The Pakistani Spectator

On 27nth December 2008, at about 5-35PM, a female patient was brought to accident and emergency department of Rawalpindi general hospital, Rawalpindi with a presentation of receiving criteria of pulse less, fixed unresponsive dilated pupil, evident pallor without breathing and an external wound on right temporoparietal region with tricking blood mixed with whitish material probably, a brain substance on physical examination.

After initial CPR, that could not achieve the motive of revival, patient was shifted to emergency operation theatre with senior team in role to hold the fort of aggressive revival, at about 5-50PM.

Inspite of effort and available means of excellence and skill, no measures and mode could faculty the drive.

Hence at about 06-16 activity of resuscitation was held up for further declaration as dead.

Ascription to the detail evaluation of wound examination highlighted as per report under authorization has been revealed as,

 
• Irregular, oval wound 5×3 cm in right temporoparietal region just above right pinna of Rt. ear with no surrounding wound blackening. However wound was surrounded by a boggy swelling and whitish material probably brain substance with sharp bony edges within the wound with no evidence of foreign body within.

 
• There was clinical finding of bleeding from ears, nostrils and throat.

 
• X-ray skull revealed, comminuted fracture at temporoparietal region with inward depress fracture segment suggesting depress fracture of 35mm on x-ray measurement i.e. approximately 3.5 cm =1.377 inches.

 
• There was 2 to 3 radio densities found underneath the fracture segment with associated soft tissue swelling and pneumocephalus.

 
• Rest of the findings was unremarkable.

 
Under the rule of available findings and data cause of death as mentioned in death summary was floated as, a depressed skull fracture leading to cardiopulmonary arrest.

This is the story of first so called effective and mandatory report of mohtarma benazir Bhutto who succumb as victim in a casualty on same dreaded day of misfortune.

Astonishingly this essential detailed report is the essence to further description and scrutiny as investigation and inquiry in murder mystery.

Here it should be kept in mind that, idyllically this report should have been cited in full scope and scoop of angles of clinical observation as record since the victim was a high profile face in terms of personality.

However the same exhibition of careful record could not became the fate.

It is again amazing that brief and sketch to the picture of wound of victim that has been interestingly establish seems to deceive, so to freeze the concept that perhaps some blunt object has caused the injury hence characterizing it to a slogans as if, it was the stricken handle that has victimized the women.

In medico legal cases any injury that involve undefined mode of impact and vehicle, documentation is always observed with high potency reason and findings. This is to delineate cause of death as suspicion at provisional assessment hence without omitting the fact of clinical findings at physical root thereby to avoid any future inquisitions at inquiry in court proceedings.

However if at all, by putting a grace look over the floated expression as report, I have no hesitation, being a professional, that this report is an inefficiently written deceiving placebo, which only fulfils undisclosed myth of questionnaire .

Conversely, if it could have been written with professional legacy and attitude the same would have itself validated the crime and assault.

Being a trained professional in health care and traumatology, I have no hesitation to share input that the receiving data as finding of mohtarma benazir Bhutto clearly prelude decision as “brought in dead patient”.

However requisite procedure of “CPR and necessary surgical cum emergency procedures” as conducted in Rawalpindi general hospital was a rational and ethical approach to declaration for revival in patient care and every practice that was conducted and carried out in hospital at that time seems overwhelmingly up to the mark as best possible approach being professional institute.

Here to lime light and vindicate as controversy on the subject, the descriptive sketch to the injury as report is highly non professional and litigating the concerned as the same is deficiently and deceivingly written.

As far as descriptive methodology and anatomical position of the wound and its site is concerned ,only professional with the knowledge of the subject can carry out the inquiry in a proper manner of questionnaire since trauma sustained and its impact on surrounding tissue with resultant ultimate picture after impact, shall expel out the source of vehicle of trauma as if it was a bullet ,a handle ,or a magnitude as blast wave of bomb.

However gently crucifying the declared version of already descriptive sketch as report, the same has reflection that perhaps the trauma sustained was resultant to blunt injury with depress fracture which under no circumstances clear off the idea without audit.

Technically blunt injury sustained at skull does have the element of depress fracture but bone chip never nib off from the root with marginal gap because of its strong attachment.

Similarly protrusion of brain substance externally can only be possible if external wound is breach as laceration.

Here it is to be pointed out that only crushing injury to the skull exudates brain substance and this is only possible if all layers of muscular attachment of skull to periosteal covering of brain have similar impact of force that disrupt strong bindings of tissue within .

However such laceration have tendency to vindicate only if injury is caused by sharp object as knife and axe etc or firearm that graze and shatter tissue in all layers.

Since the two terms knife and axe and similar object of tendency as handle are not debatable because of contour and forceful impact as thrust causing declared injury, the only weapon remains is the fire arm injury and similar metal piece from a fast moving object after blast wave.

It should be noted here that bullets and similar metal piece that have tendency to breach all layers of muscular attachment and bone have a burning tendency to blacken the area of and over presentation of infliction and penetration hence confirming the mode as firearm injury .

But as has been cited in medical report requisite finding of black burn area of tissue has been denied. There by negating the concept of firearm injury and favoring the slogan of blunt trauma that never blackens the surrounding tissue.

Under the rule of thumb, and final verdict as medical report, no element or agency can prove the injury to be though the bullet tract as wound of exit and entry are also denied same as blackening of the surrounding tissue and absence of evidence of foreign body is seconded.

After going through the report, I have no reason but to believe that said medical report seems to be a deliberate molded, untactful, unjustified means of deceive so to fulfill the desire that has been requested as order. Mr. Ather minallah, though all time slogan holder of rights and rule of law, could not even bear the burden of slight push.

After going through the report, I have no reason but to believe that said medical report seems to be a deliberate, molded, untactful, unjustified means of deceive so to fulfill the desire that has been requested as order. Mr. Ather minallah, though all time slogan holder of rights and rule of law, could not even bear the burden of slight push.