Monthly Archives: October 2016

“Eureka”

photo-09-09-16-12-12-22© Dr. Rajas Deshpande

Half day OPD today. Diwali morning. Busy busy rush.

Push ups. Weights. 30 minutes on treadmill at 7 Kmph. Feel the rushing blood. Check out a muscle or two in the bedroom mirror. Count the packs in certain position. Feel the pride of this sweat too.

For some curious reason, take your smartphone to the shower. Not only because you are a doctor, but plain simple addiction. The idiotic fear that the world will stop functioning without your supervision. It doesn’t. Or does it?

Enter the steamy hot shower feeling like a superman. Start philosophical excursions in your mind finding simplest solutions to everything. Under shower meditation is the supreme spiritual ritual of the day. Not because ‘the world cannot see your tears’, but because the world is altogether absent here in the shower.

This new shampoo is great, just takes some more time. Wait.

The phone rings. I will not pick up. I will just see who it is.

Oh my God!

It’s that Professor of mine, known for never calling anyone, never socialising, and in general being a “limited edition”, generally sarcastic. If I do not pick up his call, he won’t call again, and probably will never pick up my call again. Doctors have bombastic egos, the senior the more. He is over 80 now, and still studies a lot. © Dr. Rajas Deshpande

Pick up the phone. (Thank you Apple for making it waterproof). Come out in the bedroom dripping.

“Good Morning Sir!”

“It’s nearly afternoon, Rajas. Good afternoon! Do you have internet access right now?” Prof.

I am always proudly connected.

“Yes Sir”.

“Okay. You had referred a patient to me. It’s about him” he told me the name.

Yes. I had referred him a case I had doubts about. Things were quite odd, I had never seen a neurological condition like that. I just hope it is not something I missed, otherwise Prof. will skin me alive on phone!

“I examined him. I presented him to our Neurological society, and we concluded that this is pretty rare. There are only two such cases diagnosed with such findings till now. One is in 2004, and the other in 2012. Open your net browser, I will tell you the references”.

Wipe hands dry. Open the net. Check the references. “Yes, Sir!”

“He is going to need some more tests to confirm this condition. He cannot afford. I have written a letter for him to show to his employer, they may sponsor. Or we should look into charity. He will come to you, send me all the reports. Then maybe we will report this”. © Dr. Rajas Deshpande

“Yes, Sir”.

“Okay. Bye”.

Thank God there was no skinning! I must complete reading the reference right now! Done.

Standing there, dripping all over, I realised how much I enjoyed the “Fun” in learning, What a feeling! Eureka!

That whole day, my spiky hair may have offended many who met me, and I had no explanation. Most patients graciously forgive their doctors’ weird appearances, sentences and even some spurts of absent minded stupidity, the senior the more.

Once this very Professor was to be the internal examiner for my senior batch, and I was supposed to present him cases to be selected for the final DM Neurology exams. Terror reigned. Our best case was a Huntington’s Disease patient, and I had studied day and night the whole prior week about that and other cases. © Dr. Rajas Deshpande

He sat in the ward side room.

Trembling, I called in the patient. The patient walked in about four steps till the examination bed, and sat upon it. It was less than ten seconds that the patient was in the room.

Just before I opened my mouth, Professor said plainly “Huntington’s is too short a case for DM. Keep him in reserve. Get the next case”. I felt like being shot before even entering the battlefield!

This professor was my examiner too, for my DM final exams. His genius was scary, his comments deadly. Just as I came out after the final viva, I received a money order sent by mom. As I stood counting the money outside the exam ward, this Professor came out. Looking at me counting the money, he smiled big. © Dr. Rajas Deshpande

“Already planning a party haan?” he kept his hand upon my shoulder.

Frightened, I explained that it was just a regular money order from home.

“You will need extra money this time” he said and walked away.

My heart turned into a boombox.

My palpitations stopped only when someone told me after two hours that I had topped the exams. The whole world paused in my mind to salute three years of extreme hard work, the run of umpteen sacrifices: that of youth, food, sleep, life, enjoyment, relationships, and everything that is “normal human need”.

Of all the qualities that make a genuine doctor, the Nerdiness is probably the most undervalued one. What a doctor appears to speak or write or decide on the spur of the moment is actually the product of years of study, research and hard work, with umpteen experiences that add to the thinking process. © Dr. Rajas Deshpande

It is this same Nerdiness that saves many a doctors from the depression and other mental stresses that their life offers on a daily basis. I love reading my subject at least two hours every night, and I know many doctors who are “lost” in the quest of knowing more and more. All the humanity, compassion, social service, charity, respect and earnings on one side, it is sometimes only this “thirst of knowledge” that makes us forget the umpteen festivals, celebrations and other happy things of life we keep on missing.

Like the soldiers on the border, thousands of doctors spend their Diwalis and Christmases and Eids and Baisakhis in hospitals, tending to the care of the sick and suffering, drinking the poisons of allegations and anger. One sure-shot medicine for this is studying.

For their Festival of Lights is in the service of the suffering, and their celebration is saving life. The fire comes from their quest for knowledge. They burn colourfully to make others smile again!

Happy Diwali to all the Patients, Doctors, Medical Students, Nurses, Paramedical staff, Pharmacists, Medical Representatives, Technicians, Wardboys, Reception and other staff, Mamas, Mausis, Security staff and all those who are connected to the healthcare industry!

© Dr. Rajas Deshpande

Made In Heaven

jadhavs

If I ask him about HIS health complaints, he points at her and says “Ask her, I don’t know”.

Mr. Hanuman Jadhav brings his wife Mrs. Laxmibai Jadhav regularly for follow ups, keeps all her records filed date-wise, brings all the medicines and asks me to do the best for her, adding “Don’t worry about the expenses, we can buy for her any medicine you want”. He has no source of earning, but his children provide for them.

“She has looked after me, my home and grown up my kids. I am nothing without her” says this retired foreman of an electric company. He spent his life roaming all over Maharashtra with his family, wherever the govt. transferred him. His old wrist watch and simple clothes reveal his humble state of life’s affairs. He is minimally educated, does not know the words “Culture” or “Gentleman”, but is better cultured and more of a Gentleman than most who know those words!

He patiently listens without interrupting till she finishes all her questions. He does not behave as if he is her ‘Master’. Then at the end she asks (rather orders) me to examine him. If I ask him about his complaints, he points at her and says “Ask her, I don’t know”. Then she blushes and lists all his complaints, and he usually agrees. The only argument they have is about the other one “Not eating well enough”.

In the end she always says “My illness is not important. He must stay healthy at all costs. He has worked hard to keep us all well”. As they leave, she does not forget to remind me that I am like a son for them.

They do not ever complain about each other, not even as a joke with hidden shades of truth!

We rarely see this respect and equality for one’s own spouse, even among the best educated. These two have not read any literature, nor seen any movies about women’s lib. Since the last five years that I know them, they have been one outstanding example of genuine, heavenly love only dreamt by those in the ambition industry. Even the most educated and elite seldom treat their spouses as equal.

These two are still so shy, they urged that I stand between them for the pic!
© Dr. Rajas Deshpande

A Policeman’s Tears

© Dr. Rajas Deshpande

“She was found unconscious and naked lying on the road. The baby was near her, moving when we found her, now she also looks unconscious” said the police constable. “Actually I had my civil dress in my jeep, I covered both with my clothes and got them here. Most likely an orphan roadside beggar”.

It was early morning, I had gone to the casualty for a call as a medicine resident, and was chatting with the CMO when this police constable had rushed in the mother and the baby, probably less than a year old. He and his colleague completed the formalities and left. The CMO was alone, so I stayed on to assist.

The lady had high grade fever and some bruises all over her body, only one on the thigh deep enough that it bled. She also had a contusion upon the head. Needless to say, unclean and unkempt, visibly quite weak and poorly fed body. There was a traditional tattoo on her forearm that said “Seeta” in distorted devnagari script. The baby was dehydrated and had fever too, with only minor contusions.

“Sending her to female ward, and the baby to paediatric” said the CMO. We completed the police information and Medicolegal form, the nurses had started the IV line for the lady. I accompanied the baby to the pediatric ward, handed her over to the resident doctor friend on duty and went to the female ward to attend the other admissions. Basic medicines for fever and head injury were started for Seeta. There was no CT scan facility in the hospital. Blood tests were sent.

In absence of relatives, it’s the interns, resident doctors and nurses who attend to the necessities of such patients. Administration mocks everyone sympathetic and compassionate to such patients, be it a government, private or corporate set up. My professor advised some more blood tests. Some tests were not available in the govt. hospital, we had to send them outside. As we had just received the stipend, money was not a big problem.

Next evening I went to the pediatric ward to find out what was happening with the baby.
“She has had convulsions”, the resident colleague told me. We have loaded her with anticonvulsants, but she still has fever. Dr. Jain madam (new lecturer in paediatrics) has advised lumbar puncture, but there’s the consent problem”.
I went to talk to the lecturer, she was all insulting. “Don’t teach me what to do. We will send a request to the dean, and if he allows, then the resident will do the lumbar puncture” she said, “By the way, what’s your interest in this baby? Why don’t you mind your own business? I have heard about you.. you are in the student’s union na? Don’t throw your weight around me.” She said.

The dean consented to our request, and a lumbar puncture was done. The baby had probable tuberculous meningoencephalitis (infection of the brain and its coverings). Antituberculous medicines were started.

The comments of the pediatric lecturer made me extremely angry. Most of her resident doctors hated her attitude too. Those remarks soon spread and various sick, exaggerated and vulgar jokes about me caring for that orphan baby made rounds among my colleagues. But one good thing about wanting to do good is the shameless pride and courage that comes ingrained with it.

My colleague Dr. Madhu stood by me. She often reminded me: “There are five percent good people in the world, and 95 percent bad, Einstein has said, but it is the five percent good who take the world forward, they represent human race”. That has always pumped me up against all the mockery that I ever faced for being “too sensitive and compassionate to be sane”.

The best support for the poor and helpless always comes from the poor and helpless. The pompous, actionless “blah blah” of advising others to be more kind and compassionate is usually the trademark of those who themselves rarely help anyone. The mamas and mausis (wardboys and helpers) of the ward came together to attend Seeta during their duty.

The pediatric resident told us on the third day that the baby’s health had gone bad, and she was unlikely to survive. Dr. Madhu stopped smiling. “At least can we shift the baby near her mom?” we discussed. It was of course not possible.

Dr. Oak (real name), one of our ophthalmology genius professors, learnt about this. He came over and told us in his royal tones, to tap him anytime for any help. He also left some money with us.

On the fourth day, the lady started having convulsions too. We ran around, trying to arrange whatever the professor suggested. She was gradually sinking. Tuberculosis neglected and untreated is one of the most cruel diseases. It takes over ten days for the action of Tb medicines to kick in.

On the fifth day, the baby passed away in the morning, and the lady shortly after. That coincidence was less tragic than their trolleys being rolled into the mortuary together.

“What happens now?” we asked the mortuary in charge.
“They will be cremated as orphan, unclaimed bodies after the post mortem” he told.

In a world of billions, ruled by religious, powerful and rich, a young mother and a baby girl would be cremated as orphans! We told the mortuary assistant to please keep us posted, and came out. Of course we could not sleep.

Next day we took special permission and went to attend their cremation.
On the way, we bought some flowers, a tiny dress for the girl and a saree for her mom, probably the first new clothes ever for either of them. Dr. Madhu had already brought a few bangles, a necklace and two bindis with her.

Dr. Madhu was sobbing as we returned. The rowdy looking policeman with us also wiped his eyes. He dropped us back to the medical college in his jeep.

He said in a heavy voice as we parted:
“Doctor, we see all the worst things in the society. We meet criminals day and night. But when such young girls and babies die, I feel like shooting everyone who didn’t come out to help them. People just talk, nobody helps. God bless you. You have what it takes to be a doctor. Don’t ever change.”

© Dr. Rajas Deshpande

P.S.
Years later, I read about a divine human being from Chennai, one Mr. S Sreedhar, who collects unclaimed dead bodies from various hospitals, and performs decent and respectful last rites for them. Planning to meet and touch his feet one day.
Please share unedited.

The Revenge

© Dr. Rajas Deshpande

“I want to see the doctor immediately. It is an emergency” the woman outside the OPD chamber was loud enough, and it was for the third time that she had said this. Dr. Rahul was explaining a long prescription to the elderly couple in front of him.He dialed the reception, and asked “What’s all that noise?”. The exasperated receptionist replied : “Sir, this lady has come without an appointment, there are six waiting patients, two on a wheelchair. Other patients are already angry. She is not willing to listen”.

Dr. Rahul apologised to the elderly couple in front of him and opened the door. “What’s the emergency?” he asked the fuming lady.
“I cannot tell here. May I come in after this patient?”
“Sorry mam, there are patients already waiting. If you cannot wait, please go the the emergency department, they will check you immediately”.

To everyone’s surprise, she waited till her number came up. She came in fuming, and muttered a few words to express her anger at having to wait, the ‘F’ words were clear.

In her thirties. From a very affluent and highly educated community. Gold shouting for attention, and a ring with a solitaire so large that it usually speaks of much except love. She had come to Dr. Rahul two years ago for a Neurological problem.

“I have a severe headache since last seven days. last two days I have had chest pain and a feeling of suffocation on and off. Also, I have lost control of urine five days ago. It’s very embarrassing, I cannot leave house. I have had fever before that”.
Naturally, she is worried, thought Dr. Rahul and felt guilty. “I am sorry I couldn’t see you earlier. Why did you wait seven days? You should have come earlier, knowing your neurological diagnosis”.

“My husband was away. He said I should wait. I have a seven year old son, I can’t leave him alone”.

“Why don’t you hire help, knowing your condition?” Dr. Rahul asked.

“I can’t explain, doc. My husband is very skimpy. All he thinks about is more money. Believe me, there’s nothing else he even talks about. I am fed up. He says we don’t need help as I am not working”. She also revealed that she had not seen any doctor as her husband thought it was unnecessary, and kept on suggesting her home remedies based upon his net search. She had stopped her BP medicines a year ago, and had had headaches since a year.

Dr. Rahul asked her to change and asked if she required a nurse attendant. “No” she said, “I am ok”.

The Neurological examination was abnormal, and the Blood pressure was quite high too.
“You need admission, ECG, some blood tests, and an urgent MRI, and we will probably have to use some injections” Dr. Rahul told her.
“Out of question, doc! My husband feels all doctors are out to make more money, he says all my complaints are psychological.” / She said, tearful.
“Then please go to the casualty, we will arrange tests without admission and start treatment. But you will please have to write that you are not willing for admission”. She wrote so, and Dr. Rahul gave her a prescription.

She never went to the casualty.

Next morning at 4 AM she developed chest pain, and was shifted to nearby hospital. When they too suggested an admission, her husband brought her to the hospital where Dr. Rahul worked.
At 5 AM there were frantic calls from her husband. Dr. Rahul went and checked her again. She was stable. Her husband waited outside the ward.

“She is stable” Dr. Rahul told him.

“I am very upset with the hospital. They charged us for the ambulance, and also for the emergency tests. Also, your assistant wrote on her file that she has blood pressure since five years”.

“Yes. She has high BP since five years, we have it in our notes. We must mention only the truth by law, Sir” Dr. Rahul said.

“But we have not told her insurance company about her high BP and her Neurological diagnosis. If they come to know, they will increase the premium and not sanction this bill. Please change that or I will file a complaint”. He raised his voice.

“Complaint about what, Sir? That you did not let her follow up for two years, stopped her BP medicines, endangered her life till she almost had a heart attack, or that you treat her like a a traditional wife-slave?” shouted Dr. Rahul in his mind. A bad start of the day is nothing new for a doctor, but this was too much.

“Please go ahead Sir. We cannot change medical facts for your financial gains” he replied and left.

As the blood, urine and sonography reports came in, she turned out to have a bad urinary infection. Within hours of admission, two super specialists had attended her and explained her diagnosis and treatment plans.
The insurance company declined to sanction her bills, as they had lied. The Medical Director plainly refused to change the facts mentioned on the indoor files.

“We want discharge” the angry couple started shouting at the junior doctor in the ward, a girl who had just passed out her MBBS. When she called Dr. Rahul, she was already crying: “Sir they are using such foul language. What should I do?”
“Please discharge her as per request, mention it on the paper and obtain her signature. Send her file to me for prescription of treatment upon discharge” Dr. Rahul instructed. Standard procedure.

They went home.
Next morning, there were two emails.

The first was a complaint note from the patient’s husband, that mentioned how everyone ill behaved with them. There were also allegations of delays and excess tests done without reason. There was a huge lament about the bills, questioning everything.
The second was from the customer relations cell. The patient had alleged that a male doctor had done her sonography and 2D-Echo tests, and had not obtained her permission to “touch” her.

Next three days, there were legal discussions, explanations, meetings and much writing to furnish the correct answers to everyone concerned. Useless paperwork destroys millions of intellectual human hours. The sonologist and the doctor who had done the 2D Echo categorically explained how every rule was followed, and how the patient’s permission was obtained prior to the tests. Of course the couple was never going to be satisfied, they kept changing stance, threatening a “big revenge” through Press, and adding new allegations. Many patients could not meet Dr. Rahul, busy with this idiotic activity, and the ones who met him found him too upset.

Dr. Rahul wrote to his Medical Director to hand over this case to someone else, he didn’t want to meet that patient again.

To his surprise, the lady came back to the OPD after five days. She was feeling far better. All her complaints had vanished. She behaved as if nothing ever had happened.

Politely, Dr. Rahul told her that he did not want to continue seeing her. She laughed. “Oh you are still upset at the emails, doc? My husband was too upset because the mediclaim was declined. But we have not complained about you”.

Dr. Rahul pointed out that if the patient is admitted under his care, all complaints are directed to him and he is still responsible for everything.

“Look, Doc”, she said with an icy cold tone, “I could have complained anything against you too. I didn’t”.

That was more than what qualified for any compassion or understanding. But there was no time to fight. He stood up, opened the door, and called in the receptionist.

“Please call a female security officer and escort this madam to a female customer care executive” he instructed the receptionist “and she will not follow up with me hereafter”.

“I will make things difficult for you, doc” said the fuming lady.

“Oh, I practice Medicine in India. You cannot make it more difficult for me” he replied, now regaining his smile. A doctor is not allowed revengeful attitude.

But a goodbye smile, he knew by experience, was the best established revenge.

© Dr. Rajas Deshpande

Based upon a real experience.
Please share unedited.

The Definition Of Love

 

The Definition Of Love
© Dr. Rajas Deshpande

claude-and-marie
How frequently do we use the phrase “True Love”! As if there existed some other form of Love..
Mr. Claude Gatien, a farmer from the city of Tours in France, decided at the age of 36 that he wants to change his career. He started to work as a music salesman, selling CDs. Eventually he got a job as an assistant to a psychotherapist in Paris.
He met Ms. Marie Briquet there. She was a social worker, dedicating all her time to the sick as a volunteer. He respected her work, and helped her often. They fell in love. She told him she was having some mild neurological symptoms, mainly tremor and fatigue.
His thinking was as innocently clear as the first rays of a rising sun. Love was the only bond and the most precious thing between them. They stayed together, and started taking care of each other.
The psychotherapist who they worked with was a spiritual man, with immense love for India, mainly for its spirituality. Like most with a heart, he followed his calling. By then, Claude and Marie had developed the same affection towards spirituality, and followed their ‘Spiritual Guru’ to India.
“We fell in love with India”, Claude told me; “because for some reason I find that my mind is at peace here. We have everything in France, still we felt happier in India, because there is so much spirituality in the region, and even among its people”.
They are staying together for over 27 years now. “We never thought of marriage as we thought it is not necessary to perform rituals to prove either love or honesty of intention” Claude said, after consulting Marie in cute French. “It was her answer, but I feel the same” he added, winking!
Multiple Sclerosis, that scary disease of brain and spine, took away Marie’s ability to walk over 5 years ago. She has become almost completely dependent and wheelchair bound. Claude attends her 24/365. “I enjoy caring for her. It gives me many more opportunities to tell her how much I love her” he says.
Mostly people swear about anything that they want others to believe. A teacher taught me long ago never to “swear or promise”, but instead keep every word, complete every commitment without using the words “Promise or Swear”. “Everything you say is actually your commitment” he infused. I met the personification of that principle in Claude.
About a month ago, Marie suddenly had to be admitted in the ICU for some serious complication. Needless to say, Claude was by her side all the time. She was unconscious for over two days. One late night I had to attend some call, and went to the ICU to check if there was a change in her condition. Claude was sitting by her side, sleepy but awake, looking at her face.
“I can wait here for some time. Do you want to take a nap?” I asked him.
“Oh no, Thank you doctor. I won’t sleep till she wakes up. If she wakes up and does not see me, she will worry about me. That may stress her. Once she opens eyes, I will tell her she is ok, make her smile, then I will sleep” he said.
That was a month ago. They came for a visit yesterday. I requested their permission to share their love story. He said he was willing, then asked for her permission.
Then I saw the beautiful smile that had made Claude fall in love with Marie.
“Yes.. She says this is all there is to share about life.” Claude told me, translating.
© Dr. Rajas Deshpande