Category Archives: free

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

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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.

Hats Off, Phoenix!

(c) Dr. Rajas Deshpande.

She had paralysis, over eight times in last six years. Lost vision few times. Lost balance many times. Even lost speech and bits of memory. Severe vertigo wouldn’t let her move for days. Many hospital admissions, many injection courses and tests. Barely two weeks ago, she had come to the OPD unable to walk at all. Yet, when she entered the OPD today, walking with a spring in her steps and a smile upon her face, the first thing she said was “I am joining my office tomorrow, Doc! You must convince my husband to let me. I am all fine now”.

Dinaz Dastoor, diagnosed with Multiple Sclerosis, a cruel, unpredictable and disabling disease of the brain and spine, sets an example of grit and positivity for patients and doctors alike! She refuses to be defeated by the disease, does not take any advantage or ask for sympathy, and deals with it like a phoenix: whenever it gets her, she rises above it and flies again.

She refused to take costly medicines with many adverse effects. She refused to give up her chosen duties: housekeeping and bringing up two daughters while fighting with this monster called MS. She attributes all her victories to an ongoing support and encouragement from her husband Rohinton Dastoor and their daughters “ Everytime I feel low, every time I am down in with disability, my husband sits by me and tells me that I am going to recover. He and my daughters have adjusted their lifestyles to accommodate the unpredictable attacks of my illness. Even when growing up, my daughters took care to keep troubles out of home, never argued with me. They all kept stress away from me. Without this supporting family, I won’t be as strong as I am today.. I am really lucky” says a smiling Dinaz.

She started working and is carrying on her job very well, of course her office and superiors have been quite accommodating, a rare scenario in India.

Her husband, one of the most polite and sweetest gentlemen I have ever met, handles all situations with a smile. The only time I ever saw him worried was when Dinaz had once developed a very severe attack and was paralysed below neck. “Do what is best for her, doc. I have complete faith in your decisions” he had said.

Today, he opened up when I requested their permission to share their beautiful story. “It is not that we didn’t have to compromise. There are many desires we had to curb: traveling, adventure sports, and what not. But I always tried to imagine myself in her shoes: what if this had happened to me? How would I have liked her to understand and accommodate my troubles? That way, it was easier for me to make decisions. There are more things we can do together even now than what we can’t. We always think about what we can do, never about what we can’t”. He had just said something that would put so many “MCP” husbands to shame, especially those who ill-treat their wives holding them guilty for their illness.

“A patient and her family only expect that the doctor spends enough time with us to listen to what we have to say, understand and address our concerns, and cares for us” Mr. Dastoor commented.

Meeting this smiling couple not only brightens my day, but makes me feel grateful that I can witness this happen, and write about it!

Hats Off to this beautiful couple, who define the spirit of love in its purest form.

(c) Dr. Rajas Deshpande

Medical Profession and Charity:  A Guideline For Medical Students (Speech at a recent Medical Event)

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© Dr. Rajas Deshpande

My dear friends, you will receive many sermons about your responsibility to do charity and social service from those who do no charity themselves. Many who have never done anything worthwhile for the society will remind you of your Hippocratic oath. Beware of these distractors, your social service and charity is your own choice. Thousands of doctors who chose to settle down in the remote place, purely with an intention to serve people, and carried on general practice for over 50 years are now dependent upon someone helping them for their own medical treatment. Neither the government, nor those whom we help reciprocate. Those who lecture doctors about serving the society never answer this simple question: what if a doctor serving the society very well, needs help? Who will help him? The answer is clear. First safeguard your career, reputation, family, home, parents, future and then do charity like a king, confidently, freely and with pride. Professional goals are not the same for everyone.
Some base the entire concept of charity on the low fees, without any analysis of the quality of medical care provided and the outcomes. A patient treated free but wrong, a patient treated at a low cost with a poor outcome cannot be considered charity. “Self-Declaration” of numbers of such patients treated without an analysis of outcomes and patient feedback is nothing but cheap hidden advertisements.
All of us don’t come from the same background: Some families have lived in perpetual poverty, selling off land and compromising quality of housing, clothes and even food to send their children through the medical education. Some must repay their loans, some must attend too many family duties and some just struggle to survive with a middleclass lifestyle. The first thing that we must overcome while doing any charity or social service is the feeling that those who are unable to do it are somehow lesser to us. That discrimination must go. A doctor doing his / her job well is enough charity, they have sacrificed their youth for the society. © Dr. Rajas Deshpande
Let us look at the career options most Indian doctors have.
Medical teachers have already accepted a very low salary compared to what they truly deserve, The average salary of a medical professor in USA and UK exceeds INR 8 lacs per month, working 8 AM-4 PM, with one emergency per week. Although I do not contribute to the school of thought that one must accept the low Indian financial status, at one-fourth salary per month, our medical teachers work three times more than the doctors in the developed world (because in India the staff is never filled adequately) . Still they continue to put in their blood and sweat, training thousands of medical students, working almost 24/7, seeing far more number of patients in OPD, IPD and Emergency. This is the best possible medical social service, nay, charity being done in India, let me first respect and salute this unrecognized social service. This is an ideal premise for those who want to continue to be available for the poor masses, keep themselves abreast of the most modern medical knowledge, and impart it to the meritorious future generations of doctors.
A similar career is working as medical officers in rural / semi-rural areas, where doctors are most deficient. In most Medical Institutes run by the government or municipal corporations, sycophancy and suppression , hopeless bosses, poor administration and heavy paperwork, punishment transfers and bribery are huge limitations for those who want to honestly serve patients. Life isn’t easy in rural surroundings. Right from the lack of basic amenities like water, electricity, good schooling and transport, to a severe threat to personal security by the rampant Political Gunda culture in a superstitious, orthodox community. Who will want to voluntarily expose their family to these? However, if one does have a social standing in one’s homeland, it becomes an excellent option to serve the society. © Dr. Rajas Deshpande
Coming to the non-government career options in medicine, one is either left to private practice as an individual practitioner, which offers a lot of freedom but limited resources, or a salaried practitioner at a corporate hospital.
In the corporate hospital culture, individual charity and social service becomes almost impossible. Contrary to the image created by the media, most of the corporate hospitals actually comply with the mandatory charity, worth crores of rupees every month to those BPL, but the need of our society is far more than that, the demands are never ending. The new doctor who wants to earn a good name and income, but also wants to do something worthwhile for the society as a free service, the corporate culture offers two options: a low-salaried position for looking after the mandatory charity, or working in their low input peripheral schemes. For a beginner, especially a specialist, these are both excellent options . © Dr. Rajas Deshpande
Coming to the last option: an individual private practitioner, there are many choices but also a stark reality: you are on your own, and on the day that you don’t earn, no one else pays for your innumerable bills. Remember that when you are an independent medical practitioner, you have zero income every day that you don’t work, so a single illness or problem that keeps you home for a month will bring your bank balance to zero. Unless there is an alternative source of income, which is rarely the case with a doctor, this jeopardizes your whole existence. You may be prepared to walk through this, but you will be doing your family a great injustice if you push them into this fate. Look at those who have done the greatest charity upon earth: Bill Gates, JK Rowling etc. They have first earned, secured themselves and their dependents and then returned in plenty to the world. That is the safest way to serve the society effectively and for long.
I know almost everyone in this hall is eager to help the downtrodden, poor and helpless. But there are some things you must first thrash out for yourself. Firstly, do not feel any obligation to copy charity. You can discover your own new ways to serve the needy. Completely ignore those who tell you what should be your financial worth. Once you decide what lifestyle you want, you can chart out how much percentage of your time you can work for charity. You may want to reserve one hour a day or one day every week. Be comfortable, choose what does not become a stress factor, but please stick to whatever you decide.
One hour a day by an Indian doctor means 4-5 free patients a day, that is 30 patients a week, that is 120 patients per month, and 1440 per year. If one consultation is 300 rupees, this way you are giving 4 lac 32 thousand rupees worth service free to the society.
There is a major problem : those who take advantage of free medical service. There already are many affording patients whom most doctors voluntarily see free: relatives, teachers, other doctors and their family, classmates, staff in their hospitals, maids and servants, watchmen, neighbors etc.. There are also others who demand free consultations: administrators, politicos, local heavyweights, ministers and even top businessmen who our bosses accompany. People often say that free service does not have any value, it is not respected, but I will make a small exception here: I feel that the really poor and helpless genuinely respect your free service, remember it for life and place you near God. It is the affluent who are usually thankless for free services, and it is high time that we should stop serving them free, so that we are able to serve the really deserving ones. © Dr. Rajas Deshpande
False poverty/ income certificates, visiting repeatedly for trivial / tiny complaints, daily questioning, become a huge limitation in extending free services openly. Pune teaches you many tricks to identify and deal with such people.
An equal legal responsibility for even the free patients is the law, and a major limiting factor for private practitioners as well as corporates. However careful one may be, every doctor does commit mistakes, and our courts of law are yet unevolved medically, only rare judges are mature enough to understand the intricacies of medical decision making and still rarer doctors understand the law. Look at the big picture: a doctor is treating a poor patient as charity, and unfortunately something goes wrong. The instant conclusion that it was the doctor’s mistake, the sensational news story that follows, and the threat to personal reputation all come to play together. The chance of “Extracting” money from the hospital or the doctor, in case of any complication or death, is considered a lucrative opportunity by many local goons.
A poor young lady with a stroke presented to my free OPD. I found her to have a valvular heart disease with a clot in the heart. We arranged for her free treatment, the best cardiac team in the city operated her free, for a major valve replacement open heart surgery. Everything including all complications was explained, poof on paper. In a month, she developed valve failure, a rare but known complication. The relatives returned with a gang of goons, threatened us in the OPD with dire consequences and legal action. The very family which begged for concessions with folded hands a month ago now spoke of vandalizing the hospital, beating us up. We explained to the patient and family that this is not a surgical mistake, that this is a rare but known complication, and it was still possible to correct it. Fortunately for us, the patient herself agreed for a redo surgery. The cardiac team operated her again, free, and the patient went home walking in a few days, but no one from the family ever expressed any gratitude. We had learnt a precious lesson: do not risk your career for charity or social service, because medical degrees, once cancelled or suspended are almost impossible to get back. © Dr. Rajas Deshpande
My friends, the real richness is that of the soul, and by becoming a Doctor you have already proven all that you need to prove about your soul. Whatever I must earn, I must proudly earn without causing hurt or having to deceive anyone. And believe me, Lord has provided enough for me always. Yes, there was a time when I sat in my hostel room and sung that song “Chaand Taare Ttod Laoon” from Yes Boss . Over the years, the kind Lord has responded to most of my prayers. There is no other profession in which you have such huge opportunity: your charity and service will bring people health and life: so use it freely, every day, always. Just make sure to protect yourself to help others for decades to come, and to pass on this light to the future generations.
Jai Hind!
© Dr. Rajas Deshpande
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Humanity Face / Off

Humanity Face / Off

© Dr. Rajas Deshpande

“Your father in ICU has probably had bleeding in the brain. We need an urgent CT scan” I told the son waiting outside. The old man was admitted late in the evening, although he had had severe headache and weakness on one side since that morning. His son had just returned after a “one-hour” quick meal. Besides flaunting many brands upon his person, he had already told me that he was the vice president of a well known software company.

“Yes, doctor, I am just waiting for the approval from his insurance company.” The son replied. For doctors running in and out of critical care units, the “Cool Calm” of such educated relatives is beyond understanding. Most insurance companies work office hours, approvals come at their own speed, they are least concerned about the patient outcome.

Everything was being kept on hold. Hospitals do not want to proceed with costly tests and investigations unless they are life saving, because most relatives flatly refuse to pay if the insurance company denies approval. The doctor suffers a double blow emotionally: because things are delayed and also because relatives blame only the doctor.

“This is urgent. Please consider making the payments and filing for reimbursement later, so we can make decisions faster” I told him.

“If it is urgent, why don’t you get it done? I will not pay, his insurance company will have to approve” said the son.

I thought about the patient. In the waiting room, the patient’s wife, an old lady, kept praying. I wished she was also praying for a better son. © Dr. Rajas Deshpande. I requested the hospital authorities, and as always, they agreed to help. A CT scan was done, it did show bleeding in the old man’s brain. When informed, the son winced. “How many more days in the hospital?” he asked.

“Usually it takes a week for such patients to stabilize” we told him.

“Can you discharge him? I will arrange for some nurse to give him treatment at home. Just write the medicines he needs” he said. His mother, hesitant, asked “Is it necessary to treat here, doctor? If his health is in danger, we will stay”.

Angrily, the son cut off his mom. “No, mom, this has become a business. They will extend stay even if it is not necessary. If it is only medicines, why does he need to be in hospital?” he asked me.

“Because such patients often develop excess swelling in the brain, or other complications. They can also develop convulsions or lapse into a coma if swelling worsens” I unchained my patience.

“Do you guarantee that those complications will not happen if we keep him here?” he asked.

“No. Only that he can be managed in time, if any complication develops” I replied. There’s no word called “Guarantee” in the medical dictionary. It is only a quack’s favorite trick. © Dr. Rajas Deshpande

“Then why stay here? I have a nursing home nearby, we will go there if there is any problem” the son said, turning his back upon his mother.

The open-secret was revealed soon: the insurance cover that he had bought for his father was minimal, it was over now, and he didn’t want to pay anything from the pocket.

I explained the patient’s wife about the medicines and care, updated her with the warning signs of danger in such cases. © Dr. Rajas Deshpande

“Doc, I am alone at home with my husband all day. My son and daughter in law both work and return late. What will I do in case there is an emergency?” I gave her some contacts near her home, ambulance numbers and doctors.

“Is it okay if she calls you daily to inform the patient’s condition and ask what medicines are to be given in case of an emergency?” the son asked.

“Sorry, we cannot manage patients on phone” I replied.

“Sorry doc, don’t take this personally, but there’s no humanity left in this profession now a days. No one wants to help even an old patient” he commented. I didn’t reply.

They returned in three days, the patient comatose. The brain swelling had increased to dangerous levels. Patient was operated in emergency, saved with a great effort. The son had to foot the whole bill this time. “This is quite unfortunate” he kept saying, reminding me to keep expenses “lowest” because he was paying from his pocket. Finally came the day of discharge. Knowing the questions, I explained them the medicines on discharge.

“Doc, he is a senior citizen. You must give us discounts” said the son.

“Sorry, the hospital decides the billing. My charges are already minimal”. I told him the truth.

“Just as I said, there’s no humanity left” he looked at his mother and said. It was now the time to chain my patience. I knew the right reply this time.

“Yes, Sir”, I said “ I agree. Humanity is indeed on a decline, but more in your family than in my profession”

© Dr. Rajas Deshpande

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A Habit That Protected Me

A Habit That Protected Me

(c) Dr. Rajas Deshpande

“I cannot bear this. Help me doctor”shouted the Old man fom the waiting room, just as I entered the OPD. There were appointments before him, I requested others to wait, and most of them agreed, although a little upset. I called in the old man. He was accompanied by two of his sons, both probably professional bodybuilders.

He was a known case of Trigeminal Neuralgia, a condition that causes severe, shock like or stabbing, excruciating pangs of pain on one side of the face. This usually brings the patients to tears, and most patients come frustrated, unable to talk or eat, with the telltale sign of their hand covering that side of the face, scared to open mouth even to reply. He had had this condition over ten years now, and was quite stable, usually visiting me once a year. He had last visited only a few weeks ago, smiling and pain free. There were no new findings. He kept on shouting, saying that the pain was unbearable. This was unusual. I asked him if he had done any of the prohibited things that usually increase the pain of Neuralgia: cold drinks, icecream, shaving harshly, exposure to breezes etc. He said he had had an icecream a few days ago, but the pain had only restarted yesterday.

The sons were staring menacingly at me. “How come this has suddenly worsened doc? Is this the effect of your medicines?” one asked. I wondered why they don’t teach simple logic and reasoning in primary schools. Everyone going to a gym must, in my opinion, first be mandatorily taught normal human conversation. Otherwise they speak with their biceps. Not knowing that language, I chose not to reply him. (c) Dr. Rajas Deshpande

He was already on high doses of the medicines that controlled his pain. He also had diabetes, so I could not use the best emergency medicine for such pain: steroids. Once earlier, he had developed severe infection while on steroid, so that was out of question.

I started him on a short course of a strong pain killer. Warning him that he should take it only for three days. “His pain must stop immediately” said the other son, threateningly. “I wish so too. It should subside soon, usually it takes two to five days” I concluded the consultation.

They returned five days later. (c) Dr. Rajas Deshpande

“I am very good now, Doctor”said the old man, “The pain went away the very next day. Thank You”.

Just as I prepared to look at the musclebuckets proudly, the old man said “Doctor I need a certificate that you had advised me bedrest for five days”.

I was almost prepared to write, this appeared a justified request given what had transpired. Curious, I asked him: “But you have your own business. Why do you need this certificate?”

It was then that one of the biceps spoke: “He had a court appearacne in a criminal case on the next day of our visiting you. He could not go to the court. Now the court has asked for a certificate”.

Alarmed, I told them: “I had not advised him rest. I cannot issue a false certificate.” (c) Dr. Rajas Deshpande

They looked at each other. Then the old man said “I request you doctor. My cousin has filed a false murder charge against me and my sons. Please help us. Your certificate will save us trouble”he folded his hands.

Now the secret of why that pain had worsened suddenly had unfolded. This condition is indeed known to suddenly worsen, but when such “situations”coincide with illnesses, a doctor is the easiest to squeeze the arm of.

“But we paid your fees. His pain was actually severe that day. How can you deny us a certificate now?”asked the elder biceps.

Many video clips of daylight, open murders that happen around us daily ran through my mind. Even under the heading of compassion, was it right to help this patient, who was one of the accused? As a doctor, I am not to judge anyone and must purely decide based upon the medical merits of this case.

I had not advised him rest. I declined their request for the certificate. Angrily, the trio left my room, and on the way out, in the waiting room, loudly enough for other patients to listen, the old man said something derogatory about all doctors being heartless looters. Every new patient who walked in that day had a question mark of suspicion on their face, it took me extra effort to wipe that away in each case. (c) Dr. Rajas Deshpande

Whether it is addiction to pain killers or sleep medicine, whether it is false certificates or deceiving the medical insurance companies for claims, many patients abuse their doctors’ compassion and services. Some doctors fall easy prey to such tactics, some do it for money. Majority refuse to contribute. It is this majority that such “demanding”patients always cry against.

The doctors who help such people with such causes not only endanger themselves, but may in fact add disgrace to their profession, because it is these same patients who tell others how any doctor can be fooled, or bought with some money or threat.

As fate would have it, one of the sons came to visit me the very next month, for his wife. As I examined her and then wrote a prescription for her, I enquired about his father.

“Oh he is alright now. We got a certificate from one of our relative who’s a doctor” said the son, smiling shyly: “That’s why I brought my wife to you.. I know you will do only the right thing”.

I could only thank my teachers who had tattooed that habit upon me, and taught me that only good begets good. It is a habit that has protected me always.

(c) Dr. Rajas Deshpande

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Can Anyone Solve The Mystery of Atmaram’s Courtroom Death?

Can Anyone Solve The Mystery of Atmaram’s Courtroom Death?

©️Dr. Rajas Deshpande

A hungry poor man named Atmaram went to a big hotel, had a nice big meal, and told he had no money to pay. He was beaten up and handed over to the police. He was released after a warning and a slap.

Next day he filled up petrol in his bike, and said he couldn’t pay. He was again beaten up, handed over to the police. Then he went to the medical shop, bought medicines and mineral water, ate the medicine, drank water from the bottle, and again said he couldn’t pay. He was now jailed for a week.

Next week his house was damaged by heavy rains, so he went and requested to be allowed to sleep in the house of the chief minister. He was arrested again, thrashed up.

As angry Atmaram shouted at the police, he was beaten up by them, another crime was added to his offences. In the court, Atmaram insulted the lawyers and judges and accused them of accepting bribes and charging too much. The judge punished him extra for his behaviour. Atmaram was angry and threw his shoe at the judge. His punishment was extended.

“You must respect the authority “ the court said.

“But I am poor, I need free food and petrol and medicines. I need sympathy too” Atmaram argued.

“You should have begged and applied for favours and eaten in places that provide charity meals. Petrol, however essential, has the same price for everyone. You can sleep on the footpath, and above all, you are not allowed rudeness and violence because you are poor and needy” The court said.©️Dr. Rajas Deshpande

When released from the jail, Atmaram drank a lot of desi alcohol, had an accident and fractured many bones. He went to the best private hospital, got operated and refused to pay his bills that crossed one lac rupees. When the hospital insisted, the operating doctors were beaten up by Atmaran’s relatives, the hospital was vandalised, the police arrested the doctor who saved Atmaram’s life, the government closed down the hospital, while the media and the society kept villainising the entire medical profession.

The headlines next day reported the sympathy expressed uniformly by wag addicted tongues: some said the entire profession was tainted, some blamed the greed of the doctors, even some doctors desperate for attention shed crocodile tears about the ethics in this profession. ©️Dr. Rajas Deshpande

In the courtroom, during the trial, Atmaram sat facing the doctor, still heavily bandaged.

The hon’ble judge, kind but surrounded by security, told the doctor accused of negligence and malpractice in the court: “You as a doctor carry more responsibility for ethical behaviour upon your shoulders. You should never turn away the poor”.

The doctor, defending himself, asked “but Milord, doesn’t our constitution insist on equality? Why do you yourself or ministers get security but not the doctor? Why isn’t everyone supposed to stick to ethics in every profession including politics, police and judiciary? Why are others exempt? How do you explain beating up of doctors while also saying that the society treated them like gods?”.

There were no answers. The kind court asked if the doctor had to say anything else in his own defence.

The doctor said

“Yes Milord, but the real answers will hurt:

Jealousy against medical professionals across society and many other professions is a reality. Why else will anyone who couldn’t qualify to become a doctor try and teach the qualified doctors what they should do?”©️Dr. Rajas Deshpande

“A culture of exploitation of non-votebank groups

and a complete failure of government healthcare with no one accepting responsibility is well known to everyone, but even judges have no courage to suo motu question this and correct it, even when they see the poor dying”. ©️Dr. Rajas Deshpande

“In a country with never ending poverty, how much free can a healthcare facility provide? For how long? This is already forcing closure of hospitals and exodus of good doctors out of the country.”©️Dr. Rajas Deshpande

“Milord, can you assure that every doctor will get his/ her fees as per his service to every patient, and if the patient can’t pay, that much charge will be exempted from the income tax of that doctor? How else do you except a doctor to meet his needs and dreams? Just because there are millions of poor patients, is the doctor’s life and hard work taken for granted? If there has to be financial sacrifice, why not have everyone contribute to it by creating a national health tax fund for treatment of poor patients? Why healthcare is subsidised only at the cost of a doctor?”

Just at this point, Atmaram, who sat in front of the judge, collapsed unconscious, almost blue black.

The shocked judge requested the doctor to examine him.

“He is no more” said the doctor.

“What could have happened ?” asked the kind but sweating judge.

The doctor told the court about three possible reasons. Two of them were scientific and medical: a sudden cardiac event or a large blood clot in the lungs common after fractures and trauma.

The third non-medical, unscientific cause made the Judge seriously ponder.©️Dr. Rajas Deshpande

“Will this court be now closed down, Milord? Will your efficiency be questioned, will you allow the relatives to attack you and understand their sad situation at the cost of your murder?”

“I understand what you mean” said the kind judge.

Needless to say, the doctor was released without a blame.

Can anyone please solve the mystery of the third non medical, unscientific possible cause of Atmaram’s death?

(C) Dr. Rajas Deshpande

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“Why Don’t You Marry Her, Doc?”

photo 19-09-16, 22 52 52
Dr. Rajas Deshpande

“Sir, she cannot walk, she is paralysed below chest since last few days. Her husband doesn’t care, he has abandoned her. She has no money or insurance for tests or treatment. I want to help her, I don’t know what to do” I told my junior consultant, who was having his coffee break with senior consultant and the departmental secretaries. He looked at me in a nasty way, and said “Why don’t you marry her?” and they all laughed aloud. However, although my professor smiled with them, he asked me to get the patient’s papers.

She was a case of Multiple Sclerosis, in her early thirties, and had lost ability to walk. Her sensation below the waist, control over urine was also lost. This ghastly illness of the brain and spine often cripples the young. In many cases, when such disability develops, divorces follow. The world as we doctors see it is far more cruel, deceptive and dangerous than most illnesses humanity knows. She was left with a small daughter and no income. © Dr. Rajas Deshpande

I felt insulted, but I was in a foreign country. The junior consultant was known for his sarcastic humour and enjoyed impressing women around him, often at the cost of others, like so many dwarfs who take advantage of their chair to achieve what they otherwise cannot. I chose to ignore him, and got the papers to our boss, who called a colleague to enrol the patient in one of the upcoming research trials. That would ensure her free tests and medicines for a few years. I told her the good news. She started sobbing, then handed me a note written by her:
“I am killing myself as I have nothing left except my daughter, I cannot look after her with my disability. I have no complaints against anyone. Please look after my daughter”.
In some time, after she stabilised, she said “Doc, I had come prepared to kill myself today. My daughter is sitting in the cafeteria. If you had not told me what you did just now, believe me, I was planning to drive my wheelchair off the roof today”. © Dr. Rajas Deshpande

We called her 10 year old daughter from the cafeteria. Little did the cute child know how lucky she was to see her mother again that day.

That evening, my boss, the senior consultant, took me out for a dinner. Once the red wine loosened strained faces, he started to speak: “Rajaas, I know you are kind and you want to help others. I know you feel for your patients. But I must caution you, don’t get carried away. Your job is clear: to listen, to advise the best line of investigations and treatment, to explain, and to compassionately guide. Don’t carry too much weight upon your shoulders”.
“Why, Sir?”I asked politely, “I feel inner peace when I walk an extra mile to help my patient. How can that cause me any harm? Didn’t this lady survive just because you helped her today?”
“Because it is a never ending burden. To be able to effectively help everyone coming to you, you must have too much money and too much time. Doctors seldom have either. I lost a lot of time and money, to realise that this cycle never ends, that newer and more people need your help every day, all your life. I almost went bankrupt, collapsed and quit under stress. Then I realised that I must limit this so I could serve them best the next day”. © Dr. Rajas Deshpande

It felt like dry reasoning at that moment. However, boss continued to help patients beyond duty whenever I asked him. Over years, I realised how correct Boss was!

My dear british colleague Dr. Mindy was trying to help a patient through her divorce, I accompanied her. As the patient opened up, she revealed to Mindy that although she enjoyed marijuana, her husband was involved in the sale of other illicit drugs, and that was one reason that she wanted to divorce him. Dr. Mindy involved a counsellor to help her out. However, after they decided to patch up their marriage, the patient told her husband that she had confided in Dr. Mindy. The husband came over and politely threatened her to keep all the information only to herself, otherwise be prepared for dare consequences.
We all spent many a restless nights after that.

Emotionally disturbed, helpless patients, those who are treated unfair by family often depend upon a kind doctor. They get quite restless at times, worry a lot and then expect an immediate hearing and resolution from their doctor. From suicide threats to blackmails, there are messages that pour in once that channel is opened. This sometimes wreaks havoc in the doctor‘s life, because being disturbed affects clinical practice and decision making. The small time left for self and family is thus shot dead. A patient who becomes emotionally dependent upon the doctor can turn into a nightmare for the doctor. Over years, I learnt to balance this, going out of the way only for the few truly deserving patients.

Thousands of patients have survived just because their doctor emotionally supported them in time, otherwise they would have died of lack of will to carry on. No one ever credits the doctors who become emotional back-ups for their patients: a service that costs them time and stress, without any income. That is unfortunately considered a “duty” of the doctor, to be kind and available at bad times, but to be forgotten in good times. © Dr. Rajas Deshpande. Many actually think that good words, compliments and “a satisfaction of serving” should be sufficient compensation for the doctor. Nothing fully compensates, although kind words do sometimes make one feel good.

However, what caused worse hurt to me was some of my own colleagues who made fun of me and many other doctors who went out of their way to help patients. “Impractical, unnecessary, worthless, drama”, and so many other adjectives are used by colleagues and even seniors/ some teachers for doctors, students, residents who walk an extra mile to help their patients. I was extremely fortunate that I met some good teachers who supported my efforts without mocking me, and I continue to meet students who carry on this noble trait forwards.

When I was leaving, the junior consultant came over for the farewell too, and told me in too many words how I must learn to be “Practical”. I gave him a reply that one teacher with advanced genius had taught me years ago, for people who do less themselves and advise others a lot. This reply saves a lot of time and energy, my teacher had told me, and its beauty is that people don’t even understand that you are saying ‘those two useful words’ when you reply like this:

I just smiled at him.

© Dr. Rajas Deshpande

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The Changing Blood Group

The Changing Blood Group

(c) Dr. Rajas Deshpande

“He is sinking” shouted Dr. Siya.

The casualty registrar rushed to the bed, checked the vitals. Pulse very fast. Blood Pressure very low. Lips and nails white, hands and feet cold. The young man, unconscious, was on the verge of death.

“He must be bleeding inside. Get an urgent sonography of his abdomen”said the registrar to Dr. Siya, and call the blood bank. He will need at least two units of blood urgently”.

It was Dr. Siya’s first week into internship, she was thrilled with the idea of actually saving lives. At the young age of 22, she was witnessing death almost every other day. Along with that she was amazed to see the darkest sides of human nature: the potential of humans to hurt each other: via rapes, accidents, murders, fights. She had decided to not let this affect her attitude, and to continue to try and save every life she could.

That late night, this young man of about her own age was brought in unconscious by someone, who had just dropped the patient in the casualty and left without leaving any identity of himself. “I found him lying unconscious on the road. I don’t know anything else about him. I am just doing my duty, I have a train to catch”said the stranger and left. The patient was reeking of alcohol. He had a visible head injury. A quick CT scan had revealed minimal bleeding due to a small skull fracture. He also had had bleeding from wounds from his hands and legs, they were sutured. The patient had no identity marks, wallet or cellphone. The policy of the hospital was to provide basic treatment and shift the patient to the government hospital. The police station was already informed. Treatment was started.

Dr. Siya requested two units of blood. The blood bank called. They had only one unit of the blood for his blood group. The registrar had the same blood group, and like many doctors working in the emergency departments, he went down to donate blood.

It was nearly midnight. The fate of the life of a young man depended upon what the junior doctor did just then. There was no one to sign any consents, the protocol was to inform the hospital’s medical director and obtain consent for emergency transfusion or procedure. Dr. Siya finished the formalities, obtained the permission, and started the transfusion. If the patient had reacted or something went wrong now, they all feared, there will be a havoc in the media: that they had let an unknown patient die because they wanted money!

Dr. Siya kept on managing the show. The angry and disturbed relatives of other critical patients kept on taunting her, speaking rude and reluctant to complete simple formalities and paperwork.

The sonography was thankfully normal.

Just as the first unit of blood was over, the patient became conscious, and revealed his name. He was quite shaken with the surrounding, but told in broken sentences about his friend’s number and address. He revealed that while returning from a party, his bike was interrupted by a bunch of goons, he had fallen down, they hit him upon the head and left with all this belongings.

The friend was called, and came in. He revealed that the patient was used to smoking weed and drinking alcohol in huge quantities. They were staying in the hostel of a famous college.

The second blood unit was started, and in a short while the patient threw a convulsion. He was immediately given injectables for controlling the convulsions, he slept off with the effect.

His parents arrived early next morning.. The shocked mother was consoled and explained about the situation by Dr. Siya. The elderly father, like all fathers, equally shocked but being a father unable to cry, kept mum, just holding hands of the boy.

When the patient woke up again, the father came to Dr. Siya, and touched her feet. Too embarrased, she told him that the registrar had donated blood for the patient. The father went and thanked the registrar, again trying to touch his feet.

As Dr. Siya had finished her night duty, she prepared to leave. “Beta, Will you come soon please?”asked the tearful mother to her. “Yes Auntie, I will be back soon. Don’t worry, he is ok now”she reassured and left.

On her way back her genius young mind tried to look at the situation sitting upon her shoulder, the little third person that resides within each one who has a conscience. That booze and weed was easily available to youngsters in almost all Indian hostels, that even educated people rode bikes without helmet, that crimes were happening almost everywhere that injured and killed people, that law and order was a laughable term in many parts ofthe country, that there was no government mechanism in place to provide emergency medical / paramedic support ambulances to raod / traffic accident victims: which one is the most responsible cause, when patients like these died? Who is responsible?

She reached home, told her proud parents what had happened, that she had helped save a life. Her mother folded her hands towards the sky, said “God, let my daughter save many lives everday”.

While having the breakfast, her father turned on the TV. A famous but ill educated political leader, in his mind-and-other- organs blowing speech in Karnataka, was explaining the illiterate public how all Indian doctors charged in excess, how they were only after money, how everyone except himself was the enemy of the millions of patients surviving from critical heart attacks, accidents, strokes and other diseases. All patients getting better all over te country was only thanks to himself and his government!

Dr. Siya’s father laughed bitterly. “Next time you need blood for any poor or unknown patient, call him” he said.

Dr. Siya replied, laughing “That kind of ëver changing blood group doesn’t match anyone, it is useless for any patient, Papa”.

(c) Dr. Rajas Deshpande

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