SOME MORE ENGLISH IDIOMS AND THEIR STORIES OF ORIGINS

Idioms and Phrases are an integral part of the English language and are commonly used to make sentences fascinating. Idioms are often used in stories, poems and even in spoken words. The origins of these idioms are not always known, but they are said to originate from stories and creative writing and are modified over time. Phrases are unlike idioms, they are actually direct and to the point. They do not have figurative meanings; the expression means what the words indicate.

I have in 5 previous blogs discussed about similar English idioms and how they originated. You can re-visit them by clicking on these hyperlinks:

https://surajitbrainwaves.blogspot.com/2022/07/the-story-behind-english-idioms.html

https://surajitbrainwaves.blogspot.com/2021/05/the-origin-of-common-english-idioms.html

https://surajitbrainwaves.blogspot.com/2021/06/the-origin-of-common-english-idioms-2.html

https://surajitbrainwaves.blogspot.com/2023/05/the-history-behind-some-english-idioms.html

https://surajitbrainwaves.blogspot.com/2024/06/stories-behind-few-english-idioms.html

These are a fresh set of idioms.

"A baker's dozen" 

What does it mean? Thirteen items.

Back in 13th-century Britain, there was a law called the As size of Bread and Ale. It stated that if bakers were caught selling low-quality bread or undersized portions, they could have their hands chopped off. That's why a group or set of 13 is referred to as a baker's dozen - it was a sure-fire way of them keeping their hands! 

"Bite the bullet"

What does it mean? Accepting something difficult or unpleasant.

Where does it come from? Before, during the war, there was no time to administer anesthesia before emergency surgery. Instead, the surgeon made patients bite down on a bullet in an attempt to distract them from the pain. 

"Blood is thicker than Water"

What does it mean? Family comes over and above everything else.

In ancient Middle Eastern culture, blood rituals were performed between men to symbolize a bond that was far greater than those of family. It was believed that blood brother warriors who symbolically shared the blood they shed in battle together were said to have a stronger bond than biological brothers.   

"Break the Ice"

What does it mean? To initiate a friendship or to start a project.

Prior to trains or cars, port cities that thrived on trade suffered during the winter because frozen rivers prevent commercial ships from entering the city. To solve this issues, small ships known as 'icebreakers' would then rescue the icebound ships by breaking the ice and creating a path for them to follow. Today it has quite a different meaning - before any type of business arrangement today, it is now customary to break the ice before beginning a project. 

"Cat Got Your Tongue?"

What does it mean? This saying is said when a person is at a loss for words. 

This common saying has two possible sources. The first refers to the cat-o'-nine tails - a whip used by the English Navy for flogging. The whip had caused so much pain, the victims were left speechless. The second refers to the practice of cutting out the tongues of liars and feeding them to cats. 

"Caught Red-Handed"

What does it mean? Caught doing something wrong.

This saying originated because of law. Some time ago, if someone butchered an animal that didn't belong to him, and was caught with the animal's blood on his hands, he had to be convicted. But being caught with freshly cut meat did not make the person guilty.

"Throw the Baby Out with the Bathwater"

What does it mean? Hang on to valuable things when getting rid of unnecessary things. 

In the 1500s, most people would bathe once a year and when they did bathe the entire family would use the same tubful of water. The man of the house would bathe first, then the females and finally, the babies. By the time the babies came to wash, the water would be thick and cloudy. Consequently, the infants' mothers had to take care not to throw them out with the bathwater when they emptied the tub. 

"Eat Humble Pie"

What does it mean? To make an apology and suffer humiliation with it.

During the Middle Ages, the lord of a manor would hold a feast after hunting. Yet, while he would feast on the finest cut of meat at dinner, those of a lower standing were served a pie filled with entrails and innards, which were then known as 'umbles'. So, receiving an 'umble pie' was considered humiliating because it signified the guest's lower status. 

"the Cold Shoulder"

What does it mean? This is considered to be a rude way of telling someone that he isn't welcome. 

 Today, giving the cold shoulder is considered rude. But it was actually regarded as a polite gesture during medieval England. At the end of a feast, the host would let his guests know it was time to leave by giving them a cold piece of meat from the shoulder of beef, mutton or pork. 

"Go Cold Turkey"

What does it mean? To quit something all of a sudden.

It was believed that during withdrawal, the skin of drug addicts would become translucent, hard to touch and covered with bumps and would resemble the skin of a plucked turkey. 

"Go the Whole 9 Yards"

What does it mean? To try your best.

During the Second World War, fighter pilots received a 9-yard chain of ammunition. The saying came about when a pilot used all of his ammunition on one target, he gave it 'the whole 9 yards.'

"Highway robbery" 

What does it mean? Charging too much.

These days, most people would refer to being charged Rs. 250 for a cup of coffee as a highway robbery. With that being said, its original definition meant literally robbing travelers on or near a highway. It's thought that the phrase was first used way back in 1611. 

"Jaywalker"

What does it mean? Someone who crosses the street in a reckless or illegal manner. 

 The term comes from jay birds who traveled outside of the forest into urban areas became confused and unaware of the potential dangers in the city - such as traffic. Fascinated by their erratic behavior people began using the term 'jaywalker' to describe someone who crossed the street irresponsibly. 

"Kick the Bucket"

What does it mean? Simply put, it means to die!

When a cow was killed at a slaughterhouse a bucket was placed under it while it was positioned on a pulley. There were times when the animal's legs would kick during the adjustment of the rope and it would kick the bucket before being killed. 

"Let Your Hair Down"

What does it mean? To relax or to be at ease.

Parisian nobles risked being condemned by their peers if they appeared in public without an elaborate hairdo. As some of the more intricate styles required hours of work, it would always be a relaxing moment to come home at the end of a long day and let their hair down. 

"Letting the cat out of the bag" 

What does that mean? To reveal a secret, often unintentionally.

Nowadays, letting the cat out of the bag means spilling someone's secret, however, the phrase used to mean something completely different back in Medieval times. Back then, farmers would purchase piglets from markets, which would usually be handed over in bags. The thing is that unscrupulous dealers would swap out the pigs they were supposed to be selling for much less expensive cats. This theory is quite hotly disputed. 

"Meeting a deadline" 

What does this mean? Completing a task in time or before time

Meeting a deadline had a very different meaning during the American Civil War than it does today. A deadline was a line inside the area where Federal prisoners were kept. If any of them attempted to cross the line, they would be shot and killed.  

"More Than You Can Shake a Stick At"

What does it mean? To have more of something than you actually need. 

Farmers controlled their sheep by shaking their staffs to show animals where they had to go. But when farmers had more sheep than they could control, it was said they had 'more than you can shake a stick at.'

"No Spring Chicken"

What does it mean? Someone who is no longer in their prime.

In New England, chicken farmers generally sold their chickens during the spring because chickens born at that time of year yielded better earnings than the chickens that survived the winter. Sometimes, farmers would try to sell old birds for the price of a new spring chicken. As buyers who were aware of this complained that the fowl was 'no spring chicken' the term then came to represent anyone past their prime. 

"Paint the town red" 

What does it mean? It is often associated with getting glammed up before heading out for a night of drinking and dancing. 

But that's not what it meant back in 1837. As the story goes, the Marquis of Waterford went out for a night of drinking with some friends. They all proceeded to become quite severely intoxicated, and set about destroying property in the small English town. Things got really crazy when they stumbled upon some red paint, and literally began painting the town red. Doors, a tollgate, and a swan statue were among the victims... 

"Paying through the nose" 

What does it mean? It means paying far too much than the actual worth.

Paying through the nose for something is never a pleasant experience, but at least your face remains intact throughout. The Vikings took paying through the nose quite literally - they used to slit someone's nose from tip to eyebrow if they refused to pay tax. 

"Pleased as Punch"

What does it mean? To be very happy.

During the 17th century, a puppet show for children called Punch and Judy featured a puppet named Punch who killed people. Punch felt pleased with himself after the act of killing as it brought him so much pleasure.

"Pulling your leg" 

What does it mean? A light hearted banter. Deceive or joke in a harmless way.

You'd probably think that pulling someone's leg is just a bit of light-hearted fun, but it meant something much more sinister back in 18th and 19th-century London. Thieves would drag their victims to the ground by their legs so that they were easier to steal from. 

"Read me the riot act" 

What does it mean? To give someone a severe reprimand or warning.

If you were ever read the riot act as a child or teenager, it might have meant being confined to your room for a few weeks without being able to watch television. In 18th-century England, however, it meant that you could face time behind bars. The Riot Act of 1715 stated that groups of 12 or more people gathered on the streets could be deemed a threat to public safety, and therefore ordered to be broken up. Refusal to disperse could also have led to arrests and forcible removals. 

"Riding shotgun"

What does it mean? Sitting in the front seat, just next to the driver

Although it might be the ideal place to ride during a road trip, riding shotgun in the Old West was a much more serious matter. Stagecoach passengers literally rode with a shotgun in their hands in order to scare off robbers to ward off would-be attackers. 

Idioms can convey complex ideas succinctly and memorably. For example, “break the ice” means to initiate conversation in a social setting. They often reflect cultural values and traditions, providing insight into a society's way of thinking. For example, “the early bird catches the worm” emphasizes the value of being protective.They can often paint vivid pictures in the listener's mind. “Bite the Bullet” creates a visual of someone enduring a painful experience bravely. Phrases too can effectively convey feelings and attitudes. “Over the moon” expresses extreme happiness.

REMEMBERING PROF. D.K. CHABRA BY HIS LECTURE ON BRAIN CANCER

 

 

Dr. D.K. Chabra was a Reader in the Department of Neurosurgery when we were doing our M.S. and was always present in the Neurosurgery department either attending to his patients, or operating, or addressing some administrative problems or attending to the maintenance of some surgical equipment. You could never find him sitting idle, work was his way of relaxation. I have, in the past, written about Prof. Chabra in one of my blogs, and if you have missed it, please click: https://surajitbrainwaves.blogspot.com/2020/06/remembering-prof-d-k-chabra-today.html

He married very late in life and in his bachelor days was truly married to neurosurgery, and so had no time for family. We, residents and students were his family and to us he was a huge inspiration. I did my first carotid angiography, my first cranial burr hole, my first craniotomy and my first drainage of subdural haematoma with him breathing down my neck! He was a strict stickler of S.O.Ps and these got ingrained in our DNA. Training with him was always hands-on. 

When Sanjay Gandhi Post Graduate Institute of Medical Sciences was established, he was hand-picked by the Director to build the Department of Neurosurgery from scratch. It was a huge loss to our Institution, but the Neurosurgery department in S.G.P.G.I. flourished under his care. His influence in the new Institute was far beyond his own speciality, and his contribution in the building of his new Institute and its work culture was profound.

When we were doing our M.S in General Surgery, we the residents of Surgery, who were about to appear in the M.S. examination, would request particular teachers to teach us particular subjects, of which they were true domain expert. Thus we would request Prof. A.K. Wakhlu to revise Ano-rectal malformations with us, Dr. G.K. Singh to teach us Bone Tumours, and Prof. S.K. Bhatnagar to teach us Cleft Lip & Palate and Hypospadias. These classes would occur in the evening and no teacher ever said no to our request. One day we approached Dr. D.K. Chabra and requested him to teach us Brain Cancers. In his customary style Dr. Chabra said “give me 3 days to collect some teaching material and we will do this at 7PM next Friday. So, this is what I could recover from my notes of that evening’s class. 

Brain cancer refers to a growth of abnormal cells in the brain. These tumors can start in the brain (primary brain tumors) or spread to the brain from cancers elsewhere in the body (metastatic tumors).

Some brain tumours are non-cancerous (benign) while others are malignant “brain cancers” that grow quickly and invade tissue. Even benign tumors can cause serious symptoms by pressing on brain structures.

 

Types of Brain Cancer

Brain tumours are classified by the cells they originate from.

Glioblastoma (GBM):

This is an aggressive cancer arising from glial (supportive brain) cells, and the most common malignant brain tumor in adults. GBM accounts for about 16% of adult primary brain tumors. It grows rapidly and is difficult to cure; five-year survival rates are very low (around 6–9% for patients in their mid-40s to mid-50s). GBM often affects adults over 45 and can cause headaches, personality changes, or seizures as it progresses.

 

Meningioma:

This is a tumor of the meninges, the membranes covering the brain and spinal cord. Meningiomas are usually benign (non-cancerous) and slow-growing. They are the single most common brain tumor type, making up roughly 46% of adult brain tumors. Meningiomas often occur in people over 60 and more frequently in women, and can grow for years before causing symptoms like headaches or focal neurological deficits. Because they are often treatable (usually with surgery and/or radiation), survival rates are high – about 79% five-year survival for patients in their late 40s and 50s.

 

Astrocytoma:

This is a tumor originating from astrocytes, the star-shaped glial cells. This category includes a range of gliomas from lower-grade (grade II) astrocytomas to grade III (anaplastic) astrocytomas. These tumors tend to grow slower than GBM (which is actually considered a grade IV astrocytoma) and often affect middle-aged adults. While they are malignant, they generally have better outcomes than GBM; for example, a diffuse low-grade astrocytoma has around a 46% five-year survival in people age 45–54. Astrocytomas can cause seizures, cognitive changes, or weakness, and sometimes progress into more aggressive forms over time.

 

Metastatic Brain Tumors:

These are cancer that has spread to the brain from another organ (such as the lung, breast, colon, or skin). Metastatic tumors (also called secondary brain tumors) are actually more several times more common than primary brain cancers. Virtually any cancer can spread to the brain, but lung cancer, breast cancer, melanoma, and kidney cancer are among the most likely to do so. These tumors often present with symptoms similar to primary brain tumors. Treatment typically focuses on controlling the spread by radiation or surgery and managing symptoms.

 

Early Symptoms and Warning Signs

Brain tumors can produce a wide range of symptoms. In adults over 45, it’s especially important to recognize new or unusual symptoms and not simply attribute them to “normal aging.” Early detection of a brain tumor can greatly improve outcomes. Common early signs include:

1.      Frequent headaches: Especially headaches that are new, persistent, and worse in the morning or wake one from sleep. These may be accompanied by nausea or vomiting. While many adults get headaches, a pattern of headaches that steadily worsens over time or is coupled with other neurological symptoms should be evaluated carefully.

2.      Seizures: A seizure in someone with no prior history of epilepsy is a red flag for a brain tumour until proven otherwise. About one-third of brain tumour patients experience seizures as an initial symptom. Any sudden convulsion, unusual spell of confusion, or loss of consciousness warrants prompt medical attention.

3.      Cognitive or personality changes: Brain tumours can subtly affect memory, thinking, and mood. Family members might notice the person becoming more confused, forgetful, or having trouble following conversations and simple commands. Some tumors cause personality changes – for example, a formerly calm person may become easily irritable or apathetic. Such changes, especially if they worsen over weeks or months, should be investigated.

4.      Weakness or balance problems: Unexplained weakness or numbness in an arm or leg, or clumsiness and balance difficulty (stumbling, swaying while walking), can indicate a tumor affecting the motor areas or cerebellum. Sometimes this is mistaken for stroke; unlike a stroke, which develops suddenly, tumor symptoms often develop gradually. If you notice progressive loss of coordination or one-sided weakness, investigate for brain tumour.

5.      Vision or speech disturbances: Tumours in certain brain regions can cause blurred or double vision, loss of peripheral vision, or other visual changes. Likewise, a growth affecting language centers may lead to speech problems – difficulty finding words, slurred speech, or trouble understanding others. These symptoms, particularly if they are new and getting worse, should be promptly evaluated. What is to be appreciated is that the symptoms depend on the tumor’s location and growth rate. A slow-growing meningioma might cause very subtle issues for years, whereas an aggressive glioblastoma can produce symptoms that escalate over a short time. In any case, new neurological symptoms in midlife or later age should not be ignored.

 

 

How Brain Cancer is diagnosed?

If a brain tumour is suspected, you will have to perform a series of evaluations and tests to confirm the diagnosis and identify the tumor type. The typical steps include:

Neurological exam: The first step is usually a thorough exam of the nervous system. Check for  reflexes, muscle strength, vision, hearing, balance, coordination, and cognitive function. Specific deficits (for example, weakness in the left arm or trouble with peripheral vision) can provide clues about where in the brain a tumor might be located.

 

Imaging tests: If exam findings suggest a possible brain issue, imaging is done to look inside the skull. A Carotid Angiogram is a quick X-ray based scan that may be done initially, especially in emergency situations or to diagnose a space occupying lesion and rule out other problems. However, the preferred imaging for brain tumors is CT Scan. Even these have limitations as it is difficult to distinguish tumor tissue from normal brain or scar tissue and assess how active or aggressive the tumor might be.

 

Biopsy: Imaging alone can strongly suggest a tumor, but the definitive diagnosis comes from examining tumor cells under a microscope. To obtain cells, a biopsy is performed. In many cases, if the tumor is accessible and operable, a neurosurgeon will remove as much of it as safe during surgery and send samples to the lab. If the tumor is in a tricky location not easily removable, a smaller stereotactic needle biopsy can be done. A pathologist then analyzes the tissue to determine the tumor type and its grade.

 

Additional tests: These may include blood investigations and a spinal fluid exam in certain cases, but the neurological exam, imaging, and biopsy are the cornerstone of diagnosis.

 

Age distribution:

The risk of brain tumors increases with age. The median age at diagnosis is around 60 years. Brain and other central nervous system cancers are most frequently diagnosed in people between 65 and 74. Over two-thirds of brain tumor cases occur in those above 40. In older adults, brain tumors rank among the more common cancers – they are the seventh most common type of tumor and the sixth leading cause of cancer-related death in people over 40.

 

Survival rates:

Thanks to advances in treatment, many patients live with brain tumors for years. Overall, considering all primary brain tumors (including benign), the five-year survival rate for adults is around 72%. For malignant brain tumors in older adults, survival is much lower. Among adults aged 40 and over, only about 21% survive five years. Glioblastoma has especially poor outcomes – around 9% for ages 45–54, and around 6% for ages 55–64. For benign tumors, survival is much better: about 90% in those over 40. For example, meningioma patients typically see five-year survival rates of 80% or higher. Grade II/III astrocytomas fall in between, with survival rates from 29% to 46% in middle-aged adults, depending on grade.

It’s important to remember that survival statistics are averages. Individual outcomes vary based on tumor type, location, genetics, treatment options, and overall health.

 

Risk Factors for Brain Cancer in Older Adults

Most brain cancers do not have a clear cause, but certain factors can increase the risk:

1.      Advancing age is one of the strongest risk factors. Risk increases significantly after age 45 and peaks in the elderly.

2.      Sex: Women are more likely to develop benign brain tumors, while men are more likely to develop malignant ones like glioblastoma.

3.      Radiation exposure: High-dose ionizing radiation to the head increases the risk, especially when received for previous cancer treatments.

4.      Genetic conditions: Rare syndromes like NF1, NF2, Li-Fraumeni syndrome, and tuberous sclerosis can increase risk, though they are uncommon.

5.      Metastasis from other cancers: Lung, breast, kidney, and skin cancers are most likely to spread to the brain.

 

Thus ended Dr. Chabra’s class on Brain Cancers. He had brought a bunch of Carotid Angiograms of patients with Brain Cancers and he demonstrated Meningiomas, Secondary deposits and other intra-cranial space occupying lesions. He also projected some histopathology slides of different brain tumours to revise the types of tumours. Our institution did not have a CT Scan and MRI then and Carotid Angiogram was our only radiological investigation for diagnosing these tumours. Dr. Chabra then left with his two residents to complete his ward rounds.

Remember, this was Brain Cancer before the advent of MRI and fancy genomic profiling, targetted treatment, IDO1 inhibitors, Focoused Ultrasound, Motor Protein inhibitors, Immunotherapy, and Gamma knife.

AM I FALLING SHORT OF YOUR EXPECTATIONS?

 

Whether you are a student or a teacher, a friend or a spouse, a sports teammate / coach or a business partner, there is always a mountain of expectations from you. If you fail to deliver there is disappointment but if you do then the expectations mount. Even more is then expected from you! This is a serious challenge and can lead to burnout of even the best professional, what to talk of ordinary persons!

We've all been there - trying to do something good for someone else and failing in our goal, or wanting to help in a certain way but being unable to. When we looked at what happened to the other person, we saw a disappointed face, and as a result, we were also disappointed in ourselves. If this has happened to you even once in your life, especially during childhood and with your parents, you may still fear disappointing others and causing them to see you in a negative light. This fear isn't always justified, and in fact, it prevents you from being happy or living as you should. It's normal to want to help others, but not when it comes at your own expense or when it accompanies anxiety about failing in this goal.

I organize meetings, conferences, get-togethers quite regularly and every such organizational challenge is unique. The demands of a speciality conference are very different from that of a batch-meet. In the latter you know every person personally for the last several decades, whereas in the former the attendees are very diverse in age, affordability and seniority. Keeping up to the expectation of every person responding to my invitation and attending these meetings is necessary, but may not be easy. Over the years I have realized that you can overcome this overwhelming feeling and learn how to stop fearing disappointing others by simply performing to the best of your ability.  

 

1. Accept the fact that you will never do enough in the eyes of some people

It may be hard to hear and accept, but you must remember this important fact: if your goal is to please everyone, you are doomed to fail. Even if you act in the most correct way possible, there will always be people with a different perspective who see things differently.    Whether friends, family members, or even strangers, everyone has his or her own opinions about what's right and what's wrong. This also applies to our opinions about success and happiness, and each of us has different values that suit our character. Nothing in the world is perfect, and if you try to be perfect in the eyes of others, you will definitely fail, so don't let it bother you too much.

 

2. Analyze your behavior

Sometimes you need to take a step back and look at yourself from the outside - ask why you behave in a certain way, where your fear comes from, what causes your anxiety, and why. If necessary, consult a senior colleague or even professional therapist to help you do this, or write these questions down and try to answer them yourself - it helps!   Teachers are particularly vulnerable if they have taken up the mission of addressing a bunch of perpetually disgruntled and laggard students. The paralyzing fear of disappointing others is normal, but it's not an inherent trait you can't overcome, and the way you feel and think is more related to what's happening in your mind than to anything else. Once you resolve these issues with yourself, you can get rid of the heavy burden on your shoulders that demands pleasing the people who matter to you on one hand, but on the other hand, arouses fear in you.

 

3. Set boundaries with others

If you feel that you need to please everyone, one of the most important steps for you is to set boundaries with others; don’t let anyone mistake your kindness for weakness. While there is nothing wrong with helping others and wanting the people around you to be happy, if you are eager to help everyone to the point where you are being taken advantage of and it’s hurting you, you need to take control of the situation and learn how to say "no" when necessary. You have nothing to feel bad about. The person you say "no" to might be disappointed, but it's necessary for your own well-being. Otherwise, you'll end up disappointed in yourself.

 

4. Don’t take others' reactions to heart

The way people react to our words and actions is often not related to us, but to their own mind and the things they are going through in their lives. For example, if a friend invites you to an event and you’re afraid to say "no," it’s because you don't want to disappoint them. Perhaps you've experienced a negative reaction before, and you're worried this person might react the same way they did last time, but you need to remember that it’s not about you.   It’s possible that the person simply made certain plans and is now upset that they fell through, but that doesn’t mean they’re angry with you- they're angry that their plans didn’t work out, and their plans are not your responsibility. Additionally, you can’t expect someone else to jump for joy when you give them an answer they don’t want to hear, so it’s clear that their reaction will be negative, even if they don't show anger and only express mild sadness. Don’t try to overanalyze people’s reactions to you, instead, base your actions on your own values and needs.

The chatter in the social media should never influence your best practices. Get the drift from this chatter, but do not take it very seriously, because no one knows your constrains and circumstances better than you. There is no scope of argument, simply ignore and perform at your best level.

 

5. Reevaluate your values

If you want to get rid of the fear of disappointing others, you first need to understand exactly who you are and what your values are. This isn’t as easy as it sounds, and it takes time to do such an analysis because we are never standing still, but always changing, growing, and maturing. However, it’s important to do this and understand what we want from ourselves and from the world. You'll likely discover that pleasing others at your own expense isn't truly necessary, which can help alleviate the pressure you feel. Circumstances in life might have taught you to take everyone along at the cost of accepting and suffering mediocrity, but others might have different values, shrug off those not up to the mark, and choose to go alone. Both are right, and both sets of values demand respect.

 

6. Be the person who appreciates you

Before you even seek approval from others for your actions, you must be able to appreciate yourself. This will naturally lead to you feeling more empowered. Often, we don’t actually fear disappointing others as much as we think we do; rather, we fear disappointing ourselves. We worry about not providing support to others and feel guilty, but this doesn’t benefit us at all. To get rid of the fear of disappointing others, you need to first remember all the things you do for them and give yourself a pat on the back for that.

 

I am the most important person who should be impressed with me

Over the years I have acquired this most precious bit of knowledge, I am the most important person who should be impressed by me. To you I can suggest, forget about pleasing everybody. Find space to open your mind, give yourself time, meditate, observe, reflect, journal your feelings, and don’t be afraid to get help. I learned how to acknowledge and accept that it's okay I fell short of what I "thought" life expected of me. This gave me a safety net and allowed me to become comfortable and happy in my own skin. Practicing self love continues to be a long and winding road for me, but I am getting there. The journey of mindfulness and gratitude has given me the ultimate gift of how to find and maintain happiness and peace. I care for every one, I want to live up to their expectation, but not at the cost of what I expect of me. My message to the world is loud and clear, raise yourself to my level, because I am not going to stoop to a lower level to meet you.

 

REMEMBERING PROF. N.N. MAHENDRA BY HIS LECTURE ON SEPSIS

 

 

Prof. N.N. Mahendra was a Reader in the Department of Surgery, when we were students and later residents in Surgery. He was a thorough gentleman, and was always smiling and encouraging students. His lectures were very well curated, researched and organized. His bed-side teaching too was meticulous and very thoughtfully crafted. He was a stickler of correct illustration of physical signs and always ensured that every student under his care understood the significance of the sign and elicited it correctly. He was a very good examiner and would go an extra mile to get the correct answer out of the students, encouraging them at every step.

Prof. Mahendra was a very compassionate surgeon and his patients loved him. He had a palatial home in Mahanagar on Mandir Marg and had a small operating theatre there. I have had the privilege of assisting him in many surgeries in the private and he would refer all his Plastic Surgery cases to me, so long as he was in active practice. He was a very calm and level headed surgeon and so Prof. P.C. Dubey, Prof. R.P. Sahi and Prof. G.P. Agarwal would often request him to assist them in their private practice. His sense of timing of surgical intervention was outstanding and not withstanding how socially or politically influential the patient is, he never hesitated to operate if indicated. I distinctly remember a young Congress leader of Amethi, near Lucknow, close to the then Prime Minister of India, was involved in a pre poll violence in 1989 and was shot in abdomen. He was brought in shock, pulseless and gasping. Any other surgeon would have thought twice before accepting to be his surgeon, but Prof. Mahendra did not hesitate for a moment. He immediately took him to the theatre, opened the abdomen and stopped the source of bleeding, thus saving the young politician’s life. He was later sent by the government to some N.H.S hospital in the U.K. for recuperation.

Prof. Mahendra was very helpful to his post graduates and thesis under him was most sought after. Residents in his team had the opportunity to treat a wide variety of surgical cases, and he saw to it that every resident was getting something to do in the O.T, depending on their proficiency and seniority. It was very easy to know how he was feeling about a student / resident / patient – if he was happy, he would address the person as ‘dear’ and if he was not then as ‘master’. So, it would be “Very nice, dear” or “No master, not like this”. Every surgeon has some peculiar choices of instruments, gadgets and procedures. Prof. Mahendra loved the Mallecot catheter. After a bladder or urethral surgery, he would never use the Foley catheter or the K-90; it was always the Mallecot catheter. The sight of the Mallecot being pulled out of the penis with a jerk, still sends shudder down my spine, but he always insisted that if it is prior lubricated with local anaesthetic Xylocaine jelly, it was a painless procedure!

I will now share with you a lecture, which he gave to our class in 1978 on Sepsis.

 

When we have an infection, our body works constantly to protect us from it. Antibiotic or anti-viral drugs are sometimes needed, but unfortunately, the fight against bacteria and viruses is not always simple. When the infection is not properly treated and is out of control, immune system activity can go awry, leading to sepsis - a life-threatening condition in which the body harms itself to protect its organs. As doctors, it is highly recommended that you familiarize yourself with the dangers of the condition and its symptoms so that you can offer  medical help right away as soon as you notice it, as this may be life saving

 

Definition

Sepsis is your body’s extreme reaction to an infection. When there is an infection, the immune system works to try to fight it. But sometimes the immune system stops fighting the infection and starts damaging your normal tissues and organs, leading to widespread inflammation throughout the body.

At the same time, an abnormal chain reaction in the clotting system can cause blood clots to form in the blood vessels. This reduces blood flow to the different organs of the body and can cause significant damage or even failure.

 

A typical patient

Though sepsis can affect anyone, but people with any kind of infection, especially bacteremia, are at a particularly high risk. These are

·        Age above 65

·        Pregnant

·        Co-morbidities – diabetes, cancer, obesity, kidney disease

·        Immuno-compromised – on Cortisone or chemotherapy

·        Hospitalized patients

·        Severe injuries / large burns

·        Have indwelling catheters, tubes

·        Have suppurative infections

 

 

Why is sepsis so dangerous?

If you don’t treat sepsis, it can cause septic shock, which is an advanced state of infection in the body that causes very low and dangerous blood pressure.  When the body is in a state of septic shock, it's very difficult to improve blood pressure with intravenous fluids alone. This in turn means that it is very difficult to regain proper blood flow to the organs needed to keep them functioning. The vital organs of the body, the brain, the heart, the liver and the kidneys are at grave risk. Sepsis soon leads to septic shock.

 

Causes of Sepsis

Sepsis can be the end result of any infective condition - pneumonia, appendicitis, urinary tract infections, and cellulitis. When an offending organism, a bacteria, invades the body, the immune system of the body, the lymphocytes from the Reticulo-endothelial system, challenge it. When the host immunity gets the better of bacteria the host is cured, but when the virulence of the organism gets the better of the host resistance we get infection and, if it still remains unchecked, then bacteremia, septicemia and sepsis.

 

Symptoms

Symptoms of sepsis are very similar to those of septic shock and both go hand in hand, so if you come across a combination of the following symptoms in your patient, it is highly recommended that you diagnose sepsis and initiate lifesaving treatment.

1. Cold, clammy skin - When the body experiences sepsis, it focuses on sending blood to the most vital organs, such as the heart, kidneys, and brain, then to less important areas like the skin. However, remember that skin that feels cold and clammy to the touch is a symptom of many diseases, some of which are less dangerous - this is a sign of concern only if you also experience other symptoms of sepsis or you have a significant infection.

2. Decreased volume or dark colored urine - The kidneys are the most severely affected organs during sepsis because they are sensitive to any change in blood flow and pressure. Therefore, the effects of this condition can often be seen in the urine. When the body senses that its blood pressure is low, it tries to store as much fluid as possible, which leads to decreased urination or dark colored urine. So, oligurea in sepsis is more than just dehydration.

3. Changes in mental state - Confusion, low alertness, and dizziness or agitation can all be the result of too little blood in the brain, dehydration, and toxins that enter the body and contaminate it. If your patient experiences septic shock, all of these symptoms will appear, but by this time the diagnosis is very late. Sepsis is better prevented than treated. These symptoms must occur with infection for them to be treated as symptoms of sepsis, as these are also common symptoms of a stroke.

4. Increased heart rate - In the case of sepsis, your patient will not only experience an accelerated heart rate, such as after a morning run, but he/she will feel that his/her heart is pounding even while relaxed. The average pulse at rest is 60-90 beats per minute, and over 90, it may be a sign of sepsis. When afflicted with sepsis the body increases heart rate to improve circulation and prevent tissue damage.

5. Difficulty breathing - If your patient does not have a medical condition that causes breathing difficulties, he/she may have sepsis. Hyperventilation and shortness of breath are often encountered. As in the case of the previous symptom, this symptom is also caused by the body's need to pump more blood into its organs, in which case it is important to enrich the blood with oxygen. Because of this, the body tries to breathe faster, which causes unpleasant feelings such as difficulty breathing, or dyspnea. Some patients develop shortness of breath that makes it hard to keep a healthy breathing rate.

Other symptoms can be:

·        Small dark red spots o the skin

·        Oliguria

·        Hypotension

·        Fever or Hypothermia

·        Chills and rigor

·        Extreme pain and discomfort

 

Investigations

A combination of findings — from a physical exam, lab tests, X-rays and other tests — to identify the infection is necessary. Increased total count, above 10,000/cu mm and with more than 80% polymorphs gives a strong indication. Bacterial cultures from wound, blood, urine can diagnose both the offending organism and the antibiotics to which it may be best sensitive. X. Ray of Chest to rule our pneumonia and urine examination to diagnose urinary track infection is routinely done. Serum electrolytes, Serum Urea and Creatnine, and coagulation profile also assist in diagnosis.

 

Treatment

You shouldn't delay treatment as sepsis causes damage to the body that can develop and worsen over a few hours. The faster you treat it, the more your patient’s body will prevent injuries that will worsen his/her health later in life. While the treatment varies from person to person, it is usually an aggressive process because quick action is needed.

1.      Antibiotics – a broad spectrum one to start with to cover both gram positive and gram negative bacteria and anaerobes

2.      I.V. fluids – to maintain hydration and blood pressure so that vital organs are not starved of blood

3.      Vasopressors: These will prevent peripheral pooling of blood and help to maintain blood pressure

4.      Appropriate supportive care like Ventilation and Dialysis

5.      Surgery – If sepsis is caused by an infection that can be surgically addressed like incision and drainage of an abscess, putting an intercostal drainage catheter with under water seal to drain our empyema thoracis, or putting drains in abdomen to drain septic peritonitis, then the patient’s condition can rapidly improve.

6.      Blood transfusion – Fresh blood, rich in clotting factors and platelets can address the abnormal bleeding tendencies.

 

Treatment outcome

With timely and quick diagnosis and treatment, many people with mild sepsis survive. Without treatment, most people with more serious stages of sepsis will die. Even with treatment, 30% to 40% of people with septic shock, the most severe stage of sepsis, will die. Septic shock can cause death in as little as 12 hours.

With prompt treatment, many people with sepsis recover completely and return to leading normal lives. But others may experience long-term effects. They  may develop complications such as:

·        Insomnia

·        Nightmares and hallucinations

·        Panic attacks

·        Joint and muscle pain

·        Decreased cognitive functioning – learning, remembering, concentrating, decision making

·        Organ failure

 

Sepsis occurs when your patient’s immune system has a dangerous reaction to an infection. It causes extensive inflammation throughout the body that can lead to tissue damage, organ failure and even death. Many different kinds of infections can trigger sepsis, which is a medical emergency. The quicker you receive treatment, the better your outcome will be. When it comes to sepsis and septic shock, remember that early detection is the most important thing in order to get the best treatment for your patient.

Thus ended Prof. Mahendra’s lecture on Sepsis.