Category Archives: Best moments

Distance Yourself, Doctors.
© Dr. Rajas Deshpande

Dear Indian Doctor,
Congratulations on your bravery to face a pandemic without much support or protection. However it looks like once again a lack of funds and scientific PPE availability will be conveniently translated by one and all into “Doctor Bashing” by sermons on call of duty and other emotional yet unscientific logics. Even some administrators who have exposure to screened few, sitting six feet away from everyone are wearing PPE and N95, while appealing doctors to start opds saying there’s no risk. Should one examine a patient without touching? Do we have seven feet long hands? If we are expected to go within 2-3 feet of the patient, aren’t atleast N95 and gloves essential? But logicless arguments only waste time. Always labelled ‘Money Minded Medics’, now when doctors are sitting home, not minding money, everyone wants them to be in the forefront, appreciated by groups clapping from the safety of their homes. © Dr. Rajas Deshpande
But you know what? This has always been, this will always be. Do not expect any major change in social mindset. None of them had merit or patience to study hard for 10-15 years to become a doctor. None of them even knows what sacrifices are required in daily life, family life and personal exposure to fatal conditions on a daily basis. Their tiny grasp is limited to the last visible part: the fees for service. With an exception of honourable few, most cannot understand a medico. Least those who must please and seek attention of majority. And Majority was seldom right as per history. © Dr. Rajas Deshpande. Logic-less mobs are a reality.
Only those among us who shoe lick and toe line will be projected heroes. Most of us are beyond that. It is pathetic that no doctors’ organisations or glamorous bigwigs stood up against some of the major issues concerning fatal risks to our next generations. (DO NOT FORGET THAT).
That’s why writing this: it Is now upto each one of us to fend for ourselves. Stay calm. This is also not a time to argue with administration. Keep concentrating on your own safety while doing the best for every patient. Wear double masks if you don’t have N95. Wear cloth head cap that you can wash. Wear plain spects/ goggles. Use gloves always. If at all you touch patient wash hands thoroughly. Limit examination to necessary. Ask every patient and relative to cover nose and mouth before entering your chamber. If sanitiser is not available use spirit. Leave wallets, purses, bags in your car/ locker. Disinfect your stethoscope, torch and other instruments. Use digital blood pressure machines where possible, if you must auscultate, have the patient turn away face. Change bedsheets and pillow covers frequently. When you leave hospital please wash exposed skin thoroughly. Upon reaching home leave your footwear outside, cover your face and walk straight to the washroom. Change and immediately soak your clothes in detergent plus hot water. Take a thorough wash with preferably hot water, especially washing exposed areas like head. Take your vitamins without fail. Those with high bp and sugars please take rest and leave freely, don’t take your own health for granted. Eat well, stay safe, all of us have to save thousands and thousands for many more decades. Please do not forget that medical practice is far above and beyond one pandemic, covid or not. We must be available to serve all other deserving patients, and for them we must now take the responsibility of our own safety. No one ever stood by doctors’ well being, no one ever will.
Haven’t we always been distanced by the envious, jealous and unscientific? It’s our turn to use that distance and stay away from those. For every patient who deserves us.
All the best.
© Dr. Rajas Deshpande

An Interview With a Neurology Legend

An Interview With a Neurology Legend

Dr. Satish Khadilkar

MD, DM, DNBE, FIAN, FICP, FAMS, FRCP (London)

Dean and Professor and Head, Department of Neurology,

Bombay Hospital Institute of Medical Sciences, Mumbai.

He is a living legend, one of the best neurologists anywhere, a stunning example of what an ideal doctor should be like.

He needs no introduction to those in the medical world: he has carved his golden name in global neurosciences with his passion for Neurology and especially NeuroMuscular diseases, pioneering this specialty in India. I am grateful to Dr. Satish Khadilkar for agreeing to guide us all.

Q: How does it feel at the top?

A: Grateful to life!

In the health pyramid, ‘top’ really means ‘more useful’! And there are at least three parts to being useful: providing service, teaching and conducting research. Indeed, I am grateful to life for having provided me with the opportunities to be useful to colleagues and disease sufferers in all the three spheres.

Q: What are the most essential qualities that a doctor must possess?

A: As mentioned above; service, teaching and research are the three main pillars of medical careers. Each of these requires different virtues. Service requires patience, availability, affordability and the capacity to empathize with the sufferers. Teaching requires clarity of ideas and the ability to be inspirational to the new entrants and younger colleagues. And research requires an analytical mind to understand questions, be unbiased to design experiments in search of the answer.

Depending upon which field you choose, relevant qualities will need to be enhanced. In my mind now, as I have gone on, service has emerged as the noblest frontier for the medicine man. So the essential qualities are compassion, knowledge and the desire to help.

Q: What do you suggest we do to improve the clinical sense among newer generations of doctors?

A: Simple answer: bedside clinics by masters of clinical medicine and shadowing them to see how they utilize the limited resources.

Q: How do you deal with the ever widening knowledgebase while effectively practising as one of the busiest practitioners in the country?

A: Knowledge is of two types, one to know it yourself and the other, to know where to find it! In the present times; we have moved on to the second mode. The great thing about this era is that knowledge is freely available. We only need to develop the ability to design the search to get rapid answers to our questions. There are courses available to this effect.

While this is true for problem-based daily issues, in one’s own area of interest, one has to acquire all the manuscripts and threadbare them, assimilate them and understand them, for deeper knowledge.

Q: How do you handle the incessant negativity which doctors face while dealing with so many incurable conditions and gradually deteriorating patients?

A: Negativity in the doctor’s mind stems from the perceived personal inability to help or to provide solutions. Doctors need to appreciate that their role is limited to being knowledgeable helpers. If we keep in mind the inadequacies of medicine as a science and our restricted role, negativity is less likely to take roots.

Q: What is your take on making holidays, vacation compulsory for doctors to overcome stress?

A: Personally, I do not see the need to take holidays, as my daily work itself is a never ending holiday! I do not remember taking a holiday in last three decades. The better you gel with your work, less it stresses you and less is the need to break.

Having said that, as our work relates to human life, we have to make sure that we take adequate rest and are “on the top of our game” for the hours that we work, as our shortcomings can have consequences.

Q: What advice will you give about handling family responsibilities and duties to the new generation doctors?

A: Human relationships take very long to build and only one indiscretion is enough to undo these. So, in relationships and family, equal attention needs to be given, as you would in your profession. In today’s competitive India, we tend to take the family granted and actually end up doing the least for those who matter most!

It is best to think of this early on while planning the professional career.

Q: What best can be done to stop the exodus of doctors from India?

A: Talented Indian doctors need to be appreciated by the society and the health system in India. System needs to be more humane and responsive to the doctors’ needs. Doctors also need to understand the process of medicine, its goals, trials and tribulations. Till this happens, we shall see movement to greener pastures, where this process has evolved better.

Q: Your guiding thoughts for future Indian Doctors?

A: Let us all remember that we are in medicine to help suffering people. That is the core of medicine. We are healers and scientists. If we don’t veer from this ideal and have patience, all material wants and requirements will automatically fall in place. So to understand medicine, one must never forget that this is the noblest of all professions. I have chosen its nobility as a guiding principle for myself. I found my solace in drowning myself deep in the vast oceans of knowledge about neuromuscular disorders and using it in the service of suffering multitudes.

©️Dr. Satish Khadilkar & Dr. Rajas Deshpande

The Dictators in Hospital © Dr. Rajas Deshpande

“Let my father die. It’s ok. I will not take him anywhere. I don’t want anyone else to treat him” said the 60 year old son loudly. His old father who could listen and understand the conversation, but could not speak or move due to a paralysis, just closed eyes. Tears emerged from the corners of those closed eyes.

Like most doctors nowadays I have learned to master personal opinions and emotional responses, especially with ill-behaved patients, but this was beyond me. Not because he had shouted at me, but because he had just stabbed his father’s heart. Loudly, so that the patient could hear, I said “I think your father should feel better soon, let us see what we can do”. Then I gestured the angry son to see me out of the room. Two other men accompanying him came out and towered upon me.

About five days prior, this son had come to me with his father’s reports. The patient was admitted at a rural hospital. He had severely compromised heart function and his heart rhythm was abnormal. This caused formation of many blood clots in the heart, which went to the brain blocking blood vessels. One such large blockage had caused paralysis and inability to speak. © Dr. Rajas Deshpande

I had asked the son not to shift the patient, as the treatment started by the rural physician was accurate, we had to just wait and watch. Still, they had brought the patient in an ambulance, travelling for over 4 hours. Naturally, the patient had worsened , becoming drowsy. His heart rhythm was dangerously worse. He was unable to swallow, there was a big risk of his saliva/ mouth secretions going to his windpipe blocking his breathing.

Whenever a patient has problems out of a specialist’s expertise area, it is mandatory that an opinion of the concerned specialty expert be obtained. I asked the best heart specialist I knew to see the patient, and also a small ENT test to see if we could initiate training for swallowing. Our physiotherapists were already working upon his hands and legs gently.

However, the son (a retired govt. officer from a very respectable post) and two others attending the patient created a big scene when my junior doctor visited the patient. They started shouting and cursing that by calling other specialists we were just “increasing the bills”, and that they did not want anyone else except me to see the patient, not even the junior doctors. © Dr. Rajas Deshpande

My assistant physician called me in panic and updated about this, asking me to immediately act to deescalate the situation. Although there were many patients waiting to be attended in OPD, I had gone to this patient’s room. I explained to them that the patient needs to be seen by a heart specialist too, as his heart condition was very delicate. I also offered them to choose any specialist or hospital they wanted, if they were unhappy here, but they could not waste time as the patient was critical. That’s when the son shouted that he would rather let his father die than be seen by any other specialist.

When they came out of the room, their body language and general disposition suggested aggression. I tried to politely reason with the son that any specialist cannot sit with the patient 24/7, that junior doctors and other specialists as required will have to be called in for the best care, but they declined. The efforts of our medical superintendent and best patient coordinator went in vain. © Dr. Rajas Deshpande

“We will not allow anyone except Dr. Deshpande in the room. Our patient must get better” the son said loudly.

“I will see him till he is under my care, but I cannot guarantee any outcomes” I told them. “Let’s see” he said. He did sign the document informing about criticality of the patient.

No doctor should treat patient under pressure, duress or threat in the interest of the patient. I went to our medical director and requested that the patient be transferred under some other specialist. The hospital offered them freedom to choose, but the relatives declined. “We have come here for Dr. Deshpande, he will have to treat the patient alone” the son said. The hospital decided to take a call next day after a meeting.

That evening as I finished the OPD, I wondered how the patient was. However much angry I may have been with the relatives, the patient was more important than my anger, pride or anything else. I went to their room and checked the patient. He opened eyes and smiled. I asked him his name, and he replied in a husky tone. He was speaking now!!

The next day again, the relatives refused to transfer the patient under someone else, and I kept the treatment on. The trustless atmosphere was quite volatile, and if something had gone wrong, things would have taken an ugly turn. In the next three days, the patient spoke well, and even accepted some sips of water. His hand and leg started moving too.

“Can we take him home now?” the relative asked on the fourth day.

Happy for many reasons, but mainly the fact that the patient had improved, I discharged the patient. I had learnt my lessons. © Dr. Rajas Deshpande

Adamant, unreasonable and illogical demands by patient’s relatives jeopardising the patient’s life is a huge medical problem in India. Illiteracy, political interference, goonda culture and media support make such horror stories a routine reality. The law still expects the best patience and non-reacting approach of medical personnel, with the onus of saving lives still upon them under this pressure. Innumerable instances of harassment and humiliation of nursing staff, especially women go unreported. Relatives, especially politically connected, behave like dictators in any hospital, threatening one and all. Unless this culture ends and doctors are at a freedom to do their best for every patient, medical care in India will always remain inaccurate, incomplete and purely financially guided rather than scientific or even legal. Doctors can actually file a complaint or take legal action in such cases, but they are too many, and no doctor has time for such legal courses. In the best interest of our patients’ lives we go on forgiving and tolerating such abuse. Because neither law nor administration wants to correct the causative factors effectively.

© Dr. Rajas Deshpande

Neurologist Mumbai/ Pune

Please share unedited.

Take me for granted

©️Dr. Rajas Deshpande

Neurologist

Pune/ Mumbai

“Is your food more important than the patient?” asked a angry voice on the other end of the phone.

It was a Saturday night, about 11 PM, and I had already had a tough day. I had not had time for even lunch, my head was hurting already. I had known the patient for over five years, her husband wanted to “discuss something” urgently. I had requested him to call next day, honestly mentioning to him that I was on my way for dinner. That’s when he asked if food was more important than patient.

“No. Food is not important than the patient”, I said, “Please tell me.”

“Listen doc, today after dinner me and my wife had our usual walk in the society, when we met a neighbour who told us about a new herbal treatment for neurological patients. He said it worked like magic in paralysis cases and the cure was guaranteed. He had some extra bottles, but it is very costly. So we decided to call you and ask”.

“What is so urgent about it?”I asked.

“Not urgent, but we were both very excited and anxious, so we decided to call you and ask” He replied. I told him that that they were free to try anything they wanted, yet cautioned him to check the contents and then alone take any medicine.

I wasn’t angry.

The next morning, I had to visit a government office. There was a huge queue. By noon, as the queue extended, the officer got up and with a calm face went for his lunch, displaying a a sign “Lunch Hour”. I wasn’t angry.

©️Dr. Rajas Deshpande

I remembered the time when I had to visit a minister, a bigshot political leader for some issues about resident doctors. We had to repeatedly call for appointment, it was cancelled many times, then we were made to wait for hours, securitymen surrounded the elected representative, considered a public servant. Then at six he suddenly got up and left, quoting an urgent meeting. I wasn’t angry.

Because as a doctor I am perpetually alive to the fact that people take me for granted. That they will misuse compassion, avail of my private time for trivial reasons without feeling any guilt or compensating for it. That they will expect me to be sympathetic even with arrogant, abusive and blatant liars who treaten me with assault.

Because big ministers and political leaders who have a checkered past and disrepute of lying can openly make allegations that tarnishes the image of all doctors in the eyes of our “Election Elite Public”. Blanket allegations by many that accuse all doctors of indulging in malpractices and foreign tours or worse, ‘asking for women from pharma’ have become common.

Don’t these people know that thousands of most successful doctors in India are in fact women, and it is such a huge insult to those as well as the glorious careers of many thousand other medical professionals who live a life of an ideal doctor, who have trained millions of medical students successfully in that tradition?

©️Dr. Rajas Deshpande

More than half of those in the parliament must have been successfully delivered by a qualified doctor, and most of them must have had their children brought up/ treated by expert doctors. Most politicos must be under the treatment of some or other specialist, so that they can work well, still they have this habit of “Attention seeking” by trying to disgrace the whole profession of best qualified people of their own country.

What ingratitude!

The other day I also saw a video of some sermon in some village, making fun of doctors and specialists. The religious speaker, who could have easily qualified as a stand up comedian, and had no clue what a doctor does and why, was making cheap fun of doctors. What was more alarming was the way public was laughing and clapping, thousands of them! I wondered how many of them, their family members were treated by some doctor, and how many of them remembered it. I can understand and enjoy jokes and fun. But this was maliciously criticising an entire profession of highly educated people serving India 24/7, inspite of the hate and paranoia that surrounds them, that too by a person without any medical background or qualification! Many comedians have actually gone beyond “graceful” and “quality” comedy to cheapest low levels to criticise doctors. Hope they meet good doctors who avoid head traumas at least when their children are born!

©️Dr. Rajas Deshpande

You cannot and should not make fun of militarymen. That never means there cannot be anyone wrong in themilitary / army. But there’s a system to deal with that, it is not open for politicos, temporary ministers, and self proclaimed godmen / women / artists to criticise the military. The guilty must be punished, whether in any profession or service, and it should be done legally, and others should stop speaking about it. This should apply to the medical profession too. There indeed must be some doctors who are wrong, they must be dealt with, but we do not go out and blame everyone from other profession!

The most common allegation is about doctor’s handwriting. Well, if you have the guts and patience to listen to over 50 crying/ complaining people every day, while writing for them a “Scientific” list of medicines, which can save life or kill, without committing a single mistake, for decade after decade, then you are welcome for a handwriting challenge with doctors. Google the word “Scientific” and see how much of your speech is scientific before you speak abut doctors! For government hospitals, the daily patient number crosses 150 per doctor. Every prescription is a huge liability. If the chemist can read it and others cannot, who is illiterate?

©️Dr. Rajas Deshpande

I have seen the most artistic and best handwriting by doctors at all levels: students to specialists. Indeed, some doctors may have a bad handwriting, but in a country that has many illiterate leaders, some who never completed school or college, a society with one of the highest illiteracy rate in the world, it is such a paradox that they all have such a unity when laughing at doctors who write 40-200 pages every day, each page bringing back someone or other from suffering to relief, from death to life!

No amount of a leaders’ loud and chest thumping speech will ever save a patient from a heart attack or paralysis. No amount of comedy will take off the ventilator of a comatose patient in critical care unit. No poetry in beautiful handwriting will safely deliver a child. No political leader can stay awake in a casualty to treat a dying poor found injured on the road. All Doctors do this.

Still, I am not angry, because I have come to accept the fact that Indian society hates their most meritorious, studious children: the doctors.

Take me for granted, I am all yours.

For now.

An Indian Doctor, happy with his purpose of saving lives, reducing suffering of Patients from across the world, too busy to stand up and waste my anger on cheap attention seekers.

©️Dr. Rajas Deshpande

Neurologist

Pune/ Mumbai

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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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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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Doughnuts, Laddoo, Anyone?

© Dr. Rajas Deshpande

He was so cute and plump as a child, that everyone started calling him “Laddoo”. Soon this became his name. His parents were both hyper-educated, and both owned google browsers, so they studied about parenthood in-depth every day, and decided to provide Laddoo with the best parents and upbringing. They had many fights about how to do it right, but they took care that they never ever fought or argued in presence of Laddoo. They never raised their voice in front of him. Laddoo therefore grew up thinking that any arguments, disagreements or raising of voice was so uncivil and wrong. In a calm, disciplined home, he was being given the best of parenthood as suggested by the best parenting websites in the world.

Laddoo’s parents took care that he could only eat the most fresh and clean, organic food. Laddoo was proud that he did not eat garbage like other children of his age. He often envied those who could eat spicy, oily roadside food, especially the panipuri, kachori etc., but he remembered what his mom-dad had told him about the bacteria and viruses in such dirty food. So he never ate anything like that, but he started developing anger towards those indisciplined kids who could eat and digest anything they wanted. In the midst of beautiful, clean plenty, Laddoo started growing up resentful of everything around him. © Dr. Rajas Deshpande. At home though, Laddoo was always a prince. To encourage free thinking, his parents had decided never to shout at him or punish him. They chose only logical, scientific, calm explanations when he was wrong. Once a maid-servant who was cleaning their home shouted sarcastically at Laddoo: “You call yourself a grown up, can’t you keep your clothes in a little order?” Laddoo’s mom was shocked, she fired the maid immediately. “Such ignorant, stupid illiterates! These slumdwellers have no idea how to raise children!” she commented, patting Laddoo on his head.

“You are stupid, Mom, you and Dad both!” Laddoo shouted, “Why do you stay in India with such people around?” His mom was so thrilled to hear this, that she immediately WhatsApped Laddoo’s words to her friends’ group, adding “Laddoo has become so mature now, he’s speaking exactly what I think sometimes. I am so proud!”. Laddoo was pampered more. All that he wanted was being made available. If he did not get what he wanted, he would throw a tantrum, accuse his parents of cruelty, and write about his parents in his famous blog “Parents and Children’s Freedom”. He had many followers. His parents oozed with pride when they referred to their Laddoo as a “Child Celebrity Author”. His proficiency with cellphones and gadgets was their pet boast.

The thoughts that “I can be wrong, someone else can be better than me, someone else can grasp better, be more intelligent or successful” never crossed Laddoo’s mind. “What I think must be the final word” became his perpetual attitude. If at all anyone was successful in proving his mistake, Laddoo would immediately state how some fault of his parents, teachers or friends led him to commit that mistake. He freely used words that scared elders: abuse, violence, childhood trauma etc. This would usually hush up the matter, and Laddoo always kept on convincing himself and others that everything good that happened in his life was solely due to his own heroic efforts whereas everything bad that happened was the fault of someone else. His parents did not want to ever shake his self-confidence, so they never made an effort to correct him.

Once Laddoo spoke arrogantly and then argued rudely with his class teacher. She was so upset, that she scolded him in front of the class, called him stupid, and gave him a punishment of standing for an hour till the class was over. After returning home that day, Laddoo complained of severe pain in both legs and giddiness. He was taken to the best child specialist, then a neurologist. “There’s nothing major, please take him to a counsellor” they were told. © Dr. Rajas Deshpande.

“Indian doctors really cannot understand a thing” said Laddoo’s father, and sent his reports to Laddoo’s aunt in the USA. The experts there commented that the child may have suffered a mental trauma due to the scolding and punishment by his teacher. Laddoo’s parents immediately filed a police case, wrote blogs against the school and the teacher, and then also complained to the school about the teacher with threats of legal prosecution. It was only after the teacher and the school apologised to Laddoo, that the cases were withdrawn, and his pain and giddiness improved. No teacher ever scolded Laddoo throughout his career thereafter.

Now Laddoo is heading a major company in California. His useless, old parents live in an old-age home, pretending to be happy. They believe that their beloved Laddoo does not see them regularly because of their own parenting faults. They cannot express this to others, they just tell people “He is extremely busy”. Laddoos parents also truly believe that his success in grabbing a great job is the highest achievement of their life.

Laddoo does not have any friends. He only has drink-n-game partners in luxurious clubs. His first wife left him long ago (“She was ridiculously orthodox, she wanted to grow up kids and all”). His second wife owns a company in Washington DC, they meet twice a year. Both of them tell people how they are victims of childhood traumas., especially when they fail competing with those “unruly, ridiculously happy” colleagues. They have decided never to have children so as to compensate for their childhood traumas, bullying by friends, teachers and parents etc. “We cannot afford time for such traditional lives” they mutually agree. They believe, understand and cover each-other’s lies so effectively, that they find it difficult to grasp why others around them cannot accept those.

Laddoo does not like anyone arguing, asking him questions. “Geniuses like me do not owe an explanation to anyone” he says, often freely quoting the likes of Newton, Einstein and Steve Jobs. No one really wants to interact with him now a days. Just as people avoid the spoiled brats of rich fathers, knowing that they are beyond any resurrection, they avoid Laddoo too. © Dr. Rajas Deshpande.

“Thay are all jealous about me, my genius, my success” Laddoo thinks. His wife agrees. Both of them spend their time at home and work blaming the whole world, showing people down, being bitter to the happy ones, and repeating the stories of how they suffered in the past, how they struggled through those imaginary problems and how heroic they have been to reach where they are now. They compliment each other like the two halves of a doughnut.

I meet such Laddoos and doughnuts (men and women) everywhere now a days. They are frequent among Doctors, Patients, Engineers, Lawyers, Businessmen etc., but also very common in big offices, major posts in the governments and managements, professors, judicial offices, ministers and even among rulers.

Do you meet any?

© Dr. Rajas Deshpande

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Robodoc

© Dr. Rajas Deshpande

“The doctor wasn’t even replying. He didn’t answer my questions” the patient, an angry lady, told me about one of my colleagues. The patient’s husband sat besides her, expressionless.

I reviewed her case in detail. She had had varying complaints for over four years, mostly severe pain at various points on her body. When a patient has symptoms (complaints) grossly disproportionate to the signs (doctor’s findings), there always is a suspicion of ‘exaggeration’ or ‘lying’. This can happen involuntarily due to stress, depression or anxiety, or voluntarily usually for seeking attention. She had seen many specialists, and had received strong doses of almost all types of pain killers and other pain control medicines, still her response after every course was ‘zero relief’. That was definitely suspicious. I looked at her husband. He appeared tired and aloof, reluctant to participate in any discussion. I had to make him talk.

“Is she stressed? Have you noticed any change in her personality?” I asked them the question that usually opens the dreaded can of worms.

“I am fed up, doctor” said the husband, “She needs continuous attention. Since our marriage four years ago there’s never been a month when we did not visit a hospital. All doctors tell her to go to a psychiatrist, but she refuses. The moment I return from office she starts complaining about her health. I don’t know what to do now, I feel I am better out of my own home” he avoided looking at her.© Dr. Rajas Deshpande.

His wife started crying, and in a shrill voice, shouted at me “Why are you speaking with him, doc? I am your patient, speak to me. No one believes me. I am suffering so much!”

I assured her that I was going to help her sort out the issue. Once she calmed down, I was able to explain to her the way stress affects human mind and body, and that it was possible to get well soon. I told her that being stressed was not a “psychiatric illness” but an overworked, burdened state of mind that needs attention, and that it can often be cured by speaking with the right person. She asked me many questions. As a special case, I made an effort to reply to each one of them, even the irrelevant ones, sometimes repeatedly. She agreed to visit an excellent counsellor colleague of mine. She drastically improved in a month after the counsellor worked upon her. However, she came back with new complaints within two months. She visited me twice more, and each time cried a lot, then when I pacified her, asked the same long list of questions mixed with new ones.

My sympathy and compassion started waning. I have promised myself never to be rude to any patient ever, and I religiously follow that. Yet my patience was wavering now.

The more compassionate, patient, sympathetic a doctor becomes towards the patient and their family, the more it is taken for granted and misused. The doctor is then expected to be an unending source of “psychological support”, mentoring and motivating, and a punching bag or a cry-to teddy bear. While in a healthy doctor-patient relationship this compassionate attitude is natural and welcome, many doctors do not know when it starts growing upon them and stressing them out. It is not easy to listen to a continuous flow of medical symptomatology especially wrapped in negative emotions. While positive outcomes do bring back life into a doctor’s motivation to do better and more, this expectation to be a listener of all sorrows until the storyteller is satisfied is unnatural and impractical. It tells upon the doctor’s health. This is now happening in almost all specialties, and wise doctors are learning to separate patients into “whimpering, chronically-dissatisfied-with-everything storytellers” versus patients with genuine medical, surgical and psychiatric issues. © Dr. Rajas Deshpande.

To concentrate upon what can be corrected, to treat what is possible should be the right priority, and here’s where a doctor’s compassion, sympathy and patience are best employed. To expect a doctor to resolve issues like ‘Swabhav’ (inherent nature) of a human being is wrong. A doctor also cannot solve the root causes of stress like poverty, unemployment, interpersonal incompatibility, overambitious, over-expectant personality or attention seeking. Many patients and families expect the doctor to resolve ‘every minor issue’ related to ageing, refusing to accept that resuming complete normalcy of health is impossible after a certain age, especially with some medical conditions. Doctors can guide patients, but cannot accompany the patient and family to fine tune every minor issue.© Dr. Rajas Deshpande.

Few paranoid, suspicious, accusative, aggressive patients and the types mentioned above have now made it necessary for the doctor to be extremely aware and alert, cautious, and to some extent emotionally aloof from the patient at least in the initial phase. Every word has to be spoken with caution. This “Robotic Doctor” or “Robodoc” is actually becoming a sad reality in the Western world where every medical consultation is considered a potential chance of litigation. A careful doctor avoids getting trapped into emotional exploitation. While this may upset some patients, much of the educated class is still happy with a proper professional consultation, diagnosis and treatment rather than only a compassionate sweet talk. Given the Indian scenario where patients are driven emotionally rather than scientifically especially in the illiterate and financially challenged echelons, a doctor needs to be better equipped for avoiding misuse of his / her compassion and sympathy, as it also converts readily into a permanent source of rewardless stress. This is unhealthy for doctors.

This is one reason ‘Robodocs’ are on a rise. A sad truth about an essential evolution in the medical profession across the world. The only thing that can change this is individualising patient care.

© Dr. Rajas Deshpande

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The Gift From Heaven

He woke up today morning, caught a bus to his earlier workplace and collected some boxes. Then he got a bus again and travelled for two hours to reach me.

“I made these chocolates myself for you, doctor” he told me with immense pride.

He was paralysed on one side, since 17 years, at the young age of 23, due to stroke. He lost his job. About a year ago he came to my free opd for reduction in stiffness and weakness that had made his life difficult. After some weeks he responded well and has now resumed his work as a chef from home. I am as proud as him, and consider this Diwali gift a gift from heaven!

Thank you, Sachin Balasaheb Damle, and Hats Off to your patience, courage and grit!

Happy Diwali🙏🏻

©️Dr. Rajas Deshpande

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