Monthly Archives: February 2019

A Dark Corner In My Medical Life

A Dark Corner In My Medical Life

(c) Dr. Rajas Deshpande

“Doc, she is becoming unconscious many times since last night” said the worried husband Mr. Robert Jolly, “even since today morning, she went blank twice”.

The young Mr. & Mrs. Jolly couple was married two years ago, and both worked high-profile. Mrs. Shona Jolly reportedly never had such problems in the past, as confirmed by her mother. Just as I was asking them questions, her neck turned towards one side and she appeared to have become unconscious again. The terrifeid Mr. Jolly tried to wake her up. I asked him to step aside and checked her pulse and heart. Everything appeared fine, but she did not open eyes.

However, while I checked her, Mr. Robert Jolly’s peeping over my shoulder annoyed me, but what really surprised me was the indifference with which Mrs. Shona’s mother was standing aside, calmly watching her unconscious daughter and panicked son in law. We neurologists learn after a long experience how to differentiate whether the patient is truly unconscious or just faking it.(c) Dr. Rajas Deshpande

We are not always right, sometimes the patients indeed have unexplainable symptoms or behavior. So we try to refrain from jumping to early conclusions. I explained them that we needed to run some tests before we could finalise the diagnosis. Mrs. Shona was admitted. The husband Mr. Robert shadowed her 24/7. As the MRI, EEG and almost all other tests turned out normal, I reviewed the case and examined her again. Everything was normal. Now was the time to ask her some private questions.

“May I ask her some questions in privacy?” I asked Mr. Robert.

“”Doc, we hide nothing from each other. I am sure she won’t mind if I stay here”, he said, and looked at Mrs. Shona.

Smiling heartily, she repied “yes doc, you can ask me anything. I don’t hide anything from my husband”.

I told her that as all the tests were normal, we had to look at the possibility of psychological factors like stress, depression or personality disorders etc. , which could cause some of the symptoms she had.

“Oh no no, not at all. I am very happy, I have no stress at home or workplace. I am sure doc, this is not psychological” Mrs. Shona replied. We then had two more opinions by senior consultants. They too did not find anything abnormal. Her “attacks”continued.

On the third day, outside the ward, patient’s mother waited in the corridor, where the couple couldn’t see her. She gestured to me, and whispered hastily “Sir, I am Shona’s mother. Please refer her to a psychiatrist or a counsellor. She has had similar problem in her past, and had felt better after a psychiatrist treated her”.

This was difficult. How could I pressurise the highly educated Mrs. Shona to visit a counsellor / psychiatrist? As her husband continuously accompanied her, it would also be unfair to refer to her past illness in front of him.

I asked Mrs. Shona cautiously: “I feel at this stage we must also involve a counselor, and request her opinion about what is happening”. They both agreed, and I sent her to a counselor. Next day, I received a feedback from the counselor: that the patient definitely needs to visit a psychiatrist. I told Mrs. Shona again that I wanted to speak with her in privacy.(c) Dr. Rajas Deshpande

She quite emphatically said “Whatever it is, Doc, please say it in front of my husband”. Then I told her about the feedback from the counselor.

They went to a psychiatrist suggested by the counselor. She was diagnosed with a condition, and when they followed up to inform me, her mother disclosed in front of Mr. Robert Jolly that Mrs. Shona had been diagnosed and treated earlier for the same. She also guiltily mentioned to Mr. Robert that Shona had threatened her parents that she would cut them off in case they ever spoke about her illness to him or his family.

Once her treatment started, she improved. In a shocking turn of events, Mr. Robert Jolly chose to file for a divorce. Six monts later, I received a bitter letter from Mrs. Shona : that I had not been fair to her because I had referred her to a psychiatrist in front of her husband, that I should have kept her illness confidential and hidden from her husband. She even went on to say that in a way I was responsible for her divorce.

I had done nothing wrong, but this was indeed an emotional blow.

Patients often confess to their doctors what they hide from even their closest family members. This includes many things unacceptable to the society: drug consumption, visits to commercial sex workers, abnormal thoughts and behavior including violence, confessions about the past, extramarital affairs, porn addictions, abuse, abortions and even some diseases like AIDS, Tuberculosis and psychiatric issues as mentioned above. In the extremely orthodox and prejudiced society that we live in, even the legal, moral boundaries of what constitutes private information in such cases are not clearly defined. A husband or parents are automatically presumed to “own”the patient and every bit of information related to the patient, directly questioning the doctor and refusing to follow simple courtesies, manners or etiquettes towards their own family members. There are no presets / guidelines about privacy especially related to women or children.

A doctor’s job becomes all the more difficult when dealing with aggressive, litigant, blame-game prone patients and relatives, from both high and low educated classes. One must treat such cases extremely carefully, and our medical bodies must form strict criteria about patient information privacy that cannot be violated by even their family members.

I kept feeling sad and somewhat guilty about what had happened. But that is also what a doctor must learn to digest. One more dark corner of a doctor’s daily life.

(c) Dr. Rajas Deshpande

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The Most Precious Jewels Upon Earth

© Dr. Rajas Deshpande

“Sir, next is our old free patient” my receptionist announced on the phone.

Divya, the smart young girl of 8 years jumped into my cabin, and grabbed her chair with an authority. Confidently looking at me, she questioned, “how are you today?”

Her parents, embarrassed and charmed at the same time with her sense of ease in this big hospital, facing a doctor, hesitantly stood behind her. I requested them to sit down and went through the routine questions.

“She is all good now, no fits since last two years. She has been regular in her school and has started studying well too” her father reported.

I examined her and wrote her a renewed prescription. I noticed the mother wiping tears.

“What happened?” I asked.

Quickly smiling, she just gestured with her head “nothing” and looked at her husband.

“Do we need any tests, Sir?” Her husband asked, “We will do whatever is required”. I could feel his palpitations. They were scared that I may tell them tests, and that would mean financial disaster.

He works as a pantry boy and can barely pay the home rent with his salary. His wife somehow makes ends meet, looking after this sweet daughter and a younger son.

At the age of five, Divya had had her first convulsion. Her parents had rushed her to the government hospital. They did not have the money required for Divya’s tests and medicines even at the government hospital. So they resorted to something that hurt them worst: they had to sell little Divya’s silver jewelry, which was the most precious thing in their house. Even that was not enough, so they borrowed money and started her treatment, her father worked extra hours.

That was about three years ago. Divya’s fits continued, but her parents did not give up. Their whole life had but one aim: to stop her fits. Even after being less educated, Divya’s parents decided to go with scientific treatment, ignoring all pressures to take her to different weird people including magic healers. They did not give up hope, their will power was their boon.

Two years ago, a doctor friend sent Divya to me. With some changes in prescription, her fits completely stopped, she has now become just another normal child.

“No tests are required. Please make sure that she is regular with the medicines” I told them.

As I wrote this, I got a little emotional myself, this was the first time I had heard of any parents having to sell their daughter’s jewelry for her treatment. On one side, I was proud that even after being surrounded by perpetual pits of poverty, this girl child’s parents did not skimp upon her treatment just because she was a girl child (this often happens), but on the other I felt anger and shame that my country still lacks a basic healthcare infrastructure that can offer free quality treatment to at least children.

Yet, this had taught me my lesson. Willpower and hope are the mightiest and most precious jewels upon earth, far tougher and far more beautiful than any diamonds. For there are many who own diamonds but have neither willpower nor hope.

Meeting this rich family today was joy enough, but a greater bliss was when the kiddo put her arm upon my shoulder with the same confidence. The world is indeed hers!

© Dr. Rajas Deshpande

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Doctor Arrested. Patient Died. Who’s Guilty?

(c) Dr. Rajas Deshpande

“Doctor arrested. Patient died due to a wrong surgery”.

The black headline was shining. There was a file photo of the accused doctor, and angry, crying relatives. Sad and angry, I read through the news that did not affect me directly, yet knowing that every patient who read that news will go further away from their doctor. The already delicate and dying bond will die a little more.

Is it enough to punish this doctor?

Who all is guilty here?

The parents who forced him to become a doctor because they couldn’t?

The corrupt educational boards which allowed leaking papers and increasing marks so the student could get a medical admission? (c) Dr. Rajas Deshpande

The politicians who made it possible for even the undeserving, low-aptitude students (which has nothing to do with one’s caste or religion: it’s more to do with money and power) to become doctors and play with patient’s lives?

The governments who allowed the “Medical Business” by establishment of substandard medical colleges owned by the rich and powerful, to sell medical degrees? The managements of such substandard institutes who chose the “low”quality teachers who agreed to work at low salaries and tolerate all humiliation? The teachers who didn’t care how their student was trained? (c) Dr. Rajas Deshpande

The medical councils which ignored the ‘temporary’arrangements made by such substandard institutes to just ‘Pass the Inspection’, never providing students with adequate education or experience?

The medical policy makers who made theoretical, mcq-type education more important than clinical training?

The offices of law which ignored the repeated applications and complaints of good students from such institutions about incompleteness of educational facilities?

The Universities that allow ‘manipulation’ of medical exam passing under influence of money or power?

Or the politics of allowing cross-specialty practice without adequate training, the ‘jump-over to any pathy’ decisions to please vote banks?

Or the corporate hospitals who prefer such “substandard” doctors because they can work at lowest payments? Aggressive and “market oriented” junior doctors are preferred by many commercial-headed hospitals over those with best academics and clinical knowledge. (c) Dr. Rajas Deshpande

It is indeed a reality that some doctors cannot speak a straight sentence, some cannot spell medicine names correctly, some treat even what is not their qualification skill, and some substitute knowledge with style, overconfidence and sweet talking. At various stages in their career, there are teachers who have tried to correct them, but in these unfortunate times of “pleasing one and all” including students, it is quite difficult to ‘mentally’ train a doctor to be good and perfect.

If only the doctor mentioned above is punished, leaving all others above without correction, then it will be a classic example of example of medical negligence and injustice. It will be like treating only the heart attack without treating the blood pressure and diabetes which cause that heart attack. We know the outcome in such cases.

(c) Dr. Rajas Deshpande

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