Emedinews:Inspiration:Acres of Diamonds

One of the most interesting Americans who lived in the 19th century was a man by the name of Russell Herman Conwell. He was born in 1843 and lived until 1925. He was a lawyer for about 15 years until he became a clergyman.
One day, a young man went to him and told him he wanted a college education but couldn't swing it financially. Dr. Conwell decided, at that moment, what his aim in life was, besides being a man of cloth - that is. He decided to build a university for unfortunate, but deserving, students. He did have a challenge, however. He would need a few million dollars to build the university. For Dr. Conwell, and anyone with real purpose in life, nothing could stand in the way of his goal.
Several years before this incident, Dr. Conwell was tremendously intrigued by a true story - with its ageless moral. The story was about a farmer who lived in Africa and through a visitor became tremendously excited about looking for diamonds. Diamonds were already discovered in abundance on the African continent and this farmer got so excited about the idea of millions of dollars worth of diamonds that he sold his farm to head out to the diamond line. He wandered all over the continent, as the years slipped by, constantly searching for diamonds, wealth, which he never found. Eventually he went completely broke and threw himself into a river and drowned.
Meanwhile, the new owner of his farm picked up an unusual looking rock about the size of a country egg and put it on his mantle as a sort of curiosity. A visitor stopped by and in viewing the rock practically went into terminal convulsions. He told the new owner of the farm that the funny looking rock on his mantle was about the biggest diamond that had ever been found. The new owner of the farm said, "Heck, the whole farm is covered with them" - and sure enough it was.
The farm turned out to be the Kimberly Diamond Mine...the richest the world has ever known. The original farmer was literally standing on "Acres of Diamonds" until he sold his farm.
Dr. Conwell learned from the story of the farmer and continued to teach it's moral. Each of us is right in the middle of our own "Acre of Diamonds", if only we would realize it and develop the ground we are standing on before charging off in search of greener pastures. Dr. Conwell told this story many times and attracted enormous audiences. He told the story long enough to have raised the money to start the college for underprivileged deserving students. In fact, he raised nearly six million dollars and the university he founded, Temple University in Philadelphia, has at least 10 degree-granting colleges and six other schools.
When Doctor Russell H. Conwell talked about each of us being right on our own "Acre of Diamonds", he meant it. This story does not get old...it will be true forever...
Opportunity does not just come along - it is there all the time - we just have to see it.

Emedinews:Insights on Medicolegal issues:Post mortem in surgical death due to alleged negligence

• Information is required before beginning the medicolegal autopsy. The patient’s notes are essential along with some other relevant information. Equally important is the attendance of clinicians at the autopsy, more indeed, in deaths associated with anesthesia. 
• Discussion among autopsy surgeon and the anesthetist may arrive at an amicable conclusion of opinion to offer the investigating authority.
• The hospital lab may be requested to retain any ante mortem blood or fluid samples sent to them so that they remain available for analytical checks, such as blood grouping in transfusion mishaps, or creative phosphokinase activity in malignant hyperthermia.
• If death is due to a disease or disability, other than that for which the operation was performed, a distinction has to be drawn between those conditions that were known before the operation was performed and those which were unexpected. Naturally, operative and anesthetic techniques may have to be modified to take account of the known adverse conditions.
• Death may occur due to failure of a surgical technique. This may be inadvertent, from a true ‘accident’ sometimes caused by unusually difficult operative circumstances, to anatomical abnormalities or even failure of equipment.
• When it is a result of error of incompetence, then a legal action for negligence may ensue and the autopsy surgeon must be even more meticulous than usual in producing a detailed and impartial report.
• When a failure of equipment may be responsible, then expert examination and advice is required. Anesthetic machines, gas supply, compatibility of connections and all the sophisticated hardware of Operation Theater must be subjected to the most rigorous inspection if a malfunction is suspected. This becomes an important concern to the autopsy surgeon, because he is responsible for the eventual decision about the cause of death.
• The risk of death from all causes cardiac arrest was the most common single mode of death, being seen on average once or twice a year in most busy operating suites even under the most careful surgical and anesthetic regimens.
• Most cardiac arrest occurs at either the start or finish of the surgical procedure. 

Emedinews: Makesure:A patient with diabetes shows deteriorating kidney function

Situation: A patient with diabetes shows deteriorating kidney function.
Reaction: Oh my God! His HbA1c is very high!
Lesson: Make sure that strict glycemic control is maintained in patients with type 2 diabetes in order to delay vascular complications.

Emedinews:Insights on Medicolegal issues:Statements made in narco test have to be corroborated by further evidence

In the United States of America, the New Jersey Supreme Court banned the use of narco analysis in Pitts. V. State for lack of scientific reliability. In India as well, the use of narcoanalysis has been questioned in courts.

The main argument against narcoanalysis is that it is an infringement of the fundamental rights under Article 20(3) of the Constitution, which provides for a privilege against self-incrimination. It violates the human rights of privacy, and the right to health.

• Narcoanalysis is a tool, which is being used by investigating agencies in criminal cases, as an interrogation technique. The scientific validity of the test has been questioned by medical professionals, ethics forum and the legal validity has also been debated in several international and national cases.
• An interview conducted while the patient is deeply sedated with medication so that inhibitions are reduced and responses will be more truthful.
• Narco-analysis is a controlled administration of intravenous hypnotic medications, which induce a sleep-like state. Barbiturates or other drugs like suxamethonium /thiopentone/sodium amytal/scopolamine called truth drugs/serum are used, especially as a means of releasing repressed feelings or thoughts however Under the influence of the drug, the accused has garbled speech and tends to talk about fantasies, and labors under delusions.
• A person may talk about a crime s/he fantasized about committing, even if they actually have not done it. Their state resembles that of a person in delirium, so these tests are cannot be treated as accurate.
• The truth serum substance, sodium pentothal is the same substance that in larger dosages is used to induce a deep coma-like state for executions by lethal injection in USA. A large dose of the drug is lethal; a test could result in coma or even death. It can be difficult to determine the correct dose of the drug.
• Narcoanalysis is an invaluable tool for investigators. Since the results of the test cannot solely be used to prove the guilt of the accused, advocates of narcoanalysis point out that it is not violate of the right against self-incrimination. Statements made under the test have to be corroborated by further evidence.

Emedinews:Makesure:An 18-year-old girl complained of purulent nasal discharge, nasal congestion, pain in the cheek and upper teeth for last 10 days. CT scan showed maxillary sinusitis.

Situation: An 18-year-old girl complained of purulent nasal discharge, nasal congestion, pain in the cheek and upper teeth for last 10 days. CT scan showed maxillary sinusitis.
Reaction: Remember to give macrolides.
Lesson: Make sure to remember that clarithromycin (macrolide) 500 mg twice-daily for 7 days is not only effective in maxillary sinusitis but also in other sinusitis.

Emedinews:Inspiration:A Wise Donkey

One day a farmer's donkey fell down into a well. The animal cried piteously for hours as the farmer tried to figure out what to do. Finally he decided the animal was old, and the well needed to be covered up anyway; it just wasn't worth it to retrieve the donkey.
He invited all his neighbors to come over and help him. They each grabbed a shovel and began to shovel dirt into the well. At first, the donkey realized what was happening and cried horribly. Then, to everyone's amazement, he quieted down. A few shovel loads later, the farmer looked down the well, and was astonished at what he saw.
As every shovel of dirt hit his back, the donkey did something amazing. He would shake it off and take a step up. As the farmer's neighbors continued to shovel dirt on top of the animal, he would shake it off and take a step up. Pretty soon, everyone was amazed, as the donkey stepped up over the edge of the well and trotted off!
Life is going to shovel dirt on you, all kinds of dirt. The trick to getting out of a hole is to shake it off and take a step up.
Each of our troubles is a stepping stone. We can get out of the deepest holes just by not stopping, never giving up!
Shake it off and take a step up!

Emedinews:Insights on Medicolegal issues:Amendments to the Transplant Act 1994 is required to enhance cadaver organ retrieval for transplantation to bridge the huge demand-supply gap.

• It should be made mandatory for hospital ICUs to declare all brain deaths and register them with an online central organ registry for better coordination of cadaver organ donation, retrieval and transplantation.
• The hospitals equipped with ventilators and artificial life support system must make mandatory effort to coordinate with organ bank and retrieve organs and the reason of failure must be documented for further review
• The concept of 'required request' required to be introduced, wherein hospitals will be allowed to ask ICU patients, whether they would be willing to donate organs
• The pool of donors, including increasing the supply of organs by widening the definition of 'near relatives' by allowing organ swaps among needy families, as well as, simplifying cadaver transplant procedures.
• The paired matching should be permitted i. e. if patient A's donor does not match A and likewise for patient B, then donor switch should be allowed, if it results in a match. Swaps or exchanges between families unable to fulfill the need of their family member in need of a transplant
• The World Medical Association also recommends that “The physician may, when the patient cannot reverse the final process of cessation of vital functions, apply such artificial means as are necessary to keep organs active for transplantation provided he acts in accordance with the laws of the country or by virtue of a formal consent given by the responsible person and provided the certification of death or the irreversibility of vital activity had been made by physicians unconnected with the transplantation and the patient receiving treatment.”
• These artificial means shall not be paid for by the donor or his relatives.
• Physicians treating the donor shall be totally independent of those treating the recipient and of the recipient himself.

Emedinews:MAkesure: A 7-month-old infant presented with grunting respiration, fever, anorexia and irritability. On chest x-ray, pneumatoceles was present.

Situation: A 7-month-old infant presented with grunting respiration, fever, anorexia and irritability. On chest x-ray, pneumatoceles was present.
Reaction: Oh my God! Why did you not start erythromycin immediately?
Lesson: Make sure to remember that erythromycin is an effective drug for Staphylococcal acquired pneumonia.

Emedinews:Inspiration:The Key to Happiness

When I was a kid, my mom would prepare special breakfast every now and then. And I remember one night in particular, after a long, hard day at work. On that evening so long ago, my mom placed a plate of eggs, sausage and extremely burned biscuits in front of my dad. I remember waiting to see if anyone noticed! Yet all my dad did was reach for his biscuit, smile at my mom and ask me how my day was at school. I don't remember what I told him that night, but I do remember watching him smear butter and jelly on that biscuit and eat every bite!

When I got up from the table that evening, I remember hearing my mom apologize to my dad for burning the biscuits. And I'll never forget what he said: Honey, I love burned biscuits.

Later that night, I went to kiss Daddy good night and I asked him if he really liked his biscuits burned.

He wrapped me in his arms and said, Your Momma put in a hard day at work today and she's real tired. And besides - a little burnt biscuit never hurt anyone! You know, life is full of imperfect things.....and imperfect people. I'm not the best at hardly anything, and I forget birthdays and anniversaries just like everyone else.

What I've learned over the years is that learning to accept each other's faults - and choosing to celebrate each other's differences - is one of the most important keys to creating a healthy, growing, and lasting relationship.

And that's my prayer for you today. That you will learn to take the good, the bad, and the
ugly parts of your life and lay them at the feet of God. Because in the end, He's the only One who will be able to give you a relationship where a burnt biscuit isn't a deal-breaker!

We could extend this to any relationship. In fact, understanding is the base of any relationship, be it a husband-wife or parent-child or friendship!

Don't put the key to your happiness in someone else's pocket - keep it in your own.

God Bless You..... now, and always....

So Please pass me a biscuit, and yes, the burnt one will do just fine!!!!

Emedinews:Insights on Medicolegal issues:The Narcoanalysis test

• The most exhausting/frustrating and laborious part of a criminal investigation is extracting information from an uncooperative alleged accused and suspects by investigators in India as well as the West. No individual should be forcibly subjected to any technique/method of interrogation in question, whether in the context of investigation in any criminal cases or otherwise.
• The narcoanalysis test began to be used with a presumption that it provides a simply, nonviolent method of finding out the truth. In a world where until quite recently, torture was employed in criminal cases, perhaps narcoanalysis is a simple, civilized way of conducting criminal investigation.
• The Supreme Court of India said that narcoanalysis, brain mapping and polygraph tests cannot be conducted on any person without their consent.
• The apex court further said the confession of guilt during the course of the tests cannot be treated as evidence in court.
• The results of narco test provided clues and did not have any evidentiary value.
• There is no scientific literature to prove truth serum works, human rights groups have held the tests to be mental torture.
• "The compulsory administration of any of these techniques is an unjustified intrusion into the mental privacy of an individual. It would also amount to 'cruel, inhuman or degrading treatment' with regard to the language of evolving international human rights norms," said a Bench comprising Chief Justice K G Balakrishnan and Justices R V Raveendran and J M Panchal.
• The police, instead of collecting real evidence, relied on these tests to spread rumours about the suspect,” said Colin Gonsalves, Supreme Court advocate and director of Human Rights Law Network. “Selective leaks were made to the media that a particular suspect has made confession during the tests.”

Emedinews:Makesure:A patient with UTI with culture report showing resistance to all bacteria developed sepsis.

Situation: A patient with UTI with culture report showing resistance to all bacteria developed sepsis.
Reaction: Oh my God! why was a cocktail of antibiotics not given?
Lesson: Make sure that all patients of UTI infected with resistant bacteria are treated with a cocktail of antibiotics.

Emedinews:Inspiration:NOTHING

Only 5% of Stanford University graduates figured it out! Answer all seven of the following questions with the same word?
1. The word has seven letters
2. Preceded God
3. Greater than God
4. More Evil than the devil
5. All poor people have it
6. Wealthy people need it.
7. If you eat it, you will die

Did you figure it out?

The Answer is:
NOTHING!
NOTHING has 7 letters.
NOTHING preceded God.
NOTHING is greater than God.
NOTHING is more Evil than the devil.
Poor people have NOTHING.
Wealthy people need NOTHING.
If you eat NOTHING, you will die

Emedinews:Insights on Medicolegal issues: Estimation of blood alcohol

• About 3-4 ml of blood is drawn as sample.
• Chemically clean evacuated tubes of 5ml should be used to collect samples.
• Tubes should be water proof /not be vulnerable to freezing; they should have labels with identification codes.
• EDTA should be used as anticoagulant. Tubes with liquid EDTA /fluoride reduce the risk of hemolysis leads to altered results
• 2ml of 5% aqueous solution of sodium citrate containing 0.2% w/v of formaldehyde or 0.5% w/v of formalin solution must be added to prevent decomposition which leads to altered results
• Plastic vacuum tubes/ Plastic vacuum gel tubes are preferred to glass tubes. If vacuum tubes are not available or tubes are opened for freely flowing samples, stoppers which do not react with blood constituents should be available.
• Special boxes for tube transfer and storage, earmarked refrigerator/ freezer must be available in hospital conducting medicolegal cases.
• About 3-4 ml of blood is taken in a sterile 5ml injection vial (properly sealed and labeled) containing about 2ml of 5% aqueous solution of sodium citrate containing 0.2% w/v of formaldehyde (or 0.5% w/v of formalin solution).
• Two approximately 1cm x 1cm size blood stains are formed on clean cotton cloth/gauze pieces and, after they are dry, they are transferred to a sterile 10ml injection vial it should be properly dried, before packing to avoid decomposition and then sealed and labeled.
• Blood stains located on the body of an uninjured person are taken by rubbing with moistened clean cotton cloth pieces, it should be properly dried, before packing to avoid decomposition and then sealed and labeled.

Emedinews:Makesure:A patient with 3 hour of developing chest pain went into acute cardiac arrest.

Situation: A patient with 3 hour of developing chest pain went into acute cardiac arrest.
Reaction: Oh my God! Why was water-soluble aspirin not given at the time of chest pain?
Lesson: Make sure that all patients with suspected MI are given water-soluble aspirin to reduce chances of death.

Emedinews:Inspiration:The Story of the One Eyed Mother

My mom only had one eye. I hated her... she was such an embarrassment... She cooked for students and teachers...to support the family. There was this one day during elementary school and my mom came. I was so embarrassed. How could she do this to me? I threw her a hateful look and ran out. The next day at school... "Your mom only has one eye?!?!"...eeeee said a friend. I wished my mom would just disappear from this world. So I said to my mom, "Mom... Why don't you have the other eye?! If you're only going to make me a laughing stock, why don't you just die?!!!"

My mom did not respond... I guess I felt a little bad, but at the same time, it felt good to think that I had said what I'd wanted to say all this time... Maybe it was because my mom hadn't punished me, but I didn't think that I had hurt her feelings very badly.

That night... I woke up, and went to the kitchen to get a glass of water. My mom was crying there, so quietly, as if she was afraid that she might wake me. I took a look at her, and then turned away. Because of the thing I had said to her earlier, there was something pinching at me in the corner of my heart. Even so, I hated my mother who was crying out of her one eye. So I told myself that I would grow up and become successful.

Then I studied real hard. I left my mother and went to Singapore to study. Then, I got married. I bought a house of my own. Then I had kids, too... Now I'm living happily as a successful man. I like it here because it's a place that doesn't remind me of my mom.

This happiness was getting bigger and bigger, when... What?! Who's this?! It was my mother...Still with her one eye. I felt as if the whole sky was falling apart on me. Even my children ran away, scared of my mom's eye. And I asked her, "Who are you?!" "I don't know you!!!" as if trying to make that real. I screamed at her, "How dare you come to my house and scare my children! GET OUT OF HERE! NOW!!!"

And to this, my mother quietly answered, "Oh, I'm so sorry. I may have gotten the wrong address," and she disappeared out of sight. Thank goodness... She doesn't recognize me. I was quite relieved. I told myself that I wasn't going to care, or think about this for the rest of my life. Then a wave of relief came upon me...

One day, a letter regarding a school reunion came to my house in Singapore. So, lying to my wife that I was going on a business trip, I went. After the reunion, I went down to the old shack that I used to call a house... Just out of curiosity

There, I found my mother fallen on the cold ground. But I did not shed a single tear. She had a piece of paper in her hand....It was a letter to me. "My son... I think my life has been long enough now... And... I won’t visit Singapore anymore. .. But would it be too much to ask if I wanted you to come visit me once in a while? I miss you so much... And I was so glad when I heard you were coming for the reunion. But I decided not to go to the school. For you... And I'm sorry that I only have one eye, and I was an embarrassment for you.

You see, when you were very little, you got into an accident, and lost your eye. As a mom, I couldn't stand watching you having to grow up with only one eye... So I gave you mine... I was so proud of my son that was seeing a whole new world for me, in my place, with that eye. I was never upset at you for anything you did.. The couple times that you were angry with me... I thought to myself, 'It's because he loves me....’ My son... Oh, my son... “I was crying out loud..., if I could turn the time back...

Pause a moment and consider your life! Be thankful of what you have today compared to many millions who do not live lives as you do!

Do spend some time in prayer for your mum out there!

Emedinews:Insights on Medicolegal issues:The name Morphine is originated from the Morpheus - the Greek God of dreams

The name Morphine is originated from the Morpheus - the Greek God of dreams

• Morphine is an alkaloid of opium. It appears as white, shining crystals, has a bitter taste and alkaline reaction.
• It is very sparingly soluble in cold water but soluble in boiling water.
• Morphine hydrochloride and morphine sulphate are medicinal preparations and morphine acetate is a non-official preparation, the dose of each being 8 to 20 mg. These salts are bitter in taste, neutral in reaction and are 5 to 8 times more powerful than opium.
• Morphine has a depressant action on the cortex; the respiratory and cough centers in the medulla are depressed but the vagus and vomiting centers are stimulated.
• The spinal cord is also stimulated. Its most outstanding effect is relief of pain, partly due to depression of the cerebral area of pain perception and partly due to its euphoric effect.

Emedinews:Makesure:A 28–year–old male presented with increased frequency and occasional blood in urine. Urine examination shows sterile pyuria

Situation: A 28–year–old male presented with increased frequency and occasional blood in urine. Urine examination shows sterile pyuria.
Reaction: Oh my God! Why didn’t you check for TB?
Lesson: Make Sure to rule out TB in patients with frequency, dysuria, hematuria. A sterile pyuria is the first clue to diagnosis.

eMedinews:Inspiration:Do good and Don't ever stop doing good, even if it's not appreciated at that time.

A woman baked bread for members of her family and an extra one for a hungry passerby. She kept the extra bread on the window-sill, for whosoever would take it away. Every day, a hunchback came and took away the bread. Instead of expressing gratitude, he muttered the following words as he went his way:

"The evil you do remains with you: The good you do, comes back to you!"

This went on, day after day. Every day, the hunchback came, picked up the bread and uttered the words: "The evil you do, remains with you: The good you do, comes back to you!" The woman felt irritated. "Not a word of gratitude," she said to herself...

"Everyday this hunch-back utters this jingle! What does he mean?

"One day, out of desperation, she decided to do away with him. "I shall get rid of this hunchback," she said. And what did she do? She added poison to the bread she prepared for him! As she was about to place it on the window sill, her hands trembled. "What is this I am doing?" she said.

Immediately she threw the bread into the fire, prepared another one and kept it on the window-sill. As usual, the hunch-back came, picked up the bread and muttered the words:

"The evil you do, remains with you: The good you do, comes back to you!"

The hunchback proceeded on his way, blissfully unaware of the war raging in the mind of the woman. everyday, as the woman placed the bread on the windowsill, she offered a prayer for her son who had gone to a distant place to seek his fortune. For many months, she had no news of him.. She prayed for his safe return.

That evening, there was a knock on the door. As she opened it, she was surprised to find her son standing in the doorway.. He had grown thin and lean. His garments were tattered and torn. He was hungry, starved and weak. As he saw his mother, he said, "Mom, it's a miracle I'm here. While I was but a mile away, I was so hungry that I collapsed. I would have died, but just then an old hunchback passed by. I begged of him for a small part of his food, and he was kind enough to give me whole bread. "As he gave it to me, he said, "This is what I eat everyday: today, I shall give it to you, for your need is greater than mine!"

"As the mother heard those words, her face turned pale and red. She leaned against the door for support. She remembered the poisoned bread that she had made that morning. Had she not burnt it in the fire, it would have been eaten by her own son, and he would have lost his life! It was then that she realized the significance of the words: "The evil you do remains with you: The good you do, comes back to you!"

Do good and Don't ever stop doing good, even if it's not appreciated at that time. 

Emedinews:Insights on Medicolegal issues:What is exhumation?

The word exhumation literally means "out of ground”. It is derived from Latin words ex meaning "out of", and humus, meaning "ground".

·         It is done in cases where there is a complaint of foul play, controversy or dispute related with any unnatural or natural death of a person or persons or if death was allegedly due to any criminal action.

·         Exhumation is necessary, when the first post-mortem was inadequate, and it is thought that a second postmortem may bring some more facts to light.

·         The dead body can only be exhumed when there is a written order from executive magistrate or Higher Court of Law of the land.

·         In case of exhumation the concerned police official should approach the appropriate government hospital in writing along with the order of exhumation to constitute a medical board of at least three qualified and experience doctors.

·         Material found in exhumation/spot and further examination should be done as per law.

·         Resting places and the norm of many cultures is that the dead should not be disturbed. However, for a variety of reasons, they are disturbed through the process of exhumation.

 

(Ref: Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology Volume 2, Number 2, July-December 2001)

Emedinews:Makesure:A patient of gross ascites presents with complaints of difficulty in breathing on lying down.

Situation: A patient of gross ascites presents with complaints of difficulty in breathing on lying down.
Reaction: Oh my God! Why did you drain so much ascitic fluid?
Lesson: Make sure, to evaluate the patient thoroughly and only moderately tap the ascitic fluid since over-enthusiastic tapping can be life-threatening.

Emedinews:Inspiration:This is Good!

The story is told of a king in Africa who had a close friend with whom he grew up. The friend had a habit of looking at every situation that ever occurred in his life (positive or negative) and remarking, "This is good!"
One day the king and his friend were out on a hunting expedition. The friend would load and prepare the guns for the king. The friend had apparently done something wrong in preparing one of the guns, for after taking the gun from his friend, the king fired it and his thumb was blown off.

Examining the situation the friend remarked as usual, "This is good!" To which the king replied, "No, this is NOT good!" and proceeded to send his friend to jail.

About a year later, the king was hunting in an area that he should have known to stay clear of. Cannibals captured him and took them to their village. They tied his hands, stacked some wood, set up a stake and bound him to the stake. As they came near to set fire to the wood, they noticed that the king was missing a thumb. Being superstitious, they never ate anyone that was less than whole. So untying the king, they sent him on his way.

As he returned home, he was reminded of the event that had taken his thumb and felt remorse for his treatment of his friend. He went immediately to the jail to speak with his friend. "You were right," he said, "it was good that my thumb was blown off." And he proceeded to tell the friend all that had just happened. "And so I am very sorry for sending you to jail for so long.

It was bad for me to do this." "No," his friend replied, "This is good!" "What do you mean, 'This is good'? How could it be good that I sent my friend to jail for a year?" "If I had NOT been in jail, I would have been with you."

Situations may not always seem pleasant while we are in them, but the promise of God is clear. If we love Him and live our lives according to His precepts, even that which seems to be bleak and hopeless will be turned by God for His glory and our benefit. Hold on, God is faithful! May God bless you this week as you seek His will in every situation.

Emedinews:Insights on Medicolegal issues:What is an autopsy?

An autopsy, which is also known as a post-mortem examination, means the examination of the body of a dead person and is performed primarily to determine the cause of death, to identify or characterize the extent of disease states that the person may have had, or to determine whether a particular medical or surgical treatment had been effective. The postmortem examination includes external and internal cavity and viscus organ examination.

• The word autopsy is derived from the Greek word autopsia: "to see with one's own eyes."
• The doctor who conducts autopsy is an eye witness as well as an expert medical witness.
• Forensic autopsies are autopsies with legal implications and are performed to determine if death was an accident, homicide, suicide, or a natural event on inquest and request of law enforcement agency by a designated center and notified doctor.
• The Police and magistrate are empowered to order an autopsy under section 174 CrPc and 176 CrPc respectively.
• As per law, the forensic/legal autopsies are performed in India by medical doctors (minimum an MBBS); however, legal autopsy should only be conducted by a pathologist/forensic medicine expert, who has received specialty training in the diagnosis of diseases by the examination of body fluids and tissues.
• The doctor conducting autopsy in any dilemma must consult a doctor who has specialized in forensic medicine or an experienced doctor before finalizing medicolegal opinion.
• In academic institutions/hospitals, sometimes autopsies are also requested for teaching and research purposes, which is called pathological autopsy.
• Pathological autopsy is only conducted after obtaining valid informed consent of the legal heirs of deceased
• Doctor-patient confidentiality applies to autopsy examinations as to medical records of living patients. This means that doctors are not allowed to reveal the results of an autopsy examination to third parties without the permission of the legal heirs of the deceased.
• In many medical centers, the autopsy report is first submitted to the physician who treated the patient; the treating physician then shares the findings with the family.
• The legal heirs are always entitled to receive a copy of the autopsy report.
• The hospital is not allowed to give out any information about an autopsy or to respond to inquiries about an autopsy from any third parties.
• The family may choose to share the information with anyone they wish, but they must give written permission for the hospital to release autopsy records, just as with any medical records

Emedinews:Makesure:A patient missed his second dose of Hepatitis B vaccine and developed Hepatitis B.

Situation: A patient missed his second dose of Hepatitis B vaccine and developed Hepatitis B.
Reaction: Oh my God! Why was the vaccine not given between 1–2 months?
Lesson: Make sure that all patients who missed their second dose of vaccine at one month are given the same up to second month (1–2 months).

Emedinews:Inspiration:Live and Work

Father was a hardworking man who delivered bread as a living to support his wife and three children. He spent all his evenings after work attending classes, hoping to improve himself so that he could one day find a better paying job. Except for Sundays, Father hardly ate a meal together with his family. He worked and studied very hard because he wanted to provide his family with the best money could buy.

Whenever the family complained that he was not spending enough time with them, he reasoned that he was doing all this for them. But he often yearned to spend more time with his family. The day came when the examination results were announced. To his joy, Father passed, and with distinctions too! Soon after, he was offered a good job as a senior supervisor which paid handsomely.

Like a dream come true, Father could now afford to provide his family with life’s little luxuries like nice clothing, fine food and vacation abroad. However, the family still did not get to see father for most of the week. He continued to work very hard, hoping to be promoted to the position of manager. In fact, to make himself a worthily candidate for the promotion, he enrolled for another course in the open university.

Again, whenever the family complained that he was not spending enough time with them, he reasoned that he was doing all this for them. But he often yearned to spend more time with his family. Father’s hard work paid off and he was promoted. Jubilantly, he decided to hire a maid to relieve his wife from her domestic tasks. He also felt that their three-room flat was no longer big enough, it would be nice for his family to be able to enjoy the facilities and comfort of a condominium. Having experienced the rewards of his hard work many times before, Father resolved to further his studies and work at being promoted again. The family still did not get to see much of him. In fact, sometimes Father had to work on Sundays entertaining clients. Again, whenever the family complained that he was not spending enough time with them, he reasoned that he was doing all this for them. But he often yearned to spend more time with his family.

As expected, Father’s hard work paid off again and he bought a beautiful condominium overlooking the coast of Singapore. On the first Sunday evening at their new home, Father declared to his family that he decided not to take anymore courses or pursue any more promotions. From now on he was going to devote more time to his family.

Father did not wake up the next day.

Emedinews:Insights on Medicolegal issues:The implied duty of doctor is not the guarantee of cure but to treat the case with diligence and skill

In the Connecticut court focused on the word “ordinary”. A physician and surgeon, in the performance of his professional duties, is liable for injuries resulting from the want of ordinary diligence, care and skill.... "Ordinary" means usual, common....If in the performance of any operation there was a want of ordinary diligence, care, and skill, or if there was carelessness, then the defendant-physician is liable.

·         The implied contract of a physician or surgeon is not to cure...but to treat the case with diligence and skill. The question is...whethe^r the doctor had employed such skill and diligence as are ordinarily exercised in his profession.... The rule [is] to be reasonable....The law demands...not extraordinary skill such as belongs only to a few men of rare genius and endowments, but that degree which ordinarily characterizes the profession.

·         In 1860, the Supreme Court of Illinois issued its first decision on what constitutes the standard of care of a medical physician. The lawsuit claimed that a physician, who incidentally was represented by a then-practicing attorney named Abraham Lincoln, had been negligent for improperly applying a cast to treat a wrist fracture that had been sustained by the plaintiff. The court declared.

·         When a person assumes the profession of physician and surgeon, he must...be held to employ a reasonable amount of skill and care. For anything short of that degree of skill in his practice, the law will hold him responsible for any injury which may result from its absence.

·         While he is not required to possess the highest order of qualification, to which men attain, still he must possess and exercise that degree of skill which is ordinarily possessed by members of the profession. And whether the injury results from a want of skill or the want of its application, he will, in either case, be equally liable.

Emedinews:Makesure:A child with sore throat and the large lymph nodes developed fever.

Situation: A child with sore throat and the large lymph nodes developed fever.
Reaction: Oh my God! Why were antibiotics not given in time?
Lesson: Make Sure that all children with sore throat and enlarged lymph nodes are given antibiotics as such sore throats are streptococcal unless proved otherwise.

Emedinews:Inspiration:The Sacrifice Flower

My mother, who was a Native American, taught me all kinds of wonderful ways to pray when I was a child. A very special one was the Sacrifice Flower prayer, which she adapted from the heritage of her people, the Seneca Iroquois.

She taught me to say this prayer when I was feeling low or had a burden I wanted to be lifted. Later, I learned to use it for happy occasions and when I had a special request I wanted to make of God. Like all mothers, she could always tell when something was bothering me. She’d say to me, “All right, Jo, I think it’s time you went outside and find yourself a Sacrifice Flower. It’s time you get your burden lifted from your heart and give it to God.

So, I’d go looking for a flower. Sometimes Mother would go out with me to help me with my flower or talk about what was bothering me. Sometimes, too, she had something weighing on her heart and she would find a Sacrifice Flower of her own.

The flower was supposed to be special, one that meant a lot to me. As a girl, I picked dandelions, hollyhocks, and daises. So, I usually picked one of them. In addition, Mother said I was to be very careful with the flower because it had been selected for a holy purpose. I lovingly cupped it in my hands so nothing would happen to it.

When I got home, I did as my mother instructed and told the flower what burden I wanted lifted and taken to God. How was the flower to do this? Remember, this was a Sacrifice Flower, one that was going to die. The idea was that as life went out of the flower, it would carry my prayer to God.

That meant, of course, the flower was not to be placed in water. I had a shelf in my room that I liked to use for my Sacrifice Flower because it was sort of private and yet I could see it as I went in and out.

Every time I saw the flower, I could see it giving its life for me and I could imagine my prayer being carried to the Lord. That was true even when I was elsewhere and was just thinking about the flower. Either way, I had a strong sense my prayer was being heard. My flower and I were in union.

Sometimes it took a few days, sometimes a couple of weeks. When the flower finally died, I would take it outside, say goodbye to it, and thank it for giving its life for me and for delivering my prayer. Then I would bury it so it would have a chance at a new life, and I always hoped it would come back as an even nicer flower.

In this simple, graphic way my mother taught me how uplifting prayer can be. And, in the process, she taught me about life, too–how basic both dying and rising are to living and how important it is that we become Sacrifice Flowers for each other.

Padma Shri Awardee Dr KK Aggarwal on Delhi Govt plans big in the 12th 5 year plan 2012-17_1-2.mp3

Stay Tuned with Padma Shri Awardee Dr KK Aggarwal on Delhi Govt plans big in the 12th 5 year plan 2012-17_1-2.mp3

Emedinews:Insights on Medicolegal issues:Section 320 Indian Penal Code - Grievous injury

1. Emasculation - It means depriving a male of masculine power.
2. Permanent privation of sight of either eye - The gravity lies in the permanency because it deprives a person the use of the organ of sight.
3. Permanent privation of the hearing of either ear - It deprives a man of his sense of hearing. Injury to the tympanum or auditory nerve or by thrusting something into the ear which causes deafness.
4. Privation of any member or joint - The term ‘member’ means an organ or a limb being part of man capable of performing a distinct function. It includes, nose, mouth, hands, feet, phalanges etc.
5. Destruction or permanent impairing of the powers of any member or joint: The use of limbs and joints of body are essential to the discharge of the normal functions of the body. Their deprivation causes lifelong crippling and makes the person defenseless and miserable.
6. Permanent disfiguration of the head or face - The word ‘disfigure’ here means to cause some external injuries, which detract from his personal appearance but does not weaken him
7. Fracture or dislocation of a bone or tooth - It is not necessary that a bone should be cut through and through cut should be up to the medulla. If there is a break by cutting or splintering of the bone or there is a rupture or fissure in it, it would amount to a fracture but the doctor must document the dimension of fracture and duration/age correlation with age of injury. Dislocation means displacement. Mere looseness of teeth will not amount to dislocation. It has to prove that the tooth was originally not loose and that there was fracture or dislocation by the injury.
8. Any hurt which endangers life or which causes the victim to be in severe bodily pain or unable to follow his ordinary pursuits for a period of 20 days - A wound may cause intense pain, prolonged disease or long lasting body injury but does not fall under any of the seven clauses. A body injury/beating may not mutilate the sufferer or fracture his bones but may be so harsh and painful may cause even death. The eighth clause provides for such hurts. Under this, three different clauses of hurt are included. These are:
• Any hurt which endangers life
• Any hurt which causes the victim to be in severe bodily pain for a period of 20 days
• Any hurt which prevents the victim from following his ordinary pursuits for a period of 20 days

Emedinews:Makesure:A patient presents with recurrent scaling and itching of the scalp not responding to antikeratolytic agents.

Situation: A patient presents with recurrent scaling and itching of the scalp not responding to antikeratolytic agents.
Reaction: Oh my God! I forgot to prescribe antifungal agents.
Lesson: Make sure that patients with dandruff and seborrheic dermatitis are prescribed antifungal medications. Recent studies implicate pityrosporium yeast infection as the underlying cause.

Emedinews:Inspiration:Two large water pots-One with a crack in it

A water bearer had two large pots, each hung on the ends of a pole which he carried across his neck.

One of the pots had a crack in it, while the other pot was perfect and always delivered a full portion of water. At the end of the long walk from the stream to the house, the cracked pot arrived only half full. For a full two years this went on daily, with the bearer delivering only one and a half pots full of water to his house. Of course, the perfect pot was proud of its accomplishments, perfect for which it was made. But the poor cracked pot was ashamed of its own imperfection, and miserable that it was able to accomplish only half of what it had been made to do.

After two years of what it perceived to be a bitter failure, it spoke to the water bearer one day by the stream. "I am ashamed of myself, and because this crack in my side causes water to leak out all the way back to your house."

The bearer said to the pot, "Did you notice that there were flowers only on your side of the path, but not on the other pot's side? That's because I have always known about your flaw, and I planted flower seeds on your side of the path, and every day while we walk back, you've watered them. For two years I have been able to pick these beautiful flowers to decorate the table. Without you being just the way you are, there would not be this beauty to grace the house."

Moral: Each of us has our own unique flaws. We're all cracked pots. But it's the cracks and flaws we each have that make our lives together so very interesting and rewarding. You've just got to take each person for what they are, and look for the good in them.

Emedinews:Insights on Medicolegal issues:The extent and severity of violence used is determined from the size and swelling of bruise

• The doctor must document in medicolegal report the dimension /shape/size of the bruise because it may connect the victim and the object or weapon used in the specific case, e.g., chain, cane stick, rifle butt, boots, ligature, vehicle etc.
• The age of injury can be detected by the status of color of bruise, the extent and severity of violence or force used may be determined from the size and swelling of bruise, character and manner of the injury may be known from its distribution over the body.
• Bruising of the arm may indicate restraining the person. Bruising of the shoulder blades indicates firm pressure on the body against the ground or other resisting surface. In manual strangulation, the position and number of bruises nail marks may give an indication on the method of attack and the position of the assailant.
• The pattern bruises on chest/neck and mouth is also very important in diagnosing resuscitative injury in medicolegal cases which are invariably confused by doctor as manual strangulation/smothering.
• Pattern bruise is an important tool for diagnosing torture injury and very commonly appreciated in sole/flexor aspect of hands/buttock and back of thighs by doctors.

Emedinews:Makesure:A patient developed high altitude cerebral edema while traveling to Leh

Situation: A patient developed high altitude cerebral edema while traveling to Leh.
Reaction: Oh my God! Why was acetazolamide not started before the journey?
Lesson: Make sure all high risk patients are given acetazolamide before they travel to mountains.

Emedinews:Inspiration:The Scorpion and the Old Man

There was this old man who saw a scorpion floundering around in the water. He decided to save it by stretching out his finger, but the scorpion stung him. The man still tried to get the scorpion out of the water, but the scorpion stung him again.
A man nearby told him to stop saving the scorpion that kept stinging him.
But the man said: "It is the nature of the scorpion to sting. It is my nature to love. Why should I give up my nature to love just because it is the nature of the scorpion to sting?"
Don't give up loving. Don't give up your goodness. Even if people around you sting.

Emedinews:Insights on Medicolegal issues:The duration of abrasion is roughly estimated as fresh when it is bright red

Mechanical momentum means mass with velocity discharged into the human body by a moving object or weapon or the impact of moving body against a surface produces injuries over the body. In the first case, the counter force is provided by the body and in the second case, by the rigidity of the object / weapon / surface / wall against which the victim falls itself or forced to fall by external reason. In most cases it is seen that the mechanical injuries produced over the body are due to a combination of two above forces.

An abrasion is one of the most superficial injuries and means destruction of the superficial layers of the skin, caused by fall on a rough surface, by being dragged by a vehicular accident. According to the pattern of its causing force, abrasions are termed as scratches, grazes, pressure, impact or imprint abrasions. The duration of abrasion is roughly estimated as fresh when it is bright Red /½ day – 1day – Bright scab (covering) 2-3days – Reddish Brown covering and on 7th day - Almost normal.

• Abrasions give an idea about the site of impact and direction of the force.
• Often, they may be the only external signs of a serious internal injury.
• Patterned abrasions are helpful in connecting the wound with the object which produced them.
• The age of the injury can be determined, which helps to corroborate with the alleged time of assault
• In throttling cases, crescent abrasions due to fingernails are found in the neck; however, in smothering, abrasions may be seen around the mouth or nose.
• In open wounds, dirt, dust, grease, sand are usually present, which may connect the injuries to the scene of crime? Character and manner of the injury may be known from its distribution.
o in throttling cases, crescent abrasions due to fingernails are found in the neck
o In smothering, abrasions may be seen around the mouth or nose.
o In sexual assaults, abrasions may be found on the breasts, genitals, inside of the thighs, and around the anus.
o Abrasions around the face of the assailant indicate a struggle.
o Abrasions on the victim may show whether the fingernails of the assailant were long, irregular or even broken.

Emedinews:Makesure:A patient died after receiving penicillin injection.

Situation: A patient died after receiving penicillin injection.
Reaction: Oh my God! Why was anaphylaxis not suspected?
Lesson: Make sure that every time a patient is given penicillin injection, anti anaphylaxis measures are available.

emedinews:Inspiration:It is more blessed to give than to receive

A young man, a student in one of our universities, was one day taking a walk with a professor, who was commonly called the students' friend, from his kindness to those who waited on his instructions.

As they went along, they saw lying in the path a pair of old shoes, which they supposed to belong to a poor man who was employed in a field close by, and who had nearly finished his day's work.

The student turned to the professor, saying: "Let us play the man a trick: we will hide his shoes, and conceal ourselves behind those bushes, and wait to see his perplexity when he cannot find them." "My young friend," answered the professor, "we should never amuse ourselves at the expense someone. But you are rich, and may give yourself a much greater pleasure by means of the poor man. Put a coin into each shoe, and then we will hide ourselves and watch how the discovery affects him." The student did so, and they both placed themselves behind the bushes close by. The poor man soon finished his work, and came across the field to the path where he had left his coat and shoes.

While putting on his coat he slipped his foot into one of his shoes; but feeling something hard, he stooped down to feel what it was, and found the coin. Astonishment and wonder were seen upon his countenance. He gazed upon the coin, turned it round, and looked at it again and again. He then looked around him on all sides, but no person was to be seen.

He now put the money into his pocket, and proceeded to put on the other shoe; but his surprise was doubled on finding the other coin. His feelings overcame him; he fell upon his knees, looked up to heaven and uttered aloud a fervent thanksgiving, in which he spoke of his wife, sick and helpless, and his children without bread, whom the timely bounty, from some unknown hand, would save from perishing.

The student stood there deeply affected, and his eyes filled with tears. "Now," said the professor, "are you not much better pleased than if you had played your intended trick?"

The youth replied, "You have taught me a lesson which I will never forget. I feel now the truth of those words, which I never understood before: 'It is more blessed to give than to receive.'"

Emedinews:Insights on Medicolegal issues:What is WMA Statement on In–Vitro Fertilization and Embryo Transplantation?

The WMA urges physicians to act ethically and with appropriate respect for the health of the prospective mother and for the embryo from the beginning of life. To assist physicians in recognizing and following their ethical obligations, the WMA has promulgated this statement. From the ethical and scientific viewpoint, medical assistance in human reproduction is justified in all cases of infertility which do not respond to classical drug or surgical treatment with specific reference to: Immunological incompatibility, Irreversible obstacle to contact between male and female gametes, Infertility for unknown cause.

• In all these cases, the physician can only act with the full informed consent of donors and recipients.

• The physician must always act in the best interest of the child to be born of the procedure.

• It is the physician’s responsibility to provide the patients, at their own level of comprehension, with sufficient information about the purpose, methods, risks, inconveniences and disappointments of the procedure, and to obtain from the patients their informed consent to the procedure.

• As in any type of elective procedure, the physician must have adequate specialized training before undertaking the responsibility of performing the procedure.

• The physician must always comply with all applicable laws and regulations as well as the ethical requirements and the professional standards established by the National Medical Association and other appropriate medical organizations in the community. The patients are entitled to the same confidentiality and privacy as is required with any medical treatment.

When IVF techniques produce excess ova which will not be utilized for the immediate treatment of sterility, their use must be determined in agreement with the donors; excess ova can be:

• Destroyed

• Cryopreserved

• Fertilized and cryopreserved

(Adopted by the 39th World Medical Assembly Madrid, Spain, October 1987)

DMC order

Order DMC/DC/F.14/Comp.631/2010/ 12th April, 2010

The Delhi Medical Council examined a complaint of P K alleging professional misconduct/medical negligence on the part of JMH in the treatment administered to the complainant. The Council observes that the patient reported to JAH on 30th October, 2009 with complaint of Lt. Abdominal pain radiating to back, sweating and was found to have tachycardia and increased systolic blood pressure reading. In addition to differential diagnosis of renal colic, pain of cardiac origin was suspected. Patient was given ICU care and ECG and cardiac enzymes were investigated. Trop–T test was done to exclude cardiac (coronary) disease. As patient stayed in the hospital only for four hours and left against medical advise (LAMA), there is no question of medical negligence, otherwise it is presumed that the patient would have been further investigated and managed. Pain of renal origin and pain of cardiac original were differential diagnosis and patient was not neglected and investigated reasonably. In light of the above, prima facie, no case of medical negligence or professional misconduct is made out against the doctors.

Emedinews:Makesure:A patient with LBBB in ECG developed acute pulmonary edema.

Situation: A patient with LBBB in ECG developed acute pulmonary edema.
Reaction: Oh my God! Why was underlying low cardiac functions not suspected?
Lesson: Make sure all patients with LBB undergo echo to rule out ejection fraction. This may not be true for RBBB.

Emedinews:Inspiration:The Special One

A well-known speaker started off his seminar by holding up a $20 bill. In the room of 200, he asked. "Who would like this $20 bill?" Hands started going up. He said: "I am going to give this $20 to one of you - but first, let me do this."

He proceeded to crumple the 20-dollars note up. He then asked. "Who still wants it?" Still the hands were up in the air. "Well," he replied, "what if I do this?" He dropped it on the ground and started to grind it into the floor with his shoe. He picked it up, now crumpled and dirty. "Now, who still wants it?" Still the hands went into the air. "My friends, you have all learned a very valuable lesson. No matter what I did to the money, you still wanted it because it did not decrease in value. It was still worth $20.

Many times in our lives, we are dropped, crumpled, and ground into the dirt, by the decisions we make and the circumstances that come our way. We feel as though we are worthless, but no matter what happened or what will happen. You will never lose your value. Dirty or clean, crumpled or finely creased, you are still priceless to those who love you.

The worth of our lives comes, not in what we do or who we know, but by ...WHO WE ARE. YOU ARE SPECIAL - don't ever forget it."

Emedinews:Insights on Medicolegal issues:The doctor is not required to make speculation about weapon of offence in a MLC Case the weapon are simple other than defined weapon as dangerous in Indian law.

·    The Section 324 of IPC states that any instruments for shooting, stabbing, cutting or any instruments used as weapons of offence is likely to cause death or by means of fire or any heated substance or by means of poison or any corrosive substance or by means of any explosive or by means of any substance which is deleterious to the human body to inhale, to swallow, or to receive into the blood or by means of any animal. These all will be taken as dangerous weapons.

·         The duty of the attending doctor is to record all the injuries, its dimension as far as possible, and the body parts where the injuries are located the nature of injury whether simple or grievous, caused by sharp/blunt object, age or duration of injury and with the vital parameters like blood pressure, pulse respiration with the mental status

·         When an investing officer came in hospital he needs some specific answer for his legal investigation and to book a case under law of land

·         The injuries present could be a self-inflicted or fabricated one? if yes please mention the forensic justification

• Is there any signs, symptoms or smell of alcohol or any drug intoxication? If yes please opine about his mental status due the influence of intoxication, please also preserve the sample of blood.
• Please opine the injured or intoxicated patient is fit for obtaining his statement? If no please give duly reasons and an approximate time interval for medical revaluation for his/her fitness for statement.
• Is the condition of patient is critical, severe or serious? If so the dying declaration must be recorded by attending doctor before one or two witness. 

Emedinews:Makesure:A patient on 10 units of insulin developed hypoglycemia with 11 units of insulin

Situation: A patient on 10 units of insulin developed hypoglycemia with 11 units of insulin
Reaction: Oh My God! Why was additional insulin given?
Lesson: Make sure that insulin dose is calculated correctly. The formula is 1500/total daily dose. The value will be the amount of sugar fluctuation with one unit of insulin.

Emedinews:Inspiration:The Rose

Lifestyle is style over amount. And style is an art - the art of living. You can't buy style with money. You can't buy good taste with money. You can only buy more with money. Lifestyle is culture - the appreciation of good music, dance, art, sculpture, literature, plays and the art of living well. It's a taste for the fine, the unique, the beautiful.

Lifestyle also means rewarding excellence wherever you find it by not taking the small things of life for granted. With Valentine's Day approaching I wanted to illustrate this with a personal anecdote:

Many years ago my lady friend and I were on a trip to Carmel, California for some shopping and exploring. On the way we stopped at a service station. As soon as we parked our car in front of the pumps, a young man, about eighteen or nineteen, came bouncing out to the car and with a big smile said, "Can I help you?"

"Yes," I answered. "A full tank of gas, please." I wasn't prepared for what followed. In this day and age of self-service and deteriorating customer treatment, this young man checked every tire, washed every window - even the sunroof - singing and whistling the whole time. We couldn't believe both the quality of service and his upbeat attitude about his work.

When he brought the bill I said to the young man, "Hey, you really have taken good care of us. I appreciate it." He replied, "I really enjoy working. It's fun for me and I get to meet nice people like you." This kid was really something! I said, "We're on our way to Carmel and we want to get some milkshakes. Can you tell us where we can find the nearest Baskin-Robbins?"

"Baskin-Robbins is just a few blocks away," he said as he gave us exact directions. Then he added, "Don't park out front - park around to the side so your car won't get sideswiped." What a kid!

As we got to the ice cream store we ordered milkshakes, except that instead of two, we ordered three. Then we drove back to the station. Our young friend dashed out to greet us. "Hey, I see you got your milkshakes." "Yes, and this one is for you!" His mouth fell open. "For me?" "Sure. With all the fantastic service you gave us, I couldn't leave you out of the milkshake deal." "Wow!" was his astonished reply. As we drove off I could see him in my rear-view mirror just standing there, grinning from ear to ear.

Now, what did this little act of generosity cost me? Only about two dollars - you see, it's not the money, it's the style. Well, I must have been feeling especially creative that day, so on our arrival in Carmel I drove directly to a flower shop. As we walked inside I said to the florist, "I need a long-stemmed rose for my lady to carry while we go shopping in Carmel." The florist, a rather unromantic type, replied, "We sell them by the dozen." "I don't need a dozen," I said, "just one." "Well," he replied haughtily, "it will cost you two dollars." "Wonderful," I exclaimed. "There's nothing worse than a cheap rose."

Selecting the rose with some deliberation, I handed it to my friend. She was so impressed! And the cost? Two dollars. Just two dollars. A bit later she looked up and said, "Jim, I must be the only woman in Carmel today carrying a rose." And I believe she probably was. Can you imagine the opportunity to create magic with those around you, and all for the cost of a few dollars, some imagination and care. Remember, it is not the amount that matters but the thought and care that often has the greatest impact upon those you love.

Emedinews:Insights on Medicolegal issues: Fracture of bone–Grievous injury

The certification of grievous injury on the basis of fracture of bone is done by doctors in accordance with Section 320 IPC, which lists the injuries that are called grievous injury.
• The medical dictionary meaning of the word ‘fracture’ is breaking of a part, especially the bone or break or rupture in the bone or in continuity of a bone This definition is appropriate for the radiologist or orthopedician, but not for the purpose of certifying an injury as grievous since in many cases in legal scrutiny it has been found that the fracture reported by radiologists were tentative, superficial, fabricated or self-inflicted, hardly 1 mm deep cut in the bone or mere a ponding effect on bone with no medical or surgical complication.
• It is important for the doctor to understand that a tentative fracture medically/clinically non-significant/uncomplicated/invented by modern scan methods cannot be certified as grievous injury.
• A mere superficial cut and scratch on bone may not be grievous because the meaning of grievous is.. threatening great harm; "a dangerous operation"; "a grave situation"; "a grave illness"; "grievous bodily harm"; "a serious wound"; "a serious turn of events"; "a severe case of wound or a life–threatening disease
• It must be remembered that the cutting of a bone does not necessarily involve a fracture of that bone. In a criminal revision at the Patna High Court, in which one individual received an incised wound, 3" × 3 ¼" × 1", on the lower part of the left leg cutting the bone underneath, it was held that where the evidence was merely that the bone had been cut and there was nothing whatever to indicate the extent of the cut, whether deep or a mere scratch upon the surface, it was impossible to infer from that evidence alone that grievous hurt had been caused within the meaning of the definition of section 320, IPC.
• The supreme court in its judgment, in one case, had clarified that until and unless such a cut on bone does not extend deep up to the medullary cavity it will not constitute a grievous hurt within the definition of fracture under section 320(7) of Indian Penal Code.
• In case of hurt it is the Court that judges finally whether the injury is simple or grievous. The duty of the medical witness is only to describe the facts and not classify a hurt. The entry made in the wound certificate as simple or grievous is only meant to guide the investigating officer

Emedinews:Inspiration:The Making of a Champion

I have often thought about Muhammad Ali's fight against George Foreman in October of '74. Hyped as "The Rumble in the Jungle," it's a lesson of how to win in life. The Muhammad Ali story is a victory that people still talk about to this day. In the city of Kinshasa, Zaire, Ali faced George Foreman, the reigning world heavyweight champion. Foreman dominated the ring, winning 37 of his 40 bouts by knockout. Weeks before the fight, Ali had captured the heart of the Zaire people when he cast Foreman as a brute. Foreman, never the showman Ali was, believed his record would speak for itself.
Considered one of the hardest hitters in the history of boxing, Foreman punched his way through the early rounds with little resistance from Ali.
Muhammad ducked the worst of his punches, leaning against the ropes, protecting his face with his elbows, a technique that later came to be known as "rope-a-dope." This technique served to lessen the effect of Foreman's punches. The tactic continued throughout the seventh round. Ali fans were subdued, discouraged to watch their champion do nothing to defend himself. Ali provoked the raging Foreman with sarcastic jabs, taunting him, "Is that all you got George? and You supposed to be bad!" Foreman let loose his rage, landing tremendous body shots, determined to make Ali pay a price for his antics.
No one knew it at the time, not his trainer Angelo Dundee, or us, his devoted fans, but Muhammad Ali had a plan that was secretly unfolding before our eyes. I remember that day, although I don't recall seeing the fight until years later, rebroadcast on the Sports Channel, but in my heart I was there, sitting ringside, lamenting my hero.
Ali knew Foreman relied on phenomenal strength to overpower an opponent and had rarely gone the distance. He believed that could be his Achilles heel and concluded that the only smart thing to do was wear him out. When Foreman became tired, overconfident because Ali was not fighting back, that's when he would make his move. Ali was willing to let us see him as a failure because he never saw himself that way. Isn't that the heart of a true champion? To quietly go about doing what must be done, having enough confidence in them not to feel like they need to prove anything?
Although I believe failure was never an option in Ali's mind, he was willing to be seen as one, willing to be put under the microscope in front of the whole world. How many of us would be willing to be seen in this light? To be viewed as a failure before those who admire us? Ali was so sure of himself he was willing to try. Not long into the eighth round, George Foreman's energy finally spent, staggered. Ali sprang from the ropes and landed three beautifully-timed punches. Foreman twirled in a slow pirouette and fell. The fight was over.
Sometimes when we allow ourselves to be quiet about what we know and silently go about mastering our opponent, we can impart something to others. Ali did that. He was an example to each of us - willing to be seen as nothing, to become the greatest. Ali said it then, even if he didn't mean it at the time. He was the greatest. Ali didn't surrender that evening; our vision of him had. When he lifted the veil from our eyes we were filled with admiration. Perhaps he could have won that fight, as he had so many others, but that battle, the one Ali came back to win, stands out as one of his greatest. A victory like that can have such a long-lasting effect.
I think that's what each of us should do. We should never be afraid to be seen as nothing in order to become something greater than we ever imagined we could be. Remembering if we only follow our convictions, each challenge, every obstacle before us, can be overcome to impact the lives of others.

Emedinews:Makesure:A diabetic hypertensive was denied a beta–blocker because of the traditional teachings.

Situation: A diabetic hypertensive was denied a beta–blocker because of the traditional teachings.
Reaction: Oh my God! You should have used nebivolol.
Lesson: Make Sure that diabetics are not denied beta-blockers when indicated. Nebivolol has no side effect on glucose metabolism unlike atenolol.

Emedinews:Insights on Medicolegal issues:Grievous injury Section 320 Indian Penal Code

1. Emasculation: It means depriving a male of masculine power.
2. Permanent privation of sight of either eye: The gravity lies in the permanency because it deprives a person the use of the organ of sight.
3. Permanent privation of the hearing of either ear: It deprives a man of his sense of hearing. Injury to the tympanum or auditory nerve or by thrusting something into the ear which causes deafness.
4. Privation of any member or joint: The term ‘member’ means an organ or a limb being part of man capable of performing a distinct function. It includes, nose, mouth, hands, feet, phalanges etc.
5. Destruction or permanent impairing of the powers of any member or joint: the use of limbs and joints of body are essential to the discharge of the normal functions of the body. Their deprivation causes lifelong crippling and makes the person defenseless and miserable.
6. Permanent disfiguration of the head or face: The word ‘disfigure’ means to cause some external injuries which detracts from his personal appearance but does not weaken him
7. Fracture or dislocation of a bone or tooth: It is not necessary that a bone should be cut through and through cut should be up to the medulla. If there is a break by cutting or splintering of the bone or there is a rupture or fissure in it, it would amount to a fracture but the doctor must document the dimension of fracture and duration/age correlation with age of injury. Dislocation means displacement. Mere looseness of teeth will not amount to dislocation. It has to prove that the tooth was originally not loose and that there was fracture or dislocation by the injury.
8. Any hurt which endangers life or which causes the victim to be in severe bodily pain or unable to follow his ordinary pursuits for a period of 20 days: A wound may cause intense pain, prolonged disease or long lasting body injury but does not fall under any of the seven clauses. A body injury/beating may not mutilate the sufferer or fracture his bones but may be so harsh and painful may cause even death. The eighth clause provides for such hurts. Under this, three different clauses of hurt are included. These are:
• Any hurt which endangers life
• Any hurt which causes the victim to be in severe bodily pain for a period of 20 days
• Any hurt which prevents the victim from following his ordinary pursuits for a period of 20 days

Emedinews:Inspiration:The Oak and the Reeds

There is an old fable in which the mighty oak tree which stood for over one hundred years finally was blown over by a storm. The tree feel into a river that floated it downstream until it came to rest among the reeds growing along the riverbank. The fallen giant asked the reeds in amazement, "How is it that you were able to weather the storm that was too powerful for me, an oak tree, to withstand?"

The reeds replied, "All these years you stubbornly resisted the winds that swept your way. You took such pride in your strength that you refused to yield, even a little bit. We, on the other hand, have not resisted the winds, but have always bent with them. We recognized the superior power of the wind and so, the harder the wind blew the more we humbled ourselves before it."

Always remember to bend with the wind, and you won't be blown over by the storm!

Emedinews:Insights on Medicolegal issues:Law and Injury in medico legal cases

Injury, assault and hurt are terms invariable used by doctors in hospital practice, often as synonyms. But all these three words have different meaning in law. They have been defined by the Indian Penal Code as below.

·         Injury Section, 44 IPC defines injury- Any harm whatever illegally caused to any person in body, mind, reputation or property

·         Assault Section 351 IPC defines assault as an offer or threat or attempt to apply force on body of another in a hostile manner. It may be a common/simple assault or an intention to murder.

·         Hurt: Section 319 IPC defines hurt as Whoever causes bodily pain, disease or infirmity to any person is said to cause hurt.

The cases of Hurt/body injury that we as doctors we deal with mean bodily pain, wound, disease or infirmity voluntarily caused to any person in medicolegal cases. This would include abrasions, contusions, lacerations, stab wounds, electric shock, fire arm or ligatures etc resulting in human body injury. The doctor who is certifying an injury report should keep in mind the Penal provision, which is required by police to book the case e.g. Simple Injury: Section 323 IPC, Simple injury caused by dangerous weapons: Section 324 IPC, Grievous Injury: Section 325 IPC, Grievous injury caused by dangerous weapons: Section 326 IPC, Dangerous Injury: Section 307 IPC, Injury likely to cause death: Section 304 IPC, Injury sufficient to cause death: Section 302 IPC and causing hurt by means of poison: Section 328 IPC

Emedinews:Makesure: A patient with ejection fraction of 20% dies a sudden cardiac death.

Situation: A patient with ejection fraction of 20% dies a sudden cardiac death.
Reaction: Oh my God! Why was an ICD not put?
Lesson: Make sure all patients with ejection fraction less than 35% are put on ICD unless contraindicated.