Monthly Archives: November 2020

Thirty Years of Suffering and One Tablet of Gratitude

Thirty Years of Suffering and One Tablet of Gratitude
© Dr. Rajas Deshpande

At the age of 18, he started noticing difficulty in falling asleep because of a weird pin-prick like sensation in his calves. He ignored it initially, but later in a few months it grew so severe that he could not sleep. Then started a nightmarish phenomenon of sudden squeezing sensation on the legs, sometimes with other abnormal and disturbing symptoms like gnawing pain, pulling and jerky movement of both legs. A little massage initially helped, but within minutes, symptoms returned, and now came up to his thighs. Many a nights, he could not sleep at all.

Lack of sleep worsened his daily performance, and he started getting irritable, confused and often very depressed because of the ongoing symptoms. There were phases of relief without any apparent reason, but the problem almost always returned with more severity. He went from one doctor to another, was told he had nerve problems, muscle fatigue, deficiency, and even psychological issues. Various tests done did not show any abnormality. In the last few years, his symptoms spread over to his hands and became so severe that he could not sleep at all. He tried many medicines from many pathies but had no relief. Then he started having suicidal thoughts.

That’s when Dr. Lakshman Sathe of Dodaich arranged for a video consultation with me for Mr. Rajendra Badgujar, now 50 years old, resident of Sindkheda. As any learned neurologist will have guessed from the description above, I concluded that Mr. Rajendra was a severe case of a rare disease called “Restless Legs Syndrome”. Although rare and more common in women, this extremely troublesome condition is now increasingly recognized in Indian population. This usually is caused by a genetic predisposition, but may also be associated with certain other medical conditions including iron deficiency. The most common complaints are ‘restlessness’ of legs, due to weird squeezing, pricking sensation or jerky movements. Very good treatments usually in form of tablets are available, but most of these tablets have serious side effects if incorrectly used. Also, only if the diagnosis is accurate and not associated with any other related conditions, patients respond well.

Mr. Badgujar, who had suffered for nearly 30 years, had complete relief within a week of starting the new medicine, and is now not only having sustained relief with only one tablet, but has also slept blissfully over last two months. Still, that is not the reason for my article. This poor man travelled to Pune for 9 hours, daring the CoViD pandemic, with his family, only to personally say thank you to me. This single tablet of gratitude calmed my restless mind instantaneously!

Most neurologists can readily diagnose and treat this condition in the first or second visit itself, sometimes a few tests may be required. If the patient reaches the right specialist for various medical conditions, not only is he /she relieved at the earliest, everyone saves a lot of money and we can thus contribute to improve the reputation of our noble profession.

©Dr. Rajas Deshpande
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PS: Every qualified neurologist can diagnose and treat this condition effectively.

Say, doc!

Say, doc!
© Dr. Rajas Deshpande

“Doc, may I eat fruits?”
“Yes”
“Papaya?”
“Yes”
“Apple?”
“You can eat all fruits.”
“Banana also?”
“Yes”
“But I get vomiting after eating banana..”
“Then don’t eat banana”
“But you just said I can eat all fruits “
“I’m sorry, please eat only what you tolerate well. Anything else?”

Next patient.

“Till the time we finalise and treat the cause of your unconsciousness episodes, please don’t drive any vehicle “ I told the twenty year old girl whose family stood surrounding her dipped in worry.

Since after a head injury during riding, the patient had had fits. She continued to ride her moped to her college inspite of strict warnings by doctors not to drive. This time she was admitted because she had fallen from her bike as she had a fit while riding.

“How will she go to the college then?” asked her angry mother.

“You will have to make alternative arrangements” I replied.

“Can she drive a four wheeler?” asked her father.

“No”. I now understood that they didn’t want to understand the risk.

“Three wheeler?” asked a relative who had the most common Indian OCD: talking without thinking, expressing opinion because it’s a constitutionally granted freedom.

“What three wheeler do you want her to drive to college ?” I asked the OCD bro.

“No. I just asked out of curiosity “ he replied more guiltlessly than your favourite politician.

How many irrelevant questions should a doctor reply to patiently?
Running between emergencies, making crucial life and death decisions for others over 30-40 times a day, with zero allowance for mistakes and facing angry, troubled souls who we genuinely want to help, how much extra time and patience for irrelevant questions is a doctor expected to waste? If relevant and crisp, every doctor enjoys the conversation, effective communication. When that enters the realm of “charche pe charcha”, it frustrates the doctor. Imagine that happening about twenty times a day. © Dr. Rajas Deshpande

Can a doctor refuse to answer irrelevant questions? Yes, but that risks a bad online review, rating in spite of correct diagnosis and good outcomes!

The consultation charges that a regular doctor charges are meant for a thorough history taking, examination and deduction of possible diagnosis, advice about tests required, and the best possible options of treatment/ management. It also includes a to-the-point explanation and information to the patient and attendant. It doesn’t include the unending “questioning” and expectations that the patient/ relative should grasp everything immediately- medicine is indeed very complicated. We usually give patients the websites to read from, but it cannot be the doctor’s responsibility to make the patient understand everything- it’s like asking the Judges to explain their decisions and law to both parties involved in each case- every day.

Every medical student should learn how to patiently, courteously tell the patient and relatives to limit the conversation to relevant questions only. It is an art. One can also schedule a separate paid consultation in case the family had extended questions and needs the doctor’s extra time.

Just when I was finishing a late day, a patient who had just left returned, panting because he was running.

“Doc, I forgot to ask you- is it okay to smoke a few cigarettes? – I am quite stressed you know”.

I smiled and replied “No you can’t. Reduce stress rather than killing yourself slowly with both smoking and stress”.

That was a relevant question though, as it reminded me of reducing stress in my own life. © Dr. Rajas Deshpande

© Dr. Rajas Deshpande

Beyond Those Valleys and Mountains..The Story of a Doctor That Media Won’t Tell.

Beyond Those Valleys and Mountains..
The Story of a Doctor That Media Won’t Tell.
© Dr. Rajas Deshpande

Just after admission to a medical college, Rohan noticed that he had a twisting movement of his right hand. He was diagnosed with a common condition called “Writer’s Cramp”, which is sometimes disabling and resistant to treatment. He started changing posture and position of his hand to be able to write well and somehow continued his studies. His complaints kept fluctuating. His father, a primary teacher, passed away when he was in the second year of Medical School. His mother somehow managed with the tiny pension they received and Rohan completed his MBBS.

During internship his left hand started to become weak, he had numbness in some parts of the hand, and could not move two fingers. It was quite painful too. He came to us for his nerve damage. His worried mother had a hundred questions, fears and tears in her eyes. Studies showed that one of his nerves was severely damaged. There are very few reasons why this can happen in young patients. Diabetes, faulty Immunity, Genetic Diseases are common, but upon investigating, Dr. Rohan was found to have the most dreaded cause for his nerve damage: Leprosy.
Dr. Arjun Mapare started treating him for Leprosy.

I reassured them and we started on an unpredictable journey. I explained him the schedule of medicines and advised to continue his leprosy treatment.

Doctors get infected with dangerous diseases every day. However nerve damage especially in the hands endangers entire career of a doctor, and if treatment is not started in time, many develop lifelong disability. Nerve diseases are extremely troublesome, recoveries are rare, delayed and difficult in many.

Dr. Gajanan Bhalerao, my super energetic colleague known for his physiotherapy expertise took the challenge and worked up a strict plan which Dr. Rohan followed. He kept on working after permission from his leprosy expert.

Where there’s no light, faith guides us. Patience is a rare quality. For a few months we did not see much change, but we didn’t want to give up. Beyond those valleys and mountains that scare us, is the Sunrise.

Today, Dr. Rohan visited after many months, completely recovered from leprosy, and told us that his hands have full functionality, his nerve functions were normal and he was able to move his fingers well. His writer’s cramp in the other hand bothers him sometimes still, but what’s a doctor who can handle problems? There are hundreds of such passionate young medical students fighting through adversity right now in India, because they have a common aim- neither money, nor fame, it’s the wish to treat the sick and suffering, to save lives.

The credit of his recovery?
To Dr. Hansen who discovered leprosy bacteria, those who discovered its treatment, those like Baba Amte who spent life fighting the stigma of this disease and the thousands of specialists in urban and rural India who treat this every day …. and some thought Covid was all that’s important!

Dedicated to the memory of Dr. Baba Amte, worthy of Bharatratna and Nobel Prize both!

© Dr. Rajas Deshpande

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Photo:
With Dr. Rohan (Name Changed) and
Dr. Gajanan Bhalerao

Who Is Guilty Here?A Typical Indian Case


© Dr. Rajas Deshpande

“Sir my brother is critical. The doctors are not telling us anything about recovery. They don’t even reply to our questions about when the patient will recover. They are so inhuman! They should let the patient die if he is not going to come out of this illness, but they give us false hope that he may recover” said the friend, whose language precluded decency.

Having them seated, I requested details from patient’s friend accompanying the brother.

The patient, now in late thirties, had married against his family’s wish. He was boycot by his family, and started living with his wife. After a few days the couple started having quarrels due to his drinking habit. He frequently beat her up, and she often made a public scene of their private issues. He left her one day and returned to his family. His parents and brothers continued to taunt him. One day he was beaten up by his brothers, and in a fit of anger he drank rat poison.
He started vomiting after a few hours, became unconscious, and was taken to a quack who forced some magic potion in the patient’s mouth. Just after that, the patient had convulsions. “Take him to a doctor” said the quack. That’s when they went to a nearby rural hospital, which had no doctor. When they reached the city, patient was almost comatose. They took him to a low-cost multispecialty hospital. Upon admission his blood pressure was not recordable, breathing was almost nil, and heart was already beating too slow. The doctors there had acted fast and stabilised him, but by then his brain had suffered severe damage due to low blood pressure and very low oxygen.
In a week, he was stable, breathing on his own, opening eyes but unable to recognise anyone. Recovery in such cases is always very slow, unpredictable, and mostly incomplete. He needed supervision and nursing care, that was being done. Doctors were tired of the incessant repetitions of same questions: from relatives, politicians, and many other doctors. There’s a limit to how much compassion can one offer to its abuser. © Dr. Rajas Deshpande

I did what was the obvious thing to do: reassured the relatives that the treating doctors were doing a good job, that things were unpredictable in such cases, and that they should have trust in the ability of those qualified doctors to handle a case whom they had rescued from an almost certain death.

What ate my heart away was the blatant, glaring line of facts here: the family was not kind to him, the wife wasn’t kind to him, his relatives took him to a quack and wasted most precious time that could have saved a lot of brain damage, the quack used something that dangerously worsened the patient’s health, the rural government healthcare was inadequate, but none among the family or politicos ever said a word or questioned that. As if they were all exempt from humanity, and nothing about his health was any of their responsibility. © Dr. Rajas Deshpande
The doctors at that low-cost hospital, with minimum amenities, had still managed to save the patient, they did an excellent job, but were still labelled inhuman – just because everyone expected a full recovery of the patient, as if it was worthless to save a life unless it was complete, quick and cheap!
Indian doctors are already considered among the best all across the globe, we keep abreast of all advances in our respective fields by studying every day, we are easily available to everyone who needs our skill and opinion, we work far more than our colleagues in developed world, yet we are the most stressed, criticised, villainised and also poorest paid class of doctors, living under threats from one and all. Indian healthcare infrastructure is atleast fifteen years behind the developed world, it is us doctors who carry that burden of patient’s (googled) expectations upon our shoulders. It is frustrating to deal with the trustless, paranoid interactions with the relatives of those very patients whom we are trying to save.
What kills us most is the indecent, aggressive, violent way in which most doctors are abused in our country. Even the patients who do not recover completely speak in a vengeful, angry and complaining way to their doctors rather than any trace of gratefulness for whatever recovery was achieved.

The only way to possibly change this scenario is to change the society. Yes, to prefer a developed society where common sense and decency are not optional.

© Dr. Rajas Deshpande