(c) Dr. Rajas Deshpande
“What’s the nature of your work?” I asked the patient.
“Nothing much.. I just sit like you all day long. It’s an office job” he replied, and winked looking at his wife, who rebuked him visually. I chose to ignore the sarcastic slur. I wanted to concentrate upon the diagnosis. After a thorough examination I wrote him a prescription and explained him changes in lifestyle.
When I advised him sleep and food discipline, he proudly told me “That I am very particular about.. since so many years I eat three times a day and sleep peacefully over eight hours”. I had a strong urge to tell him that in last twenty-five years of practice, there was never a night of undisturbed sleep thanks to hospital and patient calls, and there rarely was a straight week without skipped meals. I held my rebellious tongue, another patient waited outside. All said and done, I had myself chosen this career, and the fact that people were bitter towards doctors didn’t deter me from offering to solve their health puzzles.
The next patient walked in with a big “Hullo! Raja, pehchana kya (recognise me?)?”.. he was an old schoolmate, had come with his wife. She had had complicated neurological problems. After a lengthy clinical examination, review of many reports, and a long consultation, I wrote her a prescription. (c) Dr. Rajas Deshpande
“You charge so much for only writing these few words on the paper?” asked my schoolmate, desperately trying to sound jovial but overtly being critical and again, sarcastic.
I politely asked him to sit in my chair. “Please sit here and see if you can write the same three lines” I requested him. He hesitated at first, but then came over, held the pen and asked me: “Tell me what to write..”.
I told him to first write his wife’s name on that paper, date it, and then write Rx, which begins the drug prescription. Then I told him the name of the first drug. He wrote it down correctly.
“What’s so difficult about that?” he asked..
“Now tell your wife that this drug can either do good or bad, it can solve the problem in most cases, but it has a potential to cause serious side effects, including death if she is allergic to it. It may cause bleeding in the brain, stomach or anywhere, it can cause asthma-like cough, or any unpredictable reaction”. (c) Dr. Rajas Deshpande
His wife looked suspiciously at him. “Why don’t you let the doctor write?” she said, and then turning towards me said, “Bhaisaab, my husband has this nasty habit of arguing with everyone. Excuse us, I know it takes decades of study to be able to write that prescription”.
My schoolmate was not done with being offensive yet. He smiled sarcastically. “You are trying to scare me. Have you seen any death due to this simple medicine?” he asked.
“Yes” I replied him in truth. Aspirin causes many deaths indeed!
“Write the second medicine now” I told him, “it can have reaction with the first medicine or other medicines she is already taking”.
“What to do in that case?” He asked, now hesitant.
“It depends upon what side effects emerge. Many possibilities, many different answers. But each of that line has a potential to cause serious damage.” I replied.
He rose from my chair.
“Sorry yaar. I thought you were just charging fees for sitting there and writing effortlessly. How do you remember so many hundred drugs, their side effects, their reactions with each other? Aren’t you scared?” he asked.
“I am sometimes scared. Every doctor is. You never know which prescription can turn into a nightmare. The more you have studied, the more you have experienced, the safer you feel. You can imagine the stress of writing forty prescriptions a day, an average for every doctor. Still more dangerous is the surgeon’s job, every patient entering an operation theatre has some degree of fatal risk”. (c) Dr. Rajas Deshpande
“Oh so that’s why doctors charge so much fees for every prescription!” He was indeed a fighter!
I didn’t want to explain to him that the land, the rent, the petrol, paper, and time cost the same to a doctor just like any other citizen. (c) Dr. Rajas Deshpande
Just then there was a loud noise outside. We rushed out. A patient’s child was having a fit, her body all twisted and eyes white. Such was the impact that her head was bleeding, and she was frothing at mouth. The nurse was already by her side, I wore my gloves and tried to stop the bleeding, comforting the head of this child. In some time, the fit stopped, and the pateient became all floppy. Her respiration had been blocked by the blood and froth that choked her throat. A resident doctor ran around to get a crash cart, we opened the patient’s mouth, sucked out the blockage as the nurse pushed in the injectables. The child stabilised, her breathing resumed. As the wardboys kept her on the stretcher, I noticed my schoolmate behind me who was watching this in horror. He suddenly held his head and sat down.
“He gets a chakkar (giddiness) when he sees blood” his wife told me.
The earlier patient, who had commented “I sit like you all day” was also still in the lobby, watcing this whole episode. . He came over. “I help people too – just like you. People come to me every day for my advice. I am a social worker for XYZ political party. I have also saved many lives like you doctors.” he said.
I had no prescriptions for his mentality!
No pharmaceutical makes a common sense tablet, and there’s no injection for jealous egos!
(c) Dr. Rajas Deshpande
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(c) Dr. Rajas Deshpande
As the plane landed, I called up the driver who was scheduled to pick me up from Goa airport.
“Hullo, Mr. Clement? I’m Dr. Rajas”
“Haan daktar. Tu aaya kya? Bahar nikalke miss call de mai ayega” (Have you arrived? Come out and give me a missed call, I will come there”) . He would have said the same sentence to the President as well. Goans are least hung up on artificial flowery language, they are the friendliest lot as a society. It was after a year, that the same Clement said to me: “Tere liye apun jaan bhi dega parwa nai” (“I can give my life away for you without any hassles”), when I thanked him for something.
Goa has some excellent Neurologists, and my visiting is actually redundant. Yet somehow, maybe because they keep quite busy, or sometimes patients seek a second opinion, I have been seeing a good number of patients every visit. In the very first visit, after I saw an elderly lady and explained her the treatment, she bowed and said “Dev Borem Korum Doctor”. That means “Thank You Doctor”.
Then I pleasantly noticed: irrespective of what was the diagnosis, what treatment was given, whether there was treatment for the patient’s condition or not, whether the patient improved or not, almost every patient said either “Dev Borem Korum” (Thank You) or “God Bless You Doctor”. Even if surgery was advised, even if there were side effects of medicines, even if the outcome was not as expected in rare cases, the “Thank You”and “God Bless You” never changed. It had nothing to do with any particular social class. The rich, the poor, the educated as well as the uneducated, people from every religion, every age group said it. It is a part of that culture: the Goan culture.
Late one night after the OPD, when we were driving on a beautiful long empty Goa road near the beach, I mentioned this fact to my friend Dr. Samuel (God Bless Him for the exotic dinners he takes me to!), he stopped his car and looked quite affected. “I wondered whether anyone else had noticed that. It feels so beautiful! When the patient is grateful and brings you blessings, you automatically feel responsible to do the best for them. Money never matters in that relationship. We must never take patient’s kindness for granted. So many of them actually say Thank You, God Bless you, but sometimes we are too preoccupied with work, anger, ego and other things to reciprocate and encourage that kindness”.
I told him about my late Professor Dr. Sorab Bhabha, who stood up and greeted every time a patient entered or left his cabin. The onus of initiating a good doctor-patient relationship primarily lies upon the doctor, and it is extremely essential to follow the best of manners and etiquette, kindest of language when dealing with patients.
A very sweet girl who followed up for epilepsy recently told me that she visited me not only for medical purpose but because she was inspired by the way I appear calm and composed, the fact that I never raised my voice and always spoke compassionately with everyone. I had to tell her the truth. “Thank you mam, but I am quite short tempered outside the hospital. Even the junior doctors working with me sometimes find me intimidating. But I have to change when I am with a patient. I don’t think that any patient comes to me because I am any better than anyone else in the profession. I prefer to think that they choose me because they trust I can solve their problem. Will you be rude to someone seeking your help? Then how can I get angry with a patient? Every patient coming to me has that hidden trust, which I must justify. Only rarely, if the patient misbehaves or says something insulting, do I lose my calm.”.
“That’s what I like. So humble!” she had to have the last word!
Yes! The day I bring my ego inside the hospital, I will no more be a good doctor. Even the most illiterate patient understands when the doctor is being rude or artificial. Only when it is genuine, the patient will feel the warmth of my compassion and care. It has nothing to do with sweet talking or a show of affection. The only way to do this is to actually incorporate it within one’s depths so that it becomes one’s originality. Kindness and compassion must be the original, genuine qualities of every doctor who expects gratitude from each one of his patients. It does work in most cases.
After dinner, Dr. Sam took me with two other friends to the beach and we silently stared at the luminous moon for a long time. The music of those waves matched the dance of that moonlight upon the ocean. Just as one can feel the glow of the moonlight upon one’s skin, I could feel those numerous blessings keeping my soul warm and happy.
(c) Dr. Rajas Deshpande
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©️Dr. Rajas Deshpande
He lost his ability to walk. He had to give up working. He was carried around by family members. His spine had to be operated. Still he couldn’t walk. He didn’t lose hope. He kept smiling, searching for treatments. His legs had become completely stiff like wooden logs, and they jerked violently even with the slightest movement, even if someone touched them. He couldn’t separate his legs apart. He had to use pain killers that would cause acidity, and muscle relaxants that caused lethargy and drowsiness. All this usually depresses most patients, and some lose their patience with life.
But not Mr. Dnyaneshwar Patil. He was tougher than his problems.
“I never thought my illness was anyone else’s fault. I didn’t want to exploit sympathy by complaining about my troubles. I decided to accept my illness to fight it better. I wouldn’t tell my family about my suffering. They were always ready to help, but I changed my lifestyle and needs to suit my condition. They had their life too, I did not want to make it bitter with my troubles” said Mr. Patil, a school teacher from a small village Takarkhela in Jalgaon, recalling his struggle.
His son Girish told me “Baba never raised his voice or got angry with us. Even when there was extreme pain and disability, he chose to take rest and keep smiling. He continued to do what he could, and only needed our help when he couldn’t even stand up”.
After over eight years of this agony, Mr. Dnyaneshwar Patil had another major problem. His disc in the lower spine slipped and caused immense pain. The stiffness and pain in his legs worsened, it was impossible for him to move. He underwent a spinal surgery. That relieved his pain and he could resume some movement, but his earlier woes continued.
Two years ago, one of his blood tests revealed that he had an extremely rare disease called “Stiff Person Syndrome”. Due to a defect in the immune system, there was damage in his spinal cord, which caused the stiffness in his lower body. He was given controlled doses of steroids under supervision to reduce the activity of his immune system. There was a dramatic improvement: now he walks comfortably without assistance, and has resumed his full time job of a teacher.
Today he had come for a follow up. When I asked him permission for sharing his story of amazing courage and hope, he smiled and said “Every patient must understand that they must accept the illness first to be able to fight it. One must never lose hope. I found an answer after over 8 years of not knowing my diagnosis. Some doctors had told me that my problem was psychological, that it was due to stress. I knew it was not, so I did not give up. The reward of my hope is that I can walk today”.
We often get to learn from our patients. Hope is indeed an amazing prerequisite of a good life. We congratulate Mr. Dnyaneshwar Patil for his exemplary grit and pray for his best health always!
© Dr. Rajas Deshpande
PC Aniket Yadav
© Dr. Rajas Deshpande
I entered the ICU in a torn and angry frame of mind. An old patient had had fluctuations in heart rate and blood pressure all night, and was on the thin line between life and death. Irregular heart beats had clotted his blood and he had developed a paralysis.
I had had a terrible argument with family that morning, and had left home without a breakfast, thinking that I will catch up in the canteen if hungry. The traffic on the way was as usual bad, it further worsened my mood. Messages kept pouring in: pending bills and health enquiries that were an attempt to avoid a proper consultation. One can ignore, but sometimes ignoring is stressful too!© Dr. Rajas Deshpande
As I entered the hospital, I was told about some machine not working. The technician had commented that it was beyond repair now. New one would cost over 30 lacs minimum, and this machine was required on a daily basis. My head started pounding. Another loan now, another recovery period!
As I passed the billing counter, an imposing rogue with a group stopped me. “Sir, the bill is too high, do something”. It was an open threat worded technically as a request. The relatives who folded hands to save the patient till yesterday were standing behind that rogue, looking unconcerned, not even happy that the patient was alive and being discharged after a life threatening illness. I sent them to the charity cell.
I entered the ICU, staring into my cellphone where angry messages of argument kept pouring in, a dear friend was upset that I was not available to see his relatives in another hospital immediately. © Dr. Rajas Deshpande
The old patient was sleeping. A glance at the monitor revealed that the patient’s BP was now stable. His heart rate was regular too. What a relief!
The patient’s wife got up, she was in her 80s. Fair, all white hair, and the confidence of culture upon her face, she smiled through her wrinkles and troubles. The Kumkum on her forehead was bright and fresh. She wore a torn saree, and had no ornaments except a thin thread with black beads that made her Mangalsutra. She was bending forward due to age.
She then said “He spoke to me this morning. He is feeling better than yesterday. I know he is old, but please give him the best treatment. We have been together since childhood.” Her eyes became wet.© Dr. Rajas Deshpande
Then she made an attempt to touch my feet, something that woke me up with a shock. A tingling feeling ran through my body. I held her hand and reassured her that it was ok, and returned the gesture by touching her feet too. I told her I will try my best, and that her husband appeared out of danger at that moment.
She gently prodded the patient: “Look, our doctor is here. He says you are getting better. Do you recognize our doctor? Say Namaskar to him”.
Confused for a moment, the old man stared first at his wife, then at me.
He then tried to lift both hands, but only one went up, which he raised to his forehead and whispered “Namaskar”.
The old couple, the age of my parents, was saying Namaskar to me and touching my feet, although I was many decades younger to them, because I was a Doctor. They never knew me until two days ago, but had trusted everything I said. They did not question my ability or intention. I like to be professional, but that should never compromise my manners.
I switched off my cellphone.© Dr. Rajas Deshpande
I suddenly felt ashamed of the mood that I was in. They did not deserve it. Their complete faith was to me the best return and reward of my efforts of so many years to become a good doctor. No amount of money ‘thrown at me’ by those who think of ‘buying my services’ would actually be my interest or aim. This was.
I smiled at the old lady, and told her that should she have any concerns, she can ask the staff to call me anytime, I would be glad to come over. Then, to repay her for bringing my smile back, I wrote on the billing sheet: “No charges for me in this case”.© Dr. Rajas Deshpande
When I walked out of the ICU, I was feeling proud and smiling. The faith of this patient and his wife had cured me of my bad mood too. I was prepared again to forget my personal woes, to take over the faithless hundreds, still do them good, in an attempt to reach out to the really deserving faithful, who knew their doctor would only do them good. That is the essence of my profession, my education, and my intention.
A patient who trusts a doctor earns for himself the best in that doctor. Always. Although we do not expect it to be understood by everyone.
© Dr. Rajas Deshpande
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(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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(c) Dr. Rajas Deshpande
“Why did this happen to her, doc? She is so young and had no problems till now..”asked the angry husband, who had accompanied his learned wife down with severe vertigo and headache. His tone was quite accusative, and voice raised.
My elderly professor Dr. Desai did not look up, he continued to write the prescription quietly. He had just explained in detail to the patient and her husband that this was a simple positional vertigo, which happens episodically in some patients. Although it is scary because the patient feels the world spinning suddenly, it is also called ‘benign’because it does not cause any harm beyond this spinning sensation. Some other dangerous illnesses that could cause such spinning sensation (tumors, blood clots) were already ruled out by Dr. Desai, after a thorough examination and relevant tests. (c) Dr. Rajas Deshpande
“Ï just explained that to you” said Dr. Desai to the patient’s husband, “keep some patience, take rest, and take this medicine”.
“But why did this happen to her?” repeated the husband, this time louder.
“I don’t know, many factors like allergy, infection, some internal defects can cause such problems. In case of your wife this seems to be due to the viral infection she had few days ago.” replied Dr. Desai.
A long list of patients waited outside, and he had already explained courteously whatever was necessary, spending extra time instructing the patient about care to be taken to avoid such episodes, and exercises for the same.
“So this treatment will cure her permanently?” the husband asked. (c) Dr. Rajas Deshpande
Dr. Desai, known for his patience, smiled and replied “Look dear, this illness is like cough and cold. You treat it when it happens, but that does not permanently cure it for life, one may have it again and again. You just treat it when it happens. Now you must excuse me, other patients are waiting”.
The patient went outside and wrote an extremely negative internet review about Dr. Desai.
The fact that he was seeing the seniormost doctor in the specialty who had over 30 years of experience, the fact that the doctor had spent extra time to explain and instruct, the fact that the diagnosis was accurate and that the treatment was exact did not make a difference. One little unpleasant thing – that his repeated questions were not entertained – had resulted in a negative online rating / feedback for what was an almost a flawless consultation.
Some patients ask the same long list of questions every time they visit, which frustrates the doctor. Decline to answer a repeat question, and you get a negative, angry review.
It takes long years to understand some medical concepts. Ususally experienced and clever doctors devise their own simplified versions to make laymen undertand these concepts. However, to understand some concepts or diseases, it requires a lot of different basic bits of information, which it is impossible to make the patient understand. Most patients are quite happy with the simplified versions of disease, diagnosis that their doctors tell them, but some want to dissect every word and understand everything. If the doctor cannot make them understand, they simp jump over to another doctor. While smart communication is an essential for a good doctor today, this has now resulted in another dangerously funny phenomenon: doctors who don’t know much medicine, but can make such patients happy with wise wordplay. (c) Dr. Rajas Deshpande
A few days later, an old farmer from a village walked in. He had the same medical condition. After checking him, Dr. Desai started to explain him the diagnosis. He laughed, folded his hands, and said “Doctor saheb, if I had a capacity to learn medicine, I would be sitting in your chair! I have complete trust in what you do. Just tell me how to take the mediine, what I should not eat, and I will be on my way. I only understand farming well”.
Dr. Desai looked at us students, smiled, and said “When educated, we forget that the real talent lies in knowing what we cannot understand. Some people never get the fact that ‘not everyone can understand everything’. They keep circling in the same ignorant, egoistic efforts leading to frustration. That is a different vertigo, with no treatment. This farmer’s trust saves him such trouble”.
(c) Dr. Rajas Deshpande
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© 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.
© Dr. Rajas Deshpande
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© 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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