Category Archives: mental health

The Story of a Deadly Brain Aneurysm..“Doc, was the treatment delayed?”

The Story of a Deadly Brain Aneurysm..
“Doc, was the treatment delayed?”

© Dr. Rajas Deshpande

“Doc, was the treatment delayed?”
The angry husband, Mr. Mane asked in a calm voice but the accompanying relatives had a menacing look upon their faces.

The patient, his wife Mrs. Sujata 35 years old, was brought unconscious two days ago, in a comatose state, at about midnight. I was out of city, so my colleague Neurologist rushed to the hospital and started treatment. We were constantly in touch, within an hour Sujata’s scans were completed, and she was shifted to a critical care unit. She had large bleeding in the brain, and was already beyond a possibility of surgical treatment.

About five years ago, she was diagnosed with an aneurysm in the brain. It is a defect in a blood vessel which balloons out as its walls become thinner and may rupture suddenly, causing either instant death or bleeding in the brain, many a times huge. This diagnosis needs immediate treatment, the right words that describe its risk are: “This is like sitting on a time bomb, not knowing when it is set to explode “.

Many patients do not have much symptoms besides headaches or minor neurological issues usually found on examination by a neurological expert. There are many NeuroIntervention specialists in India since last two decades, who can reach the balloon via a catheter/ tube and close the balloon/ aneurysm so the risk is eliminated and patient cured. Sometimes neurosurgeons are required to operate if the aneurysm has a wide base, and close the connection between the balloon and the artery from which it arises, by an open surgery. © Dr. Rajas Deshpande

Five years ago, we had informed all this to Mr. Mane and Mrs. Sujata. Like many educated patients nowadays, they obtained multiple opinions. Almost all doctors had told them what we had told. However one retired allopathic doctor, now quite old, and one non-allopathic practitioner told them “It is not necessary to do the surgery. Doctors these days advise unnecessary costly treatments”. They started some vitamins and health boosters. © Dr. Rajas Deshpande

The couple decided to wait. The came for follow up once after two years, we told them it was better to operate, but they said “We met our neighbour doctor, he is very senior, and he said that there’s no danger in waiting. I think he knows, see, nothing has happened in two years.. we are happy as it is!”

After that they did not follow up. They had even stopped allopathic medicines. They had come now, when she was beyond any possibility of rescue.

When after a day we told the family that she was brain dead, they asked the question above: “Was her treatment delayed?”.

After explaining to them that everything was done faster than even the best centers in America would have done, they calmed down.

Out of curiosity I asked Mr. Mane: “What did your neighbouring Doc say, the one who had advised to not operate her?”

“Oh, he was very kind. He said nature is cruel and anything can happen anytime to anyone. He arranged for an ambulance too for us.”.

Mrs. Mane didn’t make it, we all felt very sad that a young life that could have survived was lost to a wrong advice. Many doctors who do not specialise in certain complicated and advanced branches of medicine often try to please the patient by giving them an advice that attempts to impress the patient by saying what they want to hear.

It is true that sometimes surgeries are wrongly advised and performed, hence the social confusion about trust. There’s only one way out- explaining the patients and giving them credible websites to refer to, referring them to another specialist who is qualified in that branch. Some trust-less patients will still pay with their health and life. © Dr. Rajas Deshpande

If such cases go to the courts of law, challenging the speed and/ or efficiency of treatment, the honourable courts should consider delays and decisions at every step beginning from the day of onset of symptoms, the delays in visiting doctor, specialist, performing advised tests, obtaining another opinion if advised and getting the prescribed treatment in time. Just holding the doctors and hospitals responsible for not being able to rescue the patient at the last stage is not justified.

Leave aside a few wrong ones, but most surgeons only advise a surgery after deeply thinking about all possibilities, risks and outcomes. Sometimes even when the outcome is uncertain, they must operate. At such times their reputation and career is at a stake, because every mistake is nowadays amplified into a media blast. Still they think about what’s the best for the patients, and try to do their best. Surgeries and procedures, even the costliest, are the cheapest in India since last thirty years- surgeon’s fees are still lowest in all branches, and if we consider the medicolegal and media risk and a violent mobs backed by some politicos, actually the doctor is at a high risk during every major surgery. © Dr. Rajas Deshpande

A doctor is not a merchant or politician to sweet talk to the patient and give them a pleasant but wrong advice and jeopardise their future just to “retain the customer“. This is a noble profession where sometimes strongly worded and unpleasant solutions are essential to save the patient. To expect all the patients and relatives to understand complicated medical concepts and treatments (which takes even brilliant doctors years to grasp) is comical.

We sincerely hope that our society recognises the huge stress every doctor goes through, every day, trying to do their best for patients.
We also wish that the law, politicians and media note that it is often the delays before admission that kill the patients than those after.

© Dr. Rajas Deshpande

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Who Are You?

Dementia: The Brain Killer.

© Dr. Rajas Deshpande

“Just a month ago dad / mom was alright, but now replies in a word or two, appears disinterested in anything. He / she was very lively and active earlier, we are surprised that now they just sit without doing anything, usually staring out of the window, and have to be reminded for everything – food, bath and even who we are’. These words alert every doctor about dementia- a disease that is extremely scary, because the brain is slowly dying. The person suffering with this illness, if not attended in time, can deteriorate permanently and fast, forgetting even oneself, without knowing that this is happening.

What if your own brain forgets you? What if you start to complete fail to recognise your own family, children, friends, not only their names but even their faces, how much they mean to you? Worse, what if in fact you start thinking that they are after your life? Impossible, you think? Welcome to dementia, a devastating disease of the brain that shatters many of our conceptions about ourselves and the world around.

Human brain does a lot more than thinking, speaking, memorising and walking. Born nearly empty, with only basic animal instincts, it then starts filling the memory cells with whatever information is fed to it- name, caste, religion, country, culture, food habits, and also the preaching of dying for one’s own religion or country. While acquiring different skills, it starts comparing self with others, instils the cultural concepts of loving or hating others, discriminating, superiority, and even the wish for equality found in some evolved cultures. Whatever we learn and the emotional make up of our minds, is a stored data in our brain.

Add the bittersweet experiences, the eternal exposure to a mostly self-centred world and our insights, all these make up the personality of each individual, even the ego of being that person, and the addiction of thinking ‘me first’ – all of it is in fact ‘stored data’ in the cells of the brain. There’s also information necessary for communication and social interaction: from days of the week to awareness of day and night, where we are, people and environments around us and so much more.

What happens when these brain cells start dying, degenerating? All this starts fading, and the brain starts having large gaps in these storages about everything, including self. This disease starts slowly, and unless someone is having daily meaningful conversation with the patient on a daily basis, it is missed for many initial months, because the regular, hi-hullo type of conversation is preserved till late. Even the most brilliant minds start making notes and reminders, often forgetting where they kept those. They appear withdrawn, lost in thought, and often have difficulty remembering names, relationships and directions- like not knowing where the washroom is. Some of the most disciplined and cultured may also start using vulgar abuses, have spells of rage, and may accuse their beloved spouse / children of having affairs, intentions of harm and stealing. Some take off clothes in public, misbehave, leave home and get lost outside. All this because the stored memories of “What not to do” is also being lost with brain cells dying. There are many types of dementias other than Alzheimers. Some are treatable if diagnosed early.

The loved ones of such patients are usually shocked and devastated, not only with the diagnosis, but with the revelation that in many cases this is permanent. They usually think that it must be age, stress or some anger that led to this, but their frustration is usually vented at the doctor when they realise that things are progressive. Visiting quacks in various pathies who exploit hope and frustration, the patient is subjected to much experimentation, abuse and even cruelty like tying them down, beating them up, etc., thanks to our superstitious society. The real tragedy is the waste of precious time- because starting the right treatment may some parts of memory longer, and reverse some types of dementias.

The right counsellors, psychiatrists or physicians recognise the disease easily and refer the patient to a qualified neurologist in time. Certain dementias due to deficiencies of thyroid hormone, Vitamin B12 etc. and depression are reversible to a fair extent, while others may require lifelong treatment with a neurologist. If started early with the right medicines, many cases improve and sustain for months to years.

Many cases of dementia are unmasked when patients undergo surgeries, hospitalisation. Patients with dementia get scared and confused in new surroundings, change of familiar places or absence of near and dear ones. They may have many psychiatric manifestations, and even become aggressive. The most emotionally draining thing is their paranoia and accusing spouse of infidelity.

It is essential to counsel and train the family and caretakers about how to handle such patients. One needs to detach emotional interpretations of patient’s behaviour and treat them like a child. One must never force such patients- to eat, sleep, exercise or do something against their wish (unless of course if they intend to harm self or others). One must also refrain from continuously correcting them, teaching them logic and reasoning, or asking them things they cannot remember.

Who Are You? Is an extremely difficult question to answer. Whatever you are, it exists only in your brain. Take good care of it. Stay away from negative emotions of hatred and discrimination. Don’t compare yourself with others. Practice equality in its true sense, it brings calm. Eat healthy, stay happy and active. Include almonds, walnuts, fresh fruits and vegetables in your daily diet. Control blood pressure, sugars and cholesterol levels.

Avoid red meat, butter, fatty and fast food. Avoid unknown medicines.

Many consider deceit and lying as “essential diplomacies” for success, and happily sacrifice precious personal relations in a quest to succeed for money and fame. Guess who helps us when we forget who we are. Preserve your relationships, speak your mind to your close friends, near and dear ones. Share your feelings, express your desires. Shed egos and reach out to people you like, make up with them. Do this today, because tomorrow it may be too late.

© Dr. Rajas Deshpande

Neuroloigist

Pune, Mumbai.

9922753753

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Who Is Guilty Here?A Typical Indian Case


© Dr. Rajas Deshpande

“Sir my brother is critical. The doctors are not telling us anything about recovery. They don’t even reply to our questions about when the patient will recover. They are so inhuman! They should let the patient die if he is not going to come out of this illness, but they give us false hope that he may recover” said the friend, whose language precluded decency.

Having them seated, I requested details from patient’s friend accompanying the brother.

The patient, now in late thirties, had married against his family’s wish. He was boycot by his family, and started living with his wife. After a few days the couple started having quarrels due to his drinking habit. He frequently beat her up, and she often made a public scene of their private issues. He left her one day and returned to his family. His parents and brothers continued to taunt him. One day he was beaten up by his brothers, and in a fit of anger he drank rat poison.
He started vomiting after a few hours, became unconscious, and was taken to a quack who forced some magic potion in the patient’s mouth. Just after that, the patient had convulsions. “Take him to a doctor” said the quack. That’s when they went to a nearby rural hospital, which had no doctor. When they reached the city, patient was almost comatose. They took him to a low-cost multispecialty hospital. Upon admission his blood pressure was not recordable, breathing was almost nil, and heart was already beating too slow. The doctors there had acted fast and stabilised him, but by then his brain had suffered severe damage due to low blood pressure and very low oxygen.
In a week, he was stable, breathing on his own, opening eyes but unable to recognise anyone. Recovery in such cases is always very slow, unpredictable, and mostly incomplete. He needed supervision and nursing care, that was being done. Doctors were tired of the incessant repetitions of same questions: from relatives, politicians, and many other doctors. There’s a limit to how much compassion can one offer to its abuser. © Dr. Rajas Deshpande

I did what was the obvious thing to do: reassured the relatives that the treating doctors were doing a good job, that things were unpredictable in such cases, and that they should have trust in the ability of those qualified doctors to handle a case whom they had rescued from an almost certain death.

What ate my heart away was the blatant, glaring line of facts here: the family was not kind to him, the wife wasn’t kind to him, his relatives took him to a quack and wasted most precious time that could have saved a lot of brain damage, the quack used something that dangerously worsened the patient’s health, the rural government healthcare was inadequate, but none among the family or politicos ever said a word or questioned that. As if they were all exempt from humanity, and nothing about his health was any of their responsibility. © Dr. Rajas Deshpande
The doctors at that low-cost hospital, with minimum amenities, had still managed to save the patient, they did an excellent job, but were still labelled inhuman – just because everyone expected a full recovery of the patient, as if it was worthless to save a life unless it was complete, quick and cheap!
Indian doctors are already considered among the best all across the globe, we keep abreast of all advances in our respective fields by studying every day, we are easily available to everyone who needs our skill and opinion, we work far more than our colleagues in developed world, yet we are the most stressed, criticised, villainised and also poorest paid class of doctors, living under threats from one and all. Indian healthcare infrastructure is atleast fifteen years behind the developed world, it is us doctors who carry that burden of patient’s (googled) expectations upon our shoulders. It is frustrating to deal with the trustless, paranoid interactions with the relatives of those very patients whom we are trying to save.
What kills us most is the indecent, aggressive, violent way in which most doctors are abused in our country. Even the patients who do not recover completely speak in a vengeful, angry and complaining way to their doctors rather than any trace of gratefulness for whatever recovery was achieved.

The only way to possibly change this scenario is to change the society. Yes, to prefer a developed society where common sense and decency are not optional.

© Dr. Rajas Deshpande

Victim Versus Victim

Victim Versus Victim

© Dr. Rajas Deshpande

He walked in my chamber, trembling and sweating. A typical engineer, cute, nerdy and cultured, he lacked the usual poise, calm and charm that accompanies the true intellectual. Something was wrong.

“Are you ok? Do you need a glass of water?” I asked him, while glancing at the vitals that the nurse had recorded- his blood pressure was high but not in the dangerous range. His breathing was heavy, and his eyes red.

“No, Doctor, I… I .. my head..” he wasn’t able to finish his sentence. I let him relax for a few moments. Taking a deep breath in, he started: “Doc, I haven’t slept in fifteen days. My head is exploding. I feel like I will die. We did a heart check up yesterday as I had palpitations, but the cardio told me everything was normal”.

I examined him, there were no neurological findings except the extreme anxiety he was trembling with. Sometimes the mind is so troubled, it actually causes the body to manifest its suffering- causing giddiness, trembling, headaches, lack of sleep, sometimes even fatal conditions! Stress is indeed a major killer.

“Is someone with you? Are you under some stress? Where’s your family?” I asked, and he started to shake.
“I want to tell you something confidential, doc” he said, and told me one of the most horrific yet increasingly frequent stories of our times.

He is 34, married, and has a six-year-old child. His wife works too, but in a different company. He spilled out what was hijacking his mind:
“Fifteen days ago, on a weekend, my wife dozed off on the sofa besides me. Her cellphone was in the kitchen, and when I went to get a snack, a whatsapp notification appeared on her locked screen, it said ‘I love you too, can’t wait to see you. Wear white, you look beautiful ..”. The sender appeared to be a female name, but I was curious. I had complete trust in my wife and we had a very good life together. I woke up my wife and asked her to open that message, asking for details. She refused. I got very angry as she was trying to hide something. I told her that I was planning to call her father and discuss the issue. Then she told me the truth”. © Dr. Rajas Deshpande

“She had met one of her classmates in one of those ten year class reunions which have sprouted everywhere now. He started praising her, messaging her, and she said that she had fallen in love with him. She did apologise to me. I was devastated and wanted to run away, kill myself, because I had loved my wife dearly. The only reason why I did not do anything serious was our son, who is attached to both of us.”

“After a lot of thinking I decided to forgive my wife. I told her that I was ready to start again, but she had to completely stop seeing her classmate. I also requested her that I want to meet him once. We went to meet him. He is married too, has two kids, but his wife is not aware about all this. He bluntly refused to stop seeing my wife. He and my wife together told me that they cannot stop seeing each other, and that if I create any problems, my wife will approach various associations and police and tell them that I am abusing, harassing and being violent to her. You know what happens, doc, how law can be misused, how things can be twisted to make someone a villain. I am from a very cultured, educated family, we are scared of fights and legal matters, police cases etc.”

“When we returned home, my wife told me not to worry, and that if I did not interfere with their relations, I could also have the same relation with her as earlier. Now I hate her, I do not want to see her, but the thought of what will happen to our son and his future is killing me. I cannot eat, sleep or even think normally. I had severe headache since a few days, and today I vomited. My friend gave me your number, so I am here”.

Whenever someone is fasting for long, or for any reason dehydrated, the headache that follows could be extremely dangerous. We obtained an emergency scan of his brain and found that he was already developing clots in his veins, a condition that could have killed him if not treated in time. He was admitted and treated. His wife did come and attend him. He improved and was discharged in two days. I arranged for a counsellor for them, and now they are both undergoing counselling. © Dr. Rajas Deshpande

Besides the facts that I should never judge someone as a doctor, and that I am not a counsellor, I was appalled at the audacious threats (and in some cases a reality) misuse of police, legal machinery and socio-political forces under various disguises to corner and target someone. Recently a big retired police officer has commented “Show me a person, anyone, and we can show you his crimes”. The selective victimization of whoever one wants to target, while playing victim oneself, is the new name of the game: Victim Versus Victim with blurred definitions is the new world we are welcoming, thanks to the umpteen legal and social immaturities.

From gender to religion, from intellectual to financial achievements, anyone can now be blamed by anyone else, claiming to be a victim after using the system to get what one would never have achieved without that very system in place. In short, we are living in a world where a thief can enter your home, kill your dear ones, steal your belongings and if you catch and punish them, can play a victim card based upon anything from gender to caste, religion, nationality or political affiliation. This certainly cannot be called evolution, as survival of the most vicious villain will never favor human race.

Meanwhile we doctors will try and maintain our sanity to be neutral and treat everyone for their best health.

© Dr. Rajas Deshpande

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The Most Dangerous Indian Cancer

© Dr. Rajas Deshpande

Being invisible, the ability to see others without them seeing you, combined with the inexplicable curiosity about the private businesses of others (for which Indians are world-infamous) makes this an irresistible hobby. Manners and etiquette are the last attributes for which we Indians are credited anywhere, so people think it’s like our birthright to be rude, reckless, abusive and judgemental to others.

Earlier when you criticised others, people questioned your own achievements, showed your own ridiculous stupid past, and what was most feared: often proved that you are a do-nothing hypocrite idiot who likes to relish in being critical and disrespectful of others. People could show everyone what a joke your own life was, how illogical, unreasonable and irrelevant a liar you could be. © Dr. Rajas Deshpande

Invisibility gave all such idiots a protection. The ability to hide behind a fake social media identity and troll others as a group, mob, media, political outfit or – most dangerously- a system which has access to the private information about almost everyone- has now become the worst social cancer that India has ever faced. This is far more dangerous, ugly, vicious and destructive than religious divides (people now know that’s a politically cultivated poison), class divides or any other social disease that has disturbed human fabric especially in India.

Trolling is a deadly disease fast destroying everyone almost everywhere, but worst in India. The reason- it has support from the highest of people who have the ability and authority to stop it but won’t. The courts and the law enforcement agencies don’t seem to have noticed the cruel havoc this is already causing everywhere. A suo-moto intervention to criminalise all fake identities and trolls doesn’t appear uncalled for.

Shall we just accept this trolling cancer as a reality of our times that comes as a side effect of social media supported freedom of speech? © Dr. Rajas Deshpande

Does a coward who hides his / her own identity have that protected freedom of speech? Is it freedom of speech to abuse and denigrate one and all, especially the rich, famous and the respected, to use language that inflicts worse injuries than physical wounds? Is it freedom of speech to threaten murders and rapes, to threaten violence and exposing someone just because they refuse to fall into your traps of expectation and exploitation?

It can NEVER be Indian culture to threaten women with rapes and murders on social media. Which religion, which culture anywhere in the world accepts such treatment of women and kids? Where are the various Indian guardians of regional supremacy, language, culture, clothing, food, festivals etc. when the women and children are abused openly on social media in their land?

Trollers in India reached a new low by threatening a young child of a renowned sportsman recently, and the very country whose who’s who are blabbering about “Beti Bachao” appear all silent. Isn’t it a crime to threaten a child on social media anymore?

Is merely deleting those comments sufficient, is it not required to identify, shame and punish such inhuman trollers?

The idea of being able to express one’s opinion in situations like dictatorships where revealing identity could be fatal is alluring. That’s probably why freedom of speech is protected by many social media platforms. However we now know that many of these social media platforms aren’t the innocent soldiers of an individual’s rights of speech and expression, but (probably sold out) manipulators working for political, international forces which pay them well- or worse- want to spread racist hatred between classes and harbour a supremacy theory, to flaunt numbers, spy upon people and even incite mobs to loot and kill. Many leaders, businessmen, artists, actors etc. have been completely destroyed by such trolling, elections swayed in favour of some, and we boast of an illiterate populace hooked upon free internet as our national pride!

How else do we explain the incessant flow of extreme abuse which has now become a source of income and entertainment? How else do we accept that law, national and international, has kept an option of anyone to open a fake social media account?

This cancer, a “Growth” of wrong practices in the body of every nation, is destroying precious bonds between humans: because everyone has an unseen private life, not essentially criminal, but open for trolling once exposed, and one who owns most trollers will be the King! Unemployment demands increasingly crass entertainment, and the ‘kings’ know this well.

We appeal to the Supreme Court of India to please declare all fake social media accounts illegal, and bring to books the trollers who use lies, abuses and threats online.

© Dr. Rajas Deshpande

The Hurt Passion Of A Doctor

The Hurt Passion Of A Doctor
© Dr. Rajas Deshpande

The recent picture of our favourite cricketer Mr. M. S .Dhoni exhausted and fatigued on the field caused a lot of concern, and we wish him best health with many more years on the field. The passion with which he plays is inspiring, we all love and respect him just like we have loved and respected Mr. Sunil Gavaskar, Mr. Sachin Tendulkar, Mr. Anil Kumble, Mr. Virat Kohli and many other greats that the Indian cricket has produced.

By the age of 40 or so, most of the heavyweight sportspeople usually retire from a competitive life and take over other, less tiring jobs. They have spent their entire youth in working extremely hard, with untiring efforts to perfect their craft. The fields of both sports and films are unforgiving, and exceptional talent is required to make it to the top. On the plus side however is the recognition, fame, and money that follows success.

Where does a doctor stand then?

While we cannot compare any two professions given the different client-base and frustrations of each, we can definitely draw some parallels. Competing intellectually starts from school for every doctor, innumerable hours in studying, applying the best mental effort to performance, and overcoming all temptations of a light-heartedly enjoying outside world are just basic compulsions if one has to excel at least in India. The extreme competition for medical admission is worst in our country.

However, that’s just the beginning, and the real struggle starts after one joins medicine: exhausting timetables, extra work and duties, unending patient loads of an hygiene- illiterate society abandoned on health front by its own government are the basic premises. Add expectations of immediate cures and filmy, miraculous recoveries with best recommended World-class internet treatments but with “Indian Compulsions” of charity treatment by doctors from their own pockets, and a never-ending game of moral-ethical looting, compassionless exploitation begins. In the midst of all that mud, a doctor must still keep studying to be abreast of all the modernities of his science, keep a calm mind and be polite and good to even the worst behaved.

Then come home and see pictures of compassion for celebrities. No we do not envy the celebrities. We love them as much as anyone else. We just hate the hypocrisy that our people have created: that if you choose a career in medicine, you are far less likely to be loved, whatever you do, however hard you work, and even if you lose your life. The whole government machinery which rushes to wish celebs and click selfies with them on every tiny occasion cannot have the list of doctors who died treating covid patients! Has anyone seen any selfie of any minister with the doctors who saved their lives from covid?© Dr. Rajas Deshpande
There are thousands of young and old doctors in India, this very moment, working in covid wards, more exhausted and tired than any cricketer in the world. They cannot retire: 99 percent are so financially dependant on their daily income or monthly salaries, that they have silently accepted the tyrannous, cruel policies of various governments to inhumanly exploit them. They are on the verge of death due to exhaustion, and some are already having thoughts of ending it all. Over 500 have died. But the very same society has no compassion for these exhausted doctors, it has abandoned the very heroes who have stood between them and death. Their salaries are pending, they have to buy their own masks and kits, and thousands are estranged form their families for quarantines.

A society that browbeats doctors and hospitals to convert compassion into acceptance of non-payment of bills (as if doctors do not have basic compassions and humanity that everyone else has!) has money to queue up in restaurants, bars, liquor shops, malls, and bet millions on cricket matches is still completely ignorant about the exhausted doctor. We can build everything else as development agenda, but India can not invest in doctors. It can have the most modern aeroplanes and bullet trains, but it cannot pay its doctors.

The young doctor is now rethinking. Many have chosen to change their preferences and not become a doctor. Most doctors do not want to push their brilliant children into this chasm called ‘medical practice in India’: a dark, exploiting, thankless, violent and vulnerable machinery to suck out the blood of the most brilliant minds of our generation. The most important part of becoming a doctor is to reduce suffering and save lives. No one, however rich, becomes a doctor with a mindset to earn out of the dying and suffering.

That very passion to save lives is being insulted, mocked, and widely abused by our great nation today. I will continue to write to my students, to the next generation doctors to please preserve this passion: that is the most beautiful part of your soul, and please do not let it be scarred by an unevolved, regressive and exploiting society that we live in. Take care of yourself. We have a mission to save lives, without thinking whether they deserve to be saved or not. We will shortly also devise strategies to end this exploitation.

© Dr. Rajas Deshpande

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The Future Girl and Her Message


© Dr. Rajas Deshpande

At about 7 PM, I was about to finish the OPD at Ruby. One last patient was waiting, I could see her in the waiting hall outside.

My N95 was on since 10 AM, and I hadn’t had an opportunity to drink even water since I entered hospital at noon. Fatigued, thirsty and heavy-headed, like most doctors today.

‘This isn’t fair’, I was thinking, ‘I don’t deserve this torture after so many years of hard work. This pandemic seems unending, this stress is piling up on my mind and body now,. The world seems to have come to an inhuman standstill’.

The last patient walked jauntily in, a young girl of 27, her eyes smiled excited. She’s been my old case of epilepsy since last three years. She works in a virology research set up, and had told me six months ago that she’s working on Corona. Her parents are working as labourers in a local government factory.

“How are you?” I asked, mustering a smile she couldn’t see.

“All fine Sir, no fits at all. I just came to share a good news. An American University has liked my virology work and offered me a job for three years. I am leaving in three days. I will begin a new life, I have decided to spend it for virology research. I just came to say bye to you. I will of course keep in touch, but I will miss you there” and she touched my feet.

“God bless you. Stay safe at all costs. I am sure you will reach great heights and win a Nobel. Don’t forget your parents. Let me know if you need anything anytime “. I said what I could.

I was happy and sad at the same time. Happy for her career leap, and sad that such a brilliant scientist was leaving India.

I was startled that she had shaken away my fatigue and the pandemic rust that was accumulating on my mind. A sign of youth, she had taken the burning world around her as an opportunity rather than being cowed down by it. She was going to wear a mask almost all her career life, and the thought didn’t seem to affect her. She had accepted the reality faster than anyone I knew. A mind made for the future, she was travelling to the US (she has reached now) at a time that the world was locked down.

The world hasn’t come to a standstill, I realised. It is picking up. It will thrive again and boom in few months. Till then I must keep all negativity away. Till then I must do whatever it takes to survive and live the best life possible even in a pandemic. She had unknowingly come to deliver that special message before she left.

She left teary eyed and yet with a smile. My tiredness was gone. My spirits felt rejuvenated, I was grateful that she visited. Like every doctor who gets up and puts on his mask every morning for seeing their patients catch on with their life again.

© Dr. Rajas Deshpande

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The Good News: ‘Life Is In Brains’

Last three years we were planning a beautiful, comprehensive and patient friendly, “All under one roof” Neuroscience set-up at Ruby Hall Clinic.

Specialty Clinics for Multiple Sclerosis, Parkinson’s Disease, Epilepsy, Vertigo, Stroke, Brain Tumors, and all neurological investigations will be available here, on this floor. Also Neuropsychology, Speech Therapy and Counsellor for family members dealing with difficult illnesses.

My dynamic CEO Mr. Bomi Bhote has long dreamt of a world-class Neuroscience department at Ruby Hall.
“Give our society something to remember you for” he said often. I have tried my best to design this fully new Superspecality Neuroscience Department. After many meetings and many precious inputs from Dr. Purvez Grant, Dr. Manisha Karmarkar (COO), and Dr. Rebecca John, and the blessings of senior Doctors like Dr. Ravi Gulati, MD Dr. Sanjay Pathare we added one stop troubleshooting and convenience so that patients do not have to roam around.

Mr. Iqbal Chaney, Dr. Abhijit Rokade, Mr. Shailesh Kelkar, Mr. Avro Chatterjee, Mrs. Nilofer Shaikh, Mr. Tushar Patil, Ms. Ansha and so many others contributed to the efficient beauty of this set-up.

One item on the top of my bucket list thus ticked off: giving Pune, Maharashtra and India a Neuroscience Department to bank upon. This is just the beginning.

© Dr. Rajas Deshpande

Orphaned Doctor, Change and Future

Orphaned Doctor, Change and Future

© Dr. Rajas Deshpande

For two decades, I have taught medical batches one highest principle in medicine: To go out of your way to earn the patient’s confidence and trust, make the patient comfortable, understand their anger and frustration, and to never lose temper with a patient. Unfortunately, Covid 19 has started to change some of that. Because some patients and relatives do not listen. They do not care if they endanger other people’s life. They have no concept of importance of time and avoidance of “medical gossip”.

We must now treat everyone a potentially infectious source and take adequate care. Longer the exposure to a potential case, higher the chance of infection. That creates a new covid19 complication in our medical practice: dealing with the adamant, the slow, the repeating and the illogical. The days of personally explaining everything logically and patiently seem to be over, at least till the pandemic lasts, as extra time now means that much prolonged exposure. We should now record history with direct questions, examine and diagnose the patient, handover the list of tests if required and a prescription, and arrange for a telemedicine follow up of limited time to explain and discuss. In confirmed diagnoses, we can give the list of authentic websites which patient can read from and get their answers. That will eliminate a lot of unnecessary discussion and “unlimited questions because I paid for this consult”. © Dr. Rajas Deshpande

To risk his / her own life can be a doctor’s choice, but I don’t think any doctor has the right to risk the lives of his / her own children, spouse and parents. I don’t think it is right for the doctor to ignore his responsibilities towards his children, spouse and parents because he has to serve others outside family.

No doctor can endanger other innocent patients and hospital staff by exposing them to adamant, careless patients who refuse to wear masks in waiting rooms. A doctor cannot have time to go out and fight, especially with our politically powered criminals. The only way-out seems to be politely refusing to see the patient who does not follow basic mask etiquette. What is the point of explaining to a patient or a relative who wears a mask on their neck, leaving the nose and mouth open?

Many a times the doctor can diagnose and prescribe for common ailments within minutes, but it is customary to listen to the patient, to pacify their anxiety, to explain in detail and address many a fears born of google searches. The more difficult a medical condition, the more frustrating it is to explain it to patients. In every branch of medicine, there indeed are many extremely complicated medical conditions, situations which the most brilliant doctors also must make efforts to grasp.

It took me 3 years of specialty education after completing DM Neurology to understand Multiple Sclerosis or Parkinson’s Disease well enough to treat it, and even after 25 years of practice, neither me nor any of my teachers- some topmost authorities in the world- who spent their life studying these conditions can claim to have understood them fully. There are far more complicated conditions of the brain we must still keep on studying. How can these be explained to everyone from every background in few minutes?

While the medical treatment is the same for the intellectually challenged and endowed, the former takes the cake here because they stop once they trust their doctor, the later rarely can. © Dr. Rajas Deshpande

The Indian Doctor has been long orphaned by all. The pandemic has revealed the cruelty with which doctors are being exploited all over the country: especially the UG and PG students, interns and junior doctors. It is high time that every doctor takes charge of his / her own career, come out of exploiting contracts and services, even go to the courts if necessary, to be relieved of injustice, and start a good clean practice. That way at least one can serve many more patients, earn peace, satisfaction and funds, while also fulfilling the responsibility to safely look after one’s family. Resident doctors should seriously consider a national level petition to the courts of law about the various unfair practices being enforced at present.

We cannot change the clumsy, clueless, perpetually failing yet adamant mismanagers of the situation who unfortunately hold the reigns.

I’ve worked with orphans. They are most self-sufficient, beautiful souls who learn how to survive independently in a big bad world. I have learnt a lot from them, but the best thing they taught me was to not be affected by the false sympathy, artificial display of love, sweet talkers with black agendas and mean exploiters. They taught me that just holding hands without words at difficult times is far more meaningful than any huge boxes of chocolates, gifts, and to wit: thali, diya etc..

The key to wisdom is in silence. Doctors should silently change now.

© Dr. Rajas Deshpande

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#covid19, #pandemic, #India

Indian Healthcare On A Ventilator and The Mask Matrix

Indian Healthcare On A Ventilator
and
The Mask Matrix

© Dr. Rajas Deshpande

Thousands of Indians, both rich and poor, are helping out each other during this pandemic. Many employers, from large companies to even lower middle class, are paying their employees for months now, without any income. While I am very proud of this humanity among the masses, there are some serious questions in my heart. Our lives cannot be just a matrix of dependence, help, sympathy and compassion as a society. That is still exploitation and abuse, although sometimes wilful on both sides.

Only 2-3 percent Indians pay income tax, and 60 percent of total income tax comes from only 4 percent of all taxpayers. That means, 95 percent of population DOES NOT pay tax, and the ones who do pay taxes are not only compensating for the poor, but also for the defaulters, many of whom may be escaping law. With the pandemic costing the national reserves far beyond repair, it does not take great intellect to anticipate heavier taxations, tighter finances for about a decade to come, and all that burden will af course be borne by the 3 percent taxpayers. Unless you know you are special. © Dr. Rajas Deshpande

With one of the heaviest taxation, why should the nation still have to depend upon someone other than the governments / system to arrange for basics of life free of cost? People are dependent today on other compassionate people and NGOs, social groups for food, healthcare and other basics which the government should be providing them. More disturbing is the fact that when they don’t get these basic life facilities, the blame automatically shifts on those who have hard earned their affluence with education, hard work and talent: be it film stars, doctors, software companies, private hospitals or anyone who has some money: you are projected to be cold blooded and cruel rich who must either automatically shoulder the responsibility of millions of poor, helpless and unguided people, non tax-payers and everyone left out by the government, or you must face an audacious media, social trial for trying to appease the majority by criminalising your authentic, legal earnings.

Why has “HELP” become so crucial for our society today? When there are floods or accidents like the recent airplane crash, we take pride in sharing news of preventable sacrifices and write poetry about those who died because of an extremely poor infrastructure and maintainence. We glorify poor people who jump in to help, hiding important questions. Be it soldiers, pilots or doctors that we are losing every day, we miserably, idiotically dodge the basic human rights question: was it possible to prevent it? Was something wrong about the flood management, was something wrong with the airplane, was something missing in the healthcare that was earlier brought to the notice of the concerned but was ignored? © Dr. Rajas Deshpande

Instead, we choose to use the common masks to hide truth: patriotism, sympathy, compassion, donation, etc. Why could not so many richer politicians and ministers in India do for the migrant poor what some film stars graciously did? I will join the chorus in applauding those film stars, but the haunting question remains: why was the life of so many people dependant upon the compassion of a few film stars and NGOs? Why do NGOs and many others have to arrange donations to get sanitisers, masks etc. even for the police and the doctors?

News of goons fighting hospitals for inflated bills (in some cases indeed the bills are inflated), are exciting for the junta. One link is usually missing in such news: logic. Why doesn’t any of the self proclaimed, overaggressive, megalomaniac TV anchors or leaders enter any government hospital and ask questions directly to the responsible, like why there was no healthcare development in many decades there, why staff was always inadequate, why in the first place people should have to visit a private hospital which has a different financial ballgame and of course private investment. These TV anchors who speak as if they own the country and its population, act like they are above judiciary and replace reason with loud voice, are earning millions every month, why don’t they make a hospital for the poor in every town? In fact, it should be compulsory for every TV channel reporting medical news to donate all the earnings from ads during that news towards the treatment of poor patients. Every political leader should also take the responsibility of insuring health and life of every person in his / her constituency as a priority over bridges and flyovers, gardens and statues.

While everyone is making financial hey during the pandemic, doctors are made to pay in excess for all the masks, sanitisers and every other thing added to the routine by the pandemic, without any compensation. How can the private hospital escape these excess expenses? If at all the bills need to come down, let the government declare everything free: masks, sanitisers, remdesivir or tocilizumab, even the ventilators and electricity. At least strike off all taxes on these. While even the state governments are openly expressing inability to carry on without funds from central govt, how do you expect private entities like hospitals to run without charging patients? Even the hospitals should grow up now and give the patient three separate bills: one for hospital infrastructure and usables, second for doctors fees, and third for all the money that government has added to the bill: viz. taxes. If there is a request from any political strongman for reduction of bills, let the govt waive off the huge taxes part. Doctors fees are less than ten percent in all the bills, and they are the worst defamed ion all these news in spite of working so hard. © Dr. Rajas Deshpande

I feel very bad about the pilot who died while saving others, and naturally think if the airplane was indeed maintained well. I feel very bad also about the 175 + doctors who have died treating corona patients and think if they were adequately provided protection and isolation, treatment and compensation. Every day we are losing a precious healthcare asset and resource in the form of dead doctors.

We can of course shout slogans and bring in the topic of army again, crying aloud that if they can die, everyone must. The ridiculous part is that it is not the army men who usually say that, it is those who sit at home with some gadget, free internet access and a lot of time to write about everyone else, especially against the very taxpayer who pays for their internet and other facilities.

Only those who have paid their taxes should be allowed to opine politely about other professionals, and only after mentioning their own contribution to the country. Anyone who quotes the army as an example for others should be recruited in the army as per their caliber, and made to work free for three years, to help our brave soldiers.

Lastly, any sale of liquor, tobacco or any issue of driving license should be denied unless the person shows his / her own health insurance papers.

We should remove all these dangerous masks of sweet words we all love: compassion, sympathy, patriotism, bravery etc. used to hide the truth: we are financially most disorganised, almost bankrupt, and hiding behind these masks instead of being true patriots and facing the problem, while exploiting not only the taxpayer but also the never-acknowledged pride of our nation: Doctors.

Otherwise our dear country will always remain an exploitation hub, where few keep toiling and paying for many who do not work, and people sitting in tall places and high offices who earn too much while redistributing our national wealth. It doesn’t take a doctor always to tell this: our healthcare is on a ventilator.

Jai Hind!
© Dr. Rajas Deshpande

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