Emedinews:Insights on Medicolegal Issues:What is poisoning from misuse of chemical products or medicines?

People who take someone else’s medicine may suffer harm if they take a medicine that is not meant for treating their condition or take the wrong dose. Women who take medicine to try to end a pregnancy are misusing the medicine and may poison themselves. Poisoning accidents can happen when safety warnings are ignored and chemicals are used in the wrong way. The following are illustrative:

• Bleach containers usually contain a warning that bleach should not be mixed with any other cleaner. If people ignore the warning and use bleach with another household cleaner, they may be poisoned by the gases given off.
• Accidental exposure to insecticides that are meant to be used on plants or buildings, may cause poisoning.
• Sometimes people poison themselves by misusing medicines. They may take more than the doctor prescribed because they think, wrongly, that a larger dose will make them better more quickly.
• Taking someone else’s medicine is also a kind of misuse.

Emedinews:Inspiration:The Gardener and his Garden

There was once an earnest gardener who loved his work and his produce. One day he was walking through his delightful garden and happened to notice a weed. The gardener was particularly tired so he decided to leave it.

The next day he had to leave to visit his relatives in another country for two weeks. When he came back, the back yard was covered in weeds and all his produce was dead!

Reflection

Likewise, if we allow just one bad thought in our head and fail to remove it, it will sprout and instead of having to pick one weed, we will have too much to control.

If we destroy our negative thoughts, by allowing positive ones to grow, they will display in our personality like a beautiful garden.

That’s the power of positive thought. We are what our thoughts are. We should always entertain only good and positive thoughts in our mind and never give way for anything negative!

Be alert and conscious of your thoughts and pick out the weeds of your negative thoughts consciously and quickly, at the right moment.

Emedinews:Insights on Medicolegal Issues:What is obsession?

Medicolegal Update
(Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)

• In obsession, the sufferer constantly entertains an idea, without cause, in spite of all his efforts to drive the idea out of his mind. Obsession is a type of compulsive phenomenon. The classical example of this condition is, a person while going to bed at night, bolts the door of the room from inside, but after going to the bed he feels the necessity to verify and does so to see if he has bolted the door or not. He repeats this act again and again, in spite of his consciousness and in spite of his desire and efforts to stop the act.
• Obsession is considered a borderline state between sanity and insanity. In the above case, a sane person will stop after repeating the act of verification for a few times. But an insane person may continue the act all throughout the night without sleeping.

Emedinews:Inspiration:The 4 Wives

There was a rich merchant who had 4 wives. He loved the 4th wife the most and adorned her with rich robes and treated her to delicacies. He took great care of her and gave her nothing but the best.

He also loved the 3rd wife very much. He was very proud of her and always wanted to show her off to his friends. However, the merchant was always in great fear that she might run away with some other men.

He loved his 2nd wife too. She was a very considerate person, always patient and in fact was the merchant's confidante. Whenever the merchant faced some problems, he always turned to his 2nd wife and she would always help him out and tide him through difficult times.

The merchant's 1st wife was a very loyal partner and had made great contributions in maintaining his wealth and business as well as taking care of the household. However, the merchant did not love the first wife and although she loved him deeply, he hardly took notice of her.

One day, the merchant fell ill. Before long, he knew that he was going to die soon. He thought of his luxurious life and told himself, "Now I have 4 wives with me. But when I die, I'll be alone. How lonely I'll be!"

Thus, he asked the 4th wife, "I loved you most, endowed you with the finest clothing and showered great care over you. Now that I'm dying, will you follow me and keep me company?" "No way!" replied the 4th wife and she walked away without another word.

The answer cut like a sharp knife right into the merchant's heart. The sad merchant then asked the 3rd wife, "I have loved you so much for all my life. Now that I'm dying, will you follow me and keep me company?" "No!" replied the 3rd wife. "Life is so good over here! I'm going to remarry when you die!" The merchant's heart sank and turned cold.

He then asked the 2nd wife, "I always turned to you for help and you've always helped me out. Now I need your help again. When I die, will you follow me and keep me company?" "I'm sorry, I can't help you out this time!" replied the 2nd wife. "At the very most, I can only send you to your grave." The answer came like a bolt of thunder and the merchant was devastated.

Then a voice called out: "I'll leave with you. I'll follow you no matter where you go." The merchant looked up and there was his first wife. She was so skinny, almost like she suffered from malnutrition. Greatly grieved, the merchant said, "I should have taken much better care of you while I could have!"

Actually, we all have 4 wives in our lives

a. The 4th wife is our body. No matter how much time and effort we lavish in making it look good, it'll leave us when we die.

b. Our 3rd wife? Our possessions, status and wealth. When we die, they all go to others.

c. The 2nd wife is our family and friends. No matter how close they had been there for us when we're alive, the furthest they can stay by us is up to the grave.

d. The 1st wife is in fact our soul, often neglected in our pursuit of material, wealth and sensual pleasure.

Guess what? It is actually the only thing that follows us wherever we go. Perhaps it's a good idea to cultivate and strengthen it now rather than to wait until we're on our deathbed to lament

Emedinews:Insights on Medicolegal Issues:Surgical error death

A UK survey has suggested that the damage to underlying structures is the commonest complication for which patients successfully sue surgeons.

• The survey found that damage to veins, nerves and other underlying structures accounted for nearly one-third of 115 successful claims, with infection accounting for another 12%.
• Patients also sued successfully after they were burnt by diathermy, after spirit–based skin preparations ignited and after adverse reactions to iodine.
• Retained items and failed or delayed diagnosis accounted for 8% and 7% respectively of successful medical negligence claims.
• The retained items, which included a pair of forceps and a surgical pack after a hemorrhoid surgery occurred despite formal written procedures for swab and needle counts in operating theatres.
• The top award was for £550000 ($880000) and was allocated to relatives of a patient with a history of deep vein thrombosis and pulmonary embolism who died of an embolism four weeks after elective surgery for varicose veins. The patient had received no anticoagulant treatment until two weeks after surgery.

Emedinews:Inspiration: Growing deep and strong

One day, my mother and I were working together in the garden where we were transplanting plants for the third time.

 Grown from seed in a small container, the plants had been transferred to a larger container; then transplanted into the garden. Now, because I was moving, we were transplanting them once again.

 Inexperienced as a gardener, I turned to my green-thumbed mother. “Isn’t this bad for them?” I asked, as we dug them up and shook the dirt from the roots. “Won’t it hurt these plants, being uprooted and transplanted so many times?”

 “Oh” my mother replied. “Transplanting doesn’t hurt them. In fact, it’s good for the ones that survive. That’s how their roots grow strong. Their roots will grow deep, and they will make strong plants”.

 Often, I’ve felt like those small plants – uprooted and turned upside. Sometimes I’ve endured the change willingly, sometimes reluctantly, but usually my reaction has been a combination. Won’t this be hard on me? I ask. Wouldn’t things be better if things remained the same? That’s when I remember my mother’s words: That’s how the roots grow deep and strong.

Emedinews:Insights on Medicolegal Issues:A Doctor is neither a detective nor a curtain between injured/sick alleged criminal and police or judiciary

• The primary and absolutely transparent duty of a doctor/hospital is to provide medical services to sick and injured patient even if he may be an alleged criminal to save his health/limb and life without any discrimination.
• When medical care records are required for judicial/police investigation, they become medico–legal in nature and the same may be required to testify under oath in the court of law by treating doctor.
• The doctor should acquire the habit of making a careful note of all the facts observed by him with exact time and date.
• The doctor should examine the facts which come to his knowledge in his special capacity, draw his conclusions logically and correctly after a detailed consideration of the pros and cons of the case, and elaborate in the Court that interpretation, along with the medical grounds on which it is based.
• Presumption, assumption hypothesis, and mere conclusion on self defined interpretation is not a proof and conjecture is not evidence. The Court has no special medical knowledge. It relies on the medical witness for an opinion and expects him to assist it with his special knowledge and experience in perusal of truth.

Emedinews:Inspiration:A sweet lesson on patience

A NYC Taxi driver wrote:

I arrived at the address and honked the horn. After waiting a few minutes I honked again. Since this was going to be my last ride of my shift I thought about just driving away, but instead I put the car in park and walked up to the door and knocked.. 'Just a minute', answered a frail, elderly voice. I could hear something being dragged across the floor.

After a long pause, the door opened. A small woman in her 90s stood before me. She was wearing a print dress and a pillbox hat with a veil pinned on it, like somebody out of a 1940s movie. By her side was a small nylon suitcase. The apartment looked as if no one had lived in it for years. All the furniture was covered with sheets. There were no clocks on the walls, no knickknacks or utensils on the counters. In the corner was a cardboard box filled with photos and glassware.

'Would you carry my bag out to the car?' she said. I took the suitcase to the cab, and then returned to assist the woman.

She took my arm and we walked slowly toward the curb.

She kept thanking me for my kindness. 'It's nothing', I told her. 'I just try to treat my passengers the way I would want my mother to be treated.'

'Oh, you're such a good boy, she said. When we got in the cab, she gave me an address and then asked, 'Could you drive through downtown?'

'It's not the shortest way,' I answered quickly.

'Oh, I don't mind,' she said. 'I'm in no hurry. I'm on my way to a hospice.

I looked in the rear-view mirror. Her eyes were glistening. 'I don't have any family left,' she continued in a soft voice. ‘The doctor says I don't have very long.' I quietly reached over and shut off the meter.

'What route would you like me to take?' I asked.

For the next two hours, we drove through the city. She showed me the building where she had once worked as an elevator operator.

We drove through the neighborhood where she and her husband had lived when they were newlyweds. She had me pull up in front of a furniture warehouse that had once been a ballroom where she had gone dancing as a girl.

Sometimes she'd ask me to slow in front of a particular building or corner and would sit staring into the darkness, saying nothing.

As the first hint of sun was creasing the horizon, she suddenly said, 'I'm tired. Let's go now'.

We drove in silence to the address she had given me. It was a low building, like a small convalescent home, with a driveway that passed under a portico.

Two orderlies came out to the cab as soon as we pulled up. They were solicitous and intent, watching her every move. They must have been expecting her.

I opened the trunk and took the small suitcase to the door. The woman was already seated in a wheelchair.

'How much do I owe you?' She asked, reaching into her purse. 'Nothing,' I said

'You have to make a living,' she answered. 'There are other passengers,' I responded.

Almost without thinking, I bent and gave her a hug. She held onto me tightly.

'You gave an old woman a little moment of joy,' she said. 'Thank you.'

I squeezed her hand, and then walked into the dim morning light. Behind me, a door shut. It was the sound of the closing of a life.

I didn't pick up any more passengers that shift. I drove aimlessly lost in thought. For the rest of that day, I could hardly talk. What if that woman had gotten an angry driver, or one who was impatient to end his shift? What if I had refused to take the run, or had honked once, then driven away?

On a quick review, I don't think that I have done anything more important in my life.

We're conditioned to think that our lives revolve around great moments.

But great moments often catch us unaware-beautifully wrapped in what others may consider a small one.

Emedinews:Insights on Medicolegal Issues:What is minimally conscious state?

Minimally conscious state is distinguished from vegetative state by the partial preservation of conscious awareness.

• Some patients with severe alteration in consciousness have neurological findings that do not meet criteria for vegetative state (VS).
• These patients demonstrate some behavioral evidence of conscious awareness but remain unable to reproduce this behavior consistently the condition referred here as the minimally conscious state (MCS).
• To make the diagnosis of MCS, limited but clearly discernible evidence of self or environmental awareness must be demonstrated on a reproducible or sustained basis by one or more of behaviors like verbal yes/no responses regardless of accuracy, purposeful behavior, including movements or emotional behaviors that occur in relation to relevant environmental stimuli and are not due to reflexive activity.
• Some examples of qualifying purposeful behavior include: appropriate smiling or crying in response to the emotional but not to neutral topics, vocalizations or gestures that occur in direct response to the linguistic content, reaching for objects.

Emedinews:Inspiration:That little girl

 Have you ever not wanted to do something so badly that you would rather die than go? Well that’s how I felt about joining Madcaps and volunteering at Saint Vincent De Paul Homeless shelter.

 But now I believe that you should have an open mind to things because in the end you might just end up enjoying it.

 “It’s a waste of time”, I said when my mom told I had to join Madcaps, a mothers and daughters club assisting philanthropies, and then when she told me I had to volunteer at a homeless shelter I thought this just could not get worse.

 We got there late, of course, and walked to the dirty homeless shelter, where we saw a lady yelling at the security guard. He dealt with her and then led us to the kitchen where we ran into my five fellow Madcaps class of 2017 mothers and daughters. Since I’m usually so socially awkward I had met only one person at the pool party, earlier this year. I looked around for her but she was not there. Damn, I was alone!

 When the head of the kitchen came out and asked for 3 mothers to work outside the kitchen to clean up the plates and silverware, my mom just so happened to volunteer, leaving me to serve food with people I had never met before.

 Soon the homeless families started to walk in and a little girl, around 5 years old, walked up and pointed to the food I was handing out. I handed her the cold sandwich, wrapped in the sticky plastic, she nodded in a form of saying thanks, and then walked to join her family at the large table.

 As she walked away I thought of how much I had. I get to go to one of the top schools in San Diego, I have a great house by the water, and I have a warm meal every night. Then I thought of how little she had. She probably didn’t go to school, and this is where she sleeps and eats every day. It took that little girl to make me realize just how lucky I am.

 After that moment I had a change of heart. Now, I love Madcaps and don’t miss one meeting, I have gotten over being socially awkward and now have many friends, who I hang out with on a regular basis. And this year I am sure I will do more than the required 20 hours of philanthropies.

 I believe that if you have an open mind about things you can learn a lot about yourself and the people in your community, you can make new friends and realize just how lucky you are. I believe that if you have an open mind to things you can accomplish more and become a better rounded person. I believe you can make a difference just by doing one thing you don’t want to do.

Emedinews:Insights on Medicolegal Issues:Doctor is neither a detective nor a curtain between injured/sick alleged criminal and police or judiciary.

• The primary and absolutely transparent duty of a doctor/hospital is to provide medical services to sick and injured patient may be an alleged criminal to save his health/limb and life without any discrimination.
• When the medical care records is required for judicial/police investigation the records becomes medico–legal in nature and the same may be required to testify under oath in the court of law by treating doctor.
• The doctor should acquire the habit of making a careful note of all the facts observed by him with exact time and date.
• The doctor should examine the facts which come to his knowledge in his special medical man capacity, draw his conclusions logically and correctly after a detailed consideration of the pros and cons of the case, and elaborate in the Court that interpretation, along with the medical grounds on which it is based.
• Presumption is not proof, and conjecture is not evidence. The Court has no special medical knowledge. It relies on medical witness for an opinion and expects him to assist it with his special knowledge and experience in perusal of truth.
• Presumption, assumption hypothesis, and mere conclusion on self defined interpretation is not a proof, and conjecture is not evidence

Emedinews:Inspiration:Student Counting Apples

A teacher teaching Maths to seven-year-old Laiq asked him, “If I give you one apple and one apple and one apple, how many apples will you have?” Within a few seconds Laiq replied confidently, “Four!”

 The dismayed teacher was expecting an effortless correct answer, three. She was disappointed. “Maybe the child did not listen properly.” – she thought.

 She repeated, “Laiq, listen carefully. If I give you one apple and one apple and one apple, how many apples will you have?”

 Laiq had seen the disappointment on his teacher’s face. He calculated again on his fingers. But within him he was also searching for the answer that will make the teacher happy. His search for the answer was not for the correct one, but the one that will make his teacher happy.

 This time hesitatingly he replied, “Four.”

 The disappointment stayed on the teacher’s face. She remembered that Laiq liked strawberries. She thought maybe he doesn’t like apples and that is making him loose focus.

 This time with an exaggerated excitement and twinkling in her eyes she asked, “If I give you one strawberry and one strawberry and one strawberry, then how many you will have?”

 Seeing the teacher happy, young Laiq calculated on his fingers again. There was no pressure on him, but a little on the teacher. She wanted her new approach to succeed. With a hesitating smile young Laiq replied, “Three?”

 The teacher now had a victorious smile. Her approach had succeeded. She wanted to congratulate herself. But one last thing remained. Once again she asked him, “Now if I give you one apple and one apple and one more apple how many will you have?”

 Promptly Laiq answered, “Four!”

 The teacher was aghast. “How Laiq, how?” she demanded in a little stern and irritated voice. In a voice that was low and hesitating young Laiq replied, “Because I already have one apple in my bag.”

 When someone gives you an answer that is different from what you expect, don’t think they are wrong. There shall be an angle that you may not have thought about yet.

Emedinews:Insights on Medicolegal issues:Medicolegal cases & injury, assault and hurt in Indian law

The words injury, assault and hurt are invariably used by doctors in hospital practice and are used as synonyms. But all three have a different meaning as per law. It is defined by the Indian Penal Code as below:

• Injury: Section 44 of IPC defines injury as any harm whatever illegally caused to any person in body, mind, reputation or property.
• Assault: Section 351 of 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 of IPC defines hurt as whoever causes bodily pain, disease or infirmity to any person is said to cause hurt.

When we as doctors deal with cases of hurt/body injury, it means bodily pain, wound, disease or infirmity voluntarily caused to any person in medicolegal cases. These would include abrasions, contusions, lacerations, stab wounds, electric shock, firearm or ligatures etc. resulting in injury to the human body. The doctor who is certifying an injury report should keep in mind the Penal provisions (as below) required by police to book the case.

• Simple injury: IPC Section 323
• Simple injury caused by dangerous weapons: IPC Section 324
• Grievous injury: IPC Section 325
• Grievous injury caused by dangerous weapons: IPC Section 326
• Dangerous injury: IPC Section 307
• Injury likely to cause death: IPC Section 304
• Injury sufficient to cause death: IPC Section 302
• Causing hurt by means of poison: IPC Section 328

Emedidnews:Inspiration:Perception - The situation

In Washington, DC, at a Metro Station, on a cold January morning in 2007, this man with a violin played six Bach pieces for about 45 minutes. During that time, approximately 2,000 people went through the station, most of them on their way to work. After about 3 minutes, a middle-aged man noticed that there was a musician playing. He slowed his pace and stopped for a few seconds, and then he hurried on to meet his schedule.

About 4 minutes later:  The violinist received his first dollar. A woman threw money in the hat and, without stopping, continued to walk.

At 6 minutes: A young man leaned against the wall to listen to him, then looked at his watch and started to walk again.

At 10 minutes: A 3-year old boy stopped, but his mother tugged him along hurriedly. The kid stopped to look at the violinist again, but the mother pushed hard and the child continued to walk, turning his head the whole time. This action was repeated by several other children, but every parent - without exception - forced their children to move on quickly.

At 45 minutes: The musician played continuously. Only 6 people stopped and listened for a short while. About 20 gave money but continued to walk at their normal pace. The man collected a total of $32.

After 1 hour:  He finished playing and silence took over. No one noticed and no one applauded. There was no recognition at all.

No one knew this, but the violinist was Joshua Bell, one of the greatest musicians in the world. He played one of the most intricate pieces ever written, with a violin worth $3.5 million dollars. Two days before, Joshua Bell sold-out a theater in Boston where the seats averaged $100 each to sit and listen to him play the same music.

This is a true story. Joshua Bell, playing incognito in the D.C. Metro Station, was organized by the Washington Post as part of a social experiment about perception, taste and people's priorities.

This experiment raised several questions:

·         In a common-place environment, at an inappropriate hour, do we perceive beauty?

·         If so, do we stop to appreciate it?

·         Do we recognize talent in an unexpected context?

One possible conclusion reached from this experiment could be this: If we do not have a moment to stop and listen to one of the best musicians in the world, playing some of the finest music ever written, with one of the most beautiful instruments ever made, then how many other things are we missing as we rush through life?

(Courtesy: Maj GenVinay Malhotra and Vasudha Seth)

Emedinews:Insights on Medicolegal Issues:Sudden death due to cardiac origin–autopsy

Right coronary artery supplies blood to electrical area of heart

The most common cause of sudden cardiac death in adults over the age of 40 was coronary artery atheroma seen in postmortem examination in about 100 cases randomly selected by me in AIIMS mortuary.

• The most common finding at postmortem examination is chronic high–grade stenosis of minimum one segment of a major coronary artery, the arteries which supply the heart muscle with its blood supply.
• A significant number of cases also have an identifiable clot in a major coronary artery which causes transmural occlusion of that vessel.
• In 75 cases out of hundreds, the clots were seen in right coronary artery supplying the electrical area of heart.
• Death in these cases is thought to result from a period of transient or prolonged lack of blood supply in the muscle of the heart wall, which induces a ventricular arrhythmia/fibrillation and no changes in the myocardium are seen during postmortem examination.
• The absence of the histological signs of acute necrosis and a healed infarct are a common finding.
• Chronic high–grade stenosis causing previous episodes of ischemia and areas of focal fibrosis is seen histologically in the myocardium.
• Ventricular arrhythmias may arise from a myocardium, which has been previously scarred by episodes of ischemia.

EmedinewsInspiration:The key to happiness

By Vasudha Seth

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. 

Emedinews:Insights on medicolegal issues:Science shows innocent man hanged in famous British murder case

Michigan’s Foran’s laboratory has devised methods to extract and isolate mitochondrial DNA. His laboratory specializes in ancient and forensic DNA evidence, often working with human remains that are thousands of years old. The nearly 100–year–old microscope slide, sent to Michigan State from the Royal London Hospital Archives and Museum, is the same one the pathologist Bernard Spilsbury used to help hang Crippen in 1910. At that time forensic medicine/pathology was more primitive; Spilsbury’s testimony, identifying what he claimed was an abdominal scar consistent with Cora’s medical history, convinced the jury that these were Cora’s remains. Crippen went to the gallows insisting he was innocent. The present–day challenge: getting past the pine sap that sealed the slide and the formaldehyde used to preserve the tissue in order to examine the mitochondrial DNA that could identify Cora Crippen based on the genetic history of her maternal relatives.

Emedinews:Inspiration:I’d rather be in Hell

 When he died, Juan found himself in an exquisite place surrounded by all the comfort and beauty he had always dreamed of. A man dressed in white spoke to him: “You can have anything you want, any food, any pleasure, any diversion.”

 Delighted, Juan did everything he had dreamed of doing while alive. Then after many years of pleasure, he again searched out the man in white. “I have done everything I wanted to do. Now I need a job, so that I can feel useful.” – he said.

 “I’m sorry,” replied the man in white. “But that is the one thing I can’t give you. There is no work here.” “How awful!” said Juan angrily, “That means I’ll spend eternity bored to death! I wish I was in Hell!”

 The man in white came over to him and said softly: “And where exactly do you think you are, Sir?”

Emedinews:Insights on Medicolegal Issues:What is Forensic Thanatology?

Thanatology is the branch of science that deals with death in all its aspects. Shapiro, a well–known thanatologist defined death as the irreversible loss of the properties of living matter. However, it is difficult to appreciate his claim that this definition satisfies the practical requirements for death certification.

• Black’s law dictionary (Black 1951) in United States defines death as "The Cessation of life, the ceasing to exit", defined by physicians as total stoppage of circulation and cessation of vital functions, thereupon such as respiration and pulsation
• Section 46 IPC states that death denotes the death of a human being unless the contrary appears from the context.
• Section 2 (b) of the Registration of Births and Deaths Act defines death as Permanent disappearance of all evidence of life at any time after live birth gas taken place.

(Ref: Dr. PC Dikshit, Head (MAMC) MD LLB, Concise Textbook of Forensic Medicine & Toxicology, Peepee Publishers)

Emedinews:Inspiration:Hospital Window

Two men, both seriously ill, occupied the same hospital room. One man was allowed to sit up in his bed for an hour each afternoon to help drain the fluid from his lungs. His bed was next to the room’s only window. The other man had to spend all his time flat on his back. The men talked for hours on end. They spoke of their wives and families, their homes, their jobs, their involvement in the military service, where they had been on vacation.

Every afternoon when the man in the bed by the window could sit up, he would pass the time by describing to his roommate all the things he could see outside the window. The man in the other bed began to live for those one hour periods where his world would be broadened and enlivened by all the activity and color of the world outside.

The window overlooked a park with a lovely lake. Ducks and swans played on the water while children sailed their model boats. Young lovers walked arm in arm amidst flowers of every color and a fine view of the city skyline could be seen in the distance. As the man by the window described all this in exquisite detail, the man on the other side of the room would close his eyes and imagine the picturesque scene.

One warm afternoon the man by the window described a parade passing by. Although the other man couldn’t hear the band – he could see it. In his mind’s eye as the gentleman by the window portrayed it with descriptive words.

Days and weeks passed.

One morning, the day nurse arrived to bring water for their baths only to find the lifeless body of the man by the window, who had died peacefully in his sleep. She was saddened and called the hospital attendants to take the body away.

As soon as it seemed appropriate, the other man asked if he could be moved next to the window. The nurse was happy to make the switch, and after making sure he was comfortable, she left him alone. Slowly, painfully, he propped himself up on one elbow to take his first look at the real world outside. He strained to slowly turn to look out the window beside the bed.

It faced a blank wall. The man asked the nurse what could have compelled his deceased roommate who had described such wonderful things outside this window. The nurse responded that the man was blind and could not even see the wall. She said, “Perhaps he just wanted to encourage you.”

Source: http://academictips.org/blogs/moral-tale-hospital-window/

Emedinews:Insights on Medicolegal Issues:Immediate first aid may stop serious poisoning and may save life

If breathing and the heart stop, the person will die within a few minutes unless first aid is administered at once. Here is an action list. Start with the first step and follow each step in the order given. Act as quickly as you can, but stay calm.

• Check if the patient is conscious. If not, try to wake up the patient. Shout "Are you all right?" and gently shake the shoulders, but take care not to make any injuries worse. Pinch the skin on the neck and watch the face. A patient who is just sleeping will wake up, but an unconscious patient will not.
• Open the airway. The airway is the tube through which air passes from the mouth and nose to the lungs. If it is blocked the patient cannot breathe and air cannot get into or out of the lungs. A patient who cannot breathe will die within 4 minutes. In an unconscious patient, the tongue may block the throat and the airway.
• Make sure the airway is open and air can get down the throat. Place the patient on his/her back. Tilt the head back and lift the chin up with the finger and thumb of one hand on the bony part of the chin, while pressing the forehead back with the other hand. This will open the airway and stop the tongue blocking the throat.

·                     Check whether the patient is breathing after opening the airway; quickly check whether the patient is breathing. Look for the belly or the chest moving up and down. Feel the chest moving up and down. Feel the patient's breathe on your cheek. Listen for breath sounds. Put your ear close to the patient's mouth. Use all four checks. Remember that the chest may move up and down even when the throat is completely blocked and air cannot get to the lungs.

Emedinews:Inspiration:Are you blessed?

 If you woke up this morning with more health than illness..........you are more blessed than the millions who will not survive this week.

 If you have never experienced the danger of battle, the loneliness of imprisonment, the agony of torture, or the pangs of starvation.......you are ahead of 500 million people in the world.

 If you have food in the refrigerator, clothes on your back, a roof overhead and a place to sleep...you are richer than 75% of this world.

 If you have money in the bank, in your wallet, and spare change in a dish someplace....... you are among the top 8% of the worlds wealthy.

 If your parents are still alive and still married........you are very rare, even in the United States.

 If you hold up your head with a smile on your face and are truly thankful.....you are blessed because the majority can, but most do not.

 If you prayed yesterday and today........you are in the minority because you believe God does hear and answer prayers.

 If you can read now, you are more blessed than over two billion people in the world that cannot read at all.

Emedinews:Insights on Medicolegal Issues:World Medical Association (WMA) guidelines for medical doctors in biomedical research involving human subjects

• Doctors should abstain from engaging in research projects involving human subjects unless they are satisfied that the hazards involved are believed to be predictable. Doctors should cease any investigation if the hazards are found to outweigh the potential benefits.
• In publication of the results of his or research, the doctor is obliged to preserve the accuracy of the results. Reports of experimentation not in accordance with the principles laid down in this Declaration should not be accepted for publication.
• In any research on human beings, each potential subject must be adequately informed of the aims, methods, anticipated benefits and potential hazards of the study and the discomfort, it may entail. He or she should be informed that he or she is at liberty to abstain from participation in the study and that he or she is free to withdraw his or her consent to participation at any time. The doctor should then obtain the subject’s freely given informed consent, preferably in writing.
• When obtaining informed consent for the research project the doctor should be particularly cautious if the subject is in a dependent relationship to him or her or may consent under duress. In that case the informed consent should be obtained by a doctor who is not engaged in the investigation and who is completely independent of this official relationship.
• In case of legal incompetence, informed consent should be obtained from the legal guardian in accordance with national legislation. Where physical or mental incapacity makes it impossible to obtain informed consent, or when the subject is a minor, permission from the responsible relative replaces that of the subject in accordance with national legislation.
• The research protocol should always contain a statement of the ethical consideration involved and should indicate that the principles enunciated in the present Declaration are complied with.

(Ref: 18th World Medical Assembly, Helsinki, Finland, 1964 and revised by the 29th World Medical Assembly, Tokyo, Japan, 1975).

Emedinews:Inspiration:A Scorpion Moment

A Scorpion Moment

 There was a 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:What is medical fasting?

• Various blood tests require a fasting of up to 12–16 hours so that a baseline normalcy of blood can be established.
• The patient is asked to remain in a fasting state for medical reasons: surgery or other procedures of diagnostic or therapeutic intervention that require anesthetic. The presence of food in a person's system can cause complications when they are anesthetized; medical personnel strongly suggest that their patients fast for several hours before the procedure.
• Some animal studies show that fasting every other day while eating double the normal amount of food on non–fasting days led to better insulin control, neuronal resistance to injury and health indicators similar to mice on calorie restricted diets.
• Patient refusal of nutrition and hydration in terminal illness: "within the contexts of adequate palliative care, the refusal of food and fluids does not contribute to suffering among the terminally ill" and might actually contribute to a comfortable passage from life: "At least for some persons, starvation does correlate with reported euphoria."
• In homeopathic medicine, fasting is seen as a way of cleansing the body of toxins, dead or diseased tissues, and giving the gastrointestinal system a rest. During fasts, water, fruit and vegetable juices are usually taken on choice.

Emedinews:Inspiration:The world is a wonderful place

A true story happened in 1892 at Stanford University.

An 18-year-old student was struggling to pay his fees. He was an orphan, and not knowing where to turn for money, he came up with a bright idea. He and a friend decided to host a musical concert on campus to raise money for their education.

They reached out to the great pianist Ignacy J. Paderewski. His manager demanded a guaranteed fee of $2000 for the piano recital. A deal was struck and the boys began to work to make the concert a success.

The big day arrived. But unfortunately, they had not managed to sell enough tickets. The total collection was only $1600. Disappointed, they went to Paderewski and explained their plight. They gave him the entire $1600, plus a cheque for the balance $400. They promised to honor the cheque at the soonest possible.

“No,” said Paderewski. “This is not acceptable.” He tore up the cheque, returned the $1600 and told the two boys: “Here’s the $1600. Please deduct whatever expenses you have incurred. Keep the money you need for your fees. And just give me whatever is left”. The boys were surprised, and thanked him profusely.

It was a small act of kindness. But it clearly marked out Paderewski as a great human being.

Why should he help two people he did not even know? We all come across situations like these in our lives. And most of us only think “If I help them, what would happen to me?” The truly great people think, “If I don’t help them, what will happen to them?” They don’t do it expecting something in return. They do it because they feel it’s the right thing to do.

Paderewski later went on to become the Prime Minister of Poland. He was a great leader, but unfortunately when the World War began, Poland was ravaged. There were more than 1.5 million people starving in his country, and no money to feed them. Paderewski did not know where to turn for help. He reached out to the US Food and Relief Administration for help.

The head there was a man called Herbert Hoover — who later went on to become the US President. Hoover agreed to help and quickly shipped tons of food grains to feed the starving Polish people.

A calamity was averted. Paderewski was relieved. He decided to go across to meet Hoover and personally thank him. When Paderewski began to thank Hoover for his noble gesture, Hoover quickly interjected and said, “You shouldn’t be thanking me Mr. Prime Minister. You may not remember this, but several years ago, you helped two young students go through college. I was one of them.”

 The world is a wonderful place. What goes around comes around!

Emedinews:Insights on Medicolegal Issues:The right to refuse medical interventions - The Nancy Vehicle Accident Case

The US Supreme Court declared that artificial hydration or nutrition is no different from medicines

Nancy Cruzan, a 31–year–old woman suffered severe brain damage in a vehicular accident that placed her in a persistent vegetative state, dependent upon a feeding tube.

• After four years without improvement in her cognitive function, her family asked to have her artificial feeding and hydration stopped.
• In its decision, the United States Supreme Court recognized that competent patients have a constitutional right to refuse medical care.
• Using the Fifth Amendment’s guarantee that no person shall "be deprived of life, liberty, or property, without due process of law" the Supreme Court affirmed patients’ rights to refuse medical treatments. The Court declared that artificial hydration or nutrition is no different from other medical interventions. Although mentally incapacitated patients have the same right, the Supreme Court allowed states to impose restrictions on how explicit and specific the patient’s prior wishes had to be.
• After this court ruling, some of Cruzan’s friends provided evidence that she had previously expressed wishes that she would want artificial feedings discontinued in such a scenario. As a result of this testimony, her feedings were terminated.
• Mentally competent patients need not be terminally ill to exercise this right to refuse interventions they have the right regardless of health status.
• The right applies equally to withholding proposed treatments and to discontinuing initiated treatments.
• The right to refuse medical care does not imply a correlative right to demand treatment.

emedinews:Inspiration:The mother giraffe makes her child suffer

 The mother giraffe gives birth standing up, so the first thing that happens to a new-born giraffe is a fall of about two meters.

 Still dazed, the baby tries to stand up on its four legs, but its mother behaves very strangely: she gives the baby giraffe a gentle kick which sends it sprawling. It tries to get up and is again knocked down.

 This process is repeated several times, until the new-born giraffe is too exhausted to stand. At that point, the mother kicks it again, forcing it to get to its feet. After that, she does not push the baby giraffe over again.

 The explanation is simple: in order to survive predators, the first lesson a giraffe must learn is to get to its feet quickly.

 The mother’s apparent cruelty finds support in an Arabic proverb: “Sometimes, in order to teach something good, you have to be a little rough.”

Emedinews:Insights on Medicolegal issues:Should a doctor perform CPR in already injured chest patient?

When a person needs CPR or cardiopulmonary resuscitation, this means that he/she is unconscious, not moving and not breathing normally. If this is the case, the person is presumably in cardiac arrest or in a state that justifies cardiopulmonary resuscitation.

• If the person is awake, is breathing normally and therefore does not appear to need CPR, it would be correct that chest compressions and CPR may complicate the already damaged chest and further complicate the victim’s injuries.
• As soon as the victim becomes unconscious, is not breathing normally and now appears to need CPR, Emergency Services should be contacted and CPR should be initiated regardless of the injuries of the patient.
• If the person needs CPR, this means that they are clinically dead. If the victim does not receive CPR, they will simply graduate to permanent death.
• This is why, regardless of the chest injury, if the person is "dead" or in need of CPR, compressions are to be given per the American Heart Association (AHA) guidelines even if the complications could include those of punctured lungs, lacerated organs or bruised/punctured heart muscle. These injuries must be recorded in the clinical sheet.
• This would be based on the theory that a person in need of CPR is already dead and will not be harmed more even if there are negative side effects from providing chest compressions. If a person remains dead, surgery is not an option but if the person is resuscitated with CPR, and alive at the hospital, we have an opportunity to fix the injuries that may have been aggravated by doing CPR.

Emedinews:House of 1000 Mirrors

There was place known as the House of 1000 Mirrors.

A small, happy little dog learned of this place and decided to visit. When he arrived, he bounced happily up the stairs to the doorway of the house.

He looked through the doorway with his ears lifted high and his tail wagging as fast as it could. To his great surprise, he found himself staring at 1000 other happy little dogs with their tails wagging just as fast as his. He smiled a great smile, and was answered with 1000 great smiles just as warm and friendly. As he left the House, he thought to himself, "This is a wonderful place. I will come back and visit it often."

In this same village, another little dog, who was not quite as happy as the first one, decided to visit the house. He slowly climbed the stairs and hung his head low as he looked into the door.

When he saw the 1000 unfriendly looking dogs staring back at him, he growled at them and was horrified to see 1000 little dogs growling back at him. As he left, he thought to himself, "That is a horrible place, and I will never go back there again."

All the faces in the world are mirrors. What kind of reflections do you see in the faces of the people you meet?

Emedinews:Insights on Medicolegal Issues:Medical fasting

• Various blood tests require a fasting of up to 12–16 hours so that a baseline normalcy of blood can be established
• The patient is asked to remain in a fasting state for medical reasons: surgery or other procedures of diagnostic or therapeutic intervention that require anesthetic. The presence of food in a person's system can cause complications when they are anesthetized; medical personnel strongly suggest that their patients fast for several hours before the procedure.
• Some animal studies show that fasting every other day while eating double the normal amount of food on non–fasting days led to better insulin control, neuronal resistance to injury and health indicators similar to mice on calorie restricted diets.
• Patient refusal of nutrition and hydration in terminal illness: "within the contexts of adequate palliative care, the refusal of food and fluids does not contribute to suffering among the terminally ill" and might actually contribute to a comfortable passage from life: "At least for some persons, starvation does correlate with reported euphoria."
• In homeopathic medicine, fasting is seen as a way of cleansing the body of toxins, dead or diseased tissues, and giving the gastrointestinal system a rest. During fasts, water, fruit and vegetable juices are usually taken on choice.

Emedinews:Inspiration:Sometimes ignorance is bliss

My classmate, Susan, and I are in the middle of our thesis rewrites for Johns Hopkins University.

We only have two weeks left and we are both quite razzled at the prospect of doing more research in the remaining time.

Today Susan called me to say that she desperately needed more history about a small tribe of Native Americans that lives in the Grand Canyon. But there's only one telephone on the reservation and no one ever answers it.

As a matter of fact, the three times she visited the tribe's Visitor Center while she was on vacation, she said no one ever opened up the building.

Being a computer geek, I said, "Have you checked the Internet?"

She said, "No, what a great idea! Thanks."

I did a quick check using Excite while she used Yahoo and she was astounded at the information available about this little-known tribe.

She thanked me profusely for the tip and hung up.

Two hours later, she called me back sounding absolutely miserable.

"Susan," I said, "What's the matter?"

"Well," she said, "You're not going to believe it but they have their own Web page with all the information I could ever want about the tribe."

"That's great," I said. "What more could you ask for?"

"You don't understand," she said. "My article is about how isolated the tribe is and how their only path to the outside world is a little dirt trail up the side of the canyon!

On their Web page, they even have a scanned photo of the helicopter that brought the donated PC into the canyon."


Moral of the story: Sometimes ignorance is bliss -- especially when you're trying to finish a thesis on time.

Emedinews:Insighst on Medicolegal Issues:Preparation of MLC in injury cases

• The injuries produced by a blunt weapon on tense skin covering the bones, as on scalp, eyebrow, iliac crest, shin, perineum, knee or elbow look like incised wounds
• While preparing the MLC report, the doctor should keep in mind that he has to provide clues about the weapon used (sharp-edged or otherwise), the direction of the force, the duration of injury, and the location of the wound which may suggest mode of production i.e. suicide, accident, homicides along with whether the injury is fabricated or otherwise
• The wounds produced by a blunt weapon or by a fall on the hard surface, object, on tense structures/skin covering the bones, such as the scalp, eyebrow, iliac crest, shin, perineum, knee or elbow when the limb is flexed look like incised wound. But lacerated wounds, also called split lacerations, are caused by blunt force and create confusion in the mind of doctor, public and police official about sharp weapon.
• When the incised looking wounds are examined by doctor under magnifying lens, the edges of such wounds are found to be irregular with bruising and wounds are produced by blunt weapon.
• Neatly incised laceration is considered as incised wound and broken glass as dangerous weapon.
• An incised wound, cut, slash, and slice is a clean cut through the skin may or may not underlying tissues and structures caused by sharp edged instruments, which is longer than the depth of wound. It is produced by infliction of an object having a sharp cutting edge such as knife, razor, blade, scalpel, sword over the body.

Emedinews:Inspiration:A story of tomatoes

An unemployed man goes to try for a job with Microsoft as a cleaner. The manager there arranges for an aptitude test (Section: Floors, sweeping and cleaning).

After the test, the manager says: You will be appointed on the scale of $30 per day, let me have your e-mail address, so that I can send a form to complete and advise you where to report for work on your first day.

Taken aback, the unemployed man protests that he is neither in possession of a computer nor of an e-mail address.

To this the MS manager replies: Well, then, that really means that you virtually don't exist and can therefore hardly expect to be employed. Stunned, the man leaves.

Not knowing where to turn and only having about $10 left, he decides to buy a 10kg box of tomatoes at the supermarket.

Within less than 2 hours, he sells the tomatoes singly at 100% profit. Repeating the process several times more that day, he ends up with almost $100 before going to sleep that night. And thus it dawns on the man that he could quite easily make a living selling tomatoes. Getting up early and earlier every day and going to bed late and later, he multiplies his hoard of profits in quite a short time.

Not too long thereafter, he acquires a cart to transport several dozen boxes of tomatoes, only to have to trade it in again shortly afterwards on a pick-up truck.

By the end of the second year, he is the owner of a fleet of pick-up trucks and manages a staff of a hundred former unemployed people, all selling tomatoes.

Considering the future of his wife and children, he decides to buy some life assurance.

Calling an insurance adviser, he picks an insurance plan to fit his new circumstances. At the end of the telephone conversation, the adviser asks him for his e-mail address in order that he might forward the documentation.

When the man replies that he has no e-mail, the adviser is stunned: "What, you don't even have e-mail? How on earth have you managed to amass such wealth without the Internet, e-mail and e-commerce? Just imagine where you would have been by now, if you had been connected from the very start!"

After a moment's silence, the tomato millionaire replied: "Sure! I would have been a cleaner at Microsoft!"

Morals of the story

·         The Internet, e-mail and e-commerce do not need to rule your life.

·         If you don't have e-mail, but work hard, you can still become a millionaire.

·         Seeing that you got this story via e-mail, you're probably closer to becoming a cleaner than you are to becoming a millionaire.

·         If you do have a computer and e-mail, you're already being taken to the cleaners by Microsoft.

Emedinews:Insights on Medicolegal Issues:What is murder?

Murder is the act of killing another human being with malice, traditionally called "malice aforethought." Malice is defined as the intent to kill or to inflict bodily injury, either express or implied. If a deadly weapon is used, intent to kill will necessarily be implied by a court of law. The presumption is that if the assailant brought a deadly weapon with him/her there was intent to use the weapon. If the assailant picked up a weapon at the scene of the crime in an act of defense or in a provoked fit of rage, there might not be malice.

Murder, as defined in common law countries, is the unlawful killing of another human being with intent or malice aforethought and generally this state of mind distinguishes murder from other forms of unlawful homicide

• Manslaughter means unlawful premeditated killing of a human being by a human being.
• In the United States, the principle of dual sovereignty applies to homicide, as to other crimes. If murder is committed within the borders of a state, that state has jurisdiction.
• According to the modern Russian Criminal Code, only intentional killing of another human considered as a murder.
• In Sweden, Murder (Mord) is defined as a planned taking of life of another and is punishable with imprisonment between 10 to 18 years or life imprisonment.
• However, according to the Romanian Penal Code, a person can face a penalty ranging from 10 to 25 years or life imprisonment for murder.
• In Norway, an act of murder (mord or drap) may be either planned murder, intentional murder or murder as a result of neglect.
• Murder is defined in the New South Wales Crimes Act 1900 as follows:
• Under NSW law, the maximum penalty for murder is life imprisonment with a standard non–parole period of 20 years, or
• 25 years for the murder of a child under the age of 18 years, or police official
• In Finland, murder is defined as homicide with at least one of four aggravating factors: deliberate intent/Exceptional brutality or cruelty significantly endangering public safety Committed against a public official engaged in enforcing the law.