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Letter From The EditorsMerry Yuletide rom Regurg! Afer a record demand or our reshersedition, were back with a sparkly new xmas issue ull o articles to fill

your time whilst the rents crack on with the turkey and trimmings.Afer youve read our cover article on medic types and decided whichone you are, compare your tastes with Dr Pat Harkins in our new 20Questions with.. eature. We do try and retain some seriousness hereat Regurg, and this editions educational article takes you through theofen conusing concept o acid-base disorders. We hope you all enjoyreading and await our next issue in April next year!

/RegurgMagazine

@regurgmagazine

[email protected]

In This IssueRegurg Committee

Medic ypes

An Ethical Dilemma

Sicko Film ReviewwABG Interpretation

Hopeless Medic: First Aid

Medical Mixtape

20 Questions with Dr. Pat. Harkin

Homelessness & Christmas

4.

5.

9.

12.

15.

18.

20.

21.

23.


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Medic Types

As the days grow darker and the invi-ing smells o pretzels and chai latteswaf over rom the German Mar-ket, one has time to procrastinateand reflect on their work (or lacko) over the first termand com-pare with their non-medic mates.As Im sure youve noticed by now,

being a medical student is quite a lotdifferent rom being a normal uni-versity student. Firstly, normal be-ing a crucial term medics tend tobe quirky individuals some morethan others. Secondly, the termstudent. When one hears a student

on another course describe theircontact hours the urge to throttlethem with our stethoscopes canbe overwhelminghowever, youmust resist. Stethoscopes are pricey.As a seemingly separate speciesto the classic uni student, one

might then investigate ( keenRESS-loving scientists as we allare) could we then urther clas-siy medics into more genera?

Te Keen Bean

Although we are all to some de-gree, keen in signing ourselves up

or medicine, there are just a ewHermione Grangers that stand out

rom the crowd. Staying behind a-ter lectures to ask more questionsdespite asking numerous duringthe lecture, always knowing whatshappening and having things pre-pared beore even being asked you know them. You might bethem. Either way, cheers, good e-

ort, and maybe just save all yourquestions or afer the lecturesas some o us like eating lunch.

Te Stresser

in contrast with our well-pre-pared sprout we have our mas-

ters o last-minute. Most peoplehave quite requent phases o be-ing overwhelmed by the volumeso work, orgetting things thenhaving to rush them, and dealingwith random little MANDAO-

RY tasks that pop up on the VLEevery now and then (such un).But a true stresser is someone who

consistently has an expression odismay on their ace, perhaps de-

medics tend to be

quirky individualssome more thanothers

Nilo Monfared

5

Medic TypesFeature


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velops a nervous tick, or just gen-erally becomes a banter demen-tor - losing their sense o humourcompletely as the challenges o

med-school seem to drain the joyout o their lie. I you know some-one like this smile at them everynow and again. We all go throughrough patches and a riendly ace/Meateast rom Ca on Campuscould really brighten up their day.

Te Night Owl

Tis is a relatively rare but marvel-lous sub-species. One might asso-

ciate them with the stressers who

eel unsettled by the haphazardnesso a medics lie and thereore cantsleep a common misconception.

Tey do sleep just not at night.When the clock strikes twelve andthe list o distractions is narrowed,a Night Owl comes alive and pow-ers through work they have beenavoiding. Tey can ofen be heardby their flatmates Skypeing inthe dead o night, downing en-ergy drinks in the morning, andsleeping during lectures. But donot ear, these are riendly crea-

tures, and ofen provide enter-taining Facebook pictures whentheir diurnal riends take photoso their new-ound narcolepsy.

Mr. Medsoc

From one noctunal creture to an-otherTat guy. Striding downthe corridors o Worsley shaking

Medic TypesFeature

6

The student sleeping during lectures may be a stereotype...but that doesntmean it isnt true!


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peoples hands, sharing jokes, kiss-ing babies and what have you heknows EVERYONE. How? He

makes it his business to know be-cause he belongs to a brotherhoodcalled Medsoc. Even in FreshersWeek, this breed o social butterflywas distributing tickets and coor-dinating afer-parties to parties youdidnt even know were occurring.Medsocians have incredible stam-

ina, managing several consecutivenights in a row and yield cirrho-sis-resistant livers that can handle

any size bucket. You dont needto look out or this type, they willmake themselves known to you.

Is she even a medic?

Whilst Mr. Medsoc glides amonghis many comrades and conquests,

camouflaged in the cream-colouredconcrete o Worsley is a special kindo medic. Tat guy/girl you swear

Medic TypesFeature

youve never seen beore in yourlie.and yet there they are stand-ing outside your tutorial room.

Although we spend an abnormallylong time together as a course, itspretty much impossible to knoweveryone in your year. Sometimesyoull meet someone on exam daywho hasnt been to ANY lectures/tutorials. Sometimes you just thinktwo different but similar people areactually the same personi youare that person dont be offended there are too many o us to get toknow as well as wed like to. Maybeconsistently turning up to lectures,i not or getting your 9000-worth(or 3000 i youre lucky) is a

decent way o making sure peo-ple at least recognise your ace.

What am I doing here?

Whether youre a Fresher acedwith the Complement Cascade orthe first time, or a 4th year prepar-

ing or OSCEs, the question doescross our minds at some point.Most medics (i not all but not alllike to admit to it) go through amid-med-crisis. Questioning yourdecision in choosing medicine isa natural thing. Whether it be be-cause work is piling up, becausethat last lecturer made you wantto scream in rustration, or you

7


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Medic TypesFeature

8

simply havent ound anything in-teresting in a while one some-times does wonder Why the helldid I go through UCAS or this?At times like these it can be reas-suring to ask older years or advicebeore making any rash decisions.

Its nice hear about the light actual-ly existing at the end o the tunnel.O course, there are many moretypes o people who become med-ics. Some people know that they

dont actually want to become adoctor, but have an alternativemotive or getting their MBChB.Some DEFINIELY know whattheyre going to be, or example Iveoverheard oh yes, Im going to bea maxilloacial surgeon (FYI you

have to do a dentistry degree aswell to go into maxaxawkward)

Point is, despite having a large vari-ety o students with different back-grounds, we all have one aim; tomake it out o med school in onepiece. Learning alongside an inter-esting mix o people will make the5/6 years much more enjoyable.Who knows, next time you getinto an awkward lif situation A)your ault or not taking the stairsB) take the opportunity to talk

to someone you wouldnt usual-ly talk to but you know is on yourcourse you could be striking up ariendship that will last a lietime.


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You are a ourth year studenton your ACC (acute and criti-cal care) placement. Around twohours into your first day in A+E,a patient is brought into resus byparamedics. Te patient is a 62year old male in cardiac arrest.

ant who is going to be signingyou off or the next week is ask-ing you to do something to helpyour learning. You might not getmany more opportunities to intu-bate patients. But... is the practiseo intubation without the ami-lys consent ethically acceptable?

Argument for

Te main argument in support

o permitting procedures such asthis on the newly deceased is thebenefit to society. It gives physi-cians and students the opportu-nity to practise skills they mightnot otherwise acquire, providesan anatomically ideal model and

poses no danger to anyones health.It helps to ensure doctors o theuture are equipped and experi-enced with the necessary skills.Opponents say that the availabil-ity o mannequins means practiceon the newly deceased person is

unnecessary. However, these man-nequins are considered to be quitedifferent to humans anatomicallyand are too constant they do notshow variations seen in real people.Regarding the need or consent,it has been argued that by virtueo the patient using emergency

services, they have given impliedconsent by agreeing to all that

Te paramedics report that CPRen route has been unsuccessuland the patient does not have ashockable cardiac rhythm. Resus-citation efforts (CPR, intubation,drugs) continue until the patientsdeath is declared 20 minutes later.At this point, the emergency med-icine consultant removes the en-

dotracheal tube, turns to you, andasks you to attempt intubationon the now deceased patient. Heexplains that it is normal prac-tice and that it is essential to yourtraining that you learn to intubate.Te patients amily is waiting out-

side unaware o what is happening.What do you do? Te consult-

Te patients familyis waiting outsideunaware

An Ethical DilemmaArticle

9

An Ethical DilemmaAdam Brown


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strued consent should not countas valid orms o consent or thisprocedure as the aims o intuba-

tion pre- and post-death are so ex-tremely different: one is to save alie, the other is to practice a skill.What should I do i this hap-pens on my placement?

Hopeully none o us should everbe put in a situation like this as

doctors should know that carry-ing out procedures without con-sent on a deceased patient is il-legal. With skills like intubation,although they are ar less com-mon than more simple procedureslike cannulation, there will still

be plenty o opportunities to at-tempt it on your ACC placement.

Tere are also mannequins availa-ble in the Clinical Practice Centre.Never eel obliged to do somethingunethical because someone higher

up is asking you too. Chances are, iyoure gut reaction tells you not to doit, then you probably shouldnt do it!

being in the emergency depart-ment entails, including being usedor teaching. However, in reali-

ty, most patients who die in theemergency department will havebeen brought in by paramedicsin a state o impaired autonomy.Another theory put orward is theidea o construed consent. Tissays that because we have pre-sumed consent that the patient

wishes to be intubated during re-suscitation, this consent stretch-es to being intubated afer death.Tis seems quite ar-etchedthough, considering the aim o in-tubation has completely changed.

Arguments againstTe medical proessions attentionhas been drawn to the legal andethical arguments against usingthe newly dead or educationalpurposes. Such arguments clashwith the medical view that dur-

ing lie, the body and personhoodare intertwined but afer death theperson is gone and only the bodyremains. Perorming intubationwithout consent on a patient whohas just died is likely to be consid-ered repugnant by the majority,as well potentially being illegal idone without proper authorisation.Te theories o implied and con-

An Ethical DilemmaArticle

11


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12

SickoReview

Sicko Film ReviewKaat Marynissen

For those who missed Med-sins screening o Sicko a ewweeks ago, its a film I would defi-nitely recommend you take the

time to watch. It is at the leastthought-provoking, and definite-ly topical at a time when issuessuch as Obamacare can bring anentire government to a standstill.Directed by Michael Moore, Sickoaims to provide an insight into how

the American healthcare system a-ects those (and this is the crucialpoint) with health insurance. Teseare the people supposedly pro-tected by the comorting embraceo companies such as Cigna andWellpoint Inc. An embrace which,

remember, would cost the averageAmerican a cool $2,196 per year (1).

Tis act is something which will

come back to haunt you through-out the film; every almost implau-sibly egregious story is tainted withthe knowledge that these victimsare the lucky ones, those whomanaged to work with the sys-tem and persuade a company toinvest in them and their bodies.Except or when it goes wrong.We hear story afer story o thosedenied treatment, denied ba-sic care even, because somethingover which they had no controlwould have lost a company mon-ey. Dont get me wrong, Moores

documentary is meticulously en-gineered or maximum emotionalimpact. Many o the music-ladenshots o grateul tears have to betaken with the same pinch o saltone needs when watching the au-dition rounds o Te X-actor.

Strip back the melodrama howev-

Denied treatment,denied basic careeven


14/28

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er, and you are still lef with storiesthat are absolutely heart-breaking.

ake or example the 18 month-oldgirl who died afer being reusedthe antibiotics that would havesaved her, all because her motherwas unable to take her to a hospitalowned by the insurance companyshe was with. Or the 37-year-oldman suffering rom kidney can-cer, denied a bone marrow trans-plant on the grounds that it wasan experimental treatment.

Tis is when Sicko is at its mostpowerul- no narrators com-mentary and no opinion, just a

straightorward telling o the acts.It will make you ask yoursel ques-tions. Questions such as whyis it that the 6th richest countryin the world also has the highestfirst-day inant death rate out oall the industrialized countries in

the world?(2). Questions such asHow can people work within sucha system and still eel that they areulfilling their duty as doctors?Despite this, one thing which thisfilm will leave you eeling is pro-

oundly grateul. At one stageMoore investigates other health

care systems around the world,amongst which is the NHS. Incomparison to his homeland the

principle o ree at the point odelivery seems utopian, almostcomically so. Suddenly we areaced with the realisation that, de-spite its systemic ailures, its manydownalls and imperections,the very core idea o the Nation-al Health Service is truly noble.O course, this does not meanthat we should neglect to criticiseand attempt to improve it. Tereis much lef to be done and manysubsidiary principles which Imsure we would do well to revise.But please, please lets not lose sight

o why we are willing to labourand slave over the endless bureau-cratic details, why we will debate,campaign, petition and reviewBecause at its heart the NHS is abeautiul thing, and like all beau-tiul things it is worth fighting or.

1 .http :/ / inance .yahoo.com/news/How-Much-Does-Health-iw-1773357078.html2.http://www.cbsnews.com/8301-204_162-57583237/

14

Eastern OpportunitiesArticle


16/28

15

ABG InterpretationArticle

Arterial Blood Gas (ABG) InterpretationAdam Brown

Arterial Blood Gas measurementsare something we will all do on aregular basis as a junior doctor andbeyond. Tey are ofen an impor-tant test in a critically ill patient,yet many o us panic when it comesto interpreting the results. Te keyis to have a step by step, method-ological approach to interpret-

ing them which is exactly whatthis article is going to show you.It is important to remember thatthere must be a reason or doingan ABG. In other words, dont doone i the results wont change howyou manage the patient. Like any

test they use up time and money,and in the case o ABGs they arealso quite painul or the patient.ABGs provide valuable inorma-tion about blood pH and the par-tial pressures o carbon dioxideand oxygen in arterial blood, as

well as serum bicarbonate andbase excess. Electrolytes, glucose,haemoglobin and lactate are alsousually measured. In order to in-terpret an ABG, we need to knownormal reerence range values:

pH 7.35 7.45PaCO2 4.7 6.0 kPaPaO2 11.0 13.5 kPa

HCO3- 22 28 mmol/LBase excess +/- 2 mmol/L

Interpretation can thenbe split into 5 steps:

1. How is the patient?

Always try and see the patientor find out a little bit more about

their current condition first as thiswill provide you with clues to helpyou with the ABG interpretation.

2.Assess oxygenation

Is the patient hypoxaemic? o workthis out, it is important to find out

i they are receiving any oxygensupport. I the patient is breath-ing air, the PaO2 should be >10kPa. Otherwise, it should be about10 kPa less than the % concentra-tion o oxygen they are inspiring.

3.Assess pHIs the patient acidaemic? pH 7.45

4.Assess the respiratory

component

I PaCO2 is >6 kPa, this is respira-tory acidosis (or respiratory com-pensation or metabolic alkalosis).I PaCO2 is


17/28

ith MDU student membershipyou have access to:

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MDU Services Limited (MDUSL) is authorised and regulated by the Financial Conduct Authority for insurance mediation activities only. MDUSL is anagent for The Medical Defence Union Limited (MDU). MDU is not an insurance company. The benefits of MDU membership are all discretionary and aresubject to the Memorandum and Articles of Association.MDU Services Limited, registered in England 3957086. Registered Office: 230 Blackfriars Road, London SE1 8PJ. 2013.

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17

ABG InterpretationArticle

tory alkalosis (or respiratory com-pensation or a metabolic acidosis).I the respiratory disturbance

matches the direction o the pH,it is likely to be the primary dis-turbance. For example, i pHshows an acidaemia and PaCO2is high, this suggests the primarydisturbance is a respiratory aci-dosis. Remember, carbon dioxideis an acidic gas so i PaCO2 lev-els are high, the blood becomesmore acidic and pH decreases.

5. Assess the metabolic

component

For this we need to look at bi-carbonate HCO3- and base ex-

cess. Tese two values usual-ly mirror each other - i one israised the other one will be also.I HCO3- is 26 and base excess isgreater than +2, there is a metabol-ic alkalosis (or renal compensationor a respiratory acidosis.) Again,look to see i the metabolic com-ponent tells the same story as thepH. I it does, the metabolic distur-

bance is the primary disturbance.Now try this example:

A 23 year old show jumper isthrown rom her horse duringpractice. On the way to hospital she

became increasingly drowsy. Teparamedics inserted an oropharyn-geal airway and gave her high flowoxygen via a ace mask (FiO2 0.4).Her blood gas results are as ollows:

pH - 7.19PaCO2 - 10.2 kPaPaO2 - 18.8 kPaHCO3- 23.6 mmol/LBase excess -2.0 mmol/L

Using the 5 step approachwould go something like this:1. Te Patient - Reduced con-

sciousness level and obstructedairway will cause oxygenationand ventilation to be impaired,likely resulting in a respirato-ry disturbance. Tere is unlikelyto be any metabolic compensa-tion because the situation is acute.

2. Oxygenation - Te PaO2should be about 10 kPa lessthan the inspired % concentra-tion o oxygen (which in thiscase is 40%). Her PaO2 is only18.8, so oxygenation is impaired.3. pH - Te patient is acidaemic

because her pH is less than 7.35.4. Respiratory component Te


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PaCO2 is above 6 kPa, indicatingrespiratory acidosis. Tis is the sameend o the spectrum as the blood

pH, indicating the respiratory aci-dosis to be the primary disturbance.

5. Metabolic component Bi-carbonate levels are within thenormal range, indicating nometabolic disturbance, nor anymetabolic compensation or

the respiratory disturbance.

Summary: Acute respiratory aci-dosis with impaired oxygenation.Focus would need to be givento this patients airway and ven-tilation to reduce the PaCO2.

18

Hopeless Medic: First AidArticle

Medical MixtapeSarah Dabbs

Feeling stuck in a rut with yourmusic taste? Why not expand your

repertoire with some o these med-ically related ditties. WARNING:they may now pop up in yourhead at inappropriate or unex-pected times whilst on placement!

1) Bad medicine - Bon Jovi

For when youve been asked to takea sample o/examine something

particularly unsavoury youare probably going to eel a bitlike Whhhhyy did I choose

this degree?! Here is a cathar-tic song to help you through.

2) Its my life - Dr. Alban

Ok, I know it is a tenuous linkbut Dr Alban knows best.Iswear by this song.pure

90s techno trance therapy.

3) Fever Te MuppetsWhen you are called upon to exam-ine a ebrile patient, who will invari-ably sneeze and/or cough in your vi-cinity.[dont] give me ever

4)Te drugs dont work Te

Verve

Kind o depressing, but an awe-some song. Its in my head when Isee the requent-attendee IVUDsin A&E: the drugs dont work,

they just make you worse, but Iknow Ill see your ace again

5)No scrubs - LCFor when youre scrabblingaround the theatre changingroom looking or some scrubsthat dont fit like Hammer pantsor hal-mast skinny jeggings.


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20

Medical MixtapeArticle6)Dizzy - Vic Reevesand theWonderstuff

Labyrinthitis? Acostic Neuroma?Minires? Benign ParoxysmalVertigo?

7) Te first cut is the deepest P.P Arnold

Why not impress your supervisingconsultant surgeon by singing this

as they make that maiden incision?

8)Like a Surgeon Weird Al

From the brains behind AmishParadise (rehash o Gangstas Par-adise) and Just too White andNerdy (comedy cover o Riding

Dirty), Like a surgeon is the heart-elt account o a newly qualified sur-geon cuttin or the very first time.

9)St James Infirmary Blues Hugh Laurie

Tis is the kind o song that

should come with a health warn-ing.its pretty blue.but whenHouse MD is singing about StJames Infirmary, its got to makeit into the Leeds Medical mixtape!

10) Finals Fantasy Te Ama-

teur ransplants

As i getting a medical degree isntdifficult enough, these guys have

also simultaneously orged a musicand comedy career some peo-ple are just ridiculously talented.Pretty hilarious lyrics too Is it Pa-gets? No. Or Badgets? Tatdoesnt exist I thought not. Whatthe hell did you say Badgets or?


22/28

21

Intercalating Away From LeedsOpinion

1. Cats or dogs?

Cats. I have three, all Maine Coons.I like dogs, but they require walk-

ing, letting it and out, companyduring the day. Cats are better suit-ed to my liestyle.

2. Te Beatles or Te Stones?

Neither. Tey were big when I wasgrowing up, but I was a Bowie/Queen an. Not so keen on the later

music o either and now I like Bare-naked Ladies, Tey Might Be Gi-ants (both coming to Leeds soon!)and o course my daughters bandSky Larkin.

3. Star sign?

Aquaricorn. I have too many per-sonality traits to fit into one sign.

4. Tree fantasy dinner party

guests?Fantasy party with real guests orantasy guests? Ill take the latter:Nanny Ogg rom erry PratchettsDiscworld series (even though thedrinks bill might be high), Dr Shel-don Cooper rom Big Bang Teory

and the Dread Pirate Roberts romTe Princess Bride

5. Last thing you bought?A coronation chicken baguetterom Ca 7. Beore that a customdeck o Werewol cards rom the

Irish Discworld Convention char-ity auction.

6. Sweet or savoury?

Sweet. I have a horribly sweet tooth.At Xmas dinner, Im just waitingor the trifle.

7. ea or Coffee?ea. Teres a reason the coffeecream is always the last chocolateeaten at Xmas. Horrible stuff.

8. Library or nightclub?

Library. Anything the Conserva-

tives want to close down gets myvote.

20 Questions with Dr. Pat Harkin


23/28

Intercalating Away From LeedsOpinion

22

9. All time favourite song?

I like a lot o songs Ive only ever

sung one song in karaoke so Ill goor that One Week by BarenakedLadies.

10. Best read?

Only one? ough choice! Fiction -Mort by erry Pratchett. Non-fic-

tion Te Code Book by SimonSingh.11. When you were five, what did

you want to be when you grew up?

When I was five, I think all I want-ed to be was six.

12. Wine or beer?

Not an enormous an o either,though I have recently discoveredI like good brandy. And only goodbrandy! So my answer is wine, Isuppose.

13. Sun or snow?

I burn really, really easily Celticbackground and all that but I dotend to go to sunny places coveredin sunblock so effective that i I or-get to wash it off Ill get rickets.

14. PC or MAC?

PC all the way. Cheaper to buy orbuild and easier to tinker with.

15. Chinese or Italian?

Chinese, but my avourite Italian is

Duck in Hoi Sin pizza, the ultimateusion ood.

16. Star Wars or Star rek?

Star Wars. It came out when I wasa second year student, so it belongsto my adult lie whereas Star rek

is something I watched as a kid.

17. Saver or spender?

Spender, Im araid.

18. Roller coaster or Ferris wheel?

Ferris wheel but only because everyroller coaster Ive ever been on

hasnt been big enough or me toget my legs in comortably.

19. Medsoc or MSRC?

Lie member o Medsoc. Nevermade it onto MSRC.

20. Edward or Jacob?Never read any o the books orseen any o the films but taking asmy premise Vampires do not spar-kle, Id have to go or the werewol.Which one is that?


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23

Homelessness & ChristmasArticle

Stop and think about the man onthe street this Christmas- AndieIdisi

I suppose I owe this article to theman and his riend who I was at firsttrapped behind, then too struck toget away rom, while heading to-wards the station. He unknowing-ly subjected me to a verbal offen-sive; a strikingly misguided stringo complaints about the homeless.According to the learned speak-er, those who choose to live in thestreets (and he certainly seemed

clear on the act that they do take itupon themselves to adopt the role

o societys burden), were undoubt-edly drug addled wastes o time

that ought to stop bothering himand making the place look untidy.

o that man, I point out the reportI caught recently on multiple newschannels stating that up to 80,000children will be homeless this

Christmas. I wonder how he couldseem to be so oblivious o how thisrecession brought businesses totheir knees and spared ew ami-lies almost regardless o social andfinancial standings. It continues towreak havoc on the lives o many;

taking jobs, livelihoods and ofeneven homes as peoples needs in-creasingly outweigh their means.I shall skim past the schemes obig business owners deliberatelyneglecting to pass on appropriateshares o the recent upturn. But toreturn to the point, o course it was

not just jobless adults who becamehomeless, but their children too. Iwonder i the man I overheard con-siders the children at ault or theircircumstances too?

Growing up below the poverty line

(wherever governing powers canmanipulate the position o that line

Homelessness & ChristmasAndie Idisi


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Homelessness & ChristmasArticle

24

to sit best or them) can create aseemingly insurmountable num-ber o disadvantages. While scores

o individuals do make their wayout and achieve that coveted socialmobility, the idea o those trappedbehind being blamed or every as-pect o their lives is plainly shame-ul.

Strolling careree into town he con-tinued to pontificate on the othercharmless characteristics o thehomeless: under-motivated, uned-ucated and really why should hegive any one o them a penny?

His companion took the alternative

angle o bestowing pity on the manthey had passed, expressing patron-ising coos in what I ofen regard asthe isnt it sad about Arica? toneo voice. O course this is preerableto the alternative obnoxious indi-erence, but it would be somewhat

uplifing to think there was anoth-er way to respond - one with somegenuine human empathy.

Individuals do not cease to be hu-man when they become homeless.Tey do not all acquire a drug

addiction overnight (though un-doubtedly, or a percentage, sub-

stance misuse will have representeda very significant part o what ledto their situation). I hope it would

not be impossible or some to con-sider that there may have been oth-er contributors to the habit and thedamage done. Beyond this, I can-not agree that having an addictionautomatically disqualifies peoplerom deserving help.

Tere are a lot o malicious andmisinormed individuals in theworld: i you are looking or peo-ple to verbally assault, at the veryleast, dont make the homeless yourtarget, find something better to dowith your Christmas.


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