Category Archives: India

That Order To “Stop Saving Life”..

(c) Dr. Rajas Deshpande

“Arrest! Sir… Code Blue!” the nurse shouted. The casualty was full, all eight beds had serious patients, and their relatives waited near them. Every second matters.

“Everyone out” my co-intern shouted. Some moved out, some stayed. Two other interns were already attending similar patients, two of us ran to the arrested patient. The nurse had already started the chest massage. I gave patient the position for inserting the breathing tube, as my co-intern Dr. Ajoy took over the cardiac massage. The senior medical officer, Dr. Hazare, experienced with a lot of medical wisdom, stood near the bed. He calmly gave orders for the last-attempt medicines in such emergencies.

The chest massage to save lives is rather forceful, its force has to reach the heart. The chest wall has to be pumped down 2-2.5 inches with every compression, and this has to be real fast: over 100 times a minute. It looks very traumatic, but it is useless if not done exactly like this. It is quite a disturbing scene for the relatives. The patient’s son kept on shouting “Don’t hurt him” loudly. The medical officer repeatedly asked him and the five relatives around the patient to leave. They refused.

The Medical Officer Dr. Hazare then asked us to stop the CPR. (c) Dr. Rajas Deshpande

We were baffled. How could one stop the life saving CPR?

The patient who had arrested was from a nearby slum, father of a local goon out on bail, like most goons in India. He (the patient) was in his late fifties, a chronic alcoholic and smoker, with severe liver damage. He’d had excess alcohol on the prior night. That morning, he had had a convulsion, and was brought to the casualty after many hours of delay . An arrogant, drunk, politically supported crowd posing as relatives accompanied him, a common nuisance in almost every Indian hospital.

We continued the CPR. Dr. Hazare went out.

After a direct injection of adrenaline into the heart through the chest, the patient’s heart restarted, and he started to gasp, making some movements. We quickly shifted him to the ICU. The proud feeling of saving a life gripped us. There was no time for celebration, but Dr. Ajoy kept whistling on the way for our midnight tea.

Later that night, Dr. Hazare called us. He was angry, yet calm and smiling, an ability that only the most evolved souls can have.

“Listen, we are in India. Most of the people around us are not only uneducated and ignorant, they are also quite violent and paranoid. Emotional dramas are considered a normalcy. There’s a tendency to shift the blame of delayed treatment and bad outcomes on to the doctors. You were risking your life. If the patient’s heart had not restarted, the relatives could have blamed you, even hurt you”.

“But Sir, they saw that we were desperately trying to save the patient’s life” I argued.

“YOU think so. They don’t know anything about the CPR. They refused to go out. You saw how arrogant they are. These things work only when the outcome is good. If the outcome is bad, the doctor is automatically held guilty. I told you, we are in India. People like to think that doctors are wrong, whatever you do. ” Dr. Hazare said. (c) Dr. Rajas Deshpande

We didn’t think he was right. Still, we respected him for his wisdom, so we just apologised and went on to deal with the casualty again. It was a busy night, still a very negative feeling about what Dr. Hazare had said kept shadowing my thoughts. How could such a senior doctor ask someone to stop CPR?

Dr. Ajoy went to his room at 5 AM and returned by 7 AM to relieve me. I went home at 7 AM, had a quick bath and breakfast, to return at 9 AM.

The casualty was all devastated, ruins were seen all around. Many doctors were rushing in and out. All beds were empty except one.

Dr. Ajoy was on that casualty bed, unconscious, intubated and with blood soaked bandages on his head. He had many cuts on his entire body. Our colleagues were trying to push intravenous fluids fast into his veins. Dr. Anirudh, another intern with us, told me even as he could not stop crying: “That patient we had resuscitated yesterday evening… he had another cardiac arrest in the ICU this morning… his relatives came down and attacked Ajoy. They said that the patient died because of the forceful CPR. They stabbed Ajay and hit his head with iron rods. Dr. Hazare came and tried to rescue Ajoy, they even attacked him. We were waiting for you. Do you have his parent’s contact?”.

In a state of shock, I could not speak. I reached out for my bag, got my diary and called Dr. Ajoy’s father in Calcutta.

“Why?” Dr. Ajoy’s shocked father asked when I told him Ajoy was attacked, injured and serious. How could the father of a thin built, cute, brilliant scholar ever understand that people could brutally attack his child for trying to save their loved one?

I had no answers. Dr. Hazare’s sentences kept ringing in my brain, I could not utter them. (c) Dr. Rajas Deshpande

Eventually, Dr. Ajoy recovered. He is now in the UK. His father came over last week, for a check-up. While leaving, he kept his gracious hand upon my head and said with immense love: “Save many lives beta, but take care of yourself first. I still cannot sleep well due to what happened”.

That night, I stared at the sky, and kept thinking: Actually, this is why no doctor ever sleeps well in India. Saving lives comes with the inherent risk of losing one’s own, and this happens only in our beloved motherland.

(c) Dr. Rajas Deshpande

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The Sensitive Girlfriend and The Monster

© Dr. Rajas Deshpande.

“She is oversensitive, Doc. I try to explain to her that this is so dangerous, yet she does not want to change, and continues to suffer” said the boyfriend.

As a doctor, I am expected to be sensitive. I cannot be a phony and pretend to be sensitive while not being so. Fortunately, life and times, parents and teachers have always insisted that I remain sensitive to the core. I think that is one of the most precious quality any human being can have after peace. Naturally, I am biased towards the sensitive.

However, there is a big difference between the ‘hysterical, dramatizing’ ones and the truly sensitive.

“Can you give me an example?” I asked him, as the girl looked at him curiously.

“Yes” he said, “Her boss keeps on saying demeaning things to everyone, and she almost always comes home hurt. Even if I comment anything adverse, she gets hurt easily. Like yesterday I told her that she should be more practical and instead of asking to spend time with me, do something of her own. We had a great fight after that”.

“What were you doing when she asked this?” I asked him.

“Oh I was at home, relaxing, as I was tired from work” he said, cautiously.

His girlfriend smiled “Doc, he was playing games on his cellphone. I was tired after work too, but he refuses to spend quality time with me as he is now almost addicted to social media and games. The only time he wants me is when he is hungry”.© Dr. Rajas Deshpande.

I saw at once what was happening. I was myself quite addicted to social media once, but now I have started to de-addict myself. It is indeed difficult, but for a doctor it is quite essential, nay, life-saving. My patient’s life and health depend upon the accuracy an wisdom of my decisions, and that is possible with only a hundred percent concentration. But that wasn’t what bothered me here.

I have been told umpteen times by people in the ‘business’ that “sensitivity and kindness” comes in the way of making money and other professional goals, that people skin and eat you alive so long as you allow them to exploit your sensitive nature. ‘Sensitivity’ to other people’s feelings is considered a weakness in most business circles, and right from the student days, we meet people who take advantage when you respect their feelings. This ranges from exploiting those who are mannerful, helpful, and kind, to creating a deliberate emotional disturbance for the competitor during a competition. Surprisingly, this is taken as a normal strategy even in such a gentleman’s game as cricket.

I could not find it in myself to be insensitive to how others feel. I could not switch on and off my emotional responses and sensitivity. Yet, I never felt that it was a shortcoming or a weakness. In fact, most of the patients I connected best with have told me that they find it very reassuring when a doctor is sensitive. Hence I devised a personal strategy: to keep away the advantage takers, the drama people, the insensitive robots who are only after money without caring about the feelings of others around them. Observe behavior rather than words, and you know a person well. This helped me quite a lot. I earn a little less than I would want, but I think that is a universal feeling, and that is never the prime aim of life.© Dr. Rajas Deshpande.

It made my life beautiful. Sensitive people bring much positivity, trust, faith and contribute significantly to the inner peace of others. With them around you are assured that you will not be deceived, not taken advantage of. That brings you the highest luxury upon earth: peace of mind.

Most bosses work on the perpetual Indian Corporate Philosophy “Unless you squeeze and crush, there’s no juice”. Employees at all levels are overburdened, asked to do a lot more than their job profile, forced to finish within insane deadlines and still treated like they are easily disposable. Employee health, physical or mental, is never the concern of any boss. A fault-finding, comparing, humiliating language is usually what bosses prefer and most employees accept. This builds up a culture of rudeness that is now accepted as a ‘reality and normalcy’ of any business. Very few honorable bosses treat their employees according to their sensitivity to enhance productivity. I wonder if Human Rights commissions or agencies, federal or private, ever notice this.

I asked the girlfriend if she wanted to contribute. She said she understood that he was stressed, but she worried about a ‘mental disconnection’ so common now because of digital addiction, and wanted to destress him by making him laugh and feel loved. © Dr. Rajas Deshpande.

“I want a mental bonding with him and that is not happening, as almost all the time he is home he is occupied with his cellphone. In fact, doc, when we started dating, he used to tell me that my sensitivity attracted him most, he thought I could best nourish his soul” said the tearful lady.

I explained to the boyfriend that sensitivity, so long as it does not impair normal functioning, is a very precious attribute, that he was extremely fortunate that she was sensitive rather than insensitive. To consider her “right to companionship, dedicated time together” as an unnecessary ritual, because he wanted more time for social media browsing and gaming was the actual problem. In these days of equality, to “want her to be sensitive and enthusiastic” only as per his convenience was an unfair expectation. He assured me that he will make an effort to implement a few changes in his routine. I thanked him for accepting reason.

As they left, a fairy-like young girl of about 7 years walked in with posh parents. Her mother kept looking into the cellphone, and her father started to tell me about his continuous headache. Like every normal child, the kid pointed at my stethoscope and said she wanted it. Just before I could allow her, her father shouted at her.

“No” said the angry father, and looked at her mother with an expectation. The mother kept on looking into her cellphone. Then the father thrust his own cellphone on the hands of the kid and said “Here. Play your game, I need to talk to the doctor”.

© Dr. Rajas Deshpande.

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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

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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.

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© 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.

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The Most Precious Jewels Upon Earth

© Dr. Rajas Deshpande

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

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

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

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

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

“What happened?” I asked.

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

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

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

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

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

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

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

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

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

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

© Dr. Rajas Deshpande

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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

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The Killer ‘C’.. Are You A Victim?

© Dr. Rajas Deshpande.

“I have no life. I depend upon comedy shows to laugh, I don’t remember when I was truly happy anymore. There’s no connection with anyone. Inspite of working a lot and achieving too much, life seems complicated and meaningless at the same time. I have even started forgetting things now”: the 32 year old man was quite distressed when he spoke:

“Can you take a break?” I asked.

He laughed sarcastically.

“Doc, there’s so much competition in my field, that I cannot afford to take a break. They depend upon me for things to be done well. If something goes wrong, it reflects upon my career. If I am not available, I will be replaced”. He replied.

“What are your work hours?” I asked.

“I start from home at about 9 in the morning” he said. I waited for the remaining part of the reply but he didn’t speak. © Dr. Rajas Deshpande

“When do you return?” I knew the answer in his silence. I had heard it one too many times.

“There’s no fixed time” his wife replied, “Mostly after 9 at night, sometimes past midnight. But even after coming home his calls and online work continues.”

“That’s because I have to deal with the Western clients, their timezones differ” he snapped.

“May I speak with the doctor?” the wife asked him, a little insistent.

He nodded, looking down.

“Doc, we had a love marriage. He was not like this at all. He was full of life and vigor. He made everyone smile and had hundreds of friends. Now he has no friends, but even with me and our daughter, he gets hardly five minutes every day. On weekends he is so exhausted mentally to interact that the schedule is almost set: visiting mall, watching a movie, eating out and coming home tired again, immediately to sleep. He gets irritated without any reason. He was so attached to our daughter, she was his life, but now even she avoids playing with him. Even enjoyment has become mechanical” both of them became tearful.

Then, lowering her voice, she continued “Dr. Rajas, this is embarrassing, but who else can I tell this to? You are like family to us, so I will say it. We had a great sex life earlier. Now he seems to have lost all interest in me. We have lost our physical bonding just because of lack of time. And now we are losing the mental connection too, as he has started becoming quite forgetful” she completed. © Dr. Rajas Deshpande

They were the second couple today with similar problems.

Excessive work hours, traveling long distances, continuous multitasking without resting the brain and body and eating junk have become the lifestyle for not only most software engineers, but almost every doctor, sales and marketing person, and most other careers in India.

The concept of “minimal salary” and “maximum work hours”, so vehemently fought for by the human rights organizations around the world, seem quite unrelatable and impractical in India: not only competition, voluntary overwork, unrealistic financial expectations and unemployment, but a social tendency to “shove this phenomenon under the carpet” has led to a country of human robots who cannot connect with other humans.

India is an exploitation hub since decades. Cheap manpower is our famous boast. And the worst part is that they are thrown away instantly the moment their productivity is less than excess, or when someone cheaper can replace them. Years of loyalty, honesty, hard word had zero meaning in corporate world. You are just another table with an assigned process. © Dr. Rajas Deshpande. Be it secretaries, clerks, employees, students, teachers, or labourers, the message by the employer is loud and clear: work as told or go. We have many others to replace you. Eight hours of work with two hours of travel every day is itself very taxing, add two more hours of work and on is misusing body and brain both. Health is not on the cards here.

5-6 hours of sleep has become a norm with most of the above categories. For a normal brain, 7-8 hours of sleep is essential. Whatever one may hear about geniuses sleeping less, chronic lack of sleep does cause damage in the brain, that manifests as irritability, personality changes, forgetfulness and less mental efficiency.

Years ago, gymming at the Athletic Club in London ON Canada, I met an old man in the locker room. After the initial ‘Hi’, he asked me what I did. I replied that I was a postgraduate doctor, now a specialty fellow at the University. He said “Oh I did my career in health too”.

“Were you a doctor too?” I asked.

“No. I did many jobs, whatever gave me happiness and satisfaction, but I made my career in my own health. For decades now, I have eaten only healthy food, cooked for myself, taken good sleep, read a lot, traveled the world, played with kids and of course gymmed: not to show off my muscles, but to keep fit. I am ninety two now, healthy, and most importantly, happy”. © Dr. Rajas Deshpande

I told him I envied that lifestyle.

“It’s a choice, doc, and a sacrifice too. If you want health, you must give up anything that is against it. I had great job offers, but they did not go with my choice of a healthy life. Now I think I was right. I don’t have too much money, but I am happy and healthy. I had many friends with millions in their bank accounts, but they are either dead or can barely walk”.

I told that couple this short story. They appeared to understand.

“I will start working upon this, doc” said the husband.

One aspect of human evolution should be good mental and physical health. However we are going backwards. People have developed funny concepts: that muscles and physical stamina alone is health, that less weight is the best health etc. We meet many who diet excessively but piss of everyone they meet as they are continuously irritable due to hunger. Mental and physical health shows upon a person’s face: peace and happiness are its prime components. These are impossible without bonding with your family, ensuring adequate sleep and rest, and opting for stress-free career choices.

As for now, the ‘Killer C’ called career is turning out to be the biggest life- killer at least in India.

© Dr. Rajas Deshpande

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“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

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The Light Divine

(c) Dr. Rajas Deshpande

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

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

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

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

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

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

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

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

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

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

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

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

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

(c) Dr. Rajas Deshpande

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