Medicine and law Essay Example

Medicine and law Essay Example Medicine and law Essay Medicine and law Essay Introduction It is now a firmly established belief that legal and ethical considerations are integral to medical practice in the planning for the care of the patient. With the advances in medical sciences and growing sophistication of the legal framework in modern society as well as increasing awareness of human rights and changing moral principles of the community at large, doctors and other healthcare workers alike are now frequently caught in difficult dilemmas in many aspects arising from daily practice. Examples are plenty such as the duty to respect informed consent, truth-telling, breach of confidentiality, disclosure  of medical errors, rationing of scarce health resources, biomedical research, organ donation, etc. Besides, there is also growing anxiety both within the medical profession and in the community regarding increasing trends of complaints and lawsuits against doctors. From the bitter experience of many doctors who were engaged in complaint or lawsuits in the past, many of them had resulted from failing of their doctor-patient communication skill or inadequate ability to comprehend and resolve dilemmas in clinical settings. Medical ethics has developed into a well based discipline which acts as a bridge between theoretical bioethics  and the bedside. 1 The goal is to improve the quality of patient care by identifying, analysing, and attempting to resolve the ethical problems that arise in practice. 2 In addition to our moral obligations, doctors are also bound by laws and official regulations which form the legal framework regulating medical practice. It is now a universal consensus that legal and ethical considerations are inherent and inseparable parts of good medical practice across the whole spectrum. The disciplines of law and ethics in medical practice overlap in many areas and yet each has its unique parameters and distinct focus. Legal and Ethical Regulations of Medical Practice in History In ancient Egypt, practice of medicine was subject to legal restrictions. The right to practise was restricted to members of a certain class, and all doctors had to learn and follow the percepts laid down by their predecessors. Obviously, this was to protect the public from quackery. Fees for the doctors were paid by the State. If unsatisfactory results followed a course of treatment that had departed from the orthodox, the doctor responsible would be liable to punishment, which could be very harsh. Similar legal restrictions on medical practice were also  found in other early civilizations such as Babylon and India. 3 Throughout the history of mankind, medical legislation has continuously evolved to regulate the practice of medicine. The fundamental objective is to safeguard the standards of the medical profession and to protect the public against unskilled vendors of medicine who would be as injurious to the community as other criminals. The Justinian Code of the Byzantine Empire in 529 AD is probably the earliest law code found to contain clauses to require educational standard and proof of competence of doctors by examinations. It also restricted the number of doctors in each town and penalties were imposed for malpractice. By 12th century, there were well established medical legislations in Italy, namely the edict of Roger II of Sicily in 1140 and Frederick II in 1224, to prescribe organized medical teaching, set courses, examinations and qualifications. 3 In Hong Kong, laws on public health and medical practice, essentially an adoption of the English Acts, had been introduced from the early days. In 1884, the first Medical Registration Ordinance was enacted to regulate the practice of medicine in the territory. Nowadays, the Hong  Kong Medical Council is established and empowered by law to perform the following major functions: (a) assessment of qualifications and maintenance of Register of Medical Practitioners, and registration is the only valid licence to practise medicine; (b) formulating guidelines on the ethical and professional standards; (c) investigation of complaints of professional misconduct; (d) supervision of medical education and training; and (e) assessment of fitness to practise where a doctors health is of concern. 4 In addition to legal regulation, there were also codes of medical ethics to guide the doctors for proper conduct. The earliest code of medical ethics is the Hippocratic Oath originated in Greece in the 5th century BC, which evolved to regulate the standard of conduct and care by 4 MEDICAL SECTION August 2003 the medical profession at that time. 3 Indeed, the spirit of this 25-century old Oath was restated in the Declaration of Geneva by the World Medical Association in 1948. The Declaration is the basis of the modern version of the International Code of Medical Ethics, which was first formulated by the World Medical Association in 1949 with subsequent amendments by the World Medical Assembly  in 1968 and 1983 in Sydney and Venice respectively. Meaning of Law and Medical Ethics in a Nutshell In its simplest context, law can be defined as enforced rules devised by the State to govern the behaviour of its members for the mutual benefits of all. Observance of the rules must be guaranteed by some kinds of sanction directed against the rule breakers. In addition to laws for the general public, doctors are bounded by certain specific rules stipulated in statutes as well as code of professional conduct laid down by the official regulating authority, namely the Medical Council, and administrative codes  set by the institutions. Together, they form the legal framework regarding the practice of medicine, violation of which may lead to criminal or civil liability, or disciplinary actions. In addition to legal obligations, there are also expectations of society for the doctors and the goal of the profession based on long established moral principles of self-evident value, which define the moral framework of medical practice. Medical ethics can be defined as a self-imposed code of conduct accepted voluntarily within the medical profession, the observance of which depends on ones conscience and moral values. Law and medical ethics are both dynamic and are in a constant state of change with time due to changing circumstances and societal values. Thus, new legislation and court decisions give rise to changes of the law and new ethical issues emerge in response to challenges created by new technology, law or other influence. There is also wide difference in law from country to country because of factors regarding religion, culture, traditions, political systems and social standards. Fundamental Principles in Medical Ethics5 Medical ethics is an applied ethics which involves examining specific controversial issues such as abortion,  breach of confidentiality, end-of-life care, rationing of scarce medical resources. The objective is to try to identify the issue concerned, analyze it with reasoned ideas and arguments and arrive at a viable and morally acceptable resolution for it. In the realm of medical practice, it is difficult to hold rules or principles that are absolute in view of the many variables that exist in the context of clinical cases as well as new issues that arise as a result of changing circumstances and belief. Nevertheless, over the years, there are certain fundamental principles that have won a general acceptance as guideposts in the  moral analysis of ethical dilemmas in medicine. The fundamental principles that apply generally to medicine or health care at large are: (a) respect of patients autonomy; (b) the principle of nonmaleficence, i. e. , the duty to avoid harm or injury to patients; (c) the principle of beneficence, i. e. , the duty to do good to your patients, relieve their pain and suffering and to save life if you can; and (d) the principle of justice and act fairly. The values that encompass the four fundamental principles in medical ethics are self-evident. They are considered to be doctors prima facie duties to the patients  and society. It is necessary for a doctor to take all of them into account when they are applicable to the clinical case under consideration. Not infrequently, when two or more principles apply, they may be in conflict. For instance, the decision to operate on a case of acute appendicitis involves at least two competing prima facie duties on the part of the doctor. At one end, the doctor is obliged to provide the greatest benefit to the patient by performing an immediate appendectomy. At the other end, surgery and general anesthesia carry risks and the doctor is under the obligation to avoid causing harm to the patient. The resolution adopted must base on a balance between the demands of the competing principles by determining which carries more weight in the particular case. In the case of appendicitis, a generally accepted rational calculus holds that the patient is in far greater risk of harm from a ruptured appendix if the doctor do not act, than from the operation and anesthesia if the doctor proceed to surgery. Law and Medicine Broadly speaking, medical matters come into interaction with law in four aspects: (a) legislation and administrative regulations affecting medical practice; (b) court judgments  on problematic or controversial ethical issues in medicine; (c) medical matters or personnel may become subjects of lawsuits when issues of medical malpractice or alleged medical negligence arise; and (d) use of medical matters as evidence in courts for other criminal or civil proceedings such as cases of homicide, rape, wounding, workmans compensation, insurance claims and the like. The Interaction of Law and Ethics in Medical Practice Despite their distinctive roles, law and medical ethics overlap in many areas. It is indeed difficult to dissociate the legal and ethical basis of the professional duties of  doctors. For instance, both law and medical ethics address to issues of confidentiality, euthanasia, abortion, use of dangerous drugs, medical malpractice and the like. MEDICAL SECTIONVol. 8 No. 6 5 Both law and medical ethics aim at safeguarding a good standard of medical practice within the community. The overriding consideration is to ensure the health and welfare of the general public. It is fundamental that doctors should be law abiding or they may face civil/criminal consequences due to breach of the standards prescribed by legal requirements. On the other hand, an ethics percept that is not adopted into  law may be a significant professional and moral guidance but it is generally not enforceable. Often, lawmakers (courts and legislature) do take into account the views of medical profession, which may include ethical principle, when crafting laws affecting medical practice. Thus, ethical standards can be incorporated in the legislation and become part of the legal standards. At times, a doctors prima facie ethical duty may clash with his legal obligation. A notable example that often occurs is when the duty of confidentiality has to be breached by a court order and refusal to disclosure  amounts to contempt of court. It is true that law is the established social rules for conduct which, in most instance, incorporates ethical standards to which the society subscribe. However, there are also instances when laws may be bent to reach socially compelling results, which can deviate from what is ethical. An entire society can become morally corrupt. No doubt, the doctors in Nazi Germany and Japan who had participated in the most notorious human experimentations during the Second World War were ethically wrong and were convicted of war criminals in subsequent trials, although  their behaviour were not legally wrong under their social standards at that time. Growing Attention to Legal and Ethical Issues in Medical Practice Attention to legal and ethical issues in medical practice is growing intense in recent years both within the medical profession and in all sectors of the society. The ethical issues raised by new medical advances and the rapidly changing public values have provoked much debates among medical professionals and in other disciplines including lawyers, philosophers, sociologists, theologians, mass media and the community at large. Large scale  programmes such as the human genome project, end- of-life care, priority setting, rationing of medical resources, womens health have attracted profound research interest in their ethical, legal and social issues. The propensity to litigate is also on the uprising trend in recent years. This is part and parcel of the general trend that people nowadays are more conscious of litigation in all areas of life, particularly in the light of the increased awareness of their legal and human rights as well as rules of law. During the past century or so, medicine has evolved more as a science than as a mystical art. The media has also reduced the complex medical sciences to a level that will allow the general population to comprehend. Moreover, consumerism is now firmly established in medical practice and this has been promoted on a wide scale by patients rights organizations as well as authorities through public education and introduction of charters and performance pledges. In recent decades, there has also been a fall of the traditional paternalism in medical practice. Thus, the patients and their families are now more ready to speak up to protect their rights, to raise questions or doubts on the conduct  and skill of their doctors. Furthermore, issues of infringement of patients rights, malpractice and medical negligence are now attracting wide media coverage. This has undoubtedly served to alert the general public to such possibilities. The increase in medical negligence claims and litigation on issues of malpractice in recent years is reflected both in the number of lawsuits and the tremendous sum of monetary value involved. There is now greater availability of lawyers as well as compensation claim agencies who are ready to assist the patients and their families to institute legal actions against their doctors. A greater proportion of the general population is now aware that the courts can and, on occasion, do provide substantial monetary compensation for personal injury. This has obviously enhanced the growing compensation awareness in the public mind. Even in a lawsuit that has not been successful in proving the defendant doctors liability to the plaintiffs personal injury, it can still devastate the doctors career because of the media coverage it receives. The new wave of class-action lawsuits against healthcare professionals and organizations in North America is particularly worrying. The assembling of a  group of plaintiffs instead of a single plaintiff greatly expands the defendants exposure to liability. Besides, it is also likely that the media attention on such a case will attract additional potential plaintiffs. 6 Another factor that has been suggested by some health care professionals is the depersonalization of the doctor- patient relationship. It is undoubtedly easier to sue a relatively anonymous defendant, such as a hospital consultant, than to sue a family doctor whom one has known for years, and this is even truer of hospital authorities. The Scope of Law and Ethics in Medical  Practice The scope of law and ethics in medical practice is expanding all the time. Any attempt in listing out the core topics can neither be complete nor prescriptive. Some topics are of interest to doctors of all specialties whilst some topics are more important to particular specialties. The following list is based largely on the consensus statement of the teachers of medical ethics and law in 6 MEDICAL SECTION August 2003 UK on a model for core curriculum in medical ethics and law within medical education: 1. Official regulations of medical practice (a) Statutes laid down by legislature e. g.  Cap 161 Medical Registration Ordinance Cap 134 Dangerous Drugs Ordinance Cap 137 Antibiotics Ordinance Cap 138 Pharmacy and Poisons Ordinance (b) List of Misconduct in a Professional Respect issued by the Medical Council of Hong Kong7 2. Foundations of doctor-patient relationship1,5 (a) Doctors obligation of fidelity – patients expect that doctors are trustworthy, knowledgeable and competent. Doctors are looked upon as trustees of patients medical welfare, always acting in the interests of the patients. We owe a duty of not causing harm to our patients (the principle of nonmaleficence). We also have a duty to do good  to our patients if we can (the principle of beneficence). (b) Respect of patients rights, including the basic principle of human rights and their relations with moral and professional duties. (c) Respect of privacy and confidentiality – the doctor- patient relationship is essentially founded on trust and confidence. Doctors are expected to respect for patients privacy and disclose patients information only when justified. At times, there is often conflict of interest between individuals or between and individual and the public with regard to disclosure of patients information. There is also  legal requirement to protect privacy in the general sense (Cap 486 Personal Data (Privacy) Ordinance). (d) Respect of patients autonomy informed consent and refusal to treatment are basic patients rights. There are several related issues regarding the determination of patients capacity to share in decision-making (patients competence), the principle of risk-benefit equation to decide how much information to be given to patients (therapeutic privilege) and the concept of surrogate decision in cases of incompetent patients. Difficult dilemmas can arise when this is in conflict with other prima facie duties of the  doctors such as the situation when emergency interventions are required in cases of incompetent patients. (e) The difficult patients, noncompliance, hostile patients and abuse of patients rights. (f) Breach of duties leading to medical negligence or malpractice claims. 3. Death and related issues (a) The definition and diagnosis of death. (b) The persistent vegetative state – what is the meaning of human life: an organism or a person with body and mind? Is there a need for advancing the definition of life; from somatic death and brain stem death to neocortical death? 8 (c) End-of-life care – whether life support decision is  to prolong life or suffering? Difficult issues of medical futility, forgoing life-sustaining treatment, doctor-assisted suicide and euthanasia have immense ethical and legal implications. A fundamental question for doctors is whether letting to die is the same as euthanasia. 8 (d) Legal and ethical issues in organ transplantation. 9 (e) Death certification and disposal of dead bodies. 10, 11 (f) Coroner and medico-legal investigations of death. 12 4. Reproductive medicine and genetics (a) The management of infertility – the legal and ethical issues in artificial insemination and surrogate motherhood. (b) The control of fertility – sterilization and other forms of contraception. (c) The right of foetus – the legal13 and ethical issues in abortion and the question of maternal-foetal conflict. (d) Prenatal screening and wrongful life, genetic counseling and eugenics. (e) Genetic therapy – whether it is to treat the abnormal or to improve the normal. (f) Cloning of human being – its legal and ethical considerations. 5. Biomedical human research and experimentation (a) The legal14 and ethical15 regulations. (b) Ethics committee consultations. (c) The discrepancy between developed and developing countries. 6.  Special issues in psychiatry (a) Legal16 and ethical justification for detention and treatment without consent. (b) Informed consent in patients suffering from mental illness – the question of competence by the state of mind. (c) Conflicts of interests between the patients, families and the society. (d) Mental disorders and crime – mental disorders and liabilities of an individual and issues of compulsory treatment for offenders (especially in cases of sex offenders); the role of psychiatrist as an expert witness. 7. Special issues in paediatrics (a) Consent in minor. (b) Conflicts of interest between parental rights, the  rights of the child and the duty of the paediatrician. (c) Legal and ethical issues in cases of child abuse. 17 (d) The paediatricians role in child protection. 8. Healthcare delivery and resource allocation18 (a) Dilemmas in deciding a fair distribution of scarce medical resources and the rights of individual patient to healthcare services. (b) Healthcare cost crisis: its political, social and economic implications. 19 (c) The criteria for rationing healthcare resources and MEDICAL SECTIONVol. 8 No. 6 7 the sustainability of the healthcare services – does rationing simply means cutting or trimming  healthcare budget? What is a fair healthcare policy? What is the direction of healthcare reform? (d) Ethical considerations in the business aspects of healthcare – economic constraints, models of remuneration, professional freedom. The issues related to Health Maintenance Organizations and other managed care providers. (e) Responsibility of individuals for their own health. (f) Global distributions of healthcare resources: a gross unevenness. 9. Quality assurance (a) Continuity of care for patients. (b) Communications between doctors and patients, doctors and doctors. The duty to consult when  necessary. (c) Peer review and clinical audits, continuous medical education. (d) Truth-telling, disclosure of medical errors and incompetent colleagues. 20, 21 (e) Healthcare complaints – what is a fair and user- friendly mechanism to receive and resolve complaints. 10. Use of medical matters as evidence in courts (a) The medical witness – a doctor may be called to attend courts to give professional or expert evidence, or both. The objective of medical evidence is to assist the court in determining the truth and hence enabling justice to be done. A medical witness must have impartiality, reliability,  clarity and relevancy. His duty is to give evidence on a scientific objective manner commensurating with his role as a doctor as well as his expertise. (b) The issue of hired gun. (c) Conflict between a doctors duties to his patient and his role as a medical witness. Conclusion In recent years, teaching of law and ethics in medical practice has emerged as a core curriculum in both undergraduate and postgraduate medical education in many developed countries such as the US, Canada, UK, Australia and New Zealand. 22, 23 Research and discussion papers on clinical ethics and reports on medico-legal  cases now constitute a significant contribution to the expansion of medical literature, which have enriched our knowledge in the areas with widening scopes. 2 This is perhaps a major area that the medical education and training in Hong Kong need to catch up. Doctors are now expected to have knowledge and understanding of the principles of medical ethics and the legal responsibilities of the medical profession. They should also have the ability to recognize complex legal and ethical issues arising from clinical practice and sound decision-making skills to resolve them. 24 Often there is  no single or universal answer to such issues. The views within the medical profession as well as the public change constantly with time and vary from one country to another. It is therefore prudent for doctors to keep themselves informed about the current views, and when in doubt, be ready to consult their peers, lawyers and ethicists. References 1. Fletcher JC, Hite CA, Lombardo PA, Marshall MF, eds. Introduction to Clinical Ethics. Frederick Maryland: University Publishing Group, 1995. 2. Siegler M, Pellegrino ED, Singer PA. Clinical ethics revisited. BMC Medical Ethics 2001; (available from: biomedcentral. com/1742-6939/2/1). 3. Camps FE ed. Gradwohls Legal Medicine, Chapter 1. Bristol: John Wright Sons Ltd. , 3rd edition, 1976. 4. The Medical Council of Hong Kong Homepage: mchk. org. hk. 5. Beauchamp TL, Childress JF. Principles of Biomedical Ethics. New York: Oxford University Press, 4th edition, 1994 6. Lightstone S. Class-action lawsuits medicines newest legal headache. JAMC 2001;165(5):622. 7. Medical Council of Hong Kong. Professional Code and Conduct: For the Guidance of Registered Medical Practitioners. Hong Kong: HKMC, revised 2000. 8. Arras JD, Steinbock B, eds. Ethical Issues in Modern  Medicine, Part II: Defining Death, Forgoing Life-Sustaining Treatment, and Euthanasia. Mountain View, California: Mayfield Publishing Co. , 4th edition, 1995. 9. Cap 465 Human Organ Transplant Ordinance, Law of Hong Kong. 10. Cap 174 Births and Deaths Registration Ordinance, Law of Hong Kong. 11. Cap 132 Public Health and Municipal Services Ordinance, Law of Hong Kong. 12. Cap 504 Coroners Ordinance, Law of Hong Kong. 13. Cap 212 Offence Against Persons Ordinance, Law of Hong Kong. 14. Cap 278 Medical (Therapy, Education and Research) Ordinance, Law of Hong Kong. 15. Council for International Organizations of Medical Sciences. International Ethical Guidelines for Biomedical Research Involving Human Subjects. CIOMS, revised 2002. 16. Cap 136 Mental Health Ordinance, Law of Hong Kong. 17. Social Welfare Department, Government of HKSAR. Procedures for Handling Child Abuse Cases. Hong Kong: SWD, revised 1998. 18. McKneally MF, Dickens BM, Meslin EM, Singer PA. Bioethics for clinicians: 13. Resource allocation. CMAJ 1997;157: 163-7. 19. Health and Welfare Bureau, Government of HKSAR. Lifelong Investment in Health: Consultation Document on Health Care Reform. Hong Kong: 2001. 20. Hebert PC, Levin AV, Robertson G. Bioethics for clinicians: 23. Disclosure of medical error. CMAJ 2001;164(4):509-13. 21. Burrows J. Telling tales and saving lives: Whistleblowing The role of professional colleagues in protecting patients from dangerous doctors. Medical Law Review 2001;9: 110-29. 22. Position Statement: An ethics core curriculum for Australasian medical schools. Med J Aus 2001;175: 205-10. 23. Doyal L, Gillon R. Medical ethics and law as a core subject in medical education. BMJ 1998;316:1623-4. 24. Australian Medical Council. Goals and objectives of basic medical education. Guidelines for assessment and accreditation of medical schools. Canberra: AMC, 2000.

Behaviors leading to insomnia Essay Example | Topics and Well Written Essays - 500 words

Behaviors leading to insomnia - Essay Example Other symptoms that manifest because of this condition are waking up too early and suffering from fatigue upon waking up (Morin et. al., 2011). Insomnia often manifests itself as either primary insomnia or secondary insomnia. Primary insomnia refers to sleeplessness that is not caused by any underlying condition while secondary insomnia is caused by an underlying medical condition (Buysse, 2013). The various medical conditions that can cause insomnia include asthma, arthritis, cancer, pain or medication being ingested by a person (Jarin, Chen, Ivers & Morin, 2013). This condition also manifests in self, depending on its duration, as either acute or chronic. Acute insomnia lasts a shorter time, a few weeks, while chronic insomnia lasts longer. There are varied effects that arise because of insomnia. Most of the effects of insomnia affect the quality of life and performance of daily tasks (Sasa et. al., 2010). In rare cases, insomnia results in death and this type of insomnia is referred to as fatal familial insomnia. First, insomnia decreases the quality of life in the form of lack of alertness and poor memory during the day (Sasa et. al., 2010). People who suffer from insomnia are more irritable, make more mistakes and develop poor relationships with their colleagues and spouses (Calhoun et. al., 2014). Insomnia further affects the concentration and performance of the brain. Those who suffer from this condition often suffer from mental health conditions such as nervousness, irritability and fatigue (Watts, Coyle & East, 2011). The lack of sleep affects the concentration span and focus. The brain requires several hours of sleep for it to achieve optimum concentration to perform tasks. Insomnia compromises the brain’s ability to process information. The effects of insomnia are numerous and influence the lives of people significantly (Morin et.

Workshop Critique Essay Example | Topics and Well Written Essays - 2000 words

Workshop Critique - Essay Example The design chosen by this specific group put into effect KOLB's theory of experimental learning (Kolb 1976). This was against the other models for a variety of reasons. The Johari Window is specific to every individual because of its division into what the person knows about them, what others know about the individual that is known and unknown to them and what is unknown about the individual to both himself and the group (Luft & Ingham). Thus all the Johari Window does is represent information about the individual in relation to his team or group. The ladder of inference concentrates on the understanding that prevents an individual from reaching the wrong conclusions (Senge 1994). Thus, in other words it assists an individual to consider the facts and reality before making any decision. The ladder plays on the individual's belief that his ideas and data might not be the correct or rational proof that the team seeks. This idea was too specific to convincing and teaching the truth so it was foregone as the chosen concept Tuckman's theory is considered one of the most successful team concepts ever created. The concept revolves around concentrating on the team's history: from its creation to the fulfillment of the task, the theory concentrates and succeeds in understanding the entirety of achieving any given task (Tuckman 1965). Tuckman also feels the need of adding a phase known as: adjourning and transforming that applies only after the team has finished their project. Thus, the concept talks of five phases: creating a team, brain-storming ideas, creating rules and values that must be followed, carrying out the practice and learning from experience. Our team chose to follow Kolb's concept. For this concept to come into affect in its entirety it was necessary to run it against a certain sort of experimentation. Kolb's model works on the idea of a four-stage learning cycle: concrete experience, reflective observation, abstract conceptualization and active experimentation. Thus every individual in the team succumbs to four different emotions: feeling, watching, thinking and doing (Chapman 2003). Our team merged the Kolb model with certain aspects of the Tuckman model to create an activity and environment that would suit the needs to show the workings and intricacies of team-work. By choosing to play a short game, Tuckman's theory of short projects to be the best indicator came into play. Not only was the activity chosen, short but it also allowed the facilitator to observe the behavior of the team over a measurable timeframe, allowing the judgments that were created to be functional and precise. Also, the activity which took placed allowed every member of the team to engage in each aspect of Kolb's model. Not only was each team member expected to be an active participant but they were also engaged into following the rules of emotionally involving themselves into the task, participating in it, improving by watching the fellow members and eventually doing the best job they thought possible (Kolb & Fry). Outcomes and

Activity-Based Costing vs Traditional Costing Essay

Activity-Based Costing vs Traditional Costing - Essay Example The other difference between the two methods is that activity based costing is accurate because it accounts for significant issues before it allocates cost to a given product. Contra wise the traditional costing is not accurate because it only considers specific products.Activity based costing demonstrates the cost of a product cross-subsidization challenge in cases where some products costs are higher and also when other products costs are lower as compared to the traditional method produced costing. The ABC regularly demonstrates that other products cost are highly costed while others are under coasted, hence resulting in crossing subsidization.Activity based is used to progress profitability through analyzing first the clients demand products, customers may require little or considerable support. Therefore, ABC helps in determining different amounts of customer’s activities be supported, and their costs for each client benefit and, as a result, deciding customer’s pr ofitability. However, the customers benefit is determined after the consideration of the customers support. Some of the ABC disadvantages are that implementation is expensive and time-consuming to establish ABC system. The system requires more resources like software that could be costly and consultants with the necessary expertise. The other disadvantage is data misinterpretation due to challenges in interpreting ABC data with often accounting information, which can be at times tricky, regarding decision-making.

Mental Health Facility Closure: Effects on Patients

Mental Health Facility Closure: Effects on Patients Patrick A. Mallare Mental health facilities provide different services to a person at any age who are experiencing mental and emotional crisis. Some of these services include alcohol and substance abuse treatment, behavioral disorders treatment, rehabilitations and support groups. These facilities are very helpful to our society as mental health professionals work together to help and support those people in need to regain their good mental health and live normally. There are several mental health facilities around the world, however, some of these facilities are planning to close or had closed already. Some reasons of the facilities closure are related to financial issues, non-compliance with the laws and regulations or quality of care complaints. There is one in York, the Bootham Park hospital (public adult mental health hospital) have decided to closed in October 2015 with only five days notice. Care Quality Commission (CQC) inspectors came unannounced and found it was unfit for purpose and that patients were at significant risk of harm (Slawson, 2015) and forced to close in 5 days. But, per Greenwood (2016), there is a speculation that the hospital will be sold to private developers. Another mental health facility, the Community Counseling Centers of Chicago which is known as one of the largest providers of mental health services to poor North Siders; which cares for more than 10,000 patients, including children (Chicago, 2015) was about to close in May 2015 due to financial difficulties. But because of the concern to 10,000 existing patients, C4 remained open with partnership agreement to CountyCare, Cook County Health Hospitals Systems Medicaid health plan (Zumbach, 2015). Closure of any facilities whether it is small or big facilities matters to all the patients and their families as well as the employees and healthcare professionals. Mental health facilities closure has big impact to everyone especially the patients who are seeking help for their recovery. Serious problems might be encountered and will greatly affect their lives. The first option that patients will do if facility closes is to find a new facility where they would be accepted to receive the care that they need. And, looking for a new place means changing their healthcare provider. In this situation, any changes will be difficult for these kinds of patients with mental and behavioral disorders. Like what Fawcett (2014) mentioned in her article, Medical records can be transferred in the blink of an eye but it takes much longer to open up to someone and feel comfortable talking about your symptoms, particularly if you have a stigmatized psychological disorder such as schizophrenia or bipolar disorder. And, building rapport and developing a doctor-patient relationship could be difficult as well. Amy Watson, an associate professor at University of Chicago-Illinoiss Jane Adams College of Social Work who specializes in mental health policy, also stated that it takes months before youre in a position where you might know that person, trust that person and feel comfortable with really working on things with them (Fawcett, 2014). It is difficult to build a trusting relationship to anyone especially for patients with severe mental disorders/illnesses. In this situation, physical and emotional challenges may be experienced and this will affect their decision whether they will be interested to look for another facility for their treatment or just do nothing. Per Hwong (2016), San Franciscos county jail is the largest mental health facility wherein 35 to 40 percent of inmates are getting treatment for mental illness. Closure of mental health facilities is one of the reason why people with mental health issues especially poor people ended up in jail. One example that Fawcett (2014) mentioned in her article, a homeless person sleeping on somebodys car will be arrested for trespassing when the driver calls the police. In this situation, it is not really their intention to scare people. They just dont have any place to go to. And, if those homeless people are mentally ill and was not receiving the medication treatment that theyre supposed to take, then their behaviors will show and will act differently. Closure of mental health facilities or other healthcare facilities is very devastating. Patients, families, employees and healthcare professionals cannot control or stop this kind of situation. It is the owners responsibility on how to maintain the facilitys integrity, quality of care and compliance to laws and regulation to meet the quality standards in a facility. But, before both parties agrees with the closure of the facilities, they should think about their existing patients too who really needed their help. For some people with mental and behavioral disorders, that place is the only place that they know for sure a safe place to stay and get recovered. So, when people try to take away this place to them, they might be in distress again, panic and make them more confuse. I agreed with Hwong (2016) statement: Directing funding to mental health and housing services rather than more criminal justice facilities is a first step in the right direction, but clinicians and consumers must be part of the process; If we dare, we can develop innovative solutions for mental heal th care ones that allow people to live with the kind of dignity and justice that we all deserve. This is one of the main solution and alternative shelter and a place for continues recovery for people with mental and behavioral disorders when mental facilities decided to close. References Greenwood, P. (2016). The NHS mental health hospital closed with just five days warning. The Guardian. Retrieved from: https://www.theguardian.com/society/2016/mar/14/the-nhs-mental-health-hospital-closed-with-just-five-days-warning Fawcett, K. (2014). What Happens to Patients When Mental Health Clinics Close? US News. Retrieved from: http://health.usnews.com/health-news/patient-advice/articles/2014/09/30/what-happens-to-patients-when-mental-health-clinics-close Hwong, A. (2016). S.F.s largest mental health facility the jail. San Francisco Chronicle. Retrieved from: http://www.sfchronicle.com/opinion/openforum/article/S-F-s-largest-mental-health-facility-the-10645994.php Slawson, N. (2015). Bootham Park Hospital: sudden closure leaves patients vulnerable. The Guardian. Retrieved from: https://www.theguardian.com/society/2015/oct/01/ bootham-park-hospital-sudden- closure-leaves-patients-vulnerable Zumbach, L. (2015). Mental health deal keeps Community Counseling Centers of Chicago open. Chicago Tribune. Retrieved from: http://www.chicagotribune.com/news/ct-c4-countycare-agreement-met-20150515-story.html Devastating closure of mental health centers to hit 10,000 patients next month. Chicago Suntimes. Retrieved from: http://chicago.suntimes.com/news/devastating-closure-of-mental-health-centers-to-hit-10000-patients-next-month/

Role Models in The Odyssy Essay -- Homer

Role models come in all shapes and sizes. In the epic poem The Odyssey, written by Homer, Odysseus faces many challenges in which he has to use certain traits of his to overcome his problems. Odysseus is a good role model because he is brave, intelligent, and unwavering. One of Odysseus’ traits is bravery. One example of Odysseus’ bravery is when he injures a Cyclops that is 5 times his size, â€Å"I drew it from the coals and my four fellows/ gave me a hand, lugging it near the Cyclops/ as more than natural force nerved them, straight forward they sprinted, lifted it, and rammed it/ deep in his crater eye. 329-332† This quote shows how brave Odysseus and his men are to face the Cyclops. Odysseus was intelligent to think about this idea, but he was brave for actually following through and doing it. Odysseus was also brave for fighting Penelope’s suitors even when he was outnumbered, â€Å"Now shrugging off his rags the wiliest fighter of the islands/ leapt and stood on the broad doorsill, his own bow in his hand/ he poured out at his feet a rain of arrows from the quiver/ and spoke to the c...

A Game of Thrones Chapter Sixty-one

Daenerys When the battle was done, Dany rode her silver through the fields of the dead. Her handmaids and the men of her khas came after, smiling and jesting among themselves. Dothraki hooves had torn the earth and trampled the rye and lentils into the ground, while arakhs and arrows had sown a terrible new crop and watered it with blood. Dying horses lifted their heads and screamed at her as she rode past. Wounded men moaned and prayed. Jaqqa rhan moved among them, the mercy men with their heavy axes, taking a harvest of heads from the dead and dying alike. After them would scurry a flock of small girls, pulling arrows from the corpses to fill their baskets. Last of all the dogs would come sniffing, lean and hungry, the feral pack that was never far behind the khalasar. The sheep had been dead longest. There seemed to be thousands of them, black with flies, arrow shafts bristling from each carcass. Khal Ogo's riders had done that, Dany knew; no man of Drogo's khalasar would be such a fool as to waste his arrows on sheep when there were shepherds yet to kill. The town was afire, black plumes of smoke roiling and tumbling as they rose into a hard blue sky. Beneath broken walls of dried mud, riders galloped back and forth, swinging their long whips as they herded the survivors from the smoking rubble. The women and children of Ogo's khalasar walked with a sullen pride, even in defeat and bondage; they were slaves now, but they seemed not to fear it. It was different with the townsfolk. Dany pitied them; she remembered what terror felt like. Mothers stumbled along with blank, dead faces, pulling sobbing children by the hand. There were only a few men among them, cripples and cowards and grandfathers. Ser Jorah said the people of this country named themselves the Lhazareen, but the Dothraki called them haesh rakhi, the Lamb Men. Once Dany might have taken them for Dothraki, for they had the same copper skin and almond-shaped eyes. Now they looked alien to her, squat and flat-faced, their black hair cropped unnaturally short. They were herders of sheep and eaters of vegetables, and Khal Drogo said they belonged south of the river bend. The grass of the Dothraki sea was not meant for sheep. Dany saw one boy bolt and run for the river. A rider cut him off and turned him, and the others boxed him in, cracking their whips in his face, running him this way and that. One galloped behind him, lashing him across the buttocks until his thighs ran red with blood. Another snared his ankle with a lash and sent him sprawling. Finally, when the boy could only crawl, they grew bored of the sport and put an arrow through his back. Ser Jorah met her outside the shattered gate. He wore a dark green surcoat over his mail. His gauntlets, greaves, and greathelm were dark grey steel. The Dothraki had mocked him for a coward when he donned his armor, but the knight had spit insults right back in their teeth, tempers had flared, longsword had clashed with arakh, and the rider whose taunts had been loudest had been left behind to bleed to death. Ser Jorah lifted the visor of his flat-topped greathelm as he rode up. â€Å"Your lord husband awaits you within the town.† â€Å"Drogo took no harm?† â€Å"A few cuts,† Ser Jorah answered, â€Å"nothing of consequence. He slew two khals this day. Khal Ogo first, and then the son, Fogo, who became khal when Ogo fell. His bloodriders cut the bells from their hair, and now Khal Drogo's every step rings louder than before.† Ogo and his son had shared the high bench with her lord husband at the naming feast where Viserys had been crowned, but that was in Vaes Dothrak, beneath the Mother of Mountains, where every rider was a brother and all quarrels were put aside. It was different out in the grass. Ogo's khalasar had been attacking the town when Khal Drogo caught him. She wondered what the Lamb Men had thought, when they first saw the dust of their horses from atop those cracked-mud walls. Perhaps a few, the younger and more foolish who still believed that the gods heard the prayers of desperate men, took it for deliverance. Across the road, a girl no older than Dany was sobbing in a high thin voice as a rider shoved her over a pile of corpses, facedown, and thrust himself inside her. Other riders dismounted to take their turns. That was the sort of deliverance the Dothraki brought the Lamb Men. I am the blood of the dragon, Daenerys Targaryen reminded herself as she turned her face away. She pressed her lips together and hardened her heart and rode on toward the gate. â€Å"Most of Ogo's riders fled,† Ser Jorah was saying. â€Å"Still, there may be as many as ten thousand captives.† Slaves, Dany thought. Khal Drogo would drive them downriver to one of the towns on Slaver's Bay. She wanted to cry, but she told herself that she must be strong. This is war, this is what it looks like, this is the price of the Iron Throne. â€Å"I've told the khal he ought to make for Meereen,† Ser Jorah said. â€Å"They'll pay a better price than he'd get from a slaving caravan. Illyrio writes that they had a plague last year, so the brothels are paying double for healthy young girls, and triple for boys under ten. If enough children survive the journey, the gold will buy us all the ships we need, and hire men to sail them.† Behind them, the girl being raped made a heartrending sound, a long sobbing wail that went on and on and on. Dany's hand clenched hard around the reins, and she turned the silver's head. â€Å"Make them stop,† she commanded Ser Jorah. â€Å"Khaleesi?† The knight sounded perplexed. â€Å"You heard my words,† she said. â€Å"Stop them.† She spoke to her khas in the harsh accents of Dothraki. â€Å"Jhogo, Quaro, you will aid Ser Jorah. I want no rape.† The warriors exchanged a baffled look. Jorah Mormont spurred his horse closer. â€Å"Princess,† he said, â€Å"you have a gentle heart, but you do not understand. This is how it has always been. Those men have shed blood for the khal. Now they claim their reward.† Across the road, the girl was still crying, her high singsong tongue strange to Dany's ears. The first man was done with her now, and a second had taken his place. â€Å"She is a lamb girl,† Quaro said in Dothraki. â€Å"She is nothing, Khaleesi. The riders do her honor. The Lamb Men lay with sheep, it is known.† â€Å"It is known,† her handmaid Irri echoed. â€Å"It is known,† agreed Jhogo, astride the tall grey stallion that Drogo had given him. â€Å"If her wailing offends your ears, Khaleesi, Jhogo will bring you her tongue.† He drew his arakh. â€Å"I will not have her harmed,† Dany said. â€Å"I claim her. Do as I command you, or Khal Drogo will know the reason why.† â€Å"Ai, Khaleesi,† Jhogo replied, kicking his horse. Quaro and the others followed his lead, the bells in their hair chiming. â€Å"Go with them,† she commanded Ser Jorah. â€Å"As you command.† The knight gave her a curious look. â€Å"You are your brother's sister, in truth.† â€Å"Viserys?† She did not understand. â€Å"No,† he answered. â€Å"Rhaegar.† He galloped off. Dany heard Jhogo shout. The rapers laughed at him. One man shouted back. Jhogo's arakh flashed, and the man's head went tumbling from his shoulders. Laughter turned to curses as the horsemen reached for weapons, but by then Quaro and Aggo and Rakharo were there. She saw Aggo point across the road to where she sat upon her silver. The riders looked at her with cold black eyes. One spat. The others scattered to their mounts, muttering. All the while the man atop the lamb girl continued to plunge in and out of her, so intent on his pleasure that he seemed unaware of what was going on around him. Ser Jorah dismounted and wrenched him off with a mailed hand. The Dothraki went sprawling in the mud, bounced up with a knife in hand, and died with Aggo's arrow through his throat. Mormont pulled the girl off the pile of corpses and wrapped her in his blood-spattered cloak. He led her across the road to Dany. â€Å"What do you want done with her?† The girl was trembling, her eyes wide and vague. Her hair was matted with blood. â€Å"Doreah, see to her hurts. You do not have a rider's look, perhaps she will not fear you. The rest, with me.† She urged the silver through the broken wooden gate. It was worse inside the town. Many of the houses were afire, and the jaqqa rhan had been about their grisly work. Headless corpses filled the narrow, twisty lanes. They passed other women being raped. Each time Dany reined up, sent her khas to make an end to it, and claimed the victim as slave. One of them, a thick-bodied, flat-nosed woman of forty years, blessed Dany haltingly in the Common Tongue, but from the others she got only flat black stares. They were suspicious of her, she realized with sadness; afraid that she had saved them for some worse fate. â€Å"You cannot claim them all, child,† Ser Jorah said, the fourth time they stopped, while the warriors of her khas herded her new slaves behind her. â€Å"I am khaleesi, heir to the Seven Kingdoms, the blood of the dragon,† Dany reminded him. â€Å"It is not for you to tell me what I cannot do.† Across the city, a building collapsed in a great gout of fire and smoke, and she heard distant screams and the wailing of frightened children. They found Khal Drogo seated before a square windowless temple with thick mud walls and a bulbous dome like some immense brown onion. Beside him was a pile of heads taller than he was. One of the short arrows of the Lamb Men stuck through the meat of his upper arm, and blood covered the left side of his bare chest like a splash of paint. His three bloodriders were with him. Jhiqui helped Dany dismount; she had grown clumsy as her belly grew larger and heavier. She knelt before the khal. â€Å"My sun-and-stars is wounded.† The arakh cut was wide but shallow; his left nipple was gone, and a flap of bloody flesh and skin dangled from his chest like a wet rag. â€Å"Is scratch, moon of life, from arakh of one bloodrider to Khal Ogo,† Khal Drogo said in the Common Tongue. â€Å"I kill him for it, and Ogo too.† He turned his head, the bells in his braid ringing softly. â€Å"Is Ogo you hear, and Fogo his khalakka, who was khal when I slew him.† â€Å"No man can stand before the sun of my life,† Dany said, â€Å"the father of the stallion who mounts the world.† A mounted warrior rode up and vaulted from his saddle. He spoke to Haggo, a stream of angry Dothraki too fast for Dany to understand. The huge bloodrider gave her a heavy look before he turned to his khal â€Å"This one is Mago, who rides in the khas of Ko Jhaqo. He says the khaleesi has taken his spoils, a daughter of the lambs who was his to mount.† Khal Drogo's face was still and hard, but his black eyes were curious as they went to Dany. â€Å"Tell me the truth of this, moon of my life,† he commanded in Dothraki. Dany told him what she had done, in his own tongue so the khal would understand her better, her words simple and direct. When she was done, Drogo was frowning. â€Å"This is the way of war. These women are our slaves now, to do with as we please.† â€Å"It pleases me to hold them safe,† Dany said, wondering if she had dared too much. â€Å"If your warriors would mount these women, let them take them gently and keep them for wives. Give them places in the khalasar and let them bear you sons.† Qotho was ever the cruelest of the bloodriders. It was he who laughed. â€Å"Does the horse breed with the sheep?† Something in his tone reminded her of Viserys. Dany turned on him angrily. â€Å"The dragon feeds on horse and sheep alike.† Khal Drogo smiled. â€Å"See how fierce she grows!† he said. â€Å"It is my son inside her, the stallion who mounts the world, filling her with his fire. Ride slowly, Qotho . . . if the mother does not burn you where you sit, the son will trample you into the mud. And you, Mago, hold your tongue and find another lamb to mount. These belong to my khaleesi.† He started to reach out a hand to Daenerys, but as he lifted his arm Drogo grimaced in sudden pain and turned his head. Dany could almost feel his agony. The wounds were worse than Ser Jorah had led her to believe. â€Å"Where are the healers?† she demanded. The khalasar had two sorts: barren women and eunuch slaves. The herbwomen dealt in potions and spells, the eunuchs in knife, needle, and fire. â€Å"Why do they not attend the khal?† â€Å"The khal sent the hairless men away, Khaleesi,† old Cohollo assured her. Dany saw the bloodrider had taken a wound himself; a deep gash in his left shoulder. â€Å"Many riders are hurt,† Khal Drogo said stubbornly. â€Å"Let them be healed first. This arrow is no more than the bite of a fly, this little cut only a new scar to boast of to my son.† Dany could see the muscles in his chest where the skin had been cut away. A trickle of blood ran from the arrow that pierced his arm. â€Å"It is not for Khal Drogo to wait,† she proclaimed. â€Å"Jhogo, seek out these eunuchs and bring them here at once.† â€Å"Silver Lady,† a woman's voice said behind her, â€Å"I can help the Great Rider with his hurts.† Dany turned her head. The speaker was one of the slaves she had claimed, the heavy, flat-nosed woman who had blessed her. â€Å"The khal needs no help from women who lie with sheep,† barked Qotho. â€Å"Aggo, cut out her tongue.† Aggo grabbed her hair and pressed a knife to her throat. Dany lifted a hand. â€Å"No. She is mine. Let her speak.† Aggo looked from her to Qotho. He lowered his knife. â€Å"I meant no wrong, fierce riders.† The woman spoke Dothraki well. The robes she wore had once been the lightest and finest of woolens, rich with embroidery, but now they were mud-caked and bloody and ripped. She clutched the torn cloth of her bodice to her heavy breasts. â€Å"I have some small skill in the healing arts.† â€Å"Who are you?† Dany asked her. â€Å"I am named Mirri Maz Duur. I am godswife of this temple.† â€Å"Maegi,† grunted Haggo, fingering his arakh. His look was dark. Dany remembered the word from a terrifying story that Jhiqui had told her one night by the cookfire. A maegi was a woman who lay with demons and practiced the blackest of sorceries, a vile thing, evil and soulless, who came to men in the dark of night and sucked life and strength from their bodies. â€Å"I am a healer,† Mirri Maz Duur said. â€Å"A healer of sheeps,† sneered Qotho. â€Å"Blood of my blood, I say kill this maegi and wait for the hairless men.† Dany ignored the bloodrider's outburst. This old, homely, thickbodied woman did not look like a maegi to her. â€Å"Where did you learn your healing, Mirri Maz Duur?† â€Å"My mother was godswife before me, and taught me all the songs and spells most pleasing to the Great Shepherd, and how to make the sacred smokes and ointments from leaf and root and berry. When I was younger and more fair, I went in caravan to Asshai by the Shadow, to learn from their mages. Ships from many lands come to Asshai, so I lingered long to study the healing ways of distant peoples. A moonsinger of the Jogos Nhai gifted me with her birthing songs, a woman of your own riding people taught me the magics of grass and corn and horse, and a maester from the Sunset Lands opened a body for me and showed me all the secrets that hide beneath the skin.† Ser Jorah Mormont spoke up. â€Å"A maester?† â€Å"Marwyn, he named himself,† the woman replied in the Common Tongue. â€Å"From the sea. Beyond the sea. The Seven Lands, he said. Sunset Lands. Where men are iron and dragons rule. He taught me this speech.† â€Å"A maester in Asshai,† Ser Jorah mused. â€Å"Tell me, Godswife, what did this Marwyn wear about his neck?† â€Å"A chain so tight it was like to choke him, Iron Lord, with links of many metals.† The knight looked at Dany. â€Å"Only a man trained in the Citadel of Oldtown wears such a chain,† he said, â€Å"and such men do know much of healing.† â€Å"Why should you want to help my khal?† â€Å"All men are one flock, or so we are taught,† replied Mirri Maz Duur. â€Å"The Great Shepherd sent me to earth to heal his lambs, wherever I might find them.† Qotho gave her a stinging slap. â€Å"We are no sheep, maegi.† â€Å"Stop it,† Dany said angrily. â€Å"She is mine. I will not have her harmed.† Khal Drogo grunted. â€Å"The arrow must come out, Qotho.† â€Å"Yes, Great Rider,† Mirri Maz Duur answered, touching her bruised face. â€Å"And your breast must be washed and sewn, lest the wound fester.† â€Å"Do it, then,† Khal Drogo commanded. â€Å"Great Rider,† the woman said, â€Å"my tools and potions are inside the god's house, where the healing powers are strongest.† â€Å"I will carry you, blood of my blood,† Haggo offered. Khal Drogo waved him away. â€Å"I need no man's help,† he said, in a voice proud and hard. He stood, unaided, towering over them all. A fresh wave of blood ran down his breast, from where Ogo's arakh had cut off his nipple. Dany moved quickly to his side. â€Å"I am no man,† she whispered, â€Å"so you may lean on me.† Drogo put a huge hand on her shoulder. She took some of his weight as they walked toward the great mud temple. The three bloodriders followed. Dany commanded Ser Jorah and the warriors of her khas to guard the entrance and make certain no one set the building afire while they were still inside. They passed through a series of anterooms, into the high central chamber under the onion. Faint light shone down through hidden windows above. A few torches burnt smokily from sconces on the walls. Sheepskins were scattered across the mud floor. â€Å"There,† Mirri Maz Duur said, pointing to the altar, a massive blue-veined stone carved with images of shepherds and their flocks. Khal Drogo lay upon it. The old woman threw a handful of dried leaves onto a brazier, filling the chamber with fragrant smoke. â€Å"Best if you wait outside,† she told the rest of them. â€Å"We are blood of his blood,† Cohollo said. â€Å"Here we wait.† Qotho stepped close to Mirri Maz Duur. â€Å"Know this, wife of the Lamb God. Harm the khal and you suffer the same.† He drew his skinning knife and showed her the blade. â€Å"She will do no harm.† Dany felt she could trust this old, plainfaced woman with her flat nose; she had saved her from the hard hands of her rapers, after all. â€Å"If you must stay, then help,† Mirri told the bloodriders. â€Å"The Great Rider is too strong for me. Hold him still while I draw the arrow from his flesh.† She let the rags of her gown fall to her waist as she opened a carved chest, and busied herself with bottles and boxes, knives and needles. When she was ready, she broke off the barbed arrowhead and pulled out the shaft, chanting in the singsong tongue of the Lhazareen. She heated a flagon of wine to boiling on the brazier, and poured it over his wounds. Khal Drogo cursed her, but he did not move. She bound the arrow wound with a plaster of wet leaves and turned to the gash on his breast, smearing it with a pale green paste before she pulled the flap of skin back in place. The khal ground his teeth together and swallowed a scream. The godswife took out a silver needle and a bobbin of silk thread and began to close the flesh. When she was done she painted the skin with red ointment, covered it with more leaves, and bound the breast in a ragged piece of lambskin. â€Å"You must say the prayers I give you and keep the lambskin in place for ten days and ten nights,† she said. â€Å"There will be fever, and itching, and a great scar when the healing is done.† Khal Drogo sat, bells ringing. â€Å"I sing of my scars, sheep woman.† He flexed his arm and scowled. â€Å"Drink neither wine nor the milk of the poppy,† she cautioned him. â€Å"Pain you will have, but you must keep your body strong to fight the poison spirits.† â€Å"I am khal,† Drogo said. â€Å"I spit on pain and drink what I like. Cohollo, bring my vest.† The older man hastened off. â€Å"Before,† Dany said to the ugly Lhazareen woman, â€Å"I heard you speak of birthing songs . . . â€Å" â€Å"I know every secret of the bloody bed, Silver Lady, nor have I ever lost a babe,† Mirri Maz Duur replied. â€Å"My time is near,† Dany said. â€Å"I would have you attend me when he comes, if you would.† Khal Drogo laughed. â€Å"Moon of my life, you do not ask a slave, you tell her. She will do as you command.† He jumped down from the altar. â€Å"Come, my blood. The stallions call, this place is ashes. It is time to ride.† Haggo followed the khal from the temple, but Qotho lingered long enough to favor Mirri Maz Duur with a stare. â€Å"Remember, maegi, as the khal fares, so shall you.† â€Å"As you say, rider,† the woman answered him, gathering up her jars and bottles. â€Å"The Great Shepherd guards the flock.†