Category Archives: neurology

The Secret Illness Of Doctors

© Dr. Rajas Deshpande

She threw the file upon my table.

“I have no relief doctor. This giddiness is killing me. None of the medicines ever works. No doctor is able to understand my illness. Just give me some tablet and end my life” she was shouting and crying. Her parents accompanying her looked at me with anger and disdain.

She had been to many speciaalists earlier. Most earlier doctors had “wisely shuttled her off to another specialist” due to her hysterical behavior. © Dr. Rajas Deshpande.

I ordered a coffee for her and her parents, asked them to calm down, and explained that I had not found any abnormality upon her physical examination. I told them once again that sometimes we do not recognise stress playing upon our minds. We all think that we are supermen or superwomen who can tolerate any mental activity, behavior or abuse of our physical and mental capacity. Explained, they calmed down, open for suggestions. I referred them to an excellent psychiatrist colleague.

My colleague emailed me the next day after meeting them. The girl was being sweetly pressurised by her family for marriage, and the fear of having to leave the “overcaring and comfort” of her parents was stressing her out. She dramatically improved with counseling for the whole family and medicines for her. © Dr. Rajas Deshpande.

Only recently, a case of bleeding in the brain due to high BP was quite critical, and the entire family kept blaming, screaming at and in general mentally screwing the doctor’s team as the patient did not improve as quickly as they expected. Patients with bleeding in the brain may take months to improve. The worst ‘shouter’ in this case was the patient’s elder son. Many days after the patient improved, the family revealed that this elder son had had a continuous fight with his father, the patient, for many days prior over property, and on the night before admission he had slapped his father. That’s probably why the patient’s BP had shot up, causing bleeding in the brain. They had never told us this part earlier.

This is a form of abuse that almost every medical practitioner faces on a daily basis. Quarrels and stresses at home, guilts and anxieties, work pressures, irregular and atrocious lifestyles, eating habits and addictions, relationship frustrations of all kinds, personal failures and insecurities are some of the common reasons angry patients and their families unburden themselves upon the medical practitioner. Many want to avoid in-laws, pregnancy, transfers, heavy duty etc.Many do not follow medical advice and experiment upon themselves. Most of these blame doctors for their continuing ill health, little realising that the actual medicine is omitting the cause of their stress. The doctor can only help one identify this cause, suggest strategies to deal with it, but the actual action has to come from the patient and family. © Dr. Rajas Deshpande.

“Doctor Abuse” is common all over the world, but in India it also converts into frank violence. Blaming ‘compassionate communication failure” by the doctor is a joke, a society where even the closest family members do not understand each other for years, how does one expect a doctor to make someone strange ‘understand” a complicated situation? Will our courts and police “explain and communicate effectively” with criminals so that they do not commit crimes again, or will they “warn and punish” the abusers and miscreants? Abuse and violence are NEVER justified in any civil society.

The stress of such “Doctor Abuse” is phenomenal! It has now become so common, that many doctors have stopped admitting patients, many have reduced work hours, and some have even quit the profession. “Excessive stress and fear of abuse” is a secret illness of almost all doctors now!

If a doctor wanted his patients to suffer or die, why will he/ she even go to the hospital? There’s better money in almost all other intellectual professions, why would one choose to spend a lifetime amongst the sick and dying? Most doctors are doing their best for making the patient happy. A little understanding and cooperation from our society will encourage the good doctors to be better, and the bad doctors to follow their example. Violence and force will only worsen the situation. Doctor abuse must go. © Dr. Rajas Deshpande.

Always praying for the best health of patients and now, even doctors!

© Dr. Rajas Deshpande

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The Sunshine Girl

The Sunshine Girl

(c) Dr. Rajas Deshpande

The beautiful 14 year old girl was almost motionless. Her body was completely stiff, eyes fixed in one position, she could not move at all. Any attempt to speak or move would send her entire body in violent spasms. She could not even cry for the fear of this painful stiffness, but her pillow was wet with the tears rolling down her eyes. Her parents had wheeled her in on a stretcher. They had landed just yesterday in Mumbai, travelling from Iraq with her. Her father was illiterate, while the mother was a science graduate from Baghdad University. While internally torn with the condition of her daughter, the mother very calmly and peacefully explained me the condition of her daughter Khazan.

On the day of school annual function just five months ago, Khazan’s teachers in Iraq noticed that she was limping while dancing on the stage. They told her mother about this. Khazan was taken to a Neurologist there, who found that she had some neurological signs, with brown coloured rings in her eyes. This ring called a ‘KF’ring is usually found in patients who have a rare disease called ‘Wilson’s Disease’. Due to a fault in Liver, copper cannot be excreted out of body, it accumulates in the liver and in the blood, rising to high, toxic levels. This excess copper in the blood then starts damaging every organ in the body, but first it causes severe damage in the brain and eyes. If not treated, the patient becomes disabled soon and dies. The biggest problem is that many patients may worsen with treatment in the initial phase, with medicines which act fast. The cheaper medicine (Zinc) which does not cause such worsening, is too slow to act, it takes months. (c) Dr. Rajas Deshpande. Khazan was started with the first medicine in Iraq, but unfortunately, she became paralysed due to the side effects of the medicine. The Neurologist in Iraq started with the second, extremely costly drug. Her parents sold off their land, business and even home, and shifted to a rental small house to afford this medicine that had to be imported from USA. As fate would have it, Khazan reacted adversely to this too and further worsened. She became completely paralysed, could not eat or speak, and was then advised the last option, the curative treatment for this disease: Liver transplant. (c) Dr. Rajas Deshpande

They applied for loans from some charity organisations, and landed in India for Liver trasnsplantation. “We were told that the doctors in India are the best in the world, and the cost of treatment is lowest in India. So we decided to come here” her mother told. Indeed, the cost of medical as well as surgical treatment in India is lesser than half compared to the developed world. For simple appointments with specialists, the waiting list in the developed world exceeds weeks to months, and surgical appointments take years. Once, in my childhood, one of my uncles gave me some dessert, like everyday, which I didn’t care to finish. My aunt asked me with surprise: “Why don’t you eat such a delicious dessert?”. My uncle immediately said “Because he gets it so easily. Ask those who don’t get it, they will love it”.

We found that Khazan was almost skin and bones, dehydrated, and anemic. She had developed many Parkinson-like symptoms and some psychosis. I explained her condition and told her mother: that she was semi-critical, that I wanted to start with the cheaper, third medicine and give her supportive care, but it would take a long time, I could not guarantee anything. Her mother told me via the Arabic interpreter Mr. Tabrez: “Doctor, we do not want surgery for her. Do what you would have done for your own daughter. We will close our eyes and do whatever you say. We will hope she improves, but we understand you cannot guarantee anything”. Now the onus was upon me, the responsibility was mine. We started treatment. Khazan’s graduate mother knew more about Wilson’s disease than many medical students, yet she never came across as arrogant or argumentative. She politely asked doubts. A good doctor grows with every patient. (c) Dr. Rajas Deshpande

My students started helping out the family, making Khazan feel at home. Love and compassion for the patient enhances the effects of all medicines in most cases. Add the trust and willpower of the patient, and you usually have a winning prescription. From the shadows of a near-certain death, Khazan’s body and soul started to awaken to the sunlight called life. She gradually started speaking, drinking water, and in a few weeks, eating small morsels. They had to return to Iraq, and we communicated via video chats. They returned twice to India for reassessment and change in treatment.

A few months after their last visit, I received a letter. It was written in English, by Khazan. She had joined college now, and wrote that she wanted to become a doctor like me. Her mother had added in Arabic: “My girl is the sunshine of my life, thank you for bringing her back from the claws of death”. I had received my reward. Khazan is doing very well now since last three years, with God’s grace. Of course I did not forget to remind her that most of the credit of her recovery was to the unparallelled grit and efforts of her mother.

Magical, Near-supernatural, Miraculous recoveries happen every day in India. Patients, young and old, with almost nil chances of survival, walk home smiling every day, in almost every Indian town, even in the most rural areas, thanks to the efforts of thousands of doctors working 24/7. These doctors are never appreciated or rewarded. This post is dedicated to those messiahs of Indian Medicine.

(c) Dr. Rajas Deshpande

This story is real. Many doctor colleagues and physiotherapy students have helped me treat this patient over years. Wilson’s Disease can be completely cured, there are many experts working on tis in India.

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Wrong Diagnosis: The Secret Child Of Every Doctor

© Dr. Rajas Deshpande
“I don’t agree with your diagnosis” said the senior gynaecologist to me, as the rich patient and his family heard with interest and confusion, “I don’t think this patient has Parkinsons Disease”.
I had just returned from an advanced University Hospital in Canada after completing a fellowship in Parkinson’s Disease, a post-doctoral course under one of the best specialists in the world. This senior and famous gynaecologist with a large hospital had referred a case, I had seen the patient, after which he, the senior OBGY, had come to my room. I had spent over an hour studying the patient’s symptoms, and conducted the most difficult and extensive of all clinical examinations in medicine: the complete neurological examination. I had, like all doctors trained well by their teachers, deliberated the possibilities (what the doctors call ‘differential diagnosis’), and then come to this conclusion. There are no shortcuts in medicine, and I took pride in not missing any details. © Dr. Rajas Deshpande
I was open to the idea of my diagnosis being wrong. No doctor is above the patient, and ego cannot be a factor while making a diagnosis. But the ease with which this senior doctor had refuted my diagnosis without so much as touching the patient really offended me.
Obviously, this senior OBGY wanted to impress the patient by showing “I know better Neurology than this junior doctor”. The patient and his family were quite close to that senior doctor and had deep trust in his opinion. The look on their face changed immediately. They no more cared for what I had to say. My first response was anger. Then I remembered what one of my great professors had imbibed upon me: You cannot match the tendencies of some idiots. State your point, smile and leave. Truth will unmask itself in all medical cases.
“What do you think this patient has, Sir?” I asked.
“Maybe he is just tired mentally” the senior doctor said, and the family bobble-headed in assertion.
“I disagree with you Sir”. I said firmly, “All my findings are written on that paper, the patient can go to any qualified Neurologist. Only they can identify or treat such cases well”. I left the room without waiting for his infamous wise wordplay. Three years later, the same patient returned in a wheelchair, referred by another physician, and is now improving with treatment for Parkinson’s disease. The fact that he was deprived of correct treatment for over three years will remain a dark medical secret. © Dr. Rajas Deshpande
Two years ago, a seventeen year old boy was brought by his parents. He had fits, we had started him on anticonvulsants. Adequate instructions were given to reluctant parents, and the dangers of stopping medicine were explained. They never returned. Last month, his parents came. Few months ago, they were told by some doctor to stop the anticonvulsants, and start on some herbal supplements. “We thought let us try” the parents said, and stopped his medicine. The boy had a fit while sitting in his 9th floor balcony, fell and died with a head injury.
Many such cases, where light-gossipy comments by unqualified doctors about the (correct) ongoing diagnosis or treatment being wrong kill many patients with heart attacks, strokes, other heart and brain diseases, liver and kidney failures, cause worsening of otherwise treatable cancers, blood and bone diseases, and many more conditions in almost all specialties of medicine. Patients sadly prefer to choose what is convenient and cheap. Some doctors make personal comments about other doctors being wrong, corrupt, charging high, having no experience etc. Some doctors rely solely upon a “Low Fees and Sweet Talk (LFST)” formula of practice and keep on defaming the entire profession, gradually brain-washing a frightened, confused and frustrated patient. Unfortunately, many patients, both literate and illiterate, easily fall prey to such tactics. © Dr. Rajas Deshpande
What if the diagnosis is really wrong? We often meet smartypants (and smartyskirts!) medicos who just go on challenging any and every diagnosis made by others, be it their specialty or not. A simple understanding of one’s own capacity is enough marker of the intellectual level of that person for me (recall the famous Dunning Kruger Effect). To translate this crudely, stupids seldom realise they are being stupid. They create confusion and wise wordplay to dilute the reality. It is only the idiotic ignoramuses among doctors who cannot ever say “I don’t understand, you know better”.
Medicine is a logical, scientific methodology of algorithms. If a doctor thinks someone else is wrong, they must first state in writing their own examination findings, diagnosis and reasons to refute someone else’s diagnosis. Then they should explain this to the patient, and then start treatment in view of their own diagnosis, taking responsibility if that turns out wrong, and telling the patient so too. It is also an offence in the rules of medical councils to defame a fellow practitioner.
Every person in every field makes mistakes, even the best minds. It is no secret that every doctor, however qualified or experienced, makes a wrong diagnosis many times in his / her career. In most cases these are simple analytical/ judgement mistakes, rarely dangerous. To concentrate on one’s own specialty, and to refrain from pretending being an expert in “all other specialties” is the key to becoming a great doctor, especially in these days of information flooding and subspecialty training. To say that someone else is wrong, a doctor should be equally or better qualified in that subject. Age has nothing to do with it.
In a hyper-emotional, media biased, politically influenced and mostly illiterate country like India, most doctors, however straightforward and honest, find it difficult to frankly tell about their own mistakes to the patient, as the reactions and defamation are out of proportion and our law is primitive still in this field. Sometimes when the patient is capable of understanding it, I have seen many doctors, surgeons explain their mistake and the patient graciously accepting that it wasn’t intentional. This is rare though. © Dr. Rajas Deshpande
We must educate the society in general that no doctor who says “earlier doctors were wrong” or speaks ill of fellow practitioners can ever be a good doctor. The patient should first ask such a doctor “ Have you never been wrong?” and listen to the wise wordplay that follows! While we often blame patients who are arrogant, those who do not trust treating doctors, those who google-treat themselves, and in general bring stress to the medical practitioner, we must first also look inwards for our faults that have multiplied and amplified such perceptions by the society.
What hurts me most is that this is almost exclusively an Indian phenomenon.
© Dr. Rajas Deshpande
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“Dev Borem Korum” (Thank You)

(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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The Remedy of Trust

© 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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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 Real Vertigo

(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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Slaughtering The Precious

(c) Dr. Rajas Deshpande.

At the casualty door she started shouting at me even before I went in. “We don’t want any tests. We don’t want to admit him in any critical care unit. Keep him in the general ward you have, we are now financially exhausted. Give basic medicines only “. Mrs. Julie, the patient’s daughter, went on:”We have already signed palliative care form”.

“Let me see the patient first “ I said and went in.

The resident doctor had earlier told me that the patient, an old man, was conscious, speaking quite well, aware of his illness. He was intermittently getting unconscious for a few minutes. He had high grade fever. He had lung cancer, and a brain scan a few days prior had revealed that that he had a secondary in the brain too. He had just completed his chemotherapy. The resident doctor had already started medicine for fits just now.

As I examined him, the jovial Mr. Shaw smiled back and told me that he was feeling a little giddy and tired, otherwise he had no complaints. He could even stand and walk without support. His blood pressure was normal, but the heart rate was quite high due to the fever.

“I think you have probably developed seizures due to the secondary in brain. There seems to be some infection too, we will run some tests and start antibiotics” I told him.(c) Dr. Rajas Deshpande.

“When will I feel better, doctor?” He asked, “I want to be home and spend every possible day of my remaining time with my grandchildren. I want to also finish a book I am writing. I am told I have only a few months left. How much time do I have? Six months? Four atleast?” he asked, still smiling. Only doctors know what a smiling face with a crying heart actually looks like. “Every passing moment is extremely precious for me, doc! Please cure me fast” he said.

I assured him that if the tests showed nothing serious, he could go home once fever subsided, but the fits needed long term treatment. While we were having this talk he suddenly stiffened and his body developed jerky movements, then he became unconscious.

Ordering the emergency injections for fits, I told the casualty doctor to shift him to the critical care unit.

Coming out, I explained this to the angry daughter.

“Doc, we don’t want to treat him in any ICU. We also do not want any tests now. Please give him tablets instead of injections, we want to take him home as soon as his fever goes down” she replied.

This has become very common now, relatives of elderly people admitting them in hospitals, but refusing to do any tests, use injectable / costly medicines or shifting to critical care units. A doctor cannot refuse patients in such a condition, and it is an extremely painful, stressful situation to not be able to correctly investigate, treat a patient because relatives are unwilling. Ninety Nine percent of the times, money is the only reason. There are many charity, low cost and even good government hospitals, but the relatives also want the “show”of having admitted the patient at some posh hospital. Beyond a certain level, Private

hospitals cannot go on funding tests and treatments of hundreds of such patients even on a compassionate basis, because the poverty in India is never ending.

Compassion is the most abused entity in India.(c) Dr. Rajas Deshpande.

I told her that even if they had signed for palliative care, his current condition was treatable, his fever and fits caused him distress and could be treated, but she staunchly refused to let us send any tests. We started with oral medicines after a lot of deliberation, keeping fingers crossed that he responds. He did.

On the third day, Mr. Shaw walked out of the hospital with his patent smile.

Just next week, his daughter returned to the OPD: “Doc, dad passed away two days ago. After going home he had fever again, but we decided to manage him at home. Somehow he could not get through this time. I have come to get your signature on these bills from his last medicines, we want to get reimbursed”.

“Was he seen by a doctor at home?” I asked her.

“No doc, we gave him the same medicines that he was earlier given for fever. We also searched online and ordered them. But in a way we also feel he is now relieved of all his troubles” she said, hushing up the topic.

I signed the papers, a duty and an obligation.

In every hospital, every day, we see parents rushing, crying, selling everything they have, urging doctors to save their children on one side, and grown up children urging doctors to hasten up the deaths of their parents on the other . Many sweet, politically correct and legally blurred terms are now available for masking these murders.

A patient with a terminal illness may himself sign for “non-aggressive / palliative” care (meaning pain relief, superficial / minor treatment without aggressive effort to save or maintain life), or if the patient is not in a good mental condition to sign such a consent, the relatives may sign so. However, in India where children mostly are responsible for the medical bills of the elderly, they flatly refuse to treat even treatable, reversible conditions citing “öld age” as a reason. Even in case of patients with terminal illness, to presume that someone is immediately unfit to live, or fit to die is like saying it is okay to terminate their life at someone else’s wish. This is cruel, unethical, immoral, and should stand supported in no courts of law.

However, these murders are a daily routine in India, and law has tied the hands of treating doctors and hospitals as one cannot investigate or treat a patient when the relatives haven’t given a consent. An evolution in the fraternity as well as in this society is necessary if a change is expected.(c) Dr. Rajas Deshpande.

Otherwise, when we all will eventually be old, however much we want to live on for a few more days, one day someone will decide that we don’t deserve to continue to live, without ever wanting to know what we wished.

(c) 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.

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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