According to psychologist Abraham Maslow, a sense of belongingness is an important part of every human being’s hierarchy of psychological needs. It is man’s nature to look for a group a social circle where members can establish connections and find avenues to share common interests with. Such groups include cliques, student organizations in schools, and even fraternities and sororities. Most of these groups require applicants to prove their desire and determination before they are accepted. Screening methods vary from requiring attendance and participation in different kinds of initiation rites, doing simple tasks to subjecting oneself to brutal physical endurance tests, including hazing.
The common imagery surrounding hazing is the use of a wooden paddle to hit different body parts of an initiate. However, hazing can also exist in other forms such as emotional or even psychological humiliation. Hazing has recently been brought back into the limelight following the death of a UST law student, Horacio Tomas Castillo III. The victims of hazing are apparently healthy young adults. So how does being physically beaten black and blue lead to the untimely demise of the victim?
The effects of mechanical injury, specifically blunt force injury in this case, depends on the duration of exposure, strength at impact, and body parts that bear the impact. Strong forces applied to the back or over the abdomen can lead to lacerations of internal organs such as the liver, spleen, or kidneys which may lead to internal bleeding, a sudden drop in blood pressure, and death. However, most of these victims only show large contusions and hematomas over their arms and legs.
The repeated blows to the limbs lead to severe damage and rapid breakdown of muscle tissues causing a condition called rhabdomyolysis. It can also result from a variety of other causes which can include crush injuries, accidents, or even as a side effect of certain medications.
Rhabdomyolysis leads to the release of myoglobin into the bloodstream. Myoglobin is an oxygen-carrying protein that is a normal component of muscle. It gives these tissues their characteristic pinkish-red color similar to a fresh cut of red meat seen in the market. The body has protective mechanisms to keep this potentially toxic protein at very low levels in circulation. However given the large amounts liberated at the time of injury, these protective mechanisms are easily overwhelmed.
The organs primarily damaged in rhabdomyolysis are the kidneys. These organs filter blood and excrete waste products into the urine. Myoglobin is freely filtered and excreted by the kidneys. Normal urine is acidic and it promotes the formation of myoglobin casts. These are extremely small debris that can block the urinary flow. Myoglobin can also be converted into toxic compounds which can injure the different components of the kidneys. The combination of these effects lead to acute kidney injury making the kidneys unable to perform its normal excretory functions.
Signs and symptoms are related to the failing kidneys. Waste products will accumulate in the blood and body salt levels will be deranged. Patients can present with decreasing or even absence of urine outflow. The electrolyte abnormalities can lead to nausea, vomiting, confusion, or coma. A worrisome complication is sudden elevation in blood potassium levels which can lead to abnormal heart rhythms and sudden death. There can also be abnormal activation of the clotting system leading to bleeding and damage to other organs.
Rhabdomyolysis is a medical emergency warranting immediate intervention to prevent its complications. Depending on the clinical presentation, 20% to 59% of victims could still die even with treatment. These victims could have had a fighting chance if only they were quickly brought to a hospital. Local laws are in place to regulate hazing and initiation rites and it explicitly prohibits the use of physical violence. However, some organizations do not heed the law and still choose to continue traditions. Sadly, when push comes to shove, these neophytes’ so-called friends and brothers would rather leave them to perish than to face the consequences of their actions.
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Dr. Kevin Mijares is a board certified Pathologist currently practicing at Silliman University Medical Center. He was born and raised in Parañaque City, got his medical degree from the UP College of Medicine and had his training in Pathology at Philippine General Hospital. He dreams of having a healthcare system accessible by all.
Author’s email: [email protected]