Dear general physicians in India, If you really love your patients, please stop abusing antibiotics for every sore throat and cough you see in your outpatient department. Blanket use of antibiotics for every patient with respiratory symptoms will only create more challenges for our patients, especially those with high risk of multidrug resistance such as chronic liver disease as well as cancer patients. No patient has ever had a deficiency of Azithromycin and Amoxicillin + Clavulanic acid for you to prescribe them like candies. Every purposeless action will have grave reactions.

I am a Hepatologist. Arguably, I care for the sickest group of patients in medical practice – end stage liver disease. I see death almost every day in my ICU. Some are natural deaths, leading to multiple organ failure triggered by a failing liver. Some are decided. The family decided to pull the plug. They decide it was time to let go. And every time, I see the heart rate drop, the blood pressure fall and the electrocardiogram go flat. And I wonder. What goes on inside a dying brain? Was it a small black hole, that gets bigger and bigger and then engulfs the field in darkness as the heart shuts down taking the brain away with it? Or was it just all light at the end of the tunnel and then darkness, once the destination had reached? A group of doctors did something strange. Something unimaginable. And it led to them witnessing something melancholic, but beautiful. They went inside an ICU. Saw that four patients were unconscious. They were not clinically dead, yet. And not brain-dead. But were comatose. They were kept alive by a machine that pumped oxygen into their lungs. Three had brain injury due to cardiac arrest. One had haemorrhaged into the brain. All were unresponsive for a very long time and sadly, the family decided to pull the plug on them. To let them go away, peacefully. But before they did that, the loving family did something bittersweet. They signed a document which was made by the group of doctors, allowing them to study their beloveds’ dying brain. The group was led by Dr Jimo Borjigin of the Department of Molecular and Integrative Physiology, University of Michigan School of Medicine, Ann Arbor at Michigan. The doctors fitted machines to the heart and brain of the dying patients and then withdrew their life support by removing the breathing tube. Immediately after the tube was removed, the brain activity did not show anything different. But as the brain got closer to death, about 300 seconds before death, a power surge. And it occurred in the regions of the brain which was associated with conscious experience. Like the dying was suddenly yearning to live. And make no mistake, these were not “some bursts” of electrical activity that happens when the brain cells withered away without oxygen. This was a special kind of activity. These power surges increased connectivity in a region in the brain called posterior cortical “hot zone” – an area crucial for conscious perception – when it came to just before dying, the brain cells were having a cross-talk, not dying away into oblivion. They were passing final messages to each other within the regions of the brain, while the physical body lay, limp and motionless. And the doctors were heartbroken – because the final electrical pattern of surge that the dying brain was showing was the similar to those seen in dreaming humans. All the patients in the study died. But before they died, they taught us something. That even in death, our minds are resilient. That we clutch at only everything that is good. What were they dreaming of? A husband, about his loving wife? A mother, her children? Children, their parents? Or maybe a scene from a movie that changed you? Or a song under a starry sky? Or a pet who loved you unconditionally? We will never know. But know this, even in death, the mind conquers – with dreams and love, not nightmares and hate. Remember, nothing perfect lasts forever, except in our memories. Make good memories while living, so that we can re-live them in death. Go hug you family, take your children for an ice cream. Walk your dog into the sunset. Sources: ➡️"Surprising brain activity moments before death" by Dr. F Perry Wilson @fperrywilson via mdedge.com/neurology/article… ➡️Research Article: Surge of neurophysiological coupling and connectivity of gamma oscillations in the dying human brain from @PNASNews pnas.org/doi/10.1073/pnas.22…