Monthly Archives: June 2018

ICU Seventeen

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ICU Seventeen
© Dr. Rajas Deshpande
 
11 PM. Just as I finished my OPD I received a call from the ICU resident doctor: “Sir, you have a call from ICU seventeen”. I was tired and exhausted, feeling feverish that day. I was not on call, so could request them to send this call to another neurologist who was on call.
But it was ICU seventeen. I hated going to that cabin, my legs dragged heavy, my mind exploded, but I had to. © Dr. Rajas Deshpande
 
I went there, assessed the middle aged lady on the bed. She was already on a ventilator, had been unconscious since after a head injury. She had been knocked down by a speeding drunkard while crossing the road. This was day two. Examining her, I found feeble signs that indicated that her brain was not dead. . CT scan showed many injuries to the brain. I told her relatives –the husband and the son- about this, and also explained them the uncertainty and unpredictability of outcome.
“Shall we continue the treatment or let go? We are not rich, we can try only if there are good chances of her survival” said the husband and son. The husband was visibly fatigued with the situation, the son was talking to me without looking up from his iPad.
 
“Although the outcome is unpredictable, in my opinion, you must continue to try. This is not yet a hopeless case”. © Dr. Rajas Deshpande
As expected, they were unhappy.
They wanted quick answers that would either guarantee a good outcome or enable them to bank upon a doctor’s decision to withdraw life support which would make them guilt free. I did not want to hurry a decision for their convenience. My first duty was to protect the patient’s life, not to cater to anyone else’s expectations. A doctor who does not respect life in all its depth has no right to be a doctor. Especially in case of an unconscious patient, a doctor’s responsibility peaks, and sometimes he/she has to even struggle to convince the family to continue treatment. Notions like “dead patient kept on ventilator in ICU” created and catered by some stupids add to this situation. ICU expenses are indeed high. In such a scenario, any doctor who advises to continue treatment in a hope of saving life is indeed suspected to have “financial” motives.
But even that fear was below my duty to the patient. I told them that in my opinion they should not withdraw life support. I told them to continue to try.
 
“Doctor, what would you have done if your mother was in her place?” asked the son, looking up with a cunning expression from his iPad.
The explosions in my mind restarted. © Dr. Rajas Deshpande
In this same ICU seventeen, just a few weeks ago, I had witnessed my mother’s death. For three days and nights, my own colleagues had fought to tackle the umpteen complications that took away my dearest, and I stood at the door, telling them: do whatever you must, try your best, but save her. In her earlier life, mom had always wanted to live, live longer, and be with her family every moment at any cost. There was no reason for me to presume she did not want to survive. From Geeta to Bible, ever sacred book has advised “Do unto others as you would have them do unto you”. Medicine or law aren’t yet wiser than that.
I am a middle class doctor myself, not rich. I could not afford prolonged treatment. But I was willing to even sell myself if it was required to make my mother survive, even for a day more. She would have done the same for me, even more. There is no age and illness when a mother would want her child to die, and as her dearest son, it was upon me to become her mother when she grew old.
 
One cruel night took her away. I will never overcome that feeling of standing in the door of ICU seventeen, with the resident doctor and nurse, both crying too, tried to wrestle out my mom from the claws of death. That cabin, that door, that corridor brings back those moments. I cannot show that upon my face, I am a doctor. I work at the same hospital, see these places almost every day, and carry on what I must. © Dr. Rajas Deshpande
 
I paused to contain the agitations in my mind, then replied.
‘Yes, Sir” I told the son of the iPad: “I am suggesting you exactly what I would have done for my mother”. Still trustless, he continued fingering his iPad. His father sat clutching his head. They continued the treatment, but bitterly.
A week later, she opened eyes. In ten days, I received a call again “Sir, can we shift that lady out of ICU seventeen? She is fine now, conscious and oriented, accepting orally” the resident doctor asked.
 
“Yes please”, I replied, not without a tear. We couldn’t get my mother back, I will never recover from that memory, but we had defeated death in the same room! © Dr. Rajas Deshpande
Every doctor has had such experience: illness, death and extremely disturbing memories associated with it. They still have to keep their calm and continue to try for their patients what they could not achieve for their dearest ones. It is mostly taken for granted: that doctors have no feelings, that it is so routine for them to see pain and death that they are not affected by these anymore.
 
It takes a grand courage: that of a brave soldier, to be able to walk again in the corridors of death that have taken away one’s dearest people. The same diseases, illnesses, problems affect doctors and their families too, we fight them, we win or lose, but we come back to the battleground again, every day, to protect every single life we can.
Therein lies the pride of saying “ I am a doctor”.
© Dr. Rajas Deshpande
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Saving Life? Not Enough!

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© DR. RAJAS DESHPANDE

“I will kill you. I will see that you don’t practice in this city. You don’t know me” the elderly man shouted angrily outside the crowded OPD room of the senior neurosurgeon. He was surrounded by five others, two of them his sons, who instead of calming him down, were adding to the threats.

“Let him come out of the hospital. We will show him” shouted one of them.

The Neurosurgeon who stood in the OPD door did not react. He was known as a short tempered professor, a quality that often accompanies excellence in any field. © DR. RAJAS DESHPANDE

Two years ago, a young software engineer had come with his parents to the OPD of this senior Neurosurgeon. A son of a rich politician, he had an obvious sign of of a brain surgery: his skull shape was abnormal, with a part of his forehead sunken in. He had been operated for a brain tumor four years ago, it turned out to be very early stage of a cancer. He was told to keep visiting a neurosurgeon every year to check if the tumor grew back again. Now another similar tumor had grown in his brain. This time it was in an extremely dangerous area to operate, there was a high risk of death. After explaining every risk to the family, our Neurosurgeon operated him. Just after the surgery, the patient had developed brain swelling and bleeding unexpectedly, and had become comatose. Fighting these complications with all his might, the neurosurgeon finally ensured that the patient recovered completely. When discharged, the patient went walking by himself, and had no complaints. He followed up regularly for next few weeks for radiation and chemotherapy. Then he was advised to follow up every six months.

The next time he visited, after the consultation, the patient called in his wife.

“We married last month, Doctor” said the patient.

Surprised, our neurosurgeon congratulated them, wondering why the patient never told him about that arranged marriage.

In a year, the patient developed another recurrence of the tumor. Surgery was planned, and the wife’s family accompanied the patient. Rich, educated and powerful, the only thing they couldn’t own was manners. © DR. RAJAS DESHPANDE

“How come he developed a brain tumor, doctor?”asked the angry father in law of the patient.

“Well, tumors can develop in anyones brain, because of naure’s mistakes in the human body, but he has had this problem for many years now, don’t you know about it?” asked our neurosurgeon.

“No. No one told us when my sister was married to him”said the angry brother.

“Didn’t you notice the big scar on his forehead?”asked the neurosurgeon, unable to believe this. In a society that disallows marriages due to stupidest of reasons, it was difficult to believe that such an obvious sign was missed.

“We were told that he had had a small head injury. My sister had come last time. Why didn’t you tell her?”asked the other brother, keeping with the family tradition of angry misbehavior.

“She waited outside for the last consultation. Then again, you should have asked your doctor about this before finalising the marriage”.

The wife’s family walked out. The patient and his family was nowhere to be seen. That’s when the two brothers realised that there was a huge rush of patients in the OPD complex, and started shouting threats for the neurosurgeon.

“You have spoiled the life of my daughter”said the patient’s father in law to the doctor, “You should have told your patient not to marry”.

Although this was ridiculous, the neurosurgeon, who was otherwise known for his zero tolerance of stupidity and threats, took this in his stride. He called them all in and explained once more. He made them aware that the patient had never revealed any plans to marry. © DR. RAJAS DESHPANDE

The brothers refused to understand, they had to vent their anger, and here was a doctor available for it! It was like legally protected murder of decent civil etiquette, traumatising of a doctor’s dignity, backed by the society and media. Who will stand by the doctor? Who will even consider the fact that merely few months ago, this very doctor had fought to bring back their patient from the clutches of death?

The neurosurgeon got many phone calls over next few days, with threats to life and something even more precious than life for a doctor: threats to reputation. Like a thousand other storms in his life, he braved this one too. The patient was divorced by his wife. He was operated and radiation was started.

In the usual “I don’t care a hoot for idiots” style of surgeons, the Neurosurgeon chose to ignore them and do what was his duty. But when he told me this incidence, there indeed was a hint of a broken something in his eyes.

“We save so many lives, since so many years. Earlier there was a sense of fulfilment, even if the patient did not express gratitude. Now, that sense is lost. Saving life isn’t anything great for our society, it has become a mechanical job expectation from the doctor, just like the paid service of a machine. Educated and uneducated goons, even people who faint at the sight of blood come and threaten doctors as if it was routine for them to do what we do. I am quite worried about the future generations of doctors”.© DR. RAJAS DESHPANDE

Just as the neurosurgeon spoke with me, the patient mentioned above walked by, with his mother, returning from his radiotherapy session. When our neurosurgeon asked whether he is recovering well from the divorce, mother casually laughed and said “Oh! That girl was never good enough for my son. I am sure he will get to marry a better one soon. There are very few educated men with such a salary in our community” and they walked away.

Aghast, we went to the cafetaria and had a wrodless cofee, but that silence was full of regrets. As we got up, the neurosurgeon commented: “We can only save lives. Not these people or their society “.

© DR. RAJAS DESHPANDE

A real life incidence shared by Dr. Ashok Bhanage, Neurosurgeon. Patient details changed to mask identity.

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A Doctor’s Sacred Obligation

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A Doctor’s Sacred Obligation

© Dr. Rajas Deshpande

As I entered the hospital for my evening OPD, I saw our senior-most cardiologist standing by his plush big car in front of the entrance. A tall, calm and brilliant man with a reputation that many only dream of, he never spoke about himself or his work. It was very unusual, because he was either with patients or walking fast, never still like this.

Curiously, as I wished him, I couldn’t resist asking, “Anything up, Sir?”. He asked me to look at the entrance. A young lady in her twenties was coming out of the hospital, supported by her relatives, smiling and crying at the same time. As she climbed into the car that was waiting for her, she saw the cardiologist and tried to get out again. But Sir asked her to wait, went there, wished her just as her relatives touched his feet one by one, and bid her a goodbye. As they shifted her luggage in the trunk, Sir told me: “That is our 10th heart transplant case. She had come with heart failure that could not be treated, there was no hope for her survival except if she received a new heart. That was a month ago. We performed a heart transplant upon her, with consent for a risk of death on the operating table. I can’t tell you how I feel today, seeing her walk out with a new heart. I am not sure how many people have the ability to grasp this event. It is so much more than a new birth!” © Dr. Rajas Deshpande

The patient’s car rolled away slowly, the relatives folded their hands at the sky. Our dear cardiologist looked at the sky once too, sat in his enviable car and drove away with a winner’s smile.

Late that night after OPD, as I waited at the entrance watching the beautiful rain, I felt a certain calm within. Hundreds of specialist and super specialist doctors in India perform super-complicated procedures, surgeries, transplants every day in India. Some bring back most hopeless patients in coma with their sheer medical talent. Thousands of ultra-critical patients walk out of the intensive/ critical care units. Heart, Liver, Kidney transplants are happening every day, almost in all bigger cities. Joint replacements and spinal surgeries have made miraculous changes in the quality of life of millions those who would have otherwise spent last few decades of their life writhing in a bed. Most Neurological conditions can now be effectively treated to improve both lifespan and quality of life. Complicated brain tumors can be removed, aneurysms treated, many cancers cured, and paralysis reversed if treated in time. Physiotherapy makes dramatic changes in mobility of those who couldn’t even stand.

Where is all this happening? Who is doing this? What is their reward?

Most of these expertises, skills were brought to India by the private doctors who went abroad to study on their own. Most of these facilities were made possible in India by the private hospitals because they earned profits. If they didn’t, no one would invest. It is impossible for the government to invest in healthcare to this extent. Even in the rare govt. set-ups where such facilities are available, they came in too late, with many compromises, and only because some doctors there wanted to extend the benefits to the poorest of the poor, and tried hard to convince the health departments for development of such facilities. The government never spends on advanced (out of the country) education of any doctor. © Dr. Rajas Deshpande. Yet, most people imagine that when a doctor goes abroad for any conference, it is to have fun. How cheap and conceited to look down upon the saviors of so many lives!

Our politicians and leaders, media and society have always made ungrateful and derogatory comments about us. Still, the ultimate truth shines bright: that the geniuses in this profession continue to bring highest class of medical care to India, both in private and government hospitals. They do so because of their own drive: to explore, to excel and to bestow health upon millions. © Dr. Rajas Deshpande. Yes, some such doctors earn very well too, most of them earn via clean practice, pay their taxes, and still treat many patients free. However our society has almost made up its mind that a doctor should never become rich. The utopian, hypocritical notion that doctors should only be happy with the satisfaction and blessings of people they treat, without expecting financial remuneration is as laughable as saying that everyone else right from the politicians to artists or the laborers should also be happy with what they do and should not expect any remuneration. Everyone earns for their work, and so should a doctor. © Dr. Rajas Deshpande

No one will achieve anything good by merely criticizing the very profession that strives hard to save lives. The psychotic addiction some people have, of speaking ill about doctors is based upon a single reality: they want free / low cost treatment of highest quality. There indeed are a few corrupt doctors, but how fair is it to blame all others who do so much for the society?

Our society indeed needs a new, repaired and loving heart for the great doctors who bring it health and life! This ‘transplant’ is being delayed by the puny shortsighted politicos and media who belittle their own saviors. It is high time that at least the educated and intelligent among the society recognize this.

Till then, we will still try and keep your old heart beating well, for we are doctors, and even if you criticise us, we must only do good to you. That sacred obligation is the nobility of my profession!

© Dr. Rajas Deshpande

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