Monthly Archives: November 2016

The Price Of Love

© Dr. Rajas Deshpande

He tied her to the pole, abusing and insulting her.
Wielding a knife in his hand, he slapped her once more. “You are supposed to be the honest one” he shouted, “I am a man. You were talking with our neighbour. What did you say to him? Did you two fix up a place to meet secretly?” he was trembling with anger.
She looked into his eyes, and replied “Don’t you talk to other women? Doesn’t your mother talk to other men? Do you always talk about that? I was asking him about his sick wife”.
Pulling her by her hair, he said menacingly in her ears: “Look, don’t compare yourself to me. I am a man. You are supposed to be the one who gives up everything for me. Do you think I don’t know how ‘those’ women behave? You have chosen to marry me. I can do what I want”. She didn’t reply. What could she say to a paranoid, suspicious person who had one way communication? The option of violence wasn’t open for her.
As it became dark, his mood changed. He started speaking soft and sweet. He untied her from the post so she could cook. She could not eat well, the humiliation and insults, the allegations and violence wreaking havoc in her mind.
Silence fell upon the dark. The next day’s work awaited her at dawn, so she skipped the sobbing and tried to sleep.
“Make love to me” he ordered. She tried to comply.
He raised his voice “It should come from the bottom of your heart. Don’t pretend. Love me madly, deeply, and let it show in your action”.
Silently, she replied “I can’t. The only one thing that could have made me truly love you was true love from you too”. © Dr. Rajas Deshpande
This is the current scenario between the society and the good medical professional today.
Take for granted that the whole medical profession is one’s slave. Make allegations at every possible opportunity. Be suspicious and paranoid. Hold a doctor guilty for any news anywhere without logical enquiry. Make them overwork under the sacrifice tag. Disrespect them, beat them up, ask them questions as if talking to criminals. Presume every other doctor and every big hospital is a fraud.
Then, when one has a health problem, expect them to be truly, deeply compassionate, loving angels who will do the best because they are married to their principles of being good and kind to everyone.
If you expect the doctor to be truly nice and kind and compassionate to you, to make best decisions for you, ask yourself if you deserve that. No amount of money will buy you a doctor’s love and respect, no amount of hateful criticism or threats will compel your doctor to be compassionate.
A doctor’s real fees is the respect and trust you place in him / her. No amount of money is worth the value of your life. Pay with suspicion, threat and disrespect, and you destroy the compassion you truly deserve.
The doctor-patient trust is a coin with two sides, one side cannot be blank.
© Dr. Rajas Deshpande

PS: I know the word “exaggeration”. Learnt it from some movies and TV shows that criticise doctors.

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The Wrong Blood

The Wrong Blood
© Dr. Rajas Deshpande
In rolled the wheelchair. The listless elderly patient: a case of last stage of Parkinson’s disease kept staring at nothing ahead of him. He was stiff all over, drooling, and barely made any movements. His wife walked in limping, with the support of a wooden cane.
The patient needed better care: nursing, cleaning and feeding. He was developing bedsores. Once I examined him, I asked her why they had stopped his medicines. She was embarrassed to answer. “There are so many problems, doctor!” She replied, “I fell down while lifting him from the bed, my leg is fractured. I have diabetes and neuropathy myself, so cannot walk well. So I could not go out to get his medicine. I could not go to the bank also”.
I felt sorry for them, and started thinking in my mind if I should offer her free medicines till she can arrange. A pharmacist friend of mine is very happy to help out patients. By the time I finished writing prescription, she had called someone. “Speak to our son, Doctor” she requested.
Covering the microphone, I asked her where her son was. She told me he was in his office, a few kilometres away from the hospital. Angry and upset, I spoke to her son. He asked me the details of his father’s health, and also “How long do you expect this to continue?”.
I told him in short about his father, and also told him to see me as soon as possible to discuss about his father’s health. “Yes, I am busy now, but I will come and see you”. He replied.
His mother was smiling an awkward smile. “Everybody is busy with their work, doctor. We also have a daughter in the same city, but one cannot ask for help from a daughter’s family no? I just hope all this ends soon without much pain.” she said.
I wrote on his case paper with red ink: Patient’s son or daughter to visit with the patient as soon as possible for discussing his health. I told the patient’s wife to show it to her son and daughter. “He comes once in a month to meet us, I will show him then.” she replied. I gave her instructions for bedsore care.
They followed up after three months. The medicines were on, there was some improvement. However, the bedsores had worsened. The lady was still limping.
“Did you show my note to your son or daughter?” I asked.
She paused. Then, with tears rolling down her eyes, she said “Doctor, you help us so much, I cannot lie to you. Our children are not interested in us now. They do not care about our suffering. Both ask us why the other one is not available. I showed them both your note on the very next day: I went to their homes by an autorickshaw just for that, and both said they will arrange something soon, but now they don’t even pick up our phone except on Sundays. It’s Ok. Probably we didn’t grow them up well enough. Both of us were teachers, we were poor, but we had good cultural values. But our kids have time for vacations, parties, shopping, festivals – everything, except us”.
The restlessness in the wheelchair increased, and we noticed that the patient was in tears too, trying to mutter something, but unable to. His wife got up and wiped his tears. “Don’t you worry. I am enough to take care of you. I will not die before you. We probably had the wrong blood within us. This is our fate. We will manage”.
There is nothing that a doctor can do to bring the errant son / daughter to justice, I thought. Various courts of law proactively ordering gender equality in property distribution have many a times mentioned that neglecting age old parents is a punishable crime, but there are no examples of anyone set right. To expect parents to file a case against their own children is stupid.
I prayed for both of them, and also for a system where a doctor can report such criminal neglect to bring to books the irresponsible. But a doctor must take into their stride the dark side of humanity.
Whatever life brings on, tackle, overcome, and “Move On” for the good of the next patient is the holy code of action for every doctor. The next waiting patient needs to see a smile upon your face. So put it on, and Go!
© Dr. Rajas Deshpande
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The Pride Principle

The Pride Principle
© Dr. Rajas Deshpande
“Sir, we are screwed. The Chief Minister and other ministers have closed all doors, they won’t respond. Our careers are in grave danger. Can you please help us?” I frantically spoke.
From the other end of the phone, the Don, Dr. Nitu Mandke answered: “See me at my home at 12 midnight”.
The Maharashtra state resident doctor’s agitation for dignity, national pay parity and better living conditions was on, and I was given the responsibility of coordinating and being the face. For once, there was excellent communication amongst all medical colleges, thanks to the cellphones and fax machines. The divide and rule weapons of most governments which had crushed many of the earlier strikes were not working here, as we had established a multilevel network.
When students go on a strike anywhere in any field, it is almost always out of desperation, and either for dignity or rebellion against some sort of suppression and humiliation by the system. This raw power is almost as mighty as the army, and although it falls prey to political misuse sometimes, it has tremendous capacity towards achieving intellectual evolution of the society. Students never rebel for money or power. The government always treats any unrest as an offence to its ego, and uses everything at its disposal: CID, Police, Administration, Force, Threats, Caste Politics, Cheating and Legal torture to mow down student agitations. Students have no money, no experience and rare political or social backing, and must unite and stand up for themselves. © Dr. Rajas Deshpande
On the fourth day of the strike, a big politico from the ruling alliance came over to our office at Mumbai KEM. Except the party batch and stickers on the luxury SUVs, there was no telling between him and a mafia goon. The members of student’s central committee: Dr. Sanjay Singh, Dr. Dinesh Kabra, Dr. Narender Sheshadri, Dr. Pramod Giri, Dr. Nilesh Nikam, Dr. Kuldeep, Dr. Vishal Sawant, Dr. Noor, Dr. Shahid, and few others were with me. The politico did not have any scruples using an arrogant, raw and filthy language to threaten that if we do not stop and withdraw the strike, our careers and even life will be in danger. As he was from the ruling party and threatened us in presence of the police, there was nothing we could say.
There are angels everywhere. A senior police officer who was supposed to “keep a constant watch” upon us ‘student leaders’ was quite fatherly. He told us “Do what you must, but don’t declare. Dumb people cannot interpret silence. Stay away from any violence”. © Dr. Rajas Deshpande
Next day, we got a message from government that almost every silent agitator gets: you have been cut off (you don’t have enough nuisance value). Unknown calls kept threats alive.
That is when a resident doctor suggested we meet the Don: Dr. Nitu Mandke, the famous heart surgeon who was known to be a fearless, straightforward celebrity doctor. He had already watched the TV news of our agitation. One Resident Doc could contact him.
He returned home past 12.30 AM. We waited, hosted by his extremely courteous family. We briefed him the details. He asked a few questions to assess our determination and strength. He asked us to stay united and avoid any misbehaviour during the agitation. To our surprise, he picked up the cellphone and called the Chief Minister’s PA. The CM was fortunately available, and talked to Dr. Mandke. © Dr. Rajas Deshpande
“CM is going out of the state tomorrow. He has advised us to meet the Deputy CM tomorrow. Two of you come to Leelawati Hospital tomorrow at 2 PM. I will take you to the DyCM.”.
At Leelawati hospital, Dr. Mandke’s chamber was intimidatingly clean and posh, yet simple. He checked our applications for the CM and corrected them with his beautiful pen. His briefcase had every essential of writing stationary, the mark of a perfect man.
As we waited, I asked him cautiously: “Sir, shall we start?” He replied that he was waiting for someone to carry the bag on his table. I offered that I will carry it.
He laughed his thunderous laugh, and looked at us as if we were small puppies. “ Deshpandyaa, that bag has two and a half crore rupees cash for my hospital. A professional bodyguard will carry it. People kill for that. Do you want to carry it?”. I shut up.
In his big car, for the 45 minutes that his bodyguard drove us to the DyCM, I asked Dr. Nitu Mandke questions about what was going through his mind when he was actually operating the Shiv Sena Supremo Mr. Balasaheb Thackeray. Such an enormous pressure it must have been!
“Oh yes, it was stressful. But he is a gentleman, and he had assured my safety. His word is enough”.© Dr. Rajas Deshpande
That’s when we told him how some politicos had threatened us recently. He laughed and replied something that has been tattooed upon my cortex permanently:
“Rajas, a doctor is a doctor and king of lives forever. Politicos come and go. Idiots misbehave with others when the have any post or power, in any field. You should not budge. It is pathetic to see doctors licking shoes of those in power, under various pretexts. It is up to you to maintain your dignity and pride. That is the true luxury, everyone cannot afford it. So long as you do the right thing, fear nothing. The few crores in that bag is nothing compared to how I feel about myself”.
We entered the VIP zone and bungalow. His car was not stopped anywhere. The DyCM offered us tea, and gave us a patient listening.
“These junior doctors and students are my boys, our own boys, they will look after the health of our people tomorrow. You must help them” Dr. Mandke insisted. The DyCM assured he will. The spell was broken, talks resumed.
Many twists and turns later, one of the most memorable strikes was called off. There were those who never physically participated but went home during the entire struggle. They came back dissatisfied, alleging. Those who participated knew they had fought well and won.
A year later, I saw a white Lexus car in our KEM campus at Mumbai. Fond of cars and having never touched a Lexus, I went to see it from a close distance. Just as I tried to touch it, the driver’s window rolled down, and I heard “Deshpandyaa, open the door and come in. Do you like my new car?”
And I sat besides he King of proud men, one of the most proficient Cardiac Surgeons, Dr. Nitu Mandke, in his Lexus. The feeling is unforgettable, not only for the Lexus, but for his simplicity, love and affection for a nobody of a junior doctor like myself!
Needless to say, then onwards, I have guarded my pride as a doctor more than any other possession I have. That took away many opportunities and huge finances, still I am doing quite well by God’s grace, and Dr. Mandke’s blessings.
How I feel about myself is more precious than anything I can earn. The luxury of pride is mine.
© Dr. Rajas Deshpande
Dedicated to all students, resident doctors, proud people in every field, student unions and their apolitical fearless leaders.
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Targets and Doctors: A Fatal Flaw

Targets and Doctors: A Fatal Flaw
© Dr. Rajas Deshpande
“What will you become when you grow up?” a common question heard in childhood. Always weary of doing the routine and fond of a little spice in life, I had kept a list of answers to surprise and occasionally shock the questioner uncle / aunt, based upon the spontaneous dislike they generated by other questions and general behaviour and replied something like “It’s a secret” or “It depends upon when in future” etc. There is no better revenge than vagueness for some. In the moment when they paused to react to that vague answer, I would make an innocent face and ask “What was your percentage when you were my age?”. Then the explanations of how things were more difficult and in general marks were lower back then were very entertaining! Curiously, those uncles / aunties did not ask me further questions. Target hit.
© Dr. Rajas Deshpande
For the better and polite class of grown ups, I had the standard answers that my parents would like: Doctor, Scientist etc. The real answers were too “out of the league” for the culture I grew up in then. One thing was sure: the big-eyed respect that the words “I want to be a Doctor” evoked from the listener was sure better than any other response.
Somehow the wish to become a doctor caught hold better, probably because of parental influence. Once I completed MBBS, I loved the actual interaction and started realising the enormous satisfaction potential that the skill generated. The ‘high’ of vast complicated knowledge sharpened daily by experience was superior to the ability of a non-medico to understand or praise it. It was an autonomously growing satisfaction.
Then came the thought that I want to learn more. There are better skilled people, who could treat better than me. Getting admission to MD Medicine was very difficult, there was no question of paying in private colleges as we could barely even afford the govt. medical college fees. A lot of somersaults later, I got admission. There was an explosion of medical knowledge and wisdom suddenly, and there was no choice but to comply. Good and bad patients, good and bad teachers, good and bad friends, good and bad times were all drowned by the prime necessity and survival technique of every genuine doctor: Study!© Dr. Rajas Deshpande
Ego is greedy. Mine too. After MD, there was a desire that I want the highest specialisation: DM. More battles. More scars. All worth the title. With that degree, it felt like I have won the world.
At that time if anyone had said I worked for a financial target, I would have declared a war.
Many more steps in education later, I woke up to the naked reality: however good a specialist you become, you have to either have your own multicrore hospital, or work at someone else’s. Basic medical practice is far different from specialty practice, which requires more time, more investigations, intensive care and complicated treatment strategies / surgical techniques.
When one joins a private hospital, one realises this more intensely: there really are good and bad specialists. Some are very thorough in their academic base but cannot convert that in good patient outcomes or numbers. Some are very sweet and courteous with patients but they lack proper skill, knowledge or experience. The spectrum is wider than one can imagine. Obviously like in every profession, some think of earning more money as their primary aim.
Anyone who owns a hospital must invest many crores of their private money, directly or via bank loans. Sometimes the govt. helps in reducing the cost of land. But in each case, the maintainence cost of any hospital runs usually in lakhs to crores, more with each bed added. Intensive care beds are the costliest investment.© Dr. Rajas Deshpande
When the owners of any hospital invest crores of rupees, they have targets to return their loans., to maintain the expenses that run in crores again: right from 24/7 failproof electricity and water arrangements to the availability of medicines, stents, catheters etc. in the hospital premises. The nursing, reception, helper, technician staff (in most major hospitals, the staff runs in thousands) must be engaged in three shifts, and paid in time commensurate with other establishments/ professions.
The only help that comes from the govt. is initial subsidy in land / water prices. There are no tax relaxations for any hospital/ staff. 20% of all services and beds are reserved for the poor. (If anyone has doubts that the poor-reserved services are not utilised, they can verify with the charity commissioner any day). On top of this all govt. employees must be seen at pathetically low rates, and even that amount is usually pending to be paid for years if not decades.© Dr. Rajas Deshpande
Add to this the profiteering that the medical insurance companies have created: on one hand twisting the arms of private hospitals to provide specialty medicare at bare minimum rates, while on the other hand declining many deserving patients medical coverage due to idiotic reasons.
In this scenario, the last thing that a corporate / private hospital can afford is a non-performing specialist, whose salary runs in lacs of rupees every month (which is what that cadre deserves).
Most corporates / private hospitals are aware of this, and usually support a budding practitioner till his practice picks up. After that, the least he / she is expected to do is to maintain that level of practice or increase it, returning the investment that the hospital has made in his growth. The provision of a furnished room, electricity, washroom, cafeteria, parking, staff and salary to a non-performing or underperforming doctor is not affordable for every hospital.© Dr. Rajas Deshpande
This generated the word “Target”, which was quickly coloured villainous by many. Which financial endeavour can be run without setting financial targets? If anyone is naïve enough to think that all hospital owners will invest their hard earned crores for charity and leave the returns to fate, they must get examined by a qualified practitioner. If the hospital cannot generate enough profit money, there won’t be any growth in medical technology. If they cannot repay loans, the hospital will be confiscated by banks.
Many hospitals of excellent doctors have closed down because they could not sustain the charity they attempted. Indian poverty and healthcare need is beyond the capacity of even the govt. to cope up with, so to expect a private company / doctor / hospital to provide free / concessional high quality continuous medical care to everyone can only be a fool’s dream. This applies to the MRI centers, diagnostic facilities, labs, physiotherapy units etc. where multiple crores are invested.
Some hospitals realised the potential of profit making in this “Target setting” and turned greedy. Mostly good specialists do not stay at such hospitals. Even if most hospitals pinch most doctors to achieve certain numbers, not every specialist works to achieve that target. I know many who would rather keep their ethics and be good clinicians, still staying in the lesser favourite class of management, rather than selling their ethics to shine among the administrators.
The notion that “Every specialist in every big hospital is working to achieve targets by deceiving the patient” is a fatal flaw developing in the mind of our society . Fatal because this also generates fear of going to the right specialist or reaching too late for them to be able to save life.© Dr. Rajas Deshpande
If I cannot afford a Mercedes, I will drive the car I can actually afford, rather than blaming and maligning the entire car industry. Many other cheaper, equally safer options are available for travel.
The problem is, everyone wants the best, highest class of super specialty medical care in luxurious set-ups, at the price list of a sarkari dawakhana. Most doctors who studied in govt. hospitals know that the quality of doctors is very good there too, but if we give that option to the patient, they say “No, not in sarkari” because they want to avoid long lines and “general population treatment”.
As the doctor is the only responsible face that the patient sees in the hospital, many obviously end up thinking that every penny they pay is going to the doctor, at least in percentage. Many will be surprised to know that a doctor usually gets less than 10 % of the total hospital bill as his fees in most cases.
Few will understand that the real “Target” that most doctors work for is to do good to the patient, to save lives. Millions of successful treatment and surgical outcomes from the corporate and other hospitals are a proof of this.
© Dr. Rajas Deshpande
Dedicated to the private hospitals started with the aim of making available specialty medical care for the society and caught up in unfair, unjust allegations because everyone wants free healthcare.
PS: There are greedy doctors and hospitals, like in every other profession. This article is not about them. It is wrong to advise patients unnecessary procedures / tests to achieve financial targets. This article is to explain to the society that target setting is essential for any hospital where recurring investment in new technology and maintenance is also the responsibility of the owner.
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The Customer and The Patient.

The Customer and The Patient.
© Dr. Rajas Deshpande
“I have seen the patient. In my opinion she has multiple lesions (injuries) in her brain because her nerve fibre coating is destroyed. You will need some tests, and an MRI of brain.” I told the family.
Affluent, educated and polite. Patient, her parents, brother and an uncle.
Then there followed a 30 minute viva. All of them asked me questions about her medical condition. They had extensively googled, and had over fifty questions about the causes, types, her symptoms, diet, lifestyle, job, exercise, physiotherapy, marital life, treatment options all over the world and what not. I am proud of my patience, but when the questions started repeating, I politely reminded them not to.
This disease being my specialty, I was only too glad to be able to answer every question. As I wrote down the investigations, they looked at each other as if they had planned a surprise for me. The brother went out and brought in a huge bag. © Dr. Rajas Deshpande
There were consultation notes of at least 5 other neurologists, two from my own town. Repeated tests were done. Four of the five had diagnosed her correctly, and had also written the standard tests and management.
“We were very upset at the earlier neurologist. He did not have time for consults at all. And she was not happy with his attitude. So we wanted to know if he was right. That’s why we didn’t mention it earlier.” said the mother.
I kept my poker face on. As all tests were already done, I reviewed the results and wrote them the treatment plan. There was further screwing about the side effects of the medicines (I want your personal number in case I have side effects) etc. © Dr. Rajas Deshpande
The father spoke. “Yes Doc. I am working as a senior govt. officer, and we have free tests and medical consultation. If you want to repeat any tests, we can get them done at any hospital at low rates”.
They got up. I noticed that the uncle was fiddling with the smartphone. Alarmed, I asked him, “What is that? Were you recording?”
“Yes doctor, we don’t remember the conversation so we keep recording every time we meet anyone” he said without any change of expression.
I lost my patience but did not react. I was not scared of the recording, but they had to know it is wrong to record an informal conversation without the doctor being aware. But there was no time. Outside, they fought with the receptionist about my fees, and demanded that they be included as govt employee category (which has to pay @ 52 Rupees as a specialist consultation fees).
I declined. The first consultation and a second opinion can be free for such govt patients, not the whole medical hopping and shopping.
The next patient came in. a lively and smiling software professional with her father. He had obvious signs of Parkinson’s disease and was having too many side effects of medicines. As I changed his prescription and informed him of possible complications, he smiled and said “I am in your hands, Doctor. I know you are not God, but you are like a God to me. I accept all the risk. I know my illness is not your fault. Do what you think is best for me. We are not very rich, but we will try and do whatever you say”. © Dr. Rajas Deshpande
The first case went down in my mental diary as a “Customer”. The second one as a “Patient”.
There is a lot of difference that the doctor has to opt for when dealing with these two categories. In case of an arrogant, suspicious, accusative patient / relative, the doctor automatically turns his medical safety switch on. These patients will require more documentation, longer consults (hence more fees), more tests (courts always ask for proofs), safest, low profile medications that may take longer to act, and lowest reassurance. That because a simple “he should get better” is being recorded and “you said so“ will be questioned in future. So the doctor, even when asked in front of the patient, has to frankly tell all the bad possibilities about the patient’s illness. That further depresses many patients, especially the elderly and anxious. Most of these “offenders” are usually continuously dissatisfied, whatever you do for them.
One cannot put a gun to a doctor’s head and then expect him / her to be loving, compassionate and perfect. As many doctors will have realised, medical optimism is dangerous. © Dr. Rajas Deshpande
The doctor wants the outcome for each patient to be the best too: which doctor would like to be a failure?
One can easily deduce that the patients will also make such categorisation as “Doctor versus Businessman”. That is true too. But the difference is that the “Businessman” doctor is still an educated, qualified person who is trying to do good to the patient in most cases.
A judge can knock his hammer and shout “Silence” and punish the misbehaving. A policeman will lock you up if you misbehave or offend him. A minister or a government officer will have you thrown out by his security. A performer or a musician will not tolerate disturbance. There is no other profession where you tolerate insults and demeaning behaviour. © Dr. Rajas Deshpande. The nobility of a doctor (or a nurse) is that he / she will still try to do good to their offender.
Once the complete and genuine trust is felt, most doctors go out of the way to help the patient. Many will never realise, but almost every doctor has over hundreds of non paying patients: relatives, other doctors, teachers, poor patients, maids etc., hospital staff and many more. Add the forced free patients: politicos, govt. employees, and the pseudopoor.
Every “Doctor” wants to treat “Patients”, and this sacred relation still exists, although waning. I feel it is more of the doctor’s responsibility to improve this relationship. For their own good, as much as for their patient’s good.
As for the “Customers and Businessmen” mentioned above, I think they complement each other, and the true “Doctors” and “Patients” should avoid both of them.
© Dr. Rajas Deshpande

The God Pendulum

The God Pendulum
© Dr. Rajas Deshpande

Dr. Aman handed over his car to the valet, and went to the rooftop restaurant, his favourite rendezvous. The captain soon brought over his favourite coffee pot and some starters.

‘The look of love’ by Kenny G started playing. It is impossible not to feel inner peace and romance while listening to that piece. Dr. Aman started to think. Yes. He had much in life to sort out.

Sunday late afternoon. The only afternoon to relax if lucky. A moment of peace so precious, that even family duties take a back seat, the mind is so tired of the heavy duty medical practice. Heavy duty because mistakes are not allowed, and seldom forgiven. © Dr. Rajas Deshpande

It is difficult to relax at home too. The society security staff, maids, some ‘sudden’ old friends from god-knows-what-stage-of past will want home consultation, and it is rude for a doctor to say no to any health queries by anyone, anytime, anywhere. Cellphones have become the worst health hazards, more so for the doctors.

He had two patients under his care in the hospital, so he decided not to switch off the cellphone, he was responsible should they have any problem in the hospital.

The phone of course rang.

“Sir, casualty. One GP has referred for you an old lady with convulsions. She is quite bad” the medical CR appeared disturbed.

“On my way” said Dr. Aman, paid his bills, and reached the hospital. On the way he kept on giving intructions to the junior doctor.

The 65 year old lady had had fever for a week, not taken to the doctor, treated by her non-medico daughter and son with home remedies. On the seventh day, yesterday, she had had many vomitings and became unconscious. The local GP gave her some basic treatment, and sent her to the city as she had no facility to treat such a critical case. Since that morning she had also had convulsions.

She was already intubated in the critical care unit when Dr. Aman reached. CT scan of her brain was normal. Her sodium levels turned out to be dangerously low. The management requires skilful vigilance, and it was already started. © Dr. Rajas Deshpande

Her daughter and son were waiting outside the ICU. Dr. Aman updated them about her condition.

The angry son asked “Why is her sodium low? Is it because of the medicines given by the doctor yesterday? I it the side effect of those medicines?”

Dr. Aman had now acquired the skills to tame his anger. He told that it was because of the vomitings, and that they should have taken her to the doctor earlier when she had fever.

The daughter started with an emotional appeal, speaking loudly “Do whatever you want, doctor, please save my mother. You are like God to us. Nothing should happen to her. We are ready to do anything. Please save her”.

“We are trying our best. Let’s hope she recovers” Dr. Aman said the legally correct thing.

“So when will she become normal?” asked the patient’s son.

“It is not predictable, we need to reassess her after convulsions stop and sodium levels are corrected” Dr. Aman replied. © Dr. Rajas Deshpande

“So why don’t you correct her sodium levels right now?” asked the son, as looking at the surrounding relatives as if he was suggesting the obvious that the doctor had missed.

“If sodium is corrected faster than a certain rate, she will develop paralysis, it can also be permanent” Dr. Aman replied, and added “Look, boss, if you do not have trust in our treatment and skills, you can please shift her to any other hospital you wish.”

“No. no doctor. We trust you. You are like God for us. We brought her here because this hospital is big and famous, and has all facilities” said the daughter. The son just kept on looking angrily at the doctors.

On the third day, the lady became conscious. On the fourth day, she was off the ventilator.

“When will she be shifted out?” the daughter asked.

“After a day of observation in the ICU” said the junior doctor.

“Why is it necessary to be in ICU now?” asked the son.

“Because she still has fluctuating oxygen levels, and needs continuous observation” replied Dr. Aman. © Dr. Rajas Deshpande

“Why cannot you observe her in the ward room? The ICU is so costly” the angry son kept muttering.

On the fifth day they requested discharge, as the patient was walking. Her weakness was still fluctuating, and her BP was low. She was discharged on request.

Within an hour, a crowd surrounded Dr. Aman.

“What is this? Is this any bill? Are you doctor or a thief?” the daughter started shouting, to a full audience of the waiting patients.

“Listen. You knew these charges when she was admitted. I do not own this hospital. The rates are standard, and so are the criteria for free or concessional patients. Please speak to the billing department.” Dr. Aman kept his tone low still. He did not want to point at the two costly cellphones that the son flaunted.

They did not qualify for free treatment as per the govt. norms.

“Doctor your fees is also there in the bill. Atleast cut that off. We cannot afford.” The son insisted. The waiting crowd surrounding them stared at the face of Dr. Aman. “Will the doctor be human and help this poor?” was the mob expression.

To save time, Dr. Aman asked the billing clerk to scratch off all his consultation fees. Saved time is more precious than earned money for the doctor.

While leaving, the daughter looked angrily at Dr. Aman and said “We never thought that doctors will be so rude and commercial. Curse upon such doctors who extract money from the poor”.

A doctor must digest all kinds. All patients who had witnessed the scene were doubtful and upset. They knew nothing about the patient and what had actually happened. They had just witnessed the last scene.

Just five days later, the whole family returned in panic. The lady had developed many convulsions as she had stopped the medicines after going home. Now she was unconscious because of the low oxygen that had damaged her brain. This could take a long time. © Dr. Rajas Deshpande

The daughter started “You are God, Doctor, please save her” etc. etc.

Dr. Aman gave instructions about the basic management to the emergency team, then turned to the daughter and said “I am sorry. I am busy with other patients, please take her to another doctor or hospital. I cannot attend her”.

“Can you refuse a patient?” asked the son, as if he had taken a special training from Mr. Ram Jethmalani.

“Yes, I can” said Dr. Aman “No one can expect a doctor to take correct decisions under duress, threats or abuse, and if I think there’s risk to my life or reputation because of ill behaved, hostile relatives, I can even refuse emergencies”.

There was no guilt in his mind when he started the car. He had become a doctor to serve the sick and suffering. Those who did not value him, his work and his profession did not deserve his service. His dignity was as important as his humanity, he would not sacrifice it for those who didn’t deserve it.

© Dr. Rajas Deshpande

The Sweetest Pinnacle Of Life

The Sweetest Pinnacle Of Life© Dr. Rajas Deshpande

To many students who are lost in their search for the right aims and goals in life, who trusted me enough to ask that question, I have suggested that they imagine what they actually want in their life at its Pinnacle.

Success, riches, fame, awards and accolades, a legacy, achievements are all good to show and leave behind oneself. The truth is far more than that. Love and care, affection and respect in one’s evening of life is what everyone deserves, but few are fortunate to achieve. For what good is s life that spends its aged years in desolation, isolation, despair of an uncaring, loveless family one has sacrificed much to bring up well?

Hollow words of “show- love” and “pretend care” are commonly employed everywhere, especially among the rich, educated and culture-claiming pundits of humanity.

One experience I have is worth sharing: that the poorest of the poor, like the farmer in the wheelchair here, are cared for with far more genuine love and affection than many. This family collected alms and help to get him to India, and never asked for any concessions, free treatment etc., always saying they were willing to do anything for the happiness and health of this grandpa. His son standing by his side is an illiterate farmer, but is caring for his father . quoting proudly “He brought me up!”. There is no smell of “I am obliging my parent” in his behaviour.

I have met hundreds of Arabic Muslim patients who care for their parents, sons and daughters equally well, willing and with total faith in the treating doctor. It does not change with their financial status. They insist on the parents staying with them, ask questions about their food, exercise, medicines, happiness and comply strictly with the given instructions.

They naturally do not know the words “Culture, Rights, Medicolegal, Elderly care, Nursing Homes, Mercy Killing etc.”. Rarely have I seen them unemotionally “okay” with a bad diagnosis of a parent.

This old man, in my personal opinion, is one of the luckiest human beings upon earth!

© Dr. Rajas Deshpande

Thank you, Mr. Naser Ali, Mr. Abdul Hakim Mohd. Al Malahi, Mr. Majdi Jamil Aiselwi, Mr. Ahmed Anwar Aqlan!