Monthly Archives: April 2017

The Remedy of Trust

The Remedy of Trust
© Dr. Rajas Deshpande
 
I entered the ICU in a torn and angry frame of mind. An old patient had had fluctuations in heart rate and blood pressure all night, and was on the thin line between life and death. Irregular heart beats had clotted his blood and he had developed a paralysis.
 
I had had a terrible argument with family that morning, and had left home without a breakfast, thinking that I will catch up in the canteen if hungry. The traffic on the way was as usual bad, it further worsened my mood. Messages kept pouring in: pending bills and health enquiries that were an attempt to avoid a proper consultation. One can ignore, but sometimes ignoring is stressful too!© Dr. Rajas Deshpande
 
As I entered the hospital, I was told about some machine not working. The technician had commented that it was beyond repair now. New one would cost over 30 lacs minimum, and this machine was required on a daily basis. My head started pounding. Another loan now, another recovery period!
As I passed the billing counter, an imposing rogue with a group stopped me. “Sir, the bill is too high, do something”. It was an open threat worded technically as a request. The relatives who folded hands to save the patient till yesterday were standing behind that rogue, looking unconcerned, not even happy that the patient was alive and being discharged after a life threatening illness. I sent them to the charity cell.
I entered the ICU, staring into my cellphone where angry messages of argument kept pouring in, a dear friend was upset that I was not available to see his relatives in another hospital immediately. © Dr. Rajas Deshpande
 
The old patient was sleeping. A glance at the monitor revealed that the patient’s BP was now stable. His heart rate was regular too. What a relief!
The patient’s wife got up, she was in her 80s. Fair, all white hair, and the confidence of culture upon her face, she smiled through her wrinkles and troubles. The Kumkum on her forehead was bright and fresh. She wore a torn saree, and had no ornaments except a thin thread with black beads that made her Mangalsutra. She was bending forward due to age.
She then said “He spoke to me this morning. He is feeling better than yesterday. I know he is old, but please give him the best treatment. We have been together since childhood.” Her eyes became wet.© Dr. Rajas Deshpande
 
Then she made an attempt to touch my feet, something that woke me up with a shock. A tingling feeling ran through my body. I held her hand and asked her it was ok, and returned the gesture by touching her feet too. I told her I will try my best, and her husband appeared out of danger at that moment.
She gently prodded the patient: “Look, our doctor is here. He says you are getting better. Do you recognize our doctor? Say Namaskar to him”.
 
Confused for a moment, the old man stared first at his wife, then at me.
 
He then tried to lift both hands, but only one went up, which he raised to his forehead and whispered “Namaskar”.
 
The old couple, the age of my parents, was saying Namaskar to me and touching me feet, many decades younger to them, because I was a Doctor. They never knew me until two days ago, but had trusted everything I said. They did not question my ability or intention. I like to be professional, but that should never compromise my manners.
I switched off my cellphone.© Dr. Rajas Deshpande
 
I suddenly felt ashamed of the mood that I was in. They did not deserve it. Their complete faith was to me the best return and reward of my efforts of so many years to become a good doctor. No amount of money ‘thrown at me’ by those who think of ‘buying me services’ would actually be my interest or aim. This was.
 
I smiled at the old lady, and told her that should she have any concerns, she can ask the staff to call me anytime, I would be glad to come over. Then, to repay her for bringing my smile back, I wrote on the billing sheet: “No charges for me in the case”.© Dr. Rajas Deshpande
 
When I walked out of the ICU, I was feeling proud and smiling. The faith of this patient and his wife had cured me of my bad mood too. I was prepared again to forget my personal woes, to take over the faithless hundreds, still do them good, in an attempt to reach out to the really deserving faithful, who knew their doctor would only do them good. That is the essence of my profession, my education, and my intention.
 
A patient who trusts a doctor earns for himself the best in that doctor. Always. Although we do not expect it to be understood by everyone.
© Dr. Rajas Deshpande
 
 

Gods of Humanity

Gods of Humanity

© Dr. Rajas Deshpande

About four years ago, this brilliant young man entered my chamber. He introduced himself as

Dr. Amod Kale, veterinary practitioner, and said:

“I have a different favour to ask. I have a dog patient with a neurological problem, and am not able to find any references. Will you help me treat this dog? I am not charging anything to the owner. I am doing this as my own hobby” He showed me some videos.

The doggy had some jerky abnormal movements of both hind legs. Some human medicines helped the doggy, and I became friends with Dr. Amod.

Since then, he came with many more cases: rabbit, parrot, cats and dogs who had neurological problems. These animals were either abandoned or orphaned. Dr. Amod not only helped them find a home, but went out of his way to solve their medical problems, mostly spending his own money for everything.

This time he came with a new friend, Mr. Tushar Kale. On 9th March, Mr. Tushar was riding his bike near his home, when he witnessed that another bike ran over a stray dog. The biker who had hit the dog ran away, as the dog lay there in the middle of the road, unable to move.

Mr. Tushar Kale lifted up the injured dog and took him to a government veterinary hospital. As they could not offer much help, he brought the dog home and contacted Dr. Amod Kale. Dr. Amod examined the dog, started with basic treatment, and recorded some videos to show me as he thought that the dog’s spine was broken.

The spinal cord appeared to be severely damaged, there was no movement in the dog’s hind legs. The dog was never going to be able to walk normally again, although some effort could be made for improvement, it would take months. I told the duo so.

Mr. Tushar replied: “My mother said she will take care of this dog, whatever happens, because we cannot abandon the dog in such a condition”.

We started some medicines and supplements.

Mr. Tushar’s mother, Mrs. Mangal Kale, although not educated beyond primary school, has a heart of gold, so rare in today’s world. She has taken such excellent care, that the doggy has shown remarkable improvement now, in spite of some complications like a bedsore, which also is healing now.

In a world where many choose to abandon even their parents, where highly educated brothers and sisters fight for properties but not for taking care of parents, this example of a doctor and a middleclass family caring for a stray dog is so reassuring! An example that Gods of humanity still exist and thrive right in this desert of deteriorating civilisation, mothers like this is what the Earth needs most desperately right now!

Thank you, Dr. Amod Kale, Mr. Tushar Kale and Mrs. Magala Kale, for carrying forward the one tradition that differentiates humans from animals: Humanity.

© Dr. Rajas Deshpande

“Do you want a broken leg, Doctor?”

“Do you want a broken leg, Doctor?”
© Dr. Rajas Deshpande

Three days after he suffered a paralysis, after having tried Voo Doo, Herbal and some other medicines, an old man of 80 was shifted to a big private hospital once he became comatose. The three sons accompanying him didn’t even touch the comatose patient, they didn’t even care about whether he was covered properly or not.
His Blood Pressure was too high, and he turned out to have a bleeding in the brain, untreated till this moment. His brain was swollen badly.

Every private hospital has free mandatory beds for poor patients. This family was asked about their preference and eligibility. © Dr. Rajas Deshpande
“We will pay everything. Don’t worry about the money. He should get the best room and facilities” his son said. They signed the necessary documents about knowing the critical condition of the patient, charging schedules, willingness to pay etc.
Then the sons came to me and said “We don’t care about the money, doctor, but he should get completely cured”.
This was expected, experience teaches a doctor about relatives as much as about patients.
“He is 80 years old and critical. At this stage I cannot guarantee anything. Complete recovery looks impossible, partial recovery may be hoped for if he responds well to standard treatment” I replied.
“But we will pay anything you want” the younger son said.
I involved the PRO, a lady who had far better patience than myself dealing with attitude and arrogance. Explained them once again, and left after the patient was shifted to our Neuro Intensive Care Unit. © Dr. Rajas Deshpande

The patient improved in five days. Started to speak a few relevant words. Out of danger, shifted to Deluxe Room as requested. The only person who ever attended the patient was a 15 year old grandson, mostly the patient was left alone.
The sons had by then submitted some documents claiming a BPL “Below Poverty Line” status, but those were found to be false. A fake letter in the name of charity commissioner was also attempted. The hospital PRO reminded the patient’s sons about the pending bills regularly.

It became clear that none of the three sons who earned well themselves wanted to pay for their father’s treatment. They had continuous fights amongst themselves, the only thing they agreed upon was not wanting their father. The request “He must get completely cured” was not because they wanted his health, but because no one wanted to take home a disabled father to care for years.

The hospital took a stern stand. The bills had exceeded two lacs rupees, nothing was paid. This indeed was burglary with blackmail.

After repeatedly asking to meet the patient’s sons for another three days who did not pick up the hospital calls, I told the attending boy very carefully to please remind his parents to settle the pending bills, also reminding him that nothing in the treatment will wait or change because of bills.

In two hours I received a call. It was a local Municipal Councilor.
“Doctor, do you want a broken leg? Are you a doctor or a businessman? How can you speak about money to a small boy? Just keep on treating. We will do something about the bills through our MLA. If you speak about bills again, remember, there will be news about your hospital on every channel”.

Do I have time, energy to waste, filing a police complaint? Will it be any use at all? © Dr. Rajas Deshpande

In no other industry, not even in govt. offices, will anyone be given anything on credit: even for a paper worth five rupees. Even the poorest of the poor cannot get free food or travel in private industry. But the entire private medical care is expected to go on working in ‘credit’ mode, for everyone who claims to be poor. Emergency is understood, and no hospital or doctor thinks about money in case of emergency. But once emergency is over, those who cannot afford a private hospital should go to a government hospital. A private hospital needs too much investment per bed, and anyone who questions this can please sponsor one bed in any ICU for a poor patient, see for themselves what the actuals cost.

Who will even address this Burglary and Blackmail that happens everyday in every private hospital in India?

There should be an online portal by government / police for doctors and hospitals to report patients dumped by family, families who refuse to pay, those who use threats and intimidation anonymously. Then the ‘other side’ of this story will be clear.

© Dr. Rajas Deshpande

Worse than Death

Worse than Death
(C) Dr. Rajas Deshpande

“Doctor, I have started to die. Can you help me somehow?” he asked, calmly.
In his late twenties, a handsome young man, well dressed, but with a certain painful gloom upon his face that was a mismatch to an overall nice and clean appearance. What could this be? I started thinking, hoping he was wrong.

Then his shoulder twitched, and arm had a slight jerk. A pang of suspicion bit my heart immediately. He confirmed it in few seconds. Those who take life for granted are often so full of anxiety, and here he was, who had initiated a countdown to his own death, talking to me in a low but clear voice.
“Doctor, I have been diagnosed with Huntington’s disease over 7 years ago” he said, “Till now I had only these jerky movements. Now I have started having some mood problems and also memory issues. My parents died in an accident when I was three. My uncle’s family cared for me till I could go to a boarding school. I stay alone in a rental apartment, I work in an IT company”.

Examination and review of reports established that his diagnosis was correct. There is no treatment.
This illness of brain degeneration starts with abnormal movements, then causes loss of memory and other cognitive functions, mood swings, depression, finally causing complete immobility and usually death ensues due to blockage of windpipe because of food while swallowing. A patient usually survives less than 13-18 years after the diagnosis. Some commit suicide.

What do I tell someone aged 28 who knows he will definitely die soon?
Yes there are research options and support groups. Yes I can send him to a professional counsellor. Yes I can use some mood stabilising medicines and antidepressants.
But can I emotionally detach from this event as a doctor? (C) Dr. Rajas Deshpande

Diagnose and treat with empathy, educate and move on. Don’t take home the burden of your patient’s illness. Don’t get emotionally involved in your patient’s lives and problems. Never. But is that possible?

Shall I ask him if he has any bucket list of things he wants to once experience, before he forgets who he is? Is there something there that I can help him with? Has he planned anything about his life when he is mentally or physically disabled?

I told him that some medicines can help him, and wrote a prescription. Also referred him to an expert counsellor.

What would I do in such a situation? What is it that I would like to hear from the doctor, knowing the obvious too? What is so important in life when one knows that there are only a few years remaining?

Those who have the luxury of ignorance can laugh and superficially answer. Those who answer immediately have seldom used thinking. Those who are assured of their health have changing answers.
But those who know it?

I decided to ask him. (C) Dr. Rajas Deshpande

Next time he visited, he told me that he has resigned from his job, as he had problems dealing with the responsibility. He could not ride his two wheeler too, he had sold it off.

“I am going to my ancestral village, doctor. A dharamshala (religious sanctuary) has agreed to allow me stay and food, and help me as much as they can. I am also willing to donate my body for research, so at least others don’t suffer this. But I have to finalise yet”.

In India, just as there is no scope for genuine research, there also is complete lack of any infrastructure for the care of such patients.

I decided to ask him what troubled me.
“Is there something you wanted to do?” I could not bring myself to say “before you go”.

He tried to smile. His eyes welled up as he thought about the question.
“Yes, Doctor. I wanted to feel someone loving me madly at least once. In fact I had a girl in my office whom I liked. I think she liked me too. But then my diagnosis was confirmed and I didn’t want her to suffer, so I never told her. I met her before resigning, and told her the truth”.

“Everyone will only degenerate,” he continued, “I am ready to see myself degenerate early. But the one purpose, the one good memory of life that one can wrap himself with when facing the decline, is love. Everything else only reminds of loss”.Dr. Rajas Deshpande

Then, wiping his tears and sobbing, for once, openly, without the restriction of pride, he held my hand, and said, “Thank you doctor for all your help. I came to know just now, that not having loved is what I regret most. It feels worse than death. Even if I had felt true love once, I won’t have regretted this early death”.

He had only echoed what every particle, every corner and every breath of life always reminds us of, while we keep on searching for everything else.
Dr. Rajas Deshpande

Allopathy? Oh, No!

Allopathy? Oh, No!
© Dr. Rajas Deshpande

“Doctor, I don’t believe in Allopathy. There are so many traditional remedies that work wonders. We heard of this treatment where you eat certain flowers, and they cure everything, even cancer and AIDS.”
“Doctor, we hear that there are cures to many diseases, but the pharmaceuticals and doctors want people to be ill for longer, so the right treatments are hidden, and only useless costly medicines are prescribed.”
“I don’t want any medicines that cause side effects. I am allergic to almost every allopathic medicine”.

One standard answer:
“Then why are you here today?” © Dr. Rajas Deshpande

We live in a world brimming with superstitions and claims of all kinds. From parents killing a girl child to dowry deaths, from voodoo to sophisticated five-star magic healers, we have it all in our society.

Add education and a degree (not mandatory), add internet, and one becomes the King or Queen of personalized wisdom. Now one can question anything except one’s beliefs and random internet claims. Even years of training and scientifically proven facts, good or bad.

From scorpion bites to poisons of different kinds, from heavy metals in overdose to drinking one’s own pee, there are claims of cure that have been refuted by authentic scientific research, but then the easiest thing to question and suspect today are scientific knowledge and a doctor’s integrity and training, no matter how little one has studied medicine. Just as most hospitals struggle to fight infections, people happily drink urine: mostly studded with some of the deadliest microorganisms known. The fact that many children have died of Urine therapy does not seem to affect the popularity of this myth. By this logic, a person with kidney failure who is not urinating should become immortal! But only the proponents of this therapy will be able to tell why kidney failure patients die within hours of not passing urine. © Dr. Rajas Deshpande

I had a classmate who would blindfold his eyes and cross a live railway track, to prove his courage. Whenever someone questioned his safety, his pet answer was “I have done this many times, nothing has happened”.

It stands to reason (again a doubtful criteria in some communities: why base arguments upon reason when there’s superstition?), that if you believe that all Allopathy is a hoax, you have a complete freedom to stay away from it all your life; that at least will save the Allopaths some burden and free them from the daily sins they are so presumed to commit by treating with a hoax science! May be one can wear brass badges that say “I don’t want Allopathic treatment, don’t take me to an Allopathic hospital even if I am serious”.

While some Allopathic doctors do use medicines injudiciously sometimes, it is seldom with an intention to cause harm, no doctor thrives on a bad reputation. Everyone wants their patient to get better.

Those who do believe that doctors are only after money, that Allopathy is just another deception, that most treatment choices that doctors make are selfish, they are welcome to never enter another hospital again in life. There are umpteen non Allopathic therapies from magic to music that are claimed to cure every ailment that Allopathy cannot.

Is there nothing better to do in your life than to visit places that you don’t believe in? Do you get a high questioning a doctor’s scientific knowledge while being unable to question your own unscientific hearsay myths? © Dr. Rajas Deshpande

God forbid, but next time someone is sick and dehydrated, down with a pneumonia that stops breathing, has a heart attack, or bleeding from a head injury, please call that friend who suggested that scorpion stings heal everything. May be he can help.

What will happen if children are not vaccinated? What will happen if all Allopathic hospitals are shut down?

Stand outside the discharged patient’s section in any Allopathy hospital, you will hear daily stories of returning from death’s clasps. From polytrauma to cured cancers, from patients recovering from a paralysis to stopped hearts beating again, Allopathy brings life to most. Have some respect for what science has achieved!

Allopaths should stop wasting time arguing with those who continuously belittle Allopathy and sing praises for the unscientific. Use that time for saving lives of those who need you better. The easy answer is: “Yes, you may drink your pee or pet a poisonous scorpion if you enjoy its bites for your health”. Reserve the social education for those who understand logic.

We don’t believe that science needs permissions to be accepted. What is proven goes through rigorous scrutiny and is then marketed. But then again, this is expected to be understood by only those with a certain mental education, reasoning ability and logic, those who are not carried away by every myth they hear.

As for the rest, may your faith and belief alone heal you.
© Dr. Rajas Deshpande

PS: There are some traditional remedies that help some medical conditions. That does not refute the benefits that Allopathy has brought to mankind.

“I Swear”

I Swear
© Dr. Rajas Deshpande
 
“Have you forgotten your oath, doctor?” asked the Hon’ble minister to Dr. Prasad.
 
The fat elderly reporter accompanying the Hon’ble minister laughed. “We must teach these doctors a lesson” he said.
Being a doctor, good language and behavior is essential. So Dr. Prasad swallowed the immediate reaction that had sprung to the tip of his tongue, one that involved references to some passionate human interaction.
 
He then smiled.
“Sir, did you attend any school?” he asked the Hon’ble minister innocently.
The Hon’ble minister was offended. He had not had a respectable academic record. © Dr. Rajas Deshpande
“What does that mean? Do you know who you are talking to?” the accompanying reporter raised his voice.
“Yes, I know I am talking to a patient. A human being with the same organs as me, but not the same merit or intentions” said Dr. Prasad.
 
Before the cunning reporter and the Hon’ble minister could formulate a reply, Dr. Prasad continued:
“Sir, all over India, for ten years, everyone who has attended any school has recited every morning, the National Pledge. That is our promise to our beloved nation. Let me remind you of some sentences in that prayer:
I shall give my parents, teachers and all elders respect and treat everyone with courtesy.
To my country and my people, I pledge my devotion.
In their well being and prosperity alone lies my happiness.
Tell me Sir, are all politicians, ministers, media persons, businessmen, lawyers, and other professionals following this oath that they have recited every day for ten years? If yes, where does violence come from? Not only in hospitals, but in every other home, against children, against womenfolk, against even the elderly”.© Dr. Rajas Deshpande
 
“But you are a doctor, you have taken an oath to serve” said the defiant Hon’ble, expert in the art of diverting discussions.
 
“No, Sir”, replied Dr. Prasad firmly, “I have not taken any oath to tolerate violence or abuse, or to risk my own life or limb. I have not taken any oath to feed with my blood and sweat the deficient and perpetually corrupt healthcare systems. I have not taken any oath to be nice and kind to attacking, drunk, abusive or irresponsible people who enter the hospital with an almost dead patient at the last moment and then expect the doctor to perform miracles. I have never taken any oath to treat Judges and Ministers and Rich VIPs above the poor, really deserving patients. I have not promised anyone that I will neglect my family or my own health”.
 
“I have only taken an oath to honestly treat the sick with dignity, not thinking about money. That most doctors do, some who fail are common in every field. My oath is to help a patient recover. If I fail, try me in a court of law. Send me to a court that understands law better, and appeals people not to be violent, tells governments to protect everyone against violence, rather than asking doctors to tolerate violence as a part of their duty. It is exactly as backward as like asking a wife to tolerate her husband’s atrocities as a part of her duties”. © Dr. Rajas Deshpande
 
The restless tail barked again: “But the public pays for your education”
 
“I beg to differ, sir. No one is obliging anyone by paying for doctor’s education. The country needs many more thousand doctors. And we pay taxes too, to be protected. People pay taxes for a good and cheap healthcare system, please give them that, rather than them having to depend upon private hospitals. A doctor is just a small component in healthcare. Don’t blame him for expecting the same protection that every citizen expects. The infrastructure and policies are pathetic, and an intelligent taxpayer will one day understand that the doctors are not taking home any money as their alms. Everyone knows who gets richer with taxpayer’s money, Certainly not the doctors”.
 
“As for your allegation, respected reporter sir” said Dr. Prasad calmly to the tail, “You are educated, you have a responsibility to heal social ills, not widen the bleeding wounds and survive on that flowing blood. There are so many good examples of reporters / media persons who bring immense good to our society. The ability to sit in one’s chamber with all controls, and bark at everyone, manipulate speech cunningly, distort facts pretending to be holier than others, while your seat is dipped in hidden honey is not reporting”.© Dr. Rajas Deshpande
 
“Doctor, you have too much ego” said the angry Hon’ble.
 
“No sir, intolerance to stupidity is not ego. Every religious ceremony, every professional oath makes us repeat the good we must do, including a minister’s oath of office. . Very few actually do it, but everyone thinks it is only the doctor who must follow his oath” said Dr. Prasad.
 
He then checked the Hon’ble Minister and wrote him a prescription that included weight reduction and abstinence from alcohol.
 
Without a Thank You or a payment, the powerful duo left.
 
“I swear” said Dr. Prasad, smiling to himself, “I will never give them the joy of taking it lying down”.
 
That is the basic oath of every self respecting human being.
 
Jai Hind
© Dr. Rajas Deshpande
 
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