Monthly Archives: December 2019

Mumbai Diary- 3 To The Silent Patriots

Mumbai Diary- 3

To The Silent Patriots

© Dr. Rajas Deshpande

Neurologist

Mumbai / Pune

Usually I stay in Mumbai on Sunday nights to be able to attend the OPD at Lilavati Hospital on Monday. Strolling by the sea is usually a pleasant addition to a Sunday evening. However, this time there were huge crowds as Christmas was only three days away, and people thronged to have a glimpse and seek blessings of their beloved Mount Mary. I decided to use the evening to visit my favourite Udyan Ganesh Temple at the Shivaji park.

I had my car but didn’t want to drive in Mumbai traffic that day, so I requested for a rental car. As the car came up, a perfectly dressed chauffeur in a white hat got down swiftly and held open the door, politely wishing me. He must be in his sixties. “I am Abdul, Sir” he introduced himself. I introduced myself too.

“Can you please drive me to Shivaji park?. and on the way I also want to visit the Mount Mary for a minute.” I requested.

“Sure Sir” he said.

In a few minutes, as I returned after praying at the Church, we headed towards Shivaji park. © Dr. Rajas Deshpande.

We chatted, he opened up very well, a rarity in a world full of cellphone robots. His father had retired with many honours from Mumbai Police.

“Those were the days, Docsaab! We stayed in a small society, there were three Hindu and a Christian family around us. Yet there was no awareness about religion, any child went and ate in any home. There was also no hesitation in anyone scolding any child for being naughty .. we were like a single big family. Nowadays one has to think a lot before speaking even to one’s own kids!”. I agreed with him.

I met my favourite deity at the Shivaji Park and returned. As we drove back, we crossed a building belonging to an ultra-rich famous businessman. The intention of the owner to show extremely gaudy luxury and glittery affluence in every inch of that construction was truly manifest. Passing by that building, we witnessed the state police guarding its gates.

Mr. Abdul spoke in a tone with hidden bitterness: “Every glass, every brick of this building is cursed, Doctor saab. This man has cheated and looted millions to earn this kind of money. There’s nothing against anyone being rich, I mean who doesn’t like to have a lot of money? But it should not be made by sucking people’s blood”.

In a few minutes his tone normalised. His smile returned. “Docsaab, I have worked for this company belonging to Mr. Ratan Tata Sahab for over 20 years. No one has ever seen any show-off of affluence or power from the Tata family. Once I was posted as a night-duty chauffeur at Mr. Tata’s bungalow. Sitting in my car, I dozed off by midnight At about 3 AM, I heard someone knocking on my car window. I woke up with a shock: it was Mr Ratan Tata, holding his own bag. I came out of the car shaking and apologising. He said to me: “Why do you apologise? Everyone gets sleepy at night. Not a mistake. In fact I am sorry I had to wake you up, but I must reach the airport as soon as possible. Will you be able to drive, or are you feeling sleepy? I don’t mind if you sleep in the back seat, I will drive the car to the airport and wake you up there. You can bring back the car in the morning”.

Pausing to clear his emotional throat, Mr. Abdul said “I felt that it was like meeting God. Since that day I never felt like working for anyone else. People usually show off and become mannerless when they get even little power or money, they insult and mistreat their employees, dependants and staff. But not Mr. Tata, he has the biggest heart I have known”.

That this should happen with me on the very day of Mr. Ratan Tata’s birthday was such a divine coincidence for me! © Dr. Rajas Deshpande. It provoked a different line of thought.

Soldiers, Police, Doctors, and millions of workers, labourers, watchmen work day and nightshifts, silently performing their duty while also serving the nation with their blood and sweat. Somehow people tend to think that these “true patriots” do not have a right to sleep well, eat well, and spend some good time with their families. Many think that sacrificing sleep, hunger and family time comes naturally as a duty when someone chooses such a career. As if it is a crime for a soldier or policeman to feel hungry, or a doctor to need adequate sleep. As if the children of these professionals do not need a father or a mother at home! © Dr. Rajas Deshpande. Our society thinks that, it is okay for them to sacrifise, suffer, even die in the line of duty. That is hardly a sign of an evolved, civilised or humane society!

Most people in our society get to sleep eight hours, have three square meals a day, then watch TV / entertainment, and in the remaining leisure some of them scream about Patriotism, share posts of emotional speeches about loving one’s country. There’s no better patriotism than actually working hard. Those who shout slogans and bellow speeches actually do nothing good for any country.

Through this post I would like to thank the millions of silent nation lovers: men and women from all religions, from all parts of my Great India, who show their love for their nation in their work, in their perfect execution of duty and service. May this New Year bring you immense inner happiness, exuberant health and realisation of the beauty of life.

Of Course, Happy Birthday Mr. Ratan Tata, if at all this post reaches you someday! You are one of the most respected icons in this world.

© Dr. Rajas Deshpande

Neurologist

Pune/ Mumbai

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Diagnose This Indian Disease

© Dr. Rajas Deshpande

“Doctor, we had gone to the UK” the patient’s husband was telling me, “What an advanced world that is! Extremely clean and very systematic! People are so well mannered, everyone is respectfully treated. So many facilities… and there’s no pollution at all! I think that world is at least thirty years ahead of us.”

His wife was an extremely complicated case of a subtype of Parkinson’s disease, under my treatment for over three years now.

“I agree”I replied, and I meant it, although it somehow felt sad about it.

“By the way, doc,” he continued hesitantly, “while we were there our son had taken an appointment with the best Neurologist there. Actually we had to pay 250 Pounds, but we thought we could use the opportunity to get a second opinion. We met the doctor there and showed your papers. He checked the patient and advised us to repeat all the tests. He confirmed the same diagnosis and asked us to continue the same medicines given by you, and said there’s nothing more to be done. I am sorry, we completely trust you, but our son insisted on a second opinion. Now we will continue to follow up with you”. © Dr. Rajas Deshpande

I smiled and replied “I am absolutely not offended. A second opinion is a patient’s right and we all exist for the patient. I am happy that the neurologist there has agreed with the current diagnosis and treatment. The only problem is that you had to pay twenty three thousand rupees just for that one consultation ”.

“That was only for the consultation, doc! We paid separately for all the tests” his voice picked up.

Almost every patient who seeks medical care and treatment in the advanced world has experienced that things are easier, faster and cheaper in India when medical treatment is concerned. While Indian doctors may be equal to those in the western world, the technology definitely lags behind because of the red-tapism and taxation, the expectation of charity (and thereby socio-political misuse) from every investment. © Dr. Rajas Deshpande.

While the Western world is decades ahead of India, most medical specialists in India is at par with the western world, and are available at a far lower cost to almost everyone. Faster appointments, much faster turnout of investigations and reporting (probably the best in the world), diagnosis and treatment is something every Indian and especially administrations should be proud of. It takes months to get appointments with the specialist, for MRIs, and for treatments too in most cases outside India, so many from the advanced world actually travel to India for medical treatment. The costs are extremely high in most world, so are insurance premiums, and doctor’s salaries.

All the credit of this medical advance in India goes to the private medical practitioners and institutes, corporate hospitals. Yet most Indians speak in derogatory terms about them. Deliberate attempts of fault finding, accusations of greed and malpractice by politicians, society and media, allegations about medical colleagues by the dissatisfied, unsuccessful practitioners and seekers of quick fame, and an environment of perpetual mistrust and legal action has really made practising difficult for many Indian doctors. Still, we have the best turnaround time and accuracy at lowest costs. Some day someone sane in the administration will hopefully realise this.

When I handed over the prescription to the patient, the husband winked at me “Doctor, I am a pensioner old man. My son made me spend for all the medical in UK, as he had no insurance cover. Can you give us some senior citizen concession?”

Like every Indian doctor who accomodates every Indian patient, I did!

What do you call the condition where you do your best for someone, but the expectations of more never cease at the other end?

© Dr. Rajas Deshpande

Neurologist

Pune/ Mumbai

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Lost and Saved Life: The Indian Puzzle

Mumbai Diary-2

Lost and Saved Life: The Indian Puzzle

© DR. RAJAS DESHPANDE

He had a sudden, severe chest pain, so he told his office-colleague so. The colleague first called his wife and alerted her “Bhabhiji please don’t panic, I am taking your husband to this hospital, please reach there as soon as possible and give me a call once you reach”.

The cab driver grasped the situation at once and drove as fast as he could. He prayed in his heart. Just a kilometre before the hospital, there was a huge mob blocking the road. A great leader was shouting aloud about his pride for his religion and patriotism, least aware that they were all blocking many children and mothers trying to reach home, patients and doctors trying to reach hospitals. The bought crowd was eagerly listening to the violence provoking words of this rich politician, also a convict and suspect in many crimes, There was less audience at the real places of God’s worship nowadays than at political speeches giving religious sermons, mixing them with the love for one’s nation!

The cabbie honked. Two monstrous looking goons peeped in his window and started abusing him insanely, least aware about the women and children around. The cabbie was abused first for his profession, then his language, and the state he had come from, threatened to be burnt alive along with family if he honked again when the ‘great’ leader was speaking.©️Dr. Rajas Deshpande

The cabbie begged with folded hands: “Sirji forgive me, I accept my mistakes, but there’s a patient on the back seat. He looks serious, we must reach the hospital as quickly as possible. For god sake, let us go”.

One of the goons opened the back door and asked this patient his name. After he saw the chest-clutching patient almost gasping, they made way and allowed the cab to leave.

Now the patient had started profusely sweating. His face had turned bluish, and he was making efforts to even breathe well. He could not speak. As they entered the hospital, the patient’s friend noticed that the patient had stopped breathing.

He shouted in panic. The wardboy and the cabbie lifted the patient on a stretcher and ran towards the emergency room.

A frantic, fearful sound of thuds of the last heart massage was now heard, along with breaking of many glass syringes and instructions shouted by doctors and nurses. A tube to restart breathing artificially was inserted in the patient’s throat. ©️Dr. Rajas Deshpande

There was no one to cry for this patient there. His friend was sitting outside the emergency room, clutching his head, stunned. The cab driver had left without taking his bills. Religion and Patriotism stayed outside the hospital campus, they couldn’t save lives.

A young and dynamic heart specialist who had just returned to India saw the ECG of this patient. An urgent action was required. He called upon the patient’s friend to sign a consent.

The friend hesitated and refused. There were a lot of news every day everywhere about doctors fleecing patients, earning money by misuse of stents and surgeries. The friend no more believed in what this doctor told him.

“I don’t know. Wait till his wife arrives, she will be here in an hour”.

Every millisecond was crucial. The dynamic heart specialist called his medical director. “Sir, I take full responsibility for this case, he needs immediate action”. The medical director cautioned him: “Doc, if anything goes wrong, if the outcome is not good, they will file a murder case against you. Why do you want to risk your bright career at the very beginning? You must also think that you don’t have any political godfather”.

The doctor rushed the patient to the cathlab and inserted three stents in the patient’s heart, that resumed the normal blood flow to heart. The patient’s heart function returned to near normal in an hour. By the time the patient’s wife arrived, the lost life of the patient was brought back. The next day, the patient could breathe well by himself.

Now the most crucial puzzles: which state did the cabbie come from? What was the caste of this patient? To what country did the helpful friend belong? Why didn’t they go to the government hospitals run by those who criticise private doctors and hospitals? And lastly, what was the religion of the doctor who saved this patient risking his own life and career?

Any sane person with an ounce of humanity in his heart won’t ask these stupid questions. But some Indian leaders and their followers do. And it is very sad and unfortunate that the answers to these questions cannot be openly revealed in my beloved India.

©️Dr. Rajas Deshpande

Neurologist

Mumbai/ Pune

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Mumbai Diary -1. Deeply Yours

Mumbai Diary-1

Deeply Yours

After finishing the day-long opd at Lilavati Hospital Mumbai, I rushed out with an intention of driving back to Pune in four hours. An old friend- a junior doctor from Mumbai (don’t think too much in depth about her) was waiting for me in the lobby.

“There’s a Starbucks in the next lane. Have a coffee before you take off” she said. I am not a sinner to decline a coffee. And this beautiful genius doctor always enriched my soul in magical ways. Usually a double shot kenya roast espresso shoots up my IQ by a few hundred points and makes my brain tap-dance for atleast three hours. She sat in the car and we went to the coffee shop. There was no place to park, so she went in to get take-away cups and I waited in the car. The bandstand seashore was only three minutes away, We decided to go there. With Shahrukh and Salman living there, no one bothers to look at us in that area, and we can thus have a cool few minutes for coffee etc. (I repeat, don’t think too deeply about this).

Just a few feet away, an elderly fruit vendor with a ripened straight proud face, white hair and a thick white moustache was sitting with his legs folded backwards. The heaps in front of him were full, most likely he hadn’t had much business today. He stared at nothing in front of him, completely unaware of the rush hour noise.

I felt for him. I wanted to see him happy, help him without hurting his pride.

When my friend returned, I requested her “Hey, could you please do me a favour and get two kg apples from that uncle over there? Give him this, and ask him to keep the balance. Make it look polite and casual, as if at the spur of the moment“. I gave her some notes. We didn’t need to impress anyone, she would have naturally done it herself too, that’s the reason we have been friends for so long.

My friend returned with the apples, and I waited a few moments to sip some coffee, actually I wanted to witness the smile on that old fruit vendor’s face. He counted the money twice, smiled and came to our car, knocking at her window.

“Beta (my child), I have enough by the grace of God. I am happy. One has to account up there for everything they take without working for it” he pointed at the sky. Then he kept a large custard apple in my friend’s hands, and said “This if from me to you and your friend with the necktie”.

Then, smiling proudly, he went back and sat in his place.

Now, please think in depth about that.

©️Dr. Rajas Deshpande

Mumbai/ Pune

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Survival Of The Quickest

© Dr. Rajas Deshpande

This young and brilliant man, Adil Masalawala, suddenly appeared to have changed. His behaviour became different and unusual. He started mumbling and replying irrelevantly. He also had fever intermittently. His caring and worried wife Mrs. Venus consulted a physician who sent them to a psychiatrist.

The psychiatrist checked Adil and advised him admission. He started with some medicines, but suddenly Adil’s behaviour became hyper, his body started becoming stiff. Then he became drowsy, and his body started shaking violently. An MRI of the brain was reported normal. That’s when the psychiatrist advised a reference for neurologist.

When I first saw the patient, he had many features that could also be caused by side effects of some medicines. Sometimes it is impossible to conclude whether it is the disease or the medicine which is causing certain symptoms. I suggested that we stop all antipsychotic medicines. That could also be a dangerous decision. The family was counselled, and they agreed. Adil’s drowsiness improved, but he became very agitated, and his stiffness and shaking worsened.

There are many neurological diseases of the brain which start as abnormal behaviour. Strokes, some infections, tumors and swellings are examples of treatable, but there are many untreatable and dangerous conditions too. The only way was to urgently investigate the patient further. Although the family was baffled and panicked, Mrs. Venus expressed complete trust in our decisions, and allowed us to shift the patient to the ICU. I could not answer many of their questions, I did not clearly understand what exactly was happening, but this uncertainty and challenge is what medicine is all about.

There is fluid in and around the brain, which nourishes the brain and also acts as shock absorber between the skull bone and the brain. Many diseases like cancers and infections can be diagnosed by studying this fluid, which can be taken out by inserting a needle in the lower (lumbar) spine. We checked this fluid, and we got the first clue: that we were possibly dealing with a viral infection of the brain. Many more costly blood tests were required to find out which virus was causing this. The family clearly stated “Do whatever is needed in your opinion”. We sent the tests and found the answer: Adil had one of the most rare and dangerous viral infection of the brain, called Japanese Encephalitis.

About 30-40 percent of patients with this diagnosis do not survive. There is no definite treatment for this virus, but many of the manifestations can be treated and excessive care is required to avoid life threatening complications of the swelling that it can cause in the brain.

On the fourth day, Adil had convulsions. His condition worsened. We kept on treating each complication as fast as possible and tried to balance the effects and side effects of the many strong medicines that were being used to control convulsions, shaking, and the brain swelling. Besides knowledge, wisdom and experience, our major strength was the trust of patient’s family who never questioned any decisions.

Many patients who develop abnormal behaviour are mistreated as having a psychiatric problem. Most qualified psychiatrists are aware of the red flags and refer patients for a Neurologist’s opinion. However, a majority of patients with psychiatric problems in India are first taken to quacks, magic healers, mantrik-tantriks, who delay the whole process of correct evaluation, diagnosis and treatment. This leads to many deaths, and this is worst in case of cancers treatable in earlier stages.

False advertisements, some even approved by highly placed offices, celebrities and authorities attract people from all classes and cause severe delay in initiation of the correct scientific treatment. While our governments rightly pressurise allopaths to write generic medicines, they mostly turn a blind eye towards rampant misleading false advertisements claiming cures of incurable diseases and centers that flourish reaping from the hope of millions of illiterates.

We almost thought we had lost this case to a permanent disability. Adil’s body had become completely stiff, his memory had become unreliable to a great extent, and he had an incapacitating tremor. After a few days we could gradually stabilise his general condition and shift him out of the ICU. In a few weeks he was discharged, improving slowly. His family, especially his wife fought for his normalcy like a true warrior, and once he resumed his senses, Adil too made every possible effort to recover fast. One day after a few months, he was back to normal again, we declared him cured and fit, physically and mentally. He resumed his job.

Today after about ten years, Mr. Adil Masalawala and his wife Mrs. Venus came over for some trivial issue, and we recalled the horror that we went through and his victory over it. In this case, I thought it was the “Survival Of The Fastest” as the family did not waste any time in quacks, arguments, objections or mistrust, and let us doctors do the best for the patient in the fastest possible way. We are grateful to the family for this trust, and Adil’s survival and recovery itself is our reward. God bless the couple with a long and healthy life!

© Dr. Rajas Deshpande

Real Story, Real Names, With Patient’s Express Permission. Grateful to Mr. Adil and Mrs. Venus for the permission to share the story of their victorious battle.

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Doctors & Manners

“During my postgraduate training in Britain, I once wrote a psychiatry reference for a man whose symptoms appeared disproportionately out of range for most neurological conditions” one of my Neurology professors was telling me.

“After the psychiatrist saw the patient she agreed that the patient had some issues with depression due to chronic stress, and started treatment. However when I went on the next day for rounds, the patient smiled at me and spoke with some distaste: ‘Doc, thank you for referring me to the psychiatrist, I feel better after talking with her, but don’t you think you should have first discussed with me before referring me to her?’ I realised my mistake and apologised to the patient. That day onwards I never took for granted any patient.”

This Profeesor had taught me one of the best secrets of good patient care. I am forever indebted to him for this invaluable technique he taught me. Yes, genuine respect and politeness for the patient is a technique most essential for every doctor to imbibe. It is NOT artificial sweet-talk or show-compassion that matters, it is an inner wish to solve their problems when possible, to counsel the best even if there’s no treatment or cure, and to treat them equal that makes the core of a true doctor.

It is indeed true that many doctors behave in a manner-less, high-handed way with patients, speaking only medicolegal language and maintaining a distance from the patient. The other side is an artificial sweet talker whom most patients can now identify.

One definite reason for aloofness of doctors is that many patients are indeed suspicious of the doctor’s intentions, ability and integrity. Many patients actually behave quite rudely with the doctors, asking questions beyond the sphere of relevance, directly questioning the experience and accuracy of doctor’s diagnosis and treatment, expecting to understand everything about the complicated medical condition in five minutes what can only be understood over years of actually dealing with patients.

Still, it is the good doctor’s responsibility to simplify and write down his opinion about the possible diagnoses and encourage patients to read from some standard sites. That prevents many misunderstandings.

Many medical institutions have included training curriculums for doctors to learn how to behave with the patient, but these are grossly insufficient. The internal effort to treat the patient like an equal must only be self-taught by every doctor who wants to become successful in long term. To even treat an angry, paranoid patient with dignity and respect is an art. That said, there indeed are aggressive and violent patients and relatives in India, whom no doctor can tolerate. The doctor should also learn how to avoid them without being impolite.

I am grateful that I had professors like Dr. Sorab Bhabha and Dr. George Rice who took me to another level in both Neurology and best patient care including bedside manners. I may not be able to solve every medical problem, but behaviour with patients will never be a problem for me, thanks to what they taught me.

Dr. Rajas Deshpande

Neurologist Pune / Mumbai / Goa