Category Archives: Parkinson’s Disease

The Doctor Who Took Fees: One Star Review”

© Dr. Rajas Deshpande

False reviews and online beratings against doctors and hospitals have become a reality. However much a doctor goes out of the way to do the best for his/ her patient, following are the reasons why negative reviews are still uploaded, some of them ridiculous:

1. Denial of false certification.

2. Recording truth on paper like addiction (smoking, alcohol, ghutka, sleep medicines etc.).

3. Mentioning preexisting illnesses which the patient / family had hidden from the insurance companies.

4. Denial to falsify diagnosis, treatment and inflating bills to claim medical insurance benefits.

5. Denial to give concessions in standard billing, consultation, visit fees.

6. Advising necessary investigations.

7. Charging for follow up visits (different doctors, specialties and hospitals have different policies, all are usually mentioned in the information prior to consultation. All follow-ups are not same). © Dr. Rajas Deshpande.

8.. Waiting time: This is the saddest in India. The standard waiting times for specialists all over the world range from 30-90 minutes, sometimes longer, but it is only the Indian patients who convert this into a complaint. Sometimes earlier patients may have taken more time, asked more questions, sometimes patients cry when a sad diagnosis is conveyed, one cannot ask them to leave the room, there are incessant calls for emergencies etc. . The same traffic and weather conditions affect a doctor’s schedule too, but some are unforgiving. The fact that Indian doctors are available on usually the same day or mostly a week in spite of a heavy workload means nothing to our people, even those who have visited the Western world and witnessed that it takes months to years to get a specialist’s appointment there.

9. Behaviour of the doctor: Agreed that some doctors are indeed rude, some are in a hurry, and that is wrong. But usually doctors develop a lot of patience as they mature, dealing with all sorts of negativity continuously. Sometimes patients do offend doctors by asking illogical questions repeatedly, by challenging every word that the doctor says, or by making illogical demands. These demands include repeating long explanations about the diagnosis and treatment, requests to speak on phone with a distant relative to re-explain everything because they are too busy to come over, asking questions like “Are these medicines necessary?” etc. © Dr. Rajas Deshpande.

10. Unfair, illogical statements “I cannot tolerate any allopathic medicine” rules this section. What do you expect a physician to do?

11. Unfair, unrealistic expectations: Every drug has side effects, including vitamins, and these side effects are NOT the doctor’s fault. The doctor can alert the patient about common side effects, but cannot explain all side effects of every medicine, as it is impractical. Secondly, while some medicines act within seconds, some take effect over weeks to months. Those without patience who expect relief within few hours / one day usually upload angry reviews about both “no effect” and side effect” commonly.

12. Declining demands for admission. Investigations and OPD treatments are not covered by most insurance companies, so some patients demand admission even when not indicated. When refused, even if the patient was cured, the doctor still gets a negative review.

13. Google masters: Some patients bring a lot of irrelevant questions and conceptually wrong use of medical terms to the doctor’s table, and however politely one declines to waste time over such, a negative review is almost guaranteed. © Dr. Rajas Deshpande.

14. Habitual negative reviewers: I once found a negative review of a patient who had actually responded well to treatment and was cured. He had complained about having to pay for a follow up visit after few weeks. A small google search revealed that he had uploaded many reviews from those about railway stations to collector’s office, from autorickshaws to five star hotels, almost all negative. Unhappy man!

12. Professional Competitors- this is a new reality: doctors hiring agencies to boost their positive reviews and add negative reviews to their competition. The simple fact check of how many positive reviews over how much time reveals the truth.

Some negative reviews are indeed genuine, I have had them myself, and called and apologised to the patient, clarified my stand too. However when they were malicious, I have informed the concerned site manager and also posted a reply about reality.

How to know?

A negative review must have a legitimate name of the person writing it, and details of date and time of the visit. That way the doctor can also confirm whether it is genuine and help resolve it. A nameless review is always questionable, good or bad.

In a recent news, a National restaurant association has decided to sue people who upload negative reviews about food: just because they want more or free, just because of their mindset is negative, just because they are insatiable. Even IMA should consider suing people who upload wrong, defamatory, spiteful reviews about doctors. Even the ‘hired good reviews’ by doctors should be discouraged.

Issued in the best interests of patients and doctors.

© Dr. Rajas Deshpande

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The Fairy And The Prince

© Dr. Rajas Deshpande

The beautiful radiant lady wheeled in the patient’s chair and wished me with a pleasant smile. Some smiles, however beautiful, have a tragic shade. I looked at the patient Rohan. A very well built fair young man in his late twenties, must have been very handsome in the past. He sat paralysed below the shoulders, one eye closed, face twisted, and a large surgical scar upon his head, partially covered by a cap. He could not speak. Any movement would cause violent tremors. He was wheelchair bound and had to be assisted even for toilet.

Rohan and Riya had married just two years ago, against the wish of their parents. Both from very affluent, but uneducated families. Both worked at the same office. In a few months after marriage, Rohan had developed high blood pressure, and was advised treatment. Unfortunately, he got carried away with some false claims about some herbal medicines shown on National Television channels and stopped the BP medicines. The obvious happened: one of the blood vessels in his brain ruptured due to high BP, and there was a huge bleeding. A Neurosurgeon had done an excellent job by taking this high-risk case on operation table in emergency, to suck out the blood clots and save his life. However, the damage was already done by then, much of his brain was damaged on one side. Riya had been caring for him since then. She looked after him just as a mother cares for her newborn.

“Doctor, we know his paralysis will not improve now. But he is brilliant, I know his brain thinks fast and accurate. Since this stroke he cannot speak. We have come with some hope for his speech. If he could just tell me what he feels, if something is bothering him, what he wants, etc., I will be very grateful” his wife said.

We started treatment. In a few days, Rohan could speak legibly, so she was very happy. Rohan’s parents were very happy too. © Dr. Rajas Deshpande

One day, Riya’s father came with her. He asked her to wait outside my room for a few minutes, she reluctantly left. With folded hands and tears, he spoke: “Doctor sahab, my daughter married against our wish. I have forgiven her now. But I cannot see her spending her life like this. She was the most brilliant girl in our town, she had even rejected job offers to go to America because Rohan wanted to stay in India. You can see that she is still young and beautiful. Anyone will marry her; she is one in a million. I’m not saying this because she is my daughter, but you can see for yourself from how she cares for her husband. She has become his attendant now. What is her fault? How can a father see his daughter wasting away her youth like this? They have no family life. I cannot even speak to her about this. Her mother tried but Riya refused to speak. She speaks very highly of you, so I have come with this hope. Please help us”.

This was very difficult, but a duty too. If not me, who could even attempt to resolve this?

“Let us ask her about her thoughts” I told her father and requested him not to react when she spoke. We called her in. I told her in short how her father felt. She sat straight. Her face became distorted and she wept silently. Her father kept on patting her while weeping himself.

“Papa, when Rohan could recently speak after so many months, the first thing he told me was to leave him and marry someone else. He refused to eat his medicines, saying that I should leave him. Then I promised him that I will leave him after two years. That was a lie. I know he will die if I leave. I could feel his love even when he could not speak, that’s something more precious to me than whatever you think I will get if I marry someone else. Till the day he had this bleeding in the brain, he made sure I was best taken care of. He never had his food before me. How can I spend even one happy moment with anyone else knowing that Rohan is suffering in this same world? Would you be proud of me if I did that? Did you teach me to be so selfish?” She broke down. © Dr. Rajas Deshpande. Her father did not say anything. They left.

In a few weeks, Rohan followed up again with Riya. He is now gradually learning to operate a computer. He plans to start his own online business. Riya is helping him do that, while continuing to work. They are now planning for a child soon.

This fairy I met was more beautiful than any other in the dreamy stories I had heard all through my childhood. I am glad that I am a witness to this divine fairytale.

I know even of another couple, where the girl had developed a paralysis in her college days. I had counselled her and her boyfriend about future uncertainties and a possibility of a compromised married life, given her illness. “That’s not the most important thing for us” he had said. They married. Today, about 8 years since then, they have a healthy, happy kid, and he still cares for her as much, now when she is in a wheelchair. This knight lives in a rented house, runs a small grocery store, rides a bicycle, wears the simplest of clothes, yet has a heart that would put to shame many a real princes!

My world as a doctor is full of beautiful fairies and knights, named caretakers. It is because of them that thousands of patients are surviving with dignity today. Medical care is so incomplete without them! I remember my favourite author Richard Bach’s words from “The Bridge Across Forever”: “Princesses, Knights, Enchantments and Dragons, Mystery and Adventure… not only are they here and now, they’re all that EVER lived on earth!” How true!! © Dr. Rajas Deshpande.

Among the stories of sadness and suffering, most doctors also come across best of the human hearts and minds, highest forms of love and care. Such patients and relatives reinforce our own trust and faith in the ability of human efforts to heal. Thanks to what I learn from my patients, my gratitude for being a doctor is endless!

© Dr. Rajas Deshpande

Dedicated to all caretakers, young and old, who silently sacrifice much of their life caring for their loved ones.

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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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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.

Be A Woman!

©️Dr. Rajas Deshpande

A major part of the pride of being a doctor is the freedom from any discrimination between humans. Every woman or man, from any religion or country is equally important, and also equally cared for.

Yet as a doctor I have often witnessed women being stronger than men when life presents any calamities, however explosive. Women are probably more emotionally destroyed with a traumatic event, yet they pick themselves up and fight like a mother for whoever they choose to stand by and protect. And we know, a mother makes a strong army! Any patient cared for by a woman heals faster, be it a nurse, a sister, servant, daughter, wife or mother, be it a girlfriend or just a woman without any relation. In any family, it is usually the women who keep the bonds of humanity and culture alive. We have so many biases about cultures and how women are treated, but it is an unfortunate fact: that women do things men find impossible. Hence the title, Be A Woman!

We often hear from working men in the metropolises how they cannot bring a parent in wheelchair to the hospital as it would be a lot of trouble and time.

Ms. Eshrak (a psychologist) and her sister (a bank employee) brought their mother on a stretcher all by themselves, all the way from Cairo, Egypt, to Pune India, in a hope to see her walk again. To travel to another country without knowing anyone there wasn’t their biggest problem. Reaching India from the war-torn middle east is a nightmare, but once they reach, local Indians, especially police officials are very cooperative in helping out especially patients coming for treatment to India.

They found a friend in a local Arabic student Mr. Ashraf Olafi, and had him search my clinic (I am sure any good qualified neurologist could have treated them equally well!). Their mother, suffering from Parkinsons Disease, walked after many months today, so they came with the two greatest gifts for their doctor: a smiling gratitude and blessings. Of course they brought a material token!

What better proof can there be of women not being dependent upon men? If only we recognised how incomplete and incompetent humanity would be, without the strength of women!

To artificially write about gratitude for women in one’s life and to thank them superficially to impress press and public has become a fashion, few do it from their heart. I pity those “high flying, successful” men who boast about how they respect women and consider them equal, while their wives are in fact taking care of their home and children, opting for hugely compromised careers. The truth is, a man, however strong, is always indebted to some woman!

Be A Woman!

That should always have been the correct slogan..

©️Dr. Rajas Deshpande

The Poverty Vow

(c) Dr. Rajas Deshpande

Long day. Came home. Ritual steamy hot bath to wash away the hospital feel, followed by steaming hot dinner. Switched on jazz, and I picked up the pasta. Heaven descended upon my tongue.

“How perfect this moment is!” I thought, and that’s where I was wrong. The phone rang.

“Sir, 18 year old buy, had fever since a day, took some tablets, became unconscious, now comatose. Vitals are stable, although he is coughing occasionally. No past history significant. Poor family, cannot afford treatment. Father is a labourer. What should I do?”

“Get him into the ICU, intubate if required and stabilise. Arrange for an MRI”

“OK Sir, but Sir they don’t even have a deposit. They had first gone to the government hospital, but as they were not happy there they have come here”. (c) Dr. Rajas Deshpande

“We will work something out. I am on my way” I replied.

In an hour, after examining the boy and seeing his MRI and other tests, we concluded that he had viral encephalitis. The standard medicines were started.

The boy’s father, an obvious poor slum dweller, was in a state of shock. The mother, sobbing, told me the history. I reassured them. When I explained the diagnosis and treatment they asked some questions.

“We don’t understand anything, we are illiterate and poor. Do anything Sir, Just save my son, Sir” the father folded his hands together. Private hospitals have a quota for free patients, but usually it is always overloaded. I requested the hospital management to please make this a free case, they accepted.

The next day, the child opened his eyes. On the third day he started responding. I was quite elated to have his mother speak with him. However, his respiration was still shallow, and blood presure very low. His heart rate was fluctuating due to the effect of viral infection. He was still critical. I spoke to his parents twice every day, specifically reassuring them. Poor patients must never feel that they are not equally cared for. (c) Dr. Rajas Deshpande

That evening, as I attended my patients in the OPD, the patient’s father came in, requested that he wanted to have a word. He came in with six other people. None of them could possibly be poor, given their get ups.

“Yes?”I asked.

The patient’s father looked at the giant next to him. “You ask” he said to the giant.

The giant, chewing his gutkha, askked me “What’s wrong with his son?”

“I have explained them thrice”I replied, “he has viral infection of the brain. There’s a lot of swelling upon his brain”.

“How come he is not improving? His BP was normal when he came. He did not have any heart problems. Now you tell us his heart is not functioning well” asked another medical superstar with white linen and gold teeth. (c) Dr. Rajas Deshpande

“Yes, this happens commonly with viral infections” I replied, feeling hopeless. How to teach complicated medicine to this pure- muscular class? I wondered.

“But you said he had infection in the brain. How come now he has it in the heart? Is the treatment wrong?” Asked someone similar among them, in a tone nastier than medical examiners.

I looked at the patient’s father. He was looking at the ceiling, deliberately avoiding eye contact with me.

“Listen, Sir”, I told them, “Your patient has viral infection, it has primarily affected the brain, but involvement or dysfunction of other organs is well known with such infections, this is not something new to us. We are on guard, dealing with the situation. Nothing is wrong about the treatment, in fact his brain swelling has improved, and he is conscious now. Ask his mother” I looked at her.

“I don’t know” she said, “we don’t find any improvement in my child. Nobody tells us anything”.

“Haven’t I explained you and his father patient’s condition every day?” I asked. They did not reply.

The white linen gold teeth spoke again: “We want a report. We want to show the case to another doctor”

That was a relief. I gladly wrote them a report. They went doctor-shopping all day. They returned next day. Almost everyone had asked them to continue the same treatment that we had advised, except some desperate non-specialist telling them to shift the patient immediately for a surgery at his hospital. Even our gold-toothed medical superstar understood that it was wrong! (c) Dr. Rajas Deshpande

“We will continue treatment here only. But our patient must survive” came an open threat.

”I will do my best, but I cannot guarantee you anything. You may please transfer the patient under the care of any doctor of your choice” I told them.

“No no, you continue to treat him.But if anything goes wrong, we will file a police complaint. We will ruin this hospital”said one of them.

I am allergic to threats. I don’t allow them twice from the same source in my life. How could any doctor guarantee that there could be no complications? How could I say that the patient could not react to any medicine in such a critical condition? If every patient could have guaranteed improvement, what’s the need for a doctor?

“I am sorry, I am planning for a leave next few days. I won’t be able to see your patient. I have requested our management to transfer your case to another doctor” I told them.

There was a movie “Teesri Kasam”in which the lead character, at the end of the movie, vows never to help the character of the lead actress in the movie, because the very wish and effort to help her has shattered his life, caused him regret. Most Doctors are now being forced to take such a vow. Urban Poverty is not so simple and innocent in a hospital as it appears to the media and society. Whether it is the roadside rowdiness of slum dwellers who roam around with weapons or a maid’s drunkard husband in civilised society, we all understand the misuse of poverty status well anywhere outside hospital, but somehow when this happens in a hospital, the blame is automaytically pinned upon the hospital or the doctor.

But who among the vote-mongers will speak against the majority voting bank?

(c) Dr. Rajas Deshpande

A Thumb Impression Of Our Society

© Dr. Rajas Deshpande

As the highly educated family: patient, his wife and daughter stared at my face, I bought a moment of thought by continuing to write instructions. Although the intensity of what I was going to say would affect them now, I knew what the future held a difficult and mentally traumatic, draining corridor they would have to go through in coming years. How to say this? I felt sad. Even after decades of experience, no doctor feels comfortable telling the patient or relatives about a bad or incurable diagnosis. It is a curse we must shoulder. Because someone must say it, someone must sympathize and stand by the patient and family, someone must face the anger and frustration of a family that was till yesterday living in the comfort of good health, completely oblivious to the fact that things may go wrong anytime with anyone. . © Dr. Rajas Deshpande

“You have a type of Parkinson’s disease with dementia. The Parkinson’s is causing your slowness and stiffness, and the dementia is causing the memory loss and change in personality. It is good that you have come at an early stage, we will be able to prolong lifespan with a better quality of life. With your cooperation I think we can do the best possible for the patient. I will give you some links to read from. Please read them and meet me again next week, I will be happy to answer all your queries, doubts and concerns”.

The stunned wife started sobbing. The husband closed his eyes in agony. The daughter, unable to speak, held her father’s hand. Offering them some water and coffee, I explained the daughter instructions about the medicines, tests to be performed, and asked them to see me next week. I wanted to spend more time with them, but the relatives of a critical patient in ICU were waiting outside for me.

“Dr. Rajas, my husband has been a brilliant scientist. He loves reading, writing and intellectual interactions. In fact that’s why we fell in love back then when I was his student. Intellect is his life. We will both die if that is taken away from us”. It was then that I looked at the lady carefully, because till now my mind was occupied with the patient. A very graceful, intelligent, upright and hence beautiful face, the one that tells stories about the highest culture and upbringing that there is. The grey hair added to the loving kindness of her expression. Intelligent Humility, that one element often absent from so many beautiful faces, was abundant upon hers. Somehow I remembered my mother.© Dr. Rajas Deshpande

“I understand, mam. Things are not so bad as of now, and we are still in the evaluation phase. I can give you a better idea about the future once I see the results of all the tests.

It was then that the daughter spoke: “Doctor, I am in India for only the next week. Can we complete the workup before next week, because I cannot postpone my travel back to the US. And yes, I want the best to be done for my father. ” the daughter said.

“Ok” I said. I have now come to accept the socio-cultural changes.

They came next week, the diagnosis was confirmed, I counseled them.

Then I explained the medicines and other care to the patient’s wife.

“Did you understand it well, mom?” asked the daughter, “because I will not be able to help you with this everyday”. The mother replied with her kind smile.

Three months later, the patient came back, with the daughter and her husband.

‘Doc, mom passed away with a sudden heart attack a month ago. She never told us she had any complaints”.

This happens so often: that when a family member is affected, everything revolves around their health, and the warning signs of caretaker’s disease are ignored till the last moment.

“Dad has become worse now. He doesn’t eat well, doesn’t speak with us. . We tried to encourage him to make new friends with his old age home society, but he doesn’t want to interact with others, he has always been stubborn. We have arranged for a caretaker, but dad doesn’t talk to him either.”

Looking at the patient, I realized how much emotional support he needed at that moment.

“I am sorry to know about your mother. Such a nice and kind lady!” I said.

“Thanks, doc. But now you must help us. Please help us find a good old-age nursing home for dad. I cannot stay back. We can pay well”.. she had a hint of “please let us get this over fast” in her speech.

“You said you wanted to do the best for your father. The best would be for you to be with him in these days, talk with him, connect him back with life for whatever remaining awareness he has left. There’s no other person upon earth that he will ever connect with, so this becomes your responsibility”. She knew the truth well, for she broke down. “I know doctor, but I have my family to look after. I cannot take my father with me. I am sorry”.© Dr. Rajas Deshpande

She visited again with the patient, before leaving for the US. A bank officer and a lawyer accompanied them.

“Dr. Deshpande, I need a certificate, my father cannot sign, and is in no condition to think coherent now. So we want to get his banking and legal formalities about our property completed with thumb impressions. I need you to authenticate dad’s thumb impression”.

The old man printed his thumb impression in my presence. Somewhere within, I knew he was violently crying although he must be hiding it just so that his daughter doesn’t feel bad while leaving him.

That Thumb impression, Decoded, was in fact the stark face of today’s society.

© Dr. Rajas Deshpande

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The Medical License to Kill

© Dr. Rajas Deshpande

The five year old girl stopped breathing. Her father shouted in a state beyond panic. With a fear of a death worse than his own, he choked upon his own shouting. It was about 4 AM. The dozing relatives of other patients in the casualty woke up startled.

The intern doctor Anu tried to insert a breathing tube in the child’s throat, but the right sized tube wasn’t available. Dr. Anu shouted at the nurse to wake up the medical officer on duty. She couldn’t: he was deep asleep, being drunk. The child started getting blue. The heartbeats became feeble. Another nurse ran upstairs, and literally dragged the junior doctor in the ICU to the casualty. He struggled and managed to insert the tube somehow, and with the breathing bag, artificial breathing was started. The child stayed unconscious, but the heart beats were heard well now. There were no beds in the ICU, so they managed her there itself, in the casualty.

Two hours later the medical officer woke up. Unclean and unkempt, stinking of alcohol and sweat and yet careless about it, he was usually seen roaming in the hospital with swollen red eyes, talking usually about the only three things so called “Men” talk about. In hating him, many diversely thinking junior doctors united. There were complaints about him: nurses, junior doctors and patients had all written to many authorities about his drunken demeanor, ill behavior, swearing and abusive language, and even a violent attitude: he was known to slap attendants, drivers, assistants, and throwing instruments in the operation theater. © Dr. Rajas Deshpande

Dr. Anu not only hated him, but was scared of him too. She hesitantly reported what had happened in the night. “We tried to wake you up Sir, but couldn’t” she said cautiously, just like all brave girls who cannot hide what they dislike. He laughed in the style of a famous ‘Manly’ hero of the times. “Such small things keep on happening in big hospitals. Don’t worry. If I wake up for every emergency at a government hospital, I will myself die. I am doing the duty for five medical officers alone. You must accept death as a part of your daily life. Don’t get emotionally involved in patients. Some will die, we can do nothing about it”. Then, without even visiting the child once, he left, as his duty hours were over. © Dr. Rajas Deshpande

The disgust and anger that flooded Dr. Anu came out in the form of tears. She went to the nurses room and sobbed. She had not dreamt of becoming a doctor like this: helpless and suppressed. The nursing Superintendent, a motherly lady, patted her. “It is good that he didn’t wake up at night. He doesn’t know even the simple procedures. He would have probably harmed the child more in that drunken state. The only thing you can do now is to quickly learn all the life saving procedures that you can, and then don’t be dependent upon anyone else to save lives”.

“I want to complain against him. How can a doctor sleep when a child is dying during his duty?” Dr. Anu asked.

The Nursing Super smiled in shame.

“My dear, who will you complain to? This drunkard is the son of a ruling minister. They own a private medical college themselves, many come to him to get medical seats there, so they have friends and defenders in almost all high offices. Whoever questions anything about him, faces not only the ire of his father’s political goons, but suffers at many other levels to. Do you think people don’t know his addictions and ill behavior? But when the government protects him, what can anyone else do?”.

Then, as Dr. Anu stared in vacuum, the Super told her one of the most beautiful pearls in medicine: “There are some bad doctors dear, but that’s where you come in. Your responsibility increases. Learn to be strong, learn to compensate for what others cannot do. Such sick doctors who pass out without learning, who come drunk to the hospital and mistreat patients are a curse to our profession. We can’t change them. The lesser number of patients they see, the better it is for everyone. You compensate for them by becoming better”. © Dr. Rajas Deshpande

The day forever changed Dr. Anu. Providence, as always, had rewarded her for her efforts in saving the child’s life only a few hours ago.

The sad fact still remains: that some students are not trained well. Some do not have the capacity or wish to become good doctors while some are ‘pushed’ by money and power. These are the people who have learned the most deadly Indian trick: to find a political godfather who protects them from anything you do, Feed his wallet and ego, lick him all over, and then retain the ‘license to medically kill’. Please check out how many ministers and political bigwigs own medical colleges, and how many use these as ‘power channels’ to make undeserving doctors, and one can easily know where the problem lies. This by no means suggests that only the doctors from private colleges are bad, there indeed are ill behaved and drunkards among doctors passing out from govt. colleges too. The point is that they are protected by some. To first satisfy all vote banks, then collect the multicrore moolah for admissions and then create yet another channel of corruption: Eligibility test! This is a nightmare for the truly willing and deserving merit holders. About this aspect of the matter, no politician ever speaks. Who protects the Medical admission scamsters? Why do not our courts act suo moto, knowing that so many lives will be at risk with doctors produced via scams? © Dr. Rajas Deshpande. The saddest part is that many corporate hospitals look for such doctors who are also financially recklessly aggressive, and then make them compete with the good and ethical doctors.

Today on the occasion of Gandhi Jayanti, many “trumpet tongues” will be heard speaking through their hats about the Mahatma. Introspection and truth are the beginnings of even knowing the Mahatma. The criminal corruption networks which produce bad, ineligible doctors by the force of money and power must go! These are the very doctors who bring a bad name and a shame to our profession. Many a good things in the profession, saving a million lives every day and sacrifices made therein bt thousands of good docs all become a waste because of such few bad doctors. Let us all stand united in improving ourselves, giving up what’s not the part of a good doctor.

Jai Hind!

Mahatma Gandhi ki Jay!

© Dr. Rajas Deshpande

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Humanity Face / Off

Humanity Face / Off

© Dr. Rajas Deshpande

“Your father in ICU has probably had bleeding in the brain. We need an urgent CT scan” I told the son waiting outside. The old man was admitted late in the evening, although he had had severe headache and weakness on one side since that morning. His son had just returned after a “one-hour” quick meal. Besides flaunting many brands upon his person, he had already told me that he was the vice president of a well known software company.

“Yes, doctor, I am just waiting for the approval from his insurance company.” The son replied. For doctors running in and out of critical care units, the “Cool Calm” of such educated relatives is beyond understanding. Most insurance companies work office hours, approvals come at their own speed, they are least concerned about the patient outcome.

Everything was being kept on hold. Hospitals do not want to proceed with costly tests and investigations unless they are life saving, because most relatives flatly refuse to pay if the insurance company denies approval. The doctor suffers a double blow emotionally: because things are delayed and also because relatives blame only the doctor.

“This is urgent. Please consider making the payments and filing for reimbursement later, so we can make decisions faster” I told him.

“If it is urgent, why don’t you get it done? I will not pay, his insurance company will have to approve” said the son.

I thought about the patient. In the waiting room, the patient’s wife, an old lady, kept praying. I wished she was also praying for a better son. © Dr. Rajas Deshpande. I requested the hospital authorities, and as always, they agreed to help. A CT scan was done, it did show bleeding in the old man’s brain. When informed, the son winced. “How many more days in the hospital?” he asked.

“Usually it takes a week for such patients to stabilize” we told him.

“Can you discharge him? I will arrange for some nurse to give him treatment at home. Just write the medicines he needs” he said. His mother, hesitant, asked “Is it necessary to treat here, doctor? If his health is in danger, we will stay”.

Angrily, the son cut off his mom. “No, mom, this has become a business. They will extend stay even if it is not necessary. If it is only medicines, why does he need to be in hospital?” he asked me.

“Because such patients often develop excess swelling in the brain, or other complications. They can also develop convulsions or lapse into a coma if swelling worsens” I unchained my patience.

“Do you guarantee that those complications will not happen if we keep him here?” he asked.

“No. Only that he can be managed in time, if any complication develops” I replied. There’s no word called “Guarantee” in the medical dictionary. It is only a quack’s favorite trick. © Dr. Rajas Deshpande

“Then why stay here? I have a nursing home nearby, we will go there if there is any problem” the son said, turning his back upon his mother.

The open-secret was revealed soon: the insurance cover that he had bought for his father was minimal, it was over now, and he didn’t want to pay anything from the pocket.

I explained the patient’s wife about the medicines and care, updated her with the warning signs of danger in such cases. © Dr. Rajas Deshpande

“Doc, I am alone at home with my husband all day. My son and daughter in law both work and return late. What will I do in case there is an emergency?” I gave her some contacts near her home, ambulance numbers and doctors.

“Is it okay if she calls you daily to inform the patient’s condition and ask what medicines are to be given in case of an emergency?” the son asked.

“Sorry, we cannot manage patients on phone” I replied.

“Sorry doc, don’t take this personally, but there’s no humanity left in this profession now a days. No one wants to help even an old patient” he commented. I didn’t reply.

They returned in three days, the patient comatose. The brain swelling had increased to dangerous levels. Patient was operated in emergency, saved with a great effort. The son had to foot the whole bill this time. “This is quite unfortunate” he kept saying, reminding me to keep expenses “lowest” because he was paying from his pocket. Finally came the day of discharge. Knowing the questions, I explained them the medicines on discharge.

“Doc, he is a senior citizen. You must give us discounts” said the son.

“Sorry, the hospital decides the billing. My charges are already minimal”. I told him the truth.

“Just as I said, there’s no humanity left” he looked at his mother and said. It was now the time to chain my patience. I knew the right reply this time.

“Yes, Sir”, I said “ I agree. Humanity is indeed on a decline, but more in your family than in my profession”

© Dr. Rajas Deshpande

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The Higher Suffering

© Dr. Rajas Deshpande

Stuck in the heavy traffic due to rains, I tried to remain calm. The cellphone kept on ringing, patients who were waiting, those who wanted appointments, those who were to catch their ride out of station anxiously asked when will I reach. Some lost patience and raised voice. In addition, there were calls about the patients admitted in the hospital: critical decisions to be made, idiotic questions by insurance companies to be replied to. There were huge processions, the traffic was diverted, without any arrangements for ambulances. Impatient, aggressive and violent people is a reality on almost all Indian roads now. No one cares for law on the road. You are at the mercy of anyone who chooses to pick up a fight with you.

There were some issues at home too, the cook had called in sick, we had to do some emergency cooking. That had delayed my start.© Dr. Rajas Deshpande

At last, an hour late, I reached the OPD, and entered running. Faces with controlled anger greeted with cultured politeness. Prepared for bitter comments, I called in the first patient.

This was a free patient, she did not need a follow up. But being free, she visits almost religiously every month, whenever she has a fight with her husband. Sometimes, when the only guaranteed compassion is from a doctor, it can be misused. However, as I was late, I decided to respect their patience, and told them to visit a counselor. Nevertheless, my irritation heightened, that this added to the wait of other patients.© Dr. Rajas Deshpande

I certainly am impatient with meaningless waste of time, and sometimes the traffic, the sudden changes in schedules due to someone’s irresponsible behavior, and misuse of compassionate services bring me to the edge of a reaction. This was one such moment. My face must have become grim.

The next patient walked in, an elderly gentleman with Parkinson’s disease. He was accompanied by his wife. They were supposed to come back three months later, but had followed up early. I examined him, found him quite stable neurologically, but the usual twinkle in his eyes was absent. Even his usually smiling wife appeared lost. It must be the traffic, my late arrival or something likewise, I thought, and curbed my curiosity to ask them. Today was heavy and behind schedule, I must wind up fast. Yet, as I explained them that everything was stable and alright, that they need not worry, I noticed the unspoken uneasiness in their body language. A little reluctantly but keeping up with the expectation of my own heart, I asked them: “You look quite disturbed and stressed. Is anything the matter? I am sorry I came late today”.

“No, no doctor, it’s not that. But yes, he is stressed and disturbed said the wife, and looked inquisitively towards her husband. ”Shall I tell him?” she asked.

Looking down, hiding his face, the husband nodded.

“Doctor, we lost our only son ten only days ago. Someone killed him on the road. Some drunk goons dashed his car from behind, and when he got down to check the damage, they attacked him and hit him on the head with some rods. He was lying on the road for a long time, and by the time police took him to the hospital, he was gone. We came to know after a few hours. He was our only child, an engineering scholar who had returned to India with great dreams .”

The lady was silently weeping as she kept her emotions in control. The patient was sobbing, I called the receptionist to get a glass of water.© Dr. Rajas Deshpande

“We have done so much for our town and the society” said the patient, “but now I feel it was all useless. No one is safe even on the roads. We see so many rules and laws broken, so many violent and aggressive people that it has become difficult to question anyone even when they misbehave”.

I had no words to pacify them. What can pacify the parents of a dead child, that too a victim lawlessness?

The receptionist called “Sir, the next patient is shouting” she said.

“Five minutes” I requested her.

“You are busy, doc, we will leave. But I brought him here only because he feels better when he meets you. Once you reassure him, he will feel a little secure. Even I feel better when I see you. Otherwise we sit at home just staring at each other’s sunken souls. We have no relatives”.

That was a bitter eye opener to me. They had chosen me to be their lifeline in the worst times of their life, and here I was, thinking about my worries, my time, and the inevitable small happenings that block the path of every working person every day. I had momentarily ignored the fact that I must still enter the hospital with a smile, push behind myself all the negatives that pull me down. For every patient here to see me comes with a hundred fears and a thousand expectations, the least I can do for them is be compassionate and reassuring, whatever may have happened till that moment.© Dr. Rajas Deshpande

“You may see many patients in a day and listen to their troubles, doc, but you are the only doctor your patient meets in a long time. I don’t know about you, but we always feel good when we see you”. The wife added.

Yes, I had heard that earlier, in my teacher’s cabin. Once a patient develops trust in his / her doctor, they look upon the doctor as one of the most reliable resource for courage, compassion and troubleshooting, even beyond the expertise of that doctor. As doctors, we must never forget this, and stand up tall above all our personal problems to be the supermen and superwomen, the Messiahs, the Saviors that we are expected to be. Law and some idiots do push a stick in our wheels, but then the patient is far above both. A patient’s suffering is always far above that of any doctor.

I stood up, held the patient’s hand, and reassured them: that they do have a relative here in Pune. “According to the Pune tradition”, I said, “one should offer tea only when the guests are half out of the door, but I will make an exception today .”

Having them sit in the next empty room, I proceeded with the OPD. Ordering tea for everyone in the OPD waiting room, I stole a few more minutes to calm the ruffled souls of those two, and asked them to see me again, whenever they wished.

As I returned late after dark, even through the rainy night, a sweet moonlight made the raindrops glow. Just like every doctor brings back the smiles to the burning hearts of their patients!

© Dr. Rajas Deshpande