Emedinews:Inspiration:The 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! e 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.”

Emedinews:Inspiration:Dear Alcohol we need to talk,

Dear Alcohol we need to talk,

I thought I'd take a minute to discuss some troubling factors with you.

First and foremost, let me tell you that I am a huge fan of yours. Yes, my friend you always seem to be there when needed: Hidden inside chocolates. you warm us up when we are stuck in the midst of endless family gathering.

Yet lately, I've been wondering about your intentions. You see, I want to believe that you have my best interest at heart but I feel that your influence has led me to unwise consequences, briefed below for your review:

1. Phone calls: While I agree that communication is important, I question the fact that any conversation of substance could occur at 3am in the morning. Why would you make me call my ex boyfriends/girlfriends when I know for a fact they do not want to hear from me?

2. Eating: Now you know I love a good meal and though cooking is not my speciality, why do you suggest that I eat grilled steak with chilli sauce, 2 minute noodles, stale simba chips and drink nesquik with a kit Kat in my hand is beyond me. I think sometimes you go a bit too far.

3. Clumsiness: Unless you are trying to tell me that I don't have any balance, is it necessary to make me fall down the stairs and cause those black and blue marks that I get the next day. Similarly, It should not take me 45 minutes to get the key into the lock of my front door.

Further more these hangovers that you cause need to stop. I'll do my part, drink water, and take panado and grandpa before I go to sleep but please do your part and don't  let your hangover interfere with my daily activities. Especially on Mondays.

Alcohol, I have enjoyed our relationship for some years now and want to make sure that we remain on good terms. You have been my much needed companion when I don't know what to do with the extra money in my pocket. In order to continue our relationship you must carefully consider my above mentioned grievances and address them immediately. I will look for an answer no later than Thursday 5pm (PRE HAPPY HOUR) on your possible solutions and hopefully we will continue our fruitful partnership.

Emedinews:Insights on Medicolegal issues: The deceased body must be surgically well sutured after postmortem examination

• An important component of the autopsy is the reconstitution of the body such that it can be viewed, if desired, by relatives of the deceased following the procedure.
• After the postmortem examination, the body has an open and empty chest cavity with chest flaps open on both sides, the top of the skull is missing, and the skull flaps are pulled over the face and neck.
• All organs and tissue must be returned to the body unless permission is given by the family to retain any tissue for further investigation.
• Normally the internal body cavity is lined with cotton wool or an appropriate material; the organs are then placed into a plastic bag to prevent leakage and returned to the body cavity.
• The chest flaps are then closed and sewn back together and the skull cap is sewed back in place. The body must then be properly sutured and reconstructed by the doctor conducting the autopsy with a cosmetic and parlor touch and then only it should be handed over to the relative of deceased as a regard of human corpse for ritual cremation.

Emedinews:Makesure: A patient with rheumatoid arthritis developed deformity.

Situation: A patient with rheumatoid arthritis developed deformity.
Reaction: Oh my God! why was treatment not started early?
Lesson: Make sure all patients with rheumatoid arthritis are started with specific treatments within 3 months of diagnosis.

Emedinews:Inspiration:The Ripples

A man was sitting by a lake. He was throwing small pebbles into it from time to time. A young boy happened to cross by. He was intrigued to see that after every few minutes or so, the man would toss a pebble into the lake.
The boy went up to the man and said, "Good pastime, this stone throwing, he?" "Hmmm," said the man. He seemed to be deep in thought and obviously did not wish to be disturbed. Sometime later, the man said softly, "Look at the water, it is absolutely still." The boy said, "Yeah, it is."

The man tossed a pebble into the water and continued, "Only till I toss a pebble into it now do you see the ripples?" "Yeah," said the boy, "they spread further and further." "And soon, the water is still again," offered the man. The boy said, "Sure, it becomes quiet, after a while." The man continued, "What if we want to stop the ripples? The root cause of the ripples is the stone. Let's take the stone out. Go ahead and look for it." The boy put his hand into the water and tried to take the stone out.

But he only succeeded in making more ripples. He was able to take the stone out, but the number of ripples that were made in the process were a lot more than before.

The wise man said, "It is not possible to stop the movement of the water once a pebble has been thrown into it. But if we can stop ourselves from throwing the pebble in the first place, the ripples can be avoided altogether! So too, it is with our minds. If a thought enters into it, it creates ripples. The only way to save the mind from getting disturbed is to block and ban the entry of every superfluous thought that could be a potential cause for disturbance. If a disturbance has entered into the mind, it will take its own time to die down. Too many conflicting thoughts just cause more and more disturbances. Once the disturbance has been caused it takes time to ebb out. Even trying to forcibly remove the thought may further increase the turmoil in the mind. Time surely is a great healer, but prevention is always better than cure."

Before you allow a thought or a piece of information to enter your mind, put it through the triple filter test of authenticity, goodness and value

Emedinews:Insights on Medicolegal issues: Autopsies is important for further improvement in medical practice

Autopsies is important for further improvement in medical practice

• A systematic review of studies calculated that in about 25% of autopsies a major diagnostic error would be revealed. However, this rate has decreased over time and the study projects that in a contemporary US institution, 8.4% to 24.4% of autopsies will detect major diagnostic errors.
• An analysis has suggested that approximately one-third of death certificates are incorrect and that half of the autopsies performed produced findings that were not suspected before the person died. Also, it is thought that over one-fifth of unexpected findings can only be diagnosed histological, i.e. by biopsy or autopsy, and that approximately one-quarter of unexpected findings, or 5% of all findings, are major and can similarly only be diagnosed from tissue.
• According to another study, autopsies revealed 171 missed diagnoses, including 21 cancers, 12 strokes, 11 myocardial infarctions, 10 pulmonary emboli, and 9 endocarditic, among others.
• Focusing on intubated patients, one study found that abdominal pathologic conditions - abscesses, bowel perforations, or infarction - were as frequent as pulmonary emboli as a cause of class I errors. While patients with abdominal pathologic conditions generally complained of abdominal pain, results of examination of the abdomen were considered unremarkable in most patients, and the symptom was not pursued. 

(Ref: Changes in rates of autopsy-detected diagnostic errors over time: a systematic review.  JAMA 2003;289(21):2849–56)

Emedinews:Makesure:A patient with rheumatic arthritis was not given penicillin prophylaxis

Situation: A patient with rheumatic arthritis was not given penicillin prophylaxis, and subsequently developed another attack.
Reaction: Oh my God! Why was the prophylaxis not started?
Lesson: Make sure that one administers secondary prophylaxis in the setting of suspected post streptococcal reactive arthritis for up to one year after the onset of symptoms. Evidence of valvular disease after one year should prompt continued prophylaxis; otherwise, antibiotic prophylaxis may be discontinued.