Category Archives: neurology

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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Thirty Years of Suffering and One Tablet of Gratitude

Thirty Years of Suffering and One Tablet of Gratitude
© Dr. Rajas Deshpande

At the age of 18, he started noticing difficulty in falling asleep because of a weird pin-prick like sensation in his calves. He ignored it initially, but later in a few months it grew so severe that he could not sleep. Then started a nightmarish phenomenon of sudden squeezing sensation on the legs, sometimes with other abnormal and disturbing symptoms like gnawing pain, pulling and jerky movement of both legs. A little massage initially helped, but within minutes, symptoms returned, and now came up to his thighs. Many a nights, he could not sleep at all.

Lack of sleep worsened his daily performance, and he started getting irritable, confused and often very depressed because of the ongoing symptoms. There were phases of relief without any apparent reason, but the problem almost always returned with more severity. He went from one doctor to another, was told he had nerve problems, muscle fatigue, deficiency, and even psychological issues. Various tests done did not show any abnormality. In the last few years, his symptoms spread over to his hands and became so severe that he could not sleep at all. He tried many medicines from many pathies but had no relief. Then he started having suicidal thoughts.

That’s when Dr. Lakshman Sathe of Dodaich arranged for a video consultation with me for Mr. Rajendra Badgujar, now 50 years old, resident of Sindkheda. As any learned neurologist will have guessed from the description above, I concluded that Mr. Rajendra was a severe case of a rare disease called “Restless Legs Syndrome”. Although rare and more common in women, this extremely troublesome condition is now increasingly recognized in Indian population. This usually is caused by a genetic predisposition, but may also be associated with certain other medical conditions including iron deficiency. The most common complaints are ‘restlessness’ of legs, due to weird squeezing, pricking sensation or jerky movements. Very good treatments usually in form of tablets are available, but most of these tablets have serious side effects if incorrectly used. Also, only if the diagnosis is accurate and not associated with any other related conditions, patients respond well.

Mr. Badgujar, who had suffered for nearly 30 years, had complete relief within a week of starting the new medicine, and is now not only having sustained relief with only one tablet, but has also slept blissfully over last two months. Still, that is not the reason for my article. This poor man travelled to Pune for 9 hours, daring the CoViD pandemic, with his family, only to personally say thank you to me. This single tablet of gratitude calmed my restless mind instantaneously!

Most neurologists can readily diagnose and treat this condition in the first or second visit itself, sometimes a few tests may be required. If the patient reaches the right specialist for various medical conditions, not only is he /she relieved at the earliest, everyone saves a lot of money and we can thus contribute to improve the reputation of our noble profession.

©Dr. Rajas Deshpande
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PS: Every qualified neurologist can diagnose and treat this condition effectively.

Say, doc!

Say, doc!
© Dr. Rajas Deshpande

“Doc, may I eat fruits?”
“Yes”
“Papaya?”
“Yes”
“Apple?”
“You can eat all fruits.”
“Banana also?”
“Yes”
“But I get vomiting after eating banana..”
“Then don’t eat banana”
“But you just said I can eat all fruits “
“I’m sorry, please eat only what you tolerate well. Anything else?”

Next patient.

“Till the time we finalise and treat the cause of your unconsciousness episodes, please don’t drive any vehicle “ I told the twenty year old girl whose family stood surrounding her dipped in worry.

Since after a head injury during riding, the patient had had fits. She continued to ride her moped to her college inspite of strict warnings by doctors not to drive. This time she was admitted because she had fallen from her bike as she had a fit while riding.

“How will she go to the college then?” asked her angry mother.

“You will have to make alternative arrangements” I replied.

“Can she drive a four wheeler?” asked her father.

“No”. I now understood that they didn’t want to understand the risk.

“Three wheeler?” asked a relative who had the most common Indian OCD: talking without thinking, expressing opinion because it’s a constitutionally granted freedom.

“What three wheeler do you want her to drive to college ?” I asked the OCD bro.

“No. I just asked out of curiosity “ he replied more guiltlessly than your favourite politician.

How many irrelevant questions should a doctor reply to patiently?
Running between emergencies, making crucial life and death decisions for others over 30-40 times a day, with zero allowance for mistakes and facing angry, troubled souls who we genuinely want to help, how much extra time and patience for irrelevant questions is a doctor expected to waste? If relevant and crisp, every doctor enjoys the conversation, effective communication. When that enters the realm of “charche pe charcha”, it frustrates the doctor. Imagine that happening about twenty times a day. © Dr. Rajas Deshpande

Can a doctor refuse to answer irrelevant questions? Yes, but that risks a bad online review, rating in spite of correct diagnosis and good outcomes!

The consultation charges that a regular doctor charges are meant for a thorough history taking, examination and deduction of possible diagnosis, advice about tests required, and the best possible options of treatment/ management. It also includes a to-the-point explanation and information to the patient and attendant. It doesn’t include the unending “questioning” and expectations that the patient/ relative should grasp everything immediately- medicine is indeed very complicated. We usually give patients the websites to read from, but it cannot be the doctor’s responsibility to make the patient understand everything- it’s like asking the Judges to explain their decisions and law to both parties involved in each case- every day.

Every medical student should learn how to patiently, courteously tell the patient and relatives to limit the conversation to relevant questions only. It is an art. One can also schedule a separate paid consultation in case the family had extended questions and needs the doctor’s extra time.

Just when I was finishing a late day, a patient who had just left returned, panting because he was running.

“Doc, I forgot to ask you- is it okay to smoke a few cigarettes? – I am quite stressed you know”.

I smiled and replied “No you can’t. Reduce stress rather than killing yourself slowly with both smoking and stress”.

That was a relevant question though, as it reminded me of reducing stress in my own life. © Dr. Rajas Deshpande

© Dr. Rajas Deshpande

Beyond Those Valleys and Mountains..The Story of a Doctor That Media Won’t Tell.

Beyond Those Valleys and Mountains..
The Story of a Doctor That Media Won’t Tell.
© Dr. Rajas Deshpande

Just after admission to a medical college, Rohan noticed that he had a twisting movement of his right hand. He was diagnosed with a common condition called “Writer’s Cramp”, which is sometimes disabling and resistant to treatment. He started changing posture and position of his hand to be able to write well and somehow continued his studies. His complaints kept fluctuating. His father, a primary teacher, passed away when he was in the second year of Medical School. His mother somehow managed with the tiny pension they received and Rohan completed his MBBS.

During internship his left hand started to become weak, he had numbness in some parts of the hand, and could not move two fingers. It was quite painful too. He came to us for his nerve damage. His worried mother had a hundred questions, fears and tears in her eyes. Studies showed that one of his nerves was severely damaged. There are very few reasons why this can happen in young patients. Diabetes, faulty Immunity, Genetic Diseases are common, but upon investigating, Dr. Rohan was found to have the most dreaded cause for his nerve damage: Leprosy.
Dr. Arjun Mapare started treating him for Leprosy.

I reassured them and we started on an unpredictable journey. I explained him the schedule of medicines and advised to continue his leprosy treatment.

Doctors get infected with dangerous diseases every day. However nerve damage especially in the hands endangers entire career of a doctor, and if treatment is not started in time, many develop lifelong disability. Nerve diseases are extremely troublesome, recoveries are rare, delayed and difficult in many.

Dr. Gajanan Bhalerao, my super energetic colleague known for his physiotherapy expertise took the challenge and worked up a strict plan which Dr. Rohan followed. He kept on working after permission from his leprosy expert.

Where there’s no light, faith guides us. Patience is a rare quality. For a few months we did not see much change, but we didn’t want to give up. Beyond those valleys and mountains that scare us, is the Sunrise.

Today, Dr. Rohan visited after many months, completely recovered from leprosy, and told us that his hands have full functionality, his nerve functions were normal and he was able to move his fingers well. His writer’s cramp in the other hand bothers him sometimes still, but what’s a doctor who can handle problems? There are hundreds of such passionate young medical students fighting through adversity right now in India, because they have a common aim- neither money, nor fame, it’s the wish to treat the sick and suffering, to save lives.

The credit of his recovery?
To Dr. Hansen who discovered leprosy bacteria, those who discovered its treatment, those like Baba Amte who spent life fighting the stigma of this disease and the thousands of specialists in urban and rural India who treat this every day …. and some thought Covid was all that’s important!

Dedicated to the memory of Dr. Baba Amte, worthy of Bharatratna and Nobel Prize both!

© Dr. Rajas Deshpande

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With Dr. Rohan (Name Changed) and
Dr. Gajanan Bhalerao

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 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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Doctor 2025: What Happened After The Pandemic?

© Dr. Rajas Deshpande

The whole family was happily relishing desserts after a sumptuous dinner, when Mr. Shah suddenly went blank. His eyes rolled up, and he started having violent movements of his body. His daughter Amira shouted “Mom, call the emergency ambulance number” and tried to comfort her father who was now in a full blown convulsion, blood oozing from a corner of his mouth with froth.
The ambulance came with paramedics. Its driver handed Mrs. Shah a cellphone: “Please enter his Aadhar card and Insurance policy number, we will take care of everything” he said.

They collected a drop of blood, which would give all the necessary information about the patient. A video scanned the patient and recorded history and legal statements of the family members.
The sugar level was high.

“Was he given sweets? asked the paramedic.
“Yes” said Mrs. Shah.
“Did you take permission from the government? He is a diabetic, sweets are illegal” the paramedic said.
Amira pulled out a big pink note from her purse.
“Listen, please delete that video. Please take another clip, Mom doesn’t know, I will speak” she said. The attendant agreed. His salary had been halved since the pandemic.

They reached the nearest hospital in few minutes. The nurses hooked the patient with various tubes and told the relatives to wait in a counselling room. The patient appeared stable now. “This is really cool. India has made such great progress” Amira said to her sweating mother.

After a few minutes a Doctor on the TV screen greeted them, and explained them that Mr. Shah had developed bleeding in his brain. Interrupting the doctor, Mrs. Shah, sobbing, asked if her husband will be out of danger. Amira too, very anxious, asked many questions. The doctor replied very pleasantly “Just after this video call, you will see a video of all the likely things that can go wrong in your patient’s case. You will also be provided interactive links like a telephone menu, to ask any questions you want, the answers are scientifically standard. All treatment and billing is standardised”.© Dr. Rajas Deshpande.

In a fit of anger, Amira loudly asked “But doctor, we want to see you and speak with you. When will you visit the patient?”.

Smiling, the doctor replied “Oh! Sorry, but we abolished that practice long ago. We don’t directly meet thee relatives now. For every patient, we give you the diagnosis and condition, all the information is made available on the internet, you can read for yourself.”

Mrs. Shah took out the Bramhastra “But we are paying your fees. You must answer and explain to us. You must be available for the patient all the time”.

The Doctor’s smile now became distant and curt.

“No madam. The law requires that I see the patient every day and treat him / her well, which I will continue. The insurance company and the hospital to whom you pay require me to visit the patient only once in 24 hours, which I will do. I am supposed to inform you, which I just did. You are paying the hospital and the insurance company for my services, from which they both cut some amount and pay me, you are not buying my time or me. You are free to request to change the doctor, or for a second opinion at an extra cost. The government has now made it mandatory to treat the patient at the hospital that they will decide, unless you are a special category. There is nothing like personal care now, everything is standardised by the ministry. We have a PRO who can assist you with searching all the information you need”.

Amira, wiser to the world, asked directly, in a cautious, lower pitch “Doc, what can we do to get your direct services? We can pay anything you want. We want you to personally see my father, make all the treatment decisions, and we also want to speak with you daily, in person. Do you have a private hospital? Please, I beg of you, have some compassion”.

The Doctor paused with a sad face, then said in a more personal tone “ I am sorry mam, all private healthcare has been abolished in India. . Many relatives attacked and injured doctors, most spoke in an abusive, rude manner, many wasted our precious time with illogical, repetitive and absurd questions. So the unnecessary was eliminated . During the pandemic of 2020, doctors were abused by our society so badly, that many died, many left either the profession or the country. Now the number of doctors is very low, We have a wild, abusive society that swings between begging for compassion and free treatment to violently attacking doctors. So all hospitals are now controlled by the government, and all doctors just follow the treatment recommendations set by the government. Even the brands and quality of medicines, stents, instruments for each patient are decided by the government, according to that patient’s category”

Mr. Shah’s condition was worsening day by day. Once every day, Amira received updates about her father via a lengthy SMS, with advertisements of big business houses, who had access to every data in the country. Nothing was private anymore.

Amira asked the PRO one day “What happens to the poor patients who don’t have money?”

The PRO smiled in disdain. “There are special insurance schemes and different stadium-hospitals for them. They have the same system, but low cost everything, including medical staff. Those who cannot afford even basic insurance are sent a CD of patriotic songs and motivating sermons. After the pandemic, this has emerged as the most cost effective way of healthcare.”

“What if I want to take my father outside India for treatment?” asked Amira, now fed up with all the robotic answers. All human touch in medicine was lost.

The PRO looked at her in awe. “Are you in Politics? Are you super-rich like celebrities? Because taking someone out of India for medical treatment is reserved only for them, or those who have special links”.© Dr. Rajas Deshpande

Every morning, Amira and her mother went to a temple and prayed. One day, Amira asked the doctor: “Doctor, what if this was your father. Would you do the same?”

The doctor replied “Mam, My father died because I was posted in the pandemic ward. He was a high risk case but I did not get exemption. I think I am already doing far more for your father than I did for mine”.

On the fifth day, Mr Shah woke up. In a week’s time, he was scheduled for a discharge. Arguing about the hospital bills or complaining about the treatment with the insurance company or the government was now considered anti-national, so she carefully remained silent and paid all the bills, right from that for the first drop of blood collected at home and the ambulance. The pandemic tax and GST almost doubled every bill. Everything was authentic and standardised.

On the day of his discharge, a political leader came over, and a picture was taken with Mr. Shah. “Recovered due to the untiring efforts of the party and the government” said the newspaper the next morning.

On the way home, Mr. Shah told Amira “That doctor was fantastic. When will we see him again?”

Amira replied “I don’t know. The government will assign a doctor for you to follow up now”.

Mrs. Shah looking far away, said “At the temple every morning, I prayed for two things: for your health and for return of the good old days of personal relations with our doctors”.

© Dr. Rajas Deshpande

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Much of this is happening right now. This is the foreseeable unavoidable future.