In the New Testament of the Bible, there is a scene where Jesus resurrects a man by the name of Lazarus back four days after his death. This “miracle” is of course a fictitious event, but nonetheless, the name Lazarus has come to symbolise resurrection after death. For example, there are two actual medical conditions named after Lazarus, both related to death.
The first is called Lazarus phenomenon, where a person who is declared to be clinically dead spontaneously returns to life. This is an extremely rare event that has only been recorded in about 30 cases. In most of these cases, the patients had suffered a cardiac arrest, with all attempts at resuscitation (e.g. CPR, adrenaline) had failed. Sometime after the person was declared clinically dead (usually around 5~10 minutes), the person’s circulatory system would suddenly start on its own and the person would be “resurrected” (quite literally). In one case, a 61 year-old woman was declared officially dead after her heart stopped and her vitals did not return after continuous resuscitation. At the morgue, however, she was found to have a pulse and breathing on her own. She later sued the hospital for the neurological and physical injury caused by oxygen deprivation during her death. There is even a case report of a patient who returned to life two and a half hours after dying (although he died again 3 weeks later).
Of course, the Lazarus phenomenon is not a miracle. In most cases, it is hypothesised that when resuscitation is attempted then stopped, there is a rare chance of the relieving of pressure causing blood to fill the heart, causing a sudden expansion and kickstarting the electrical circuit. Other factors that may influence this is hyperkalaemia resulting from ischaemia and high doses of adrenaline given to the patient during resuscitation having a delayed effect.
Because of this rare “complication” of death, doctors are advised to observe the patient for about 10 minutes after declaring them dead. Just in case.
The second is called Lazarus sign and it occurs not in dead patients, but brain-dead patients. Brain-dead patients are immobile as their higher functions such as cognition and motor functions are destroyed. However, there are rare cases where the brainstem is somehow stimulated, triggering a reflex arc from the spinal cord. This reflex is seen as the patient suddenly raising their arms and dropping them on their chest in a crossed position, much like Egyptian mummies. As the spinal cord is not usually damaged in brain-dead patients, this reflex arc is possible, similar to a knee jerk reflex. The Lazarus sign should not be misinterpreted as a sign that a brain-dead patient is conscious, as it is an involuntary movement. However, it has been mistaken for the resuscitation of a patient, or in some cases, as a miracle.
Among the thousands of signs and symptoms in the field of medicine, there is one that every doctor and medical student knows since the development of medicine. Clubbing is an easily noticeable sign in a patient’s fingers that can have wide implications on their health.
Clubbing is essentially when the angle (gap) between the fingernail bed and finger disappears. The formal definition is much more complicated, such as “the loss of the normal <165° angle, or Lovibond angle between the nailbed and the fold”, but for all intents and purposes the simple definition is sufficient.
To see if a patient has clubbing, the physician carefully studies the fingers against light. There are a few ways to check for clubbing but the most popular methods are holding the fingers out straight and holding them parallel to the ground, checking the angle between the nailbed and finger, or the Schamroth’s window test. The latter test is done by holding two opposing fingers (such as the left and right index fingers) against each other nail to nail. The fingers are then held against the light so that the light can shine through the “window” that is made. If the window is not seen, the test is positive and the patient has clubbing.
What does clubbing suggest? Clubbing was first noticed by Hippocrates, the father of Western medicine, who observed that people with clubbing tended to grab their chest and fall dead. This is one of the most common associations to clubbing – a congenital cyanotic heart defect such as tetralogy of Fallot or patent ductus arteriosus. Other common associations are related to the lungs, such as lung cancer (one of the most common causes) and various other lung diseases such as interstitial lung disease, tuberculosis and other chronic infections. There are also a myriad of other diseases associated to clubbing, including but not limited to: Crohn’s disease, ulcerative colitis, cirrhosis, celiac disease, Graves disease and certain types of cancers (lung, gastrointestinal and Hodgkin’s lymphoma mainly). Clubbing can also be idiopathic, where there is no apparent cause for the clubbing and the person just has it (possibly just born with it).
Despite knowing about clubbing for over 2000 years, we still do not know the exact reasons for clubbing. There are theories that it is related to a fall in blood oxygen content leading to vasodilation in the peripheries. As the pathophysiology is not clear and so many diseases are associated with it, when clubbing is found in the patient the physician should investigate the related organ systems (heart, lungs, GI mainly) to narrow down the possible cause of it. As many of the causes (such as lung cancer) carry a rather morbid prognosis, it is quite important to notice whether the patient has clubbing when doing a physical examination.
Red, green, blue, white… There are many colours that we can see and there are even more different combinations of colours possible. It is common knowledge that some colours clash with each other while some synergise very well. A common example of a “good combination” is when you use complementary colours. Complementary colours are two colours that oppose each other on the colour wheel, creating an effect where they brighten each other. This makes it very eye-catching and attracts people’s attention. For example, blue and orange make a bright contrast making them a popular colour choice for movie posters. Red and green, and yellow and purple are also examples of complementary colours. Complementary colours are an important concept in art and design as it helps the product stand out.
Complementary colours have an interesting relationship with our sense of sight. If you stare at a colour for a while then quickly look at a blank, white surface, you will see an afterimage of the complementary colour. A good example is when you have your eyes closed under bright sunshine and upon opening your eyes the world seems a blue hue (the blood vessels in your eyelid make the light appear orange as it reaches your eyes). This is because the retinas try to negate the intense colour by downregulating the nervous signals corresponding to that colour, which makes the complementary colour stand out. Furthermore, the photoreceptors in the retina become fatigued after stimulation, causing a reduction in the signals sent for that colour.
Knowing about complementary colours is very useful when designing a sign or poster that easily attracts people.
90% of human communication is non-verbal. This shows how facial expressions and body language have a powerful effect on our subconscious. Even the position of the hand can send a clear signal.
An open hand suggests peace, love and openness. Because of this, if the other person has his or her palm showing, you will feel more comfortable talking with them and view them in a more positive light. Jesus is often pictured in a pose with his arms stretched and palms showing, sending the message: “I would like to embrace you”. The same signal is used to initiate a hug.
On the other hand, a closed hand sends a cold message of strictness and professionalism. Therefore, people who are debating or negotiating often have their hands flat on a table or their lap to symbolise their resolution and defiance.
From this analysis, we can tell that an open hand is a good way to gain the affection of another person. Furthermore, this body language can manipulate the other person’s subconscious.
From my experiments, I found that when given the choice between a closed fist facing up and another fist facing down, the subject would choose the fist with the palms facing up about 90% of the time. Although it is a crude test, it definitely beat the 50:50 statistics that is expected. This experiment was probably affected by other factors. Especially because people will usually choose the unusual choice due to curiosity (as when told to pick a hand, the person will usually have both fists facing down) and due to the psychology of “the unusual fist will probably contain something more interesting”. Also, most people who chose the downward-facing fist later said that they “deliberately chose the other fist because they felt they were supposed to choose the upwards-facing fist”. Thus, they too were first attracted to the unusual fist.
This test must be done suddenly to bypass the logical conscious mind and have an effect on the subconscious mind. If you take too long to explain the test, the results become skewed. Bypassing the conscious mind to suggest an acceptable choice to the subconscious mind – this test shows the basic principles of hypnosis.