Wednesday, 31 October 2012

Pro-Choicers, you've been prophesied!

"Daughters of Jerusalem, do not weep for me; weep for yourselves and for your children. For the time will come when you will say, 'Blessed are the childless women, the wombs that never bore and the breasts that never nursed!' Then they will say to the mountains, 'Fall on us!' and to the hills, 'Cover us!' For if people do these things when the tree is green, what will happen when it is dry?"

Hint: it's not Nostradamus.

Monday, 29 October 2012

Today's random reflection

I think my left leg, particularly the ankle, is my locus minoris, or weakest spot. Already a few times it has caused me to slip and fall, and that left ankle always sustained the worst injuries, usually a sprain. This morning I did it again - slipping and falling - and I could just blame the wet moss, but why did it have to be the left ankle *again*? The abrasion on my right knee is nothing compared to it. (well okay, the wound did sting, but it was much better after I took care of it with some normal saline and topical antibiotic)

On the bright side, that little accident magically jinxed away my sleepy head because I suddenly got into a fight-or-flight mode.

Walking is hard and painful now. Another little trial to immerse me in a contemplative environment for the Year of Faith? Another reminder that I should take more lightly my pride in my own speed? Maybe. I hope so. Or maybe it's only me overthinking things ;-)

On an unrelated note, I realised that I did better in surgery rotation than internal medicine. IM is absolutely fascinating to study, but when it comes to patient management, I lose that sense of fun. I like my pathology to be more tangible and visual, probably because I'm a visual person myself. I don't think I'm gonna go into IM for residency. As long as I can prescribe standard family practice medication for IM-related pathology I think I'm alright.

Saturday, 27 October 2012

Did you matter?

It's been a while since I read something that is both light and thought-provoking. Yesterday I picked up If I Stay by Gayle Forman and finished it in one sitting. Yes, I know it's classified as a young-adult book, and I might be a little too old mature for young-adult lit, but hey I don't mind, as long as it's tasteful. After all, it is the young-adult book The Giver by Lois Lowry that first introduced me to the fascinating dystopian realm.

Anyways, If I Stay is in no way ground-breaking or faith-shattering; in fact, it is pretty simple and straightforward, but it delivers one question: will there be people who mourn after you die? Will there be people who desperately whisper your name in your ear, hoping that you would choose to stay?

And what are you going to show your Creator, on the day you finally face Him? Have you made a good use of all the grace and talents He'd given you? Have you put a smile on somebody's face and made their lives a little better? Have you sown the seeds of truth? The seeds of peace? Have you, through your very being, proclaim divine love?

Did you matter?

"One day your life will flash before your eyes. Make sure it's worth watching."

Wednesday, 24 October 2012

As constant as the rising sun

I want to invite you on a journey. Let's go up the mountain with me. We leave at midnight and arrive before dawn. I want us to watch the sunrise together. After that we can go down and have fun in the village, and then we head to the beach to watch the sunset. How does that sound to you?

Actually no, it doesn't have to be today. It can be any day. And after our journey, YOU can make your own. If there's a guest in town, you can invite him or her to the usual place to watch the sunrise or sunset with you. You can do it over and over again, at different places, with different moods, accompanied by different people, yet watching the same sun, because we only have one sun.

And yet you never think of the sun as archaic or boring. No. In fact, you delight in its monotonous behaviour. Because then you have something to rely on, something you can hang on to. There's security in what is constant. When you're having a long day at the office, a rough evening with the family, or a stressful night in a haunted house, you can say to yourself: "Don't worry. The sun will rise again tomorrow and everything will be fine." Do you honestly know that the sun will rise again tomorrow? No. But you dare to hope because that's what the sun has been doing ever since it was created. You trust it. It never disappoints, it's always there. The sun may be clouded or eclipsed at times, but it's there. To believe otherwise is simply absurd.

Sure, sometimes you hate it. You hate the fact that the sun still stubbornly rises on a Monday morning, because that means you have to get up and go to school or work. But what if one day the sun decides to be innovative and doesn't appear on that Monday morning? What if it likes its creativity and decides a random time to rise and set?

Wouldn't you rather prefer a predictable sun behaving in a repetitious manner?

That's exactly what the Church does. She teaches the Truth that comes from God. Since God is constant and unchanging, so is His Truth, and so must be His Church. His Love is also constant and unchanging, given freely to everybody, good, and bad; therefore, the appropriate response to that Love must also be a constant and unchanging Liturgy of the Mass.

The Pope, a mere human, is powerless to change the Church or her laws, because they come from an Authority higher than himself. Expecting the Pope to lift the ban on contraception, abortion, same-sex marriage, and a number of other things is like expecting an astronomer to change the orbit of the sun.

So the next time you feel sick, confused, and lost in the uncertainties around you, you know where to look. There is a place as constant as the rising sun. Go uphill and find the Church, the City on the Hill, blazing forever with the light of Truth and Love that can only come from God. It is Home. Home is always there for you no matter what.


Image: "The Sunrize", Ivan Aivazovsky, 1874

Monday, 22 October 2012

Lily of the Mohawks

St. Kateri Tekakwitha, the new gal in town

Of the seven new saints canonised by the Pope on October 21, possibly the most unique and attention-grabbing is the Native American woman Kateri Tekakwitha.

I recall of getting to know Blessed Kateri some months ago. I've forgotten what I was reading on the net, all I know is it was a coincidence ("Well nothing is a coincidence, honey," thus saith the Lord). I think it was a random Catholic blog that mentions her as the blog's patroness. Kateri had not been canonised then, and to be honest I have a teeny wee problem about asking for intercession from someone who hasn't been officially declared a saint, so I just thought, "Wow how nice to know that there's a Native American who was a faithful Catholic... if only she was a saint!"

Lo and behold, a saint she became.

It's not hard to find out the reason why I am so drawn to this young woman. First, Kateri was a member of an indigenous tribe that practises local beliefs, namely animism and magic. This kind of spirituality is close to most Indonesians' hearts, even those who have adhered to an organised religion, and many tribes here still actually practise animism and magic, both the "white" and "dark" ones. Having a friend in heaven who truly understands the difficulties of talking to this group of people is tremendously encouraging. And who knows, maybe she's got some tips and tricks she could lend me if I ask her in prayer.

Secondly, Kateri is a radical proof of the universality of the Church. A lot of non-westerners think Christianity is foreign because it's a "western religion", what with all the western missionaries, Caucasian-looking statues of the saints, and the profoundly Roman liturgy. And if you think this is a Catholic problem, think about Pentecostal communities who sing nothing but English-language Hillsong tracks during their services. Or the Reformed communities where the word "church" recalls in mind an ultra-modern fiberglass building sitting majestically in the middle of a wealthy area. Soooo western, isn't it.

Please don't get me wrong, I have no problem with all these "western" things, because I know Christianity is anything but western (or eastern or southern or northern). But I need to say that other people might get it wrong, to the point that it becomes an impediment to someone's conversion.

Looking at the face of Kateri Tekakwitha, however, clears up this prejudice. True Christianity, that is, the Catholic Faith, is universal; it has its roots in Judaism, but it is not exclusively linked to the Jewish ethnicity, like Hinduism to the people of India and Taoism to the people of China. The Catholic Faith is celebrated in many cultures and many tongues, in every nook and cranny of the earth, including in the heart of an Algonquin-Mohawk. And consequently, any Catholics regardless of their upbringings, can become a saint. That's because the Kingdom of God is a real multiethnic country.

Thirdly, and this is the most personal reason: Kateri is different. She doesn't wear a nun robe, a medieval dress, a Jewish robe, or a crown. Not that these are bad of course; the three saints after whom I am named are a nun, a Jewish woman, and a princess. But I like people who are different, in a positive way. Being different is refreshing, and often inspiring. It shows that you don't have to change who you are to be a good Christian. You can, and should, remain a cheerful humorist, a serious bookworm, a charming royalty, a Pocahontas... only in a better version. God will lift up your personality, your talents, your entire identity to a sanctified level, to be used for the benefits of the Kingdom. Kateri is much like Joan of Arc, only more... tribal :)

Welcome to the sky club, Miss Kateri Tekakwitha!

Monday, 15 October 2012

Misunderstanding #2

After a very painful Misunderstanding #1, today I had to endure through another one. Thank God it was short but it still frustrated me a little.

Enter the clinical nutritionist. She's a soft-spoken elderly woman with a somewhat belittling gaze (don't you love such a creepy contradiction? She sort of reminds me of Professor Umbridge). Since the mastery of clinical nutrition is not in our syllabus, rounding with her is not an obligation. In fact, most of us does it out of politeness, without really understanding what's going on (but hey, we try our best!).

This morning she asked me about a patient's complaint. Now let me explain first to you English speakers who might be reading this, that in English the wording of her question would be along the lines of "Tell me how the patient feels today", which will cause no problem. However, in Indonesian she was asking about the patient's "keluhan" (complaint) and because Indonesians love to shorten things down, she didn't bother to add "hari ini" (today).

I assumed the latter, because that's usually what attendings on round cared for for the first time. So I gave her just that, the patient's complaint that morning. And she stared at me squarely and told me simply, "You're all over the place." She explained that I should not be led astray by the patient's story, that it is *I* who must direct the conversation, that I shouldn't have told her everything the patient told me without first sorting them out and condensing them. [Do you agree? Discuss.] And she finished off her quick lecture by reminding me, like I needed reminding, that a good history contributes 80% to the final diagnosis.

History, history, history. SO she was waiting to hear that patient's history, the chief complaint that had made him seek help in the first place.

Good grief.

Friday, 12 October 2012

Litany of Humility

O Jesus! meek and humble of heart, Hear me.
From the desire of being esteemed,
Deliver me, Jesus.

From the desire of being loved...
From the desire of being extolled ...
From the desire of being honored ...
From the desire of being praised ...
From the desire of being preferred to others...
From the desire of being consulted ...
From the desire of being approved ...
From the fear of being humiliated ...
From the fear of being despised...
From the fear of suffering rebukes ...
From the fear of being calumniated ...
From the fear of being forgotten ...
From the fear of being ridiculed ...
From the fear of being wronged ...
From the fear of being suspected ...

That others may be loved more than I,
Jesus, grant me the grace to desire it.

That others may be esteemed more than I ...
That, in the opinion of the world,
others may increase and I may decrease ...
That others may be chosen and I set aside ...
That others may be praised and I unnoticed ...
That others may be preferred to me in everything...
That others may become holier than I, provided that I may become as holy as I should…


Dis the most difficult prayer.

Thursday, 11 October 2012

Percussing the heart

Does any of you still do cardiac percussion? We Indonesian medical students are still trained to do it, our physical exam books still explain how to do it, but I seldom see foreign resources doing likewise. Sure, in the fast-paced modern medicine, we have plenty of diagnostic tools like the X-ray that are more accurate, but sometimes we need a handy bedside examination for a quick assessment of, say, a pleural effusion. So I wonder if thoracic, and more specifically cardiac, percussion has become a lost art.

In cardiac examination, percussion is performed to determine the borders of the heart, which in turn will determine if there is a cardiomegaly. It is a rough estimation, but the more you do it, the more trained your ears will become, and I believe the more accurate the results will be, just like any other things in life.

Here's how you do it on an adult patient:

In case you've forgotten.

1. Have the patient lie supine on the examination table.

2. Start from the right side of the chest. Percuss the intercostal spaces (ICS) down the right midclavicular line until you reach the dull sound of the liver. Go up one ICS and start percussing towards the sternum until you reach a weak dull sound. That is the right border of the heart. Normally it is found on the 4th ICS at the right parasternal line.

3. Now we move to the left side. Percuss the ICS down the left parasternal line until you reach a weak dull sound. That is the conus pulmonalis or the "cardiac waist" as they say it in radiology. Normally it is found on the 2nd-3rd ICS at the left parasternal line.

4. Still on the left side. Percuss the ICS down the anterior axillary line until you reach the tympanic sound of the stomach. Go up one ICS and start percussing towards the sternum until you reach a weak dull sound. That is the left border of the heart. Normally it is found on the 4th-5th ICS at the left midclavicular line.

Normal chest radiography.
Blue circle is the "cardiac waist", formed by the pulmonary trunk and left atrium.
Original image source: Life in the Fast Lane. Circle by me.

Some sources are more detailed, although they do not explain precisely how one should percuss.

Upper right border: 2nd ICS at the right parasternal line
Lower right border: 4th ICS at the right parasternal line
Upper left: 2nd ICS at the left parasternal line
Lower left: 4th ICS at the left midclavicular line

Hope this helps! :)

Tuesday, 9 October 2012

ASA physical status classification system

ASA = American Society of Anesthesiologists

Class 1: A normal healthy patient.
Class 2: A patient with mild systemic disease.
Class 3: A patient with severe systemic disease.
Class 4: A patient with severe systemic disease that is a constant threat to life.
Class 5: A moribund patient who is not expected to survive without the operation.
Class 6: A declared brain-dead patient whose organs are being removed for donor purposes.

If the surgery is an emergency, the physical status classification is followed by "E" (for emergency), for example "3E". Class 5 is usually an emergency and is therefore usually "5E".


  • Anesthesia: To indicate a patient's overall physical health or "sickness" preoperatively
  • General: To predict risk, and thus decide if a patient should have–or should have had–an operation.

Levine's grading of heart murmur

  • Grade I: very faint, may only be heard by an expert, not heard in all positions, no thrill.
  • Grade II: soft, heard in all positions, no thrill.
  • Grade III: loud, no thrill.
  • Grade IV: loud, with palpable thrill.
  • Grade V: very loud, with thrill, heard with the stethoscope partly off the chest.
  • Grade VI: loudest, with thrill, heard with the stethoscope entirely off the chest (just above the precordium, not touching the skin).

Top 50 Saints' Quotes for Trials and Sufferings

Sufferings include not only the difficulties of daily labours, but also holy inconvenience like self-denial, self-sacrifice, patience, humility, and obedience.

In no particular rank.

1. "Fire cannot last long in water, nor can a shameful thought in a heart that loves God. For every man who loves God suffers gladly, and voluntary suffering is by nature the enemy of sensual pleasure." -St. Mark the Ascetic

2. "Be very careful to retain peace of heart, because Satan casts his lines in troubled waters." -St. Paul of the Cross

3. "If you purify your soul of attachment to and desire for things, you will understand them spiritually. If you deny your appetite for them, you will enjoy their truth, understanding what is certain in them." -St. John of the Cross

4. "Do not put faith in constant happiness, and fear most when all smiles upon you." -St. Ignatius of Loyola

5. "Patience obtains everything." -St. Teresa of Avila

6. "Do not look forward to what might happen tomorrow; the same Everlasting Father Who cares for you today will take care of you tomorrow and every day. Either He will shield you from suffering or He will give you unfailing strength to bear it. Be at peace, then, and put aside all anxious thoughts and imaginations." -St. Francis de Sales

7. "If you attach your heart to certain places and occupations, obedience oftentimes places you in some other place that you may not like; to be always cheerful, be always humble and obedient." -St. Ignatius of Loyola

8. "When harmed, insulted or persecuted by someone, do not think of the present but wait for the future, and you will find he has brought you much good, not only in this life but also in the life to come." -St. Mark the Ascetic

9. "Nothing great is ever achieved without much enduring." -St. Catherine of Siena

10. "No man discovers anything big if he does not make himself small." -Ven. Archbishop Fulton J. Sheen

11. "Don't say: 'That person gets on my nerves.' Think: 'That person sanctifies me.'" -St. Josemaria Escriva

12. "We put pride into everything like salt. We like to see that our good works are known. If our virtues are seen, we are pleased; if our faults are perceived, we are sad. I remark that in a great many people; if one says anything to them, it disturbs them, it annoys them. The saints were not like that---they were vexed if their virtues were known, and pleased that their imperfections should be seen." -St. Jean Marie Baptiste Vianney

13. "Place your hopes in the mercy of God and the merits of our Redeemer; say often, looking at the crucifix: There are centered all my hopes." -St. Paul of the Cross

14. "The greater and more persistent your confidence in God, the more abundantly you will receive all that you ask." -St. Albert the Great

15. "Be gentle to all and stern with yourself." -St. Teresa of Avila

16. "Obedience is the complete renunciation of one's own soul, demonstrated, however, by actions. More exactly, it is the death of the senses in a living soul. Obedience is a freely chosen death, a life without cares, danger without fears, unshakable trust in God, no fear of death. It is a voyage without perils, a journey in your sleep. Obedience is the burial of the will and the resurrection of humility. Obedience is to give up one's own judgement but to do it with wise consultation. It is very costly, beginning to die to the will and the senses. To continue dying is hard but not indefinitely so. In the end all aversion stops and absolute peace takes command." -St. John Climacus

17. "It was pride that changed angels into devils; it is humility that makes men as angels." -St. Augustine

18. "Suffering is the very best gift He has to give us. He gives it only to His chosen friends." -St. Therese of Lisieux

19. "Blessed the one who continually humbles himself willingly; he will be crowned by the One who willingly humbled himself for our sake." -St. Ephrem of Syria

20. "When we have to reply to anyone who has insulted us, we should be careful to do it always with gentleness. A soft answer extinguishes the fire of wrath." -St. Alphonsus Maria de Liguori

21. "Humility if the true guardian of chastity." -St. Philip Neri

22. "God sends such purgations to you, directors of consciences, that you may acquire the science of the saints and the art of directing souls. You will suffer also in another way. Love will be your executioner. Let it do its work; it knows how. In this martyrdom we have need of extraordinary grace and strength; but God will bestow it. Without this divine help it would be impossible to bear up." -St Paul of the Cross

23. "We must submit to the Will of God and kiss the hand that strikes us, for we know it is better to suffer in this life than in the next, since one moment of suffering willingly accepted for the love God, is worth an eternity of happiness." -St. Margaret Mary Alacoque

24. "The more the intellect withdraws from bodily cares, the more clearly it sees the craftiness of the enemy." -St. Mark the Ascetic

25. "They who load us with insults and ignominies give us the means of acquiring treasures more precious than any that man can gain in this life." -St. Ignatius of Loyola

26. "We should let God be the One to praise us and not praise ourselves." -Pope St. Clement I

27. "If humble souls are contradicted, they remain calm; if they are calumniated, they suffer with patience; if they are little esteemed, neglected, or forgotten, they consider that their due; if they are weighed down with occupations, they perform them cheerfully." -St. Vincent de Paul

28. "Do you wish to rise? Begin by descending." -St. Augustine

29. "Humility is the mother of many virtues because from it obedience, fear, reverence, patience, modesty, meekness and peace are born." -St. Thomas of Villanova

30. "Consider the outcome of every involuntary affliction, and you will find it has been the destruction of sin." -St. Mark the Ascetic

31. "I often thought my constitution would never endure the work I had to do, (but) the Lord said to me: ‘Daughter, obedience gives strength.'" -St. Teresa of Avila

32. "Don't give in to discouragement. If you are discouraged it is a sign of pride because it shows you trust in your own powers. Never bother about people's opinions. Be obedient to truth. For with humble obedience, you will never be disturbed." -Blessed Mother Teresa of Calcutta

33. "As iron is fashioned by fire and on the anvil, so in the fire of suffering and under the weight of trials, our souls receive that form which our Lord desires them to have." -St. Madeleine Sophie Barat

34. "Whenever anything disagreeable or displeasing happens to you, remember Christ crucified and be silent." -St. John of the Cross

35. "If God sends you many sufferings, it is a sign that He has great plans for you and certainly wants to make you a saint." -St. Ignatius of Loyola

36. "Suffering is a great grace; through suffering the soul becomes like the Saviour; in suffering love becomes crystallised; the greater the suffering, the purer the love." -St. Faustina

37. "Trials are nothing else but the forge that purifies the soul of all its imperfections." -St. Mary Magdalen de Pazzi

38. "Never be in a hurry; do everything quietly and in a calm spirit. Do not lose your inner peace for anything whatsoever, even if your whole world seems upset." -St. Francis de Sales

39. "Be at peace with your own soul, then heaven and earth will be at peace with you." -St. Jerome

40. "She who desires peace must see, suffer and be silent." -St. Teresa Margaret

41. "He who knows how to forgive prepares for himself many graces from God. As often as I look upon the cross, so often will I forgive with all my heart." -St. Faustina

42. "Peace is not just the absence of war. Like a cathedral, peace must be constructed patiently and with unshakable faith." -Blessed Pope John Paul II

43. "The greatest greatest honor God can do for a soul is not to give it much, but to ask much of it." -St. Therese of Lisieux

44. "We always find that those who walked closest to Christ were those who had to bear the greatest trials." -St. Teresa of Avila

45. "When it is all over you will not regret having suffered; rather you will regret having suffered so little, and suffered that little so badly." -St. Sebastian Valfre

46. "Suffering borne in the will quietly and patiently is a continual, very powerful prayer before God." -St. Jane Frances de Chantal

47. "Thank God I am deemed worthy to be hated by the world." -St. Jerome

48. "It is good to think about our having our citizenship in Heaven and the saints of Heaven as our fellow citizens...Then it is easier to bear the things that are on Earth." -St. Edith Stein

49. "The angels and the saints rejoice at the sight of men on earth who struggle, suffer and labor for the love of Christ." -Blessed Rafel Arnaiz Baron

50. "He that rises after his falls, with confidence in God and profound humility of heart, will become, in God's hands, a proper instrument for the accomplishment of great things; but he who acts otherwise can never do any good." -St. Paul of the Cross


These are the quotes that resound most loudly in my heart at the moment. Undoubtedly there are many other beautiful and powerful quotes from our bros and sis in Heaven. Isn't it just comforting to know that they have been through similar, if not the same, paths? What are your favourite saints' quotes?

Sunday, 7 October 2012

He was here, and then he wasn't

Death, like birth, happens everyday. As a lowly med student, I can't say that I'm able to boast my experiences, but the mere amount of deaths I've seen so far could, at least, grant me the sight of Thestrals.

But what makes this one death so heartbreaking? The patient (let's call him J), age 18 years-old, very much compos mentis, was admitted to the hospital for recurrent episodes of cough and occasional dyspnea due to what he described as "a lot of mucus in the throat". He also admitted to experiencing 6 kg weight loss over the course of 1 month. He had been to another doctor who gave him a simple cough medication that didn't work too well. On the evening of his admission, J went into an episode of generalised tonic-clonic seizure that lasted for approximately 1 minute. On the next day he went into two more episodes separated only by 7 hours. A history of epilepsy or previous seizures was denied by both the patient and his father. An ENT consult was made, and a CT scan of the head was ordered for the next day.

J's second morning at the hospital went as usual. Med students went on rounds, got pimped and everything, and new lab results were reviewed. During the rounds J was as conscious as before, that is to say, even more conscious than some of us sleep-deprived derps med students. In short, that was an ordinary boring morning until a woman, a family member of another patient, called us loudly and pointed to J's bed. All of us jolted from our chairs and saw J was seizing again. And so we were relieved. Nothing happened. Well okay, a seizure was taking place, but we had expected something worse. We just stood by J's bed, one of us did the usual things for a seizing patient (protecting his head, etc.), and we all waited until he stopped seizing a few short seconds later.

But then the unusual took place. J did not respond to his father calling him. After the seizure stopped he turned flaccid and not... quite awake. My ER-trained instinct sent me immediately to the nearest BP cuff and torchlight. I palpated the radial pulse first. Nothing. Alright, BP then. This is wrong, I thought. I got no blood pressure reading at all. Maybe the equipment was faulty? Maybe my stethoscope isn't placed correctly? I repeated my reading but nothing, still. No detectable pulse and BP. I handed it over to a nurse but the result was the same. My friend reported absent carotid pulse and mydriatic pupils. Wait, what?! A nurse quickly set up an ECG reading. Ventricular tachycardia. A shockable rhythm, I know, but we don't have defibrillators, and our only instruction was to do manual CPR. But of course it was futile. In a few seconds, J was no more.

Can you imagine his father's shock? Can you imagine our shock? Can you imagine what heavy guilt the father must have felt, when the internist mentioned aspiration as the cause of death? Aspiration, due to the water he gave his son to drink, to relieve that pesky little cough.

It was so sudden. So unexpected. It was a sharp ache to the heart, so sharp that for a long moment everyone in the room---med students, nurses, other patients and their families---fell silent. For a long moment only a scream of agony over the loss of a son was heard. It was way too unreal and a part of myself honestly wanted to laugh it off and told the father that his son was coming back. That this was just a normal part of a seizure. That this was anything but death.

But death it was. It took a while to sink in, but it was there, as mighty as it has always been. Medical explanations sounded strange and far away. Like some fake tunes that try too hard to please. Like a pair of hands that tries to cup the entire water in the ocean. They answered the how, but never quite answered the why. Why, of all people in the world, did it have to be a handsome young man who hadn't even reached his 20's, with fresh dreams and aspirations, with a bright smile that had made us wonder what he was doing at this hospital in the first place.

So this makes me think:

You are only here for one moment and it lasts exactly one lifetime.


The day after, the bed sheet was new and it was identified with another patient's name.