Category Archives: brain

A Fountain Of Youth


© Dr. Rajas Deshpande

From college days, a single habit, which I am probably most obsessive about, has saved me from a lot of trouble while facing so many difficult bad phases. Above exercise, I have loved my meditation.

It is indeed emotionally fatiguing to listen to same and new health complaints practically every day of your life, year after year. Add consoling crying and angry, panicked patients and their relatives, frustrated with themselves, with life, and also sometimes with the doctor. Who other than doctors can know the helplessness while receiving and delivering a bad news? To bear all this one needs immense emotional strength, patience and mental stability. Almost every doctor tries to help and soothe the patient. But the more sensitive, deeply thinking doctors bear the brunt of this emotional overload differently: it affects them negatively.

A common advice given to most such “sensitive and emotional” doctors is ‘detach yourself’, do not involve your feelings much, try and just do what is scientifically, professionally correct. How is it possible to squeeze out the pain that reaches your blood? To learn to be able to deal with this, I needed a major effort, and after a lot of suffering and speaking with some evolved medical and spiritual souls, I could devise a mental platform to deal with this. To be able to clean the slate before the next patient walks in is an art that needs dense practice. A doctor who can ignore and detach from pain and its expression cannot be a good doctor, although I understand that not everyone will agree with this. To their credit, I have also seen many dry, non-conversant and short tempered doctors who actually are far more receptive to their patient’s pain.

Vienna has excellently preserved the home of the great Sigmund Freud. His furniture, papers, books, fossil art and even clothes are maintained well. Freud sat for long hours on his high backed chair, looking at the dense greens outside his window, while fathoming the complicated, layered depths of human minds. In his office, there is a glass cabinet displaying his hand written application for financial support towards higher education, requesting grants. If that genius had to seek financial support by applying to far less intellectuals in his time, where do mere mortals like me stand? There were many times when my finances were in doldrums. Most of the hands that help usually usurp far more than their help in future, so I had to also make a long bucket list of what I did not want. However, my fate was as stubborn as myself, and it gave me enough with its blessed hands always.

It is not possible to be a good doctor if one harbours negativity, sadness, anger, depression and especially regrets within oneself. That’s where meditation saved me for years. If I want to think deep at length about something, I visit my rendezvous where I get a secluded corner and unlimited black coffee. As for this daily meditation though, not much is required. I just sit in a quiet place, switch off all gadgets and lock myself away from human reach. Then I just tell myself: I am completely forgiving everyone who hurt me, misbehaved or cheated me, without any conditions. I will not carry any negatives about them in my heart. In fact I do not want their apologies and I don’t care whether they regret what they did or nor, whether they change or not. Even today, I will meet many who will take advantage, speak arrogantly, misbehave or try to show me down, but I will have already forgiven them, ensuring to protect myself and my work. I will not lose my temper today. I will take excess precautions not to hurt anyone with my word or deed. If I do commit a mistake, I will apologise immediately. What people do is not my problem. How I react is indeed my responsibility. So when I finish my day, I come back with no anger, irritability, frustration or chaos in my mind. Things that are most important for me: my patient’s health, my student’s skills and my writing- I will protect them from any disturbances that may dilute their perfection. I want to satisfy my ego in the greatness and success of my work, the intensity and beauty of everything that I do, not by showing anyone else down. I will return today with a clean and fresh mind.

This simple reminder every morning helps me defeat any diversions from internal peace while working in the highly tense hospital atmosphere. This simple meditation takes me only five minutes, and usually my Alta Rica Black makes my meditation deliciously bittersweet. My accompanying picture is during one such meditation, but as censor boards would object, I have filtered the image.

To be able to forgive the whole world is probably the best thing I ever learnt! It is extremely tough and taxing to forgive the near and dear ones who usually top the list of those who hurt you, but it is equally rewarding too. Please do try it, it will make you at least ten years younger.. and if you can master the art of forgiving yourself for all your mistakes too, then probably you will enter the fountain of youth.

© Dr. Rajas Deshpande

Please Share Unedited

The Suicide In Our Brain


© Dr. Rajas Deshpande

My mom once badly thrashed me up for jumping into a river for swimming (and for many other things I cannot mention here). The sadness of not getting my dream PG seat of surgery nearly killed me. A very brilliant, extremely mischievous and beautiful girlfriend of mine had to marry someone else. Years later, I went through a divorce. During each of these phases, thoughts of suicide crossed my mind like every normal person, several times. During all exams, thoughts of suicide, poetry and a rebellious dropout haunt many. After every suicide, disturbing thoughts of ‘exactly what, how and when’ haunt any sensitive mind.

During my student days, I spent an hour daily in a small space behind our boys hostel to use the double bar, the only facility for exercise. One senior, Sunil, was also a regular visitor, and we became friends. He was repeating a term. He was always smiling, calm and an introvert. Many students made sarcastic fun about his being aloof. Somehow he was nice to me, we usually spoke about stamina building.
One morning I woke up to the shocking news of his suicide. He had hung himself in his hostel room. I had met him only two days prior, and he was as smiling and quiet as ever, had exercised well, spoken in a normal tone, and while leaving had said his customary words of parting “chal bhetu parat” (okay, we’ll meet again)”.

Many theories came forward, and a professor who was always rude to many including Sunil was gossiped a lot about. It was also revealed that Sunil was under treatment for depression since a few years. Some said he was frustrated with his failure and poverty. For a good few months, I did not dare go to that double bar again. I wondered about his parents. How could he have done this? I asked one Dr. Madhu, a psychiatrist who often visited our college from UK. He replied “Well, there is no point in presumptions and allegations. How can one not think about near and dear ones, especially while doing something so drastic with themselves? Suicide is way beyond the grasp of a normal mindset. We must never forget that although immediate causes may act like triggers, usually suicidal thoughts build up over a long period”.
I started reading more about it.

Since then I know of many medicos (and others) who committed suicide for various reasons: failures, stress and negativity, depression, disturbed relationships, blackmail, boredom, harassment etc. I’ve also managed many suicide-attempt cases like burns, hanging, poisoning, drowning or self inflicted wounds. I have followed up with some of these patients for medical issues. It is indeed difficult to deal with some of those cases. To add to the problem, some (not all) anti depressants and other medicines may worsen suicidal tendencies or cause them in a patient who did not have them earlier.

The mental suffering of a genius is beyond the realms of a normal and mediocre mindset. The more extraordinary your mind is, the more it suffers, and only a better brain is able to understand that suffering. One who can feel for others suffers most. © Dr. Rajas Deshpande.

Two other common triggers for suicide- failure and loss- are more manageable. We are so engrossed in marrying our dreams with the rude reality around us, that we create a perpetual high-friction, tense atmosphere in our own mind. Instead, we must learn to unchain our dreams and expectations from the current reality. One can always attempt to change the situation around, but that needs a healthy mind. Unfortunately we do not have gyms made for the mind.

Human brain compels to repeat. We can develop an addiction for anything: negative or positive. The thoughts of futility, ‘having no other options’ can also make home in one’s mind. To be able to catch and prevent this can help some, but not all. Suicidal thought or intention is NOT a mental weakness. No one is any braver for not killing oneself. Suicidal thinking is a state of mind not in control of the owner of that mind, and can be reversed if the right steps (seeing a psychologist) are taken in time. © Dr. Rajas Deshpande.

The importance we all give to complete acceptance and best success is cruel. Parents today want to grow up only gold-medal champions, who can then never be graceful in their failures, or satisfied with being the second best. Lesser success is no success today. No one achieves all that they want. To be able to accept failure must be taught from school. A different, failure-accepting attitude by parents and society during development of a child’s mindset is desperately required. Tying failure to the feeling of being inadequate and worthless is a common crime we all commit.

That brings us to the last thought of this article: we must learn to never let the behaviour of others affect our joys. The wise will get this immediately: one deliberate hurt is too many, never allow another. Exit the situation, it is not called running away, it is protecting yourself. A Mahatma Gandhi cannot feel comfortable amongst a gang of mafias. That said, if all suicides are investigated well, many others in future can be prevented: white collared and financial criminals, trust-breakers who instigate others for suicide are quite common in our society.

Sometimes it is an internal phenomenon to have suicidal thoughts, some other times a sudden emotional shock or breakdown can provoke such an action. We must take every mention of a suicide seriously, even if the person is smiling or casual while saying it. A change in behavior pattern of a beloved introvert can also be an alarm, one must spend more time with them without being intrusive. © Dr. Rajas Deshpande.

Glamorisation of suicide is an open abuse perpetrated upon our social conscience, worst in India, and should be declared criminal, as this may fatally affect some potential young minds. The mindless repetition of suicidal news has a devastating effect on many stressed minds, and who is not stressed today?

Medicine is a difficult career: long, hard and emotionally fatiguing, with late rewards (rarely financial), and legendarily thankless. Many doctor work on the verge of thoughts about quitting. The concept for vacation, rest or good sleep is not allowed to most doctors. This drives some across the edge. The only way to stop this is that each and every doctor looks after their own stress levels, that they take adequate rest and sleep, find leisure and entertainment, every few days. Socio-federal expectations never end, while our life withers away.

A change in career is a good idea, if you feel frustrated for long. One can always excel in a PG branch once not wanted, one can reappear and pass exams, one will meet better people. Most importantly for medicos, education is not a forever state, and after passing, medicine enables us to practice anywhere we like. Let us not make drastic decisions affected by transient scenarios like bad seniors, frustrating workloads or those recurring breakup’s! © Dr. Rajas Deshpande

If given a chance again, I will choose nothing but to be the Neurologist that I am today. The memories of that thrashing by mom strengthen my resolve to stand up to the unpleasant and stern parenting duties so crucial for the safety of my own children. That divorce liberated me (and her) from many more years of painful discomfort. Life, even without anything that I possess now, is still beautiful. Still, every single thing that I possess today is a dream for many, and adds to the inherent beauty of my life. That deeply roots my faith in the wisdom “Whatever happens is for good“. © Dr. Rajas Deshpande.

There are many glaring examples of those who turned tables to win over fate, overcame failures, deception, breakups, crises- financial and emotional, defamation, bullying and humiliation. Almost all of them have dealt with suicidal thoughts, some sought right help, and now are living proofs that this is possible only if one lives on.

I feel like whispering to every silently suffering soul out there: Dream, fight, chill, win or lose, but never give anyone the right to take away your charm. That little muscle-machine ticking in your chest right now, the insane neurochemical chatter of your neurons which makes you say ‘I think’, are miracles specifically made for you. That little hand you hold, someone’s moist eyes upon seeing you, and the enormous capacity of your coconut to imagine a beautiful future – are all precious blessings. Let’s not belittle them by asking for something more just to smile once again.
Smile NOW for what you are, smile NOW for what you have!

About that b. em.& b.. girlfriend… well I fondly miss her still, but every time I think of her, I cannot help smiling!

© Dr. Rajas Deshpande

A Love Letter For All Haters Of Allopathy

A Love Letter For All Haters Of Allopathy
© Dr. Rajas Deshpande

Allopathy / Modern medicine is like my mother to me. Naturally, when someone tries to spread misinformation about this path of healing, it is my territory to defend, and I will. I am open to the idea that I may not understand other pathies well, I understand mine only because I studied it well. Time and again, I have received many articles criticising Allopathy in many languages. Most of these articles make claims about their own ‘pathy’ being divine or magical, curing everything. They justify this with some twisted quasi-scientific logic, very convincing for those who are a few sandwiches short of the picnic.

We Allopaths save more lives on any given single day than all other pathies combined can save over months. Thousands of doctors from other pathies who have recovered from heart attacks and strokes and other critical medical conditions will testify that Allopathy saved their lives. The facts that there are far more Allopathic hospitals all over the world, that corona patients in ALL countries are being treated primarily by Allopaths leaves no space for any argument whether Allopathy is useful or not. © Dr. Rajas Deshpande.

To understand basics of medicine, it takes five years for the highest rankers of each generation. To criticise it without studying it requires an outstanding idiot.

Think Cricket. We all enjoy seeing the Master Blaster perform, aware that he has gone though extensive practice and patience to be where he is. Yet even those who have never qualified to be in their own family’s cricket team, will advise the Master on TV how to play. They can be ignored as certified nincompoops. The other category- copiers- are most dangerous. They will just pick up the Master’s style / words, copy the technique, use all the same external paraphernalia and then pretend to be superior to the Master Blaster. Truth and scientific logic then takes a hit out of the boundary.

From Mahatma Gandhi to Einstein, from Daniel DeFoe to P.G. Wodehouse, from Bachchan to Tendulkar, greatest of the great have faced undeserved criticism from envious, jealous, noodlebrained nobodies whose only chance to some attention is criticising any success, achievement and affluence. © Dr. Rajas Deshpande

Some of the best brains in each generation get into Allopathic medicine, and are trained in a curriculum made by highly educated achievers in the field of science. The same Nobel prize as was won by the greats like Guru Rabindranath Tagore, Amartya Sen, Abhijit Banerjee, Dr. Hargobind Khurana, has also been won by those who form the basis of Allopathy or Modern medicine.
Our science is based upon the principles and practice of basic biosciences like physiology, biochemistry, pharmacology, genetics, all defined by geniuses across the world. We follow the principles of scientific evidence as defined by science, not by personal whims and hunches. . Our paths are enlightened by brilliant guidelines of people who discovered the causes and treatment of diseases like malaria, tuberculosis, HIV etc. saving millions of lives. Each year, there is a Nobel prize dedicated to medicine.

Thus, thought processes of many generations of geniuses in science have made us Allopaths. We we are in fact relieved to know that everybody cannot understand us. That would have made our minds average.

Millions recover every day from heart attacks and strokes, thanks to Allopaths. Millions who would have otherwise spent their life on bed, walk well again because Allopathic knee and spine surgeons can perform complex surgeries, cheapest in India. Ask any patient of Parkinson’s Disease, Epilepsy or Heart failure, what happens if they miss their Allopathic doses. It is our challenge to anyone who hates Allopathy to take care of one dialysis patient without dialysis, treat one bleeding brain injury or one heart valve defect without surgery or one patient of respiratory paralysis without ventilator. © Dr. Rajas Deshpande

Maharshi Charak and Maharshi Sushrut are respected all over the world because of their own good work. I have met some very respectable Ayurvedic pratitioners. They never use Allopathic terminology to impress thier patients or name their medicines. They know their own limitations.

Using the terminology from Allopathy while criticising it is like calling your wife by the name of your neighbour’s beautiful, out-of-reach wife whom you like. From migraine to arthritis, from brain to corona, why do they use the words of the very science they refute? The height of this idiotic ridiculous is to twist scientific information, using Modern medical terms (protein, genes, virus, corona etc.) to justify the basis of their own treatments! How in the name of science are you going to treat a condition which your branch didn’t even know the name of? These hypocrites will use X rays and MRI, blood tests etc. reported by doctors – radiologists, pathologists in Modern medicine and prescribe their medicines saying that the Allopathic medicines are useless!

Why are bridge courses requested if Allopathy was useless? Why don’t we see those various criticising pathies open up their own original hospitals and practice their own science, why would so many graduates from different pathies be working with allopathic hospitals today? If you are so confident of your pathy being superior, please take an oath that you will never practice other pathies, that you or your family will never take treatment from any another pathy. © Dr. Rajas Deshpande

My Allopathy/ Modern Medicine is not perfect. We have failures. We have limitations. We have multiple, dangerous and sometimes fatal side effects, all recorded and informed to the patients. Nothing is hidden. Our pathy is unfortunately costly, as it has many licences, instruments and processes. But we have the largest number of people all over the world rushing to us every moment, we are here and ready, day and night, serving and saving them, with scientific principles universally accepted and respected.

Every accident goes to an Allopath, bleeding and dying, in a hope to survive. Most diagnosed cancers receive their treatments and some are even cured in Allopathic hospitals. Every coma reaches an Allopathic hospital, with their family’s folded hands begging to bring back a father, a mother, wife, husband, child back from the clutches of death. Most of these go back alive and happy, some we cannot save. Are these failures of Allopathic medicine your strengths? Could you have saved those? Do our minor inabilities, limitations, failures make you feel great? If so, you need a visit to a qualified psychiatrist: if your pathy has one.

It is pathetic to see the excessive quackery allowed in rural India, looting innocents with cheap deceptive tactics, false claims of curing jaundice, rabies, paralysis, epilepsy and what not. It is pathetic to see famous public figures criticising Allopathy and then themselves getting admitted in the best, priciest, Allopathic hospitals in India or abroad. What other proof of shameless hypocrisy do we need? Criticising Allopathy is a serious disease. I think it is a type of anosognosia: inability to understand the reality of one’s own illness/ condition.

After reading such baseless criticisms of Allopathy, my foremost wish is to invent ways to perform a brain transplant on their authors. However, a “rejection” of a good brain by their bodies (you know, a dangerous side effect of Allopathy) is really worrisome. So we will let them be- please treat yourself with your best medicine: Allonil.

© Dr. Rajas Deshpande

Allopathy is now known as “Modern Medicine”. However to reply the critics and to best reach masses I have used the term Allopathy, which they use while criticising it.

Welcome to translate this article in local languages with due credits. This article is only aimed only at those who spread misinformation and hatred for Allopathy. I do not disrespect any other recognised pathies.

Please share unedited.

Change The Medical Scene, India: Article One. Healthcare Failure In India: Problems And Solutions

1: Etiopathogenesis
(c) Dr. Rajas Deshpande

This is my heartfelt attempt towards initiating a change in the Indian healthcare system. We all, even the government, wants it to improve but nobody seems to know where to start.

I appeal the younger generation of doctors to please think deeply about this article in terms of your future, unless you want to face the same humiliation, insecurity, inhuman attitudes, suppression and threats all your life, just because you are divided. I intend to offend no one, my non-Utopian aim is that every patient as well as every doctor should be happy, healthy and satisfied. There indeed are more good than bad doctors in India, but guess who dominates the scene.

In this series of articles I have tried to first identify the basic problems, and will propose probable answers in my later articles. Before we analyse outsiders, let us first take an honest look at ourselves.

Problems Within Medical Community:

  1. We have many class differences between doctors. This is the most prominent cause of non-unity of doctors. These class differences may be summarised as (a): Intellectual: some doctors are far more intelligent and skilful than others. (b): Cultural: some doctors know the best ways to behave and speak with patients, others have an arrogant, ill-mannered, abusive and sometimes filthy, inviting a bad reputation. (c): Academic/ Clinical: some doctors are trained at extremely good institutes, some put in gigantic self-study efforts, and therefore are academically and / or clinically better even if their medical degree is the same. (d): Financial: some need financial support and critical effort to survive through medical courses, fighting till in their thirties to settle down, while for some others, financially it’s a cakewalk.
  2. Shameful tendency amongst doctors, of discrimination based upon State, Caste, Region, Religion, Academic Institute, City, Financial Status or Political party, generating an “Insider-Outsider” culture. This has also resulted in many hospitals employing doctors from a particular religion or socio-cultural/ financial status even if better candidates are available. Few honourable exceptions.
  3. Jealousy, Insecurity and Envy: There are successful and struggling doctors in every branch. The shameful tendency of some established doctors to suppress and disallow juniors in their institutes is well known. Most wise institutes now employ two or more competing masters in every branch and fire up their egos against each other, to have them fight tooth and nails. Guess who profits and who bleeds. The comic tragedy is that even very brilliant doctors fall prey to such tactics. © Dr. Rajas Deshpande.
  4. Financial desperation: Juniors who come from poorer backgrounds, in spite of better abilities, have no money to invest, make their own hospitals, and must work at bigger hospitals under such competing seniors, and the only way they are allowed to survive is by getting better numbers. This results in a very hostile, bitter work culture.
  5. Killing Humanity: The entire medical community is guilty of perpetually ignoring, intimidating, suppressing and blackmailing medical students, especially postgraduate resident doctors. India has probably the worst inhuman treatment for its budding and junior doctors, with no one interested in addressing their problems. They live in most pathetic conditions, often six in a single room. They are inhumanly overworked, with a shameless answer “We did it, now you do it” from their seniors. “No food and No sleep” is nothing to be proud of, it is Torture. Post graduate students and resident doctors are not only FORCED to work far beyond human capacity, they are overtasked with mindless curriculums. The “Slaves” in our history were far better off compared to how the resident doctors are treated today in India.
  6. Extremely low quality medical institutes: Guess who owns and runs these, still churning out valid degree holders.
  7. Nepotism: Where “Premium” students, often children of the powerful, politicians, administrators, doctors, socially prominent are treated differently, groomed specially and airlifted to success while others, however meritorious and efficient, are humiliated and suppressed. © Dr. Rajas Deshpande.
  8. Master-Slave Culture: In every private or Corporate owned hospital, there is an unwritten rule: never cross the Master-Slave boundaries, never ask questions, you are here because we allow you to be. Should you dare to correct someone about policies, ethics, financial irregularities, excess profiteering, you are unceremoniously thrown out, given the title of a rebel, a troublemaker, and your reputation as a doctor is torn beyond redemption. This is the worst for surgeons than physicians, as ‘badmouthing’ / deliberate ill-reputing of a surgeon can ruin their entire career. Unfortunately, it is not only the hospitals, but different classes of doctors mentioned above participate in this mudslinging too. No institute in India has an honest troubleshooting department for doctors. There is no respite, there is no organisation, doctor’s body, government department that protects a doctor thrown out, defamed or harassed by corporates or big hospitals. Very few hospitals are doctor- friendly.
  9. Even in government service, sycophancy is the strictest tradition.
  10. The SP Syndrome: Shoelicking-Postholders are the worst tragedy in healthcare. Even after being qualified doctors, these ‘doctors’ have learnt the quick-ladder culture to sit in a medical administrative chair. They know which side to please, and are seldom seen working in the interest of either the doctors or the profession. They have but one agenda: strengthening their chair-bum glue. They are found almost everywhere in healthcare, and many enjoy the administrative superiority and control over better qualified and even senior doctors. There are rare honourable exceptions who try and balance the hospital and doctor’s sides. However, those involved in policy making are rarely in direct contact with the patients, have rarely had a reputation / experience of good medical practice, and are happy with hypothetical speeches sweetened for their powerful masters. Senior doctors have never stood up for an unfairly fired or colleague, and often our own community disowns a doctor harassed by healthcare giants or government. Thousands of excellent doctors have either left the country or live in dark anonymity just because there was no Godfather for them. This is a major cause of policy failures and pathetic research in Indian healthcare, inspite of having some of the best medical brains upon earth.
  11. The only thing that helps a good doctor is long-term goodwill generated over years, where patients spread a good word about their relief from that doctor. Against this is pitched the permission to hospitals for self-advertising, which often misleads the society.
  12. Once a doctor starts a hospital, there are so many taxes / overheads that he / she must shoulder, so much paperwork, that it is difficult to concentrate upon patients alone. Add innumerable laws, restrictions, rules that make it impossible to sustain over long term. Bribes are a stark reality wherever rules, restrictions are involved. This is why many doctors have closed down smaller hospitals.
  13. While doctors are only allowed to charge their (mostly) limited fees, almost everyone else in the profession earns a lot more profit, often unjust. From rooms, service, nursing, gloves, catheters, to procedures, from canteen to labs to radiology to pharmacy, the hospital and pharmas earn profits everywhere (this is acceptable in proportion of the investment). The one paid least in the final bill is the doctor / surgeon, who usually earns a piddly sum in spite of being the most important factor in the chain. The doctor is also primarily responsible medico-legally for every case. Patients are upset with the doctor even after saving their lives because the bill is fat, not knowing that most doctors have no say in hospital billings. © Dr. Rajas Deshpande.
  14. The Corruption: There is no denying the fact that some doctors participate in various “unethical” means of earning via “commissions”. While all corruption is wrong, this is an extremely hot and debatable issue, where many questions are unanswered. For example, if a doctor owns a hospital and a lab and a pharmacy, he can profit under all three headings, but if a doctor working with him is also paid from this profit, it is presumed unethical. Our society is too financially biased, and it will never accept the necessity of profits in healthcare. However, the same society or its government has no answers to what a good ethical doctor should do if there are financial emergencies like this pandemic where his / her income is near nil. Hence the doctor is left to ensure his / her own income, with or without patients. Our society will preach doctors a lot of pompous lessons of ethics and compassion, but won’t feed the doctors family if he is in financial trouble due to all the good and free work he does. To completely eliminate “backdoor incomes”, the only way is that the doctor’s fees will shoot up.
  15. Over-smart Attention seekers: This community of doctors will do anything to garner attention. They will make news for being cheapest, they will construct new theories of individual, private research and blabber about them on national / state channels, massage the egos of power, speak against their own colleagues just to get praise from society and media and so much more. They hunt celebrities and powerful to be seen with, always speak the language of “Sweet, Beautiful, Positive” and imply from their wisely framed speech that only they can understand compassion and patient’s feelings while other doctors don’t. These are the usual early birds on TV, who criticise their own professional colleagues whenever there is violence against doctors, preaching about communication, making the society feel that ‘bashing up of junior doctors’ is justified, just because they could not communicate well. They will go to any unscientific extent to fool the public to be in good books of the government and administration, and completely vanish when their profession is suffering. This attention-seeking community has done the worst harm to medicos and the reputation of our noble profession.
  16. Doctor’s Organisations: “………………………………………………………………………………………………………………………………………………………” .

To Be Continued
© Dr. Rajas Deshpande

Please Share Unedited


© Dr. Rajas Deshpande
“Sir, we are screwed. The Chief Minister and other ministers have closed all doors, they won’t respond. Our careers are in grave danger. Can you please help us?” I frantically spoke.
From the other end of the phone, the Don, Dr. Nitu Mandke answered: “See me at my home at 12 midnight”.
The Maharashtra state resident doctor’s agitation for dignity, national pay parity and better living conditions was on, and I was given the responsibility of coordinating and being the face. We had successfully established a multilevel network.
When students go on a strike anywhere in any field, it is almost always out of desperation, either for dignity or for rebellion against some sort of suppression by the system. Students never rebel for money or power. This raw student power is almost as mighty as the army, and although it falls prey to political misuse sometimes, it has tremendous capacity towards achieving intellectual evolution of the society. The government always treats any unrest as an offence to its ego, and uses everything at its disposal: CID, Police, Administration, Force, Threats, Caste Politics, Cheating and Legal torture to mow down student agitations. Students have no money, no experience and rare political or social backing, and must unite and stand up for themselves. © Dr. Rajas Deshpande

On the fourth day of the strike, a big politico from the ruling alliance came over to our office at Mumbai KEM. There was no telling between him and a mafia goon. The members of student’s central committee: Dr. Sanjay Singh, Dr. Dinesh Kabra, Dr. Narender Sheshadri, Dr. Pramod Giri, Dr. Nilesh Nikam, Dr. Kuldeep, Dr. Vishal Sawant, Dr. Noor, Dr. Shahid, and few others were with me. The politico did not have any scruples using an arrogant, raw and filthy language to threaten that if we do not stop and withdraw the strike, our careers and even life will be in danger. As he was from the ruling party and threatened us in presence of the police, there was nothing we could say.
There are angels everywhere. A senior police officer who was supposed to “keep a constant watch” upon us ‘student leaders’ was quite fatherly. He told us “Do what you must, but don’t declare. Dumb people cannot interpret silence. Stay away from any violence”. © Dr. Rajas Deshpande
Unknown calls kept threats alive. That is when a resident doctor suggested we meet the Don: Dr. Nitu Mandke, the famous heart surgeon who was known to be a fearless, straightforward celebrity doctor.

We went to his home, and waited, hosted by his extremely courteous family. He returned home past midnight. We briefed him the details. He asked a few questions to assess our determination and strength. He asked us to stay united and avoid any misbehaviour during the agitation. To our surprise, he picked up the cellphone and called the Chief Minister’s PA. The CM was fortunately available, and talked to Dr. Mandke. © Dr. Rajas Deshpande

After the call, Dr. Mandke told us: “CM has advised us to meet the Deputy CM tomorrow. Two of you come to Lilavati Hospital tomorrow at 2 PM. I will take you to the DyCM.”.
At Lilavati hospital, Dr. Mandke’s chamber was intimidatingly clean and posh, yet simple. He checked our applications for the CM and corrected them with his beautiful pen. His briefcase had every essential of writing stationary, the mark of a perfect man.

As we waited, I asked him cautiously: “Sir, shall we start?” He replied that he was waiting for someone to carry the bag on his table. I offered that I will carry it. He laughed his thunderous laugh, and looked at us as if we were small puppies. “ Deshpandyaa, that bag has two and a half crore rupees cash for construction of my hospital. A professional bodyguard will carry it. People kill for that. Do you want to carry it?”. I shut up.

In his big car, for the 45 minutes that his bodyguard drove us to the DyCM, I asked Dr. Nitu Mandke questions about what was going through his mind when he was actually operating the Shiv Sena Supremo Mr. Balasaheb Thackeray. Such an enormous pressure it must have been!
“Oh yes, it was stressful. But he is a gentleman, and he had assured my safety. His word is enough”.© Dr. Rajas Deshpande.

That’s when we told him how some politicos had threatened us recently. He laughed and replied something that has been tattooed upon my cortex permanently:
“Rajas, a doctor is a doctor and king of lives forever. Politicos come and go. Idiots misbehave with others when the have any post or power, in any field. You should not budge. It is pathetic to see doctors licking shoes of those in power, under various pretexts. It is up to you to maintain your dignity and pride. That is the true luxury, everyone cannot afford it. So long as you do the right thing, fear nothing. The few crores in that bag is nothing compared to how I feel about myself”.

We entered the VIP zone and bungalow. His car was not stopped anywhere. The DyCM offered us tea, and gave us a patient listening.
“These junior doctors and students are my boys, our own boys, they will look after the health of our people tomorrow. You must help them” Dr. Mandke insisted. The DyCM assured he will. The spell was broken, talks resumed.
Many twists and turns later, one of the most memorable strikes was called off.

A year later, I saw a white Lexus car in our KEM campus at Mumbai. Fond of cars and having never touched a Lexus, I went to see it from a close distance. Just as I tried to touch it, the driver’s window rolled down, and I heard “Deshpandyaa, open the door and come in. Do you like my new car?”
And I sat besides the King of proud men, one of the most proficient Cardiac Surgeons, Dr. Nitu Mandke, in his Lexus. The feeling is unforgettable, not only for the Lexus, but for his simplicity, love and affection for a ‘nobody’, a junior doctor like myself!

Needless to say, then onwards, I have guarded my dignity and pride as a doctor more than any other possession I have. That took away many opportunities and huge finances, still I am doing quite well by God’s grace, and Dr. Mandke’s blessings.
How I feel about myself is more precious than anything I can earn. The luxury of pride is mine.
© Dr. Rajas Deshpande

Dedicated to all students, resident doctors, proud people in every field, student unions and their apolitical fearless leaders.
Please share unedited.

Save Lives. Share.

My Brothers And Sisters
Please stop posting/ reposting bad news as many amongst us are on the verge of giving up.
If you feel sad/ suicidal please speak to a friend, family member, doctor or psychologist/ counsellor.
If someone speaks about having suicidal thoughts, please seek professional advice of a counsellor asap.
Don’t give motivational speeches or tell the sad and depressed to just “take it easy”, that “you need to be strong like me, this is mental weakness “, do not suggest them exercise or yoga as a remedy. Spirituality, philosophy and meditation are NOT the initial / sufficient remedies for depression.
Let a professional handle it, depression is completely reversible if treated by the right specialist: Psychologist, Counsellor, Psychiatrist or if none is available, any qualified doctor.
Depression is not madness, those feeling sad are neither mad not weak. Please help them recover by keeping a positive atmosphere around them, and connecting them to the right help. Switch off news channels and feeds. Watch comedies and happy music. Play board games with them. Eat something they enjoy together. Make sure they sleep well.
Please tell them in simple and direct languhow much you love/ adore / respect them, this one step may change their perspective.
These corona days will pass soon. In a life of many decades, we are just sacrificing a few months: to stand again, to fight and to win.
© Dr. Rajas Deshpande

Requesting to share this one to reach as many as possible, your share may save someone’s life.
I have never urged to share my posts. The purpose of this post is obvious. Do please share with all your near and dear ones.

The Last Bullet For Indian Private Healthcare


© Dr. Rajas Deshpande

Many doctors, nurses and other staff, police officers are dying due to corona exposure. Recently the quarantine period of doctors was cancelled. To add to this, very ridiculously, doctors’ salaries were reduced, and covid funds were deducted from even frontline warriors’ salary. This is like taking money from a soldier’s paycheck to fund the army!!

When I recently heard some people shouting about excess bills in hospitals, doctors not working etc., I felt like shouting back too, but one cannot argue with a sold TV screen.

For decades India has had
Excess urban crowding,
Very poor hygiene.
Very high poverty and illiteracy.
Lack of town-planning for slums.
Severe lack of state/ national healthcare infrastructure.
Tiniest budget for healthcare.
Perpetually under-functioning government hospitals. Every season hundreds die due to epidemics.

Where were you till before the pandemic? Who is responsible for all of the above? Do you want to discuss these factors which are responsible for the pandemic chaos today? Or now you just blame it all upon Doctors and Private hospitals?© Dr. Rajas Deshpande

Only private doctors with small nursing homes and dispensaries, clinics were shouldering all healthcare needs that government hospitals could not provide. They had low profits and catered to middle and lower class. These were destroyed in last few years because of too many stringent regulations and costly licensing. Many closed down. Legal troubles by relatives, politicos supporting them and vandalising hospitals forced many private doctors to stop admitting patients. Protection to doctors was denied by almost all governments till before this pandemic.

Indian poverty is never ending, and charity cannot run anything perpetually unless there’s a strong fund generating mechanism supporting it. If someone expects that doctors charging 2 rupees fees are the ideal healthcare for all our medical needs, they should happily go to such a doctor. We highly respect them too, but it is their choice and there are obvious limitations to that. To develop advanced healthcare in India, higher profits were necessary for higher investment. Corporates, some businessmen and the likes of Mr. Ambani pitched in. Advanced healthcare with heart and liver transplants, complicated brain surgeries, cancer treatments came to India because of these investors. They accepted all the conditions of governments to accommodate over twenty percent poor, nonpaying patients via various schemes. The payments for running these schemes were delayed by various govts for years, and the hospitals were arm-twisted in still continuing to treat everyone. The only source of profits was private and some insurance patients who were paying a higher fees for facilities: from air-conditioning, food to choice of specialists. Higher quality of staff, especially nursing and technicians who can operate high end machinery and robotics requires very high salaries. Maintenance costs are heavy. A specialist cannot do much without such a very good team. Each of these requires good if not great salaries, as they are continuously invited by developed countries who pay far higher.

But then every patient wants the highest facilities, best staff and specialist team, with no payment or basic payment. There’s no concept of billing beyond actual price of medicines and room charges. Service and maintenance is considered a ‘free right’. © Dr. Rajas Deshpande
Even in this modern era of equality, a higher class Indian officer like a minister gets a higher room, better food and other facilities, even higher medical bill sanctions, whereas the labourer from his department gets minimum basic facilities and bill eligibility only for general ward. Law allows higher healthcare’s standards and payments for higher officials. Why do they even have classes in railways and airplanes? If a “Gareeb bechara” migrant wants to fly home, should we offer him road transport or compassionate air travel? Why don’t we do for all the poor something that you all expect doctors and hospitals to do?

We don’t mind if basic and emergency healthcare is uniformly cheap or free for everyone. But when you force a high-end medical commodity (skill-time-investment-staff) to be sold at a loss or extremely marginal profit, you kill the system.

Doctors do not differentiate when making a diagnosis or treating anyone from any financial/ power background. But the private hospitals must be allowed to cater to different classes, earning their profits. That is their only stimulus to grow forward, engage best personnel and bring advanced healthcare to India. Different governments have failed at maintaining high standards of healthcare in their respective set-ups (with some proud exceptions- but because that’s where our powerful go). Some hospitals indeed take more bills for better class of services, including staff, but none of them forces a patient to come to them. Even these hospitals never deny free emergency treatment to anyone.

“But isn’t healthcare a charity? Haven’t you taken oaths to serve?” our loudmouth hypocrites ask.

Yes we have taken an oath to serve everyone rich and poor equally, but no, we have not taken any oath to neglect our own health and well being. Yes we have taken an oath to serve, but we have not taken any oath to live in perpetual poverty and financial stress. Yes we are under an oath to do our best for every patient, but we will not be bending backwards to fulfil their unreasonable demands. Yes we want to save every life, even if it is dangerous , but we will not unnecessarily endanger our own life because someone forces us. We haven’t taken an oath to abandon our families. The Hippocratic oath does not ask any doctor to stay hungry, work without sleep, and do the unscientific because various governments cannot pay for adequate number of doctors. Still we are doing all this already. Let us be clear: we proudly and intellectually serve our country, but we refuse to be considered slaves of either the system or the society. © Dr. Rajas Deshpande

Capping bills in private hospitals will be the last bullet for all advances in healthcare development in India. Be prepared to go back to the chaos of ancient times in that case. Quality will suffer most: right from specialists to nurses to medicines. You can of course force one generation of doctors to work like this, under low cost and excess work. People aren’t fools to send their children to such hells of social slavery. Yes you read that right. There’s a difference between service and slavery. Do not attempt to turn medical service providers into slaves. It will backfire very sourly.

Instead of this, the government can invest in existing private healthcare players to create low cost infrastructure alongside their private hospitals, or privatising its own healthcare institutions with increased capacity. Our governments do have friends in very high places who can invest.

We love India. We are not against any particular government, and this post is not against any leader or party. But we do feel very strongly that healthcare decisions must be made involving everyone concerned, that this people-pleasing for short term will turn out to be a huge disaster in long run, and it will be irreversible. If any government thinks that cancelling hospital permits and doctors’ licences in a country with severe shortage of medical services is the right way forward, God help it.

If private and corporate hospitals start shutting down now, it will be permanent. India will then have to mostly rely upon prayers alone for healthcare. And of course those who think they know medical science more than doctors. India has no dearth of such “fatally self-medicating” ignoramuses.

Jai Hind

© Dr. Rajas Deshpande

Please share unedited

Suspend All Doctors, Cancel Their Registrations…


© Dr. Rajas Deshpande

Have you ever spoken with a doctor, a judge, a police, minister or an an IAS officer in their office? Almost every common man has had almost a similar experience: an arrogant air of authority, hidden hints of superiority and a subtle dose of “I know better than you” whenever one tries to argue. Now we know all of the above can be wrong occasionally, at all levels. Of course, there are exceptions in all professions. In a new world which is now shedding away traditional chains of inequality and racist slavery, we Indians are probably the most reluctant to change. In performing one’s duty, no one is superior to those they serve.

A doctor needs to be patient and compassionate with the ill-behaved and arrogant, unlike police, judge or minister who will punish people for such behaviour. Additionally, far before COVID19, there have been fatal infections like MDR Tuberculosis and other viruses which have endangered and even killed doctors. The stress of this daily fear of death is difficult to explain to the idiots who argue “but you yourself chose this profession, nobody forced you, you knew all the time about these risks”.
My dear infinite stupid, yes, I chose this profession willingly, knowing the risks, but to live on and serve, not to willingly and knowingly expose myself to fatal infections. A soldier joins the military ‘to live on and fight and protect the country, not with a wish to die with enemy’s bullets’.
When a citizen tells them from the comfort of a protected home that “You already knew you could die in the army”, it is ingratitude and insult to their profession. We choose to be in this profession because our compassion and courage is higher than our fear, not because we want to die. To be honest, we do not expect many to even grasp this concept. © Dr. Rajas Deshpande

I have deep respect for some Judges, IAS and police officers who are geniuses, and the first mark of a genius is a humble openness to all logical argument, with parsimony of words and zero presumptions of having a superior knowledge. Even a few minutes with them enhances your life. They are calm and respectful of others. Their language is never “Suspend, Fire, Transfer or Shoot”, because they know what it takes for a genuine person to reach where they are. These geniuses are far above attention seeking, cheap media publicity, arrogant show of authority and blame-mud-slinging to cover their own mistakes, inferiority complexes, and inadequacies.

It takes longest time and a hardest curriculum with hands-on experience of years to make every single doctor. The more specialised a doctor becomes, the rarer it is to replace his experience. Still anyone can commit mistakes.
If a Judge, a police Officer, a Minister, an IAS officer is wrong, does our constitution allow any TDH in media or society to get up and threaten them with suspension? Can you imagine a nagarsewaks / municipal councillor / local politico, goons or even major/ minor officers threatening a judge, IAS officer or a commissioner with cancellation of their rank, licence or degree? Even the courts of law do not suspend anyone or strip them of their hard earned registration without giving them a complete and patient hearing.

Yet almost every TDH in almost every nook and corner in India, from temporarily elected less-schooled representatives to highly educated junior and senior administrative officers often threaten on TV channels that doctors’ registration, licence and degrees will be cancelled. This apparently gives them a sense of pride and accomplishment and also sends a wrong message to a public that these doctors must serve.

In a country where the policy makers have miserably failed for generations to create enough doctors for their population, where we still continue to have that discrepancy, suspending a doctor is like snatching away food from someone already dying of hunger. One doctor gone screws up many patients’ lives. There’s no other profession where generations are taken care of, lifelong, by one person. Yet apparently, some officer’s egos are more important than those patient’s families, health and lives.

Every day there are news of political, social reasons of suspending, threatening doctors. Deny concessions, freebies, shoe-licking, decline to compromise upon scientific principles or accept inhuman conditions for doctors, and almost every officer unleashes their administrative adrenaline pumps against the entire medical profession. Refuse to accept incorrect policies and guidelines that are against patient’s interests, and insubordination leads to losing your jobs. The most shameful and pathetic addition to this “Suspend-Crazy” admin category are some senior doctors who fail to guard the principles and juniors of their own glorious, noble profession. © Dr. Rajas Deshpande

Like every Judge, Police or IAS officer, even politician, every doctor has also worked very hard to earn their degree and licensing. Every Medical college and University in India is approved by the government. The Medical Council of India has been given the authority and statute to license a medical practitioner upon presenting his / her degree and following principles it has laid down. No one other than the MCI should be able to cancel the licence of a registered medical practitioner. Every case of suspension of a doctor: whether a postgraduate or a senior doctor should be referred to a separate impartial MCI committee. Even the Hon’ble courts of law usually request expert opinion before concluding about medical issues / cases. Yet, our admins and politicians from different states suspend and threaten doctor’s registration cancellation as if it was granted by them or their party or government as a favour. No. We don’t accept that. Every IMA branch in every city must stand by such victimised doctors, protest such injustice, represent the harassed doctor and protect him/ her.

There of-course are doctors who commit mistakes, like Police Officers, IAS officers, Ministers or even some Judges. All of them should be accountable and be brought to the right penalty with the same dignity as others. No one has the right to pretend that a doctor is a slave to their whims, greed and tantrums. © Dr. Rajas Deshpande

The Hon’ble Supreme Court has very clearly stressed the fact that it is very important that doctors should be able to work and make their decisions without stress, insecurity, duress or fear. The article above intends to highlight that same purpose, especially in the light of some recent happenings. Every doctor out there is risking life only to save others, serve the nation. They do have problems, issues and insecurities that need sorting out. Please address their issues scientifically and logically, rather than inhumanly threatening them by suspension and cancellation of licences because you have no resources, funds or answers. Treat your doctors with the same compassion that you expect from them. Or, if you know better, if you want doctors to blindly follow unscientific instructions of admins and whims of politicos why make doctors? Suspend all doctors at once and do it all yourself.

India will definitely be healthier if you listen to the doctors, and don’t threaten or suspend them for trivial reasons.
Jai Hind!

© Dr. Rajas Deshpande
Written with a sad heart that on one hand where the Hon’ble PM has asked people to respect and appreciate the efforts of doctors, nurses and other corona warriors, many are looking for reasons to corner, threaten and suspend them at the drop of a hat, sometimes just for headlines.

Please Share Unedited.

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

Note From A Doctor Who Worked Against Plague and Many Other Epidemics


© Dr. Rajas Deshpande

When I volunteered to work in the plague ward during an epidemic while working as a resident doctor, my parents justifiably panicked. I was all excited and trying to stand upto my own ambitious expectations. That was a different time. Many epidemics later, now I am careful. Ambitions and expectations are the same: to serve most and to be the fearless best, but there’s an addition: to be very careful. © Dr. Rajas Deshpande

If I know you by myself, you too must be dead scared and frustrated. Not of death alone, but of the perpetual uncertainty atleast now.
Let us remind ourselves that like the umpteen fancy fears and frights in our mind, over ninety percent of bad things that our sometimes-villainous minds project actually never happen. Some bad does happen, but we have learned to move on, whatever happens. Let is not dwell on the fears and umpteen negative scenarios which our minds are creating right now, especially those related to our loved ones, and stupid musings about what happens to our belongings. If we look back, we realise that all of us have been addicted to negative thinking in negative situations. Even the ghosts below our bed have grown up now, it’s high time we do too!

Ok, this virus is indeed bad, there’s a huge risk. But there are countries that have already defeated this virus by arresting its spread. There are many (94% minimum in India) who will recover even if they catch this virus. The better we stay away from each other (my hobby) and wash hands (my passion for which almost every posted student has made fun of me), the faster we will defeat the bugger. Fear generates too much negativity and affects our mood and even immunity. This semi-irrational fear in our mind needs to be replaced by learned ‘care’ and abstinence from the tendency to return to thoughts about death. © Dr. Rajas Deshpande

I am as tired of the ‘house arrest’ as everyone else too. I am longing for those long drives in sun and rain. It is difficult to concentrate when under fear. But then there indeed are things that engage my mind (of course, besides this frigging cooking, cleaning and laundry) more passionately than any of my fears: that I want more life, that I want a better tomorrow. I am lost in the thoughts of finding love, making friends that vibe, finding cures for neurological patients, driving an Aston Martin one day, and of course the traditional yet true wish: leaving a legacy of something great behind myself: just like most of you think too. Let’s keep planning, now while we have time to reset priorities.

If I was authorised (don’t shoot yet), I would have banned all those media channels from spreading fear. I am only authorised to suggest this to my sane friends who are suffering from immense fear: turn off your TVs, take a book, have tea or coffee, chat with family members and take a nap if you’re bored, rather than digging for bad news. © Dr. Rajas Deshpande

Make notes about what plans you have to stay safe till you reach hundred. Implement them with a resolution that you will witness the end of this pandemic and achieve everything you want.

Most of us will meet again at that bright end of this tunnel! I want you ‘smiling healthy’ when there.. Whatever little number of close friends I have know that I never say goodbye.
I prefer “See you again soon”.
Take Care till then.
© Dr. Rajas Deshpande

Please share unedited