Monthly Archives: June 2017

Living By The Words ‘Being A Doctor’.

 

Living By The Words ‘Being A Doctor’.

 

© Dr. Rajas Deshpande

“He is critical, an emergency heart surgery is planned tomorrow morning. The surgeon says there is very little chance of surviving this. I don’t know what to do. I cannot imagine this is happening to us.” Dr. Ranjeeta Joshi was crying on the cellphove, still making an effort to keep her voice even. Her squeezing agony about the sudden illness of her Orthopedician husband Dr. Sudhir Joshi reflected in each word she uttered.

This was a weird coincidence! I was not working that day, attending a court summons because a patient was being divorced for having epilepsy. On the way back I also had had a terrible argument with a very precious friend, we were both hurt. Both these had emotionally upset me badly, and so on my way back to Pune, I changed my route to visit my favourite Ganesh temple, where I usually rediscover my lost calm when life batters my patience and bludgeons my peace. Just as I entered this temple premises, I had received this call from Dr. Ranjeeta.

I knew the couple well because Dr. Ranjeeta is struggling bravely with two bad diagnoses: Multiple Sclerosis and Rheumatoid Arthritis. The fluctuations of both cripple her often, but she stands back stronger every time. I knew she was already using a walker. Dr. Sudhir is one of the most renowned Orthopaedic surgeons in Mumbai, with his own hospital at Dadar. Dr. Ranjeeta looks after the administration of that hospital.

I was shocked. I didn’t know exactly how I could help. I reassured her. I told her I was praying for both of them, and urged her to have complete faith in a good outcome. One of the best cardiac teams, Dr. Ramakant Panda, Dr. Vijay DeSilva, Dr. Tilak Suvarna and their colleagues were to operate Dr. Sudhir in few hours. I prayed for the couple, informed her so, and returned to Pune.

She kept updating me. The surgery lasted over 11 hours. Dr. Sudhir was shifted to CCU.

Dr. Ranjeeta ran the show at their Dadar hospital. The staff of their hospital refused to accept salaries that month, and told Dr. Ranjeeta: “You have always looked after us and our families. Now it is our turn to stand by”.

Every passing day was like a slow mountain of fear heavy upon the shoulders of everyone involved. While using her walker and occasionally a wheelchair, Dr. Ranjeeta successfully managed to attend all his needs as well as home and hospital. Dr. Sudhir gradually came out of critical status, in a few days started walking again, and within two months started attending his patients.

Barely after 10 weeks of this major calamity, this medical phoenix started performing major surgeries again, back to his “Doctor Normal”.

When they came today, I was quite moved to see him all back to normal. Of course the love that the couple emanated for each other is beyond words, and I will refrain from expressing what is more beautiful unsaid!

Dr. Ranjeeta, with tearful eyes and a smile, said “We are so happy and grateful to God that we won! I feel every doctor must decide to be a survivor, strive to keep fit, because so many lives depend upon him / her.” she said.

“You are such a brave motivation!” I told Dr. Sudhir.

“It is my privilege to be a doctor, not everyone is lucky enough to become one. In death no one has a choice, but in life we do. I wanted to live and practice again, because being a doctor is a special ability! I can do so much for so many. I love this so much, that this itself became my motivation to survive and become fit again.” Dr. Sudhir replied.

As I stood mesmerised by his words, a beautiful guide to every doctor, he extended something.

A Montblanc Special Edition JFK Fountain Pen, something I was window shopping for so long!

What I ever did to deserve it, I will never know. But this beautiful pen will always remind me of the great JFK,, and more importantly, how I must make the best of my own life as a doctor .

One of the most famous quotes of JFK reads: “As we express Gratitude, we must never forget that the highest appreciation is not to just utter words, but to live by them”. There are thousands of prayers involved in becoming a doctor, in surviving, in reaching where we are today, each one of us. If only we live by our words, what we promised ourselves to be, never giving up, we can defeat so many adversities that stand between us and our life-goals.

Thank you, Dr. Sudhir and Dr. Ranjeeta Joshi, for this reminder, and being a great example.

© Dr. Rajas Deshpande

The Proof Is In The Pudding

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© Dr. Rajas Deshpande

Seven years ago, Srinirmala Kanduri and her doting husband Vamsi Krishna came over frustrated by what appeared to be an unending punishment: Srinirmala suffered from a common type of epilepsy called CPS (Complex Partial Seizures), and was already taking three to four different anti epileptic medicines for the same. Her fits were still uncontrolled, and she would become unconscious without warning. She also had severe panic attacks, in which sudden fear grips the person, and a feeling of doom with actual physical symptoms like sweating, breathlessness, palpitations and blackouts keep reappearing. This not only made her own life miserable, but her husband had to rush home many times as she used to be alone. Their whole existence revolved around the fear and uncertainty of her illness, even at this young age, they could not plan any future.

Her physical examination was normal, and in spite of so many issues and side effects of the medicines, Srinirmala always kept a positive attitude. “I want to overcome this. I want to defeat this illness” she said every time. Sometimes, the medicines used for the treatment of epilepsy / seizures may themselves cause / worsen seizures. That’s what was happening with her. We gradually reduced her medicines, and were able to bring her to a single medicine, although she required frequent SOS medicine for her panic attacks.

Her husband Vamsi Krishna, working with Infosys then, relentlessly cared for her like a parent. He adjusted everything in his own life to suit her requirements: job, duty hours and undeclared leaves. He was not only completely supportive and understanding, but never even showed that he was doing anything extra for her. “We married in love” he says even today with his shy smile!

Then came the great trial of a woman with epilepsy. She badly wanted to become a mother. They were quite anxious and apprehensive, like all patients of epilepsy who face this situation. Vamsi was comfortable always with her choices, and said he would even support her if she wanted to avoid having a child. This is a nightmarish situation, given the emotional attachment that the mother and father have with the child they imagine. Now a days some safe medicines are available, although there’s none with a “completely safe” profile. Epilepsy medicines taken during pregnancy, almost all, have some risk for causing adverse effects upon the baby. Adding a simple medicine like folic acid and some supplements reduces this risk significantly.

Srinirmala and Vamsi decided to bite the bullet. These are the decisions that actually make the lives of the successful. We reduced her medicine doses to minimum, folic acid was added, and Srinirmala came with the good news soon. All through her pregnancy, her husband never left her alone except for his duty. Fortunately no fits came during her pregnancy, and she warded off her mild panic attacks with courage.

Then one day, THE call.

Shanmukhapriya was born in Hyderabad, under the care of Dr. Bhagyalakshmi at the Yashoda hospital, and both mother and the baby were smiling fit!

Another battle against epilepsy was won!

“There are ups and downs. There is uncertainty, no one can escape these. Keeping patience in difficult times helped me most, and that’s what I will advise everyone who plans to go ahead with extending the family while battling epilepsy. When I explained my situation rather than hiding it (stigma associated with epilepsy among the ill educated is a curse in India), my colleagues and bosses at Infosys and later Cognizant were very supportive.” says Vamsi Krishna.

Now Srinirmala has completely recovered, and rarely needs to hit the panic button. “I think it is very important to decide once and for all : that I will live normal, I will be fearless, whatever happens. That is what helped me win my battle” she says.

Then, as she asked the cute, sweet, and beautiful Shanmukhapriya (she is my child too, I feel, and the parents kindly allow me that) to blow a flying kiss at me, she commented “The proof is in this pudding”.

© Dr. Rajas Deshpande

PS: Thank you, Mr. Vamsi Krishna and Mrs. Srinirmala for allowing me this write-up for patient education, and Thank you Ms. Shanmukhapriya, for your heart throbbing smiles!

Beyond Fear: The Lady Who Defeated Brain Cancer

 

Beyond Fear: The Lady Who Defeated Brain Cancer

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© Dr. Rajas Deshpande

About a year ago, a young man came with the MRI reports of his 64 year old mother, 
Mrs. Vijayalakshmi, who was then in Bijapur. She had developed paralysis on the right side of her body, could not speak, and was losing her consciousness fast.

The MRI looked bad, a big tumour was compressing much of the left side of her brain. It looked cancerous, and needed immediate surgery as a life saving option. Otherwise the tumor could damage the heart / blood pressure and respiratory control centres in the lower part of her brain, that risked life. The situation could turn into an emergency anytime now.

The family was devastated. They brought her to Pune. She was sinking fast. Required investigations were done, and we explained the facts to the family. The surgery could risk life or also cause permanent disability, including permanent loss of speech.

Her husband, Mr. Venkat Babladi was always by her side, with his hands folded, and had only one thing always to say every time any doctor visited her: “Please save her doctor, do everything possible”.

She was operated. Her husband, son Mr. Anand Babladi, and his wife all stayed in the hospital, taking turns to attend her. The tumor was sent for analysis.

On the third day, the report brought the bad news: it was a type of cancer called primary central nervous system lymphoma. These tumors have a high death risk, with or without treatment, especially after the age of 60.

“Tell us doctor, where can we do the best treatment for her? We want to do everything” her husband and family kept on telling us. She was still in critical care, but had started now to speak a few words.

Our oncologist Dr. Minish Jain and his assistant Dr. Yuvraj Rangam took over, and started high dose chemotherapy. She developed many complications, some related to the medicines, but her family always stood firm. Every day, her husband sat by her, holding her hand, and telling her that she was going to recover, that he will ensure all was well. Her son and daughter in law arranged for all expenses and logistics, not by staying away and sending money, but by attending her every day after their respective jobs. After few days she was discharged with advice to continue chemotherapy.

Unfortunately, Mrs. Vijayalakshmi had a fall while walking at home, and fractured her hip, she had to be operated. Her chemotherapy had to be stopped. It was resumed after she recovered from the fracture. Then in few weeks, radiation therapy was started. As a rare complication, she developed life threatening brain swelling, and had to be shifted to critical care unit. She lost her speech again. Her husband, who was now on the verge of an emotional collapse, met us outside her room and with tearful eyes, asked only one question daily: “She will be ok na, doctor?”

Medical treatment is mostly standard all over the world, but the affection and care of one’s family is not. Hundreds of doctors treat thousands of such patients, many patients get cured of cancers and other dreadful diseases, a simple statistic that is never made public by those who perpetually talk against medical professionals. Equally unrecognised is the fact that a caring family makes a huge difference in the patient’s recovery, this has become very rare now.

After a year, we repeated her scans recently, and told her the ultimate medical good news: she had defeated brain cancer! Her scans did not show any tumor activity at all. She comes smiling to the OPD now, her husband holds her hand on one side, and son on another.

The most beautiful gift she gave me this time is that she learned two new Hindi words specially for me, because everytime I saw her I asked her how she was, and could not understand her answer.
This time, her husband poked her, then she smiled and said “Achcha hai”.

Those two words were the winning roar of a simple, middleclass woman against a dreadful killer disease!

© Dr. Rajas Deshpande

PS: Thank you, Babladi family for the kind permission to share facts.

Please share unedited.

The Power

The Power

© Dr. Rajas Deshpande

“He is probably brain dead” said the daughter, holding back tears.

“Now we have to make a decision whether to continue treatment or not. We are not that rich. Can you help us decide?”.

Not very pleasant, nonetheless the inevitable duty of a doctor: to decide when to pull the switch off. We suffer these decisions too. I went with them.

The patient had developed a heart attack just after a supra major heart surgery, the risk was already predicted by doctors and accepted by the relatives. Now he had no visible signs of any brain function, and the doctors had updated the family so. What with film stars alleging that “some hospitals keep dead patients on ventilators”, most hospitals and doctors now are on the overprotective / overcautious drive, especially with a society that has more blind faith in cinema than in medical profession. © Dr. Rajas Deshpande

As I examined the patient, the handsome junior cardiac resident doctor, Dr. Paramjeet, standing by my side kept on informing me details. An uncorrupted mind of a resident doctor, who wants to do good to all patients, save every patient with heroic efforts was too evident in his demeanour. As in most cardiac care units, the smartest and fastest nurses were hovering around, silent angels who do such enormous complicated brilliant work without any hoopla about it!

I found some doubtful signs of life in the patient’s brain. I told the relatives “His brain is alive, we do not even have a right to think of stopping treatment at present”.

“Don’t worry, Sir, we want to continue. Make all efforts for him please, we will make arrangements too” said the daughter, with something that most doctors see every day: tears, smile and a heavy throat all at once. © Dr. Rajas Deshpande

As I instructed about the changes in prescription, I noticed that Dr. Paramjeet was tearful too.

Outside the CCU, I asked him what was wrong with him. He told me he had had an argument with his boss that morning, when the boss had told him to inform the relatives about this patient being probably brain dead. He had assisted his boss for this surgery, and was reluctant to let the patient die under any circumstance. However, the boss had seen many more seasons, and knew what was legally required, even if it was against common sense sometimes. The boss cared for the patient as much, but was aware of how things go wrong when the relatives are suspicious and faithless.

I received a call from that unit after two days again. The patient had started moving one leg. Dr. Paramjeet and the nursing staff were very excited when they told the details of his improvement. There definitely were more signs of life. The family was completely cooperative, and repeatedly assured the doctors of their trust in the on-going treatment and the staff’s efforts.

In another week, the patient opened eyes. In a month, he started speaking a few words, and standing without support. He was discharged. © Dr. Rajas Deshpande

Yesterday, the whole family came for a follow up. Dr. Paramjeet accompanied them too, happily carrying his gift bag. The patient had regained almost all his faculties, the cardiac surgery had given him a new life. The family told him once again in front of me, what all had happened. Then the wife, who was always there by the patient’s side but had never spoken a word, folded her hands and handed over to me a box of sweets and a shirt and started to speak, but choked upon her emotions. “You returned me my husband” she said. © Dr. Rajas Deshpande

Well, my mental OCD acts up sometimes too, and I told her that it was the cardiac surgeon, Dr. Paramjeet and the nursing staff who saved her husband, not me.

“Yes, but it was you who told us we must try. You doctors have powers like God” she said.

That was simple to answer.

“Tai (Sister)”, I replied to her, “Whenever a patient completely trusts the doctor, it becomes an automatic responsibility of that doctor to cross all barriers and make every effort to save that patient. That power is in your faith. We have just done our duty”.

When they left, Dr. Paramjeet showed me his gift: a wrist watch and a gold chain. “I am gifting these to my Mom and Dad, Sir, when I go home this diwali!” he told me.

I knew how his parents would feel. Every doctor knows it.

© Dr. Rajas Deshpande

Please share unedited.

Profit and Loss

Profit and Loss
© Dr. Rajas Deshpande

Case 1:
45 year old man. Many weeks of tiredness, then three days of fever, quack treatment. Developed convulsions, admitted in coma. Blood sugars over 500. The long term past sugar index is very high, suggesting he has had untreated diabetes for months. After stabilizing patient in few minutes, I brief the relatives about critical condition.
His brother asks: Why is his sugar so high? He never had sugar. Is it because of any of the medicines you are giving?
I explain them that he has had high sugars for long, the tests say so. Also that we are giving him medicines to control sugar.
The wife says: “We don’t know all that. I think some medicines have made him unconscious”.
When he was discharged recovered, they fought about the bills saying that wrong medicines had caused delay in recovery. They gave negative feedback because the bills were not reduced to their quotes. “We were duped, we lost so much money” the son kept alleging aloud. © Dr. Rajas Deshpande

Case 2:
Old man, 82. Lung cancer, under radiation. Two episodes of paralysis, diabetes, blood pressure, now has drowsiness since Tuesday. His son and daughter in law come to opd on Saturday evening. The old man needed immediate admission and MRI. I tell them so.
“What is your diagnosis?”, “Exactly why is he drowsy?” “Why admission??” “Exactly what treatment?” “What will be effect of the treatment?” and many such screwing questions (sometimes I wanna ask back: when will you exactly pee next?) later, they went home. In the interest of the life of the old man, I chose not to lose patience.© Dr. Rajas Deshpande

They come back two days later, he had become unconscious.
“Why, doctor, why? He was walking till Sunday” cried the daughter, angrily asking us. “Why can’t you make him conscious? It’s been two days”.
Not only the arrogant tone, but the open distrust was offensive. “What is the exact reason of his unconsciousness?” “When exactly will he become conscious?” “Exactly blah blah?” asked the son, as if he was a Judge, and the doctors were criminals.
I wanted to tell them exactly what they were and where they belonged, but refrained. Patient first.
The treatment was on. Three days later, the old man opened eyes. “He has always had a strong will power. We knew he would recover” told his daughter to us.
Upon discharge, they wrote very bad reviews because the bills were not reduced to their expectation.
© Dr. Rajas Deshpande

Both came for follow up later.
In both the cases, a few years ago, I would have made an effort to spend more time, compromise self respect and continue treating them. Not now. Especially when peacock-fame decision makers decide about the fates of specialist doctors. Now, I tell them to please follow up with whichever doctor they can trust.

What about the probable income from such patients? Let me quote a dialogue that only Mr. Amitabh Bachchan could have delivered, from a film ‘Trishul’ that influenced me much since my college days:
“Zindagi mein kuchh baatein faayde aur nuksaan se upar hoti hain, lekin ye baat kuchh log nahi samajhte” (Some things in life are above profit or loss, but some people don’t understand that)”.
© Dr. Rajas Deshpande

The Zen Of a Doctor: An attempt of honest meditation

The Zen Of a Doctor
An attempt of honest meditation
© Dr. Rajas Deshpande

I am now tired, mentally fatigued, I want to recover to joy. I do not want to lie to myself.

I love treating patients, resolving their health problems. I love the feeling of their recovery. I love the gratitude that comes my way. I am proud of this ability to be compassionate, to harbor empathy and to understand and fight suffering of another human being. I am proud, that money is not on the top of my priority lists. © Dr. Rajas Deshpande

But now I am tired of the whining: not the whining of suffering, for that is mine to destroy happily, but the whining by choice of adopting an extremely stressful, dirty, unclean, unhealthy lifestyle, not preparing to change, not preparing to pay for health, and then blaming it all upon a doctor. Women openly suppressed by husbands and large families, children tortured by parent’s whims, men exploited by their own desires and careers, and an orthodox, superstitious society where the most literate and educated believe in sometimes poisoning themselves with unknown medicines, and then have the audacity to question a qualified doctors’ intentions in writing a prescription. © Dr. Rajas Deshpande

They want everything of the best quality, from panipuri to cars, and are willing to pay extra for every luxury, while expecting that only healthcare must come free, and the very doctor whom they cannot trust, cannot tell the truth to, must treat them with best empathy and honesty, give them enough time to ask unnecessary questions and doubts, and then should waive off the fees out of sympathy. © Dr. Rajas Deshpande

I am also tired of the corrupt practices in medicine, and the hopeless scenario that everyone rather tends to believe that the doctors are all corrupt (some indeed are, but so are few in every profession, shut up pseudo Einsteins of argument!) rather than seeing the open markets established by uninhibited corporates who are seen hand in hand with the administrators, some pharmaceuticals and some in power. Corruption by those in high places, that ranges from producing some of the worst quality, inexperienced doctors, to dispensing lower quality everything just because they have understood this trick: people fall for low cost anything, even health. Such a disaster that people do so many unnecessary tests under the “Health Check” scams themselves, but when the doctor advises even one test, suspect him / her of wanting more money! © Dr. Rajas Deshpande

I refuse to be exploited. I can only change myself, not the world. Hence this meditation.

I want to live a good life: not full of gold and diamonds, but of joy, health and inner peace. Of independence, financial as well. Of my own choice and preference, not what the society decides for me. I want quality time for myself and my family too. © Dr. Rajas Deshpande

I do not want to be a busy doctor irritated and shouting at everyone: I would rather earn less and guard my composure. Those who cannot respect this will be given a chance to understand, but only once.

I will continue to stay highest in my principles. I will refuse to compromise on the quality of healthcare I want to practice, just because someone wants a cheaper, faster but less ethical alternative, less correct choice. I will see less number of patients and rather spend enough quality time with each of them, and charge them higher as per time and expertise, rather than hurrying through.

I will choose to encourage trust in my patients with my own behavior and words, but if I realize they are still trustless and question my integrity, I will refer them to their choice of another specialist, because I want to retain my best peace of mind for my next patient.© Dr. Rajas Deshpande

I will not take the extra effort to explain everyone why I do what I do, my duty is to be honest to myself and my God, my patients. I have limited time, now and in life, and I will expect that faith, trust and a level of basic intelligence (that has nothing to do with education) will enable everyone to see clearly that I mean well. That is my promise to myself: I will always mean well to my patients, and offer them my best. That should never preclude my own happiness. This will enable me achieve my inner peace so essential for a doctor.

I feel better with this already.

© Dr. Rajas Deshpande