interstices provided by the legs of the chairs which towered above the
overturned desk, lunged blindly into the darkness, for they could not see
their opponent. For a few minutes all was confusion—the din of clashing
steel, the hoarse cries of the assailants, and Gilles' ironical taunts as he
parried all these aimless thrusts with the coolness of a consummate
swordsman—all merged into a chaotic uproar. The next moment, however,
Herlaer went down, and then de Borel, each with a deep gash in the leg,
which had ripped up the flesh from the ankle to midway up the calf.
The front of the desk happened to be kidney-shaped, and it was through

the aperture formed by that front as it lay on its beam end that Gilles' sword
had suddenly darted out once and then again, like some vicious snake, with
maddening rapidity and stealth, inflicting the sharp flesh wounds which had
so disconcerted his assailants. They, entirely taken unawares, irritated by
this attack from a wholly unforeseen quarter, not only fell back with some
precipitancy, but also with a marked cooling off of their primary ardour.
They had come straight from a festive gathering, were wearing silk hose
and low shoes of velvet, and at this moment were wishing that their ankles
had been protected by substantial leather boots. Somewhat sulkily they set
to to staunch their wounds with their lace-edged handkerchiefs. De Landas
watched them with a scowl, giving the while a short respite to his opponent
—the latter, of a truth, well ensconced behind his barricades, was more
difficult to get at than had at first been supposed.
There ensued a hasty council of war. Herlaer, limping, was despatched

for reinforcements. The varlets who had effectually dealt with Jehan might
as well come and lend a hand to dress their masters' wounds. Jehan, indeed,
lay prone upon the flagstones of the hall, having apparently succumbed to a
blow on the head, of which one of those same varlets was even now
boasting with inordinate vainglory to his companions, when they were all
incontinently called away to attend upon the young seigneurs.
De Landas in the meanwhile had returned to the assault. Leaving Herlaer

and de Borel in the hands of their henchmen, he called the others lustily to
him.
'À moi, du Prêt, Maarege, La Broye!' he cried. 'Beware of the fox's

underground burrow, and en avant!'
He had espied the small coffer, seized it by one of its handles and
dragged it across the floor. Aided by Maarege, they succeeded in placing it
in position so as to block the aperture below the barricade. Now there was
no longer any danger from that quarter; the enemy was getting foiled at
every turn. And with renewed valour they once more rushed to the assault.
Gilles now was on his feet, ensconced in the angle of the wall, so as to
allow his sword arm full play; and indeed, in his skilful hands the
magnificent Toledo blade seemed like a living, breathing thing—a tongue
of steel which darted in and out of the improvised barricade, forward, to
right, to left, parry, en garde, thrust, lunge—out of the darkness, now and
then only catching a glint of light upon its smooth surface, when it would
flash and gleam like a streak of vivid lightning, to subside again, retire,
disappear into the gloom, only to dart out again more menacing, more
invincible than before.
And every time that this tongue of living flame shot out of the darkness
it left its searing trail behind. Maarege was bleeding from the shoulder, du
Prêt from the thigh; La Broye had a gash across the forehead, and de
Landas' forearm was torn from the wrist to the elbow. On the other hand, de
Landas' sword was also stained with blood. He gave a cry of triumph.
'À moi, de Borel! Herlaer!' he called to the other two. 'At the barricades,
while we keep the rogue busy. He cannot hold out much longer!'
And, indeed, the combat was far too unequal to last. One man against
six, and his only ally was the darkness. That too was failing him, for his
assailants' eyes were becoming accustomed to the gloom. They were able to
descry him more easily than before, and there was not a mean swordsman
amongst them, either. Even now, under cover of a vigorous onslaught made
by de Landas and his three seconds, de Borel and Herlaer—their wounds
temporarily dressed—rushed for the barricade and dragged first one chair
and then the other away, and finally succeeded in throwing the two others
right into Gilles' legs, thus hampering the freedom of his movements. True,
that during this rapidly executed manoeuvre, de Borel received a gash
across the cheek and Herlaer a thrust in the arm; but the solitary fighter's
position had been rendered decidedly more precarious.
'Throw up your hands, you fool!' exclaimed de Landas with grudging

admiration at his opponent's swordsmanship. 'Unmask, and go your way,
and we will call quits over this affair!'
Gilles' only reply to the taunt was an ironical laugh. The chairs
encumbered his legs, but his sword arm was free, and he had once been
counted the finest swordsman in France. Attack and parry again, thrust and
en garde—six blades menaced him, and he, ensconced in the dark angle,
kept the six of them at bay! Now du Prêt's sword, with a vigorous blow, was
knocked clean out of his hand; anon Maarege's blade was broken in two
close to the hilt.
Confusion now reigned supreme. Fight and excitement had whipped up
the blood of all these young gallants till a perfect fury of hatred for the
invincible opponent drew a blood-red, veil-like mist before their eyes. The
frantic desire to kill was upon them; their wounds no longer ached, their
arms felt no weariness; the breath came with a hissing sound through their
quivering nostrils. Now Maarege and La Broye succeeded in further
demolishing the barricade, dragging away the table, overthrowing the
chairs, making the way clear to right and left of these for a concerted attack
upon the foe. Gilles, quick as a bird that scents an attack, skipped over the
obstacle, darted to the right, where the curtained window was, and shadows
still hung dark, almost impenetrable.
Already he was en garde again, close to the window this time—seemed

still fresh and full of vigour though bleeding from more than one wound.
He loved this fight, as a hungry man loves the first morsel of food which a
kindly hand places before him; loved it for its excitement—one of the
keenest he had ever sustained. De Landas' fury stimulated him, maddened
jealousy was so obviously its mainspring; and Gilles felt as if he were
fighting for the possession of Jacqueline. His fine Toledo blade filled him
with joy—at this very moment it pierced de Borel's thigh as easily as it
would have done a pat of butter.
'There's for one of you!' exclaimed Gilles in triumphant exhilaration.
De Borel was now out of action, and La Broye was weakening

perceptibly; but du Fret had recovered his sword and Maarege was
brandishing the broken stump of his rapier, whilst de Landas, drunk with
jealousy and with rage, returned to the assault again and again, heedless of
his wounds. The room was a mass of wreckage. Overturned furniture,
broken débris, scraps of silken doublets and velvet mantles, shoulder knots,
tassels and bits of priceless lace, littered the floor; the matting in places
showed dark crimson stains and had become slippery under the ceaseless
tramp of feet. With his barricade all tumbled about him, Gilles was more
open to attack, for there were still four of them at least against him, and
they pressed him closely enough just now.
'At him, friends!' de Landas contrived to shout, in a voice rendered

husky with exhaustion. 'At him! The rogue is weakening rapidly! One more
effort, and we have him!'
'Nay, by God! Ye have not!' exclaimed Gilles lustily, and parried with
dazzling skill an almost simultaneous attack from de Landas and Herlaer on
one side and Maarege and du Prêt on the other. They fell on him with
redoubled energy, wellnigh frenzied by the seeming invincibility of their
foe, their own impotence. They had thought to make sure of victory, had
come in their numbers to administer humiliation and correction, and now
were half crazy with impending defeat. And so vigorous became their
attack, so determined were they to bring that hated foe to his knees, that it
seemed for the moment as if he must succumb, as if only some sort of
magic could save him.
But for a man of Gilles' temperament there could be no such thing as

defeat. Defeat for him meant humiliation, which he could not tolerate, and
the failure of Madame la Reyne's cherished plan. He was not only
defending his life now, but her schemes and her happiness. His perfect
blade accomplished miracles of defence; again and again his enemies
returned to the charge. But that blade lived; it breathed; it palpitated with
every thrust and every parry, swifter than lightning's flash. Now it was du
Prêt's turn to stagger under a slashing cut on the shoulder, whilst La Broye
was almost swooning with loss of blood.
'For two! And for three!' cried Gilles with a laugh. 'Three more of you,
and I have done!'
With a cry of rage de Landas turned to the serving-men who, appalled by

the fury of this combat, were cowering together in a far corner of the room,
hardly daring to breathe.
'Here, Jan!' he shouted hoarsely. 'Peter! Nikolas! All of you! Seize that
man! Fall on him! Seize him! At him! At him, I say!'
For just the fraction of a second the men shrank away still further into
the angle of the room, terrified at the uncontrolled rage which had prompted
the monstrous and cowardly command. They hesitated but only for one
instant, and during that instant there was breathing time for all. But the
next, egged on by de Landas' threatening commands, they gathered
themselves together and came forward at a rush.
Gilles at once saw this new, this unexpected source of danger. The utter
cowardice of this fresh attack lent him strength and power to act. With one
of those swift, masterful gestures of his which were as unexpected as they
were unerring, he threw aside his sword and seizing one of the heavy chairs
which lay prone close by, he raised it above his head and brandishing it like
a gigantic swivel he stood there, towering, menacing, breathing hatred too
now against the dastardly foe who could thus outrage every canon of
chivalry and of valour.
He struck out with the heavy chair, to right, to left. The varlets paused,
really terrified. De Landas egged them on, prodded them with his sword. He
had wandered so far now on the broad road of infamy, he was ready to go
on to its ignominious end.
'Fall on him, Jan! Nikolas! All of you, you abominable knaves!' he cried
huskily. 'Fall on him; or by Satan, I'll have you all hanged to-morrow!'
He beat them with the flat of his sword, kicked them and struck at them
with his fist, till they were forced to advance. The heavy chair came down
with a crash on the head of one man, the shoulder of another. There were
loud curses and louder groans; but numbers were telling in the end. One
more assault, one more rush, and they were on him. Then Gilles, as if by
instinct, felt the folds of the heavy window curtain behind him.
To gain one second's time, he threw the chair straight at the compact
mass of men, disconcerting the attack; then with both hands he seized the
curtain, gave it a mighty wrench which brought it down in a heaped up
medley of voluminous folds and broken cornice, and threw the whole mass
of tangled drapery on his onrushing foes. De Landas, who was in the
forefront of the aggressors, was the first to lose his footing. Already weak
with loss of blood, he stumbled and fell, dragging one or two of the varlets
with him. The edge of the cornice struck du Prêt on the head and completed
the swoon which had already been threatening him, whilst Maarege, dazed,
uncomprehending, stared about him in a state of semi-imbecility.
The other knaves, paralysed by some kind of superstitious fear, gazed on
him open-mouthed while Gilles, still moved only by the blind instinct of
self-preservation, extricated himself from his newly-improvised stronghold.
His first instinctive act was to stoop in order to pick up his sword again.
A momentary lull—strange and weird in its absolute stillness had
succeeded the wild confusion of awhile ago. Gilles staggered as he
straightened out his tall figure once more, was at last conscious that even
his splendid endurance had been nigh to breaking point. There was a mist
before his eyes, through which he could vaguely perceive a cowering group
of lacqueys quite close to him, huddled up together almost at his feet in the
gloom; others, whose vague forms could be discerned under the fallen
tapestry: further on, de Borel, lying helpless beside Herlaer; Maarege still
clutching his broken sword; La Broye in a swoon, lying across the upturned
desk, and de Landas, half-sitting, half-reclining, on an overthrown chair,
obviously struggling against dizziness, his hand outstretched, with
convulsed fingers that still threatened and pointed at the hated foe.
For the moment Gilles could not move. The mask on his face scorched
his brow and cheeks as if it had been made of hot iron, and yet, though he
longed to tear it off, his arm, from sheer exhaustion, refused him service.
He longed to get out of that door, to find Jehan; but his limbs felt as if they
were weighted with lead: his very brain was in a state of torpor.
Just then, through that semi-conscious state, he heard swift footsteps

approaching down the main staircase, then across the hall. The serving-
men, almost blind with terror, heard them too, crouched yet closer together
in the gloom. They dragged themselves along the floor, nearer to Gilles, as
if for protection. Experience had taught the poor wretches that, whatever
else happened, they would be made to suffer for all that had occurred. True,
they deserved all that they would get, for they too had played an ignoble
part; but whatever else happened there would be floggings or worse for
them. Their employers were too weak now to protect them even if they

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Alyson Honeycutt, M.A., N.C.C.

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Section I Becoming a Health Care Professional. . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Chapter 1 Challenges and Responsibilities of Health Care Professionals . . . . . . . . 3

Chapter 2 The Philosophy of Individual Worth and Equitable Care. . . . . . . . . . . . 13

Chapter 3 Self-Awareness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Section II Understanding Human Behavior. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Chapter 4 Influences on Behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Chapter 5 Physical Needs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Chapter 6 Social and Emotional Needs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

Chapter 7 Emotions and Behavior. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75

Chapter 8 Adjustment and Patterns of Behavior. . . . . . . . . . . . . . . . . . . . . . . . . . 93

Section III Behavior and Problems in Living. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105

Chapter 9 Common Threats to Adjustment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107

Chapter 10 Effects of Trauma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .123

Chapter 11 Defense Mechanisms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141

Chapter 12 Frustration and Inner Conflict. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157

Section IV Effective Human Relations and Communication. . . . . . . . . . . . . . . . . 175

Chapter 13 Effects of Illness on Behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177

Chapter 14 Human Relations and Coping with Patient Behavior. . . . . . . . . . . . . . 187

Chapter 15 Practicing Effective Communication. . . . . . . . . . . . . . . . . . . . . . . . . . 203

Section V Death and Loss. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217

Chapter 16 Grief and Loss Throughout Life. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219

Chapter 17 Death: Attitudes and Practices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237

Chapter 18 Caring for the Dying Person. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255

Section VI Trends in Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269

Chapter 19 Health Care Through the Ages. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271

Chapter 20 What Is Healing? Who Is the Healer?. . . . . . . . . . . . . . . . . . . . . . . . . 291

Chapter 21 Managing Stress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307

Section IV (chapters 13-15) explores the components of effective communication. ­Practice

Changes to the Tenth Edition

Instructor & Student Resources

Using Understanding Human Behavior

About the Author

Reviewers of the Tenth Edition

Becoming a Health Care

and satisfactions of being a health care professional. People

you will be challenged to serve each person effectively. Section I is

designed to help you become aware of the realities of a health career

and to help you learn strategies to succeed as both a student and a

health care professional.

Challenges and Responsibilities

Challenges and Satisfactions in Health Care

Approval versus Inner Satisfaction

Setting Goals for Inner Satisfaction

Setting Standards of Performance

Excellence and Patient Safety

Providing Client-Centered Care

Section IV (chapters 13-15) explores the components of effective communication. Practice

FIGURE 1-2 Empowerment contributes to patients’ self-esteem and sense of well-being.