150000 Deaths, 500000 Accidents Or A Strict Law?

(c) Dr. Rajas Deshpande

Neurologist Pune/ Mumbai

Ask any doctor in India, how traffic related deaths and injuries cause havoc in the casualties every day. In a country with nearly five lakh traffic related accidents and one lakh fifty thousand deaths every year, with many more lakhs seriously injured and disabled for life, the strictest of the traffic rules and highest penalties are not only justified, they are mandatory. Any doctor will testify the daily typical histories of drunk driving, unqualified driver, jumping signals, overspeeding, gross neglect of lane and general traffic discipline. Add parents who allow under-age children to ride and drive, husbands who wear helmets while rest of the family rides on two-wheelers without helmets and so on. Most horrific is the case of people with medical conditions unfit for driving: thousands are out there with heavy vehicles, risking the life of everyone around. This is gross negligence.

Indians take pride in describing the how safe and peaceful it is to drive in a Western country, where everyone follows traffic rules, but the same Indians gladly use the philosophy of “If everyone follows the rules then I will also follow” to break rules in most cases. In fact, a national shame is that many take pride in breaking traffic rules, disrespecting and attacking traffic police, and indulge in road rowdiness.

This new traffic act is a bold and welcome step by Mr. Nitin Gadkari, and every right minded doctor and intellectual should welcome it in the right spirit. In a completely unruly traffic scenario, the fines and punishments should indeed be intimidating to prevent traffic crimes. Any effort to dilute it is like saying “Let People Die”.

To please the society by diluting this act so as to allow risking the lives of thousands is a dangerous and foolish proposition. At least doctors should strongly stand by this act. The Hon’ble Minister also posed a logical question: “If you do not break the traffic rules, why should you be afraid of being fined?”. This law and the high punishments are all indeed in the best interests of tyhe society and the nation.

The only probable amendment to request in this act would be to also add severe penalties and punishments to the contractors who have ruined roads by substandard work, potholes also cause many a deaths. A huge population comes with spinal, vertebral, neurological and orthopedic problems created by bad roads. Let the ones who make such roads or do not maintain them also face law with the same equality. There also should be non bailable arrests and severe punishments for road rage and violence.

Congratulations and Thank You, Mr. Nitin Gadkari, for this act.

(c) Dr. Rajas Deshpande

Neurologist Pune/ Mumbai

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Marathi Version on my FB page.

The Fairy And The Prince

© Dr. Rajas Deshpande

The beautiful radiant lady wheeled in the patient’s chair and wished me with a pleasant smile. Some smiles, however beautiful, have a tragic shade. I looked at the patient Rohan. A very well built fair young man in his late twenties, must have been very handsome in the past. He sat paralysed below the shoulders, one eye closed, face twisted, and a large surgical scar upon his head, partially covered by a cap. He could not speak. Any movement would cause violent tremors. He was wheelchair bound and had to be assisted even for toilet.

Rohan and Riya had married just two years ago, against the wish of their parents. Both from very affluent, but uneducated families. Both worked at the same office. In a few months after marriage, Rohan had developed high blood pressure, and was advised treatment. Unfortunately, he got carried away with some false claims about some herbal medicines shown on National Television channels and stopped the BP medicines. The obvious happened: one of the blood vessels in his brain ruptured due to high BP, and there was a huge bleeding. A Neurosurgeon had done an excellent job by taking this high-risk case on operation table in emergency, to suck out the blood clots and save his life. However, the damage was already done by then, much of his brain was damaged on one side. Riya had been caring for him since then. She looked after him just as a mother cares for her newborn.

“Doctor, we know his paralysis will not improve now. But he is brilliant, I know his brain thinks fast and accurate. Since this stroke he cannot speak. We have come with some hope for his speech. If he could just tell me what he feels, if something is bothering him, what he wants, etc., I will be very grateful” his wife said.

We started treatment. In a few days, Rohan could speak legibly, so she was very happy. Rohan’s parents were very happy too. © Dr. Rajas Deshpande

One day, Riya’s father came with her. He asked her to wait outside my room for a few minutes, she reluctantly left. With folded hands and tears, he spoke: “Doctor sahab, my daughter married against our wish. I have forgiven her now. But I cannot see her spending her life like this. She was the most brilliant girl in our town, she had even rejected job offers to go to America because Rohan wanted to stay in India. You can see that she is still young and beautiful. Anyone will marry her; she is one in a million. I’m not saying this because she is my daughter, but you can see for yourself from how she cares for her husband. She has become his attendant now. What is her fault? How can a father see his daughter wasting away her youth like this? They have no family life. I cannot even speak to her about this. Her mother tried but Riya refused to speak. She speaks very highly of you, so I have come with this hope. Please help us”.

This was very difficult, but a duty too. If not me, who could even attempt to resolve this?

“Let us ask her about her thoughts” I told her father and requested him not to react when she spoke. We called her in. I told her in short how her father felt. She sat straight. Her face became distorted and she wept silently. Her father kept on patting her while weeping himself.

“Papa, when Rohan could recently speak after so many months, the first thing he told me was to leave him and marry someone else. He refused to eat his medicines, saying that I should leave him. Then I promised him that I will leave him after two years. That was a lie. I know he will die if I leave. I could feel his love even when he could not speak, that’s something more precious to me than whatever you think I will get if I marry someone else. Till the day he had this bleeding in the brain, he made sure I was best taken care of. He never had his food before me. How can I spend even one happy moment with anyone else knowing that Rohan is suffering in this same world? Would you be proud of me if I did that? Did you teach me to be so selfish?” She broke down. © Dr. Rajas Deshpande. Her father did not say anything. They left.

In a few weeks, Rohan followed up again with Riya. He is now gradually learning to operate a computer. He plans to start his own online business. Riya is helping him do that, while continuing to work. They are now planning for a child soon.

This fairy I met was more beautiful than any other in the dreamy stories I had heard all through my childhood. I am glad that I am a witness to this divine fairytale.

I know even of another couple, where the girl had developed a paralysis in her college days. I had counselled her and her boyfriend about future uncertainties and a possibility of a compromised married life, given her illness. “That’s not the most important thing for us” he had said. They married. Today, about 8 years since then, they have a healthy, happy kid, and he still cares for her as much, now when she is in a wheelchair. This knight lives in a rented house, runs a small grocery store, rides a bicycle, wears the simplest of clothes, yet has a heart that would put to shame many a real princes!

My world as a doctor is full of beautiful fairies and knights, named caretakers. It is because of them that thousands of patients are surviving with dignity today. Medical care is so incomplete without them! I remember my favourite author Richard Bach’s words from “The Bridge Across Forever”: “Princesses, Knights, Enchantments and Dragons, Mystery and Adventure… not only are they here and now, they’re all that EVER lived on earth!” How true!! © Dr. Rajas Deshpande.

Among the stories of sadness and suffering, most doctors also come across best of the human hearts and minds, highest forms of love and care. Such patients and relatives reinforce our own trust and faith in the ability of human efforts to heal. Thanks to what I learn from my patients, my gratitude for being a doctor is endless!

© Dr. Rajas Deshpande

Dedicated to all caretakers, young and old, who silently sacrifice much of their life caring for their loved ones.

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“Dev Borem Korum” (Thank You)

(c) Dr. Rajas Deshpande

As the plane landed, I called up the driver who was scheduled to pick me up from Goa airport.

“Hullo, Mr. Clement? I’m Dr. Rajas”

“Haan daktar. Tu aaya kya? Bahar nikalke miss call de mai ayega” (Have you arrived? Come out and give me a missed call, I will come there”) . He would have said the same sentence to the President as well. Goans are least hung up on artificial flowery language, they are the friendliest lot as a society. It was after a year, that the same Clement said to me: “Tere liye apun jaan bhi dega parwa nai” (“I can give my life away for you without any hassles”), when I thanked him for something.

Goa has some excellent Neurologists, and my visiting is actually redundant. Yet somehow, maybe because they keep quite busy, or sometimes patients seek a second opinion, I have been seeing a good number of patients every visit. In the very first visit, after I saw an elderly lady and explained her the treatment, she bowed and said “Dev Borem Korum Doctor”. That means “Thank You Doctor”.

Then I pleasantly noticed: irrespective of what was the diagnosis, what treatment was given, whether there was treatment for the patient’s condition or not, whether the patient improved or not, almost every patient said either “Dev Borem Korum” (Thank You) or “God Bless You Doctor”. Even if surgery was advised, even if there were side effects of medicines, even if the outcome was not as expected in rare cases, the “Thank You”and “God Bless You” never changed. It had nothing to do with any particular social class. The rich, the poor, the educated as well as the uneducated, people from every religion, every age group said it. It is a part of that culture: the Goan culture.

Late one night after the OPD, when we were driving on a beautiful long empty Goa road near the beach, I mentioned this fact to my friend Dr. Samuel (God Bless Him for the exotic dinners he takes me to!), he stopped his car and looked quite affected. “I wondered whether anyone else had noticed that. It feels so beautiful! When the patient is grateful and brings you blessings, you automatically feel responsible to do the best for them. Money never matters in that relationship. We must never take patient’s kindness for granted. So many of them actually say Thank You, God Bless you, but sometimes we are too preoccupied with work, anger, ego and other things to reciprocate and encourage that kindness”.

I told him about my late Professor Dr. Sorab Bhabha, who stood up and greeted every time a patient entered or left his cabin. The onus of initiating a good doctor-patient relationship primarily lies upon the doctor, and it is extremely essential to follow the best of manners and etiquette, kindest of language when dealing with patients.

A very sweet girl who followed up for epilepsy recently told me that she visited me not only for medical purpose but because she was inspired by the way I appear calm and composed, the fact that I never raised my voice and always spoke compassionately with everyone. I had to tell her the truth. “Thank you mam, but I am quite short tempered outside the hospital. Even the junior doctors working with me sometimes find me intimidating. But I have to change when I am with a patient. I don’t think that any patient comes to me because I am any better than anyone else in the profession. I prefer to think that they choose me because they trust I can solve their problem. Will you be rude to someone seeking your help? Then how can I get angry with a patient? Every patient coming to me has that hidden trust, which I must justify. Only rarely, if the patient misbehaves or says something insulting, do I lose my calm.”.

“That’s what I like. So humble!” she had to have the last word!

Yes! The day I bring my ego inside the hospital, I will no more be a good doctor. Even the most illiterate patient understands when the doctor is being rude or artificial. Only when it is genuine, the patient will feel the warmth of my compassion and care. It has nothing to do with sweet talking or a show of affection. The only way to do this is to actually incorporate it within one’s depths so that it becomes one’s originality. Kindness and compassion must be the original, genuine qualities of every doctor who expects gratitude from each one of his patients. It does work in most cases.

After dinner, Dr. Sam took me with two other friends to the beach and we silently stared at the luminous moon for a long time. The music of those waves matched the dance of that moonlight upon the ocean. Just as one can feel the glow of the moonlight upon one’s skin, I could feel those numerous blessings keeping my soul warm and happy.

(c) Dr. Rajas Deshpande

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Slaughtering The Precious

(c) Dr. Rajas Deshpande.

At the casualty door she started shouting at me even before I went in. “We don’t want any tests. We don’t want to admit him in any critical care unit. Keep him in the general ward you have, we are now financially exhausted. Give basic medicines only “. Mrs. Julie, the patient’s daughter, went on:”We have already signed palliative care form”.

“Let me see the patient first “ I said and went in.

The resident doctor had earlier told me that the patient, an old man, was conscious, speaking quite well, aware of his illness. He was intermittently getting unconscious for a few minutes. He had high grade fever. He had lung cancer, and a brain scan a few days prior had revealed that that he had a secondary in the brain too. He had just completed his chemotherapy. The resident doctor had already started medicine for fits just now.

As I examined him, the jovial Mr. Shaw smiled back and told me that he was feeling a little giddy and tired, otherwise he had no complaints. He could even stand and walk without support. His blood pressure was normal, but the heart rate was quite high due to the fever.

“I think you have probably developed seizures due to the secondary in brain. There seems to be some infection too, we will run some tests and start antibiotics” I told him.(c) Dr. Rajas Deshpande.

“When will I feel better, doctor?” He asked, “I want to be home and spend every possible day of my remaining time with my grandchildren. I want to also finish a book I am writing. I am told I have only a few months left. How much time do I have? Six months? Four atleast?” he asked, still smiling. Only doctors know what a smiling face with a crying heart actually looks like. “Every passing moment is extremely precious for me, doc! Please cure me fast” he said.

I assured him that if the tests showed nothing serious, he could go home once fever subsided, but the fits needed long term treatment. While we were having this talk he suddenly stiffened and his body developed jerky movements, then he became unconscious.

Ordering the emergency injections for fits, I told the casualty doctor to shift him to the critical care unit.

Coming out, I explained this to the angry daughter.

“Doc, we don’t want to treat him in any ICU. We also do not want any tests now. Please give him tablets instead of injections, we want to take him home as soon as his fever goes down” she replied.

This has become very common now, relatives of elderly people admitting them in hospitals, but refusing to do any tests, use injectable / costly medicines or shifting to critical care units. A doctor cannot refuse patients in such a condition, and it is an extremely painful, stressful situation to not be able to correctly investigate, treat a patient because relatives are unwilling. Ninety Nine percent of the times, money is the only reason. There are many charity, low cost and even good government hospitals, but the relatives also want the “show”of having admitted the patient at some posh hospital. Beyond a certain level, Private

hospitals cannot go on funding tests and treatments of hundreds of such patients even on a compassionate basis, because the poverty in India is never ending.

Compassion is the most abused entity in India.(c) Dr. Rajas Deshpande.

I told her that even if they had signed for palliative care, his current condition was treatable, his fever and fits caused him distress and could be treated, but she staunchly refused to let us send any tests. We started with oral medicines after a lot of deliberation, keeping fingers crossed that he responds. He did.

On the third day, Mr. Shaw walked out of the hospital with his patent smile.

Just next week, his daughter returned to the OPD: “Doc, dad passed away two days ago. After going home he had fever again, but we decided to manage him at home. Somehow he could not get through this time. I have come to get your signature on these bills from his last medicines, we want to get reimbursed”.

“Was he seen by a doctor at home?” I asked her.

“No doc, we gave him the same medicines that he was earlier given for fever. We also searched online and ordered them. But in a way we also feel he is now relieved of all his troubles” she said, hushing up the topic.

I signed the papers, a duty and an obligation.

In every hospital, every day, we see parents rushing, crying, selling everything they have, urging doctors to save their children on one side, and grown up children urging doctors to hasten up the deaths of their parents on the other . Many sweet, politically correct and legally blurred terms are now available for masking these murders.

A patient with a terminal illness may himself sign for “non-aggressive / palliative” care (meaning pain relief, superficial / minor treatment without aggressive effort to save or maintain life), or if the patient is not in a good mental condition to sign such a consent, the relatives may sign so. However, in India where children mostly are responsible for the medical bills of the elderly, they flatly refuse to treat even treatable, reversible conditions citing “öld age” as a reason. Even in case of patients with terminal illness, to presume that someone is immediately unfit to live, or fit to die is like saying it is okay to terminate their life at someone else’s wish. This is cruel, unethical, immoral, and should stand supported in no courts of law.

However, these murders are a daily routine in India, and law has tied the hands of treating doctors and hospitals as one cannot investigate or treat a patient when the relatives haven’t given a consent. An evolution in the fraternity as well as in this society is necessary if a change is expected.(c) Dr. Rajas Deshpande.

Otherwise, when we all will eventually be old, however much we want to live on for a few more days, one day someone will decide that we don’t deserve to continue to live, without ever wanting to know what we wished.

(c) Dr. Rajas Deshpande

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The Most Precious Jewels Upon Earth

© Dr. Rajas Deshpande

“Sir, next is our old free patient” my receptionist announced on the phone.

Divya, the smart young girl of 8 years jumped into my cabin, and grabbed her chair with an authority. Confidently looking at me, she questioned, “how are you today?”

Her parents, embarrassed and charmed at the same time with her sense of ease in this big hospital, facing a doctor, hesitantly stood behind her. I requested them to sit down and went through the routine questions.

“She is all good now, no fits since last two years. She has been regular in her school and has started studying well too” her father reported.

I examined her and wrote her a renewed prescription. I noticed the mother wiping tears.

“What happened?” I asked.

Quickly smiling, she just gestured with her head “nothing” and looked at her husband.

“Do we need any tests, Sir?” Her husband asked, “We will do whatever is required”. I could feel his palpitations. They were scared that I may tell them tests, and that would mean financial disaster.

He works as a pantry boy and can barely pay the home rent with his salary. His wife somehow makes ends meet, looking after this sweet daughter and a younger son.

At the age of five, Divya had had her first convulsion. Her parents had rushed her to the government hospital. They did not have the money required for Divya’s tests and medicines even at the government hospital. So they resorted to something that hurt them worst: they had to sell little Divya’s silver jewelry, which was the most precious thing in their house. Even that was not enough, so they borrowed money and started her treatment, her father worked extra hours.

That was about three years ago. Divya’s fits continued, but her parents did not give up. Their whole life had but one aim: to stop her fits. Even after being less educated, Divya’s parents decided to go with scientific treatment, ignoring all pressures to take her to different weird people including magic healers. They did not give up hope, their will power was their boon.

Two years ago, a doctor friend sent Divya to me. With some changes in prescription, her fits completely stopped, she has now become just another normal child.

“No tests are required. Please make sure that she is regular with the medicines” I told them.

As I wrote this, I got a little emotional myself, this was the first time I had heard of any parents having to sell their daughter’s jewelry for her treatment. On one side, I was proud that even after being surrounded by perpetual pits of poverty, this girl child’s parents did not skimp upon her treatment just because she was a girl child (this often happens), but on the other I felt anger and shame that my country still lacks a basic healthcare infrastructure that can offer free quality treatment to at least children.

Yet, this had taught me my lesson. Willpower and hope are the mightiest and most precious jewels upon earth, far tougher and far more beautiful than any diamonds. For there are many who own diamonds but have neither willpower nor hope.

Meeting this rich family today was joy enough, but a greater bliss was when the kiddo put her arm upon my shoulder with the same confidence. The world is indeed hers!

© Dr. Rajas Deshpande

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“If Only”

© Dr. Rajas Deshpande

Dr. Raina sat devastated in her chamber. Medical tragedies are a part of any doctor’s daily life, but this was cruel, because it was preventable.

A young patient in 20s, Mr. Pandey, was brought to her, with mild headaches. He had started dieting and exercising a month ago, and the entire family was hooked on to some herbal preparations that claimed to confer health without any side effects. His examination was completely normal. The patient and his highly educated parents were extremely anxious. Dr. Raina had explained to them that even if the examination was normal, sometimes headaches may be the only early warning sign of some diseases, and hence she would recommend an MRI of the brain.

“Is it necessary? Does his examination tell you something is wrong?” asked the father.

“His examination is normal, however, in many diseases that manifest only as headaches, one may not find anything wrong upon a clinical examination” Dr. Raina explained.

“Like what? Which diseases?” asked the mother, hardly aware that her anxiety was adding to her son’s distress.

Dr. Raina hesitated. When the patient or family is already so anxious, how can one utter names like cancer, tumor, aneurysm, etc.? If the doctor uses such words, some patients lose their sleep for weeks even if the tests reports turn out normal. A doctor has to be wise enough to avoid worrying the patient unnecessarily. © Dr. Rajas Deshpande

“Well, infections like sinus disease, pressure changes in brain water, and some others which are rare” Dr. Raina said cautiously.

“Any dangerous diseases? How much is the possibility? Can we wait?” the father bombarded.

Dr. Raina controlled her discomfort and agitation. Educated or not, when a patient visiting a doctor talks as if they know better medical decision making than the doctor, the doctor mentally switches off the ‘compassionate involvement of a doctor’ and becomes a ‘legally alert’ medical professional. Questions are welcome, suspicious cross examination is not.

“The possibility of finding anything grievous like clots or tumors is extremely low, but this is usually the standard investigation to complete the evaluation of the case” she replied. She had told them to get the MRI done. They asked if it was an emergency. She said it didn’t appear to be, based upon the normal examination. She wasn’t ‘God’ to see inside the body.

She prescribed the patient some simple medicines for headache, preparing for another round of questions.

“Are these steroids? Are these antibiotics? Do these cause addiction? Do they cause damage to the liver or kidney?” she patiently replied to the family. © Dr. Rajas Deshpande

Why won’t a doctor think of these things when writing a prescription? Do you ask a pilot if his steps while flying are correct? Do you cross question a Judge about how he makes his decisions? Do you ask a soldier fighting with terrorists why he is firing, how many bullets, and in which direction?

The mother checked the medicines and said “Don’t mind doc, but I will first google these medicines and then start in a day or two. We will also think about the MRI”. They left.

Just two days later, the patient was found unconscious in his bed at home. Rushed to the hospital, his brain showed blockage of the venous channels in his brain, that had caused huge bleeding. He was operated in an emergency and was now paralysed on one side. He had also lost speech. The surgeon who operated the patient could manage to save his life with a great effort. The parents were still suspicious about the surgery being wrong. Many opinions were obtained, and it finally dawned upon them that what was being done was the best. The combination of unknown content medicines, low water intake, atrocious dieting and exercise had probably caused clots in his brain, leading to the blockage and bleeding.

One evening, when Dr. Raina was passing by the wards, the patient’s mother stopped her. “He is our only child. Our whole life was woven around him. Will he ever speak? Will he ever walk? Please tell us the truth”.

“We will try, although it looks quite difficult. It may take weeks to see some improvement. But we have seen miracles, let us hope for another” Dr. Raina replied. It was useless to blame anyone now, she refrained from the obvious ‘if only’. © Dr. Rajas Deshpande

They came back in a few weeks after discharge. Now the son was in a wheelchair.

The mother proudly told Dr. Raina: “You know doc, after discharge we took him to a remote village in south India, where he was given special massages and an ancient secret diet. That’s why he is now improving, he has just learnt to say “Aai (mother)”.

Dr. Raina did not reply. There was no cure for the disease of faithlessness in the society that she worked for.

© Dr. Rajas Deshpande

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The Light Divine

(c) Dr. Rajas Deshpande

The lady in the ICU appeared quite disturbed and shaken. Bewildered, she kept looking at her husband’s face, wiping her tears and his forehead with a corner of her saree.

Her husband, Mr. Mohan Vitthal Kadam, was critical, he had also gone completely blind suddenly and paralysed. While working as an electrician with a company in Jejuri, he was often noticed to have high blood pressure inspite of taking regular treatment with his family doctor. One day at work, he suddenly had a severe headache and went completely blind. Terrified, his colleagues rushed him to the nearest hospital. His blood pressure had shot up far above the dangerous levels. The local doctors gave him emergency treatment and sent him over to Pune. That’s why I had come to the ICU.

I introduced myself politely to his wife, and asked her the details. Sobbing intermeittently, she told me what all had happened. I examined Mr. Kadam. His BP was still high, but not in dangerous zone anymore. He was confused, unable to speak clearly. His left side was paralysed too. He pointed towards his head, indicating that he had a headache. His MRI showed many areas of his brain damaged due to high blood pressure. The areas which control the visual information coming from the eyes were damaged heavily. His brain was swollen dangerously. He could need an emergency surgery.

This condition, known among doctors as “Cortical Blindness” is a common but griveous condition: the patients eyes and the nerves are intact, they actually can see and carry the images to the brain, but the visual areas in the brain cannot see / read that information, because they are dead or injured. I informed this in simpler words to Mrs. Kadam.

“Will he ever see me again? Will he see our kids? How can he live the rest of his life with such blindness?” her questions came mixed with sobs and tears. I had very few answers, but I told her I was hopeful of a recovery. “We will first concentrate on reducing the swelling upon his brain, so we can avoid surgery” I told her. Their son came over and attended his father alternating with his mother. Mr. Kadam ‘s brain swelling gradually reduced, surgery was no more required. His BP was well controlled in two days. His paralysis also improved, but he still was completely blind.

Once he could understand the situation, he asked only one question: “Can I see my wife and children at leaast once in life again?”.

“We will try, I am hopeful” I replied. We had started with all the supplements that help recover brain damage. When he was discharged after ten days, he was still not able to see anything. He returned today.

“After we went to our village, many people told us to abandon allopathic treatment and go for secret herbal medicines and magical remedies. Somehow, myself and my wife decided to have complete faith in what you had told us. We continued your medicines and kept praying. The only light in my life then was the trust I had that I will get better. After two months, I could suddenly see a light bulb at night in our home. I immediately called my wife and told her so. Then onwards, there was a gradual improvement. I tried every day to see the faces of my wife and kids. In another two weeks, I could see them again That was the happiest day of my life.”. Mr Kadam became emotional. “Doctor, my company offered me a substantial sum as disability compensation, but I did not want money. I only wanted to see my family. Now that I can, I came here to thank you. Now I can even read a newspaper…but the darkness of being blind was far less hurtful than the thought of never seeing my dear ones again.. I cannot forget that. Thank you again, You are God for us” Mr. Kadam said.

I told him that I was just another doctor, that we were both cared for by the same God, that any qualified doctor would have done the same. I had not done anything extraordinary. But it is difficult to control a grateful patient.

“No doctor, we believe that doctors are God’s hands specially made to treat patients” he persisted.

I could only thank him. Thousands of doctors all over the world, all across India, do this every day, and receive blessings and gratitude that fills up their hearts with a joy that cannot be described.

Now I think there is a reason why Mr. Kadam came today. Many good and bad things happened in 2018. While making resolutions for the incoming new year, I was thinking once more what is most important in life. Mr. Kadam provided with many answers to that question. What matters is gratitude for what you have, especially health, gratitude for your family, and the ability to help others through their darkness. Who except a doctor is better placed to help others with health and life? Whatever other resolutions a doctor may make, one of them remains a universal favourite: ’ Let all my patients improve, and live happily a long life. Let me make every effort for that.’

Thank you. Mr. &. Mrs. Kadam, for allowing me to share this story.

(c) Dr. Rajas Deshpande

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Be A Woman!

©️Dr. Rajas Deshpande

A major part of the pride of being a doctor is the freedom from any discrimination between humans. Every woman or man, from any religion or country is equally important, and also equally cared for.

Yet as a doctor I have often witnessed women being stronger than men when life presents any calamities, however explosive. Women are probably more emotionally destroyed with a traumatic event, yet they pick themselves up and fight like a mother for whoever they choose to stand by and protect. And we know, a mother makes a strong army! Any patient cared for by a woman heals faster, be it a nurse, a sister, servant, daughter, wife or mother, be it a girlfriend or just a woman without any relation. In any family, it is usually the women who keep the bonds of humanity and culture alive. We have so many biases about cultures and how women are treated, but it is an unfortunate fact: that women do things men find impossible. Hence the title, Be A Woman!

We often hear from working men in the metropolises how they cannot bring a parent in wheelchair to the hospital as it would be a lot of trouble and time.

Ms. Eshrak (a psychologist) and her sister (a bank employee) brought their mother on a stretcher all by themselves, all the way from Cairo, Egypt, to Pune India, in a hope to see her walk again. To travel to another country without knowing anyone there wasn’t their biggest problem. Reaching India from the war-torn middle east is a nightmare, but once they reach, local Indians, especially police officials are very cooperative in helping out especially patients coming for treatment to India.

They found a friend in a local Arabic student Mr. Ashraf Olafi, and had him search my clinic (I am sure any good qualified neurologist could have treated them equally well!). Their mother, suffering from Parkinsons Disease, walked after many months today, so they came with the two greatest gifts for their doctor: a smiling gratitude and blessings. Of course they brought a material token!

What better proof can there be of women not being dependent upon men? If only we recognised how incomplete and incompetent humanity would be, without the strength of women!

To artificially write about gratitude for women in one’s life and to thank them superficially to impress press and public has become a fashion, few do it from their heart. I pity those “high flying, successful” men who boast about how they respect women and consider them equal, while their wives are in fact taking care of their home and children, opting for hugely compromised careers. The truth is, a man, however strong, is always indebted to some woman!

Be A Woman!

That should always have been the correct slogan..

©️Dr. Rajas Deshpande

The Poverty Vow

(c) Dr. Rajas Deshpande

Long day. Came home. Ritual steamy hot bath to wash away the hospital feel, followed by steaming hot dinner. Switched on jazz, and I picked up the pasta. Heaven descended upon my tongue.

“How perfect this moment is!” I thought, and that’s where I was wrong. The phone rang.

“Sir, 18 year old buy, had fever since a day, took some tablets, became unconscious, now comatose. Vitals are stable, although he is coughing occasionally. No past history significant. Poor family, cannot afford treatment. Father is a labourer. What should I do?”

“Get him into the ICU, intubate if required and stabilise. Arrange for an MRI”

“OK Sir, but Sir they don’t even have a deposit. They had first gone to the government hospital, but as they were not happy there they have come here”. (c) Dr. Rajas Deshpande

“We will work something out. I am on my way” I replied.

In an hour, after examining the boy and seeing his MRI and other tests, we concluded that he had viral encephalitis. The standard medicines were started.

The boy’s father, an obvious poor slum dweller, was in a state of shock. The mother, sobbing, told me the history. I reassured them. When I explained the diagnosis and treatment they asked some questions.

“We don’t understand anything, we are illiterate and poor. Do anything Sir, Just save my son, Sir” the father folded his hands together. Private hospitals have a quota for free patients, but usually it is always overloaded. I requested the hospital management to please make this a free case, they accepted.

The next day, the child opened his eyes. On the third day he started responding. I was quite elated to have his mother speak with him. However, his respiration was still shallow, and blood presure very low. His heart rate was fluctuating due to the effect of viral infection. He was still critical. I spoke to his parents twice every day, specifically reassuring them. Poor patients must never feel that they are not equally cared for. (c) Dr. Rajas Deshpande

That evening, as I attended my patients in the OPD, the patient’s father came in, requested that he wanted to have a word. He came in with six other people. None of them could possibly be poor, given their get ups.

“Yes?”I asked.

The patient’s father looked at the giant next to him. “You ask” he said to the giant.

The giant, chewing his gutkha, askked me “What’s wrong with his son?”

“I have explained them thrice”I replied, “he has viral infection of the brain. There’s a lot of swelling upon his brain”.

“How come he is not improving? His BP was normal when he came. He did not have any heart problems. Now you tell us his heart is not functioning well” asked another medical superstar with white linen and gold teeth. (c) Dr. Rajas Deshpande

“Yes, this happens commonly with viral infections” I replied, feeling hopeless. How to teach complicated medicine to this pure- muscular class? I wondered.

“But you said he had infection in the brain. How come now he has it in the heart? Is the treatment wrong?” Asked someone similar among them, in a tone nastier than medical examiners.

I looked at the patient’s father. He was looking at the ceiling, deliberately avoiding eye contact with me.

“Listen, Sir”, I told them, “Your patient has viral infection, it has primarily affected the brain, but involvement or dysfunction of other organs is well known with such infections, this is not something new to us. We are on guard, dealing with the situation. Nothing is wrong about the treatment, in fact his brain swelling has improved, and he is conscious now. Ask his mother” I looked at her.

“I don’t know” she said, “we don’t find any improvement in my child. Nobody tells us anything”.

“Haven’t I explained you and his father patient’s condition every day?” I asked. They did not reply.

The white linen gold teeth spoke again: “We want a report. We want to show the case to another doctor”

That was a relief. I gladly wrote them a report. They went doctor-shopping all day. They returned next day. Almost everyone had asked them to continue the same treatment that we had advised, except some desperate non-specialist telling them to shift the patient immediately for a surgery at his hospital. Even our gold-toothed medical superstar understood that it was wrong! (c) Dr. Rajas Deshpande

“We will continue treatment here only. But our patient must survive” came an open threat.

”I will do my best, but I cannot guarantee you anything. You may please transfer the patient under the care of any doctor of your choice” I told them.

“No no, you continue to treat him.But if anything goes wrong, we will file a police complaint. We will ruin this hospital”said one of them.

I am allergic to threats. I don’t allow them twice from the same source in my life. How could any doctor guarantee that there could be no complications? How could I say that the patient could not react to any medicine in such a critical condition? If every patient could have guaranteed improvement, what’s the need for a doctor?

“I am sorry, I am planning for a leave next few days. I won’t be able to see your patient. I have requested our management to transfer your case to another doctor” I told them.

There was a movie “Teesri Kasam”in which the lead character, at the end of the movie, vows never to help the character of the lead actress in the movie, because the very wish and effort to help her has shattered his life, caused him regret. Most Doctors are now being forced to take such a vow. Urban Poverty is not so simple and innocent in a hospital as it appears to the media and society. Whether it is the roadside rowdiness of slum dwellers who roam around with weapons or a maid’s drunkard husband in civilised society, we all understand the misuse of poverty status well anywhere outside hospital, but somehow when this happens in a hospital, the blame is automaytically pinned upon the hospital or the doctor.

But who among the vote-mongers will speak against the majority voting bank?

(c) Dr. Rajas Deshpande

“My Turn Now”

©Dr. Rajas Deshpande

“I don’t want to live like this. I have stopped eating since today. Please do not be angry with me for this, but I cannot see you and my children suffer because of my illness. Let me go with peace” Geetanjali said to her husband.

Eighteen years after her marriage, in her late thirties, Geetanjali suddenly lost the function of one half of her body. Her children were still in school. Her husband Gajendra Jagtap works as a school teacher and does some farming on a small piece of land they own. The whole family was shocked and shattered with this calamity that befell Geetanjali. But Gajendra Jagtap decided not to be broken down by destiny, and took his wife immediately to the best hospitals in Mumbai. They were told that Geetanjali was suffering from Multiple Sclerosis. After a few days of treatment, they could not afford to stay in Mumbai and came to Pune as it was nearer to their village. The Multiple Sclerosis Society of Pune extended its helping hand. Geetanjali was yet unable to stand up or walk. ‘This illness is totally unpredictable, anyone can develop blindness or disability anytime’ doctors told them. Geetanjali felt hopeless. She was very depressed with the thought of stressing her husband financially to provide for the treatment expenses. She also worried if her children’s education will suffer due to her illness and financial constraints. This was the reason she decided that she did not want to live any further, and gave up eating or drinking anything.

But Gajendra was not the typical Indian husband. This B. Sc. Graduate who had taken up teaching in a rural school as his profession had a big heart, and harbored principles of equality and respect for women, just like a highly educated spouse in a developed country. He told Geetanjali, ‘You have served me and our children for over eighteen years now. When I was working in the school or in the farm, you looked after the home, cooked for us and fed us sumptuously. Now give us a chance to repay for what you have done for us. It’s my turn now. I am going to take care of you just like you cared for us.’ Geetanjhali could not hold her emotions and sobbed when she narrated this story to me.

‘At that point of time, I felt like living only to help my family. I decided to use whatever few healthy days I had to make my husband and children happy.’ She started to fight her disability with a new spirit, and in a few months could walk very well again. Since then she had attacks of this disease many times, but vehemently fought it to recover every time, with the help of her husband.

Gajendra told me “I explained my children our situation. I told them that we don’t have much money left, and that they must only complete their education based upon merit. We are very fortunate that our children decided to grow up quite early in their childhood. Both of them studied very well, and my elder son is now doing his post graduation which he got through a scholarship in Delhi. Even my daughter got excellent marks and is now pursuing her post graduation by winning a scholarship. Both of them take care of their own expenses, and never bother us for money. Even I have decided that whatever our destiny presents us with, we will face it with a smile, and never accept defeat in any situation. We have to visit hospitals many times, spend on treatment and investigations, travel many times, but we do it all with a spirit of winning together. Whenever she can, she still takes care of the home, and when she can’t, I do it with the help of my daughter. But we never feel desolate or depressed”.

In the developed world, people suffering from this illness get a lot of healthcare facilities, and even income tax concessions. However, this farmer from a lower middle class background who does not receive any such help, has not only resurrected his family, but created a new life for his wife with his sheer love and determination. The most admirable thing about his love story is the respect and feeling of equality with which he thinks of his wife. Geetanjali also stood up firmly with him to conquer this illness, with all her love and might. Together, they have indeed defeated their destiny.

We sincerely pray for the excellent health, well-being and long life for each member of this wonderful and ideal family.

© Dr. Rajas Deshpande

Neurologist, Pune

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Quit Quit

© Dr. Rajas Deshpande

In the first year of medical school / MBBS, I had a heart break. It made me feel like quitting medicine as I did not feel like going to the same class again. I started bunking classes, spending a lot of time in a small book house which allowed you to read books without having to buy them. Costly coffee shops were not a fashion then. The phase lasted for about three months, till a professor (God bless him!) who knew me informed my parents when I bunked his class. A lot of firing, two tight slaps by mummy dearest, and I was back on track. I had hated that professor for some time and did not talk to my parents for the firing for a few days.

Towards the end of second year I got so engrossed with philosophy, poetry and study of different religious texts from various religions, that I was convinced I wanted to give up medicine and be a philosopher, author. I attended college but my mind was too occupied to concentrate. It was then that I came across a professor who was very brilliant and approachable. He told me to just ‘sail through’ and let the storms in my mind settle. “Teenagers like you must learn to tame the fires within” he said it wisely. I carried on.

Motivation to me is a myth. Some have it within themselves, some don’t. One who needs motivation keeps needing it all the time. I will do something else better maybe, but then I will have quit medicine. Over a period of time I learnt that no one succeeds by being half hearted. I don’t want to leave an unfinished task behind me. I didn’t want to be a quitter.

Then onwards I did fairly well and secured my MD seat. But a crueller test was written for my future.

I joined DM Neurology course in Mumbai. In a few days I had a terrible non-academic argument with one of the professors and was told to get out. Hurt, I left Mumbai and came to Pune. My sister had a rented flat, I stayed with her and mostly roamed alone, usually sitting and musing in a local garden Sambhaji Park. Grew a beard and a belly. I was ashamed to go back to my parents because I did not want to face them with an “I Can’t”.

A few days later, my father called. “Start the next thing today. Quit or don’t quit, but don’t waste time. Any decision in life should not take more than a few seconds to make. You only have to listen to your heart. Take a step, if wrong, correct it. Don’t hover”. © Dr. Rajas Deshpande.

I had desperately wanted to be a Neurology DM. That’s what my heart resounded. I joined back the next day. Since then, I have always made this rule for myself: never to prolong any decision making about my own life. It does not take more than a few peaceful seconds to listen to your heart and act upon it. The moment you allow others to choose for you, you create a mess. There are sometimes great sacrifices involved, one must give up a lot to pursue the path of the heart. But it is the most rewarding path to pursue. There’s nothing money can buy for an unhappy heart, so the choice of money over what your heart truly craves is always a mistake. © Dr. Rajas Deshpande.

There were times when I was angry and upset with parents, teachers, others who meant well and told me I was wrong. Looking back at what life has given me, I regret that. They too did not know the future like me, but they had deep faith in what I could achieve. Their anger, advice and reprimands came with the purest intentions of making my life the best it can be. Today when I have achieved more than what I set out to, I crave for one opportunity to meet each one of them and express my heartfelt gratitude towards them.

Medicine is gruelling. It is not for the weak hearted. Study for decades amongst a culture of corruption, socio-politically motivated decisions, unfair competitions, pathetic living conditions, and then face the tears, sickness, frustrations, accusations, deaths and ungrateful wrath of multitudes for all your life. But it is also the only profession which allows one human to literally take away pain, suffering and death from another. It is the only vocation that brings one closest to the highest form of human achievement: saving lives, easing pain, curing diseases. © Dr. Rajas Deshpande.

Many medical students as well as doctors at different stages in their career feel like quitting. I just want to remind them: one saved life, one smiling patient defeats all other negatives about this profession. You are the ONLY ONE who can make this possible. Others may or may not recognise this, it is for yourself. This is the best gift you can give yourself: the ability to save life.

It is the tendency to hover upon indecision, confusion and delay that one must quit. Quit the choice to quit. Life’s too beautiful to waste time when your heart always knows where to go.

In the memory of my father Dr. Kalidas Deshpande, on his birth anniversary (Ganesh Chaturthi).

© Dr. Rajas Deshpande

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A big salute to this extraordinary benchmark of values in medical profession.

On 4th August due to rain havoc and release of dam waters there was unprecedented flooding in some areas of Pune. Unfortunately this flooded the new Jupiter hospital in Baner, jeopardising the lives of a hundred patients including critical, and even a tribal baby who had had a heart transplant. Within minutes the hospital authorities reacted with an efficiency comparable only to a military task force. The staff, doctors and nurses worked in coordination to shift every patient to other hospitals in Pune, other hospitals too graciously accommodated them on an emergency basis.

It is extraordinary that Jupiter Hospital not only arranged for a safe transfer of every patient, they sent doctors and nurses with each patient to help them settle in another hospital.

Every bill for every shifted patient till their discharge from other hospitals was paid by Jupiter hospital, not a single rupee had to be paid by the patient. The entire staff and doctors stood by this effort, some offered their salaries of next six months to help this task. The administration very politely declined to accept this, and continued to care for each of their doctors and staff even when the hospital had to be shut down for nearly a week.

As the hospital reopens completely recovered from the damage caused by the calamity, I salute this extraordinary phenomenon which should be hailed by every person with their heart in the right place.

Congratulations Dr. Ajay and Dr. Ankit Thakkar for setting this fabulous example of humanity.

God, Doctor and The Killer Snake.

© Dr. Rajas Deshpande

Dattaram started breathing fast and coughing. Red skin, rashes. Pulse 140. BP not recordable. This unfortunate young labourer, bitten by a cobra only a few hours ago, had now developed severe dangerous reaction or ‘anaphylaxis’ to the only medicine that could have saved him: the injection of anti snake venom. I stopped the intravenous drip immediately and shouted at the sister to bring the crash cart. We injected him with the most powerful drug Adrenaline which we had kept ready in a syringe.

He was brought by a friend to the hospital just after 10 PM. His villager friend who had brought him directly from the farm had gone back to bring Dattaram’s family. They were not expected for a few more hours. So the patient was all ‘care-of’ me, then a junior intern at the government medical college hospital. That was the era before cellphones and ventilators in government hospitals. © Dr. Rajas Deshpande.

Some venomous snake bites cause death by paralysing the breathing muscles, while others kill by clotting the blood inside the arteries. Dattaram was bitten by a paralysing snake, and his eyelids had already started drooping, he was also having difficulty in swallowing and coughing. Other medicines were started to counter the paralysis, but the killer venom was spreading. Time was running out. I started having palpitations. I was to be the active witness to his destiny. The ward was already full, the second intern was busy too.

The only way out was to give him extremely small doses of the antivenom again, gradually increasing the dose every few minutes, till a full concentration dose could be given. This is called desensitisation. I had never done it earlier. If he reacted again to any such smaller dose, there was nothing else to do. This was dangerous, and required a written consent by patient’s relatives. There was none. His pulse was now 120, and his BP was now recordable. I kept reassuring him. © Dr. Rajas Deshpande

I called up my professor through the ward landline and informed him in short.

“Go ahead, be careful. I will take care of the stupid consent from the medical director. Call me if required” he said.

I went to Dattaram. “Listen, Dattaram, I need to use a medicine against the snake venom. Some patients may may have reaction to that medicine. I will try and do this very carefully, but sometimes it may cause problems. Is it Okay?”

In a hoarse voice, he said with great difficulty: “You are my God. Do whatever you can. Keep me alive atleast till I meet my wife and daughter”. I told him I will.

I started to inject him the antisnake venom doses. First extremely diluted, then in gradually increasing concentration. His blood pressure was stable. However, after a few minutes, his breathing became shallow. He became drowsy. His respiration was paralysed. The snake venom was winning the race. I put in a breathing tube. The nurse started pumping air in his lungs through a rubber bag. I was sweating, thinking, panicking, observing and praying all at the same time. © Dr. Rajas Deshpande

He was tolerating the antivenom well. After a few hours, I decided to give him the final big dose again. I restarted the same medicine that had almost killed him a few hours ago.

His wife and daughter arrived. I quickly explained them what had happened, as the lady kept on patting her unconscious husband’s head. The daughter, barely 12 years old, was crying muffled. There’s a state of numbing that comes after extreme shock: that is terrifying to witness. Big city and poverty on one side, hopelessness of the situation on the other. The lady suddenly got up, took out a few ten-rupee notes and extending them to me, touched my feet “I will sell everything we have, please save my kumkum (husband). Look at the face of my daughter. Where will we go without him? You are God for us” she said repeatedly.

I did not crave to be a God, I just wanted to be a good doctor. Shall I be angry that she was trying to bribe me? Never. I remembered what my grandpa had said on the day that I joined medical college: “If you want to be a good doctor, try to imagine yourself in the place of your patient”. I suddenly realised that even though I was not God, in the eyes of this lady, her husband and the daughter, I was their only hope. I have always hated wordplay, I am rather a feelings man. I understood what they meant. The life of every patient depends upon my best effort and nothing less. © Dr. Rajas Deshpande

“Tai, I will try my best. Don’t worry. Keep that money with you. You don’t have to sell anything; we have all the medicines. You can both have tea if you want, this sister will get you some. Let me please attend your husband now.” I requested.

A few hours after that, by morning, Dattaram opened eyes. He met his wife and daughter. By noon, he started to breathe by himself, so we removed the tube. By the time my professor took rounds, Dattaram appeared stable. Medical professors never openly praise students. My professor kept his hand upon my shoulder, smiling. “Too bad, this did not happen on a cricket ground or a film theater, otherwise you would be rewarded with cars and bungalows.” he said with his characteristic red-chilly-smeared wisdom.

When Dattaram was discharged, his wife got me some sweets, and invited me to their village. “Doctor, we are very poor, but I will cook for you the best meal you will ever eat” she said.

Most doctors make a genuine best effort to save the patient: who would want otherwise? Yet sometimes we win, sometimes we don’t. In this case my effort was blessed. I will perpetually be grateful to my own God, praying that he rewards the effort of every doctor trying to save a patient.

As for the cars and bungalows, who has enough time to use them when lives are to be saved?

© Dr. Rajas Deshpande

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Soulmates, Military Grade!

Group Captain Y. S. Marwa and his wife Mrs. Gurkirat Kaur have bravely stood with each other through thick and thin. They are both above 85. They care for each other extremely delicately. Many couples do, but the noticeable difference here is the willingness, involvement and sense of duty with which they both do it. While he is the picture perfect gentleman, she compliments his personality beautifully too.

Just a few weeks ago, Gp. Capt. Marwa unfortunately had a severe heart attack. Even in the ICU, his mind was preoccupied with only one thought: “I must get better fast to take care of her”. Thanks to the efforts of doctors at the military hospital in Pune and his own willpower, he recovered completely and joined back his chosen duty.

“We had taken a vow when we got married, I am just keeping my word” he says with a handsome smile. A military man to the core, he walks straight in the face of every adversity and defeats it with his monumental determination. In a world that is stuck in superficial, glittery meanings of ‘Love’, this couple personifies the very essence of the word ‘Soulmates’.

They don’t forget to bless me every time we meet, and my day turns sunny whenever they visit. I wish them both a many grand decades of love and togetherness, health and happiness.

Dr. Rajas Deshpande

Yes: The Most Powerful Word.

©️Dr. Rajas Deshpande

Mohanad, child of a small time mechanic in Yemen, developed a devastating condition called “Transverse Myelitis” which causes sudden damage to the main connecting cable from brain to the rest of the body, called “Spinal Cord”. He not only lost all sensation, but was completely paralysed below the waist, his control over passing urine was also lost. That was seven months ago. He was told that his remaining life will be in a wheelchair. He wasn’t convinced.

His mechanic father and farmer brother decided to get help and travelled with him to India for his treatment. When he came, he could not feel anything below waist and had no movement at all.

One beautiful thing about being a child is that you don’t have inhibitions, fears or anxieties like adults. One can learn from children how to be optimistic beyond par. They have more “Yes” in their minds.

When I met him for the first time, I thought the child was a little upset with his own situation. To boost his morale I told him I was going to make every effort to make him walk again, but I needed his help.

He smiled.. “Yes, I want to walk. I will walk. I will run” he said.

He worked hard. Took medicine without complaining. Never cried. Did all that was planned for him.

Today after three months, he has started to gradually improve. Most of his recovery is natural, with some supplements and nerve strengthening medicines, and physiotherapy. He came in with a cute big smile to report this improvement today. He will travel back to his country next week. He knows there’s a long long way to go before realising his dreams, but that’s the beauty of dreams: when they come true, they make you proud of yourself that you overcame all that stood between you and your dreams.

Mohanad deserves a big applause for his grit and courage. I pray that he always smiles this beautiful smile all his life! I have become a fan of his “Yes I can!”.

#medic #medicine #medical #doctor #doctors #docteur #doktor #arzt #lakare #medicina #patient #doc #medicalpractice #lijek #medicin #child #india #kid #sweet #india #travel # #medicalschool #health #healthcare #doctors #cute #arab #yemen #arabic #arabian

The Euthanasia Named NMC

© Dr. Rajas Deshpande

Sweet Poison, Gorgeous Vamp, Philanthropist Criminal or NMC. All of these have one thing in common: the taste, the appearance is deceptive.

Just a while ago, doctors had complete autonomy and freedom to elect the best to the medical councils. They failed. Doctors had chances to unite and rectify glaring obvious malpractices in their own profession. They failed. Doctors had a freedom to pressurise elected medical council members to enforce ethics and discipline in Indian medicine, to arrest corruption. They failed. © Dr. Rajas Deshpande.

The parliamentary standing committee said something like “MCI looked only after doctor’s interests, not that of public, it is necessary to reduce the monopoly of doctors, so there should be diverse stakeholders at the helm”. The fact was that MCI looked only after its own interests, not even those of the real doctors of India: the thousands who were shouldering the actual healthcare burden especially in govt hospitals and rural areas, underpaid and unprotected. Malpractices became rampant. The general social jealousy about doctors which was earlier suppressed by respect converted into open anger and fuelled a paranoia that did not spare the best of the medical practitioners. For the sins of few, majority suffered. Patients too suffered at all levels. Govt medical services were always pathetic (and will remain so even after NMC), and there was no reign over the corporates who dominated and dictated the scene. Competition and petty egos destroyed any chances of any good unity among doctors. There could not be a deeper nadir for the profession. © Dr. Rajas Deshpande.

That fathered the NMC. Doctors will need to unite now like never before if they want to change this “Law”. Laws can be changed. But is it necessary in this case? Decide for yourself.

1. The ultimate, complete control of this “Autonomous” NMC is is in the hands of the central government. Majority members are govt. officials, a minority are to be chosen by medical professionals, and in every case, all that the central govt. decides is going to be a binding upon the NMC. That is like cutting off the wings of a bird and naming it “Independent and Free”. NMC, its advisory committee search committee or its four component boards will all be dominated by govt.’s chairs. Central Govt will also decide about the funding and salaries of the NMC members and its Chairman. We all know who sits in the top chairs of govt. institutes and how many among them can speak against the govt. So tomorrow if the govt wants to make ANY decision about ANYTHING that governs Indian Doctors, it can. Who will stop them if wrong? Such is the control of Central Govt. over this NMC, that if a doctor is unhappy about some decision of state medical council, he can go to NMC, and if unhappy about NMC’s decision, he will have to appeal to….? Courts of law? No. Something higher: the central govt!! So every medical practitioner’s career is ultimately in the hands of the central govt. Better join the party. Or quit medicine.

2. The entrance examinations are more simplified. All undergraduate examinations will be through NEET. All who have completed undergraduate course (MBBS curriculum) will appear for the Final MBBS exam which will also be common National exam (NEXT) for Medical Licence and PG admissions. Due to legal status of institutes like AIIMS, PGI, etc., they will conduct a separate PG entrance exam. Although this appears simplified, given the history of corruption (at almost all levels) in such exams and delays that waste millions of youth-years, one is worried about an undercurrent ‘sale’ of PG seats. But wait, not everyone must pass the licensing exam. You can entirely skip the difficult MBBS course, do something else, and bridge over in 6 months, without having to pass the licensing exams. That’s the third bullet.

3. Some AYUSH doctors are better than some MBBS doctors. Many who can not get into MBBS in spite of merit opt for other streams, with a hope to become a good doctor. They are actually contributing a lot to our healthcare, many of them know their limitations. One cannot object to their wish to practice allopathy if they want to study and upgrade themselves, the only objection is to exempt them from the common licensing exams. That will be very unfair to our society, most of whom will never know whether the doctor treating them has adequate experience, qualification and wisdom.

A newly passed out lawyer cannot do a “Six Month Bridge Course” to become a High Court Judge. A new recruit in Police cannot become an Inspector though a “Six Month Bridge Course”. A Municipal Councillor / Nagarsewak cannot “Bridge Course” himself into a Health Minister or Prime Minister. One needs to qualify though a common mandatory process. After MBBS, one cannot do a “bridge course” to become an MD that requires three years of intense responsibility handling, studying, treating patients under supervision and obtaining a deep insight into that subject. It is not possible in six months even for an allopath. Likewise, if an AYUSH doctor must practice allopathy, they must go through the necessary training (two to three years) and more importantly qualify the same common licensing exam before they practice the complicated allopathy.

AYUSH is an excellent idea, but it is immature as of now.

© Dr. Rajas Deshpande

4. The Doctor:Patient ratio in India is misquoted. Due to poor payments and infrastructures, very few doctors stay either in rural areas or govt. services, and the whole equation is skewed. The very purpose of AYUSH was to bring in more medical personnel, but that would work if these (3.5 lacs) “bridge” course doctors honoured the opportunity and worked only where there was a scarcity of doctors (urban and rural). What is more likely is that these additional doctors will also join the existing urban trend. Who can blame them for wanting a better life?

5. The newer policies of “more data, more paperwork, more record keeping, tighter control” over doctors will only result in private practitioners becoming more paranoid, giving up all the voluntary charity that they did every day, spending more time per case: and that will reduce numbers and spike fees. I can foresee most private practitioners closing down clinics. More rules and paperwork mean more corruption and exploitation in our country. This will turn into higher cost per consultation. Private healthcare will be out of reach for the poor. The good doctor will no more sit in his own clinic, he will turn to a safer corporate hospital. (Is that the aim?).

© Dr. Rajas Deshpande

6. The NMC bill entirely skips any word about regulating the large private healthcare sector. It does not have any provisions to protect new and good doctors from the tyranny and forces of corporate expectations. Some private hospitals have excellent policies and ethics, some corporates are very doctor and patient-friendly, but many remain to be corrected. There is no authority to the NMC over such hospitals.

7. There is no mention about improving staff and facilities at govt. hospitals, about any rules that ensure the best free healthcare for millions of poor patients in India. The ground reality that many patients suffer and die due to lack of staff, medicines, technology, tests and surgeries at government hospitals finds no mention in the reports of the Parliamentary committees that suggested the NMC. They did not mention the pathetic, unsafe and inhuman conditions in which Indian medical students and resident doctors live and work. They did not mention who will be responsible if a patient dies in a govt hospital due to lack of facilities or medicines. They appear to be more concerned about the price control of 40 percent seats in private medical colleges.

It is sad that in spite of many doctors in and around the central government, the medical field’s autonomy died with this bill. Shall we call it Euthanasia or “Physician assisted death” of the autonomy of medical profession? © Dr. Rajas Deshpande. In the era of the MCI, doctors were orphans, now in the era of NMC, they have become slaves.

The corrections in this bill will have to be put forth and pursued by a totally unified doctor’s organisation. “Painkiller Agitations” will not work. We must ask for complete release of the NMC from the cages of central government. Like in the UK, Indian NMC should be made up of 50% Senior Doctors representing all states and specialties, and the remaining 50% can be selected by the patient organisations: Judges, Media Stalwarts, Journalists, Artists, Ministers and Eminent Social Personalities. We must ask for transparency and fool-proofing of all medical entrance exams. We must ask for the right education, experience and licensing of AYUSH doctors, and welcome them once they qualify.

This article is written with my heart which bleeds for my profession and my patient alike. Bharat Maata Ki Jay!

© Dr. Rajas Deshpande

PS: Thank you Dr. Avinash Deshpande, Aurangabad, for some valuable inputs. If there are any technical mistakes, please let me know so I can correct.

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Best Option: A Patient’s Birthright. A Message For Upcoming Good Doctors.

(c) Dr. Rajas Deshpande

“He told us he had seen and operated many cases and has a good experience” the sobbing wife told. Her husband, who was operated by a doctor notorious for his gigantic claims of “Curing Everything” with greyzone treatments, procedures and risky surgeries. The patient had walked into the hospital for a simple intervertebral disc prolapse surgery and was operated. The surgery had gone terribly wrong, and the patient had lost power in both legs, his bladder and bowel control.

Complications can happen in any case, and the best of the doctors are helpless in the face of some complications. That said, there are also doctors who overshoot their skills to do something they should not. can not, and cause damage to the patient. Both of these lead to excessive reaction, defamation and anger about the medical profession. It is the second case that needs attention here.

It is indeed necessary that patients must get emergency care. This is the most misused reason quoted to go on treating patients beyond one’s knowledge, specialty, experience and wisdom. (c) Dr. Rajas Deshpande

I am a Neurologist. I have done MBBS, then MD in Medicine, then DM in Neurology. Now that Neurology becomes my final specialty, although I have conducted deliveries as a qualified MBBS during my internship, although I have treated heart attacks during my MD residency and later practising as an MD, I should now NOT conduct deliveries or treat heart attacks unless there’s no specialist available in the town within reasonable timeframe. There also are some neurologists better trained than me in some subspecialties like stenting of the brain’s blood vessels or in muscle diseases, so if a patient can benefit with a better opinion, I must refer him/ her to such a specialist. However this is the most flouted ethic in medical practice today. “Änyone Treat Anything” has become the traffic equivalent in India, and this is causing enourmous damage to the reputation of our profession.

When specialists are available, Depression should only be treated by a qualified psychiatrist. Heart patients must be seen by cardiologists, stroke and brain diseases by neurologists or neurosurgeons. There are even priorities of which cases should be treated or not by physicians and surgeons. In the rural areas, where there is scarcity of specialists, an MBBS or MD doctor can actually handle almost every emergency in every specialty. Thanks to these doctors, rural India still gets excellent emergency care. But there is medical care beyond emergency. In Urban areas, where specialists are available, patients should be given an option to obtain the best opinion for their condition. (c) Dr. Rajas Deshpande

The fact remains that the best care is only possible with the best qualified and experienced specialist in that illness, and this is blatantly denied to many deserving patients. “Ï can treat each and everything” has become a stupid boast. This leads not only to unnecessary or incomplete investigations, but also to dangerous outcomes. Fierce ‘business’competition especially encouraged at corporate hospitals has fuelled this practice. Innocent patients are often misguided and taken for a ride by those practising “cross-specialty” medicine, trespassing their area of expertise under the blanket titles of ‘Émergency’. Overconfidence is the first face of a bad doctor.

Such doctors then investigate the patient haphazardly, delay the whole process till diagnosis, and referred to the right specialist. Some cunning doctors invite the specialist for a single consultation to make the right diagnosis, then once they get the diagnosis, google and treat the patient with bookish knowledge rather than wisdom that comes only with experience. Some call the specialists only when the case gets complicated. The specialist does not have a moral right to tell the patient or family that their treatment is incorect, delayed or under a wrong specialist. (c) Dr. Rajas Deshpande

It is also the duty of a specialist that the referred patient is correctly investigated, that the referring doctor, general practitioner or family physician is involved in the care of a referred patient, and after the issue is resolved the patient is referred back for follow up with their original doctor.

Sometimes, only invasive / operative options are informed to the patient where noninvasive or medical treatment options are available with comparable efficacy. This again is denying te patient the best options. Most qualified postgraduate doctors follow the ethics and restrict themselves to their wisdombase. The few who are “aggressive and invasive”bring a bad name to the whole profession. Amplifying the severity and painting a bad pictiure to push patient into choosing a particular option must be avoided, so should falsely underplaying the risks involved or a bad prognosis. (c) Dr. Rajas Deshpande

The only way out for this malady is that doctors self-regulate good practices and start informing the patient about this. Patients must be educated to obtain the correct specialist’s opinion very early in the course of their illness, they must also learn to boldly ask their treating doctor which specialty is best qualified to treat their condition. Medical Insurance companies should deny insurance claims if the patient is not treated under care of the right specialist. Ego should never be a part of any medical process. My teachers have referred me neurology cases, and I have referred my cardiology/ psychiatry/ rheumatology or other cases to my students qualified in those respective specialties. The day I became desperate to treat what I am not qualified or experienced to treat, I will quit medical practice.

Most doctors try their best to do good to their patients. However, the patients’ birthright to the best treatment option or specialist should never be denied to them. Every patient has a right to know who is the best specialist to treat their condition, and a complete picture of all treatment options available from which they can choose. Most patients, after such discussions, trust their doctor to choose the best option. Every doctor should then proudly choose what is best for his / her patient.

(c) Dr. Rajas Deshpande

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The Mathematics Of Kindness

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© Dr. Rajas Deshpande

“Are you coming, doctor, or shall we file a complaint? We will go to the police if you don’t come in an hour”.

It was about 12 noon on a Sunday. My sister and her family were visiting for three days, this would be our only lunch together in this year. All other days I am in the hospital at the lunch hour.

A teenager was admitted for last two days with repeated alleged episodes of fainting with unconsciousness. His friends and family were all at the hospital, calling incessantly from different numbers. They were given my cell number by a colleague as he thought it was an emergency. I had seen the patient four times in last two days, rushing from the OPD as there were alarming calls. We had done all the necessary tests and found nothing wrong with the kid, we had concluded that he was malingering / faking these episodes. A neurologist has many tricks to unmask the truth. We had explained the facts to his family, a psychiatrist had confirmed this, and scheduled a meeting with the family on Monday. Till then we had added anti-anxiety pills and told the family to be patient. All the vital parameters were normal. I had explained the family to be patient.

My boss called, he was frustrated too. “Ja ke dekh le ek bar (Go and see him once). Some minister just called for him” he said.

Excusing myself from the lunch, I reached hospital. The teenager’s girlfriend was standing in panic by his side, crying while he was ‘unconscious’. The brother and friends raised their voices: “Why is this happening, doctor, why don’t you do something? Why is he not responding to the treatment? It is three days now. He is suffering so much”.

I am trained as a doctor to tolerate anger, frustration, anxiety, stupidity, bitterness or accusations, but I refuse to tolerate drama.

“I have explained to you many times. This is not real unconsciousness. A psychiatrist will have a meeting with your family tomorrow, till then there’s nothing more we can do”.

“What if he dies? What if you are wrong?” shouted the relative. I did not have an answer. I left the ward after messaging my boss, also asking him to transfer the case under someone else. The next day my psychiatrist friend called me. The teenager’s girlfriend was from another religion, parents on both sides had opposed their marriage, and this illness was their “brilliant solution” to get the parents to change their minds and agree. Cheap drama!

There’s no mathematics to kindness, we have all been taught. Do good, be compassionate and don’t expect any returns. People take advantage, but that is Their nature, you be yourself, kind and compassionate.

I was once returning from my Goa visit, there were long queues of frustrated people. Two apparently rich Indian tourists walked in, typically dressed for a Goan vacay. They saw the long lines, changed their faces, and rushed to the front of the line. One of these approached a foreigner in the line: “Excuse me, we will miss the flight… we were stuck in traffic.. my sister is sick, I must reach Delhi in time”. The foreigner, knowing that these were blatant lies, still allowed him to go ahead of himself. Kindness is almost a compulsion. Once on the other side of security, these “line-jumping liars” had the obvious expression upon their face: “Ullu banaya tum sabko (We made a fool of y’all)”.

At the hospital entrance, I often meet a paraparetic man in his scooter for the disabled. He usually blocks the hospital entrance with his three-wheeler scooter parked there while he talks at leisure with his friends. If anyone honks, they all play this “Can’t you see he is disabled? How rude!” card, intended to make others feel guilty. Even when it is an ambulance or a doctor’s vehicle, he will intentionally slowly move from the spot.

Every doctor, almost every day, meets people who blatantly lie: to bypass waiting lines, to ‘finish off with parent’s health issues over the weekend’, or to get concesions, free treatment. Some lie to exploit kindness and compassion, some to exploit financially. There are no guidelines defining an emergency and the charges for such “pseudo emergencies”. A doctor on duty must always resopnd to an emergency, but if off duty, he should be able to refuse cases on a holiday. All government hospitals have a 24/7 emergency department, the patient can be taken there.

Recently heard that an Indian lawyer charged in crores to an Indian client stuck on an European airport for a legal advice in an emergency. There were no cries about compassion, kindness or even patriotism. What should a doctor charge for a pseudo-emergency, especially when a precious holiday is wasted?

When I discharged this case, they asked me when to follow up. I replied without hesitation: “Never with me”.

© Dr. Rajas Deshpande

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