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:Attitude is everything

 Jerry was the kind of guy you love to hate. He was always in a good mood and always had something positive to say. When someone would ask him how he was doing, he would reply, "If I were any better, I would be twins!"

 He was a unique manager because he had several waiters who had followed him around from restaurant to restaurant. The reason the waiters followed Jerry was because of his attitude. He was a natural motivator. If an employee was having a bad day, Jerry was there telling the employee how to look on the positive side of the situation.

 Seeing this style really made me curious, so one day I went up to Jerry and asked him, "I don't get it! You can't be a positive person all of the time.

 How do you do it?" Jerry replied, "Each morning I wake up and say to myself, 'Jerry, you have two choices today. You can choose to be in a good mood or you can choose to be in a bad mood.' I choose to be in a good mood. Each time something bad happens, I can choose to be a victim or I can choose to learn from it. I choose to learn from it. Every time someone comes to me complaining, I can choose to accept their complaining or I can point out the positive side of life. I choose the positive side of life."

 "Yeah, right, it's not that easy," I protested.

 "Yes, it is," Jerry said. "Life is all about choices. When you cut away all the junk, every situation is a choice. You choose how you react to situations. You choose how people will affect your mood. You choose to be in a good mood or bad mood. The bottom line: It's your choice how you live life."

 I reflected on what Jerry said. Soon thereafter, I left the restaurant industry to start my own business. We lost touch, but I often thought about him when I made a choice about life instead of reacting to it.

 Several years later, I heard that Jerry did something you are never supposed to do in a restaurant business: he left the back door open one morning and was held up at gunpoint by three armed robbers. While trying to open the safe, his hand, shaking from nervousness, slipped off the combination. The robbers panicked and shot him. Luckily, Jerry was found relatively quickly and rushed to the local trauma center. After 18 hours of surgery and weeks of intensive care, Jerry was released from the hospital with fragments of the bullets still in his body.

 I saw Jerry about six months after the accident. When I asked him how he was, he replied, "If I were any better, I'd be twins. Want to see my scars?" I declined to see his wounds, but did ask him what had gone through his mind as the robbery took place.

 "The first thing that went through my mind was that I should have locked the back door," Jerry replied. "Then, as I lay on the floor, I remembered that I had two choices: I could choose to live, or I could choose to die. I chose to live." "Weren't you scared? Did you lose consciousness?" I asked.

 Jerry continued, "The paramedics were great. They kept telling me I was going to be fine. But when they wheeled me into the emergency room and I saw the expressions on the faces of the doctors and nurses, I got really scared. In their eyes, I read, 'He's a dead man.' "I knew I needed to take action."

 "What did you do?" I asked. "Well, there was a big, burly nurse shouting questions at me," said Jerry. "She asked if I was allergic to anything. Yes,' I replied. The doctors and nurses stopped working as they waited for my reply. I took a deep breath and yelled, 'Bullets!' Over their laughter, I told them. 'I am choosing to live. Operate on me as if I am alive, not dead."

 Jerry lived thanks to the skill of his doctors, but also because of his amazing attitude. I learned from him that every day we have the choice to live fully. Attitude, after all, is everything.

Twenty-six percent school girls say they will never marry a smoker

In a prospective survey, conducted by Heart Care Foundation of India among school going girls, 26% girls said that they would never marry a smoker. The survey included 195 school girls, belonging to class X-A, aged 15-16 years, from 16 Convent Schools in Delhi.

Speaking on the occasion, Padma Shri and Dr. B C Roy National Awardee Dr K K Aggarwal President Heart Care Foundation of India said that 72% girls answered that if they come to know that their would-be partner was a smoker, they would insist upon the partner to stop smoking before the marriage. Only 2% said that they would agree to marry as the fact that their partner smoked did not matter to them.

None of the girls smoked cigarettes or consumed tobacco products. However, 26% were exposed to passive smoking in their house. Of these, 80% had objected about it to their family members. The remaining 20% said that though they wanted to intervene but could not because of fear.

Fifty-eight percent girls agreed that they would object if someone was smoking in public in front of them. However, 38% girls said that instead of objecting they would rather remove themselves from the smoking area and move to a non-smoking place. Only 4% girls said that they did not care if somebody around them was smoking.

Ninety-five percent girls agreed that they would not begin to smoke on peer pressure from a friend or a boyfriend, even if they insisted on a single casual cigarette smoking. But, 5% girls said that they would be willing to do so to show their friends and their boyfriends that they too were modern.

Eighty-six percent participants were convinced that smoking is injurious to health. But, 14% girls felt that smoking helps in reducing depression. Also, 2% girls said that if they see doctors smoking in public, they would change their perception that smoking is bad for the health.

Emedinews:Insights on Medicolegal Issues:Lacerated wound

The direction of the shelving of margins of a lacerated wound indicates the direction of the blow applied to cause the wound as seen in MLC cases.

• Lacerations are tears or splits of skin, mucous membranes, muscle or internal organs produced by application of blunt force to a broad area of the body, which crushes or stretches the tissues beyond the limits of their elasticity.
• Crush injury from a direct blow may produce an irregular or stellate laceration with a variable degree of devitalized tissue, abrasion and visible contamination.
• Do not close a laceration if there is visible contamination, debris, non–viable tissue or signs of infection. Wounds may involve vascular areas of the face and scalp where the risk of infection is low or extremities where infection becomes a greater risk, along with the possibility of tendon and nerve damage. The elderly and patients on chronic steroid therapy may present with "wet tissue paper" skin tears following relatively minor trauma.
• When produced by a blunt weapon, such as club, crowbar, stone, brick etc., a lacerated wound is usually accompanied by a considerable amount of bruising of the surrounding and underlying tissues, and has inverted and irregular edges. The direction of the shelving of margins of a lacerated wound indicates the direction of the blow applied to cause the wound.
• When a heavy weight such as the wheel of a heavy cart or a truck passes over an extremity, by its shearing and grinding force, it tears the skin from the underlying tissue and crushes the muscles and soft part lying beneath it realizing considerable blood and fat in them.
• Crush injury syndrome or fat emboli may follow a lacerated wound. The tear, avulsion, split are types of laceration.

Emedinews:Inspiration:A new pair of shoes

When I got sober my sponsor told me that I had to be willing to change everything about my life -- everything. So, I wore blue jeans and switched to slacks. I wore western shirts and switched to T-shirts. But the one thing I just couldn't give up was my cowboy boots.

I went to my sponsor and said, "Surely I won't get drunk over a silly pair of cowboy boots. I'm willing to change a lot of things, and if needed I could even give up those boots, but it seems so silly." My sponsor said, "I don't know how silly it is, or if you'll get drunk over those cowboy boots, but I can tell that you are not 'entirely' willing, though."

"Okay, okay," I said. "I'll prove it to you. I'll give up the boots for 30 days just to demonstrate my willingness to God." So, I bought a pair of tennis shoes, and after 30 days of not wearing my cowboy boots, wearing tennis shoes instead, the strangest thing happened -- my feet stopped hurting.

That's how it was getting sober and giving up the high life. I never stopped to think that the boots were causing my feet to hurt, or the booze was causing my life to hurt. I got willing to give up the stuff, one day at a time, for 30 days, then 60 days, then 90 days ... and my life stopped hurting.

And every day I do something different, some change in some small way. Maybe I just put my socks on different, or drive to work a new way. Every day, I try to do Little Things in a Big Way so that when Big Things happen I can handle them in a Little Way.

Preventing the recurrence of maltreatment

Be Human Stop Child Abuse (http://behumanstopchildabuse.emedinews.in/)
(Team IMA for CMAAO)

In the context of the federal child welfare performance measurement system, recurrence of maltreatment refers to circumstances in which children that have previously been substantiated as victims of abuse or neglect experience another incident of substantiated maltreatment. Multiple episodes of maltreatment can lead to: (1) more serious short and long term negative consequences (2) entry into the juvenile justice system and (3) juvenile delinquency.

(Source: Carnochan S, Rizik-Baer D, Austin MJ. J Evid Based Soc Work. 2013 May;10(3):161-178)

Emedinews:Insights on Medicolegal Issues:Abrasion injury in medicolegal cases

Mechanical momentum means mass with velocity discharged into the human body by a moving object or weapon or itself due to 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 by himself or is 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 above two forces. Abrasion is one of the most superficial injuries and involves destruction of the superficial layers of the skin, caused by fall on a rough surface, or being dragged by a vehicle. Abrasions are of different types based on the pattern of the causative force viz. scratches, grazes, pressure, impact or imprint abrasions. A doctor can help legal investigation by his evaluation and documentation of abrasions as below.

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

Emedinews:Inspiration:A most important lesson

During my second month of nursing school, our professor gave us a pop quiz. I was a conscientious student and had breezed through the questions, until I read the last one: "What is the first name of the woman who cleans the school?"

Surely, this was some kind of joke. I had seen the cleaning woman several times. She was tall, dark-haired and in her 50s, but how would I know her name? I handed in my paper, leaving the last question blank.

Just before class ended, one student asked if the last question would count toward our quiz grade."Absolutely," said the professor.

 "In your careers, you will meet many people. All are significant. They deserve your attention and care, even if all you do is smile and say 'hello'."

I've never forgotten that lesson. I also learned her name was Dorothy.

Emedinews:Inspiration:Cracked Pots

 A water bearer in China had two large pots, each hung on the ends of a pole which he carried across his neck. One pot 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 2 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, 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. 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.

 Blessings to all my crackpot friends and relatives

Emedinews:Insights on Medicolegal Issues:WMA declaration of Malta on hunger strikers – Guidelines for medical management

The doctor must assess the mental capacity of the individual. This involves verifying that an individual intending to fast does not have a mental impairment that would seriously undermine the person’s ability to make health care decisions. Individuals with seriously impaired mental capacity cannot be considered to be hunger strikers. They need to be given treatment for their mental health problems rather than allowed to fast in a manner that risks their health.

As early as possible, physicians should acquire a detailed and accurate medical history of the person who is intending to fast. The medical implications of any existing condition should be explained to the individual. Physicians should verify that hunger strikers understand the potential health consequences of fasting and forewarn them in plain language of the disadvantages. Physicians should also explain how damage to health can be minimized or delayed by, for example, increasing fluid intake. Since the person’s decisions regarding a hunger strike can be momentous, ensuring full patient understanding of the medical consequences is critical. Consistent with best practices for informed consent in health care, the physician should ensure that the patient understands the information conveyed by asking the patient to repeat back what they understand.

Emedinews:Insights on Medicolegal Issues:How will a doctor assess the severity of stab wounds by external examination?

The severity is based exclusively on the location and depth of penetration seen in autopsy.

• The important medical considerations include the type of weapon used e.g. knife length, shape, straight or serrated, and manner of assault, whether the stabbing is overhand/underhand.
• The gender of the assailant may have some importance, in that women tend to stab "overhand." Penetration tends to be deeper with the "underhand" thrust.
• Stab wounds to the chest should always be considered dangerous and likely to cause death until proven otherwise.
• Central stab wounds, below the clavicles and to either side of the breastbone means sternum, can result in penetration of the heart. Chest wounds can result in puncture and rupture of the lung or marked bleeding within the chest cavity causing hemothorax.
• Stab wounds to the abdomen will often result in an exploratory laparotomy to rule out serious damage. Slow bleeding inside the abdomen is extremely difficult to diagnose, and should be considered a possibility in every case.
• Stab wounds to the upper back can involve the lung or heart.
• Stab wounds to the lower and middle back can involve the kidneys and ureters. Evaluation of stab wounds to the back that may have punctured the kidney will require intravenous pyelography for evaluation. The presence of blood in the urinalysis indicates injury to the kidney, bladder or ureter.
• Examination for sensation, movement and pulses of the victim should be carefully done and documented in case of stab wounds to the hands/legs that do not lacerate nerves, blood vessels, or tendon structures.

Emedinews:Inspiration:The Real Pearl Necklace

 Jenny was a bright-eyed, pretty five-year-old girl. One day when she and her mother were checking out at the grocery store, Jenny saw a plastic pearl necklace priced at $2.50.

 How she wanted that necklace, and when she asked her mother if she would buy it for her, her mother said, “Well, it is a pretty necklace, but it costs an awful lot of money. I’ll tell you what. I’ll buy you the necklace, and when we get home we can make up a list of chore that you can do to pay for the necklace. And don’t forget that for your birthday Grandma just might give you a whole dollar bill, too. Okay?”

 Jenny agreed, and her mother bought the pearl necklace for her. Jenny worked on her chores very hard every day, and sure enough, her grandma gave her a brand new dollar bill for her birthday. Soon Jenny had paid off the pearls.

 How Jenny loved those pearls. She wore them everywhere-to kindergarten, bed and when she went out with her mother to run errands. The only time she didn’t wear them was in the shower; her mother had told her that they would turn her neck green.

 Now Jenny had a very loving daddy. When Jenny went to bed, he would get up from his favorite chair every night and read Jenny her favorite story. One night when he finished the story, he said, “Jenny, do you love me?” “Oh yes, Daddy, you know I love you,” the little girl said.

 “Well, then, give me your pearls.” “Oh! Daddy, not my pearls!” Jenny said. “But you can have Rosie, my favorite doll. Remember her? You gave her to me last year for my birthday. And you can have her tea party outfit, too. Okay?”

 “Oh no, darling, that’s okay.” Her father brushed her cheek with a kiss. “Good night, little one.” A week later, her father once again asked Jenny after her story, “Do you love me?” “Oh yes, Daddy, you know I love you.”

 “Well, then, give me your pearls.” Oh, Daddy, not my pearls! But you can have Ribbons, my toy horse. Do you remember her? She’s my favorite. Her hair is so soft, and you can play with it and braid it and everything. You can have Ribbons if you want her, Daddy,” the little girl said to her father.

 “No, that’s okay,” her father said and brushed her cheek again with a kiss. “God bless you, little one. Sweet dreams.” Several days later, when Jenny’s father came in to read her a story, Jenny was sitting on her bed and her lip was trembling. “Here, Daddy,” she said, and held out her hand.

 She opened it and her beloved pearl necklace was inside. She let it slip into her father’s hand. With one hand her father held the plastic pearls and with the other he pulled out of his pocket a blue velvet box. Inside of the box were real, genuine, beautiful pearls. He had them all along. He was waiting for Jenny to give up the cheap stuff so he could give her the real thing.

 The same with our Heavenly Father, He is waiting for us to give up the cheap/fake things in our lives. Are you holding on to harmful relationships, habits, activities… which you have come so attached to that it seems impossible to let go? Sometimes it is so hard to see what is in the other hand but do believe one thing, God will never take away something without giving us something better.

Child sexual abuse in China: A meta-analysis of 27 studies

Be Human Stop Child Abuse (http://behumanstopchildabuse.emedinews.in/)

(Team IMA for CMAAO)

Objective: To examine whether Chinese studies of child sexual abuse (CSA) in the general population show lower prevalence rates than other international studies, and whether certain features of these studies may help to account for variation in estimates.

Methods: A meta-analysis and meta-regression were conducted on 27 studies found in the English and Chinese language peer reviewed journals that involved general populations of students or residents, estimated CSA prior to age 18, and specified rates for males or females individually.
RESULTS: Estimates for Chinese females were lower than the international composites. For total CSA for females, the Chinese pooled estimate was 15.3% (95% CI=12.6-18.0) based on the meta-analysis of 24 studies, lower than the international estimate (Stoltenborgh, van IJzendoorn, Euser, & Bakermans-Kranenburg, 2011) but not significantly. For contact CSA for females, the pooled estimate was 9.5% (95% CI=7.5-11.5), based on 16 studies, significantly lower than the international prevalence. For penetrative CSA for females, the pooled estimate was 1% (95% CI=0.7-1.3), based on 15 studies, significantly lower than the international estimate of 15.1%. Chinese men reported significantly less penetrative CSA but significantly more total CSA than international estimates; while contact CSA reported by Chinese and international males appeared to be roughly equivalent. Chinese CSA prevalence estimates were lower in studies from urban areas and non-mainland areas (Hong Kong and Taiwan), and in surveys with larger and probability samples, multiple sites, face-to-face interview method and when using less widely used instruments.
CONCLUSIONS: The findings to date justify further research into possible cultural and sociological reasons for lower risk of contact and penetrative sexual abuse of girls and less penetrative abuse of boys in China. Future research should examine sociological explanations, including patterns of supervision, sexual socialization and attitudes related to male sexual prowess.

(Source: Ji K, Finkelhor D, Dunne M. Child Abuse Negl. 2013 Apr 30)

Emedinews:Insights on Medicolegal Issues:Can medical interventions be stopped?

Every medical intervention, including artificial nutrition and hydration, may be terminated at the patient’s request. Specific legal cases have sanctioned the withholding or withdrawal of respirators, chemotherapy, blood transfusions, hemodialysis and major surgical operations. In Cruzan, the United States Supreme Court definitively stated that artificial nutrition and hydration are medical interventions that can be withheld or withdrawn under the guidelines that apply to other medical treatments (Cruzan v. Director of Missouri Department of Health, 110 S. Ct. 2841 [1990])

Emedinews:Inspirtaion:The least important word is I

The six most important words are “I admit I made a mistake”
The five most important words are “You did a good job”
The four most important words are “What is your opinion”
The three most important words are “If you please”
The two most important words are “Thank you”
The least important word is “I”

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 Cookie Thief

 A woman was waiting at an airport one night, with several long hours before her flight. She hunted for a book in the airport shops, bought a bag of cookies and found a place to drop. She was engrossed in her book but happened to see, that the man sitting beside her, as bold as could be. . .grabbed a cookie or two from the bag in between, which she tried to ignore to avoid a scene.

 So she munched the cookies and watched the clock, as the gutsy cookie thief diminished her stock. She was getting more irritated as the minutes ticked by, thinking, “If I wasn’t so nice, I would blacken his eye.”

 With each cookie she took, he took one too, when only one was left; she wondered what he would do. With a smile on his face, and a nervous laugh, he took the last cookie and broke it in half. He offered her half, as he ate the other; she snatched it from him and thought… oooh, brother. This guy has some nerve and he’s also rude, why he didn’t even show any gratitude!

 She had never known when she had been so galled and sighed with relief when her flight was called. She gathered her belongings and headed to the gate, refusing to look back at the thieving ingrate.

 She boarded the plane, and sank in her seat, and then she sought her book, which was almost complete. As she reached in her baggage, she gasped with surprise, there was her bag of cookies, in front of her eyes.

 If mine are here, she moaned in despair, the others were his, and he tried to share. Too late to apologize, she realized with grief, that she was the rude one, the ingrate, the thief.

Emedinews:Insights on Medicolegal Issues:Exhumation of corpse – America

In America corpses are exhumed when there is a need to identify a body or to establish cause of death like in the case of suspected homicide.

• The remains of President Zachary Taylor were exhumed in 1991 to determine whether or not he had been poisoned, and the famous outlaw Jesse James’s grave was excavated to prove that it was his body in the coffin. In addition, archaeological investigations often involve exhumation.
• Under modern law, courts usually do not allow exhumation unless there are substantial and compelling reasons to do so.
• In a landmark U.S. Supreme Court decision Justice Cardozo stated, "The dead are to rest where they have been lain unless reason of substance is brought forward for disturbing their repose."
• Three general principles govern the law of disinterment in the United States. First, it is presumed that a "decently buried" body should remain undisturbed where it was placed unless good reason is given to do so. Second, disinterment is considered the private concern of the immediate family and the cemetery. Third, if there is disagreement among the close relatives regarding a proposal for exhumation the matter is adjudicated by a court of equity. The court considers (in order of importance) the wishes and religious beliefs of the deceased (if these can be determined), the wishes of the spouse of the deceased, the opinions of other close relatives, and the policies and regulations of the cemetery when determining if exhumation should be allowed.
• California Labor Code stipulates that if it is suspected that a person has died as a result of injuries sustained in the course of his employment, the investigating appeals board may require an autopsy and, if necessary, the exhumation of the body for the purposes of autopsy. However, in accordance with the rules of equity, the close relatives can, if they wish, prevent the state (i.e., California) from either exhuming the body or performing the autopsy.

Emedinews:Inspiration:Anger, Envy & Insults

 Near Tokyo lived a great Samurai, now old, who decided to teach Zen Buddhism to young people.

 One afternoon, a warrior – known for his complete lack of scruples – arrived there. The young and impatient warrior had never lost a fight. Hearing of the Samurai’s reputation, he had come to defeat him, and increase his fame. All the students were against the idea, but the old man accepted the challenge.

 All gathered on the town square, and the young man started insulting the old master. He threw a few rocks in his direction, spat in his face, shouted every insult under the sun – he even insulted his ancestors. For hours, he did everything to provoke him, but the old man remained impassive. At the end of the afternoon, by now feeling exhausted and humiliated, the impetuous warrior left.

 Disappointed by the fact that the master had received so many insults and provocations, the students asked: “How could you bear such indignity? Why didn’t you use your sword, even knowing you might lose the fight, instead of displaying your cowardice in front of us all?”

 “If someone comes to you with a gift, and you do not accept it, who does the gift belong to?” asked the old Samurai. “He who tried to deliver it.” replied one of his disciples.

“The same goes for envy, anger and insults.” said the master. “When they are not accepted, they continue to belong to the one who carried them.”

Emedinews:Insights on Medicolegal Issues:Failure to detect poison in chemical analysis by forensic lab

In some cases no trace of poison is found on analysis although from other circumstances it is quite certain that poison was the cause of illness or death. The possible explanations of a negative finding are:

• The poison may have been eliminated due to vomiting, stomach wash or diarrhea
• The whole of the poison may have disappeared from the lungs by evaporation or oxidation
• The poison after absorption may have been detoxified, conjugated and eliminated from the system
• Some drugs are rapidly metabolized, making extraction difficult.
• Some biological toxins and venoms, which are protein in nature cannot be separated from body tissues.
• Some organic poisons especially alkaloids may, by oxidation during life, or due to faulty preservation, or a long interval of time, or from decomposition of the body, deteriorate and cannot be detected.
• If the poison act slowly and death is delayed following production of irreversible organic changes, the poison may be completely metabolized and excreted.
• Many drugs may be present in very small amounts and these may require considerable amount of viscera for their identification.
• When the wrong or insufficient material has been sent for analysis.

Emedinews:Inspiration:Weakness or Strength?

Sometimes our biggest weakness can become our biggest strength. Take, for example, the story of one 10-year-old boy who decided to study Judo despite the fact that he had lost his left arm in a devastating car accident.

The boy began lessons with an old Japanese Judo master. The boy was doing well, so he couldn’t understand why, after three months of training the master had taught him only one move. “Sensei,” the boy finally said, “Shouldn’t I be learning more moves?”

“This is the only move you know, but this is the only move you’ll ever need to know.” the sensei replied. Not quite understanding, but believing in his teacher, the boy kept training.

Several months later, the sensei took the boy to his first tournament. Surprising himself, the boy easily won his first two matches. The third match proved to be more difficult, but after some time, his opponent became impatient and charged; the boy deftly used his one move to win the match. Still amazed by his success, the boy was now in the finals.

This time, his opponent was bigger, stronger, and more experienced. For a while, the boy appeared to be overmatched. Concerned that the boy might get hurt, the referee called a time-out. He was about to stop the match when the sensei intervened. “No,” the sensei insisted, “Let him continue.”

Soon after the match resumed, his opponent made a critical mistake: he dropped his guard. Instantly, the boy used his move to pin him. The boy had won the match and the tournament. He was the champion.

On the way home, the boy and sensei reviewed every move in each and every match. Then the boy summoned the courage to ask what was really on his mind. “Sensei, how did I win the tournament with only one move?”

“You won for two reasons,” the sensei answered. “First, you’ve almost mastered one of the most difficult throws in all of judo. And second, the only known defense for that move is for your opponent to grab your left arm.”

The boy’s biggest weakness had become his biggest strength.

Emedinews:Insights on Medicolegal Issues:Grievous hurt as per IPC

It is very difficult to draw a line between those bodily hurts which are serious and those which are slight. To make out an offence of voluntarily causing grievous hurt, there must be some specific hurt, voluntarily inflicted and coming within the scope of following as per law. As per Section 320 Indian Penal Code (IPC), the following kinds of hurt are designated as "grievous":

• Emasculation: It means depriving a male of masculine power.
• 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.
• 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.
• 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.
• 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.

Emedinews:Inspiration:Building Your House

An elderly carpenter was ready to retire.

He told his employer-contractor of his plans to leave the house-building business to live a more leisurely life with his wife and enjoy his extended family.

He would miss the paycheck each week, but he wanted to retire, they could get by.

The contractor was sorry to see his good worker go and asked if he could build just one more house as a personal favor.

The carpenter said yes, but over time it was easy to see that his heart was not in his work.

He resorted to shoddy workmanship and used inferior materials, it was an unfortunate way to end a dedicated career.

When the carpenter finished his work, his employer came to inspect the house.

Then he handed the front-door key to the carpenter and said, "This is your house... my gift to you."

The carpenter was shocked!

What a shame! If he had only known he was building his own house, he would have done it all so differently.

So it is with us. We build our lives, a day at a time, often putting less than our best into the building.

Then, with a shock, we realize we have to live in the house we have built, if we could do it over, we would do it much differently.

But, you cannot go back. You are the carpenter, and every day you hammer a nail, place a board, or erect a wall. Someone once said, "Life is a do-it-yourself project."

Your attitude and the choices you make today, help build the "house" you will live in tomorrow. Therefore, build wisely!

Emedinews:Insights on Medicolegal Issues:What is an impulse and its medicolegal importance?

Impulse is a sudden and irresistible desire or force in a person that compels him to the conscious performance of some act for which there is no motive; for example, kleptomania means an irresistible desire to steal articles which may be of small value and even, may be of no use to the person stealing the article. A sane person who has self–control and judgment capacity may not finally give shape to his impulsive or compulsive desire. But an insane person, who lacks in self–control and judgment capacity, cannot resist the impulse and may commit any offence. Thus, in connection with commission of an unlawful act, impulse is a good defense for an insane person which is not so for a sane person. Some types of impulses are:

• Dipsomania: This is found in alcoholics who have an irresistible desire to take alcoholic drinks.
• Pyromania: Here, there is an irresistible desire to set fire to things, which may be important and valuable. The person is not conscious or careful, at least temporarily, to the possible dangers of his act.
• Mutilomania: This is an irresistible desire to injure and mutilate animals, commonly the domestic pets.
• Sexual impulse: The person may feel compulsive urge to perform sexual intercourse, often in a perverted way. There may be some psychic problem concerning the sexual behavior; or the person may be a victim of mental sub normality.

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 was making him lose 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:Clinical and forensic autopsies have an overlapping role towards each other

• Postmortem examination of a dead body is carried out to gain insight of anatomy and pathology of corpse and close examination of the injuries, marks of weapon or disease process and it is important for forensic application of medical knowledge.
• Whether it is a clinical/pathological or forensic, autopsy is nothing but the medical study of a dead body and is carried out to enhance clinical findings and its correlation with patient clinical manifestation during the treatment or understanding some unrevealed aspect of disease/diagnose the disease, which has caused the mortality when antemortem efforts have failed or the autopsy/disease process in situ. These findings may be simultaneously used for medicolegal purpose.
• The procedure of both the autopsies is same; the autopsy conducted by a forensic expert in cases of sudden/unexpected/unexplained death is nothing but a pure clinical autopsy.
• The opinion expressed on the basis of a clinical autopsy is examined or cross examined in departmental/institutional peer review as the findings and opinion after a forensic autopsy has to withstand the acid test of cross examination by the defense lawyer/prosecutor and judges on circumstantial evidences available before honorable court.

Emedinews:Inspiration:Weakness or Strength?

Sometimes our biggest weakness can become our biggest strength. Take, for example, the story of one 10-year-old boy who decided to study Judo despite the fact that he had lost his left arm in a devastating car accident.

 The boy began lessons with an old Japanese Judo master. The boy was doing well, so he couldn’t understand why, after three months of training the master had taught him only one move. “Sensei,” the boy finally said, “Shouldn’t I be learning more moves?”

“This is the only move you know, but this is the only move you’ll ever need to know.” – the sensei replied. Not quite understanding, but believing in his teacher, the boy kept training.

Several months later, the sensei took the boy to his first tournament. Surprising himself, the boy easily won his first two matches. The third match proved to be more difficult, but after some time, his opponent became impatient and charged; the boy deftly used his one move to win the match. Still amazed by his success, the boy was now in the finals.

 This time, his opponent was bigger, stronger, and more experienced. For a while, the boy appeared to be overmatched. Concerned that the boy might get hurt, the referee called a time-out. He was about to stop the match when the sensei intervened. “No,” the sensei insisted, “Let him continue.”

 Soon after the match resumed, his opponent made a critical mistake: he dropped his guard. Instantly, the boy used his move to pin him. The boy had won the match and the tournament. He was the champion.

 On the way home, the boy and sensei reviewed every move in each and every match. Then the boy summoned the courage to ask what was really on his mind. “Sensei, how did I win the tournament with only one move?”

 “You won for two reasons,” the sensei answered. “First, you’ve almost mastered one of the most difficult throws in all of judo. And second, the only known defense for that move is for your opponent to grab your left arm.”

 The boy’s biggest weakness had become his biggest strength.

Emedinews:Insights on Medicolegal Issues:Delusions of grandeur

Also termed as delusion of exaltation

• This is a delusion of pleasant belief or feeling. The sufferer remains in a state of feeling of greatness, power and wealth. He may be extravagant in his thinking and action and may commit some crime in such a state of mind or may ruin his money or property.
• Erotomania is a type of delusion of grandeur, where the sufferer believes that a person of very high rank or social status loves him/her. The sufferer also believes that the imaginary person communicates his love in some manner or other, by posture or by communication in a secret or symbolic way.
• When a person suffering from delusion of grandeur, believes that he will be killed by another person for the huge property he possesses and if as remedial step he kills that person then he will have diminished responsibility for the commission of the act because though in this case there are elements of fear and apprehension about his own life and to safeguard his life he has killed the person, yet he is not fully absolved from the act he has committed because in such a case he could have tried lawful protective steps for his life i.e., he could have sought for the help of the police…

Emedinews:Inspiration:Determination and Persistence

This is a real life story of engineer John Roebling building the Brooklyn Bridge in New York, USA back in 1870. The bridge was completed in 1883, after 13 years.
In 1883, a creative engineer named John Roebling was inspired by an idea to build a spectacular bridge connecting New York with the Long Island. However bridge building experts throughout the world thought that this was an impossible feat and told Roebling to forget the idea. It just could not be done. It was not practical. It had never been done before.

Roebling could not ignore the vision he had in his mind of this bridge. He thought about it all the time and he knew deep in his heart that it could be done. He just had to share the dream with someone else. After much discussion and persuasion he managed to convince his son Washington, an up and coming engineer, that the bridge in fact could be built.

Working together for the first time, the father and son developed concepts of how it could be accomplished and how the obstacles could be overcome. With great excitement and inspiration, and the headiness of a wild challenge before them, they hired their crew and began to build their dream bridge.

The project started well, but when it was only a few months underway a tragic accident on the site took the life of John Roebling. Washington was also injured and left with a certain amount of brain damage, which resulted in him not being able to talk or walk.

“We told them so.” “Crazy men and their crazy dreams.” “It’s foolish to chase wild visions.”

Everyone had a negative comment to make and felt that the project should be scrapped since the Roeblings were the only ones who knew how the bridge could be built.

In spite of his handicap Washington was never discouraged and still had a burning desire to complete the bridge and his mind was still as sharp as ever. He tried to inspire and pass on his enthusiasm to some of his friends, but they were too daunted by the task.

As he lay on his bed in his hospital room, with the sunlight streaming through the windows, a gentle breeze blew the flimsy white curtains apart and he was able to see the sky and the tops of the trees outside for just a moment.

It seemed that there was a message for him not to give up. Suddenly an idea hit him. All he could do was move one finger and he decided to make the best use of it. By moving this, he slowly developed a code of communication with his wife.

He touched his wife’s arm with that finger, indicating to her that he wanted her to call the engineers again. 

Then he used the same method of tapping her arm to tell the engineers what to do. It seemed foolish but the project was under way again.

For 13 years Washington tapped out his instructions with his finger on his wife’s arm, until the bridge was finally completed. Today the spectacular Brooklyn Bridge stands in all its glory as a tribute to the triumph of one man’s indomitable spirit and his determination not to be defeated by circumstances. It is also a tribute to the engineers and their team work, and to their faith in a man who was considered mad by half the world. It stands too as a tangible monument to the love and devotion of his wife who for 13 long years patiently decoded the messages of her husband and told the engineers what to do.

Perhaps this is one of the best examples of a never-say-die attitude that overcomes a terrible physical handicap and achieves an impossible goal.

Often when we face obstacles in our day-to-day life, our hurdles seem very small in comparison to what many others have to face. The Brooklyn Bridge shows us that dreams that seem impossible can be realized with determination and persistence, no matter what the odds are.

Source: http://academictips.org/blogs/determination-and-persistence/

Emedinews:Insights on Medicolegal Issues:What is the right to reject medical interventions?

The Nancy Beth Cruzan automobile accident case

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. In addition, the right applies equally to withholding proposed treatments and to discontinuing initiated treatments. Of note, this right to refuse medical care does not imply a correlative right to demand treatment.

Emedinews:Inspiration:Be Content About Your Life

Wonder if any of you ever had the feeling that life is bad, real bad…and you wish you were in another situation. Do you find that life seems to make things difficult for you, work sucks, life sucks, and everything seems to go wrong….

It was not until yesterday that I totally changed my views about life; after a conversation with one of my friends.

He told me despite taking 2 jobs, and bringing back barely above 1K per month, he is happy as he is. I wonder how he can be as happy as he is now, considering that he has to skimp his life with the low pay to support a pair of old-age parents, in-laws, wife, 2 daughters and the many bills of a household. He explained that it was through one incident that he saw in India……

That happened a few years ago when he was really feeling low and was touring India after a major setback. He said that right in front of his very eyes, he saw an Indian mother chopped off her child’s right hand with a chopper. The helplessness in the mother’s eyes, the scream of the pain from the innocent 4 years old child haunted him until today. You may ask why did the mother do so, has the child been naughty, was the child’s hand infected??

No, it was done for two simple words — to beg. The desperate mother deliberately caused the child to be handicapped so that the child could go out to the streets to beg. I cannot accept how this could happen, but it really did, just in another part of the world which I don’t see.

 Taken aback by the scene, he dropped a small piece of bread he was eating half-way. And almost instantly, flock of 5 or 6 children swamped towards this small piece of bread which was then covered with sand, robbing of bits from one another. The natural reaction of hunger. Stricken by the happenings, he instructed his guide to drive him to the nearest bakery. He arrived at two bakeries and bought every single loaf of bread he found in the bakeries.

The owner was dumb folded, but willing sold everything. He spent less than $100 to obtain about 400 loaves of bread (this is less than $0.25/per loaf) and spend another $100 to get daily necessities. Off he went in the truck full of bread into the streets. As he distributed the bread and necessities to the children (mostly handicapped) and a few adults, he received cheers and bows from these unfortunate. For the first time in life he wondered how people could give up their dignity for a loaf of bread, which cost less than $0.25. He began to ask himself how fortunate he was as a Singaporean. How fortunate he was to be able to have a complete body, have a job, have a family, have the chance to complain what food is nice what isn’t, have the chance to be clothed, have the many things that these people in front of him are deprived of…..

Now I begin to think and feel it, too. Was my life really that bad? Perhaps….no,… it should not be bad at all….

What about you?

Maybe the next time you think your life is bad, think about the child who lost one hand to beg on the streets.

Emedinews:Insights on Medicolegal Issues:Phenol poisoning is known as carbolism

• Poisoning by phenol is known as carbolism because of the carbolic acid.
• The acid in a concentrated form acts as a corrosive and remotely as a narcotic poison.
• It coagulates proteins but does not form a firm chemical combination with them. Applied to the skin, it causes a burning sensation followed by tingling, numbness and anesthesia due to its effect on sensory nerve endings.
• Dangerous symptoms may be caused by 0.3 to 0.42 g of carbolic acid; about 2g is the average fatal dose. A quarter of a teaspoon full dissolved in glycerin killed a six month old child.
• Carbolic acid is largely used as an antiseptic, as a disinfectant and as a preservative. It is used in the preparation of many disinfecting powders.
• Carbolic soaps should not be used for enemas. Several cases of accidental and suicidal poisoning by carbolic acid have occurred as it can be easily procured.
• On account of its powerful odor and taste, it is rarely used for homicidal purposes though it has been sometimes used for murdering children and infants.

Emedinews:Inspiration:To Love and To Be Loved

 Once upon a time ….

 A very poor man lived with his wife. One day, his wife, who had very long hair asked him to buy her a comb for her hair to grow well and to be well-groomed.

 The man felt very sorry and said no. He explained that he did not even have enough money to fix the strap of his watch he had just broken. She did not insist on her request.

 The man went to work and passed by a watch shop, sold his damaged watch at a low price and went to buy a comb for his wife. He came home in the evening with the comb in his hand ready to give to his wife. He was surprised when he saw his wife with a very short hair cut. She had sold her hair and was holding a new watch band.

 Tears flowed simultaneously from their eyes, not for the futility of their actions, but for the reciprocity of their love.

 Moral of the story: To love is nothing, to be loved is something but to love and to be loved by the one you love, that is everything.