Many of us are devout followers of Shiva. But, we worship Him without understanding the deep meaning of Shiva.

In Hindu mythology, Shiva is one of the three forms (trimurtis) of God, Brahma, Vishnu and Mahesh, the Hindu Triumvirate.

The Parmatama or spirit or what is called as God can be classified as a mixture of three forces representing Generator (creator or Brahma), Organizer, (maintainer or Vishnu) and Destroyer (completing or Mahesh or Shiva).​​​​​​

These three similar forces come into play in our body to perform any work. They can be denoted as: Idea generation or creation, maintaining or organizing the contents of the idea, and then destroying or completing, so that new work can be undertaken through Ganesha, the Lord of new beginnings.

One must understand and implement the principles of Lord Shiva in day to day life. This can be done by understanding the meaning of the form of Shiva.

Classically, Shiva is worshipped in a sitting meditating pose, sitting on a deer’s skin with a background of White Himalayas and blue sky (akash). Shiva is also depicted with ashes from graveyard smeared on his body, a snake around his neck, Ganga flowing out of his hair, three eyes, blue neck, trishul in one hand and damru in his other hand.

 All these symbolic representations have a deep spiritual meaning and tell us about Shiva’s principles of success.

Of the three eyes of Shiva, the left eye indicates love; the right eye signifies justice and the third eye wisdom or intelligence. To work effectively, one must use both eyes i.e. doing every work with love and justice. Any work done with love and without justice will lead to pampering, and justice without love will lead to rudeness. The third eye should be used in times of difficulty. The message here is: whenever you are in difficulty, use your intelligence and wisdom. The opening of the third eye opening means the disappearance of ignorance (darkness or pralaya).

The half open-eye meditating pose teaches us that in daily life, one should be as calm as if you are in the meditation pose. Being calm or practicing calmness helps in achieving better results.

The snake around the neck represents ego. And, the downward posture of the head of the snake indicates that ego should be directed towards the consciousness and not outwards. The ego should be kept under control and not let it overpower you.

The blue colour symbolizes sin or negative thoughts. Shiva as neelkanth (blue neck) teaches us that one should the negative emotions should never be expressed nor suppressed; instead they should be altered or modified. This indicates that the poison is neither to be drunk nor to be spitted out but to be kept in the throat by making it a part of the life. For example, an episode of anger should neither be expressed nor suppressed. Suppressed anger releases chemicals in the body causing acidity, asthma, angina and diarrhea etc. Expressed anger creates an unhealthy social environment. The only way is to alter or modify the anger by wilful cultivation of opposite positive thoughts in the mind. Therefore, the process of silently passing on love to any individual can take away the angry thoughts from the mind (love is opposite of anger).

The ash on the body of Shiva reminds that everything in the universe is perishable and nothing is going to remain with the poison. The message here is that ‘you have come in this world without anything and will go back without anything, then why worry’.

The trishul in one hand represents control of three factors i.e. mind, intellect and ego. It also represents controlling the three mental gunas i.e. sattva, rajas and tamas.

The damru, the hollow structure represents ‘taking all your ego and desires out of the body’.

The blue Akash represents vastness and openness; the white mountains represent purity and truthfulness.

Shiva also depicts anger mangament. Do not supress or express anger, keep it in the throat and continously ( Jathadari), with spontaneous flow of positive thoughts ( Ganga), keping your mind cool ( half moon) neutralise the negative thougts keeping your ego ( Sheshnag) under control. 

It is customary to fast on Shivaratri. Fasting does not simply mean missing a meal or not eating that day; it also means fasting or abstaining from all negativities “see no evil, hear no evil and speak no evil”. Fasting also indicates controlling the desires for eating foods (like fermented, sweet, sour and salt) and controlling the negative thoughts both in the mind as well as in action.

By adopting these principles, one will attain a free flow of knowledge, which is represented by the Ganga coming out of the hairs of the Lord Shiva. The matted hairs of Shiva represent tapas and signify that nothing in the universe is impossible without contemplation and repeated practice.

If one follows Shiva’s principles in everyday life, one will find no obstacles in routine life as well as in the spiritual journey.

Never ignore warning symptoms in heart patients

Sudden death is preceded by symptoms in preceding one hour in 80% cases

Warning symptoms often precede the sudden cardiac arrest event in a large number of patients, but symptoms may be unrecognized or minimized by patients, and subsequent ascertainment of symptoms is often limited, particularly in patients who do not survive the event.

In addition, patients who have sudden cardiac arrest and are resuscitated often have a retrograde amnesia and hence do not remember events or symptoms that may have been present.

In most studies 51 percent patients have warning symptoms within four weeks preceding SCA and eighty percent of patients experience symptoms at least one hour before sudden cardiac arrest and 34 percent having symptoms more than 24 hours before the arrest.

Chest pain (46 percent), dyspnoea (18 percent) and 4 dizziness, fainting, or palpitations ( 4%) are the most common symptoms, with women more likely to have dyspnoea than chest pain (31 versus 24 percent).

Patients with symptoms concerning for cardiac disease, particularly new or unstable symptoms, should seek prompt medical care for potentially life-saving evaluation and treatment.

Postmortem: 48 lakh fine for giving high oxygen to premature baby

Rajasthan state consumer forum on Friday imposed a fine of Rs 48 lakh on a private hospital situated at Kothputli town on the outskirts of Jaipur, for its negligence that led to an infant turning blind. 

Case

Nikita was admitted to Sanjivani Hospital situated at Kothputli on August 30, 2014, when she was told that the infant was underweight.

She was given 30% oxygen.

The infant developed ROP (retinopathy of prematurity)

Allegation: 30% oxygen was too much and caused ROP

Normal O2 should be 21%

Award: 45 lakh compensation

Discussion

Is it negligence, error of judgment or difference of opinion?

What is ROP?

• ROP is a developmental vascular proliferative disorder that occurs in the retina of preterm infants with incomplete retinal vascularization.
• It is an important cause of severe visual impairment in childhood.
• ROP develops in 21% of patients and severe ROP in 5% in infants < 32 weeks gestation. No infant born at >28 weeks GA required surgical intervention.
• The incidence of ROP in preterm infants (BW <1251 g) is 68%.
• The incidence of ROP is 8%, 19% and 43% among infants born at ≥32 weeks, >27 to 31 weeks, and ≤27 weeks gestation, respectively

Risk factors

The most important risk factor for developing ROP is prematurity. However, more than 50 separate risk factors have been identified.

• Low birth weight, low gestational age, assisted ventilation for longer than one week, surfactant therapy, high blood transfusion volume, cumulative illness severity, low caloric intake, hyperglycemia, and insulin therapy, have been independently associated with higher rates of ROP
• Other possible risk factors include sepsis, fluctuations in blood gas measurements, intraventricular hemorrhage, bronchopulmonary dysplasia, systemic fungal infection, and early administration of erythropoietin for the treatment of anemia of prematurity.
• Poor longitudinal weight gain
• Elevated arterial oxygen tension is also thought to contribute. However, ROP is not the only consideration in determining the optimal target oxygen level in preterm infants. Excessive reduction of target oxygenation saturation has been associated with increased mortality.
• Infection may worsen the course of ROP.

Breast milk feeding appears to play a protective role in preventing ROP.

Infants with trisomy 21 appear to be at a lower risk for ROP compared with other infants

The optimal SpO2 for preterm infants who receive supplemental oxygen therapy has not been fully established. Based on the available evidence, the most prudent target range for SpO2 in preterm infants is between 90 and 95%. This range minimizes both the low and high extreme oxygenation levels that have been associated with adverse outcomes and mortality.

Oxygen to a newborn is not decided by % of oxygen but by the SPO2 levels

• Based on the available evidence the current recommendation is a target oxygen range from 90-95% resulting in minimizing extreme oxygenation levels for all preterm infants
• This target range appears to be safe for preterm infants ≥28 weeks gestation.
• In the most mature preterm infants (gestational age >34 weeks), the risk of ROP decreases and the upper limit can be increased to 97%.
• There is also a paucity of data regarding oxygen target ranges as the preterm infant advances in age. However, by 2-3 weeks postnatal age, the risk of intermittent hypoxia increases, which may aggravate ROP by enhancing retinal proliferation. As a result, with advancing age one should typically raise target saturation to >95% if the infant still needs supplemental oxygen when the corrected PMA is >32 weeks.
• Targeted SpO2 levels of infants with congenital heart disease, BPD, or pulmonary hypertension are individualized based upon the clinical status of the neonate due to the paucity of data regarding optimal oxygenation for these disorders. 

Opinion

At the most it can be difference of opinion. It does not appear to be negligence unless oxygen was given without measuring SPO2 levels.  

What can be done?

• Challenge in the higher consumer forum
• Defence: Give opinion of experts and published literature​​​​​​​.

Charter of Patients’ Rights: Right to Information 

There has been a paradigm shift in the doctor-patient relationship. The balance is no more tilted in favor of the doctor as patients do not regard doctors as “parent figures” who took medical decisions on their behalf. They are equal partners in decision making today.

All patients have the right to know their health status and treatment. This right to information arises out of the principle of patient “autonomy”, which means that patients have the right to choose their doctor, the type of treatment. They even have the right to reject treatment.

Understanding this right of the patient builds a strong doctor-patient relationship, which is based on mutual trust and respect.

Patient autonomy is the legal and ethical basis for informed consent, which again gives the patient the right to make decisions about their health based on the information given. Failure to give all the facts to the patients that are necessary for them to take a decision regarding their treatment is a violation of their rights.

A valid consent has three components: Disclosure, Capacity and Voluntariness i.e. provision of relevant information by the doctor, capacity of the patient to understand the information given and take a decision based on the adequate information, without force or coercion. This is informed consent. Any permission given under any unfair or undue pressure makes the consent invalid.

Informed consent is not only an ethical obligation, but also a legal pre-requisite today. Not taking consent is gross negligence.

The National Human Rights Commission has drafted a charter of patient rights to be implemented by the Ministry of Health and Family Welfare. 

The Right to Information is as follows:

“Every patient has a right to adequate relevant information about the nature, cause of illness, provisional / confirmed diagnosis, proposed investigations and management, and possible complications to be explained at their level of understanding in language known to them.

The treating physician has a duty to ensure that this information is provided in simple and intelligible language to the patient to be communicated either personally by the physician, or by means of his / her qualified assistants.

Every patient and his/her designated caretaker have the right to factual information regarding the expected cost of treatment based on evidence. The hospital management has a duty to communicate this information in writing to the patient and his/her designated caretaker.

They should also be informed about any additional cost to be incurred due to change in the physical condition of the patient or line of treatment in writing. On completion of treatment, the patient has the right to receive an itemized bill, to receive an explanation for the bill(s) regardless of the source of payment or the mode of payment, and receive payment receipt(s) for any payment made.

Patients and their caretakers also have a right to know the identity and professional status of various care providers who are providing service to him / her and to know which Doctor / Consultant is primarily responsible for his / her care.

The hospital management has a duty to provide this information routinely to all patients and their caregivers in writing with an acknowledgement.”

Applicable laws

•   Annexure 8 of  standards for Hospital level 1 by National Clinical Establishments Council set up as per Clinical Establishment Act 2010
•   MCI Code of Ethics
•   Patients Charter by National Accreditation Board for Hospitals (NABH)
•  The Consumer Protection Act, 1986​​​​​​​.