Monthly Archives: July 2015

A ‘Poor’ Indian Patient.

Alcohol addiction and heavy drinking for decades. Over 5 packets of Gutkha / tobacco per day for many years. Few accidents due to drunken driving, once head injury after a bike accident, without helmet. Poor diet control. Diabetes, blood pressure, heart disease, obesity. Rich landowner. Came to OPD with a personal attendant to hold his files and medicines, and carry his napkin. 8 rings, gold and platinum, with various precious stones. Thick gold necklace. Costly perfume. Arrogant to the core in behavior, artificially formal language on the verge of threatening. Age 62.

Free consultation and treatment since many years under some government scheme, so has seen almost all senior specialists in town, in different hospitals.

The consultant advised a simple diagnostic test. Patient asked for 30% senior citizen concession for that non-urgent test, which is not sanctioned free by govt. The lady technician said it is not in her authority to sanction concessions. His tone changed: “I can sue you for this.. you are delaying my emergency treatment for money”. His attendant’s face became ferocious, like a dog ready to attack.

“We will do the test now, Sir, but you will have to make the payment and get a receipt. These are hospital rules, I cannot bypass them. This is not an emergency test” the tech explained.
He sat there. “Do the test first, I will pay the money tomorrow when I collect the report. I don’t have any money right now. I will pay tomorrow” he said with a shameless diplomatic smile upon his face, winking at his attendant. The tech did the study after asking the consultant.
Next day he came with two attendants, all white linen, gold studded and sandalwood perfumed. The tech asked him to make the payment before issuing the report.
“You had agreed that I will get senior citizen concession” he said to the tech. She panicked in anger: “I never said that” she retorted. “You did, I heard it” said the doggy attendant.

She didn’t answer. Closing the door, she silently cried in anger.
After waiting a while, they went to the billing, were denied concession as per rules again, got the reports, and went to the doctor, angry at having had to pay.

“You have severe nerve damage related to alcohol and poorly controlled diabetes” the consultant told him.
“It will be completely cured, no?” he asked.
“No. only partial improvement is possible” consultant.
“But I just spent 3000 INR for the test” again six extremely angry eyes stared at the doc.
“That was for confirming the diagnosis and extent of damage” Consultant.
“Ok” said the landlord. “Now give me medicine that will cure this completely”.
“I just told you it cannot be cured completely. These medicines will control and in some cases improve the damage” Consultant.
“Are these medicines costly?” He asked.
“One of these is a little costly. It is your choice whether to take it or not” the consultant still hung on to patience.

“I know doctor.. what these drug companies do for you… TV..Foreign trip.. Hotel… Party..” then he looked at his attendants and winked, touching his nose. “You should think of poor patients like us. In earlier days, doctors always gave cheap medicines, that too without any tests”.

The consultant stood up. Other patients were waiting, and he couldn’t afford to waste time or spoil his mood.The patient didn’t get up. Sitting as comfortably, he read through all the medicines again and asked repeated explanations of the purpose of each medicine. Then, he handed over the paper to his attendant.

“Reduce and stop alcohol and tobacco, and control diabetes well. Also eat carefully as advised” said the consultant, regaining composure.
“Yes. Give me your phone number so I can call you if I need to ask something.”
“Sorry, you can call the hospital helpline, I do not advise on phone” consultant said.
“But I just paid 3000 Rs.”he said.
“That was for the test” consultant.

He got up, and looking at his attendants, commented “All doctors have become thieves now. Hospitals have become shops to loot poor patients”.

After the OPD, the consultant went out for a tea, all mentally drained with humiliation and anger, and burning inside at this hopeless situation all over India. From the cafeteria, he saw the landlord patient boarding his Range Rover, parked next to the doctor’s own Santro.

The consultant’s phone sounded a text alarm.
“Your loan installment is overdue. Please make immediate payment to avoid legal action” it said.
© Dr. Rajas Deshpande.

Ban Bloody Everything. Why only Doctor’s Apron?

Apron

Recently there was a study saying that Doctor’s Aprons may (not definitely) spread infections. This inference is quite established and proven many years ago, and solutions for this have been discussed at length. One must congratulate that this is proven again in India. However, the news headlines “Ban the Doctors from wearing aprons” appeared today. This is being projected as a “Long Neglected Mistake” of Indian Medical Profession. There are enough doctor’s bodies and other organisations to take a call about this, every hospital also has an infection control policy.

Let us see what all the doctors use all through the day:
Their own clothes. Usually clean and ironed. Apron. Shoes and socks. Stethoscope, Hammer, Torch, Ophthalmoscope or other scopes required for bedside examination. (This is why even the pockets are specifically designed in a doctor’s apron). Disinfected clothes in the OT / procedure room.

The purpose of an apron is not only pride as wrongly projected. Most doctors see over 25 patients, some above a hundred every day. These patients have clothes which are wet / stained with blood, pus, snot, urine, faeces, and the doctor cannot examine patients from far away, without coming in contact with each patient. Many are brought in in an emergency, there is no time to clean the patient before examination. Then, sometimes a doctor has to rush from his OPD chamber to clean and dress a wound, to apply plasters, to start IV lines, all of these are known to cause stains very frequently, especially iodine. Imagine the OPD patient’s response to a doctor with his / her clothes all stained! In India, a consultant doctor also has to usually run through many hospitals every day.

So then, ideally a doctor should change his / her clothes after seeing every patient and wear a new pair of shoes. They should also shave their head as hair is a good storage for germs. After coming out of each ICU /CCU /NTU / PICU / SICU etc. units, every doctor should take a wash to prevent germs from being carried upon his / her person. A doctor visiting seven wards in a day should take a bath at least nine times, carry a wardrobe with those many pairs of clothes and shoes, and few extra sets for an emergency: because, seeing one patient and then seeing another with the same clothes on may spread germs!

Or they can wear plastic disposable aprons/ masks / gloves for each patient. In private sector, these accessories will be profit-billed to the patients (one set= @ 100 INR), as many times as they are used. So if four doctors will attend a patient in ICU, the patient will pay for four sets of plastic gowns. In a country like India where even basic medicines, equipment, wards, beds, lifesaving drugs are all short in almost all govt. hospitals, this will open up a whole new department of corruption, contracts for such disposable aprons, and waste upon pilferage .

Or, like most of us already do, doctors can wear aprons which are washed / sterilised every day, alternating pairs, changing / discarding whenever infectious exposure is strongly suspected.

While most private hospitals maintain extensive cleanliness and disinfection protocols, these are usually neglected in most charity / govt. set-ups, where extremely old, dilapidated buildings, and old broken beds, furniture, storage systems, computers, fans, plumbing, electric wiring etc. carry all sorts of infections and do spread it. The current “Ban everything that spreads infection” policy must then close down everything that can spread infection, including all hospitals in old buildings to prevent spread of infection.

Then ideally doctor must also wash the stethoscope etc. instruments after every patient. Or why use them at all? Just do all the tests where there is no physical contact with the patients, so no germs will be spread! Also, after every patient, all equipment like MRI machines etc. must be thoroughly cleaned at the patient’s expense. Doctors must also be banned from using any phones, as all phones carry more germs than the aprons. Let the emergency messages be sent via so many pigeons adoring the windows of almost all govt. hospitals!

Then again, the relatives thronging to meet every patient, holding hands with them, wiping their tears, nose etc., and bringing in billions of germs into the hospital. Please ban them all.

Spitting, public urination, tobacco and alcohol, toxic colours and sweets, roadside food, drugs, street violence, poverty, hunger, Malaria, Dengue openly kill thousands in India every day. But some newspapers printed this news as if the doctor’s aprons were the main killers in this country.

Tomorrow same study will be applied to all nurses’ and wardboy’s and porter’s dresses too. These staff members have far more physical contact with the patient than the doctor. We are a country severely deficient in healthcare, every hospital is flooded with patients, there are not enough nurses and doctors to attend only a single patient all day long. Do they all change disposable gowns for every time that they touch different patients? Will there be enough time? Will the patient pay? Will the govt. provide for it?

Medical students wear aprons for all these purposes and also for the discipline. Patient must be able to identify the doctor, and the doctor must be able to reach the patient in time in case of an emergency. Or there are innumerable instances of people posing as doctors and taking advantage of the patient. In an illiterate country, name tags / nameplates are not always read. Even during the worst epidemics of swine flu and bird flu, the govt. was unable to provide masks to medical students or many doctors. Will they provide disposable gowns to medical students?

In India, shameless staring at a woman’s body is like a ritual among most classes, and female doctors face too much of this embarrassment everyday while being busy with patients. Sometimes the apron helps them deal better with such groping eyes.

Please don’t give the people one more reason to hate the doctor, to think that the medical profession does not have a brain of its own, that people have to demand banning doctor’s aprons. I won’t be surprised if there are new regulations and arrests of doctors for wearing aprons, and litigations for spreading infections by wearing aprons. Just because some countries and systems are paranoid and populist, everyone else does not have to blindly imitate.

I know what exaggeration is. It is also the only way to combat the ridiculous. Fashion doesn’t suit a good doctor, any which way.
© Dr. Rajas Deshpande

PS: The study was necessary and its publication an excellent achievement. This article is about misrepresentation of facts by some.

Most horrible days as a Doctor: Part 1

Most horrible days as a Doctor: Part 1
© Dr. Rajas Deshpande

“Ready?”
As I held the knife, Dr. PTJ said: “Hold the knife like a pen, keep the tip on the skin, and with a controlled but firm pressure downwards, swipe its edge down as you feel the skin resistance. Don’t go deep at all. I am here. Start”.
Sweating a little, I prayed and looked at the open abdomen in front of me. It moved passively, slowly, breathing, albeit tense. Everyone waited impatiently. Dr. PTJ was known to be short tempered even by surgeon’s standards.

As I cut open the first alive human body, tiny spurts of blood oozed out, he wiped them away. This is the “second take-off” in surgery, the first one starts when the patient is anaesthetized. I kept on assisting Dr. PTJ, as he opened different layers of the abdomen below the skin, stopping the bleeding at each level. He opened the innermost layer called peritoneum, and the swollen intestines, blue-black by now, popped out. He showed me how to clamp the swollen part at both ends, and cut it open, cleared the gangrenous, dead parts and sutured the open ends in layers. That surgery of that complicated intestinal obstruction took above three hours. During pauses, he showed me the ‘danger areas’ where one could cause fatal bleeding. He then taught me the stitching back of abdomen in layers.
One life was saved in a thousand steps, I was euphoric like a child. I had done nothing, but the seniors still praised, maybe just to encourage. Looking at my face, Dr. PTJ joked “You cannot smile until the patient is discharged”. I thanked him and came out.
It was 11 AM. Ecstatic, I went out and went with my friend Manoj for a smoke and a tea, A casualty servant came rushing there: “Sir, come to casualty, fast”. I ran there leaving Manoj alone.

There was a chaos. Police had brought 4 cases of stabbing in a religious riot. There was blood all over the floor. Dr. PTJ was shouting: “Call the other three surgeons and anesthetists. One stay here. Rajas, you check vitals, start IV and put in a feeding tube, send blood for grouping and lab, then wait till the anesthetist gives fitness. When your reliever comes here, you can join me in OT”. He was tense.

One of the new patients had already arrested (no heart sounds), and the other intern was trying to resuscitate him with a CPR. There was only one working “curtain stand” in the casualty, now occupied by a dead body. So everyone else including other patients and relatives could see the CPR, where the chest massage caused oozing of blood from the abdominal wounds.
The other three were all in shock, very low BP, bleeding from chest or abdomen. Just as we finished starting IV lines and covering the bleeding wounds, ordering blood sampling and ECGs, another ambulance came over with six more. In next five hours, over 30 patients filled up the 10 bedded casualty. Stabbed or shot. Some came in pairs, having stabbed each other. Some brought dead. The casualty floor was all blood. Every medical officer, intern, nurse, wardboy, was in the hospital, working on their best steam. The blood bank techs were about to faint.
I went to the OT. Four of the surgeons were operating already, with combined staff. They were from different religions, including the communities fighting outside. Dr. PTJ and Dr. AM, with whom I was posted, both sobbed as they operated. They knew the outcomes when they opened the abdomen.
The rioters had used swords, knives, blunt rods, almost anything for stabbing. But where there was a sword or knife used, they had not only stabbed, they had rotated the blade inside the victim, thus cutting many vital organs like liver, spleen, lungs and blood vessels. Intestines were cut open in many places. In most cases, it was ‘stabbing to kill’, not only to hurt. This was professional work or that of the insane.
Over 15 died that day, and many more next week. Almost from every religion, but with one common thread: they were all poor.
The hospital turned into a large mourning station those days. Mothers and sisters, sons and daughters, Brothers and Wives, young and old of all religions mourned in shock while there were calls of “Religious Harmony” by the leaders surrounded by bodyguards, from their gilded bungalows.

The TV kept on shouting: “All leaves of all the doctors and hospital staff are cancelled, doctors not reporting immediately to work will be suspended. Negligence will not be tolerated. All hospitals have been ordered by the govt. to deal with the situation adequately, necessary funds are being generated through donations. Leaders of our country have expressed shock and pain. More blood is required, they have appealed the public to donate blood”.
No talk of the responsibility, of the perpetrators, or of the criminals.
No talk of unprepared and severely deficient health services and severe shortage of medicines, equipment, manpower, ambulances, everything.
The wardboys and mausis (female helpers) who cleaned the blood on the casualty floor were unusually silent for weeks later, many lost weight.

The sane in the society: the middle and lower classes, as always, lent their shoulder to the situation: People helped victims reach the hospital, bought them medicines, called their families, and donated money, clothes, blood. They carried the dead bodies for funeral with the shocked families. From every religion.

We all were aggrieved beyond repair, for lifetime, for we had seen a face of our society that stays hidden: right in our backyards, ever ready to pop up again at the wish of the powerful. In future I met many doctors from different parts of India, and they all have scars of various religious and other riots, bleeding scars that refuse to heal.

Months later, the two surgeons from two warring religions, who were in the OT in those horrible days, were in the casualty late, having tea with us all. Dr. PTJ asked Dr. AM: “How’s your cute son?”.
Dr. AM was in tears. He replied: “I hit my son today for the first time. He asked for either a gun or a sword after seeing a hit movie where the hero shoots point blank, cuts the enemy’s head, stabs their tummies through and through, and blood spurts out. He wanted to do that too. There are a million laws against love in this country, but none against killing on the screen, which stimulates kids. We proudly say India never attacked any other country, but forget that we have an internally violent, warring, illiterate and poor society, where a common man is never secure”.

He left India in a year.

© Dr. Rajas Deshpande

A Murderer’s Family That Almost Killed Us

A Murderer’s Family That Almost Killed Us
© Dr. Rajas Deshpande

The whole city awaited a murder, just like in the book ‘Chronicles of a death foretold’ by Mr. Gabriel Garcia Marquez. It was during my internship. I was posted in the civil hospital casualty along with Dr. Anwar and Dr. Junaid, my batchmates. The postings were phenomenal in that we got “Hands-On” experience on a variety of Medical Emergencies.

As a result of a professional rivalry between two big families, one head was shot down point-blank in cold blood on a busy street. The brother of the dead had sworn that he will kill the killer soon. It was just a question of time. We heard the progress in hushed tones during night-tea with wardboys and ambulance drivers.

One night we had our customary 2 AM tea on the street opposite the hospital, and were just re-entering the casualty when there were panicked screams outside, and a whole lot of people barged in, asking for doctor on duty. Dr. Anwar said that the medical officer was in his room, and asked about the patient.

The patient was the victim’s brother, the infamous one who had sworn to kill the murderer. He had developed vomitings and diarrhea, and had become unconscious. He also heavily smelt of alcohol. The medical officer on duty came over, a skin specialist. He examined the patient, ordered medical tests including blood alcohol levels and the analysis of aspirate from the tube inserted in the patient’s stomach. Writing the treatment plan, he told us to carry it on, and left to retire.

I looked for a good vein to start the IV fluids. Dr. Junaid recorded the pulse and BP, both a little out of range but acceptable. Got the vein. . Gave him the advised medicines. The patient was stable.

Dr. Anwar started to write the police information note. We must inform all medicolegal cases immediately to the police in hospital campus, by law. Dr. Junaid whispered to me: some relatives smelt of probably Marijuana.

We were in a cubicle, the dressing room besides inpatient casualty, made of Government-grade cheap plywood, with a wooden table and metal chair, patient bed, IV stand, and an elementary dressing cart. It had only one door, now blocked by atleast 20 relatives, all shouting angrily about why the patient was still unconscious. ‘If something happens to him you will not survive’, some of them kept on repeating. They were headed by an extremely aggressive and big lady, who said she was patient’s sister. We told her he was stable and expected to improve.

“Why isn’t he conscious yet?” she asked angrily.

We started getting anxious.

The security guards were meekly standing behind the crowd. They were both government servants, and this crowd was above them, government, and even law, in that moment.

The telephone rang. It was the hospital’s ambulance driver, our night-tea partner, calling from a ward. He said in hurried and anxious voice “Sir, they are not good people. Leave that room. I will keep the ambulance ready outside if you want to come out. Don’t argue with them:” he said.

“We cannot” I said. The relatives were right there. “We need some IV fluids” I told him.

“Yes, sir” he got it.

Dr. Anwar handed over the police information sheet to a wardboy waiting out, through the crowd.

The patient’s sister snatched it from his hand. “What is this?” she asked.

“The senior Doctor asked us to file an MLC (medicolegal case) as there is suspicion of alcohol intoxication and food poisoning.. just a routine procedure” explained Dr. Anwar, carefully choosing his words but still with hesitation. It is never easy to talk to someone angry and aggressive.

Then there was a loud noise, a wet and heavy and muffled thud. She had slapped Dr. Anwar. “My brother is dying, and you want to file police case?” she caught hold of his shirt-collar, bent and lifted him with her hand between his legs, kicking him all the while. Myself and Dr. Junaid ran to her, saying, many things that meant sorry, it was just a procedure, that we were told by our senior, her brother is not dying but stable etc. etc. You know how coherent one can be in such a situation.

We were pushed back violently by two of them. “You don’t move from here till our brother is conscious” we were told, with added expletives, a hefty man held my shirt collar and violently pushed me into the wall near the patient. I smelt the burnt marijuana too. Another stout one was tugging at Dr. Junaid’s shirt, which ripped off. Gentlest among my friends, I cannot forget Dr. Junaid’s face in that moment. Slaps continued, as the incharge sister and nurses tried to shout and try to intervene, but the crowd didn’t allow them to enter the room.

© Dr. Rajas Deshpande

The aggressive lady lifted up Dr. Anwar, and banged him on the plywood wall. It gave away, shattering also the glass within it. Dr. Anwar started shouting for help as she continued to fist and kick him with others as he lied on the floor. One relative lifted up the chair and started randomly hitting things with it: the telephone, the glass on the cubicle walls and finally aimed it at us. Five feet away from us, there stood this goon with a metal chair aimed at the two of us held to a wall by other relatives.

That moment is framed in my mind for forever. We were treating his brother, none of this was our fault, we didn’t know them at all, still, they were ready to kill us.. Not one insane person, but a whole crowd! Any legal action later on won’t matter once we die or are hurt. A doctor’s life meant nothing for those goons who had both power and money.

We begged him not to throw the chair.

He threw it with a wild gusto anyway, and as we turned away to dodge it, the chair hit us, its edges cut through Dr. Junaid’s’s ear and my arm. Pain was less of an agony than what was happening. The incharge sister outside started screaming and crying aloud.

The patient moved, and pulled out his IV line. His blood started soaking the white bed sheet. Just as I moved to get a syringe to temporarily block it (it was an open needle), someone slapped my back. “Can’t you see he is bleeding? Stop it”. Dr. Junaid reconnected the IV line with bare hands, trembling.

At this point, the Civil Surgeon entered, an old man with many political and social connections. He was accompanied by two-three police constables and the senior doctor on duty who had called them. The family knew the CS as well as the police. He pacified them, told them he will look after the patient personally, and asked them all to go to his room.

The incharge sister, a mother to all, still crying, took us to the doctor’s room, and dressed our wounds. The ambulance driver got us some coffee.

The CS never asked us if we were hurt. He kept on telling the stories of how he calmed down the crowd for ages later. He never felt responsible for what happened, nor reprimanded his “friends” for their violent behavior with his junior doctors.

The patient improved, and was discharged in three days. The whole family came to take him away again. They left without any thanks or apologies.

About a week later, our patient fulfilled what he had promised his family: He killed his brother’s murderer in open daylight, witnessed by dozens on a busy city square.

Dr. Anwar and Dr. Junaid have long left India, and are happily settled in safer countries. Twenty years down the line, I continue to read the same story almost every other day, recalling and re-living the horror.

Anyone can walk in with a crowd in any Indian Hospital and violently destroy life and property, under the pretext and excuse of being angry at anything they don’t understand or like. . A law exists now, but you know the implementation. Mandatory action against any violence/ threatening /Intimidation in any Medical Premises must be implemented, without the doctor / hospital needing to file a complaint. You know what happens to witnesses in India.

I pity the brains of those who blame doctors for “not explaining properly to the anxious relatives” thus justifying the violence and attacks. No Judge, No Govt. Officer, No police officer “explains everything “ to anyone when we go to their offices, in fact most of them treat “Junta” (everyone else / common man) as a waste. That doesn’t allow us to attack them and destroy property. This is only “softly dealt” about doctors and hospitals.

We need a concrete plan against this domestic violence mostly cultivated by those in power. Or a National Revolt against violence in Medical Premises.

© Dr. Rajas Deshpande

Doctors and Religion

Doctors and Religion.
© Dr. Rajas Deshpande

“You are in our prayers everyday”.. one of the greatest achievements in becoming a doctor is hearing this sentence.

But hey! You all are also there in our prayers every day!

Whatever the religion, whichever faith one may come from, whether rich or poor, whether our concepts, philosophies or traditions match or clash, we doctors treat each patient with the same devotion: making his / her health better. A doctor will only ask about your religion to know your genetic risks and tendencies, lifestyle and diet. Beyond that, no doctor thinks differently about patients from different religions. Who knows better than the doctor, the oneness of human body, inside out?

We don’t have to kill, sing, dance, wear T shirts or shout to prove our unique tradition of “Humanity”: we carry it upon our head from the day we are born as a doctor, till the day we die. Every day in every casualty anywhere in the world, elixir of humanity flows from the doctors and nurses to the patient, and in their prayers lie the true wish of every doctor: “Let all suffering end”.

Most of those visiting religious places ask for health and life. Doctors too work to safeguard these two, all over the world, irrespective of their beliefs. Science gives us the knowledge, Experience hones our wisdom, but the prayers of millions in different religions give us the ability and responsibility to make the right choices.

Our patients, whichever religion they belong to, bring us religious gifts from their highest places of devotion. From Varanasi and Mecca, From Jerusalem and Amritsar, Ma Vaishno Devi, Our Lady of Good Health in Velankanni, Lord Ayyappa temple, Khwaja Ajmer Shareef, Shri Tirupati, Bodh Gaya and many other holiest places, I have received Lord’s blessings via my patients, just like most of my colleagues I know. Abe Zamzam and Gangajal have both felicitated the work of many of us, via God’s messengers to the Doctor: the patients.

Any patient from any country and any religion holds some basic respect for the doctor they go to, for their education, and also for their presumed ability to help.. This “trust of a stranger” is probably the greatest endangered human connection upon earth today.There is no better opportunity to serve humanity than to become a doctor. If there is any social place where everyone is really equal, it is the heart of a good doctor. There are offenders of faith, and misusers of the system everywhere in the world: few doctors and few patients, but not all.

There is so much for the doctor to learn from different religions. The art of medical practice is incomplete without basic knowledge and understanding of human behavior, faith and mindsets. While “scientific” is the highest and umcompromisable criteria for a doctor’s action, this will only bring the patient health, which is incomplete without happiness. Happiness will only come from a doctor who understands human nature well. There, in the wish for happiness in each mind, resides the Lord. Some call it science, some God. Some do not believe in God, both doctors and patients. If themselves genuine, they still connect well via bonds of honesty, kindness, truthfulness and mutual respect: similar foundations as that of most religions.

Many patients will not believe this, but most doctors pray for all their patients everyday before starting their work.
In the good of their patient, they know, lies their own good.
© Dr. Rajas Deshpande

A Mother who killed the Wife

A Mother who killed the Wife
© Dr. Rajas Deshpande

“He is angry with us, doctor. He refuses to recognize us, even his parents and children sometimes. It was all my fault, I fought with him so many times over small things. I have said sorry so many times now.. But he is not ready to talk again like he did.. Some doctors said he is in shock, some advised psychiatric treatment. We did all we were told, but he is worse by the day. Please bring him back, doctor!” said the extremely depressed and tearful middle-aged lady. In her lap was a five year old daughter, seated behind her were her in-laws (patient’s parents) and her elder child, a 9 year old boy. My professor was listening carefully, and we Neurology residents were juggling possibilities in our minds.

I was assigned the work-up of this case. After a week-long evaluation and opinions of some senior neurologists in Mumbai, it was concluded that he was an exceptional case of early-onset Alzheimer’s disease. The patient Mr. Bhooshan, an electrical engineer, was about 39 years old then.

Every morning that I entered the ward, I found his wife begging him to forgive her and talk normally again, he looked at her blankly, often irritated and with a questioning face. She would bring the kids to him every evening, and prod them to talk to him, crack jokes, and in general “get him to talk”. He would occasionally call them near himself, pat them, then suddenly vanish mentally from the scene. He sometimes asked his wife about them by names, but didn’t always recall the names accurately. Somehow, children sense moods excellently. They tend to know when a parent is disinterested / hurt / tired or ‘just not there’. These kids did whatever their mother suggested, but they were ok with just sitting by his side, in his lap, holding his hand.

I never saw his aging parents without teary eyes that begged for relief from this hell.

We have different memory areas in brain for sights, smells, words etc., as well as disciplined cascades of time-based memories in our mind. A large part of this is what we call the “Past”. Hidden therein is also our knowledge of ourselves: Name, Birth, Family, Culture, Religion, Education, Friends, Nature, everything that makes someone’s personality unique.

Imagine losing parts of this memory. Imagine not knowing who you are. Imagine being lost “Inside” your own mind. Then also imagine ‘not even knowing that you are lost’. It is only initially that the patient knows and cares about such loss of memory. Unlike dramatic depictions of “violent anger because of forgetting things” in some unstudied movies, patients usually also lose their concern / insight about what is happening to them.

There is a point of no return in the mental / cognitive decline in patients with dementia / memory loss, comparable only to the death of one’s mind as one knows it. Scary.

Relevant medicines were started. There was negligible response.
Mr. Bhooshan gradually became almost blank, and spent most of his day in the bed, often wandering aimlessly and watching windows in the ward. His wife couldn’t come to terms with this. She mostly just sat in a corner, often crying whenever kids visited. Right from Prayers to Herbals, everything that anyone suggested, was being done by the family.

Our counselors talked to her, even prescribed her with mild antidepressants, but she had just collapsed inside.

One evening, I didn’t see her by the patient. Curious, I enquired about her to the patient’s mom who was instead attending him. “Their daughter, the 5 year old, is admitted in the pediatric ward below with high grade fever. She is with her.” replied the old lady.
I went to the pediatric ward after finishing my duty.

I found the kid in bed, weak but comfortable, and smiling. Her mother, the patient’s wife, was telling her funny stories, laughing aloud and imitating comical characters, as she fed the child. Mrs. Bhooshan was a totally different lady then. She talked to me very nicely, without any hint of ‘hiding sorrow’, naturally. The innocent, happy kid invited me to sit by her and share her food.

In two days, the kid was discharged. Her mom had completely changed. She started taking good care of Mr. Bhooshan again, but now with a mysterious peace upon her face, often smiling and mothering her husband too, like her other kids.

Satisfied with the sacrifice that this ’mother’ had made by killing the ‘wife’ within herself, life had smiled upon them again, in the face of an obvious tragedy. They returned home, and she was still nursing him and looking after the kids one year later when I passed my exams and left Mumbai.

Their life had changed, but moved on.
So had mine. I started writing a diary.
Dr. Rajas Deshpande

Best Moments In a Doctor’s Life

  Best Moments In a Doctor’s Life.

© Dr. Rajas Deshpande

1. The sound of restarting heartbeats when resuscitating a patient.

2. Closure after a difficult surgery where only the surgeon knows how he has saved a life.

3. A perfect surgery / procedure / stenting without complication.

4. Seeing the beautiful cute face of a healthy newborn.

5. Managing a major bleeder successfully.

6. Reversal of paralysis after thrombolysis (clot-buster injection).

7. Termination of Status Epilepticus (non-stop fits / convulsions / seizures).

8. Control over infection. Every infection is life threatening potentially.

9. Waking up of a comatose patient.

10. The genuine “Thank You” of a patient relieved of pain / stress / illness.

11. When someone random recognizes you in public and thanks you in front of your kids / family.

12. When the poorest of the poor collect enough money and gift you sweets for treating them free.

13. When a patient too educated to believe your truth goes to your professional competitors and many others, and is told the same, so returns to you with greater faith.

14. When you can answer all questions asked by students after a lecture / clinic (without Herapheri / bluffing).

15. When a student performs well and patient gives a good feedback about them.

16. When you silently prove your clinical argument with good results.

17. When anyone at work says “Take some rest now.. You have been working too much”.

18. Qualifying for a medal/degree/publication of significant repute.

19. When you know that it’s not only the medical skills, but also your passionate involvement, speed and coordination that saved the patient.

20. When traffic police “Let you go” for minor offences just because you are a doctor, especially on the way to an emergency.

21. When someone says “I want to become a Doctor like you”.

There are many more. Every day is filled with both tears and smiles, and the doctor has to balance these by using his/her soul as the fulcrum. At the end of the day, death humbles everyone, but it is the doctor who stands to defend everyone else’s life without thinking if they are good or bad, friend or enemy.

Who will believe that money, home, family, cars, looks, luxury, and even love, romance are secondary joys for most doctors, after they have attended all their patient’s issues? This pride is precious. The suffering a choice.The rewards immaterial.

A good doctor is the best a human being can be!

© Dr. Rajas Deshpande

Come on India, take a selfie with this daughter of yours!

Come on India, take a selfie with this daughter of yours!

© Dr. Rajas Deshpande

“Will I ever win? I feel suicidal.” said the 25 year old orphan with Multiple Sclerosis. In a world drooling over the stories of “10 Richest” or “20 Most Beautiful” women, there’s hardly any scope for noticing an orphan girl who fights alone against an incurable disease.

VS, a dignified young Indian lady, divides her life fighting three wars: living as a single female at a bed-share facility for women, working her job as a receptionist at a nearby clinic that earns her a minor income, and the incurable neurological disease Multiple sclerosis that causes disability at an early age.

“My mother left me at an orphanage when I was 2 years old. She saw me last when I was 3. After that I don’t know anything about her or my father. The orphanage taught me how to survive with wild human beings around. They also helped for my education. I was diagnosed with MS when I was 20. They shifted me to Pune for better climate. Now I am pursuing BA”. VS told me.

“The owner of the orphanage in Pune didn’t know Multiple Sclerosis, and always said I was ‘faking’ my limp and fatigue. She made me do a lot of physical work. I couldn’t. So I left that orphanage”.

She then stayed at various places: a blind school where a volunteer was required, homes of other MS patients who came to know her through MS society, sometimes on the streets and now got a bed share at a dingy, cramped female hostel.

“Whenever I get sick and cannot walk due to MS attack, a local hospital helps me with steroid doses, the MS society gives some medicines free. Sometimes other MS patients pay for my treatment”.

Now she has developed mood swings and depression, common in MS patients especially her age. Naturally, her behavior is intolerable or unacceptable to those who invite her to stay with themselves. Where we cannot tolerate the raised voice and mental fluctuations of our own parents and children, who is trained to shoulder those of an orphan? Who will pause their own life to feel the dying mental pulse of someone who knows that there will be no one to look after her if at all she is crippled, and that there is no cure for her illness yet?

No language in this world can describe Loneliness.

“Some societies help, but they have their rules. The MS society helped me many times. But then, how long can I do this?”

She is now tired. She knows her limp will not improve. She knows free treatments are not the only answer. “I feel suicidal often now, I know things will never be my way. Life will always be at the mercy of someone’s help”.

I told her it is common to feel so in MS, and good treatments and counseling can help most patients.

Her reply left me shut: “Sir, I don’t need that. I plan to fight this with my own mind, for I want to survive without any mental dependence.  Someone should have counseled my mother about how I will feel all my life when I come to know that she dumped me”.

“I wanted to marry and have children. Who will marry me? I know I am beautiful and some men are after me, but none for marrying..”. These are probably the most difficult words for a proud woman to say to anyone, and her eyes clouded red.

As VS broke down in a tearless silence, I fought with a hundred false reassuring words I could say.  I didn’t want to insult her suffering by saying them. A doctor must learn to cry within, still with a smile upon his face.

I remembered the story about Lord Jesus Christ, describing his “Via Dolorosa” (journey of pain), when he had to carry his own cross while being tortured all the way to the site of his own crucifixion.

There are so many patients who know they are going downhill, that they will never return to good life again. No songs of motivation, no thunderous clapping of groups, no shouting of any slogans, no celebrations of their plight will ever cure them. This world is addicted to “superficial temporary relief” in an attempt of “self glorification” at the cost of someone else’s suffering. Real answers are far away.

We are all engaged in shamelessly loving ourselves. So much so, that a country that plans multi-crore space missions in search of new life cannot take care of the “Live” suffering of a young woman existing NOW, here, amongst us! A country proud of 100 crore stars and billion dollar IPLs cannot support its own daughter in suffering.

Come on India, take a selfie with this daughter of yours!

There is no hope for dignity without money.

The new definition of “Orphan” is “poor”.

And these words just screams in a black hole !

God solve this please.

© Dr. Rajas Deshpande

Real story. VS is in Pune, and kindly permitted me to write her story.

RD

Humans?

© Dr. Rajas Deshpande

2 AM, about 20 years ago. Civil Hospital Casualty Nanded.
World asleep.
In came rushing a crowded jeep. Panicked passengers carried someone in a blood soaked bedsheet. Huge bearded man in 40s. Heavy bodybuilder. White kurta pajama now blood red. Hacked by many with mashetes (kukri), swords, knives. From head to toe.
Innumerable cuts. Breathing fast, shallow. Eyes open, looking at us, whenever fluctuating consciousness allowed. They had an expression without pleading or pain. He knew what was coming. Probably a combination of hope and gratefulness. He couldn’t talk.
He was a sarpanch (head) of a nearby village, known criminal, rapist, murderer and was thus punished by the villagers whom he had offended. His cousin accompanying him told us. Remaining people left as fast as they came. In a patient cut at over a hundred places, but still alive, where does one start? No ICU. OT not functional. Nearest big city Hyderabad, 8 hours away. No blood donors. We ran around, but the inevitable kept torturing us all its life.
In about 20 minutes he died.
Those eyes with an expression I can’t name lived on in my mind.
………
A known gangster, age 19, admitted critical, stabbed by a rival gang leader. They’d had a fight over a girl. The murder was planned months ahead, the knife used was said to be coated with some chemical / herb known to be a sureshot killer. The threat of this “planned murder” had already circulated in some groups. His statement was recorded by police.
As I started the blood transfusion (an intern’s job), awaiting him to be shifted for emergency surgery, he whispered to me, barely managing these words: “Please save me Doctor. That girl was mine. I must kill him. Please save me, I will give you anything you want. But I want to kill him”.
“Calm down. Take slow, deep breath. We will try best, we have started the medicines, you’ll be ok.” I reassured best I could. He held my hand and squeezed it. “I love her, doctor. Save me. I cannot die with this feeling. She was mine. I want to take revenge”.

The poison worked early. He sank even before he could be shifted to the OT.
His last words of revenge lived on in my mind.
……
“What do you do?” asked my lecturer to this shackled prisoner in infectious ward, admitted for cholera. Scars were his face.
“I am a sharp shooter. Supari murderer (contract killer)”. He was in his twenties. He had no expression upon his face.

I was always idealistic. He was my age. Late that night, after all work, I went to him. He was sitting blankly with his guard from prison, who read a news paper.
“Where are your parents?” I asked this patient.
After a pause, he answered: “My father was also in this line. He’s dead. I took revenge for him, then started this job”.
“And your mother?”
“Why do you ask all this? When will I be discharged?”.
“In two days” I answered, and asked again pleadingly, somehow I was curious about his mother.
“She killed my father to run away with her lover. I killed that lover. She is in another jail.”
There still was no expression on his face.
“Can I smoke a cigarette?” He asked me.
“Not here”. I told him, and winked at the guard, who took out his bidi (country cigarette) bundle.
I offered him our ward tea, and just sat there.

He appeared a bit relaxed. “I have a little sister in my state, 12 years old, in a boarding school. I want her to become a doctor like you”.
“She will” I said, happy not knowing why! “I am sure you will help her”.
It was then that he looked at the sky and smiled a smile that tore through chains of shame, guilt, agony and helplessness.
“Today was her birthday” he said, and then he looked at me.

That face again had no expression, but it made burning scars upon my mind.
…….
Based upon real experiences.
© Dr. Rajas Deshpande