The Royal Medical Screw

The Royal Medical Screw© Dr. Rajas Deshpande
Panicked call “Rajas, rush please, immediately”.

I was home for Bhai-dooj in Diwali. My sister was visiting from Bangalore, she visits only once a year, with her family, and justly expects me to be home when she’s here. That’s the only vacation I ever take annually. My sister was about to perform the aarti. 

Then this call.

“Rajas, my neighbour has become extremely violent after an episode of unconsciousness for a few minutes. He is reaching casualty in 5 minutes” said my senior colleague.

“Yes, Sir, I am starting” I replied as I got up, begging with gestures my angry sister to understand, “Please ask the medical CR to call me once the patient reaches casualty”.

Get the car keys. Your mind, heart and soul are already with the patient. Just as I left the door, my sister slipped some sugar in my mouth, saying one should never leave a pooja halfway. “God will understand” I replied the standard answer given by almost all doctors.
The registrar called “Sir he is 56. His vitals are stable. No fever, no neurodeficit. Just very rowdy and incoherent”

“Is he drunk? What’s his occupation?” I asked from my car.

He was a businessman, took alcohol daily over three pegs, and had not had any major illnesses till now. I ordered for an urgent MRI under sedation, instructing to monitor oxygen and be prepared for intubation. Dealing with a traffic worse than most video games, I reached casualty in few minutes.
His wife, a well known author, was all in tatters. She caught hold of my arm and begged: ‘Please save him doctor, whatever it takes.. we don’t have any relative, I will be dead if something happens to him’. © Dr. Rajas Deshpande

MRI was normal. After work-up, his diagnosis was concluded to be a type of fit / seizure. He was started with a medicine for controlling fits, and improved within 24 hours, discharged in two days with advice to follow up in 7 days. He was instructed not to drive, a standard instruction for all cases with fits.
They came over only after a month.

“Doc, we wanted a second opinion. So we saw one neurologist (from their own community). But we were still not satisfied, so we went to Mumbai, my friend knows someone at that biggest hospital. We saw him there. That neurologist also told us to continue the same medicines as you advised. We had also sent all his details to the XXXX clinic in the UK, they advised us to come for check-up. So we are leaving for London next week. Till then we will continue your treatment. We thought we will just come and inform you”.

 “All the best” I told them, managing a smile just as my patience slapped my pride.
They returned only after a month. All tests redone, same diagnosis (with a lot of printed papers, receipts and a different wording), and change of medicine to another, newer, costlier anticonvulsant. The doctor who met them in London charged about fifty times more. Our own Indian doctors were all so damn cheap! 800 rupees for one opinion.. one can have at least four specialist opinions for everything! © Dr. Rajas Deshpande
“Can he drive to his office now?” the wife asked sweetly.

“I had advised not to drive. Is he driving?” I asked.

They looked at each other with immense pride. “Yes, doctor, but he’s a fighter, he doesn’t like to give up. He tried himself and has started driving on the next day of discharge” she was talking of her hero. “We also reduced the dose of your medicine to half, as he thinks that much dose is not necessary. When can we stop the medicine?”

“You must continue for at least one year.” I said, “What did the London specialist tell you?” 

“Oh he said lifelong, but we think he does not need that”.
At the end of patience, there can be violence or silence. 

The doctor has only one option.
“In my opinion he must take this dose for a year and not drive at all. He will risk his own life and other people’s too”. I said 

“But we read that this medicine has a side effect on the liver” asked the caretaken hero.

Strange question from a man who is drinking over 90 ml of alcohol for over 30 years!

I asked him to give up alcohol instead of the medicine. 

He smiled a smile that would put to shame best of the diplomats. 
“Tell me doctor, were all those tests necessary when I was admitted? We spent a lot.”

“Then why did you repeat all those tests in London?” I asked.

“They told us that they will only rely upon their investigations. We had no choice”.

At the end of silence there is renunciation.
I stood up. “Well, sir we did what we thought was justified in your case at that moment. Ask your wife what your condition was and how you improved. You could have chosen to go to any doctor or hospital. You chose the biggest and the one with top class facilities. I have told you my advice, you are free to follow or not to follow it. You are welcome to go to the doctor who suits you best. Excuse me, but I must see another patient now”.
“Do we have to pay again today? We just came to discuss”.
What now, after renunciation?
My sister continued to be sarcastic about me leaving that day. She had left the next day, we didn’t get much time to talk.  

“How is that patient?” she asked on cell one day.

I narrated her with anger what all had happened.

“God will understand” she replied, but not sarcastically. 
In a faithless, trustless world, thousands of doctors rush for emergencies all over India, risking their lives, without ever asking who is the patient, whether they will pay or not, whether they are good or bad. Nobody pays the doctor for even the petrol / travel in case of rushing for a non paying patient, while most paying patients count each rupee as if it was a kidney. © Dr. Rajas Deshpande.
By the way:

That patient is in the ICU now. He had a fit while driving at night, while he was under influence. 

We are doing our best. They have also sent an urgent email to London, with their credit card details.

© Dr. Rajas Deshpande

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