Category Archives: Hospital

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

Please share unedited.

A Soldier’s Real Pain

© Dr. Rajas Deshpande.

“There’s immense pain, Sir, in my thigh. I cannot bear it. I want to kill myself. Please do something” said the elderly man, with tears. A proud soldier from the army, he had fought three wars with bravery, and won many medals. Once a bullet had hit him in the lower back and had caused severe injury that bruised his nerves which control the leg sensation. The back wound healed, but the leg pain had stayed. Many drugs and injections had failed.

I somehow noticed that the brave soldier avoided to look at people directly in the eyes, and there appeared to be some unknown sadness behind this. I asked him openly about it. “Yes, I feel sad, but I don’t know why” he replied.

With his consent, I added an antidepressant (they are excellent in controlling pain too). He started responding well. In about ten days, he started to walk without support. Very happy about the pain being controlled, he expressed it with heaped praises for the doctors.

Once when I visited him, he was alone in the room. He was looking at a photo album.

“Come doctor, I was just remembering you” he said, “This is an old picture when I returned to our army base after an incident. There was a firing from the other side, we were not able to see the enemy soldier. It was a dense hilly area packed with trees. We started to move sideways and formed a “V” shape, moving towards where the firing was coming from. We spotted a hidden tank, and three camouflaged soldiers hiding behind it. They would climb up the tank and fire occasionally. Once we located them, it was all easy. We shot them down one by one in few minutes. Apparently, there were two more of their soldiers hiding at some distance, they started to fire. We fired back, they were injured, but managed to ran away. We took this picture just after that victory”.

Then he kept the album down.

“I was very happy then.But last few years, as I grew old, I often think about those I killed. I have no fear or guilt. Yet I feel bad about them. They must have had families and children. They must have left home with promises to return. Their parents, spouses and children must have prayed to the same God for their safety and return. I lost my colleagues too and I know how their families suffer till date. I am second to none in patriotism, but I think we must now evolve to resolve things without having to kill people. I love my country more than any politician, but I will be happy if the politicos of any country stand with the army at the border when declaring a war, handle a gun and feel the pain of having to kill another human being. That is what makes me sad”.

I remembered what one of my neurosurgery professors had once described in frustration after a marathon 8 hour brain surgery: “It takes our team such a huge skill, investment and scary hard work to be able to remove one bullet from someone’s brain without endangering the patient’s life. I can’t believe that we live in a world that still makes, sells and uses bullets and allows killing”.

A doctor is married to humanity. No doctor in the world will speak in favour of injuring or killing someone. A live being’s body is too precious to be cut through. It is indeed necessary to eliminate terrorists who kill others indiscriminately, or to defend the country’s safety, but to be “Proud of killing” someone is difficult to understand atleast for me. Just as I cannot understand the enemy’s happiness and pride if they kill a soldier on this side.

I understood the sadness in his eyes better now. I told him he was just doing his duty, he had no choice. He laughed and replied “I wonder if the ones who ran away injured are also suffering this same pain in their country. If they are, I wish they recover too, because it is difficult to live with this pain”. I told him I appreciated his benevolent statement.

One of the most influential sentences in human history has been said by Mahatma Gandhi: “An Eye For An Eye Makes The Whole World Blind”. The likes of Einstein were in awe of this Indian who advanced humanity. There indeed are countries which have resolved issues between themselves and for decades have had peace, investing in health and development rather than defense. Patriotism and politics mixed will only pollute patriotism. If peace has a chance, it must be the only choice.

Life of every soldier is as precious as that of every decision-making politician in any two countries going to war. Many injuries last lifelong, many soldiers are disabled, many thousand are paraplegics who do not get help or healthcare access. Many a soldier’s families suffer in poverty. They have done their duty: gone ahead and fought with their life at risk, but the country does not seem to have enough resources to handle the requirements of injured soldiers, or support their families.

As in the case of every other social issue, there are thousands of “pseudopatriots” who shout and speak about their love for the country, encourage war and killing, but when told about the injured soldier’s woes, wisely avoid the topic. Every country respects a fighting soldier, but there are few countries which also take care of the injured soldiers and their families, or support a dead soldier’s family.

As doctors, we sincerely stand by those injured and suffering, and pray that there are no more injuries and deaths anywhere in the world. There is no difference in any two human beings for a doctor.

© Dr. Rajas Deshpande

Please share unedited.

Hope-Milking: An Ugly Medical Curse

© Dr. Rajas Deshpande

Mrs. Patel sounded very happy, almost on the verge of shouting: “Dr. Deshpande, did you see the new video? Finally there is a cure for my husband’s condition. I have already booked tickets, we are travelling tomorrow”.

I had seen the video. I knew from experience that it would not help her husband much. Yet, the words in that video advertisement were framed so effectively, that even a low-brainer medic would be confused about the truth.

The effects are indeed magical, but not for the patient. By the time the hype of such viral videos dies down, thousands of patients have already bought the product, earning unprecedented fame and/ or funds to the makers of such videos. This has become an excellent tool for attracting patients under a false pretext.

There are many medical conditions which have no treatment or cure. This is saddening, and we doctors face the justified frustration of such patients and their relatives many times every day. We are also equally eager for cures. It is taxing and nerve-wrecking to hear patients vent the pain of the same issues repeatedly for years. But for the sake of the patient, we must listen, be patient, and keep reassuring them with compassion and sympathy. But we must never lie to them. © Dr. Rajas Deshpande

“Transfer the patient to our hospital, we will manage better” some doctors say, get the patient transferred under themselves, and after a lot of ‘costly surgery, treatment etc.” simply tell the relatives that it was all inevitable and unfortunate. Wrong assurances and milking the hopes of such critical patients is uncalled for, and to a great extent, unethical. Add the tags like “cheap, charity and low-cost” to healthcare, and such a trap is complete. © Dr. Rajas Deshpande

Many videos and articles claiming “dramatic relief, cure”, “new technology”, “diet therapies”, “herbal treatments”, “sexual weakness / ED”, “weight loss”, “sugar control”, “stem cell therapy in unindicated medical conditions” “hair growth” etc. circulate and become viral. Both educated and uneducated patients who hope for a better life fall pray to such hidden advertisements. Months or years later, they realize that their condition is the same or worse. Some develop adverse effects like damaged kidneys, liver or brain, and never realize that it was related to unscientific decisions from years ago.

This is medical pickpocketing.

The saddest part is this: many patients respond to any medicine or procedure / surgery (placebo effect) for a short while, and some with psychosomatic illnesses indeed feel a ‘dramatic relief’. Those who do not benefit seldom come forward. Such medical ads never show how many patients suffered side effects, how many did not respond, or what are the hidden costs. © Dr. Rajas Deshpande

It is sad that this “Hope-Milking” disease has spread rampantly among all streams, including allopathic / modern medicine. Some doctors now publish videos of their own personal discoveries, formulas, potions, without declaring contents, without scientific studies (or with mock/ manipulated scientific trials), as if there is no FDA, Medical Council, experts in respective fields or any such authority. There is no difference between such doctors and roadside herbal medicine quacks or different Babas / Maulas selling ‘magic medicines’ to a predominantly illiterate nation.

Besides being unethical, such practices falsely convey “I know better than all other experts in my field”. That is cheap! Medical councils, doctor’s bodies and IMA should strongly discourage such practices, from all genuine and other streams of medicine.

After a few weeks. Mrs. Patel followed up. “Dr. Rajas, I am sorry. We were carried away by the ad. Initially he felt better, we spent a lot of money, but now we realize it was too costly, it had a lot of side effects and it was not a permanent cure as advertised. We were happy with the earlier treatment”.

Just as I walked in the hospital lobby, I saw a large crowd in front of the television set. National news bulletin was on, dead soldiers and their crying families were being shown. Simultaneously running were the ads by different quacks. A lady was asking her son to jot down the number of a man who claimed to “completely cure all heart diseases with a single medicine”.

I prayed for the health of whoever her patient was, and walked ahead. I had a lot of genuine medical work to attend.

Written in the best interests of my beloved patients and profession.

Please share unedited.

© Dr. Rajas Deshpande

PS: My dear patients, before falling pray to any “new dramatic medical treatment/ cure” traps or ads, please consult your regular doctor and confirm authenticity. You can also visit authentic medical sites like Medscape, Medline Plus, National Institute of Health (NIH), Mayo Clinic, UpToDate to know about the latest approved treatments for all medical conditions. Do not rely upon blogs, support groups, viral videos or personal/ individual sites for making treatment decisions. This can be very dangerous.

Reboot Fate, Kanika Is Here!

Reboot Fate, Kanika Is Here!

© Dr. Rajas Deshpande.

At 12 years she was on the top, an athlete who also won the scholar badge for three consecutive years and special honors at her school. Just then, a rare neurological condition played havoc in her life. She had multiple tumors, suffered a paralysis, was wheelchair bound for over two years. Then she suffered from depression, suicidal thoughts, high blood pressure, and multiple health issues which sometimes threatened her life. She had to leave school. She suffered bullying by kids her age, she had severely painful muscle tears that made it impossible to move hand and leg. Many hundred blood tests, some invasive procedures like lumbar punctures, and even a biopsy were all inconclusive. She also went through medical horrors: rude doctors, huge expenses and uncertainty. Her diagnosis is still not fully established.

But her status as a winner in the battle with fate is well established. Meet Kanika Kesri. She walked again after two long years today.

In August 2015, Kanika started having fever and severe headaches, and started becoming weak. Lot of tests were done, and she was found to have a tumor in her abdomen. A surgery was planned in Delhi, she was taken there. The specialist decided to first biopsy her tumor. The biopsy revealed a possibility of tuberculosis, so anti tuberculous medicines were started. She developed paralysis of the face and eyes, nothing could be done as the only medicines that could improve her condition – steroids- could cause dangerous worsening of her tuberculosis. In December 2015 she developed weakness in the left leg and could not walk. An MRI done then showed that she had developed multiple tumors in the brain and spine. She was then diagnosed with the most dangerous and often fatal form of tuberculosis: MDR (Multi Drug Resistant) Tb.

She was started with additional medicines and her parents were told that nothing more could be done. Her condition worsened during one of the lumbar punctures and she became bedridden, almost completely dependent. Someone told her father one of the worst medical possibilities: that this could be some form of cancer.

One of my earlier patients, Mr. Rahul Agarwal, brought Kanika’s father Mr. Pankaj Kesri to me in a devastated frame of mind. Lost in uncertainty, extremely angry at the behavior of some doctors, and frustrated with the expenses while being away from the job for a few months, he was still very polite and humble.

Her case was indeed baffling. I went through all the details, involved my colleagues at Ruby Hall Clinic, and even some of my teachers in Mumbai. The answer was almost the same everywhere: don’t know what this exactly is, but don’t stop the anti-tuberculous medicines.

Something was wrong, the girl was deteriorating in spite of taking the tuberculosis treatment. In a discussion with her parents, when her father said he had complete trust in the way we were treating her, I put forth an option: to give Kanika steroids, and if she improved, to consider withdrawing the anti-tuberculous medicines. This involved a serious risk to her life if her presumed tuberculosis worsened. With a very heavy heart, her family consented.

We started steroids. Kanika improved. We stopped the tuberculosis medicines. She continued to improve. She could now stand with a walker. Unfortunately, twice during physiotherapy sessions, Kanika tore her muscles: once in the thigh, which made it impossible for her to walk. She was bedridden again.

Till this time, Kanika was all positive, vigorously working to recover. The long illness now started to affect her mind. She became depressed, her sweet smile vanished. She tried to join school, but isolation and bullying worsened her mental agony. She started having suicidal thoughts. Very mature for her age, Kanika decided even in that condition that she was going to defeat the situation. She confessed about her thoughts to her parents. We arranged a counsellor for her. Just as Kanika started to recover from depression, the side effects of steroids started to come up: weight gain and high blood pressure. New blood pressure medicines were added. There are some alternatives to steroids, but she did not tolerate them.

Kanika wanted to study further. She joined home schooling, an excellent option made available by the central government, through NIOS (National Institute of Home Schooling).

One of the most complicated cases I have seen in this young age group, Kanika suffers from a very rare autoimmune condition. Her immune system has some dysfunction that causes multiple tumors in her body, these tumors usually resolve with steroids as they suppress immune system. The closest condition that resembles this is known as Neuro-Sarcoidosis, but some of Kanika’s tests for this were negative too.

Kanika’s parents chose to always come across pleasant and polite. “I know my daughter’s health is above all my complaints. I have chosen to concentrate on the positives” Mr. Pankaj Kesri says. Kanika’s mother Mrs. Rajni had to face a double-edged problem: while adolescent Kanika developed many ups and downs in her moods, Mr. Pankaj Kesri was transferred out of Pune. Mrs. Rajni fought alone on many fronts, while also looking after Kanika and her elder sister Kritika, who they call their pillar of strength.

It all was rewarded today, when Kanika walked without support after almost two long years. I was so happy with the miraculous moment, that I called upon my CEO, Mr. Bomi Bhote, who has always encouraged highest standards of medical care, leaving no stone unturned to bring it under his roof. He was so happy to see Kanika walk again, that he recorded the moment himself. “My wish is to see you run” he told a smiling Kanika.

We learnt a lot: many a times, some patients tolerate a lot while facing medical issues: the worst being a rude doctor. We doctors must ourselves ensure that we offer the best compassionate counseling to each such patient before we demand their faith and trust. It is never automatic. The process of medical care is an ongoing one, and it must be guided by a single principle: decision making in the best interests of the patient. A lot of study and awareness of medical advances on a daily basis is essential.

Kanika to us is an example of exemplary courage, grit, maturity, positivity and patience. She is a role model for anyone who is going through a negative medical phase. May she get back to normalcy soonest possible, may she recover completely, may she achieve whatever she sets out to achieve. She has proven many times over till now that she is a born winner.

In the beautiful moment that Kanika walked again, I found the blessings of my parents and teachers.

© Dr. Rajas Deshpande

PS: Thank You, Ms. Kanika, Mr. Pankaj and Mrs. Rajni Kesri for permission to share this story of courage.

Please share unedited.

A Dark Corner In My Medical Life

A Dark Corner In My Medical Life

(c) Dr. Rajas Deshpande

“Doc, she is becoming unconscious many times since last night” said the worried husband Mr. Robert Jolly, “even since today morning, she went blank twice”.

The young Mr. & Mrs. Jolly couple was married two years ago, and both worked high-profile. Mrs. Shona Jolly reportedly never had such problems in the past, as confirmed by her mother. Just as I was asking them questions, her neck turned towards one side and she appeared to have become unconscious again. The terrifeid Mr. Jolly tried to wake her up. I asked him to step aside and checked her pulse and heart. Everything appeared fine, but she did not open eyes.

However, while I checked her, Mr. Robert Jolly’s peeping over my shoulder annoyed me, but what really surprised me was the indifference with which Mrs. Shona’s mother was standing aside, calmly watching her unconscious daughter and panicked son in law. We neurologists learn after a long experience how to differentiate whether the patient is truly unconscious or just faking it.(c) Dr. Rajas Deshpande

We are not always right, sometimes the patients indeed have unexplainable symptoms or behavior. So we try to refrain from jumping to early conclusions. I explained them that we needed to run some tests before we could finalise the diagnosis. Mrs. Shona was admitted. The husband Mr. Robert shadowed her 24/7. As the MRI, EEG and almost all other tests turned out normal, I reviewed the case and examined her again. Everything was normal. Now was the time to ask her some private questions.

“May I ask her some questions in privacy?” I asked Mr. Robert.

“”Doc, we hide nothing from each other. I am sure she won’t mind if I stay here”, he said, and looked at Mrs. Shona.

Smiling heartily, she repied “yes doc, you can ask me anything. I don’t hide anything from my husband”.

I told her that as all the tests were normal, we had to look at the possibility of psychological factors like stress, depression or personality disorders etc. , which could cause some of the symptoms she had.

“Oh no no, not at all. I am very happy, I have no stress at home or workplace. I am sure doc, this is not psychological” Mrs. Shona replied. We then had two more opinions by senior consultants. They too did not find anything abnormal. Her “attacks”continued.

On the third day, outside the ward, patient’s mother waited in the corridor, where the couple couldn’t see her. She gestured to me, and whispered hastily “Sir, I am Shona’s mother. Please refer her to a psychiatrist or a counsellor. She has had similar problem in her past, and had felt better after a psychiatrist treated her”.

This was difficult. How could I pressurise the highly educated Mrs. Shona to visit a counsellor / psychiatrist? As her husband continuously accompanied her, it would also be unfair to refer to her past illness in front of him.

I asked Mrs. Shona cautiously: “I feel at this stage we must also involve a counselor, and request her opinion about what is happening”. They both agreed, and I sent her to a counselor. Next day, I received a feedback from the counselor: that the patient definitely needs to visit a psychiatrist. I told Mrs. Shona again that I wanted to speak with her in privacy.(c) Dr. Rajas Deshpande

She quite emphatically said “Whatever it is, Doc, please say it in front of my husband”. Then I told her about the feedback from the counselor.

They went to a psychiatrist suggested by the counselor. She was diagnosed with a condition, and when they followed up to inform me, her mother disclosed in front of Mr. Robert Jolly that Mrs. Shona had been diagnosed and treated earlier for the same. She also guiltily mentioned to Mr. Robert that Shona had threatened her parents that she would cut them off in case they ever spoke about her illness to him or his family.

Once her treatment started, she improved. In a shocking turn of events, Mr. Robert Jolly chose to file for a divorce. Six monts later, I received a bitter letter from Mrs. Shona : that I had not been fair to her because I had referred her to a psychiatrist in front of her husband, that I should have kept her illness confidential and hidden from her husband. She even went on to say that in a way I was responsible for her divorce.

I had done nothing wrong, but this was indeed an emotional blow.

Patients often confess to their doctors what they hide from even their closest family members. This includes many things unacceptable to the society: drug consumption, visits to commercial sex workers, abnormal thoughts and behavior including violence, confessions about the past, extramarital affairs, porn addictions, abuse, abortions and even some diseases like AIDS, Tuberculosis and psychiatric issues as mentioned above. In the extremely orthodox and prejudiced society that we live in, even the legal, moral boundaries of what constitutes private information in such cases are not clearly defined. A husband or parents are automatically presumed to “own”the patient and every bit of information related to the patient, directly questioning the doctor and refusing to follow simple courtesies, manners or etiquettes towards their own family members. There are no presets / guidelines about privacy especially related to women or children.

A doctor’s job becomes all the more difficult when dealing with aggressive, litigant, blame-game prone patients and relatives, from both high and low educated classes. One must treat such cases extremely carefully, and our medical bodies must form strict criteria about patient information privacy that cannot be violated by even their family members.

I kept feeling sad and somewhat guilty about what had happened. But that is also what a doctor must learn to digest. One more dark corner of a doctor’s daily life.

(c) Dr. Rajas Deshpande

Please share unedited

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

Please share unedited

Doctor Arrested. Patient Died. Who’s Guilty?

(c) Dr. Rajas Deshpande

“Doctor arrested. Patient died due to a wrong surgery”.

The black headline was shining. There was a file photo of the accused doctor, and angry, crying relatives. Sad and angry, I read through the news that did not affect me directly, yet knowing that every patient who read that news will go further away from their doctor. The already delicate and dying bond will die a little more.

Is it enough to punish this doctor?

Who all is guilty here?

The parents who forced him to become a doctor because they couldn’t?

The corrupt educational boards which allowed leaking papers and increasing marks so the student could get a medical admission? (c) Dr. Rajas Deshpande

The politicians who made it possible for even the undeserving, low-aptitude students (which has nothing to do with one’s caste or religion: it’s more to do with money and power) to become doctors and play with patient’s lives?

The governments who allowed the “Medical Business” by establishment of substandard medical colleges owned by the rich and powerful, to sell medical degrees? The managements of such substandard institutes who chose the “low”quality teachers who agreed to work at low salaries and tolerate all humiliation? The teachers who didn’t care how their student was trained? (c) Dr. Rajas Deshpande

The medical councils which ignored the ‘temporary’arrangements made by such substandard institutes to just ‘Pass the Inspection’, never providing students with adequate education or experience?

The medical policy makers who made theoretical, mcq-type education more important than clinical training?

The offices of law which ignored the repeated applications and complaints of good students from such institutions about incompleteness of educational facilities?

The Universities that allow ‘manipulation’ of medical exam passing under influence of money or power?

Or the politics of allowing cross-specialty practice without adequate training, the ‘jump-over to any pathy’ decisions to please vote banks?

Or the corporate hospitals who prefer such “substandard” doctors because they can work at lowest payments? Aggressive and “market oriented” junior doctors are preferred by many commercial-headed hospitals over those with best academics and clinical knowledge. (c) Dr. Rajas Deshpande

It is indeed a reality that some doctors cannot speak a straight sentence, some cannot spell medicine names correctly, some treat even what is not their qualification skill, and some substitute knowledge with style, overconfidence and sweet talking. At various stages in their career, there are teachers who have tried to correct them, but in these unfortunate times of “pleasing one and all” including students, it is quite difficult to ‘mentally’ train a doctor to be good and perfect.

If only the doctor mentioned above is punished, leaving all others above without correction, then it will be a classic example of example of medical negligence and injustice. It will be like treating only the heart attack without treating the blood pressure and diabetes which cause that heart attack. We know the outcome in such cases.

(c) Dr. Rajas Deshpande

Please share unedited.

“If Only”

© Dr. Rajas Deshpande

Dr. Raina sat devastated in her chamber. Medical tragedies are a part of any doctor’s daily life, but this was cruel, because it was preventable.

A young patient in 20s, Mr. Pandey, was brought to her, with mild headaches. He had started dieting and exercising a month ago, and the entire family was hooked on to some herbal preparations that claimed to confer health without any side effects. His examination was completely normal. The patient and his highly educated parents were extremely anxious. Dr. Raina had explained to them that even if the examination was normal, sometimes headaches may be the only early warning sign of some diseases, and hence she would recommend an MRI of the brain.

“Is it necessary? Does his examination tell you something is wrong?” asked the father.

“His examination is normal, however, in many diseases that manifest only as headaches, one may not find anything wrong upon a clinical examination” Dr. Raina explained.

“Like what? Which diseases?” asked the mother, hardly aware that her anxiety was adding to her son’s distress.

Dr. Raina hesitated. When the patient or family is already so anxious, how can one utter names like cancer, tumor, aneurysm, etc.? If the doctor uses such words, some patients lose their sleep for weeks even if the tests reports turn out normal. A doctor has to be wise enough to avoid worrying the patient unnecessarily. © Dr. Rajas Deshpande

“Well, infections like sinus disease, pressure changes in brain water, and some others which are rare” Dr. Raina said cautiously.

“Any dangerous diseases? How much is the possibility? Can we wait?” the father bombarded.

Dr. Raina controlled her discomfort and agitation. Educated or not, when a patient visiting a doctor talks as if they know better medical decision making than the doctor, the doctor mentally switches off the ‘compassionate involvement of a doctor’ and becomes a ‘legally alert’ medical professional. Questions are welcome, suspicious cross examination is not.

“The possibility of finding anything grievous like clots or tumors is extremely low, but this is usually the standard investigation to complete the evaluation of the case” she replied. She had told them to get the MRI done. They asked if it was an emergency. She said it didn’t appear to be, based upon the normal examination. She wasn’t ‘God’ to see inside the body.

She prescribed the patient some simple medicines for headache, preparing for another round of questions.

“Are these steroids? Are these antibiotics? Do these cause addiction? Do they cause damage to the liver or kidney?” she patiently replied to the family. © Dr. Rajas Deshpande

Why won’t a doctor think of these things when writing a prescription? Do you ask a pilot if his steps while flying are correct? Do you cross question a Judge about how he makes his decisions? Do you ask a soldier fighting with terrorists why he is firing, how many bullets, and in which direction?

The mother checked the medicines and said “Don’t mind doc, but I will first google these medicines and then start in a day or two. We will also think about the MRI”. They left.

Just two days later, the patient was found unconscious in his bed at home. Rushed to the hospital, his brain showed blockage of the venous channels in his brain, that had caused huge bleeding. He was operated in an emergency and was now paralysed on one side. He had also lost speech. The surgeon who operated the patient could manage to save his life with a great effort. The parents were still suspicious about the surgery being wrong. Many opinions were obtained, and it finally dawned upon them that what was being done was the best. The combination of unknown content medicines, low water intake, atrocious dieting and exercise had probably caused clots in his brain, leading to the blockage and bleeding.

One evening, when Dr. Raina was passing by the wards, the patient’s mother stopped her. “He is our only child. Our whole life was woven around him. Will he ever speak? Will he ever walk? Please tell us the truth”.

“We will try, although it looks quite difficult. It may take weeks to see some improvement. But we have seen miracles, let us hope for another” Dr. Raina replied. It was useless to blame anyone now, she refrained from the obvious ‘if only’. © Dr. Rajas Deshpande

They came back in a few weeks after discharge. Now the son was in a wheelchair.

The mother proudly told Dr. Raina: “You know doc, after discharge we took him to a remote village in south India, where he was given special massages and an ancient secret diet. That’s why he is now improving, he has just learnt to say “Aai (mother)”.

Dr. Raina did not reply. There was no cure for the disease of faithlessness in the society that she worked for.

© Dr. Rajas Deshpande

Please share unedited

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

Please share unedited.

“Alive Or Dead?”

(c) Dr. Rajas Deshpande

“I saw the news myself. The doctors declared her dead. They took her home. In a few hours, her son noticed her breathing, they immediately took her to another hospital, where she became conscious. Doctors are absolutely careless now a days. All doctors and hospitals work for only money..” the hefty dark man with a large moustache was telling this story loudly to a group of about eight people sitting around him, three of them quite pretty, young and attractive.

“Yes,”replied another, tall and fair, but with a shrill voice: “Doctors have become butchers now. My friend’s father suffered a head injury, and was dead on the spot. But the doctors told us he was alive and kept his dead body on the ventilator for five days, saying that his heart was beating. All for money”.

I was sitting in the cafetaria of our hospital, it was nearly ten at night. I had just attended a call for a patient of convulsion, in the recovery room , where patients are kept for a few hours after major surgeries. . The patient, who had had fits since childhood,had presented with heart failure due to a defective heart valve, and had undergone a major heart surgery to replace the valve just two days ago. He had had another fit. The cardiac surgeon Dr. Ramnath had personally called and requested me to rush and assess the patient. He was quite worried, like most surgeons are after major surgeries. After making some changes to the patient’s prescription, I called up and informed Dr. Ramnath. He was relieved “Thank you, Rajas. Will you please wait in the cafetaria? I would like to have a coffee with you” he had said. (c) Dr. Rajas Deshpande

That’s why I was waiting in the cafetaria, as usual my back towards the world. The group sitting behind me probably wasn’t aware that I was a doctor, or likely had chosen to ignore it.

In the next ten minutes, there followed many anecdotes by various members of that group: that allopathic treatment is costlly yet useless, all doctors are sold to the drug companies, that humanity has vanished from the medical profession, etc.

The most beautiful sign of growing up is not reacting to a certain type of people. I practised it, although rattled with all that I had heard.

Dr. Ramnath walked in. His trademark fast pace and smiling face brightened the small cafetaria.

“Hi, Rajas, sorry to keep you waiting. Much obliged that you could come. I have just seen him. Oh Hi..!” he said, noticing that two people from the group stood up.

“Namaskar doctor! How is our patient? ” asked a person with the moustacheo.

“He is quite stable now, all is well. I will shift him out tomorrow if everything is okay” Dr. Ramnath said.

“Then why did he have a fit? Why didn’t you tell us that could happen?”asked the moustacheo. He had found a gentleman, polite, highly educated doctor replying his questions courteously, this was his chance to misuse it to impress the three PYTs in the group. (c) Dr. Rajas Deshpande

Dr. Ramnath’s smile vanished. “I had explained to the patient’s family. May I know who you are?” he asked to the moustacheo. Even a surgeon has limits to the misuse of patience.

“I am patient’s father’s friend” he replied, his voice on an offended backfoot.

“Please see me in my office by making an appointment”Dr. Ramnath told him.

We went over to another corner of the cafe and ordered our mutual favourite Italian Roast black coffee. (c) Dr. Rajas Deshpande

Two weeks later, the patient came to my OPD for adjustment of the fits medicine. The moustacheo came too. The patient had recovered magically, now living a new life. I told the family so.

The moustacheo was not yet satisfied. He asked many questions. I had most answers. At the end of it, I asked him what he did.

“I work as a commission agent in property deals” he told me.

“If I may ask, how much are you educated, and in which field?” I asked him.

“Oh I left school after tenth standard. Why?” He was offended.

“Can you google?” I asked him.

“Yes” he said proudly.

“Please read about ‘Lazarus Syndrome’” I told him, writing it down on a piece of paper for him.

There are many examples all over the world, where a patient’s heart stops functioning, and doesn’t respond to the usual measures of CPR / resuscitation, but automatically starts beating again after a few minutes, and the patient becomes conscious later. This is called the ‘Lazarus phenomenon’. It happens because of a complicated combination of chemical, electrical and physical changes in the heart, even many minutes after it stops. This has been reported more than 38 times all over the world. However, it is only in India that doctors are beaten up, hospitals vandalised, and the media earns crores by shouting poisonous about this headline. One state government even shut close an entire superspecialty hospital because of such incidence! (c) Dr. Rajas Deshpande

On the other hand, if a doctor tries to keep the patient alive even when the brain has stopped functioning, or the heart is failing, then some of our less educated muscular bollywood heroes cry foul about the entire highly qualified medical profession, that “doctors are keeping dead bodies on the ventilator to extract money” and even slap doctors in the hospital on the screen, to impress their quality of box office. Maybe we must call these “Ëxperts of life and death” in media and bollywood to treat every patient, to perform operations, and even to certify every unfortunate death that may happen in some cases. It is because of this poison spread by these ‘pseudo heroes’ at the cost of the best doctors in the world, that even after the best outcomes at the cheapest rates, Indian doctors have to face the bitterness and wrath of our society.

Whether a patient is “Dead or Alive”? Everyone in India other than qualified doctors seems to know better!

(c) Dr. Rajas Deshpande

Please share unedited.