Monthly Archives: April 2019

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 reassured her that it was ok, and returned the gesture by touching her feet too. I told her I will try my best, and that 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 my feet, although I was 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 my 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 this 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

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That Order To “Stop Saving Life”..

(c) Dr. Rajas Deshpande

“Arrest! Sir… Code Blue!” the nurse shouted. The casualty was full, all eight beds had serious patients, and their relatives waited near them. Every second matters.

“Everyone out” my co-intern shouted. Some moved out, some stayed. Two other interns were already attending similar patients, two of us ran to the arrested patient. The nurse had already started the chest massage. I gave patient the position for inserting the breathing tube, as my co-intern Dr. Ajoy took over the cardiac massage. The senior medical officer, Dr. Hazare, experienced with a lot of medical wisdom, stood near the bed. He calmly gave orders for the last-attempt medicines in such emergencies.

The chest massage to save lives is rather forceful, its force has to reach the heart. The chest wall has to be pumped down 2-2.5 inches with every compression, and this has to be real fast: over 100 times a minute. It looks very traumatic, but it is useless if not done exactly like this. It is quite a disturbing scene for the relatives. The patient’s son kept on shouting “Don’t hurt him” loudly. The medical officer repeatedly asked him and the five relatives around the patient to leave. They refused.

The Medical Officer Dr. Hazare then asked us to stop the CPR. (c) Dr. Rajas Deshpande

We were baffled. How could one stop the life saving CPR?

The patient who had arrested was from a nearby slum, father of a local goon out on bail, like most goons in India. He (the patient) was in his late fifties, a chronic alcoholic and smoker, with severe liver damage. He’d had excess alcohol on the prior night. That morning, he had had a convulsion, and was brought to the casualty after many hours of delay . An arrogant, drunk, politically supported crowd posing as relatives accompanied him, a common nuisance in almost every Indian hospital.

We continued the CPR. Dr. Hazare went out.

After a direct injection of adrenaline into the heart through the chest, the patient’s heart restarted, and he started to gasp, making some movements. We quickly shifted him to the ICU. The proud feeling of saving a life gripped us. There was no time for celebration, but Dr. Ajoy kept whistling on the way for our midnight tea.

Later that night, Dr. Hazare called us. He was angry, yet calm and smiling, an ability that only the most evolved souls can have.

“Listen, we are in India. Most of the people around us are not only uneducated and ignorant, they are also quite violent and paranoid. Emotional dramas are considered a normalcy. There’s a tendency to shift the blame of delayed treatment and bad outcomes on to the doctors. You were risking your life. If the patient’s heart had not restarted, the relatives could have blamed you, even hurt you”.

“But Sir, they saw that we were desperately trying to save the patient’s life” I argued.

“YOU think so. They don’t know anything about the CPR. They refused to go out. You saw how arrogant they are. These things work only when the outcome is good. If the outcome is bad, the doctor is automatically held guilty. I told you, we are in India. People like to think that doctors are wrong, whatever you do. ” Dr. Hazare said. (c) Dr. Rajas Deshpande

We didn’t think he was right. Still, we respected him for his wisdom, so we just apologised and went on to deal with the casualty again. It was a busy night, still a very negative feeling about what Dr. Hazare had said kept shadowing my thoughts. How could such a senior doctor ask someone to stop CPR?

Dr. Ajoy went to his room at 5 AM and returned by 7 AM to relieve me. I went home at 7 AM, had a quick bath and breakfast, to return at 9 AM.

The casualty was all devastated, ruins were seen all around. Many doctors were rushing in and out. All beds were empty except one.

Dr. Ajoy was on that casualty bed, unconscious, intubated and with blood soaked bandages on his head. He had many cuts on his entire body. Our colleagues were trying to push intravenous fluids fast into his veins. Dr. Anirudh, another intern with us, told me even as he could not stop crying: “That patient we had resuscitated yesterday evening… he had another cardiac arrest in the ICU this morning… his relatives came down and attacked Ajoy. They said that the patient died because of the forceful CPR. They stabbed Ajay and hit his head with iron rods. Dr. Hazare came and tried to rescue Ajoy, they even attacked him. We were waiting for you. Do you have his parent’s contact?”.

In a state of shock, I could not speak. I reached out for my bag, got my diary and called Dr. Ajoy’s father in Calcutta.

“Why?” Dr. Ajoy’s shocked father asked when I told him Ajoy was attacked, injured and serious. How could the father of a thin built, cute, brilliant scholar ever understand that people could brutally attack his child for trying to save their loved one?

I had no answers. Dr. Hazare’s sentences kept ringing in my brain, I could not utter them. (c) Dr. Rajas Deshpande

Eventually, Dr. Ajoy recovered. He is now in the UK. His father came over last week, for a check-up. While leaving, he kept his gracious hand upon my head and said with immense love: “Save many lives beta, but take care of yourself first. I still cannot sleep well due to what happened”.

That night, I stared at the sky, and kept thinking: Actually, this is why no doctor ever sleeps well in India. Saving lives comes with the inherent risk of losing one’s own, and this happens only in our beloved motherland.

(c) Dr. Rajas Deshpande

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Religion? Caste? Race? Nationality?

Religion? Caste? Race? Nationality?
No, I cannot think about that.
A Bullet has shattered the skull, damaged half the brain of this young person of 22 years.
A surgeon has put together the pieces of skull, a fragment of metal is still seen deep inside the brain. This person has a whole future of decades to tackle with a severe disability. As doctors, we only think: what best can be done to repair the brain, how best to resettle the patient in their future life, how to help them overcome their disability.
”Shoot, Kill, Hunt, Enemy, Revenge” are not the words any true doctor in this world can ever like!
We can never think about the race, caste, religion or nationality of any human being. Because a Doctor is always above any sort of discrimination. © DR. RAJAS DESHPANDE
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The Real Vertigo

(c) Dr. Rajas Deshpande

“Why did this happen to her, doc? She is so young and had no problems till now..”asked the angry husband, who had accompanied his learned wife down with severe vertigo and headache. His tone was quite accusative, and voice raised.

My elderly professor Dr. Desai did not look up, he continued to write the prescription quietly. He had just explained in detail to the patient and her husband that this was a simple positional vertigo, which happens episodically in some patients. Although it is scary because the patient feels the world spinning suddenly, it is also called ‘benign’because it does not cause any harm beyond this spinning sensation. Some other dangerous illnesses that could cause such spinning sensation (tumors, blood clots) were already ruled out by Dr. Desai, after a thorough examination and relevant tests. (c) Dr. Rajas Deshpande

“Ï just explained that to you” said Dr. Desai to the patient’s husband, “keep some patience, take rest, and take this medicine”.

“But why did this happen to her?” repeated the husband, this time louder.

“I don’t know, many factors like allergy, infection, some internal defects can cause such problems. In case of your wife this seems to be due to the viral infection she had few days ago.” replied Dr. Desai.

A long list of patients waited outside, and he had already explained courteously whatever was necessary, spending extra time instructing the patient about care to be taken to avoid such episodes, and exercises for the same.

“So this treatment will cure her permanently?” the husband asked. (c) Dr. Rajas Deshpande

Dr. Desai, known for his patience, smiled and replied “Look dear, this illness is like cough and cold. You treat it when it happens, but that does not permanently cure it for life, one may have it again and again. You just treat it when it happens. Now you must excuse me, other patients are waiting”.

The patient went outside and wrote an extremely negative internet review about Dr. Desai.

The fact that he was seeing the seniormost doctor in the specialty who had over 30 years of experience, the fact that the doctor had spent extra time to explain and instruct, the fact that the diagnosis was accurate and that the treatment was exact did not make a difference. One little unpleasant thing – that his repeated questions were not entertained – had resulted in a negative online rating / feedback for what was an almost a flawless consultation.

Some patients ask the same long list of questions every time they visit, which frustrates the doctor. Decline to answer a repeat question, and you get a negative, angry review.

It takes long years to understand some medical concepts. Ususally experienced and clever doctors devise their own simplified versions to make laymen undertand these concepts. However, to understand some concepts or diseases, it requires a lot of different basic bits of information, which it is impossible to make the patient understand. Most patients are quite happy with the simplified versions of disease, diagnosis that their doctors tell them, but some want to dissect every word and understand everything. If the doctor cannot make them understand, they simp jump over to another doctor. While smart communication is an essential for a good doctor today, this has now resulted in another dangerously funny phenomenon: doctors who don’t know much medicine, but can make such patients happy with wise wordplay. (c) Dr. Rajas Deshpande

A few days later, an old farmer from a village walked in. He had the same medical condition. After checking him, Dr. Desai started to explain him the diagnosis. He laughed, folded his hands, and said “Doctor saheb, if I had a capacity to learn medicine, I would be sitting in your chair! I have complete trust in what you do. Just tell me how to take the mediine, what I should not eat, and I will be on my way. I only understand farming well”.

Dr. Desai looked at us students, smiled, and said “When educated, we forget that the real talent lies in knowing what we cannot understand. Some people never get the fact that ‘not everyone can understand everything’. They keep circling in the same ignorant, egoistic efforts leading to frustration. That is a different vertigo, with no treatment. This farmer’s trust saves him such trouble”.

(c) Dr. Rajas Deshpande

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