Category Archives: Politics

Illegal Heroes

Illegal Heroes

© Dr. Rajas Deshpande

“I was at the disco last night. We danced a lot, I exceeded my ususal capacity of 180 ml alcohol, and had two or three large pegs extra. I must have smoked a little extra too yesterday, I was too stressed”’ said the 30 year old man, who was admitted one afternoon in an unconscious state. He had had a fit in the office that morning. The MRI had shown a large bleeding / haemorrhage in his brain. This illness, cerebral venous thrombosis, is quite common among those who are dehydrated, those who have untreated sinus infections, and among those who take contraceptive pills. If not treated in time, it can quickly cause brain swelling that may lead to disability or death.

Over next three days he gradually improved. Brain swelling started to recede, and he asked for a discharge. Faster and to-the-point care had improved his condition, thanks to modern healthcare. A psychiatrist had already counselled him about deaddiction. When we sent his file for discharge, his mediclaim insurance was declined because this illness was related to alcohol consumption. Immediately, his tone became bitter, his colleagues dissected the case papers asking for justification of each test, each medicine, and also why he was even hospitalised. Gratefulness is often waived off by doctors as a lost quality among saved patients, but it is difficult to tolerate arrogant distrust. We firmly explained him what was done and why.

“We will pay your bills, we will claim the insurance later, but you must change your notes, remove alcohol and smoking from his papers” said the patient’s brother.

“We cannot change the case notes, it is illegal. Also, we have already sent copies to the insurance company, a standard procedure. You are not obliging us by paying the bills, we have provided healthcare service that saved your brother, who was about to die due to alcohol consumption” we replied.

Within an hour, a local politician, an elected member, who came in his Range Rover with his personal armed bodyguards and human doggies, started his anti-medical show that had drama, emotion, tragedy, threats of violence and revenge and everything else but truth and honesty. He spoiled the day for everyone involved, caused disruption of hospital work for over six hours, and left with a threat of “burning down the hospital soon”. When our PRO asked him whether he wants to pay the bills of this patient to help them, his reaction was the hallmark of a true politician: change of topic to how the medical profession has lost its reputation.

Almost every doctor, every hospital in India is being threatened and pressurised by our own lawmakers at almost all levels into changing facts, writing false details, extorting concessions for the rich and poor both, only to increase their own vote banks at the cost of the healthcare industry. Most politicians, many government officers instead of financially helping the patient, ask the hospital to treat free or cut off bills.

How legal is this authority? If a politician writes to a court or lawyer or hotel or an Airline to waive off fees/ bills of a poor person, will they ever? Why are the doctor’s services and hospitals taken for granted here? How sad that such illegal means make pseudo-Heroes in our country!

Everytime the politicos pressurise a doctor or a hospital to treat their paying cronies free or concessional, some other truly deserving patient suffers because hospitals, small or big, can only do a certain level of charity. How fair is it to deny healthcare to the deserving poor just because they cannot flex a political muscle? This phenomenon is ruining the whole purpose and concept of charity healthcare measures all over India.

Aren’t these elected members responsible for the disgusting state of the civil and government hospitals and healthcare all over India? That is their domain of authority. This is like messing up one’s own home and family and requesting the one with a better home and family to pay and comply for one’s own needs. How shameful is it for the elected members of different parties to have to send people, especially the poor, to the private hospitals, because their own set-ups are failing perpetually? Empty posts, inadequate staff, poorest funding, non-availability of quality technology and medicines and red tapism have created massive monuments of the healthcare failures of different lawmakers all over India, and these are the very people who come threatening to the hospitals of burning them down! Hear this, any Milord?

If the honourable Prime Minister and Health Minister invite feedback from every patient leaving every civil and government hospital, the gravity of this situation will be understood better. Many repairs “at home” are required before “the neighbours home” is raided. We as doctors and hospitals must together request these authorities and offices to protect us from such daily insults, extortions and exploitation.

The very next day, an old man, a retired Indian Military officer, was expressing himself in the OPD with tears in his eyes: “Ye desh ka kuchh nahi honewala (This country cannot progress). People here, at all levels, want corruption, legal escapes to save money, and will elect anyone who throws them petty bits. Votes are bought for such favours as alcohol, gifts and cash. Sycophants rule, criminals are seen hand in hand with some rulers. Who do you think will get elected with such means, saints? You can guess what progress we expect if the lawmakers are first in line to break laws..”

There was nothing more sinister I heard that day. I am worried about the healthcare in my beloved country. God save the future generations from such illegal heroes!

© 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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Victim? Dr. Reena’s story

Victim? Dr. Reena’s story

© Dr. Rajas Deshpande

“I am being victimised, Sir! I have tried to do my best, but my senior has developed some prejudice against me and has started to find faults with everything I do. I don’t know, I feel suicidal sometimes” the resident doctor Reena said, breaking down. She was into medicine, one of the toughest branches for post graduation.

This was a difficult situation. It is very well known that some seniors and teachers do take advantage of the situation to mistreat and misuse their students or subordinates. It is also well known that both men and women in every profession, including medicine, have strong gender biases and favouritism. Sycophancy is so essential in India, that I wonder sometimes whether an official bachelors / masters “Chamchagiri” (sycophancy) certificate will be necessary before people are selected for their jobs.

I gave her some instructions to ignore words and minor incidences, and concentrate on doing her official duties with concentration. I also counselled her about how to handle egoistic, arrogant seniors. She was supposed to follow up next week.

That weekend, I met a colleague of mine, Dr. Anand, in the coffee shop. There was no OPD, it being a Sunday. We sipped coffee in the canteen, telling each other funny stuff about other colleagues. Medicine provides great entertainment too, in the form of various types of doctors, and we start with ourselves usually. © Dr. Rajas Deshpande

Just then, another doctor came in, Dr. Anand invited him to join us and introduced me to him as Dr. Ashwin. “Ashwin was my junior resident” said Dr. Anand, “and one of the most brilliant students. He’s a wiz. He wanted to work for the downtrodden, so he has continued to work at the govt. hospital after his MD. Most dedicated! That’s why most girls around us liked him and we all envied him”. It is rare for Anand to praise someone this much, I was quite impressed and happy.

But Dr. Ashwin appeared quite disturbed. Dr. Anand asked him if he was ok.

“No, yaar. I am facing a big problem. There’s this girl in my unit, who has made my life hell. She has filed complaints against me to the dean, my name is all mud”.

“Complain against you?” said Dr. Anand, truly surprised “Even your wife never complains against you”. He was trying to lighten up the mood. © Dr. Rajas Deshpande

“Yes. But you know how heavy our PG duties are. This girl, besides being lousy and careless, refuses to finish her work, constantly looks at the watch and doesn’t want to be corrected. How can we tolerate carelessness in medicine? There are patients in the ICU and this lady keeps busy with her cellphone! I gave her a warning that I will complain, but instead, she went ahead and complained that I was harassing her, implying serious charges. Fortunately my wife and the dean understand the situation, but you know some people in the campus would rather see me down. I don’t know what to do. I am thinking of resigning”.

“Can you share her name?” I asked, cautiously. The guess was correct. It indeed was Dr. Reena.

“I tried to talk to her, I requested her to call her parents. Apparently she has grown up as a pampered child, her parents refuse to even think that she can be wrong. They started complaining that their daughter didn’t get enough rest and good food, that she has always been a super genius kid and how many a times even her teachers could not understand her genius”.

Now the picture was clear, with the other side of the story revealed.

There indeed is, nowadays, a rampant tendency to play a victim, especially to cover up for one’s own failures, inadequacies and lethargy. Children who allege that their failures are either because of their parents being over disciplined or completely negligent, boys who hate their parents and refuse accepting that they fell short of hard work and dedication because of too many diversions, girls who sometimes lie about “sexual abuse”, and employees who underperform only to blame it upon a racist / pervert / prejudiced boss are classical examples when stress factors are analysed well. There was one girl who alleged abuse by her step father, just to tell me minutes later that it was probably her imagination, and that she didn’t know if it was a dream! It was her mother who then revealed that the girl had always used that ‘dream reality’ sequence whenever she wanted something and was refused. © Dr. Rajas Deshpande

There indeed is rampant true victimisation in all these areas, and one must always stand by the victim. But the overflow of sympathy that drowns sense and reasoning (thank you, media and some movies!) must always be avoided. Differentiating ‘true’ and ‘pseudo’ victims is never easy especially because there always will be the social biases. Most Indian men unfortunately truly look down upon women, most seniors think that juniors cannot be more intelligent, parents often mentally overpower logic when dealing with kids etc.. Still there indeed are many who hide behind the “victim” tag, just to take advantage of the sympathy and protection it offers, using it to hide their own negative side. A lot of people use suicide threats, false complaints and other pressure tactics to emotionally exploit and threaten others. When this happens in a workplace, it poisons the whole atmosphere. There is indeed no protection for the true victims here.

Next time when Dr. Reena came to visit, I told her how I chanced upon the doctor who was “troubling” her. As expected, she cried and defended her stance, but after some gentle coaxing, when I reiterated that the actual problem must be dealt with, she agreed to have a meeting with Dr. Ashwin. I called in a female counsellor too, and in a few meetings, we could sort out the issue.

Medical career is, difficult, it is important to do every single thing perfectly and with utmost care and concentration. No one else can ever replace the life-saving responsibility of a doctor on duty. A doctor who isn’t fully attentive to everything about every patient can be dangerous.

Dr. Reena agreed to go by the duties allotted and improve her performance, while Dr. Ashwin reassured her that he had nothing personal against her, that she could always compare her duties and performance with her other batchmates. He also told her that now onwards he will mind his words better. She withdrew the complaint.

Dedicated to those such who have had this horrible experience.

© Dr. Rajas Deshpande

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A Habit That Protected Me

A Habit That Protected Me

(c) Dr. Rajas Deshpande

“I cannot bear this. Help me doctor”shouted the Old man fom the waiting room, just as I entered the OPD. There were appointments before him, I requested others to wait, and most of them agreed, although a little upset. I called in the old man. He was accompanied by two of his sons, both probably professional bodybuilders.

He was a known case of Trigeminal Neuralgia, a condition that causes severe, shock like or stabbing, excruciating pangs of pain on one side of the face. This usually brings the patients to tears, and most patients come frustrated, unable to talk or eat, with the telltale sign of their hand covering that side of the face, scared to open mouth even to reply. He had had this condition over ten years now, and was quite stable, usually visiting me once a year. He had last visited only a few weeks ago, smiling and pain free. There were no new findings. He kept on shouting, saying that the pain was unbearable. This was unusual. I asked him if he had done any of the prohibited things that usually increase the pain of Neuralgia: cold drinks, icecream, shaving harshly, exposure to breezes etc. He said he had had an icecream a few days ago, but the pain had only restarted yesterday.

The sons were staring menacingly at me. “How come this has suddenly worsened doc? Is this the effect of your medicines?” one asked. I wondered why they don’t teach simple logic and reasoning in primary schools. Everyone going to a gym must, in my opinion, first be mandatorily taught normal human conversation. Otherwise they speak with their biceps. Not knowing that language, I chose not to reply him. (c) Dr. Rajas Deshpande

He was already on high doses of the medicines that controlled his pain. He also had diabetes, so I could not use the best emergency medicine for such pain: steroids. Once earlier, he had developed severe infection while on steroid, so that was out of question.

I started him on a short course of a strong pain killer. Warning him that he should take it only for three days. “His pain must stop immediately” said the other son, threateningly. “I wish so too. It should subside soon, usually it takes two to five days” I concluded the consultation.

They returned five days later. (c) Dr. Rajas Deshpande

“I am very good now, Doctor”said the old man, “The pain went away the very next day. Thank You”.

Just as I prepared to look at the musclebuckets proudly, the old man said “Doctor I need a certificate that you had advised me bedrest for five days”.

I was almost prepared to write, this appeared a justified request given what had transpired. Curious, I asked him: “But you have your own business. Why do you need this certificate?”

It was then that one of the biceps spoke: “He had a court appearacne in a criminal case on the next day of our visiting you. He could not go to the court. Now the court has asked for a certificate”.

Alarmed, I told them: “I had not advised him rest. I cannot issue a false certificate.” (c) Dr. Rajas Deshpande

They looked at each other. Then the old man said “I request you doctor. My cousin has filed a false murder charge against me and my sons. Please help us. Your certificate will save us trouble”he folded his hands.

Now the secret of why that pain had worsened suddenly had unfolded. This condition is indeed known to suddenly worsen, but when such “situations”coincide with illnesses, a doctor is the easiest to squeeze the arm of.

“But we paid your fees. His pain was actually severe that day. How can you deny us a certificate now?”asked the elder biceps.

Many video clips of daylight, open murders that happen around us daily ran through my mind. Even under the heading of compassion, was it right to help this patient, who was one of the accused? As a doctor, I am not to judge anyone and must purely decide based upon the medical merits of this case.

I had not advised him rest. I declined their request for the certificate. Angrily, the trio left my room, and on the way out, in the waiting room, loudly enough for other patients to listen, the old man said something derogatory about all doctors being heartless looters. Every new patient who walked in that day had a question mark of suspicion on their face, it took me extra effort to wipe that away in each case. (c) Dr. Rajas Deshpande

Whether it is addiction to pain killers or sleep medicine, whether it is false certificates or deceiving the medical insurance companies for claims, many patients abuse their doctors’ compassion and services. Some doctors fall easy prey to such tactics, some do it for money. Majority refuse to contribute. It is this majority that such “demanding”patients always cry against.

The doctors who help such people with such causes not only endanger themselves, but may in fact add disgrace to their profession, because it is these same patients who tell others how any doctor can be fooled, or bought with some money or threat.

As fate would have it, one of the sons came to visit me the very next month, for his wife. As I examined her and then wrote a prescription for her, I enquired about his father.

“Oh he is alright now. We got a certificate from one of our relative who’s a doctor” said the son, smiling shyly: “That’s why I brought my wife to you.. I know you will do only the right thing”.

I could only thank my teachers who had tattooed that habit upon me, and taught me that only good begets good. It is a habit that has protected me always.

(c) Dr. Rajas Deshpande

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Saving Life? Not Enough!

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© DR. RAJAS DESHPANDE

“I will kill you. I will see that you don’t practice in this city. You don’t know me” the elderly man shouted angrily outside the crowded OPD room of the senior neurosurgeon. He was surrounded by five others, two of them his sons, who instead of calming him down, were adding to the threats.

“Let him come out of the hospital. We will show him” shouted one of them.

The Neurosurgeon who stood in the OPD door did not react. He was known as a short tempered professor, a quality that often accompanies excellence in any field. © DR. RAJAS DESHPANDE

Two years ago, a young software engineer had come with his parents to the OPD of this senior Neurosurgeon. A son of a rich politician, he had an obvious sign of of a brain surgery: his skull shape was abnormal, with a part of his forehead sunken in. He had been operated for a brain tumor four years ago, it turned out to be very early stage of a cancer. He was told to keep visiting a neurosurgeon every year to check if the tumor grew back again. Now another similar tumor had grown in his brain. This time it was in an extremely dangerous area to operate, there was a high risk of death. After explaining every risk to the family, our Neurosurgeon operated him. Just after the surgery, the patient had developed brain swelling and bleeding unexpectedly, and had become comatose. Fighting these complications with all his might, the neurosurgeon finally ensured that the patient recovered completely. When discharged, the patient went walking by himself, and had no complaints. He followed up regularly for next few weeks for radiation and chemotherapy. Then he was advised to follow up every six months.

The next time he visited, after the consultation, the patient called in his wife.

“We married last month, Doctor” said the patient.

Surprised, our neurosurgeon congratulated them, wondering why the patient never told him about that arranged marriage.

In a year, the patient developed another recurrence of the tumor. Surgery was planned, and the wife’s family accompanied the patient. Rich, educated and powerful, the only thing they couldn’t own was manners. © DR. RAJAS DESHPANDE

“How come he developed a brain tumor, doctor?”asked the angry father in law of the patient.

“Well, tumors can develop in anyones brain, because of naure’s mistakes in the human body, but he has had this problem for many years now, don’t you know about it?” asked our neurosurgeon.

“No. No one told us when my sister was married to him”said the angry brother.

“Didn’t you notice the big scar on his forehead?”asked the neurosurgeon, unable to believe this. In a society that disallows marriages due to stupidest of reasons, it was difficult to believe that such an obvious sign was missed.

“We were told that he had had a small head injury. My sister had come last time. Why didn’t you tell her?”asked the other brother, keeping with the family tradition of angry misbehavior.

“She waited outside for the last consultation. Then again, you should have asked your doctor about this before finalising the marriage”.

The wife’s family walked out. The patient and his family was nowhere to be seen. That’s when the two brothers realised that there was a huge rush of patients in the OPD complex, and started shouting threats for the neurosurgeon.

“You have spoiled the life of my daughter”said the patient’s father in law to the doctor, “You should have told your patient not to marry”.

Although this was ridiculous, the neurosurgeon, who was otherwise known for his zero tolerance of stupidity and threats, took this in his stride. He called them all in and explained once more. He made them aware that the patient had never revealed any plans to marry. © DR. RAJAS DESHPANDE

The brothers refused to understand, they had to vent their anger, and here was a doctor available for it! It was like legally protected murder of decent civil etiquette, traumatising of a doctor’s dignity, backed by the society and media. Who will stand by the doctor? Who will even consider the fact that merely few months ago, this very doctor had fought to bring back their patient from the clutches of death?

The neurosurgeon got many phone calls over next few days, with threats to life and something even more precious than life for a doctor: threats to reputation. Like a thousand other storms in his life, he braved this one too. The patient was divorced by his wife. He was operated and radiation was started.

In the usual “I don’t care a hoot for idiots” style of surgeons, the Neurosurgeon chose to ignore them and do what was his duty. But when he told me this incidence, there indeed was a hint of a broken something in his eyes.

“We save so many lives, since so many years. Earlier there was a sense of fulfilment, even if the patient did not express gratitude. Now, that sense is lost. Saving life isn’t anything great for our society, it has become a mechanical job expectation from the doctor, just like the paid service of a machine. Educated and uneducated goons, even people who faint at the sight of blood come and threaten doctors as if it was routine for them to do what we do. I am quite worried about the future generations of doctors”.© DR. RAJAS DESHPANDE

Just as the neurosurgeon spoke with me, the patient mentioned above walked by, with his mother, returning from his radiotherapy session. When our neurosurgeon asked whether he is recovering well from the divorce, mother casually laughed and said “Oh! That girl was never good enough for my son. I am sure he will get to marry a better one soon. There are very few educated men with such a salary in our community” and they walked away.

Aghast, we went to the cafetaria and had a wrodless cofee, but that silence was full of regrets. As we got up, the neurosurgeon commented: “We can only save lives. Not these people or their society “.

© DR. RAJAS DESHPANDE

A real life incidence shared by Dr. Ashok Bhanage, Neurosurgeon. Patient details changed to mask identity.

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Can Anyone Solve The Mystery of Atmaram’s Courtroom Death?

Can Anyone Solve The Mystery of Atmaram’s Courtroom Death?

©️Dr. Rajas Deshpande

A hungry poor man named Atmaram went to a big hotel, had a nice big meal, and told he had no money to pay. He was beaten up and handed over to the police. He was released after a warning and a slap.

Next day he filled up petrol in his bike, and said he couldn’t pay. He was again beaten up, handed over to the police. Then he went to the medical shop, bought medicines and mineral water, ate the medicine, drank water from the bottle, and again said he couldn’t pay. He was now jailed for a week.

Next week his house was damaged by heavy rains, so he went and requested to be allowed to sleep in the house of the chief minister. He was arrested again, thrashed up.

As angry Atmaram shouted at the police, he was beaten up by them, another crime was added to his offences. In the court, Atmaram insulted the lawyers and judges and accused them of accepting bribes and charging too much. The judge punished him extra for his behaviour. Atmaram was angry and threw his shoe at the judge. His punishment was extended.

“You must respect the authority “ the court said.

“But I am poor, I need free food and petrol and medicines. I need sympathy too” Atmaram argued.

“You should have begged and applied for favours and eaten in places that provide charity meals. Petrol, however essential, has the same price for everyone. You can sleep on the footpath, and above all, you are not allowed rudeness and violence because you are poor and needy” The court said.©️Dr. Rajas Deshpande

When released from the jail, Atmaram drank a lot of desi alcohol, had an accident and fractured many bones. He went to the best private hospital, got operated and refused to pay his bills that crossed one lac rupees. When the hospital insisted, the operating doctors were beaten up by Atmaran’s relatives, the hospital was vandalised, the police arrested the doctor who saved Atmaram’s life, the government closed down the hospital, while the media and the society kept villainising the entire medical profession.

The headlines next day reported the sympathy expressed uniformly by wag addicted tongues: some said the entire profession was tainted, some blamed the greed of the doctors, even some doctors desperate for attention shed crocodile tears about the ethics in this profession. ©️Dr. Rajas Deshpande

In the courtroom, during the trial, Atmaram sat facing the doctor, still heavily bandaged.

The hon’ble judge, kind but surrounded by security, told the doctor accused of negligence and malpractice in the court: “You as a doctor carry more responsibility for ethical behaviour upon your shoulders. You should never turn away the poor”.

The doctor, defending himself, asked “but Milord, doesn’t our constitution insist on equality? Why do you yourself or ministers get security but not the doctor? Why isn’t everyone supposed to stick to ethics in every profession including politics, police and judiciary? Why are others exempt? How do you explain beating up of doctors while also saying that the society treated them like gods?”.

There were no answers. The kind court asked if the doctor had to say anything else in his own defence.

The doctor said

“Yes Milord, but the real answers will hurt:

Jealousy against medical professionals across society and many other professions is a reality. Why else will anyone who couldn’t qualify to become a doctor try and teach the qualified doctors what they should do?”©️Dr. Rajas Deshpande

“A culture of exploitation of non-votebank groups

and a complete failure of government healthcare with no one accepting responsibility is well known to everyone, but even judges have no courage to suo motu question this and correct it, even when they see the poor dying”. ©️Dr. Rajas Deshpande

“In a country with never ending poverty, how much free can a healthcare facility provide? For how long? This is already forcing closure of hospitals and exodus of good doctors out of the country.”©️Dr. Rajas Deshpande

“Milord, can you assure that every doctor will get his/ her fees as per his service to every patient, and if the patient can’t pay, that much charge will be exempted from the income tax of that doctor? How else do you except a doctor to meet his needs and dreams? Just because there are millions of poor patients, is the doctor’s life and hard work taken for granted? If there has to be financial sacrifice, why not have everyone contribute to it by creating a national health tax fund for treatment of poor patients? Why healthcare is subsidised only at the cost of a doctor?”

Just at this point, Atmaram, who sat in front of the judge, collapsed unconscious, almost blue black.

The shocked judge requested the doctor to examine him.

“He is no more” said the doctor.

“What could have happened ?” asked the kind but sweating judge.

The doctor told the court about three possible reasons. Two of them were scientific and medical: a sudden cardiac event or a large blood clot in the lungs common after fractures and trauma.

The third non-medical, unscientific cause made the Judge seriously ponder.©️Dr. Rajas Deshpande

“Will this court be now closed down, Milord? Will your efficiency be questioned, will you allow the relatives to attack you and understand their sad situation at the cost of your murder?”

“I understand what you mean” said the kind judge.

Needless to say, the doctor was released without a blame.

Can anyone please solve the mystery of the third non medical, unscientific possible cause of Atmaram’s death?

(C) Dr. Rajas Deshpande

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A Medico’s Last Certificate

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© Dr. Rajas Deshpande

A continuous beeping filled up the air in the ICU. Over twenty hearts kept making rhythmic sounds, the nurses kept on silencing the false alarms that rung every now and then, and informing us about the ones that needed attention.

We had kept the cake in the doctor’s room, we were waiting for the right moment. It was well past midnight, we had all wished Dr. Steve a happy birthday, but the ICU was full and busy, we waited for an opportunity to cut the cake.

A very old Parsi man, just recovering from a massive heart attack, was not maintaining his blood pressure. As his alarm sounded again, we rushed to attend him: Dr. Steve, myself and our nurse Ms. Divya. As we adjusted his intravenous drips, he asked us our names. He was funny, and always made us smile in spite of the deadly shadows that surrounded us. When we told our names, he smiled. “See, there’s a Hindu, a Christian and a Parsi happy in this small 10 by 10 room, but they cannot all stay peacefully outside in this big country!” .. Dr. Steve, always interested in one-upmanship, smiled and said, “If you want, we also have a Muslim and a Sikh doctor outside. Shall I call them in?”

With the typical instant Parsi wits, the old man replied “Arrey no no bawa, all our ********** (I did not completely understand that word) political leaders will die if people from all religions come together”.

It was difficult to say whether we were treating his heart attack or he was treating out tired minds. © Dr. Rajas Deshpande

The CMO called, there was a new patient coming up, a young lady in respiratory failure due to pneumonia. As the nurses prepared the new bed, Dr. Steve took down notes from the CMO. Ms. Divya was one of our most efficient and agile staff nurse. Very beautiful and brilliant, she took responsibility upon herself with a passion that would put to shame even some doctors. We all knew that there was something going on between her and Dr. Steve, but both of them kept mum. I knew for sure though, because Dr. Steve had once confided to me about this crush he had upon her. However, overwork always suffocates personal life in a hospital.

The stretcher rolled in, noisy with calls of panic. The patient was gasping. Urgently shifting her on the ICU bed, Dr. Steve intubated her. She coughed a lot, and both Dr. Steve and Ms. Divya were showered with blood stained secretions. Dr. Steve had his mask on, but Ms. Divya had not had the time to put hers on. He angrily shouted at her, while adjusting the patient’s tube, to wear her mask. I finished securing the IV line, and started pushing in the emergency medicines. © Dr. Rajas Deshpande

The patient was a young lady, who had suddenly developed fever, cough and cold. On the second day she had become restless, was admitted in some nearby hospital, but as she continued to worsen in spite of treatment, she was referred to us. It was a viral pneumonia, an extremely invasive and dangerous viral infection had started filling up her lungs with fluid and blood. Just as her oxygen levels improved, she developed an irregular heart rhythm: viral infections often cause severe damage to the heart, a condition called myocarditis. In two hours after admission, the lady died. Horrible moments followed, telling her broken husband and stunned kids that she was gone forever. Completing the formalities and paperwork, we returned to the grind: we were medicos: there’s no choice for us to sit down, panic, repent, mourn or run away.

No one was now in a mood to cut the cake. No one even spoke about it. Next night, Ms. Divya bought another cake, and we all silently wished Dr. Steve a belated Happy Birthday.

Jutst ten days later Ms. Divya developed fever, cough and cold. The same deadly virus, most likely. We all panicked. Dr. Steve took leave and attended her, as her family was far away in Kerala. She had come to Mumbai to earn enough for her family. In spite of all efforts, Ms. Divya passed away in just three days. The faces of her elderly parents and younger brother became one of the worst memory-scars in our lives. Shortly after, Dr. Steve developed the symptoms too, but survived.

I took him out sometimes, to bring him back from the pit of depression and shock that he had sunken in. One evening, when we sat silently on Marine Drive, he said, “I will never have a Happy Birthday again. You know, Divya’s family has no support at all. I have decided to help them out for some time, till we find an alternative”. © Dr. Rajas Deshpande

Staring at the ocean, I kept wondering: In this country, where crores of rupees are thrown almost every other day for even miniscule achievements in cricket and cinema, where millions are spent from public funds upon the useless travel, security, meetings and social dinners etc. luxuries of the super-rich MLAs and MPs, where billions are spent by every political party in elections, there are no funds for the nurses, doctors and other staff who risk or lose their lives serving their patients. If a bridge collapses and many die, if there’s a major accident due to lapses in administration, there is immediate compensation, in an attempt to seal complaining lips. But if a medico is injured or killed, the best thing our society has to say is: “This is because all doctors work for money, it must be the fault of communication on the doctors part!”

We walked that whole night, along the ocean, silently crying. Sometimes the only solace for a medico is the thought that someday someone will desperately need a good doctor or a good nurse, and not find them around. Many medicos who do extraordinary good to their patients do not get any certificates for what they do. Most don’t care. Because we carry our death certificates in our pockets every day. One last certificate that we work very hard for.

© Dr. Rajas Deshpande

Dedicated to the nurses and doctors, medical staff who suffered / died because they served patients, saving lives.

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“Why Don’t You Marry Her, Doc?”

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Dr. Rajas Deshpande

“Sir, she cannot walk, she is paralysed below chest since last few days. Her husband doesn’t care, he has abandoned her. She has no money or insurance for tests or treatment. I want to help her, I don’t know what to do” I told my junior consultant, who was having his coffee break with senior consultant and the departmental secretaries. He looked at me in a nasty way, and said “Why don’t you marry her?” and they all laughed aloud. However, although my professor smiled with them, he asked me to get the patient’s papers.

She was a case of Multiple Sclerosis, in her early thirties, and had lost ability to walk. Her sensation below the waist, control over urine was also lost. This ghastly illness of the brain and spine often cripples the young. In many cases, when such disability develops, divorces follow. The world as we doctors see it is far more cruel, deceptive and dangerous than most illnesses humanity knows. She was left with a small daughter and no income. © Dr. Rajas Deshpande

I felt insulted, but I was in a foreign country. The junior consultant was known for his sarcastic humour and enjoyed impressing women around him, often at the cost of others, like so many dwarfs who take advantage of their chair to achieve what they otherwise cannot. I chose to ignore him, and got the papers to our boss, who called a colleague to enrol the patient in one of the upcoming research trials. That would ensure her free tests and medicines for a few years. I told her the good news. She started sobbing, then handed me a note written by her:
“I am killing myself as I have nothing left except my daughter, I cannot look after her with my disability. I have no complaints against anyone. Please look after my daughter”.
In some time, after she stabilised, she said “Doc, I had come prepared to kill myself today. My daughter is sitting in the cafeteria. If you had not told me what you did just now, believe me, I was planning to drive my wheelchair off the roof today”. © Dr. Rajas Deshpande

We called her 10 year old daughter from the cafeteria. Little did the cute child know how lucky she was to see her mother again that day.

That evening, my boss, the senior consultant, took me out for a dinner. Once the red wine loosened strained faces, he started to speak: “Rajaas, I know you are kind and you want to help others. I know you feel for your patients. But I must caution you, don’t get carried away. Your job is clear: to listen, to advise the best line of investigations and treatment, to explain, and to compassionately guide. Don’t carry too much weight upon your shoulders”.
“Why, Sir?”I asked politely, “I feel inner peace when I walk an extra mile to help my patient. How can that cause me any harm? Didn’t this lady survive just because you helped her today?”
“Because it is a never ending burden. To be able to effectively help everyone coming to you, you must have too much money and too much time. Doctors seldom have either. I lost a lot of time and money, to realise that this cycle never ends, that newer and more people need your help every day, all your life. I almost went bankrupt, collapsed and quit under stress. Then I realised that I must limit this so I could serve them best the next day”. © Dr. Rajas Deshpande

It felt like dry reasoning at that moment. However, boss continued to help patients beyond duty whenever I asked him. Over years, I realised how correct Boss was!

My dear british colleague Dr. Mindy was trying to help a patient through her divorce, I accompanied her. As the patient opened up, she revealed to Mindy that although she enjoyed marijuana, her husband was involved in the sale of other illicit drugs, and that was one reason that she wanted to divorce him. Dr. Mindy involved a counsellor to help her out. However, after they decided to patch up their marriage, the patient told her husband that she had confided in Dr. Mindy. The husband came over and politely threatened her to keep all the information only to herself, otherwise be prepared for dare consequences.
We all spent many a restless nights after that.

Emotionally disturbed, helpless patients, those who are treated unfair by family often depend upon a kind doctor. They get quite restless at times, worry a lot and then expect an immediate hearing and resolution from their doctor. From suicide threats to blackmails, there are messages that pour in once that channel is opened. This sometimes wreaks havoc in the doctor‘s life, because being disturbed affects clinical practice and decision making. The small time left for self and family is thus shot dead. A patient who becomes emotionally dependent upon the doctor can turn into a nightmare for the doctor. Over years, I learnt to balance this, going out of the way only for the few truly deserving patients.

Thousands of patients have survived just because their doctor emotionally supported them in time, otherwise they would have died of lack of will to carry on. No one ever credits the doctors who become emotional back-ups for their patients: a service that costs them time and stress, without any income. That is unfortunately considered a “duty” of the doctor, to be kind and available at bad times, but to be forgotten in good times. © Dr. Rajas Deshpande. Many actually think that good words, compliments and “a satisfaction of serving” should be sufficient compensation for the doctor. Nothing fully compensates, although kind words do sometimes make one feel good.

However, what caused worse hurt to me was some of my own colleagues who made fun of me and many other doctors who went out of their way to help patients. “Impractical, unnecessary, worthless, drama”, and so many other adjectives are used by colleagues and even seniors/ some teachers for doctors, students, residents who walk an extra mile to help their patients. I was extremely fortunate that I met some good teachers who supported my efforts without mocking me, and I continue to meet students who carry on this noble trait forwards.

When I was leaving, the junior consultant came over for the farewell too, and told me in too many words how I must learn to be “Practical”. I gave him a reply that one teacher with advanced genius had taught me years ago, for people who do less themselves and advise others a lot. This reply saves a lot of time and energy, my teacher had told me, and its beauty is that people don’t even understand that you are saying ‘those two useful words’ when you reply like this:

I just smiled at him.

© Dr. Rajas Deshpande

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MEDICARDIA: A Doctor’s Diagnosis.

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© Dr. Rajas Deshpande

Rimless spects, ipad, T-Shirt and denims. Brilliant face, thinning hair. Attitude. A face carefully wiped off of any expression. The typical new age intellectual waited outside the ICU. Body language: severe anxiety.

“Doctor, do whatever you must, his convulsions must stop” said Mr. Prasad. His father was having continuous fits for over three hours, he was just admitted directly in the ICU after all the home remedies had failed. His oxygen levels had dropped to dangerous levels. Patient had ready aspirated during his convulsions. His food had regurgitated and entered his windpipe.

The last treatment for continued fits is completely paralysing the patient with general anesthesia, intubating and starting artificial respiration with a ventilator. There is risk, but lesser than if the patient continues to have fits. Every doctor, for every patient, must make a decision based upon the risk-benefit ratio. Every treatment, medicine or surgery, also has potential risks. The decision that can potentially cause someone’s death is not easy to make. Every doctor lives on the edge of this risk.
Add distrust and suspicion, and we are dealing with law more than with medicine. Welcome to the medico nightmares! © Dr. Rajas Deshpande

The critical care team had already explained the risk to the Mr. Prasad. He had signed the consent, including understanding of the critical condition. We intubated the patient and ventilator was started. The fits stopped. A chest physician was also involved in the treatment. Monitoring of the brain waves still showed abnormal currents in his brain, so he was kept paralysed next two days.

On the third day, the patient developed fever, most likely he had developed a chest infection, so common after aspiration. His condition worsened, his blood pressure dropped. We informed the family.

“Why didn’t you prevent this?” asked Mr. Prasad.
“Sir, have you ever had any cough, cold, fever?” I asked.
“Yes, many times. What has that to do with my father’s infection?“ he replied.
“Why couldn’t you prevent it?” I asked, “Anyone can develop an infection or a heart attack anywhere outside the hospital and it is ok, but if it happens inside a hospital, why does it suddenly become a doctor’s fault? Hospital acquired infections are possible in spite of all precautions, in the best of the hospitals across the globe. The elderly population is especially more prone for infections.”
This being a routine question, there was no reason for me to lose my patience. © Dr. Rajas Deshpande

Our team worked hard to maintain the unconscious patient alive. His heart rate fluctuated, blood pressure dipped to non-recordable sometimes, blood sugars went high, liver and kidney functions were deranged, but we kept on playing the “Medical Chess”, where one doesn’t know what move nature will make next, the only possible next step is to accurately, promptly and wisely counter that complication.

His lungs started failing, the chest physician advised steroids. At this stage steroids could either be life saving, or could cause havoc by worsening the infection. Mr. Prasad was explained the situation.

“What are the chances of survival and complete recovery?” he asked.
“Unpredictable, Sir” I replied.
“Then why use steroids?” he asked.
“If we don’t, the chances are less than if we do”. I replied.

Steroids were added. The patient stabilised and then started improving gradually. Over next five days there was a dramatic recovery. Steroids were stopped.. Mr. Prasad remained expressionless, questioning every move. Three days later, once he started breathing by himself, the ICU team informed me that the patient could be extubated- the tube for ventilation could be taken out. I was in the OPD, I okayed the decision.

In a few minutes, Mr. Prasad rushed into my OPD.
“Doc, my father cannot speak. He has lost voice”. He was quite angry and anxious.

“Let me check” I said and went to the ICU.
The patient was otherwise fine. The throat tube inserted for ventilation sometimes causes swelling in the throat, involving the vocal cords, and such “hoarseness” or loss of voice is common after this procedure. Using steroids facilitates recovery, but in this case, it was now risky to use steroids. We explained the situation to Mr. Prasad. © Dr. Rajas Deshpande

“When will he recover from this?” he asked.
“Usually two weeks, but still one cannot say exactly” I replied.

“Why didn’t you tell this to us earlier? This is atrocious. I will file a complaint. We will go to the court. My friend is a reporter. I will also write on social media about this, that because of the treatment here my father lost his voice” he started shouting.

He did file a complaint with the hospital. Everything was on paper, everything was medically and legally correct. Still the administration must ask me questions and I must reply. Many long emails and documentations followed. One reporter called and enquired about the case, I explained her the situation.

I didn’t sleep well those five nights. Medicolegally we were safe, but who was to deal with the media allegations, the resultant defamation, irresponsible hurtful comments by every TDH on the social media?.

The patient was still under my care. I saw him daily, he was making good recovery. His voice became normal in next three days. He was shifted to the wards and then discharged. He was advised to continue anticonvulsant medicines. Mr. Prasad did not say a goodbye, didn’t write a feedback, he didn’t withdraw his complaint. They just disappeared, and did not follow up. I kept on dealing with the paperwork for a few days even after discharge. I still had a thin bleeding layer of patience left. © Dr. Rajas Deshpande

About a month later, at late night, I got a call from the casualty. The same patient was convulsing. Mr. Prasad had requested to call me.

He revealed that after the discharge he had searched for ‘the best’ neurologists in India, took his father to two of them, and was advised to continue exactly what we had advised. Then he researched internet, found an “ancient remedy” for epilepsy rediscovered recently by a famous baba, that guaranteed complete cure. They had stopped the anticonvulsants advised by me three days ago, as the Baba’s site blasted all modern medicine and the dangerous effects of allopathic drugs.

My remaining patience was destroyed, However, the patient was my first responsibility. I advised the treatment, we intubated the patient and started ventilation again.

“What are the chances, Sir?” asked the rimless eyes with expressionless face.

“We have started with the emergency treatment, the patient will be shifted to the ICU. I cannot accept this case, please admit your father under another specialist” I said. © Dr. Rajas Deshpande

“Look doc, I am sorry if you felt bad about last time. We paid full bills and we will pay again, we have mediclaim. I want you to treat him” he said.

“I don’t work for the mediclaim companies. You cannot pay me for the damage you caused to my peace of mind, the waste of time you caused by writing falsified complaints. You cannot pay me for the sleepless nights because of your threats” I told him.

His face changed. Panic appeared on that expressionless face. He folded hands. There were tears in his eyes. “Doc, I am sorry. I got carried away by what people say about modern doctors. I will do whatever you want. Please save him. I promise I will immediately write an apology to the hospital ”.

Needless to say, a doctor’s heart has many hard scars, but it is the easiest to melt. It did, once again!

© Dr. Rajas Deshpande

Real experience, some facts changed to mask identity.
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The Changing Blood Group

The Changing Blood Group

(c) Dr. Rajas Deshpande

“He is sinking” shouted Dr. Siya.

The casualty registrar rushed to the bed, checked the vitals. Pulse very fast. Blood Pressure very low. Lips and nails white, hands and feet cold. The young man, unconscious, was on the verge of death.

“He must be bleeding inside. Get an urgent sonography of his abdomen”said the registrar to Dr. Siya, and call the blood bank. He will need at least two units of blood urgently”.

It was Dr. Siya’s first week into internship, she was thrilled with the idea of actually saving lives. At the young age of 22, she was witnessing death almost every other day. Along with that she was amazed to see the darkest sides of human nature: the potential of humans to hurt each other: via rapes, accidents, murders, fights. She had decided to not let this affect her attitude, and to continue to try and save every life she could.

That late night, this young man of about her own age was brought in unconscious by someone, who had just dropped the patient in the casualty and left without leaving any identity of himself. “I found him lying unconscious on the road. I don’t know anything else about him. I am just doing my duty, I have a train to catch”said the stranger and left. The patient was reeking of alcohol. He had a visible head injury. A quick CT scan had revealed minimal bleeding due to a small skull fracture. He also had had bleeding from wounds from his hands and legs, they were sutured. The patient had no identity marks, wallet or cellphone. The policy of the hospital was to provide basic treatment and shift the patient to the government hospital. The police station was already informed. Treatment was started.

Dr. Siya requested two units of blood. The blood bank called. They had only one unit of the blood for his blood group. The registrar had the same blood group, and like many doctors working in the emergency departments, he went down to donate blood.

It was nearly midnight. The fate of the life of a young man depended upon what the junior doctor did just then. There was no one to sign any consents, the protocol was to inform the hospital’s medical director and obtain consent for emergency transfusion or procedure. Dr. Siya finished the formalities, obtained the permission, and started the transfusion. If the patient had reacted or something went wrong now, they all feared, there will be a havoc in the media: that they had let an unknown patient die because they wanted money!

Dr. Siya kept on managing the show. The angry and disturbed relatives of other critical patients kept on taunting her, speaking rude and reluctant to complete simple formalities and paperwork.

The sonography was thankfully normal.

Just as the first unit of blood was over, the patient became conscious, and revealed his name. He was quite shaken with the surrounding, but told in broken sentences about his friend’s number and address. He revealed that while returning from a party, his bike was interrupted by a bunch of goons, he had fallen down, they hit him upon the head and left with all this belongings.

The friend was called, and came in. He revealed that the patient was used to smoking weed and drinking alcohol in huge quantities. They were staying in the hostel of a famous college.

The second blood unit was started, and in a short while the patient threw a convulsion. He was immediately given injectables for controlling the convulsions, he slept off with the effect.

His parents arrived early next morning.. The shocked mother was consoled and explained about the situation by Dr. Siya. The elderly father, like all fathers, equally shocked but being a father unable to cry, kept mum, just holding hands of the boy.

When the patient woke up again, the father came to Dr. Siya, and touched her feet. Too embarrased, she told him that the registrar had donated blood for the patient. The father went and thanked the registrar, again trying to touch his feet.

As Dr. Siya had finished her night duty, she prepared to leave. “Beta, Will you come soon please?”asked the tearful mother to her. “Yes Auntie, I will be back soon. Don’t worry, he is ok now”she reassured and left.

On her way back her genius young mind tried to look at the situation sitting upon her shoulder, the little third person that resides within each one who has a conscience. That booze and weed was easily available to youngsters in almost all Indian hostels, that even educated people rode bikes without helmet, that crimes were happening almost everywhere that injured and killed people, that law and order was a laughable term in many parts ofthe country, that there was no government mechanism in place to provide emergency medical / paramedic support ambulances to raod / traffic accident victims: which one is the most responsible cause, when patients like these died? Who is responsible?

She reached home, told her proud parents what had happened, that she had helped save a life. Her mother folded her hands towards the sky, said “God, let my daughter save many lives everday”.

While having the breakfast, her father turned on the TV. A famous but ill educated political leader, in his mind-and-other- organs blowing speech in Karnataka, was explaining the illiterate public how all Indian doctors charged in excess, how they were only after money, how everyone except himself was the enemy of the millions of patients surviving from critical heart attacks, accidents, strokes and other diseases. All patients getting better all over te country was only thanks to himself and his government!

Dr. Siya’s father laughed bitterly. “Next time you need blood for any poor or unknown patient, call him” he said.

Dr. Siya replied, laughing “That kind of ëver changing blood group doesn’t match anyone, it is useless for any patient, Papa”.

(c) Dr. Rajas Deshpande

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