Category Archives: free healthcare

Slaughtering The Precious

(c) Dr. Rajas Deshpande.

At the casualty door she started shouting at me even before I went in. “We don’t want any tests. We don’t want to admit him in any critical care unit. Keep him in the general ward you have, we are now financially exhausted. Give basic medicines only “. Mrs. Julie, the patient’s daughter, went on:”We have already signed palliative care form”.

“Let me see the patient first “ I said and went in.

The resident doctor had earlier told me that the patient, an old man, was conscious, speaking quite well, aware of his illness. He was intermittently getting unconscious for a few minutes. He had high grade fever. He had lung cancer, and a brain scan a few days prior had revealed that that he had a secondary in the brain too. He had just completed his chemotherapy. The resident doctor had already started medicine for fits just now.

As I examined him, the jovial Mr. Shaw smiled back and told me that he was feeling a little giddy and tired, otherwise he had no complaints. He could even stand and walk without support. His blood pressure was normal, but the heart rate was quite high due to the fever.

“I think you have probably developed seizures due to the secondary in brain. There seems to be some infection too, we will run some tests and start antibiotics” I told him.(c) Dr. Rajas Deshpande.

“When will I feel better, doctor?” He asked, “I want to be home and spend every possible day of my remaining time with my grandchildren. I want to also finish a book I am writing. I am told I have only a few months left. How much time do I have? Six months? Four atleast?” he asked, still smiling. Only doctors know what a smiling face with a crying heart actually looks like. “Every passing moment is extremely precious for me, doc! Please cure me fast” he said.

I assured him that if the tests showed nothing serious, he could go home once fever subsided, but the fits needed long term treatment. While we were having this talk he suddenly stiffened and his body developed jerky movements, then he became unconscious.

Ordering the emergency injections for fits, I told the casualty doctor to shift him to the critical care unit.

Coming out, I explained this to the angry daughter.

“Doc, we don’t want to treat him in any ICU. We also do not want any tests now. Please give him tablets instead of injections, we want to take him home as soon as his fever goes down” she replied.

This has become very common now, relatives of elderly people admitting them in hospitals, but refusing to do any tests, use injectable / costly medicines or shifting to critical care units. A doctor cannot refuse patients in such a condition, and it is an extremely painful, stressful situation to not be able to correctly investigate, treat a patient because relatives are unwilling. Ninety Nine percent of the times, money is the only reason. There are many charity, low cost and even good government hospitals, but the relatives also want the “show”of having admitted the patient at some posh hospital. Beyond a certain level, Private

hospitals cannot go on funding tests and treatments of hundreds of such patients even on a compassionate basis, because the poverty in India is never ending.

Compassion is the most abused entity in India.(c) Dr. Rajas Deshpande.

I told her that even if they had signed for palliative care, his current condition was treatable, his fever and fits caused him distress and could be treated, but she staunchly refused to let us send any tests. We started with oral medicines after a lot of deliberation, keeping fingers crossed that he responds. He did.

On the third day, Mr. Shaw walked out of the hospital with his patent smile.

Just next week, his daughter returned to the OPD: “Doc, dad passed away two days ago. After going home he had fever again, but we decided to manage him at home. Somehow he could not get through this time. I have come to get your signature on these bills from his last medicines, we want to get reimbursed”.

“Was he seen by a doctor at home?” I asked her.

“No doc, we gave him the same medicines that he was earlier given for fever. We also searched online and ordered them. But in a way we also feel he is now relieved of all his troubles” she said, hushing up the topic.

I signed the papers, a duty and an obligation.

In every hospital, every day, we see parents rushing, crying, selling everything they have, urging doctors to save their children on one side, and grown up children urging doctors to hasten up the deaths of their parents on the other . Many sweet, politically correct and legally blurred terms are now available for masking these murders.

A patient with a terminal illness may himself sign for “non-aggressive / palliative” care (meaning pain relief, superficial / minor treatment without aggressive effort to save or maintain life), or if the patient is not in a good mental condition to sign such a consent, the relatives may sign so. However, in India where children mostly are responsible for the medical bills of the elderly, they flatly refuse to treat even treatable, reversible conditions citing “öld age” as a reason. Even in case of patients with terminal illness, to presume that someone is immediately unfit to live, or fit to die is like saying it is okay to terminate their life at someone else’s wish. This is cruel, unethical, immoral, and should stand supported in no courts of law.

However, these murders are a daily routine in India, and law has tied the hands of treating doctors and hospitals as one cannot investigate or treat a patient when the relatives haven’t given a consent. An evolution in the fraternity as well as in this society is necessary if a change is expected.(c) Dr. Rajas Deshpande.

Otherwise, when we all will eventually be old, however much we want to live on for a few more days, one day someone will decide that we don’t deserve to continue to live, without ever wanting to know what we wished.

(c) Dr. Rajas Deshpande

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Doctor Abuse: A Medical Specialty

© Dr. Rajas Deshpande

Using the doctor’s private cell / social media accounts for free consultation, second opinion and opinion about investigations. Stalking to send reports, messages whenever online. These are now getting on the nerves of many doctors. I have completely stopped replying to any medical messages on social media / whatsapp.

Relatives, family and friends seeking free medical consultations on holidays, weekends. Directly coming home for a free consultation on holidays (On one unfortunate Sunday morning, back when I was naïve, one neighbour with a Luxury car came home and discussed his old age problems for two hours, reviewed his wife’s reports, then keeping 100 rupees on my table, said “Actually in my childhood doctors would charge only two rupees for consultation, but now it has all become costly”). I have now completely stopped this, refusing politely to see anyone without appointment, except in a true medical emergency.

Expressing Anger, Bitterness, Distrust and Sarcasm towards the doctor for diagnosis (especially incurable), for advising surgery, admission or costlier treatment options (the rich are unhappy with costly medicines, the poor usually do not complain). © Dr. Rajas Deshpande. I have now started to explain in the second consult, after finalizing diagnosis, what to expect, what not to expect.

Expecting the doctor to replace the lost bonds in family because the children do not want to spend time or efforts for their parents (‘you tell him, you spend some time counseling him’). I have started to refer such patients to qualified counsellors.

Taking an advantage of compassion and kindness to save money (Cannot bring patient to hospital, patient is too old, I am too weak to travel, we are out of station etc.). A general rule is that one must be treated, especially in emergency, only after a thorough examination by a doctor. I am now refusing to be emotionally blackmailed.

Seeking free consultations: relatives, friends, classmates, staff, other doctors, watchmen, maids, neighbors, drivers: there’s an unending list who the doctors are expected to see free. Add to these political leaders, VVIPs, government officials, administrative staff etc. Sometimes the doctor voluntarily waives off charges as respect, and some of the above actually request to pay themselves, but most expect a free consultation and in fact argue about it. I have made my own rules about treating only the deserving poor free, and those who need it. I refer them to the right center for help.

Multiple free consultations. This is a paradox: that many who get free consults / treatments usually think it is “not correct or adequate”, take a paid consult somewhere, and then come back knowing that the best was already being done for them. Such patients, when they know t is free, come every week even if they are told to follow up after three months. I have now started specifyinfg that the free consultation in a non-emergency is only once in three months.

Many patients book multiple appointments on the same / consecutive days and then do not bother to cancel the unused slots. This results in heavy losses for the doctor. Some patients call multiple times to book appointments and finally do not turn up, never bothering to inform. I have started to make a list of such patients.

Lying. Many patients / relatives lie about why they did not follow up in time, why they did not take treatment, why they did not do the advised tests, about multiple treatments at the same time, about their condition being an emergency etc.. Many a times parents are abused by their children, and multiple lies are told about why basic care was being denied to the patient. The doctor is supposed to cover up and compensate for the lack of care and compassion at home. © Dr. Rajas Deshpande. I have decided not to cover-up, and to refer them to a family counsellor.

Unnecessary information: Many patients do a lot of unnecessary tests and expect the doctor to “just have a look” at those even when normal. Few understand that time is the most precious commodity for a doctor, (most efficient doctors run late because of unnecessary discussions) and when one seeks opinion, it should be a targeted exercise to resolve the immediate concern. For regular check-ups, one must prefer to visit their regular general practitioner. I have started to refuse to see tests I have not advised, if they are normal.

“Resolve all my life’s problems”: many patients, when they find the doctor caring and compassionate, expect him / her to resolve all the issues pertaining to their old age, relationship issues and spend a lot of time “listening to the sad stories” about their life, and their opinion / rants about them. While in some cases it is necessary to wholly understand the patient’s mind, this is primarily an issue to be addressed by a psychiatrist and a counsellor.

A patient in distress is often not in a position to understand the doctor’s expectations and the nitty-gritty of manners and etiquette, and while still being caring and compassionate, we doctors must learn to politely decline such abuse in the kindest words possible. Once educated, most patients follow the instructions well.

Happy Doctoring!

© Dr. Rajas Deshpande

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The Most Precious Jewels Upon Earth

© Dr. Rajas Deshpande

“Sir, next is our old free patient” my receptionist announced on the phone.

Divya, the smart young girl of 8 years jumped into my cabin, and grabbed her chair with an authority. Confidently looking at me, she questioned, “how are you today?”

Her parents, embarrassed and charmed at the same time with her sense of ease in this big hospital, facing a doctor, hesitantly stood behind her. I requested them to sit down and went through the routine questions.

“She is all good now, no fits since last two years. She has been regular in her school and has started studying well too” her father reported.

I examined her and wrote her a renewed prescription. I noticed the mother wiping tears.

“What happened?” I asked.

Quickly smiling, she just gestured with her head “nothing” and looked at her husband.

“Do we need any tests, Sir?” Her husband asked, “We will do whatever is required”. I could feel his palpitations. They were scared that I may tell them tests, and that would mean financial disaster.

He works as a pantry boy and can barely pay the home rent with his salary. His wife somehow makes ends meet, looking after this sweet daughter and a younger son.

At the age of five, Divya had had her first convulsion. Her parents had rushed her to the government hospital. They did not have the money required for Divya’s tests and medicines even at the government hospital. So they resorted to something that hurt them worst: they had to sell little Divya’s silver jewelry, which was the most precious thing in their house. Even that was not enough, so they borrowed money and started her treatment, her father worked extra hours.

That was about three years ago. Divya’s fits continued, but her parents did not give up. Their whole life had but one aim: to stop her fits. Even after being less educated, Divya’s parents decided to go with scientific treatment, ignoring all pressures to take her to different weird people including magic healers. They did not give up hope, their will power was their boon.

Two years ago, a doctor friend sent Divya to me. With some changes in prescription, her fits completely stopped, she has now become just another normal child.

“No tests are required. Please make sure that she is regular with the medicines” I told them.

As I wrote this, I got a little emotional myself, this was the first time I had heard of any parents having to sell their daughter’s jewelry for her treatment. On one side, I was proud that even after being surrounded by perpetual pits of poverty, this girl child’s parents did not skimp upon her treatment just because she was a girl child (this often happens), but on the other I felt anger and shame that my country still lacks a basic healthcare infrastructure that can offer free quality treatment to at least children.

Yet, this had taught me my lesson. Willpower and hope are the mightiest and most precious jewels upon earth, far tougher and far more beautiful than any diamonds. For there are many who own diamonds but have neither willpower nor hope.

Meeting this rich family today was joy enough, but a greater bliss was when the kiddo put her arm upon my shoulder with the same confidence. The world is indeed hers!

© Dr. Rajas Deshpande

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The Light Divine

(c) Dr. Rajas Deshpande

The lady in the ICU appeared quite disturbed and shaken. Bewildered, she kept looking at her husband’s face, wiping her tears and his forehead with a corner of her saree.

Her husband, Mr. Mohan Vitthal Kadam, was critical, he had also gone completely blind suddenly and paralysed. While working as an electrician with a company in Jejuri, he was often noticed to have high blood pressure inspite of taking regular treatment with his family doctor. One day at work, he suddenly had a severe headache and went completely blind. Terrified, his colleagues rushed him to the nearest hospital. His blood pressure had shot up far above the dangerous levels. The local doctors gave him emergency treatment and sent him over to Pune. That’s why I had come to the ICU.

I introduced myself politely to his wife, and asked her the details. Sobbing intermeittently, she told me what all had happened. I examined Mr. Kadam. His BP was still high, but not in dangerous zone anymore. He was confused, unable to speak clearly. His left side was paralysed too. He pointed towards his head, indicating that he had a headache. His MRI showed many areas of his brain damaged due to high blood pressure. The areas which control the visual information coming from the eyes were damaged heavily. His brain was swollen dangerously. He could need an emergency surgery.

This condition, known among doctors as “Cortical Blindness” is a common but griveous condition: the patients eyes and the nerves are intact, they actually can see and carry the images to the brain, but the visual areas in the brain cannot see / read that information, because they are dead or injured. I informed this in simpler words to Mrs. Kadam.

“Will he ever see me again? Will he see our kids? How can he live the rest of his life with such blindness?” her questions came mixed with sobs and tears. I had very few answers, but I told her I was hopeful of a recovery. “We will first concentrate on reducing the swelling upon his brain, so we can avoid surgery” I told her. Their son came over and attended his father alternating with his mother. Mr. Kadam ‘s brain swelling gradually reduced, surgery was no more required. His BP was well controlled in two days. His paralysis also improved, but he still was completely blind.

Once he could understand the situation, he asked only one question: “Can I see my wife and children at leaast once in life again?”.

“We will try, I am hopeful” I replied. We had started with all the supplements that help recover brain damage. When he was discharged after ten days, he was still not able to see anything. He returned today.

“After we went to our village, many people told us to abandon allopathic treatment and go for secret herbal medicines and magical remedies. Somehow, myself and my wife decided to have complete faith in what you had told us. We continued your medicines and kept praying. The only light in my life then was the trust I had that I will get better. After two months, I could suddenly see a light bulb at night in our home. I immediately called my wife and told her so. Then onwards, there was a gradual improvement. I tried every day to see the faces of my wife and kids. In another two weeks, I could see them again That was the happiest day of my life.”. Mr Kadam became emotional. “Doctor, my company offered me a substantial sum as disability compensation, but I did not want money. I only wanted to see my family. Now that I can, I came here to thank you. Now I can even read a newspaper…but the darkness of being blind was far less hurtful than the thought of never seeing my dear ones again.. I cannot forget that. Thank you again, You are God for us” Mr. Kadam said.

I told him that I was just another doctor, that we were both cared for by the same God, that any qualified doctor would have done the same. I had not done anything extraordinary. But it is difficult to control a grateful patient.

“No doctor, we believe that doctors are God’s hands specially made to treat patients” he persisted.

I could only thank him. Thousands of doctors all over the world, all across India, do this every day, and receive blessings and gratitude that fills up their hearts with a joy that cannot be described.

Now I think there is a reason why Mr. Kadam came today. Many good and bad things happened in 2018. While making resolutions for the incoming new year, I was thinking once more what is most important in life. Mr. Kadam provided with many answers to that question. What matters is gratitude for what you have, especially health, gratitude for your family, and the ability to help others through their darkness. Who except a doctor is better placed to help others with health and life? Whatever other resolutions a doctor may make, one of them remains a universal favourite: ’ Let all my patients improve, and live happily a long life. Let me make every effort for that.’

Thank you. Mr. &. Mrs. Kadam, for allowing me to share this story.

(c) Dr. Rajas Deshpande

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The Full Stop and The Comma

The Full Stop and The Comma
(c) Dr. Rajas Deshpande

A panic struck voice shouted on the other end of the phone: “Doc, This is Neerja. My husband suddenly cannot remember anything. Not my name, not even the kids. I am rushing him to the hospital. Can you please see him now?”.

Mrs. Neerja Dev was my old patient, under treatment for migraine. Actually it was late and I was done for the day, but when faith and trust calls, a doctor cannot say no. I drove back to the hospital.

Her husband Mr. Alok, a young and handsome software engineer in his early thirties, was placed in a big multinational. He was his company’s blue-eyed beloved, groomed for a long-term high flying career. His salary much exceeded that of the President of India. I had met him earlier, when he accompanied his wife. Quite brilliant, he had an arrogant attitude to go with his achievements. Neerja had often complained in privacy that she had a lot of stress as her husband worked excessively, had too much responsibility upon his shoulders, and growing up two daughters was left to her. “He loves me and the kids, but he has no time to spend with us” she had often complained.
“There’s cut-throat competition in the software industry, I need to work hard to be where I am” Alok had replied curtly whenever the topic came up. (c) Dr. Rajas Deshpande

I reached the hospital and examined him. Indeed, Alok was blank. He could just answer his name, and yes/ no to some questions, but he could not even complete a sentence. As he struggled to find words. Neerja was devastated, and could not stop crying. Their sweet daughters, aged fourteen and seven, boldly waited outside the casualty.

“Did he have fever? Did he take any new medicines? Did he fall down? Was he fasting?” I went on with a long list of questions. Nothing should be left to chance, every bit of information must be collected for an accurate diagnosis. There were no clues from the history. His pulse, heart, and blood pressure were normal. He was able to move well, and had normal sensation all over the body.

We rushed him into the MRI. Alok had many large white spots all over his brain in the MRI, a condition that is called “demyelination”. This usually happens in young patients after viral infections. Some other abnormalities in the immune system can also cause this. I explained the situation and its uncertain outcome to Neerja.

“There is no threat to his life right now, but we cannot comment anything about the recovery”. I concluded.

“What now? Will he recover at least enough to remember me and our kids? What will we do?” She broke down again.

“High dose Steroids may help some patients, but this treatment may increase his blood pressure, sugar levels, and also his chances of developing an infection. Are you ok with this risk?”

“I will leave it all to you. I cannot understand anything now.” She replied.

We started the injections of high dose steroids. His heart rate, blood pressure and sugars were continuously monitored, fluctuations treated promptly. The ward doctors, nurses stayed upon their toes, informing me every hour about him.

Friends from his company and even his boss visited. The boss just asked how long it will take for him to recover. “You know, we have deadlines and our clients need to be informed” he said.

After three days, Alok started to gradually recognise family and friends. In about ten days, he spoke well, and even started understanding what had happened. He was shocked.

“What about my job? Can I work from the hospital? They are dependent upon me. My boss has immense faith in me. Many high end projects need my supervision” he asked impatiently. (c) Dr. Rajas Deshpande

As controlled mental activity is good for recovery of brain functions, I allowed him to work from his hospital bed for an hour or two.

The next day he was all depressed: “Doc, I cannot remember many things necessary for my work. I cannot afford this. Please don’t tell anyone from my company. How long is this going to take? Will I ever completely recover?”

I wished I could reply, but I had no answer. Every doctor is frustrated when explaining uncertainty about outcomes.

“This is going to be a long process. I cannot say how much recovery is possible or how long it will take” I explained to him. His wife and friends requested my permission and sent his reports to various specialists in the developed world, and were reassured that the ongoing treatment was correct. Finally, they accepted the situation.

Alok followed up every month. After first three months his company fired him. His boss who he treated like God, refused to even meet him, and did not reply to his emails. For him Alok was dead. Word spreads. Although recovering fast, Alok did not get any new job. Neerja took up a job, and they divided the housekeeping chores and babysitting among themselves.

The family is now far less stressed, the kids are far more happier now because their father spends more time with them. At a lower income, they have reached a higher happiness bracket. The kids took every effort to jog their father through the past memories,and that has helped him recover faster. There is no higher medical stimulus for recovery than love. (c) Dr. Rajas Deshpande

Yesterday, all of a sudden, Alok came over with a box of sweets, and a greeting.

“I have decided to start my own business. I feel confident now. I may have lost some bits of my brain, but my heart is still strong enough to dream big. I have decided to turn this full-stop into a comma. But this time I have decided that I will first reserve time for my family and then work hard. It is because of them that I am back. I just came to thank you for standing by. My daughter has made this greeting for you “.

The sweets were of course delicious, but the greeting hand-made by his daughter moved me.

It said: “Thank you, doctor, for giving back our papa his dearest family”.

(c) Dr. Rajas Deshpande

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The Poverty Vow

(c) Dr. Rajas Deshpande

Long day. Came home. Ritual steamy hot bath to wash away the hospital feel, followed by steaming hot dinner. Switched on jazz, and I picked up the pasta. Heaven descended upon my tongue.

“How perfect this moment is!” I thought, and that’s where I was wrong. The phone rang.

“Sir, 18 year old buy, had fever since a day, took some tablets, became unconscious, now comatose. Vitals are stable, although he is coughing occasionally. No past history significant. Poor family, cannot afford treatment. Father is a labourer. What should I do?”

“Get him into the ICU, intubate if required and stabilise. Arrange for an MRI”

“OK Sir, but Sir they don’t even have a deposit. They had first gone to the government hospital, but as they were not happy there they have come here”. (c) Dr. Rajas Deshpande

“We will work something out. I am on my way” I replied.

In an hour, after examining the boy and seeing his MRI and other tests, we concluded that he had viral encephalitis. The standard medicines were started.

The boy’s father, an obvious poor slum dweller, was in a state of shock. The mother, sobbing, told me the history. I reassured them. When I explained the diagnosis and treatment they asked some questions.

“We don’t understand anything, we are illiterate and poor. Do anything Sir, Just save my son, Sir” the father folded his hands together. Private hospitals have a quota for free patients, but usually it is always overloaded. I requested the hospital management to please make this a free case, they accepted.

The next day, the child opened his eyes. On the third day he started responding. I was quite elated to have his mother speak with him. However, his respiration was still shallow, and blood presure very low. His heart rate was fluctuating due to the effect of viral infection. He was still critical. I spoke to his parents twice every day, specifically reassuring them. Poor patients must never feel that they are not equally cared for. (c) Dr. Rajas Deshpande

That evening, as I attended my patients in the OPD, the patient’s father came in, requested that he wanted to have a word. He came in with six other people. None of them could possibly be poor, given their get ups.

“Yes?”I asked.

The patient’s father looked at the giant next to him. “You ask” he said to the giant.

The giant, chewing his gutkha, askked me “What’s wrong with his son?”

“I have explained them thrice”I replied, “he has viral infection of the brain. There’s a lot of swelling upon his brain”.

“How come he is not improving? His BP was normal when he came. He did not have any heart problems. Now you tell us his heart is not functioning well” asked another medical superstar with white linen and gold teeth. (c) Dr. Rajas Deshpande

“Yes, this happens commonly with viral infections” I replied, feeling hopeless. How to teach complicated medicine to this pure- muscular class? I wondered.

“But you said he had infection in the brain. How come now he has it in the heart? Is the treatment wrong?” Asked someone similar among them, in a tone nastier than medical examiners.

I looked at the patient’s father. He was looking at the ceiling, deliberately avoiding eye contact with me.

“Listen, Sir”, I told them, “Your patient has viral infection, it has primarily affected the brain, but involvement or dysfunction of other organs is well known with such infections, this is not something new to us. We are on guard, dealing with the situation. Nothing is wrong about the treatment, in fact his brain swelling has improved, and he is conscious now. Ask his mother” I looked at her.

“I don’t know” she said, “we don’t find any improvement in my child. Nobody tells us anything”.

“Haven’t I explained you and his father patient’s condition every day?” I asked. They did not reply.

The white linen gold teeth spoke again: “We want a report. We want to show the case to another doctor”

That was a relief. I gladly wrote them a report. They went doctor-shopping all day. They returned next day. Almost everyone had asked them to continue the same treatment that we had advised, except some desperate non-specialist telling them to shift the patient immediately for a surgery at his hospital. Even our gold-toothed medical superstar understood that it was wrong! (c) Dr. Rajas Deshpande

“We will continue treatment here only. But our patient must survive” came an open threat.

”I will do my best, but I cannot guarantee you anything. You may please transfer the patient under the care of any doctor of your choice” I told them.

“No no, you continue to treat him.But if anything goes wrong, we will file a police complaint. We will ruin this hospital”said one of them.

I am allergic to threats. I don’t allow them twice from the same source in my life. How could any doctor guarantee that there could be no complications? How could I say that the patient could not react to any medicine in such a critical condition? If every patient could have guaranteed improvement, what’s the need for a doctor?

“I am sorry, I am planning for a leave next few days. I won’t be able to see your patient. I have requested our management to transfer your case to another doctor” I told them.

There was a movie “Teesri Kasam”in which the lead character, at the end of the movie, vows never to help the character of the lead actress in the movie, because the very wish and effort to help her has shattered his life, caused him regret. Most Doctors are now being forced to take such a vow. Urban Poverty is not so simple and innocent in a hospital as it appears to the media and society. Whether it is the roadside rowdiness of slum dwellers who roam around with weapons or a maid’s drunkard husband in civilised society, we all understand the misuse of poverty status well anywhere outside hospital, but somehow when this happens in a hospital, the blame is automaytically pinned upon the hospital or the doctor.

But who among the vote-mongers will speak against the majority voting bank?

(c) Dr. Rajas Deshpande

The Other Side Of Life

(c) Dr. Rajas Deshpande

“Wear your helmet” said my grandma, as I kicked my scooter “and don’t argue”.

I could have argued with the POTUS, but not with my grandma. I had come to my uncle’s house to visit my grandma, with the additional attraction of eating the delicious Diwali snacks she made. I wore my helmet and scooted back as fast as I could. My duty started at eight PM in the ICU, and the resident doctor who was on duty had warned me that she had to be with her in-laws for her first Diwali with the new family. All icu beds were full, one patient was intermittently gasping, unlikely to recover, and three others were fluctuating.

Firecrackers, lighting, happy people in new clothes were all around, yet out of mind. I parked the scooter outside the ward and ran in.

“Thank you thank you” said my predecessor, and explained me the cases and ongoing treatment.

When at the bed of the patient who was intermittently worsening, she told me “Listen he’s on dobutamine drip, we don’t have it, I have borrowed two ampoules from the medical shop outside. I will pay him later. His family has no money”. Many critical drugs were not available in the icu, a common problem even today across India.

She left.

Behind the ICU building, a political party was celebrating the festival in a pandal, with repeated announcements of its achievements. Loud lewd music was playing, less irritating than the dramatised loud repitition of the party leaders’names. (c) Dr. Rajas Deshpande

Three more heart patients came in, but the ward beds were full, there already were twelve patients on the floor. This is a common scenario in almost all government hospitals across India. We begged the ward resident doctor to help us, and he agreed to shift three of his patients to the floor. The heart patients were taken on the beds outside ICU, and their medicines were started. We struggled at every step. The student nurses, enthusiastic and energetic, virtually carry half the weight of the doctor’s work upon their shoulders. (c) Dr. Rajas Deshpande

A municipal councillor walked in drunk, and started abusing the ward resident doctor for shifting “his”patient to the floor bed. Aggressive and drunk, his language was more offensive than his personality. We tried explaining to him that there were critical heart patients, but he insisted that his patient be taken on the bed. We then requested a stable young patient, who agreed reluctantly to go to the floor bed.

While this was being done, another old man was rushed in, his bronchitis/ asthma had worsened due to the excess pollution, a common problem in modern India. He was too late, his ambulance had been held in traffic. Already blue-black, he could not be saved inspite of frantic efforts. There were no relatives with him, we completed the paperwork and sent him to the mortuary.

In a few minutes, the fluctuating icu patient had a cardiac arrest. Loud noises of emergency carts, glass ampoules being broken open, and panicked cries filled up the ward. Starting CPR, we tried best to restart the silent heart. Such moments are beyond prayers, the doctor’s heart appeals through his hands, a dead patient’s heart. After a few minutes, the best sound in the world- that of a heart beating again- could be heard. Fingers crossed, we restarted his life-supports and gently informed his wife about what had happened. She was sobbing violently. I went to the doctors’ room to wash my hands.

It was then that the political pandal music could be heard again. (c) Dr. Rajas Deshpande

“Our party has made this big decision. You will all have to pay a little extra, but we will give you a modern, advanced, beautiful India. We will make more advanced satellites, bridges, we will buy the best fighter jets in the world, more bullet trains and bigger statues shortly. We are already ranking very high in the world, we will continue to grow. The only major problem in India is other political parties” the speeches were heard loudly, with proud shouts of joy and claps from the pandal.

At about 5 AM, things settled down enough to sip some water. The nurses had made tea for themselves, the incharge sister Mrs Joseph lovingly ordered me to take a quick break and have a cup of tea. She read my face. (c) Dr. Rajas Deshpande

“Doctor, I have been in this government hospital for nearly thirty years now. Nothing changes, whichever party comes to power. No one cares about the poor patients or their life. We need millions of doctors and nurses more, we need beds, equipment, so many more medicines, but we have to keep begging to the government as if we need it for personal use. Hundreds of patients die every day due to lacknof Medical care, because they cannot get beds, medicines or critical care. I was fed up long ago and wanted to quit. I had excellent offers from middle east and even UK. But I thought, if I left, who will look after these poor patients?”. She was to retire shortly.

Thousands of excellent doctors and nurses, pharmacists, and oher hospital staff carry on caring for poor and desperate patients in government and even private hospitals all over India, they are paid peanuts, are exploited inhumanly, yet keep working through festivals and celebrations, away from their families, with a smile upon their face. Right now, millions of critical patients are being attended by thousands of doctors, nurses and other hospital staff without thinking about salary, rewards, medals, sweets, new clothes or any form of celebration. The only medical festival is a saved life.

This post is to stand up and say a heartfelt “Thank You” to these doctors and nurses who are spending this Diwali with their patients.

(c) Dr. Rajas Deshpande

Please share unedited

The Tribe and The Ring

(c) Dr. Rajas Deshpande

“Before coming to India, I searched a lot and bought this holy stone for you, the same one I was given as blessing for a good future. I wear exactly the same ring. As a mark of my gratitude for the treatment my son Hathim received in India, we want to make you a part of us. Please wear this ring” said Mr. Jade from Yemen.

About a month ago, he had left for Saudi Arabia, leaving his children back in India, to continue treatment. His younger son suffered from a very rare type of epilepsy (Lennox-Gastaut Syndrome) of uncontrolled fits / convulsions and was not mentally growing up well. The 16 year old elder brother cared for the younger one, as they stayed at a rental house in Pune. The case was very difficult, and I had to seek help from my teacher Dr. Sangeeta Ravat in Mumbai, who suggested crucial inputs in managing the kid. Fortunately, the fits are now controlled well, and the father arrived in India to take back the kids to Yemen.

He not only gifted a bag of perfumes, dates and sweets from his country (most Arabic patients, however poor, usually bring gifts for the doctors they visit), but also personalised the bond by bringing for me the same ring that someone had given him for a good fortune. Superstitions apart, but wishing for someone the same that one wishes for oneself is the core of almost every religious text.

Of course the major credit here is that of my teacher Dr. Ravat. I did nothing extraordinary, many doctors treat their patients with their soul, and get excellent results. The reason for this post is the pride of belonging to that tribe called “Doctors” which breaks not only the boundaries between countries, but all the walls between cultures, languages, and societies. This “Doctor”tribe has the rarest opportunity in the world: a free entry in the heart of any human being anywhere upon earth!

This ring is dedicated to that tribe: all doctors who have gifted health and life to millions.

As the beautiful kid travels back to his country, we pray for the best health and happiness for him and his entire family!

(c) Dr. Rajas Deshpande

With Mr. Jade, Master Hatham, and a friend Ms. Arwa.

Hon’ble Babaji’s Medical Interview

© Dr. Rajas Deshpande

A long fleet of luxury cars entered our big hospital. Sirens and whistles, security guards brandishing their AK 56s. and shouts of humiliation for the common men and women suddenly filled up the scene.

Hon’ble Babaji had arrived. A vacuous smile and blessing hands greeted one and all. Babaji was known to cure one and all with his blessings, secret medicines, chants, touch, and even exercises. There was nothing he didn’t treat, so he was the ultimate superspecialist with highest experience and cure rate. No deaths were ever reported among those millions treated by Babaji.

I was in the ward with some of my colleagues, a junior doctor then. The most reliable pleasure in the life of junior doctors is pretty, beautiful and handsome colleagues to work with! Rare exceptions with extreme merit are of course there.© Dr. Rajas Deshpande

A rich businessman and senior minister was admitted in emergency with a heart attack last night. Doctors had performed an emergency angioplasty, barely in time to save his life. Highest offices in the country had warned doctors to ‘do the very best’ for him, till the time he could be flown out of the country for the most advanced treatment. After the meeting of money, influence and power, we got a chance to request Babaji for a small interview to guide us inexperienced doctors. Looking at some of the prettiest faces among us, he gracefully consented. Here are some excerpts of the interview for the benefit of mundane, inexperienced new generation doctors and junta:

Doctor A ( looks OK): Namaskar Babaji! Can you tell us where you studied this art of curing all the illnesses?

Babaji: Beta this is the inheritance of generations, bestowed upon those who perform some secret rituals, it took me many years in the forest to learn it all.© Dr. Rajas Deshpande

Dr. Me ( looks ugly as you know): But Babaji, did you have patients to treat in the forests?

Angry Babaji: No. To learn this secret art you do not need to practice upon patients like your medical science. Once we know, we can directly cure everyone.

Doctor B (stunningly beautiful, common crush): Babaji, can you tell us how you treat a case of open head injury?

Babaji (with an gracefully sexy smile): Come beta, sit here, so you can hear me. We first hold some leaves hard pressed against the wounds to stop bleeding, then pray for the patient with some internal healing chants. We then call the relatives and explain them how futile and fragile life is, and ask them to accept fate. Usually they do. Some rare ones take such patients to hospitals. There too, some die and some survive. Those who survive mostly do because of the prayers. You can come to our place if you want to know how to treat all types of emergencies. We have even made some dead alive!© Dr. Rajas Deshpande

Doctor C (Meritorious. That’s all.): Babaji, there are so many poor patients dying in so many government hospitals, in small villages, everywhere. There are so many hunger deaths too. How come you and your chelas are never seen working your magical powers for such poor and needy patients? In the same time that you visit a businessman, minister or appear in a TV interview, you could treat and cure hundreds with the power you claim to have.

Babaji (red): You will not understand, because you do not have faith. Next question.

Doctor B: Babaji, you and your drug company earn in multiple billions. You are a saint yourself, and do not have material aspirations. Then where does all this profit go? Are you secretly using it to help treat poor and downtrodden?

Babaji (drinks water): There are many charities we do, but one must not tell others what charity they do. We submit the reports to the government. I am getting late, beta, it is my prayer time.

Doctor A: Just one more question, Babaji.. it is said that you cure diseases like cancers, AIDS etc which have no medical cures. Is that true?

Babaji (winks one eye): If you ask me in front of media, I will say no. Because I do not like too much attention and fame. But if you come to our place, you will see the miracles that our ancient formulas and personally researched products can make. They are all FDA approved and safe. Millions have been cured. We treat everything!© Dr. Rajas Deshpande

Babaji smiled proudly and got up.

As he walked in the lobby, many poor patients and their relatives who tried to touch his feet were pushed away by his security. Only pausing to answer questions by TV channels, posing holy, Babaji disappeared in his luxury car.

I went back to the room of the rich senior Minister to record his blood pressure. He was on the phone, talking to someone “Yes, yes, Babaji just confirmed his plan to buy another aeroplane. I have promised him that you will design the customized interiors for his new plane. Come over tomorrow”.

Then, as I recorded his notes, I politely asked the rich minister “Sir, why didn’t you go to Babaji first when you had chest pain?”

He replied what most Indian Politicians, Media personnel, and many Judicial experts feel: “You are too inexperienced about these things, Doctor”!

© Dr. Rajas Deshpande

Please share unedited. Any resemblance to any human being or animal is deeply regretted and unintentional. Praying for better logic and reasoning in all human beings.

The Parceled Sandwiches

(c) Dr. Rajas Deshpande

Entering the hospital that morning, I was wondering if I could finish early and go for a relaxed dinner with a friend who was visiting. Iwas in an excellent mood when I entered the hospital at about 10 AM. That’s when I heard the noise.

In the entrance lobby, there was a group of men, women and children, wailing, crying, shouting, pulling their hair, beating chests, and throwing their hands and legs around lying upon the floor. Few of them were shouting loudly “All doctors are looters. They robbed us and still killed the patient. How can our patient die? Catch them. Kill them. Burn the hospital” this was accompanied by abuses that cannot be mentioned. The security staff and PROs were patiently trying to tell the violent relatives that there were other patients and relatives, that there were women and children around, but the most vulgar of the abuses continued.

I walked past the abusive crowd and met my resident doctor in the ICU. The first case was that of an old man who had had a fall a week ago, but was treated at home for the first three days. Three days later, the old man had suddenly become unconscious, and on admission was found to have a large bleeding in his brain. If not operated within minutes, he would have died. Our neurosurgeons rushed in and operated him with a huge risk. Now he had just started responding, but was still not fully conscious. (c) Dr. Rajas Deshpande

“Why is he still unconscious, doc? Was the surgery not done correctly?” the son asked.

“We have repeatedly told you Sir, the delay in admitting your father has caused a lot of damage in his brain. We cannot predict when and how much he will recover. The surgery was done to prevent imminent death. In my opinion, he is steadily improving. ”I explained again.

One after another, different faces of suffering and allegations, pain and expectations kept mounting and in a few hours it became difficult to feel happy. I am seriously not the type who can keep a perpetual meaningless smile upon my face without actually being happy. However, I must keep calm and smiling, because the next patient will be coming in with a lot of hope, expectation and fear. I did my best.

But my hope of having a relaxed dinner with the friend was gone. All I wanted now was to go home, take a hot shower and try and kill the negativity that was cluttering my mind. The wails and cries of the crowd were still noisy in my heart. “Who must have died? What must their family be going through? What about their children and spouse? Was this preventable?” I was curious. (c) Dr. Rajas Deshpande

The casualty called. A young girl had come with fits. Her old farmer parents had brought her. Stabilising her, and completing the examination, I asked questions to her father. With teary eyes and folded hands, he told us “We have no one and nothing left. Please do something”. Reassuring him, I messaged my CEO, who graciously allowed to treat her as a free case. I started writing notes.

“What was the ruckus in the morning?”I asked the resident doctor standing besides me.

“Oh that!” he replied “That patient was admitted for a head injury two weeks ago. He drank too much alcohol, and his bike had slipped. We admitted him as an emergency, and treated him on compassionate grounds as he was comatose. The relatives were well aware about the poor outcome. We did everything we could. I don’t know why they reacted so. Someone told me that the local politico wanted to extract some funds from the hospital”. This was not unknown, but loss of life does cause unexpected reactions, the doctors and the hospital staff bear the brunt.

Many patients were treated that day, many came cured, many went home happy, many expressed gratitude. But the fact remained that I was unable to forget the wailing family and the accusing son of the ICU patient. Am I supposed to smile and be happy for those cured and improving, or am I supposed to feel sad about the death and suffering I see every day? The emotional highs and lows that happen in every doctor’s day are too wide, too heavy and dynamic. It is not easy to forgive and forget bitterness, thanklessness and paranoid accusations on a daily basis for years, and keep smiling in between. (c) Dr. Rajas Deshpande

My friend called. “Rajas, I am standing outside your hospital. Come let’s have a quick bite. My bus leaves in anoter one hour” she said. We entered the nearest restaurant. Her witty words indeed relaxed me somewhat, and she ordered soup and sandwiches, knownig my favourites. As the steamy soup eased my throat, I started telling her about my day. My cellphone rang.

“Is that you, doctor Deshpande? Do you remember my father Mr. Ramakant who you were treating? He passed away today. We were supposed to come to you three months ago, but as I was out of India, I couldn’t bring him. He had stopped all medicines”.

I winced. Mr. Ramakant was fairly healthy, happy and stable on medicines, they were told never to stop the treatment. How should I react?

“Very Sorry to know” I said.

“That’s okay doctor. My problem is that no doctor is giving a death certificate for him, as he had not seen a doctor since long. We need it for the funeral. If I come to you now, can you please write a death certificate for him? I will pay your charges” he said.

“Sorry, someone has to examine him and issue a certificate. Please call your neares doctor home, or take thepatient to the nearest hospital” I told him. As I kept away my cell, I avoided looking at my friend.

“What happened?”my friend asked. Looking at my face, she sensed it.

“Oh. Sorry” she asked the waiter to parcel the sandwiches.

Both of us knew that neither was going to eat them.

(c) Dr. Rajas Deshpande

Please share unedited. Please let the society know what a doctor’s day is typically like.