Monthly Archives: January 2017

Stop This Anesthesia

Stop This Anesthesia
© Dr. Rajas Deshpande

“Why so Doctor? Why cannot my child be like others?” asked the angry mother.

Just as I started to reply her, the patient: a 23 year old boy, went into a flurry of jerks. His body stiffened up, his eyes rolled up, and his face turned blue. He was already on the examination bed. Me and my student tried to support him there. We activated the code blue, just in case.
But the fit stopped. The boy came to, gradually. The nurse cleaned the bloody froth from his mouth. Heart rate and BP were normal now. Patient remained confused.

The mother, silently sobbing while patting his head, showed me the many large scars upon his face, head, and elsewhere. “He falls down many times every day and often injures himself. Can you imagine, doctor, what a mother’s heart feels to see her child bleeding every day?” © Dr. Rajas Deshpande
It was a case of hypoxic brain damage. The child was born in a village, the labour was prolonged and they could not reach a bigger hospital in time. If they had facilities, the child would have been normal today. Since birth, the child had had mild mental retardation and convulsions resistant to many medicines, They refused a surgery. I tried to counsel them. In many cases, we can control fits with a good combination of different medicines. But that takes time over a few months.

“We are farmers, doctor. We cannot stay home all day, we need to work to earn. The medicines are all so costly. I can sell everything to treat my son. But please tell me this will stop” the father’s voice was quivering.
It is easy to expect a doctor to detach himself emotionally from the patient, but then it is also like denying the patient empathy and understanding so crucial to their wellbeing.
“I will try my best, and I feel we can control the fits with medicines. Also, I can arrange for free medicines for your son whenever you cannot buy them. Never worry about my fees, I will be happy to treat him free. But make sure that his doses are never missed.” My teachers spoke through me.

“What after my death? Who will care for him? Who will bring him medicines? Who will ensure he takes them?” said the hefty man, and broke down. The proud feel it most difficult to declare their agonies. He tried to hide his face. The father and the mother sobbed on either side of the patient, who wasn’t yet alert enough to grasp it. © Dr. Rajas Deshpande
“There are some help communities and groups for epilepsy patients. We will enroll him into one. They will arrange for his medicines. I will also introduce you to some pharma companies who will give him free medicines as required”.
Then, pausing to realize the unasked question, I replied “And after me too, my students, colleagues or most doctors I know will never decline to treat him free. You just have to show them this note” .
I made a small note of such a request. I have never known any of my students or colleagues refuse to see a deserving patient free.

The tension in the room was melting. The parents had stopped sobbing. A possibility of hope and reassurance destroys the worst of darkness. The father folded his hands in gratitude, but couldn’t speak. The patient had a glass of water and they left.
But my mind was on fire again. Who’s guilty here?
Shall we blame fate for the blatant failures of a system? © Dr. Rajas Deshpande

Why didn’t their village have facilities to ensure good delivery? Why wasn’t it possible for them to reach bigger hospital in time? Who is responsible for millions of children who develop lifelong preventable illnesses just because of a cruel lack of healthcare infrastructure? Patients with heart attacks and strokes and cancers die everywhere everyday, unable to afford treatment or to reach hospitals in time.

In a country that needs serious improvement in almost every area of healthcare infrastructure, the whole focus is being directed at the repeated exams for doctor’s requalification.
Do we need it at all in a country that is grappling with critical shortage of doctors, and where we are promoting every other pathy to allopathy with a six month training? We need many care homes, support systems for patients who cannot afford medicines. Many more ambulances. Many more hospitals in remote areas, Many more qualified doctors to work there while being able to afford a dignified life.

But the only decisions being made are about more exams for truly qualified doctors: why? This tranquilizer to divert attention from the main issues that need correction is the worst treatment possible for Indian Healthcare. © Dr. Rajas Deshpande

Doctors are never defined by the examinations that they pass, being a doctor is far more than passing qualifying examinations. But who will educate those who never bothered to pass any dignified exams?

Just before inducing the anesthesia, the patient is told “You will feel sleepy now. Everything is ok. Take a deep breath”. With complete faith, the patient goes unconscious. It is the doctors who ensure he / she returns safe. Some rare unfortunate patients never know that they will never wake up, because there are things a doctor cannot control.

That unfortunate patient is just like the Indian Society today.
How qualified are the healthcare policy decision makers?
© Dr. Rajas Deshpande

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Sirs, Madams, Soldiers and Slaves

Sirs, Madams, Soldiers and Slaves
© Dr. Rajas Deshpande
 
“Who will face the bullets on the border if everyone starts arguing?” shouted the officer.
He was a municipal corporation deputy chief in a metropolis. I was representing a students’ union for resident doctors, and we were demanding two major changes: that our salaries be deposited in a bank (hundreds of resident doctors, wardboys and other staff were supposed to queue up within the first three days of every month, in front of the accounts office to collect monthly salary, some could not because their duties did not allow them), and that the libraries be kept open 24 hours, as our work hours were never defined, and rooms being shared, it was not always possible to study in hostels. The demands were many years old, nothing had moved.
But this time we had decided to use a new weapon: Strike. © Dr. Rajas Deshpande
Sensing trouble as we had recently carried out a successful strike, the deputy chief blasted his arguing lethargic assistants who resisted every change: the hallmark of most administrations.
That’s when the deputy chief shouted upon them and ordered to comply immediately.
“Yes, Sir” they said. The next month, both these things changed in all Municipal hospitals. Threat had achieved what the system would never have allowed to happen.
 
Few years later, studying in Canada, almost every boss or senior I met insisted that we call him / her by name, and not Sir / Madam. “It stinks of slavery somehow” said a professor whose thinking affected me profoundly. © Dr. Rajas Deshpande
“Why are so many brilliant Indian students so intimidated to openly argue, come out with suggestions or put forth a contrary opinion in front of their boss?” he once asked me, “I don’t think respect can be placed above logic. So I think fear must be involved”.
 
That set me thinking. It was true. From the parents who directly start slapping children for questioning them or talking about issues like sexuality, to the teachers who misuse their authority to suppress students by threats, failing in exams and scarring their CVs, we had grown up in the dual pressure system: cultural limitations that prevented thinking out of box, and intimidation by fear of humiliation and failure: from both family and teachers. There were rare honorable exceptions: teachers and parents who encouraged to think free.
 
What happens when someone in India argues against the prevalent system? First ridiculed, then refuted, threatened and often destroyed or outcast by the system whose malfunction he / she has questioned. From judiciary to journalism, from schools to parliament, and from doctors to labourers, his/ her own people question his / her sanity or intention. © Dr. Rajas Deshpande
 
No wonder we have mastered the British art of establishing a foolproof slavery system.
 
Look at the scientific and literary outputs. Look at the productivity and innovation. A country that boasts of geniuses is happy to play the role of “cheap intellectual labour”, proudly flaunting the business, outsourced to it primarily for low costs, as an achievement. These super-talented brains in business or in any other field must only walk the narrow path, at the speed of one of the slowest systems, limited by humungous paperwork, red tapism, favouritism and corruption. . Public condemnation and humiliation await those who differ in their opinion.
 
What happens when one follows all the rules of argument in such a system?
 
Suppose a soldier tired of his heavy duty without adequate food complains about it to his superior, what is the typical answer he will get? Is it too difficult to imagine what will happen to his career? How many are the chances that a military superior, a government officer or your own boss will say “You are right, my dear, I am sorry you had to face inconvenience, we will correct this immediately” and do it? Sorry. We grow up with incessant reminders of how we are second to, under, helpless, and lesser than the people we work for, including our administrations. © Dr. Rajas Deshpande
 
We live in a fool’s paradise. We like to stay hidden behind the fears of our little sins and mistakes (who doesn’t commit some?) being exposed, our socio cultural apple cart being upset and our perpetual orgasm with comfort zone being threatened.
 
When the hallmarks of slavery: calling everyone “Sir” or “Madam”, standing up, bowing, compulsory greeting, applauding and agreeing without pausing to think or argue are so perfectly blended with cultural traditions of respecting the elders, we create a foolproof prison for thought. It is indeed a mystery why a country which has so many elders, and so many respectable people, is yet to be at the top in any field! Do all these “Sirs and Madams” truly behave or achieve to match that respect?
 
A country where seniority, relation, political strength and connections, nuisance value, money and age surpass all other intellectual criteria of leading and promotion by merit, do we really dream of becoming number one in the world? © Dr. Rajas Deshpande
 
Every genuine intellectual, artist, scientist (and there will be many who will throttle up their throats to praise the existing system for obvious rewards) will dislike being tied down by limitations. The ones who have spent their youth standing up and saluting “Sirs and Madams” have had their time. It is high time we start thinking of the youth and the future generations.
 
When I returned from Canada, I had changed. I knew I could not change the system, but I could definitely change myself. I have since then never expected or insisted anyone calls me “Sir”, respects me out of context, or stands up / greets me. I prefer people, even students calling me by my name, and it has never taken away the affectionate relationship we share. I have always encouraged my children, my students and the scanty number of friends to be completely free in their thinking, to think of the whole world as their home and humanity as their culture, to politely argue without arrogance or spite, and to accept what is right without thinking who said it. Those who presume that “uncontrolled freedom will always go in wrong direction” confuse between misuse of freedom and non adherence to civil duties.
 
This small contribution to eradicate slavery of thought was one of my many duties towards life.
 
As for the soldiers on the borders of any country, who just “take orders from people sitting in air-conditioned offices, to face bullets,”, let us at least gather some courage to stand up to the sacrifice they make in the name of their country, and try to realize the meaning of this precious word : Freedom.
© Dr. Rajas Deshpande
 
PS:
Only for free thinking intellectuals.
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Emergency: The Doctor Is Not In

Emergency: The Doctor Is Not In
© Dr. Rajas Deshpande

“It’s an emergency, doctor” shouted the angry son at my OPD door at closing time, around 11 PM. We rushed to the casualty. It indeed was an emergency. His father had developed a stroke, and was found to have a moderate sized bleed in his brain.

His younger son who had done some medical diploma in some yet-unrecognised pathy had stopped his father’s blood pressure and diabetes medicines three months ago. “I was observing him at home. The BP was high and the sugar was around 300, but I was trying my own medicines, as I don’t have faith in allopathic medicines” the son told me without a trace of shame or guilt.

“How long has your father had these high BP and sugar levels?” I asked him, impatience choking me.
“May be a month” he had replied coldly.
The treatment initiated by the casualty doctors had stabilised the patient. © Dr. Rajas Deshpande
As we returned to OPD, the angry resident doctor with me said “He should be booked for attempted murder”.

Within three days of the admission, both the sons of this patient decided to take him home. Patient had still not recovered his consciousness well, and was being fed via a feeding tube. “We will manage him at home. We will call you if anything is required” they told me.

Grown up by now, I replied “I am not available on phone. Please see your local doctor or take him to the nearest hospital should he have any problem”. © Dr. Rajas Deshpande
“What if it is an emergency? He is under you care” the elder son asked aloud, in a threatening voice.
“He is not under my care once discharged. We will advise him medicines and give other instructions. I am not your paid servant. I am not available for consultation on cellphone” I told them my working hours. I had not become a doctor to be abused by those who wanted to save time and money. © Dr. Rajas Deshpande

Then over four months later, the two brothers entered my room at 9 PM.

“Doctor, our father is having vomitings with blood since yesterday morning. He is not responding well when we speak. Can you prescribe something?” the elder brother asked “He is at home, we thought we will first give him some medicine and try”.
“Why didn’t you admit him even when he had bloody vomiting yesterday?” I asked, almost knowing the answer.
“We thought it will stop. Also, there was nobody to admit him. We both have our office jobs.
“I cannot prescribe anything without seeing such a serious patient. You must take him to the nearest hospital with a gastroenterologist. Please treat this as an emergency” I told them. © Dr. Rajas Deshpande

However their calm was unruffled.
“We will take him to some hospital near our home. They will treat him immediately no?” asked the younger one.
Before I could reply, the elder brother raised his voice again: “They will have to. Or we will show them. This is an emergency. If something goes wrong, we will bring down the hospital”.

In two days, we read the news of a small nursing home ransacked and destroyed, doctors manhandled by relatives because this patient had died. The doctors who tried to save him were arrested under an allegation of “attempted murder”.

The word “emergency” is as familiar to every doctor as his own name. Hundreds of deaths in casualty are related to delayed admission at the terminal moment, and no one looks at the gruesome ignorance, neglect and delay behind the scenes, which equals murder by the patient’s own friends/ relatives. © Dr. Rajas Deshpande. Addicted to thoughtless emotional outbursts, our society usually reacts without logical thinking except few intellectuals who do not constitute a vote bank.

Drug reaction? Beat up the doc!. Patient in casualty or hospital died? Beat up the doc! Arrest them! Jail them! If the same patient is killed due to wrong treatment by his relatives, or dies at home because he was never taken to the hospital by family members: it’s okay!

Many who are advised right tests don’t do those. Many who are advised right medicines do not take them. Many do not undergo the correct procedures / surgeries advised. Because the patient is “King consumer!” Then when their health deteriorates. It is suddenly the medical profession that becomes responsible for everything that goes wrong.

Time has come for IMA to demand an enquiry into the circumstances few hours / days / weeks prior to every death in casualty and emergency where the doctor / hospital was blamed. Right from neglect, ignored medical advice to hidden information, many skeletons will tumble out. An IMA legal cell should start filing cases of culpable homicide in every such case. Then alone, equality principle will prevail.

Time has come when small hospitals, nursing homes and clinics, which were earlier trying to rescue serious patients in emergency, will display this board after the regular OPD hours:

“Emergency services not available. Doctor NOT in campus”.
© Dr. Rajas Deshpande

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Thank you, Life; Thank You, God!

Thank you, Life, Thank You God!
photo-07-01-17-21-14-15-2
This was my first birthday without either parent, and I woke up feeling sad about it. Who knew, by the end of the day, God will have set things right, as He always does! Add to that an important message that the day left..

Knowing myself, I cannot understand how someone can like or love such an asocial reclusive loner who is obsessive, over-expectant, irritable, slightly egoistic, sarcastic, does not party or gossip, and cannot understand many people around himself.

Somehow though, the friend list is full, thousands of wishes pour in from across the world, and personalised messages and calls and prayers for happinees, health and everything good keep resounding the day with God’s grace. I did not know how many souls I am connected to, and my heart is full of joy today that so many people actually think of me!

Many colleagues dropped in to wish (in fact since two days prior!), bringing gifts (Oh I love them!). And at the end of the day came the family: my beloved students, who come with the sole aim of make me laugh, become a child again.

To deserve this love over and over again, for this is my only treasure and achievement, I must now make an effort: to be less sarcastic, irritable, obsessive, and to be always thankful for these beautiful people in my life. I will make an honest effort!

I can never forget what my friends and students love me most for: my effort to imbibe kindness and humanity and to live a life drenched in an honest culture of creative intellect and equality. On this birthday, I have promised myself to try and improve myself every which way possible, to deserve this love and affection.

Thank you, everyone who wished me today!

Thank you God, Thank you Life, for today!
(c) Dr. Rajas Deshpande


Bravo! Aarya Ambekar

Bravo! Aarya Ambekar

A few years ago, my mother would often call me and my kids to watch especially this cute little girl Aarya Ambekar sing in SaReGaMaPa. Sweet and humble, expert at winning hearts that she is, we all loved her innocent smile and super perfect ease in singing like a pro. Inspite of being a celebrity with lacs of fans, her humility is so natural that she herself messaged me that she loved to read my articles (her father DrSamir Ambekar is a mutual connection). A celebrity herself complimenting spontaneously is an unforgettable moment!

She has worked very hard from a very tender age to maintain her singing “Sadhana” under the guidance of her mother. Waking up at 3.30 every morning just to practice music for over a decade is dedication par excellence. No wonder she has won so many prestigious awards!

This singing wonder is now lifting a curtain to display her new talent: her movie “Ti Sadhya Kay Karte” releases tomorrow. Gruelling hard work has gone into the making of this film which directly relates to almost all of us through a delicate subject in our hearts: First Love.

I wish her the best and pray for immense success of her efforts with her team.

@aaryaambekar @tisadhyakaykarte

The Wrong Sacrifice

The Wrong Sacrifice
© Dr. Rajas Deshpande

“Come home this weekend.. I feel like seeing you” my father said. He was already feeling sad, missing my sister who had married three months ago.

That was 14th October, a day prior to my sister’s birthday. I had taken a week’s leave for her marriage and preparations.
I felt sorry for Baba and desperately wanted to meet him. I was quite attached to him.

I asked my professor, and was reminded that there was a shortage of resident doctors, we had a ward full of 50 patients, 10 more than the capacity. “You have to sacrifice some things once you become a doctor, Rajas. I am sorry, but you cannot get leave at present” my professor said.

Late that night I called Baba and told him so. I could feel the heaviness in his throat as he replied “Ok. I am proud that you value your duty and responsibility above me. Take care. And yes, don’t forget to wish your sister tomorrow for her birthday, and get her some good gift. She must be missing us too”.

I had had one of those cruel “brother-sister” fights with her, and we weren’t talking. Another carefully protected window to our childhood, we enjoyed those fights which multiplied our love.

“You have always sided with her, Baba. You are partial to her” I replied with pretend-anger.
He laughed “That’s because I have made you tough enough to take care of yourself in any situation. She has a delicate mind” Baba said.

I assured him I will call her. I did, and wished her a Happy Birthday. She was ecstatic. That evening on 15th October, I called up home. My mom picked up. She told me that both of them were feeling very sad about being away from us especially because it was sister’s birthday. “Baba has tears in his eyes all day” she said.
I tried to cheer up Baba. “I have called your laadli daughter and wished her. I have also sent her a nice dress from Mumbai. Now you have to buy me something when I come home okay?”
“When will you come?” he asked again.
“As soon as my professor allows” I replied.

The next afternoon, on 16th October 2000 at 2.30 PM I received a call that Baba had had a sudden cardiac arrest and passed away. I suffer that call till this minute. I will never recover from the trauma of that moment.

Now, whenever someone questions the integrity of a doctor, the honesty and hard work of genuine doctors or accuses them of working only to earn money, or high-handedly suggests that the hardships and sacrifices involved in this field are ‘chosen’ and mandatory, I feel I made a wrong sacrifice for an undeserving society.

There are sayings in every religion about some animals not understanding their holy texts. Medicine is my religion and I will not explain its holiness to the donkeys who refuse to understand it. Be it the corporators, MLAs or MPs from ruling parties who attack doctors, Journalists or reporters who spew poison against every doctor, or the perpetually “cheap and free” demanding class.

There are thousands of doctors who have gone through this situation: sickness, marriage, rituals and even death in their families which they could not attend just because they were working to save someone, attending other patients. I know of umpteen doctors who got one day leave for their marriage, when their child was born, or their parent was sick.

Before you question a doctor’s intent and integrity, before you talk loose about this profession, please do search your soul.
© Dr. Rajas Deshpande

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