Monthly Archives: May 2015

“Why can’t the doctor be more compassionate, spend more time with patients?”

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“Why can’t the doctor be more compassionate, spend more time with patients?”

© Dr. Rajas Deshpande

Ms. Bonnie Wilson asks:
“When are doctors (not all) going to grow some compassion or least show some and listen to what we actually have to say and maybe spend just a few more minutes to get to know the patient a little bit???? Then maybe more patients would appreciate their doctor more. I’ve been fighting a disease for 16 years now and a lot of doctors don’t even spend five minutes with you. Only speaking from many years of experience as a patient”.

Dear Ms Wilson, thanks for asking this question, it helps me introspect.

Simple answer:
Give the doc a patient who pays as per time and skill required for the consult, and they will spend an entire day with that patient. Give the doc a patient who writes down “Doctor, I have complete faith and trust in you, do your best to treat me, I promise not to sue you or blame you if in the course of my treatment something goes wrong. I respect your intention, and know that you are a human being capable of mistakes, I will be compassionate to you too.”, and they will cross all barriers to help / satisfy that patient every which way medically feasible.
Also add “I will endlessly wait in the doctor’s waiting room till the earlier patient smiles and leaves”.

Not possible? There you are!
In the 15 years of medical training, we hear innumerable sermons about being compassionate and “Listening to and Understanding” the patient. We have always learnt and taught in medicine to “Listen” carefully, so most doctors attempt this in practice, not all keep it up. Some learn the knack to “extract” the correct info to work faster.

Now imagine the Doctor’s side.

How long is “Little longer”?
75% patients really don’t have the sense of time when they talk about their illness. Instead of being to the point and realizing that this is a “professional consultation”, they go on to recite unnecessary over description / umpteen repetitions of the same complaints, even after the doctor jots them down, with confused details of their own symptoms, changing them often. Some tell their own interpretations about each of the symptoms, and complete detailed conversations that they had with their family / other doctors about those symptoms. Many ask the doctor to repeat long explanations, then some relatives ask it again. Many revise prescription medicines at least three-four times, in spite of writing down correct instructions. Many keep blaming the doctors and crying in our cabin for “incurable” disease diagnoses, thinking that the doctor is hiding good treatment for want of more money! We sympathize and explain, but cannot go on all day, especially if other patients are waiting anxiously for their turn.

Many patients fumble, forget, come disorganized (this is super-exaggerated in India, where there is no unified health record system, and patients carry messed up bundles of test reports / case sheets from many different specialists). Most (even literates) come without even the list of currently ongoing medicines, then call their family from doc’s cabin to enquire about these, and then the huge discussion about spellings, content etc. consumes double the scheduled time of consult, while other patients wait and complain. There is total lack of awareness of one’s own health responsibilities, even those who spend hours chatting in the waiting room don’t organise their thoughts or make notes for the consult, wasting time with the doc in “recalling” things!

In the western world too, there are many patients who go on describing the “unnecessary detail”, some talk too much, some talk slow, take a long time to recall and answer, and mostly come “unprepared” for the consult, without noting down questions they want to ask, and symptoms / medicines they want to discuss. Then the innocent “recalling” in the doctor’s cabin is quite irritating for the overworked doctors.

The third and the most difficult category of patients: the “over-prepared” patients / relatives, who have hyper-googled every symptom, every medicine and then come with a huge (and mostly irrelevant) list of questions about their minor symptoms. Stupidest of the claims on the internet are then discussed unnecessarily, and the frightened patient / relative really test the patience of the doctor. They are seldom satisfied with anything or anyone.

At what price?
Enter medical insurance. Enter the “Charitable Labelling” of healthcare in India, where iPhone will cost the same as in USA and UK, but the superspecialist doctor trained in USA/UK/Canada/ Australia etc. (with his own life, merit and money) must charge as per the basic general practitioner and local socio-political expectations. So the doctor has no freedom to charge the consult as per time required.

Result: more time translates into less income, worldwide.

Reaction of the society: So what if you earn less? You are a doctor. You are a spiritual saint who just earns in goodwill and respect, converts that by magic into money and then we charge you everything including taxes in cash! We all can dream luxury and good life, you can’t!

My question: What’s in it for the doctor in spending more (extra) time with the patient?

It is a pleasure for the good doctor to spend more time, explain in detail and compassionately listen to each patient, but then he/ she returns home to piles of unpaid bills and an unhappy family. Most Indian specialists don’t even afford their own home by the age of 40! Most western doctors are frustrated by the dictat of insurance companies that for a decent earning, they must see higher number of patients. No insurance company pays a good doctor better.

As for Compassion issue:
I have some really innocent questions to ask patients / society:

1. When any doctor was prosecuted for medical negligence in some case, how many times has any patient openly said “This doctor was very good to me”? Many doctors prosecuted must have saved hundreds of lives. Who stood by them when their careers were ruined by single mistakes? How many patients whose life they saved offered to help with the compensations the punished docs had to pay?

2. How many times did society / luminaries / media show compassion to the needs / plights of medical profession? Underpayment and Overwork, Victimisation and Insecurity are universal in this profession. Who showed any compassion ?

3. Can you be compassionate to someone who is being a “Customer” with the right and threat to sue you for an amount that will ruin your life, reputation, career and family? Can you be compassionate to someone who suspects every motive of yours, cross checks everything you say, argues with you, threatens you, does not have faith in you and will forget you the day their health problem is over, only to return when they need you again?

4. Can you be compassionate to someone who records your words of reassurance and uses them against you as a legal proof of “misguiding”? Can you talk nicely to someone who treats you arrogantly, mannerlessly and looks down upon you as a “Money maker” rather than a respectably educated hardworking Doctor?

Indian Docs carry the whole burden of the country’s mismanaged healthcare system upon their shoulders. Millions of poor, unaffording patients are RIGHT NOW being treated by thousands of doctors FREE. Most patients get better than not.
But
When the uneducated filmstars rubbish the whole profession to prove themselves tall, some movie claims that doctors treat dead bodies to earn more money, no one speaks a word against it. Why?
When senior doctors who spent lifetime serving the poor are wrongly suspended by politicians without any enquiry, not a peep from the society.
Why?
When doctors are killed, attacked upon, and abused, media justifies / glorifies such events.
Why?
Some of the senior doctors cannot stop talking ideal, even at the cost of their children’s lives. “Spend more time with the patient, be more compassionate” they say. I agree.
But we never hear from them when a doctor is killed. They are never seen defending those doctors who faced 12 crores worth compensation punishments, when laws like PCPNDT send young and old doctors directly to jail for documentation errors. It is very fashionable and hip to be a hypocrite and speak what people like. To understand any issue, there is a simple formality: think of both sides. Who thinks about the Doctor’s side of the story?

There is a worldwide notion: that doctors are guilty of earning more money by wrong means like hurrying. For those who think this, I have one question: Which Doctor in the world has more money than the price of YOUR life? If they save you, they are blamed for high charges. If they don’t save you, they are sued for unbelievably stupid compensations. This is the paradox: that lost lives have become costlier, saved lives don’t matter anymore.

There of course are a few greedy doctors, who need to improve. These are few and a shame.

The real tragedy of our faithless lives is this: Nobody ever thinks that a doctor may really be working faster and harder to help more patients rather than to earn more money!! He/ She may be struggling with his / her loans, sacrificing his/her own health and family time, fighting frustration, but still listening day-in and day-out to crying, complaining people merely out of the wish to relieve their agonies.

What price is the time you are away from your family? What price is years of sleepless nights? What price is the mental trauma of seeing dead bodies every day? What compassion did any doctor get for these, from media, judiciary, society, anyone?

© Dr. Rajas Deshpande

PS: Less time does not mean wrong diagnosis or approach. Mostly it means “Cut off talk to bare minimum interaction necessary for this consult”.

@ Bonnie Wilson, thanks for the opportunity you created for me to answer this concern. While this is not a personal reply, I agree with you that more time and compassion will go a long good way, but then both sides need to introspect and change.
RD

The Grandiose Genius

The KHAMIR poison.
© Dr. Rajas Deshpande

“Doctor, we think that doctor treating my mom is giving her the wrong treatment. She is in the ICU, unconscious, for last three days” said the angry and crying son.
A 55 year old nice farmer lady with epilepsy, well controlled with two medicines, without fits for last three years had suddenly developed many fits / convulsions at home, and was now in ICU, ventilated because of the necessity to paralyse the patient to control fits (a common recommended treatment). Her brain had suffered damage due to lack of oxygen as breathing was compromised during fits.

As per their request I called to talk to the doctor treating her. She courteously explained that the patient was admitted after many convulsions, in an unconscious state, with dangerously low oxygen levels. The management since admission that she narrated appeared the correct one recommended in this case. “We will try to wean the patient off venti tomorrow” she said.

10 days later, the patient visited my OPD with her sons. Having known me earlier, the emotional lady held my hands and cried a while, thanking God for her rebirth.

“What happened on that day?” I asked her.

“Oh I had missed my antiepileptic (fits) medicine for five days.” She said.
“Why?” I asked agitated, as we clearly explain to every patient the importance of taking medicine regularly, in time, and stocking extra too.

“I live in a village. My son sends me this medicine from Pune. This time I told him a month earlier, but he couldn’t send it as he was busy”. Said the ever forgiving Mom.

I looked at the son. He said, semi guilty, “Doctor, I thought four five days of break in treatment would not make a difference. Also some people tell us that sometimes doctors prescribe unnecessary medicines for years, so we were confused whether she should continue. She had not had a convulsion for three years too”.

“Then why did you blame that ICU doctor?” I asked, still sizzling inside with hurtful anger.

“You can understand, Sir, we were emotionally disturbed as Mom was critical. Also, we had to spend a lot for her treatment”.
>>>>>>>>>>

A case of brain cancer, stage 4. Headache neglected for years. MRI was delayed for months after the doctor advised it for headache. Then done at a free center by long awaited appointment. Multiple secondaries had caused block to the flow of brain water (CSF). Operated by one of the best reputed neurosurgeon, only to restore the lifesaving flow of CSF and obtain biopsy. It proved stage 4 cancer. Patient by now medically unfit for radiotherapy. The relative kept on asking: “Was the neurosurgeon wrong? Was the surgery done correctly?”.

Where do we bring faith and trust from, in this world where even brothers, sisters, parents are killed for money and most couples find it difficult to respectfully trust each other?

The more kindness the doctor shows, the more he/ she is taken advantage of. People look at every chance of not paying or paying less, and if paying at all, expecting a miracle with that payment. From someone they don’t trust.

In the widening valley between patient and the doctor, where trust is paramount, shows like Satyamev Jayate and some other media have further created a rift that has caused severe damage. This “KHAMIR” poison has really caused immense corrosive effect on this beautiful profession of intellectuals. Like other cheap “filmy” philosophies, conclusions by revengeful murders, the whole allegation game neglects the very high standards of education, compassion and sacrifice practiced by 90% Doctors in India and elsewhere.

Of course a logical analysis is not to be expected from someone not well educated. Many celebrities have been victims of the “genius grandiose” that money and fame brings.

The effect of this “Khamir poison”:

Many if not most patients now enter the hospitals with suspicion in their mind, and aversion for the entire process of consultation, paying fees, investigating, admission and taking treatment, all of which is a natural healthy process followed worldwide in all hospitals. Indian patients are unaware of how good the available specialist medical services are, at least in the urban/ semiurban areas, at the lowest costs anywhere in the world. Just because there are a few unfair practices (btw, most of which originated out of the policylessness and “charity for all” expectations from healthcare industry) and few greedy doctors, so many others suffer, doctors and patients too!

It takes 2 years to get an appointment of Joint replacement Surgeon, One year for a Neurologist, One year for a cardiologist, Three months to do an MRI, in most of the developed world. These can be expedited only in emergency, where one cannot have the choice of a specialist. This is mainly because they work 8-5 OPDs. Even senior docs in India work late nights and earn one tenth or less in most cases, to be available for anyone within a day irrespective of their financial / social status.

The notion that everything best in medical care should also be low priced or free is damaging the future of this profession. Add to this the loose talk by middle-school educated celebrities who have great hold on the illiterates / semi-literates, people who are angry at the govt., at their own poverty, unemployment etc., and find the “Intellectual, hardworking and doing comparatively better” class of harmless doctors an easy target to screw for their personal frustrations.

The “Khamir” poison is not a surprise, for it definitely stems from a desperate attempt to use one’s celeb status to cover for the lack of any serious academic achievements and intellect by attacking those who have these. What surprises is the willingness with which both the illiterates and literates swallow it, not knowing how harmful it is for themselves.
© Dr. Rajas Deshpande

Milord, please don’t try this Medicine!

MLH

An old saying “The young man knows the rules, but the old man knows the exceptions” seems to keep our judicial officers forever young. The following article is not for a comparison between doctors and legal professionals (my best friend is a lawyer, and I owe much of my reasoning and tea bills to him).

Not always while learning could we understand or agree with some decisions made by our seniors, as they either contrasted with the “textbook” instructions, or were never mentioned anywhere, it was the sheer genius and practical experience of those seniors that often saved lives. Such risks were almost always well calculated against the risk of death, and discussed with patient’s relatives whenever they had a capacity to understand (rare). We have never seen a doctor working / acting with the intention of “causing harm” to the patient.

There are often (not at all rare) situations when even two of the world’s best authorities do not agree upon some medical issue. This is beyond the “average IQ” people to comprehend, as they can only understand the most simplified. It is not because of a clash of egos, but a tie between two dead ends.

This is why medical definitions and management guidelines change very frequently. This is why every practicing doctor becomes a criminal, having ‘bypassed’ some guideline somewhere in his / her career for doing good to the patient who did not fit in the medical definition or was not mentioned in the textbooks.

It takes @ 6 years to become basic allopathic doctor, and @ 15 years to become a medical specialist. Only half of this training is in the books, remaining half is the actual experience of dealing with the thousands of complicated medical problems and learning to untangle the situation by an extremely difficult decision making. But we see some specialists do very well as compared to others, and to presume it is only because they “cut-practice” is intellectual poverty! Most doctors who do well do so because of their exceptional abilities in their field, especially in this society with such a bias against doctors as a class!

Legal training does not include medical knowledge and reasoning, it usually deals with crimes like rapes, sexual aberrances, poisonings and murders. Beyond that, a lawyer would have to make a special effort to learn from prior judgments about the precedents set mostly in the western world. To apply these to Indian medical practice is humorous. We have a legal system which has many differences from the western: be it relationships, marriages, sex, rapes, political crimes or homosexuality. In most of these the judges quote “Indian Culture and difference in society”. Separate laws and courts have evolved where industries and money was concerned. Military conducts its own trials / court martial.

But the most intellectually complicated field dealing with human life is left out to be handled by people who may be very good in law, but have little or no knowledge of the intricacies involved in handling a complicated medical case. Most of the judges and lawyers, with due respect, would lack the basic knowledge about the “unpredictability” of various medical treatments, procedures and clinical outcomes, despite best medical brains involved in their use.

Summarily, doctors are as law-dumb as those not doctors are medical-dumb. To allow anyone except medical professionals to either make laws or to try doctors in courts that have had no medical training or acumen (which, incidentally takes years of day & night training in hospitals) is like asking an MBBS doctor to analyse and decide about the decisions of a Supreme court judge. We are so mentally enslaved to the ancient British system, that we have to rise and salute the authority of every judge because they are so “highly placed” socially, legally and ethically (then what are all the criminals doing out in the society and different governments?) that a doctor who deals with human life, saves hundreds for all his life has to beg them with folded hands. Beg to understand that he / she was trying to save a human life, and they will decide the merit based upon their puny medical knowledge, which is unchallengeable!

Laws practiced today were mostly made over 100 years ago. Medical science changes daily. Only the sane and solid minds will sense the paradox here. We need separate Medical courts. Thousands dying due to incorrect political decisions and accidents do not receive even pebbles as compensation despite knocking the doors of all courts, but a single inadvertent medical mistake is punished with 12 crores compensation, a lifetime income beyond 95% doctors in our country!

Yes. Doctors should not have to stand in regular courts begging mercy for trying to do good. We must have medical courts, with special judges who have adequate (atleast MBBS level) knowledge about human body, and are also trained as well in law. Only a multidisciplinary panel of young and old doctors and legal experts can properly analyse the merits or otherwise of a medical case. Or the MCI should conduct qualifying examinations for Judges who conduct medicolegal cases, or train them with experts from various superspecialties about basic principles of a Doctor’s approach to complicated medical issues. Also about the non-medical issues that kill a patient (delay in admission, addictions, health neglect, non compliance with advised tests / treatment, neglect by family etc.) which never appear in legal discussions of negligence cases.

Come on. I have immense respect about the Judiciary and its abilities, I have immense faith in its intentions. However, being a doctor, I cannot harbor superstitions or blind faith. I DO NOT believe that the regular Judges or doctors will understand all that happens in a spaceship travelling to the Mars, only the astronauts can understand those intricacies.  I do not believe that anyone who has not composed the same music as Mozart or Tchaikovsy or AR Rehman or Ilayaraja should criticize them.

The present tradition of any court trying medical cases can only be equated to the legal system punishing an acclaimed singer for singing a wrong note! Unfortunately, as this profession concerns life, the “Wrong Note” or “Bigda Sur” can result in health complications. But then to completely avoid it, one must stop singing.

This is why most new generation Indian Doctors are leaving India. Not that there are better Judges outside, but better payments for the frustration involved!

If not anything else, my dear and most respectable Milord, Sir, please understand the dire necessity of a  “DURESS FREE DOCTOR” the society deserves.

© Dr. Rajas Deshpande
Picture courtesy medicolegal literature help http://www.invohealth.com with thanks.

God help the Indian Doctor.

God help the Indian Doctor.
© Dr. Rajas Deshpande
A court recently awarded a compensation of 12 crores to a patient because that’s what she would have earned if alive, as she held a job in the US. While human life is invaluable, there has to be a logic / discipline to such punishments. What compensation was ever awarded to the families of doctors injured / killed by patient’s relatives? Given that those docs would have saved many lives in their future careers, what does the Indian legal system hold the value of the dignity, career, disability and life of a doctor?

Death consequences in India:

If a politician kills someone, his whole party and the people, media houses favoured by his/ her party, and even police officers in his / her favour will stand by him / her. In cases of rapes and murders, there are umpteen examples where even police refuse to register cases because of political interference / influence. There are extremely rare examples of someone being debarred from making laws and participating in the running of country, even as criminal trials are on against them. They are not suspended or punished in 99% cases.

If anyone among the rich and glamorous drunk-drives over and kills people on the road, their whole profession (who usually pose as social icons) stands behind them, so does almost 90 percent of the media which glorifies the good deeds of such icons in defence of the deaths they have caused. The whole system machinery works as a deaf / dumb spectator to their blatant, laughable lies in the courts of law, and many from the society actually sing praises of their “glory”. They are not suspended or punished in 99% cases, in fact the legal systems ensure best humanitarian services for them.
No judges are suspended for a wrong decision.

The law, police etc. accept openly the presence of Mafia and goon houses, media glorifies the stories of daylight murders and bloodbaths by these for ransom etc., and we seldom see anyone even arrested. “Contract murders” are a blooming eventuality, so are gangrapes. No media glorifying crimes like rapes and murders are seen even reprimanded.

With even a little social uproar, compensations are paid for the dead or other victims, in a hope to suppress their agitation against the criminal.

Now come home to this:
If a patient dies while undergoing treatment and the relatives are upset/ illiterate / goons, they can beat up the doctors, even kill them. Doctors are immediately suspended without enquiry and their careers mostly end there.

While the earlier classes of “rich and powerful murderers” dance naked all over the country, the three classes of most stressed-out servicemen : doctors, military and police are completely neglected, the value of their life being zilch for the system and society alike.

Policemen dying while fighting with terrorists get lesser compensation than sportsmen get awards from the governments. Militarymen’s families live eternal poverty after their supreme sacrifice. And doctors who die while treating patients are not even acknowledged by our society or media.

People can see the same film twice, eat the same costly dessert twice, go on unnecessary vacations to enjoy just because they afford and like it, spend on petrol and internet without thinking twice. Many now go for “complete/ whole body check-ups” even when unnecessary, but when a doctor advises investigations or charges fees, they talk of malpractice. Then again, if there is a death in the hospital, the doctor is readily sacrificed, either in career or in life, without any compensation.

One part of this tragedy is some medical professionals itself who live in a “separate paradise”, talking what public and media likes, denying the reality, pretending “All is well” and declaring how proud they are of being in the current situation, where doctors are attacked and killed every other day. They are like the legendary saints who “missed the opportunity”.

But the saddest part of this tragedy is that our non-medical (and even some medical) social intellectuals choose to keep shut when it comes to the rich and powerful, but vomit poisonously and readily bare their fangs at the medical profession.

God help the Indian Doctor.
© Dr. Rajas Deshpande

Painful Injection

Injection
© Dr. Rajas Deshpande

“Anyone Treat Anything” and the “Add-On complaints”.

“Doc I have come to you for this severe headache since last five months”.
Examined, investigated, prescription given.
5 days later:
“Doc there is no relief. This back pain is killing me”.
“What about the headache you had?”
“Oh that went away the next day, but this backache has been there for years now. I forgot to tell you last time. I also want you to review and advise about my Sugar and BP medicines”.
……………..
Specialty practice in India is considered to be just like family practice. The concept of “problem-based” consultation is yet to arrive. Once seen by a specialist, all the subsequent health issues are thought to be automatically the responsibility of that doctor, and he / she is supposed to solve them at a “Follow-Up” charge for years. The concept of “New health issue, New consult” is yet to dawn.

Unfair to compare, but this is like visiting a hotel once to eat an unlimited Rice Plate, and then keeping on visiting repeatedly later to reap the “unlimited” benefit from the bill paid on the first day.

There are two sides. Some specialists also encourage this “treating everything” once the patient comes to them, and often transgress their field of expertise to keep on treating everything till the time something goes wrong, when alone a cross-reference is made. Once someone starts practice in some specialty, they should ideally only stick to that branch, unless it is an emergency.

Even at the cost of patient “misunderstanding and blaming”, some specialists follow this correct practice of referring to another specialist where indicated.

“You only give the treatment, doc for everything.. we have faith in you” is very rewarding and beautiful to hear, but at the same time a doctor who thinks he/she can should think twice.

The second issue is that of “Going on adding” the complaints even after the doctor has finished examination and has already issued a prescription.

The whole process is logical, and disciplined: recording the complaints and other medical details, then performing a physical examination, reviewing old test reports and advising new, writing a prescription, and explaining the condition and management to the patient. There are limitations in the time spent for one patient, and a single significant complaint added later after the prescription is written can change the diagnostic possibilities (“I just remembered, I had episodes of unconsciousness / tuberculosis / head injury in the past”). It then becomes imperative that the doctor rewrites the case history, and changes tests advised and even treatment sometimes.

There are simple solutions, but these become difficult in India.
1. The doc must spend extra time with every patient to give them sufficient time to remember. This is feasible only when the charges are time based, as some patients are not done talking even after 30 minutes. The experienced docs then learn the skills and tricks to save time and to “steer” the patient.
2. Patient can fill up / record forms while in the waiting room, where almost all important questions are already mentioned, so one cannot miss. This is difficult in two ways: most of our population is illiterate, and even the literates do not fill up these forms properly. Also, most of the working class come “flying” in a hurry to “get over with this quickly and fly to another meeting/ chore”, so they keep busy with their cellphones in the waiting area (sometimes even in the doctor’s chamber). Secondly, such mention of “all earlier health issues” also invites unwanted exaggeration of otherwise minor complaints especially in the depressed / suppressed / anxious and overenthusiastic patients, often diverting from the main health issue.
3. Doctor’s assistants / junior doctors “filtering” the information for each case: this may be the best option, but again the specialist must take responsibility for their mistakes. Also, one must remember that patients often do not take the “assistant doctors” seriously and may omit crucial information while talking to them. Also, a patient who pays for a specialist’s service deserves interview and examination by that specialist, not only a quick overview of an assistant’s opinion.
4. Patient must make and retain a notebook / digital diary common to all his / her medical issues, consults, details of all prior treatment and tests and carry it for every consult, minor or major. While the doctors / hospitals are supposed to keep their own records, they are blind to what happens outside their medical jurisdiction, so it becomes almost useless. A unified national healthcare software is at least 10 years away.

The IMA / MCI must devise large scale patient education programmes that will help curb the misunderstandings, hate, violence which society harbors towards medical professionals. Encouraging correct referrals, specifying doctor’s fees based upon the equation of “Time + Skill + Experience + Complications in a case” at different levels from family practitioners to super specialists may also help. A basic model of “Primary General Practitioner” who attends simple health issues with referral to a specialist based upon patient’s choice / proximity / GP’s honest opinion and suggesting at least two specialist names will help control this “Anyone Treat Anything” practice so rampant today.

There always will be allegations of “cut practice” whenever there is referral, as average human nature finds pleasure in blaming others especially successful and presuming everyone else a sinner while imagining oneself a moral-ethical icon.

To imagine that everyone in the medical profession is a sinner and guilty, and everyone in the society is innocent is a sign of immaturity of intellect. This is our working diagnosis right now.
© Dr. Rajas Deshpande

The Bollywood Hospital

The Bollywood Hospital

© Dr. Rajas Deshpande

“You are invited for the inauguration of The Bollywood All-or-None Good Doctor’s Ultimate (BANGDU) Hospital” said the card. I was ecstatic, because now I could meet the so-claimed best experts in the field of medicine, the Bollywood heroes who “create” and advise the screen doctors, and know best about medical profession. This was also my lifetime lucky chance to learn about new methods of medical practice yet to be discovered by the actual medical professionals practicing all over the world, like conducting heart transplants only by using cellphone batteries and delivering babies using toilet vacuum pumps over Skype after graduating in engineering, which all the Medical councils seem to approve without hesitation.

My good friend with emotional incontinence (uncontrollable crying / laughter) Mr. ‘Arun Khar’ (Mr. A) was to be the medical director of this hospital, because usually he declares himself the perfect and best at the outset, and everyone else has to be compulsorily less smarter in his shows, movies or whatever else he does. As I wished him a good evening, he reminded me that I should now call him ‘Dr. A’ as the Bollywood Medical University has conferred upon him the superspecialty degrees in all medical and surgical branches within one year of joining the course because he was too smart: in fact, he showed me the special “Oversmart of the Century” certificate conferred upon him by the BMU.. There was one more reason that he was chosen the boss: he had also produced huge number of patients via his work, in the field of violent revenges and other human injuries so essential to improve other human beings.

The crowd was overwhelming, as the public and some TV channels were very excited that the “Real Good Doctors” from Bollywood with Godly qualities were now available for their free and most accurate miraculous treatment, there was no possibility of any patient dying. Unless of course they wanted to shoot for some movie, where the script demanded that the patient died. The hospital was decorated by the best imported designers in artful colours, live orchestra played beautiful tunes stolen from the western musicals, but the theme was Indian (sorry, Desi). The ambulances standing outside had turbo and nitro modes, and their sirens were created by the best South Indian Music Directors, in the “Karuna Rasa” (nectar of compassionate pity). The paramedics and ambulance drivers were said to be trained by the best Hollywood stunt masters. Each ambulance was also equipped with praying priests from at least four different religions.

So it came that Dr. A started showing me around.

“This is out Casualty in charge Dr. Mithun Coconut”, he said as we entered the casualty, introducing me to a sickle-wielding man who was threatening all the casualty doctors. “He has already killed three doctors today for not saving the dead bodies of our innocent film stars who were fighting gang wars with guns, bombs and knives since their childhood”, Dr. A proudly hugged Dr. MC. They both wiped their eyes after taking the right pose in front of the camera.

Dr. MC then explained the relatives of a critical patient of brain tumor, by showing them an X-ray film of pelvis on the view box. How artistic and meaningful!

I was curious about the blood bottles hanging upon each wall, ready to be transfused, labeled “Lost son 1, Lost Mom 3” etc. When I asked about it, Dr. A answered with a trademark cunning smile: “That is our creative idea: so we don’t waste time in blood grouping etc., we can readily transfuse blood when the lost relatives are here. We are so advanced, we even have emotional singers sitting in the casualty specially for that occasion”.

“These are our Operation theatres”.. he showed me two rooms with green and red bulbs over the door. We entered the first room. It was empty. “This is our ‘Director’s cut’ OT… Different genius directors invent different medical / surgical procedures, like cutting the heart and keeping it in the freezer till the hero kills the villain, hero holding his totally cut head for days so it fits back, conducting online deliveries etc… we have reserved this OT for such emergencies. You routine doctors will never be able to match us!”.

The second operation room had specialized music systems to adapt to the patient’s heart rate and criticality. It automatically started to show the patient’s life in flashback and played songs sung by either his / her parents or fiancé in the past, so their heart would restart. “The doctors and anesthetists are very well trained here to look frightened and concerned into each other’s eyes and sweat heavily when the patient goes serious. We have three specially trained “tears of joy” nurses who smile a curiously contorted smile when the patient’s heart restarts. The lighting also adapts to the situation” He described.

Then we went to the ICU.

The moment we entered, someone karate-chopped my neck and hit me on the head. As I regained consciousness, Dr. A introduced me to the ICU in-charge: Dr Akkha Kumar. I had heard the name earlier: He was world famous for his work: killing all those who were living and saving all those who were dying. “Why did you hit me?” I asked, hiding behind Dr. A. He looked at me angrily and said “This is my style.. I assault all qualified doctors, govt. officers etc. to prove that I am better than them. Do you understand?” He asked, pointing a gun at my forehead. “Yes, Sir”. I said.

A nurse came running “Dr. Akkha sir, the patient has had a cardiac arrest.. they are resuscitating him”.. Dr. AK jumped over three beds and thrashed the doctors who were trying to save the arrested patient: “You idiots.. his heart has stopped.. Khattam… Don’t treat this dead body now..”.. “But sir, she’s young, and may survive..” said one young doctor… “Bang”. He received a bullet in his forehead. “My Style, remember?” asked Dr. AK to me. Some people came in and actually performed a pooja and aarti upon him for his human values: after all killing and violence was such an easy solution to all problems, which the likes of Gandhi and Einstein had missed!!

In the next room, there were many elderly ladies. “We even provide these praying and crying Moms to our patients at discounted rates. They have a degree in emotionally blackmailing the doctor, and the only way our patient’s will start talking again, however critical with whatever diagnosis.” Explained Dr. A.

There were sounds of loud music coming from the auditorium next door. As we entered it, we saw the ever clever and strong  Chunabhai MBBS: whose famous radical theory of providing “alcohol and sex” to all dying patients had caught the fancy of our times. The old methods of religious recitals and soulful things were so bland for the dying! How could sex and alcohol not make them happy in their last days? These were the only things one could want in life, especially when dying young with grievous illnesses! Chemotherapy, Radiotherapy, Counseling.. were old treatments. How innovative and mind-blowing!

“Is it all free?” my natural question.. “Yes, for those who watch our movies. You must show the tickets for entry in this hospital. Those in emergency can buy tickets for our shows in the multiplex on the top floor.. we thought of everything.. medical charity is our aim”. “What is your first response when an emergency arrives?” I asked Dr. A innocently.

He smiled his famous “Ain’t I cutely great?” smile, and said: “Just see”.

In a few minutes, an ambulance rushed in. Dr. A was at the forefront with his team. What a hero!! The patient was apparently having a heart attack.

They made a circle around the patient. Dr. A and his team removed their shirts. Some wardboys came with buckets and mugs. Some others rushed in with a huge water pipe. The orchestra opened with loud drums, to which they all danced: “Jab Life ho out of control … Toh Hoton ko karke gol.. Seeti bajake bol… Alll Izzz Welllll (Basically a hindi song meaning when Life gives you the raspberry, just say All Is Well to yourself till situation resolves!)” .

As the music drowned the patient’s voice, I saw the relatives and TV channels line up to get the autographs of these greatest doctors upon earth!

(c) Dr. Rajas Deshpande

PS: Purely an imaginary story. No truth at all. Any resemblance to any human, animal or non living entity or event is purely a perversion of reader’s imagination.

PPS: For all the criticism of medical profession they show, whenever the b’woodians need to show a hero / heroine intellectual, he / she is a good doctor automatically. This post is for the real good doctors!

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Who killed this patient?

Who killed this patient?

There were huge banners. People were happy, dancing to the most recent Bollywood item song, throwing colours and distributing sweets. Their big leaders, standing perpetually garlanded in a decorated open vehicle were smiling lovingly at people, returning “Namaskars (Salutations)”, and intermittently instructing the “key followers” about the whole process.

Behind this was a congregation of at least a thousand cars, buses, trucks and two wheelers, and also an ambulance, from the window part of which everyone could see the tense faces upon which tears rolled.

The intern doctor sitting besides the ambulance driver knew me. From six cars away, he shouted : “stroke, stable, in window period, three hours now” meaning that the patient may be given one injection if he/she could reach hospital within ninety more minutes, that can potentially reverse stroke, and save disability and / or life. “Time is Brain” in stroke, we are hammered, “Time lost is Brain Lost”.

The traffic police were too occupied with the procession to attend the ambulance. There were threats of bomb blasts, so they had to safeguard the VIPs. Some young students parked their bikes and started to rearrange traffic to make way for the ambulance, and gave up when they met the blank, expressionless stares of people who won’t move, often demeaningly reminding those students that they were not traffic police. The whole procession behind the celebration was that of stuck, delayed, cursing working class of all socio-economic levels, wishing that they hadn’t left the house today. Each one of them would have to apologise to many, listen to humiliating words from their bosses or miss some important assignment / meeting / interview / exams. Some would miss chances of a lifetime.

One of the most frustrating thing to witness as a doctor in India is this blockade of the ambulances, along with the working class and public transport due to morchas (processions/ mass protest) / VIP bundobast and celebrations ranging from election victories, marriages and various other socio-religious occasions. What is the fun in causing distress to someone else by blocking traffic? Why cannot these be banned on the roads meant for public transport? There are umpteen grounds / lawns and other venues in almost all cities where people can gather to celebrate saving the disinterested from a day’s distress.

There is no objection to celebration or cultural / social / religious occasions. But causing delays and discomfort to the public and those in an emergency is criminal. There must definitely be laws against causing blockage to traffic when granting permissions to such processions, but these laws are hardly any use once the processions are on the road. Also, why should the already scanty and overworked police force suffer the heavy duty management and stress of such private celebrations? This waste of manpower and public resources is enormous, if one can imagine that there are literally thousands of such events happening daily all over the country.

Political / social / religious celebrations and VIP bundobast have become the “Show of Might” events at the cost of public funds and discomfort. There must be designated areas for bigger congregations outside the city, avoiding rush hour jams that are torture and harassment to the working class.

Add to this the deafening (and often vulgar) music. What God in which religion would like it? How unpleasant are these scenes of drunken vulgar dancers on the streets, swinging and making gestures with the screeching music? That hard drinks are openly served on the road in soft-drink bottles is no secret, neither are the “special cars” serving these. How religious is this, and why the bigwigs and “Respected” people don’t talk about it? Why don’t the different sect heads / religious heads guide people that this is no way to appease any God, and God is found only within oneself, that too when one gives up causing any pain to anyone else?
The dirt left back, the mess, colours, the paper dishes, glasses, filth from burst crackers etc.. is the nightmare for the municipal workers the next day. The “clean city” initiative is thus raped virtually by many such processions.

In a country where hunger and lack of medical treatments kills thousands, where ‘beggars with sick kids on each road’ has become one of our identities, where farmers commit suicide because of loans and poverty, where the words “Lack Of Funds” star upon each page of explanations wherever the government needs to provide facilities, where does all this ‘affluence’ to celebrate in lacs / crores come from?

If only all the money involved in the “Victory, Bail, Jail release etc.” celebrations, socio-religious functions and decorations of various types, “Power demonstration procession” funds go towards the development of good healthcare facilities in India, we can provide excellent healthcare services to the millions who deserve them. That will definitely not anger any God, nor take away the “image” some leaders want in public eyes.

That intern doctor who worked at another hospital met me after about three days, with a black eye. “We reached late, sir. The patient had a convulsion on the way and by the time we reached he was gasping. The relatives beat up the casualty staff and even me. I feel like leaving this profession sir”.

If legally analysed, who is guilty here and must be punished? Many will use the words “System”, and say we are the society, we are the system, for that has become our new language now.

For we are scared to accept that there are two societies in India: The Carers and the Care-nots. The civilized and the powerful. The life of a common man can easily be sacrificed, and the blames can easily be pinned upon the hospitals.

This patient would have survived if he reached hospital in time. He deserved it. Who killed him?

As for the garlanded leaders who take public discomfort for granted to satisfy their ego-parades, some of them do really deserve those garlands. Plenty.

© Dr. Rajas Deshpande

PS: I have seen some rare traffic policemen going out of the way to clear way for ambulances. Rare.

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New Indian Culture?

New Indian Culture?
© Dr. Rajas Deshpande

This boy in coffee shop made the regular tray: coffee and a paper napkin and served it on the counter to the youngish man in thirties. The customer asked for more napkins. The coffee-shop-boy gave him two more.

The shop was full, with ladies and kids, mostly visitors to the hospital.

“Tere ghar se derra kya too (Are you giving these from your home)?” shouted the bulky customer. “Lafda karneka kya tereko (Do you want a fight)?… Ek baar bola toh chupchap dus deneka (Told once, you must give me 10)… Meri marzi (it’s my wish).. I am coming here since before you were born.. Shut up and know who you are.. Saale do kaudi ka waiter (you’re just a cheap two penny waiter)”.

The whole silent coffee shop observed, sipped their coffees and ate their food.

The senior worker intervened “Let it be.. take as many tissues as you want.. He is new..” etc.
Turning around, this coffee shop boy from a faraway town wiped his eyes, not only of humiliation, but of the control he had to muster to prevent anger getting the better of him.
…………….

This family in a Small car stopped at the busy signal, in the rush hour. The elderly man in his sixties driving the car had his wife besides him and two ladies, probably his daughters, and two small kids in the back. As the signal turned green, the bike in front of their car started and suddenly braked. The screeching car just touched the bike, albeit slowly, the bike didn’t even sway. Embarrassed and half-smiling, the elderly man at the steering opened the window, said “Sorry, galati se hua..laga kya (sorry, it was by mistake.. are you hurt)?”..

The two men, probably just out of “Gym” for they had a typical posture (and also probably drunk), parked the bike in the middle of the road, opened the car door, held him by the shirt-collar, and started thrashing the elderly. One hit the man, now folding hands and begging pardon, with his shoes. They simultaneously called upon the traffic police to act upon this car driver who ‘hit their bike from behind’. The horror of the ladies and kids inside the car was multiplied, and anger peaked, when the cop asked license to the elderly first.

The elderly man’s terrified wife got down, argued that there was no damage, it was a small mistake, and the car driver had already apologized.. All this while, one of the bikers kept holding the shirt collar of the elderly man, jerking him and occasionally slapping him.

The traffic cop assured those two bikers that he will “Take Care of this uncle”, and requested the biker duo to leave. With further foul obscenities, they left.

The traffic cop returned the license to the car driver.
“They are a local politician’s kins.. not good people to fight with.. you are lucky that I was here.. Just let go and leave the area before they return”.
……………….

These are routine, daily, everywhere instances. Both above are true. We have no current solution to the extremely ill-behaved “body-builder” and “long-haired” types who go around exercising their “Manliness and Muscle” upon all and sundry, especially the labour and the “working middle” class. They do not care if there are women or children around. They are extremely eager for a “Lafda / Rada (fight)”, searching for the right target to establish their local supremacy. They walk in the middle of the road, looking into the eyes of oncoming traffic, then looking the other way, deliberately slowing their walking speed. They won’t budge from the crucial entrances / turns / stairs to give way to other people passing by. They will indecently peep into cars with women and girls, they will speak dirty aimed at passing women, and await a chance for anyone to argue with them, just to prove their might.

Even the Indian film hero has changed to adapt to this new breed. Now they are everywhere.

One can’t do anything to help when these things happen.
Leave aside the fact that they are mostly protected by the very people trusted by public to run the show. May be physico-financial strength rather than ideologies have become the prime necessities of most political parties. But the fact remains that this causes irreversible, severe mental trauma upon the kids, upon the person who suffers such abuse.

I am sure neither the coffee boy nor the car driver uncle will have slept peacefully for many days after that. I felt the cutting pain of this boy living alone far from his family to earn his bread, there was no call for anyone to insult him like that. I am tortured by the thought of what those grandchildren must have felt about the whole thing, and how their grandpa will face them now onwards. I am sure these things make permanent scars upon one’s mind.

We in India are evolving in many spheres, financial and others. But unless our “behavior and mentality” changes as a society, all other evolutions are meaningless, nay, dangerous.

When Darwin meant survival of the fittest, I am sure he didn’t imagine this Indian species namely “Privileged Goons”. If this is all the fitness required to survive in India, God help us!

© Dr. Rajas Deshpande

The Brain-Alive Heart-Dead.

The Brain-Alive Heart-Dead. (c) Dr. Rajas Deshpande “We don’t want her to suffer. We don’t want any ventilator etc. treatments”. Said the calm son, no traces of emotional tones in his speech. His mother was admitted last night with stroke. Quite a sophisticated family, this son owning a company of repute. His teenager daughter was sitting by her grandma in the ICU, patting her unconscious forehead. “Can she hear us doctor?” the distraught daughter asked. “Sometimes, only when she is a little more conscious”.. It is difficult for me to be emotionally rude. “Because I want to talk to her only once more.. to say sorry.. I was sulking after a fight with her when this happened.. I should never have fought with her…” the sweet soul broke down. Her father tried to calm her. This is where I received the first shock. His pacifying his own daughter had a formality. It did not suggest “I am proud of your emotional bond with my mother”… It rather suggested “Grow up, you stupid, these things happen”. As I walked out of the ICU, his wife wished me. “How is Ma, doc?” she asked, accompanied by her brother. I told her the truth: “Fluctuating, but critical still”. Then the expected question: “How long, doc? We don’t want her to suffer too much”. “Sorry, can’t say at present”. If I myself ever had an accident, I want to live. I want my doctor to try the best to make me survive, to give me one more chance to see and touch and hear my dear ones. I want to say sorry to those I may have offended, and also to say proper goodbye to those who love me. I will not want my family to decide whether the doctors should try their best for me or not. I have asked this very question to some people I have faith in the sanity of. The answer rarely was “Don’t save me if it took a lot of effort”. Some classified further: “If I was to remain in a vegetative state permanently, then alone let go”. Most of my old / very old patients explicitly state that they want to live as much as they can, with as much health that they can get. Nobody except the depressed / frustrated actually say that they want to die, a statement in itself contradictory to their being in the hospital. I have had differences with some colleagues who “Let Go” and encourage the willing family to make the same decision. It is useless, they argue, to spend so much and try for such a small possibility of meaningful survival. Patient must be able to choose dying with dignity, they advocate. Many of my colleagues differ like myself, and for a reason: if the patient has expressed a wish prior in complete senses that he / she wants no resuscitation / effort to be made for their survival, then a doctor must respect that. But I think NO one else can make that decision on behalf of the patient after they have lost senses. An unconscious patient is still alive until he / she is brain dead, and it automatically becomes a duty of the doctor to make all efforts to try for the best outcome. There are many sweet excuses people quote, including suffering, dignity, torture, tubes, pain etc. to justify “letting the patient die”. The real reasons often are: expenses, time, hard work, stress, uncertainty associated with an elderly being ill and the perceived “uselessness” of a debilitated / old / disabled person in the family, adding to the future bills. Elderly do not even have emotional value in many families now. We are in a world where people have learnt the tact of carrying out entire discussion hypocritically, knowing that both are actually lying, but still pretending to understand each other. Such discussions decide the fates of hundreds of unfortunate old and unconscious patients who then become victims of “Lacklove” decisions made by the very people they gave birth to and grew up! Expenses can be reduced by offering care in smaller nursing homes / govt. hospitals. The decision of whether the patient will live or not should not be open to discussion about patients who have NOT written a will against their own treatment. If the patient is “Brain-Alive”, treatment must continue. For no team of Neurologists / experts in the world will guarantee the outcome on the bad side: there are always chances of regaining meaningful consciousness in every patient who is not brain dead. And we the living who attempt every day taking whatever tiny chances we get to survive, to grope more and more of life we can should be the last people to say “Let Go” when it comes to someone else’s life. It would morally amount to a murder. “We hear some doctors keep dead bodies on ventilator in the ICU just to extract more money” said one “business minded” friend to me once. We doctors are trained against violence as it hurts the very human body we are meant to guard. So I answered him verbally only: “With all hospitals almost running full, critical patients in waiting areas why would any hospital keep on ventilating the dead?”. There are monitors, files, paperwork, and many doctors, nurses, other staff in each critical care unit: how can people imagine that the dead will be kept on machines in such units? Or is it just another social trick to mask the mirror of reality? A small question: If the hospitals start declaring who all chose to “SHUT DOWN” life support systems upon their own relatives / parents, took such critical patients home, admitted them late beyond life-saving period, will the society be happy about it? Then why make such gruesome allegations against a whole profession who even bring some dead back with immense effort, without even knowing them? Why do you think thousands of “Code Blue” teams run without caring for their own life when someone is dying, anywhere in the world? God knows how many doctors pay patient’s bills, especially in emergency. So many doctors start the treatment in corporate hospitals, accepting the responsibility for patient’s bills as relatives come unprepared (no corporate hospitals move without advance or insurance except in emergency). There are also many relatives who don’t sleep, don’t even eat till their patient regains consciousness. There are many who silently suffer with the patient. Many sell their belongings to pay hospital bills and still tell the doctor “Try your best doctorsaab, don’t worry about anything. I will pay every bill”. These, unfortunately, are the illiterate, poor, rural and real human beings. These two: the doctors and relatives who try to save the critical, especially old patient desperately are both being classified under “Impractical, Stupid” people gradually. Because our society has matured to money. As I met the patient next day, still in the twilight zone between life and death, there was no one with her except the granddaughter with swollen eyes. She exclaimed, smiling through her tears: “Doc, she opened her eyes and looked at me for a few seconds… She didn’t say anything, but I knew she recognised me and she was happy to see me.. I know her eyes.. she was awake in that moment” and she broke into sobs. Mercy in the skies often comes alive only with love. The patient regained her senses in a week. As she asked for discharge, holding her grand-daughter’s hand, she looked at her son standing by, and proudly told me “Doc, this is my son.. He owns the XYZ company.. He takes very good care of me”’ Avoiding eye contact with anyone, he hugged his mother and said “I love you Ma”. His teenage daughter kept staring at the floor. I looked at her face. I don’t wish to see that extremely scary expression again. © Dr. Rajas Deshpande

Cure This Headache

Cure This Headache
© Dr. Rajas Deshpande
This young woman in early thirties complained of severe headaches. She was accompanied by a caring but frustrated husband, and two sweet kids. One withdrawn and cranky while the other one was hyperactive.
“These headaches started only after shifting to this city 5 years ago” she said. They were from a state far away.
“I am usually fine on holidays, but on almost all other days I wake up feeling sick, without energy, and even a small factor like bright light, loud noise or reading brings on the headache. It then becomes so severe that I have to sleep or take pain killers. I can’t sleep every day, so I take this painkiller daily. Even small stress at work makes me very irritable, and when I return home I have no energy left to do anything. We have started fighting a lot” she said looking at her husband with wet eyes. “I know he is tired of my headaches, but what can I do? We have seen so many doctors in so many places”.
“She used to be very happy when we married, doc” said the husband, “I feel this is a totally different girl now. I do everything I can to help her, but I have work pressure too”.
Nuclear family. Both working 6/7 days. Both on highly responsible posts. Long hours. Changing shifts too.  Kids attended by maids when not in a day care. Their parents on both sides far away.  They have had two kids with a very short interval between them, so their “growing up” is almost together.
“Is it possible that one of you change the job?” I ask this very cautiously, almost knowing the answer.
“No, Doc, our current jobs have excellent prospects and incomes too” said the husband.
“Can you change the timings, so you get an hour ‘s rest without having to attend any tasks?”
“I can’t change the timing. I don’t think I am stressed.  My husband helps me a lot by cooking and looking after the kids. It’s a daily affair now. If these headaches are gone, I will be all right”.
The caring husband who was until now attending both the kids, especially the hyperactive one, said “I have suggested her that she can take a break, but she wants to continue as she thinks she will get bored at home”. He threatened the hyperactive one, now climbing upon my table, with his hand.
I explain that the habit of taking painkillers may itself be worsening the headaches, in addition to the “dual” stress at work and home. All said and done, a woman usually attends two jobs when she works. I also enquired if they can have their parents stay with them alternately, so things will be better arranged at home.
“They don’t get along well with us, doc. My parents irk him and I don’t get along well with his parents too. We have had a love marriage”.
“Sometimes I feel like ending my life” she started crying.
Her examination was completely normal.
As I wrote the notes, I wondered how many of these things were correctable. Nobody wants “Gyaan /Philosophy” or counselling. No amount of medicines were going to take away the basic problem: lifestyle without rest or peace, and no time for love. What happens to a relationship where there is no more “Gelling”of the husband and wife, of parents and kids because they don’t get time to be together?
One of my Yoga teachers, Mr. Mohandas (at the Kaivalyadham Center on Marine Drive Mumbai) always told me: When you mix the “sample curd” and milk, it will not all become curd immediately. It has to stand for some time before the mixture forms new curd. Any relationship that has to mature into something meaningful will require quality time spent together, both with and without the kids. This time has to be separate from merely eating or sleeping together, or travelling for work.
Fast friends who fall in love and marry end up in tangled fights after becoming too busy, sucked up in the work and family routine so much that they become strangers again. Everything for a good life is at their footstep, but life itself has taken a vacation for lack of time. Bodies change, and so do minds. Too much company becomes an irritating nag. Need for personal space is disputed if at all recognised. Meditation is not truly possible when chores keep knocking your door.
As I advised her some medicines and Yoga, I could not help but suggest her that they both need to rearrange priorities in life.
It is not my place and these are not the times that one can “politically correctly” suggest the right options: but kids growing up neglected because both parents are either working or tired when at home is certainly not a healthy option. Lifestyle choices should not take childhoods for granted.
In Canada, they have a law: that one must have one separate bedroom for each kid above three years.
In India, we desperately need this: that at least one parent / grandparent must spend few dedicated hours with kids every day, quality time without being exhausted or irritable.
I wished the mother well via my prescription, but my heart was with those two kids.
For what those two kids were unknowingly suffering is beyond our society’s conscience to deal with, and maturity to logically talk about.
© Dr. Rajas Deshpande