Monthly Archives: January 2016

Dr. Madhu

 

© Dr. Rajas Deshpande

Blue-Grey eyes, fair pink face and curly hair. Tall, thin, agile and always happy. Boyish demeanour. Life of the moment. Most unmarried resident doctors swooned  over her , and most married ones secretly admired her. Her name was Madhu. She studied neonatology, and often baby-talked to those who  tried to be macho around her, making a chutney-pulp out of their muscular egoes. She stayed in the room next to mine, with another girl, a resident doctor from surgery.

We often shared the late-night breezy balcony on the 12th floor, overlooking the secretive city lights, when we sat in different corners studying, reading, writing or just thinking things over.

My shyness (really, I swear!) probably was quite noticeable, as once late after midnight, she asked me if I would like to share the tea that she and her roommate were planning to make. My roommate Dr. Vinay, who was studying besides me, said yes before I could. “So this is why you study here late night” he winked at me, as I made vigorous attempt to not blush and defend my non-involvement in the whole issue.

I became good friends with Madhu. She was from Madhya Pradesh, her parents were middleclass teachers like mine. She was engaged to be married to a handsome postgraduate businessman from her own community, staying then in the UK. ‘Don’t tell anyone yet, I want to declare only after I pass my MD’ she warned me with big eyes and a beautiful long finger wagging at my nose when she confided this. With the busy residency, there was no scope for any further interaction beyond the customary midnight tea-talk where we shared our joys and woes. But we waited for and enjoyed those moments.

Her roommate, the surgery girl, was very attractive too. However, she used to be mostly quiet, often sulking, and in general appeared unhappy. Once she was crying, so I asked Madhu if we could help her some way. “No”, Madhu replied,  “She has problems at home, she married early after MBBS, and now her in-laws are insisting that she has a child. Her husband is an engineer and says that he wants to avoid late pregnancies, he wants two kids minimum. She has two more years to finish MS, she knows having a kid will affect her learning, and we don’t have leaves as you know, so she will skip a term”. Complicated. Many female doctors go through the hell of this twin task: high-demanding duties in career and life at the same time. Perpetual shortage of doctors precludes any leaves, and many families do not support women’s careers whole heartedly. Some girls do it all with a smile, some collapse, often compromising on their career.

© Dr. Rajas Deshpande

One black morning brought the bad news: the surgical resident, pregnant, returning home early morning after a heavy emergency night, lost control of her car and hit a pole, died on the spot.

Nobody can be held responsible in our great legal system for this death except herself.

Madhu was devastated. Myself and Vinay accompanied her in her sleepless and horrible nights, there was no question of being able to study. After three such sleepless nights, she went home for a week. She returned with the determination of studying better, she had to complete her MD to be able to marry sooner. Our routines returned to a clouded normal again. Madhu’s legendary smile was scarred.

After about two months, she started coughing. One day I found her having high grade fever, so reported this to her HOD, and got her medicines and some food. Vinay and I attended her for next two days till her parents arrived. Many tests were done.

On the third night of their arrival, at about 1 AM, her father came to the balcony where I was studying. He was a tall, bald, fair and intelligent man. “Madhu asked me to talk to you”, he said, “will you please keep this confidential?”.

Scared to the core and praying in my heart, I reassured him that I won’t disclose anything to anyone.

He started to sob violently like a child. He strangulated a wail, covering his mouth tightly with his hands. In broken short sentences, he told me that Madhu had developed tuberculosis of the lungs.

“Is that all?” I asked and realised this might be very impolite. “I mean, is there anything more than that too? “ I rephrased my question. “No, but what will we do now? We are destroyed. Why should such a sweet fairy like my child suffer this?”.. A father crying for his daughter is unbearably painful.

“Tuberculosis is curable if treated correctly, there is no need to worry at all.. I am sure she will improve. We will show her to Dr. Karnad” … We were all very proud of Dr. Karnad’s abilities and knowledge.

© Dr. Rajas Deshpande

“ He has seen her today and started treatment. I am not sure if we should inform her department and her fiancé. This news spreading is not good for her”. His dilemma was genuine.  They decided what most middle class people do: have faith in the power of good and honest. They informed her department, and had her fiancé talk with Dr. Karnad.

She went home. There she developed liver failure due to the anti-tuberculous drugs, a common side effect. Treatment was delayed for another two months. After six months she returned. Her fiancé had broken the engagement while she was in liver failure phase. He had married someone in a haste after that.

She kept studying and working hard. We often went to the mess together for dinner.  She had lost her shine, more due to her broken engagement than her illness and medicines. She who always talked with such passion about her fiancé never mentioned him again ever.

When I once asked her if she still felt hurt, she said “Yes, it hurts beyond my ability to bear. But what hurts more is the thought that I was about to marry him”.

She was eventually free of all medical problems, but decided not to marry. She passed well, went to a developed country, and is practising quite successfully there. In a recent email, she wrote: ‘One spell of an infection, and the whole concept of humanity, human behaviour changed for a doctor like me.  I wonder what it does to the illiterate and poor. I know, but I feel scared to pin the blame here. I wish I had grown up in the developed world where I practise now’.

Many female doctors have to bear the brunt of social, familial and cultural expectations, pressures, insults, humiliation and sacrifices while studying the extremely demanding science of medicine. They lose their happiness, give up simple pleasures of life just to be able to cope up with their wish to serve humanity, at the cost of their own life. They are any day superior to their male counterparts, as they also shoulder the toughest responsibility: being a mother, while being a doctor. Unrewarded, unrecognised, and many a times not even acknowledged, they stand tallest in the fraternity, taller than any material or scientific achievers!

My highest respects to them.

© Dr. Rajas Deshpande

 

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The wisdom of discrimination

  • The wisdom of discrimination
    © Dr. Rajas Deshpande

    “You are next to God, doctor. You make the decision for us”.
    “Most Doctors work heartlessly only for money”.

    Both these sentences are heard equally commonly.

    Many patients from all socio-economical classes come prejudiced to the hospital / doctor. These patients have red flags and suspicion about everything that the doctor advises or speaks. Scary media headlines run on the screen of their minds as they enter the clinic or hospital, and their body language, facial expression and words all make the treating doctor quite uncomfortable, with the hanging sword litigation at a wrong word or deed. It becomes very difficult to make choices of investigations, advice and treatment decisions in such cases.

    But there also are many who come over for the resolution of their health issue with genuine faith and respect for the doctor. They have heard the blaring news too, but have still made a decision to invest their complete faith in the treating doctor. They will do all the necessary tests, take medicines as advised, and not suspect that the doctor intends to deceive them for want of more money. They are also mature and open to the fact of a doctor being a human, and graciously forgive doctors for minor or major mistakes, convinced that the doctor is acting in good faith.

    However, always juggling busy schedules and overworked, many doctors learn to maintain a “safe distance” from every patient, and justifiably treat every patient as a potential litigant. Many of us actually assume an artificially compassionate, overly cautious and rudely technical approach in a hope to find the right mental vein of the patient or to get him / her into the comfort zone of “workable enough trust”.

    While this usually works in most cases, it also turns off the many genuine, trusting (usually poor and illiterate) patients who come expecting a friendly doctor who they can relate to. They want to pay, they want to comply with what all the doctor advises, but still find the doctor remote, technical and aloof. They fail to understand why the doctor did not reciprocate their warmth, smile and openness. It takes many more interactions for both sides to understand each other.

    ‘Discrimination’ is mostly used as a negative word in the modern world. However, it means ‘differentiating one thing from another’(e.g. His tact and temper, his dexterity and discrimination, enabled him to do good service). The law discriminates facts from allegations, true from false. We must discriminate between good and bad, between harmful and harmless. The media must discriminate between a good and bad doctor. The patient must discriminate between what is good for their health and what is not.

    Medical teaching presumes that every student automatically learns human behaviour as they interact with thousands of patients while learning medicine. Most senior, experienced and intelligent doctors can tell a “RED FLAG” patient in the first few minutes of interaction and turn ‘ON’ the caution button within. However, the young and less experienced doctors are often shocked with the sudden change in the attitude of a patient they tried to do good to, thereafter losing their faith in every subsequent ‘customer’, and adopting a policy of distant, cautious, careful interactions with them.

    It is high time that doctors and patients both learned wise discrimination. The patient and doctor should both meet each other openly, with the customary intent of doing good and having complete faith in each other’s intent and innocence. At the first hint of suspicion, disbelief, questioning of intent or legal language on the part of the patient, the doctor should turn on his guard and avoid informal discussions / reassurance and initiate a technical-legal approach, and involve fellow clinicians, obtain second opinions.

    At the first instance of a doctor being wrong, the patient should directly and openly talk to that doctor and seek explanation, then if dissatisfied, obtain a second opinion, or approach higher authority (Medical Director of the hospital or Civil surgeon, NOT media or police). There is no compulsion on any patient to continue treatment with some doctor, and at the first hint of mistrust about any doctor, the patient can avail services of another specialist / hospital. There is no justification for gundaism, abusive language, violence, irresponsible rumour spreading or defamation.

    In cases of emergencies where there is no time to change the doctor or the hospital, and less time for interaction and explanations, the treating doctor / hospital must have a separate “emergency treatment consent form” to be signed by the relative / patient, wherein the doctor is given the authority to do what he / she thinks is the best with available expertise and facilities for the patient fearlessly, without any threat. If the relatives are not willing to let go of the police case and abuse / violence / media defamation threats, the doctor / hospital should be able to decline emergency treatment for their own safety. This by no means gives any freedom from medical negligence litigation to any doctor / hospital.

    Because of some bad doctors, most good doctors suffer. Because of some bad patients/ relatives, almost all good patients and relatives suffer.

    We must discriminate wisely, but this discrimination should not be based upon caste, creed, sex, nationality or financial status. It should be based upon behaviour and faith, because the good patient who still has faith for our profession must not suffer.
    © Dr. Rajas Deshpande

     


     

The Divine and the Doc

3.45 AM 
Someone knocked my room. Mrityunjay, my room partner who was in his usual studying position: half on the bed and half upon the table expectantly looked at me to open the door, as I was all perched upon the floor near the door, surrounded by books. If books were seen open in our rooms, one could predict that the final exams were very close.

The delay in opening door obviously invited a nasty and offensive comment from those outside, referring to what we could be doing in the room, having wasted the whole year without studying. This was enough to wake up anyone sleepy.

I opened the door. Feroz, Ganesh and Shrinivas entered. As we came out of the hostel, Aniruddha, Yogesh and Manoj joined us. The night outside was colder than our enthusiasm for the exams. 

Behind the college campus, the dawn was waking up to the tandem noise of stove burners and clinking of ceramic. Teapots whistled guiltily, and cigarette smoke rose pensively. Workers in those small shops, covered in humble blankets meditated in their habitual routine, reluctant for any human interaction. The stage was all set for another mundane day. Who knew life was to throw open one of its beautiful chambers for me that day!

We went ahead to the lone roadside bakery in a slum, which took out puffed bread at sharp 4 AM. Those bread puffs (samosa puffs) with the hot sweet tea would redeem most of the life lost in the prior night of studying. 

As we silently cherished this feast, nobody spoke. Even the most favourite topics: philosophies about life, life partners and a rotten education system were banned in this hour.

I had started early last evening to binge-study, and planned to sleep after this early morning “dinner”. 

So everyone else returned, and I ordered another cup of tea and a matchbox.

The pan shop owner Mr. Ahmed switched on his tape recorder. It is surprising: that in the early morning no one tries to impress anyone else, one is happier to be oneself. Some Arabic verses caressed the mysterious dark of the dawn. Their intensity was so genuine, the agony was so honest in that voice, that I went to Ahmed and asked about it. Smiling, he gave me the cover of a cassette; a treasure what was to become a habit later in life: Praises of the almighty by Mr. Nusrat Fateh Ali Khan.

The particular song that was playing then has become my all time favourite: “Ya Haiyo Ya Qayyoom” which describes the glory of God in so many different magical ways that one is stunned at the meaning that small verses can carry, which are difficult for so many books to even touch.

Exam-time automatically activates the rebel, the poet, the philosopher and the lazy bum within many. This exam-screwer syndrome is difficult to treat. I borrowed the cassette from Ahmedbhai and played both the sides : “Tum ek Gorakh Dhanda Ho” on the other side was equally disturbing, where the great Mr. NFAK blames and praises God and blasts the hypocrisy of “discriminating between humans”. While challenging God for the immense suffering all the good people go through, he has hidden his love for the very concept of God being within each one of us.

“Hairan hoon mere dil mein samaye ho iss tarah

Halanki do jahan mein samate nahin ho tum” … simply superb!

Ofcourse I had to search for meanings, learn Arabic words and talk to some wise ones to know the meaning of some verses. In a few years, I had a vast collection of his works, and am indebted to him each time I listen to his songs: they gave me an insight into humanity and God that only a spiritual Guru could have.

Oh and yes, we all passed first class too.

Another exam. Bad times.
Visiting the “Supari Hanuman” temple, my friend Girish Kore had updated me with the English word for “Pradakshina” on that eve, we didn’t talk anything about medicine then! 

Walking that late night with my equally “nonconformist” friend, Shrirang, he suddenly halted in the middle of the road, and asked me to shut up and listen. This being the routine madness that we shared, I listened. There was someone distantly singing, the singer was lost in his voice. We traced the sound, found it coming from a temple, and to my utter discomfort, Shrirang knew it, and he declined to tell me what the song was. I could recognise the voice of the genius instantly: Kumar Gandharva, but had not heard this album.

“It is not for you” said Shrirang, “You will become mad(er) if you hear this album” he commented. This was temptation irresistible. Upon begging him, he agreed on one condition: that I will listen to those songs only after my exams. 

This album is now almost completely in my heart: “Nirguni Bhajans”.

“Tije ban mein paanch paradhi unke nazar nahi parana

Heerana samajh bujh ban charana…..

Tohe mar tero mas bikave, teri khal ka kare re bichona
Heerana samajh bujh ban charana…..”

 Indeed this album threw me out of gear for quite some time, and I could return only after a few months to normal ways of the world. But thereafter, life became easier, I knew what to expect from myself, my life and others. Peace.

On my way to appear for DM Neurology exams in Mumbai, travelling 14 hours overnight, when the bus stopped at a hotel for early morning filter coffee, I was blessed with “Sri Venkatesha Suprabhatam”: no one was left unblessed in that hotel, I know from my own experience! 

“By the rivers of Babylon” , “Shankara Bharanamu” and so many other pieces of the wisdom of God’s own people have endowed our lives with such perpetual bliss!  

Nanded, where I did my internship, has one of the holiest Sikh temples (Gurudwara), where prayers start early morning and people from all religions benefit from the inherent divinity of those prayers. To go there and “ Matthha Tekna” (bow to the Almighty) is itself attainment of what we live to achieve: peace within. So many come here to shed tears and smile again. I have often felt a complete disappearance of negative feelings visiting this shrine!

As I studied higher and higher in medicine, I found these things more and more useful, more and more relevant in knowing people and their souls.

One is married to one’s own sufferings, but to mature to someone else’s pain and to know that all suffering, all pain is universal: illness, death, loss affect each one of us in the same way, no one is free of it… this was real insight I felt every doctor must have, and have since tried to imbibe in every student I met.

 The greatest pain of humanity: artificial differences between humans, has been treated by these divine artists, songs, verses for hundreds of years. As a community, Doctors all over the world join the pride of belonging to the cult of these “saviours of humanity”, a role beyond medicines and surgeries played by every doctor, but neglected by the world. 

Everybody can pass an exam with enough effort, most can get good marks, many are successful materially, but only a rare few earn peace. One thing is definite: one cannot attain peace having hurt someone, leaving a fellow human being suffering.

A happy, satisfied patient is the best degree, highest rank in medicine one can strive for. These maestros in music from so many different religions but praising one Lord have given me so much love to spread!

© Dr. Rajas Deshpande

The Doctor Without Shoes

(c) Dr. Rajas Deshpande

The practical started, we had to prick our own or each-other’s fingers to collect a drop of blood and make a Peripheral Smear : A thin film of blood between two glass slides. The technique requires practice to make a thick and thin layer from the drop of blood as you slide the edge of one slide over another. We were also ‘helping’ our batchmates, especially our own respective individual crushes.

“Where are your shoes?” asked the lecturer Dr. Chiman loudly to Laxman, one of our batchmates. Laxman was wearing slippers (flip-flops).
“I don’t have shoes sir, sorry sir, I will buy them next month” Laxman.
“Don’t you get scholarship every month? You are even exempted from paying fees.. Why can’t you buy shoes?” asked the irate Dr. Chiman.
Laxman was exempted from paying fees for some meritorious feat.
“Sir I have to send my scholarship home since last few months: my younger brother is studying and Dad is not keeping good health, so income is suffering” he answered, embarrassed in front of the class.
“I don’t know. You must wear shoes in labs and wards. It is a rule.”
Dr. Chiman was about to go on further.

We knew that Laxman’s parents stayed actually in a mud-hut. We felt hurt. It was then easy for Mahendra to drop a small rack with some empty test tubes, which broke. I started arguing with him and we pushed each other. We were both then fired in words from Dr. Chiman’s personal vocabulary, many of them from Maharashtra-Karnataka border, which have a strong phonetic component, matched only by Punjabi abuse. After arguing and defending for a few minutes, we were asked to leave the lab. Mission accomplished, as the shoes topic was over for then.

Laxman became a closer friend and a member of our late night –early morning hostel group that specialised in the extraordinary, and survived mostly upon tea and its white spouse. Be it music or philosophy or medicine, when Laxman spoke we noticed the futility and limitations of everything unless one had enough money to buy good food and good health.

I had a poster of Gabriela Sabatini (playing the French Open) upon my cupboard, and was amazed to learn that tennis or cricket or glamour did not enthral Laxman at all, he was continuously thinking about survival on merit.
© Dr. Rajas Deshpande

He hailed from an extremely backward area, barely reachable by road. His parents worked as labourers in that remote village, usually towing and disposing dead animals. He was unused to urban ways, and almost everything he had was either second-hand or borrowed: clothes, books, comb, bucket, pens etc. Even the slippers he wore were worn out. Even then, a boon of youth, nobody amongst us including himself much cared for his appearance, we still were good friends and tea-shop mates, and shared the same hostel. He was usually jolly and confident, however, he was often very shy and embarrassed with female students around, probably conscious of his shabbiness.
Of course there were smart-asses in the class who tried to belittle him: usually the richer class students who had to show someone else down to impress others around.

Posh-chic appearances and convent English were enough effective catalysts to attract opposite sex, but the girls were too smart even then to give full marks to only these. So these smart-asses either looked for someone to “show down and make fun of”, or to achieve something respectable somewhere.. Laxman was their easy target, but he declined to be a victim. He stayed gracefully involved in his studies., neglecting bitter mockery and hurtful high-handedness.

He walked everywhere. Good / palatable food is usually prohibited in the Indian government medical college campuses, all young growing talent is expected to survive upon cheapest filth selected via tenders. We who rented bicycles to go to the mess for meals felt far more luckier than Laxman, and often went double-seat with him. His mess was of course one of the lowest priced. He went home twice a year, for vacation, and came back with many Bajra rotis and Thecha (crushed and sautéed salted chilli dip) that we eagerly finished within a day of his arrival.
© Dr. Rajas Deshpande

He saw movies or went to picnics only when his group / batch covered for his expenses, that too if they insisted on his joining. He never asked for favours. All the time outside the classroom and mess, he was in the library or his room, studying. His homework, practical books / journals were always complete in time, and he was one of the favourite students of most of our teachers.

Once Mahendra bought a Rayban. As we tried those gold-dark green aviators by turn, in a desperate hope of looking better enough to impress passing girls from junior batches, the owner’s palpitations could be heard. When Laxman tried them, he became suddenly sad and quiet. Mahendra, quite a sensitive soul, immediately explained how he himself couldn’t afford them, but got them as a gift from an uncle in Dubai. “We will buy many like these in future” I tried to pacify Laxman.
“It’s not that. Those glasses are so cool to the eyes! My father and mother work hard in scorching sun all day for years, what a great relief it would be for them to wear such goggles!” he said. He took home two pairs of cheaper goggles next time.

He passed with very good marks.
He had no tears and did not become emotional when receiving the merit awards. All that happened was too matter-of-factly dry for him. He had earned it all, there was no reason to be too happy or too sad about it, these luxuries were for those who had time upon their hands.

He did his MD in Medicine too, we worked in the same unit. I once met his visiting parents. As the father openly and proudly praised the doctor’s room in the ward of that govt hospital, Laxman’s mother kept her hand upon my back. “What would you like to eat next time? Laxa says you like my Bajra Rotis” the eternal mother asked.

After his MD, Laxman chose to work in three different slums in a metropolis, charging two and five rupees (now maybe ten or twenty) per patient as his fees. He travelled to two slums per day, and worked 18 hours. Widely loved and respected, he continues to serve the community that needs healthcare most, the community he comes from.

This is also the story of many hundred doctors in India, who live and die poor, earn great merits, serve the neediest, but are never seen in any award lists, any felicitations or accolades. History is good to most heroes at least after their death, but in case of such doctors serving the poor in India, anonymous oblivion is the eternal reward. For the government and our society, he is just another ‘private doctor’.

May the new year bring upon them recognition and gratitude.

You see, the smear of the same drop has to be spread out thick and thin to tell human blood correctly.
© Dr. Rajas Deshpande

Real story, some identities masked. Please share with credits.