Learning Critical Care Medicine

“The time may come when penicillin can be bought by anyone in the shops. Then there is the danger that the ignorant man may easily under dose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant. Here is a hypothetical illustration. Mr. X. has a sore throat. He buys some penicillin and gives himself, not enough to kill the streptococci but enough to educate them to resist penicillin. He then infects his wife. Mrs. X gets pneumonia and is treated with penicillin. As the streptococci are now resistant to penicillin the treatment fails. Mrs. X dies. Who is primarily responsible for Mrs. X’s death?” Above statement has been borrowed from the Alexander Fleming’s noble lecture delivered on December 11, 1945. [1] Fleming’s serendipitous discovery of penicillin and its therapeutic potential in treating bacterial infection was a boon to mankind. However, shortly thereafter resistance to penicillin as well other discoverd antibiotics was observed. Scie

“Ethics is knowing the difference between what you have a right to do, and what is right to do.”  -  Potter Stewart, Associate Justice, United States Supreme Court, 1958-1981 . Before the evolution of modern medicine, death had been a well-accepted inevitability of life, wished to happen at home surrounded by family members. This inescapable truth had become an integral component of every religion, culture and society with defined rites and rituals. With the advent of cardiopulmonary resuscitation and organ support technologies in the second half of last century, this integrated approach to end of life started receding towards denial, altering the trajectory of the process of dying. [2] Now ordinary people want and demand everything to be done to prolong the life of their loved ones, as it gives a virtual satisfaction to them and answer to others. Chest compression, defibrillation, escalating vasopressors, mechanical ventilation, dialysis, artificial nutrition in the loneliness of i