Category Archives: Spiritual

The Beautiful Secret

©️Dr. Rajas Deshpande

“I found her outside the public toilets near sassoon hospital” the lady said almost as a whisper after her daughter left the room. “She does not know. Nobody knows. Please don’t tell her ever”.

That 15 year old girl Teju was brought to me over 10 years ago, with uncontrolled fits. Not all fits / seizures are convulsions, there are many different types. Teju would suddenly behave abnormally without knowing it for a few minutes and then start crying. Her studies were affected as she had such episodes many times a day. She had been to some excellent doctors, but as she did not tolerate the medicines she had stopped them and refused to go to a doctor. Her mother Latha had somehow convinced her to meet a neurologist only once, so they were here.

Latha was a single, middle aged lady, who worked at a few homes all through the day mostly as a cook. Her husband had died long ago, and she barely managed to maintain her livelihood while living with Teju in a chawl. She narrated Teju’s history to me, but when I asked about parents having any fits or other neurological illness, Latha winked at me and said “No, I am okay, even her father was okay”. Then she asked Teju to get her a bottle of water from the canteen, and just as Teju closed the door behind herself, stunned me with her words: “I found Teju outside the public lavatory near sassoon hospital . She does not know. Nobody knows. Please don’t tell her ever”.

Then she explained in a hurry: “Doctor, you are like a brother, I will not lie to you. I had run away to marry my husband, but he was an alcoholic. He died in a road accident. I had no one left in life, and wanted to die myself. One night I was returning home from my job, and went to the public toilet on the way. There in a large heap of waste I saw this girl, only a few weeks old, almost dead. I took her to a doctor, told she was my sister’s daughter, and got her treated. Then I could not think of letting her go, I had found my purpose in life. I am a good cook and get by with salary from cooking at over 5 homes now. I want her to study well, but this epilepsy has been our curse now. I wish I was rich so I could treat her well”.

That last sentence hurt me. One, she was rich. Two, she thought good treatment needs one to be rich.

Teju had reentered, so we changed topic. I explained Teju her diagnosis in medical, scientific terms, and the reasons why this illness happens, how we can control it with the right medicines, and how her quality of life will be far better if her fits were controlled. “You will be able to look after yourself and even your mom well in the future if you are self sufficient” I used the trump card. She agreed to take treatment.

“Secondly, never worry about fees. You are a free case now onwards. You can even get discounted medicines at some pharmacies”. I told them addresses. Latha hesitated: “Doctor, we will pay, we don’t want to take advantage. We don’t want you to hush up because we don’t pay”. Their concern was genuine, and I assured them that I will do my best for them. No good doctor will turn away a treatable patient for want of money, I know many who treat poor patients free, unfortunately it never comes on record.

That was long ago. We were able to control Teju’s fits in a few weeks, and bring her drugs to a single dose of medicine. She followed up every six months regularly, each time with her mother. She gew up well, and always topped her class.

Only last month, she came alone.

“Doctor, I have a good news. I have been selected by a software giant in the USA. They have offered me a gorgeous salary too. I am leaving in a week’s time. I have come to tell you two things: first, please take care of my mother for a year, I am planning to take her with me to USA after that. Secondly, I can now pay the fees for both myself and my mom. I am rich now! So please tell your receptionist to make a bill for all my consultations till now.”

I laughed and congratulated her. “Well. I have promised your mom something, I will sort out about the fees issue later with her. As for her medical care, don’t worry I am here. I am glad you are taking her with you, many can’t”.

“Oh never! I can’t dream of leaving mom alone here. She has grown me up alone after my dad died. I know how hard she has worked for her daughter” shesaid, with wet eyes.

I had an emotional moment, a sudden urge to tell Teju the truth. But I refrained. This indeed was the truth now. Latha was Teju’s mom, and I had no right to change that. I regained my composure.

When she touched my feet, she asked “Do you want anything from the USA doc?”

“Thank you, I have everything I want with God’s grace” I told her the truth. Indeed, He had given me the ability to change lives positively, to contribute to humanity in innumerable ways, to help people live better lives, nay – the best lives they could. What more could I ask for?

©️Dr. Rajas Deshpande

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True Story, names changed.

God, Doctor and The Killer Snake.

© Dr. Rajas Deshpande

Dattaram started breathing fast and coughing. Red skin, rashes. Pulse 140. BP not recordable. This unfortunate young labourer, bitten by a cobra only a few hours ago, had now developed severe dangerous reaction or ‘anaphylaxis’ to the only medicine that could have saved him: the injection of anti snake venom. I stopped the intravenous drip immediately and shouted at the sister to bring the crash cart. We injected him with the most powerful drug Adrenaline which we had kept ready in a syringe.

He was brought by a friend to the hospital just after 10 PM. His villager friend who had brought him directly from the farm had gone back to bring Dattaram’s family. They were not expected for a few more hours. So the patient was all ‘care-of’ me, then a junior intern at the government medical college hospital. That was the era before cellphones and ventilators in government hospitals. © Dr. Rajas Deshpande.

Some venomous snake bites cause death by paralysing the breathing muscles, while others kill by clotting the blood inside the arteries. Dattaram was bitten by a paralysing snake, and his eyelids had already started drooping, he was also having difficulty in swallowing and coughing. Other medicines were started to counter the paralysis, but the killer venom was spreading. Time was running out. I started having palpitations. I was to be the active witness to his destiny. The ward was already full, the second intern was busy too.

The only way out was to give him extremely small doses of the antivenom again, gradually increasing the dose every few minutes, till a full concentration dose could be given. This is called desensitisation. I had never done it earlier. If he reacted again to any such smaller dose, there was nothing else to do. This was dangerous, and required a written consent by patient’s relatives. There was none. His pulse was now 120, and his BP was now recordable. I kept reassuring him. © Dr. Rajas Deshpande

I called up my professor through the ward landline and informed him in short.

“Go ahead, be careful. I will take care of the stupid consent from the medical director. Call me if required” he said.

I went to Dattaram. “Listen, Dattaram, I need to use a medicine against the snake venom. Some patients may may have reaction to that medicine. I will try and do this very carefully, but sometimes it may cause problems. Is it Okay?”

In a hoarse voice, he said with great difficulty: “You are my God. Do whatever you can. Keep me alive atleast till I meet my wife and daughter”. I told him I will.

I started to inject him the antisnake venom doses. First extremely diluted, then in gradually increasing concentration. His blood pressure was stable. However, after a few minutes, his breathing became shallow. He became drowsy. His respiration was paralysed. The snake venom was winning the race. I put in a breathing tube. The nurse started pumping air in his lungs through a rubber bag. I was sweating, thinking, panicking, observing and praying all at the same time. © Dr. Rajas Deshpande

He was tolerating the antivenom well. After a few hours, I decided to give him the final big dose again. I restarted the same medicine that had almost killed him a few hours ago.

His wife and daughter arrived. I quickly explained them what had happened, as the lady kept on patting her unconscious husband’s head. The daughter, barely 12 years old, was crying muffled. There’s a state of numbing that comes after extreme shock: that is terrifying to witness. Big city and poverty on one side, hopelessness of the situation on the other. The lady suddenly got up, took out a few ten-rupee notes and extending them to me, touched my feet “I will sell everything we have, please save my kumkum (husband). Look at the face of my daughter. Where will we go without him? You are God for us” she said repeatedly.

I did not crave to be a God, I just wanted to be a good doctor. Shall I be angry that she was trying to bribe me? Never. I remembered what my grandpa had said on the day that I joined medical college: “If you want to be a good doctor, try to imagine yourself in the place of your patient”. I suddenly realised that even though I was not God, in the eyes of this lady, her husband and the daughter, I was their only hope. I have always hated wordplay, I am rather a feelings man. I understood what they meant. The life of every patient depends upon my best effort and nothing less. © Dr. Rajas Deshpande

“Tai, I will try my best. Don’t worry. Keep that money with you. You don’t have to sell anything; we have all the medicines. You can both have tea if you want, this sister will get you some. Let me please attend your husband now.” I requested.

A few hours after that, by morning, Dattaram opened eyes. He met his wife and daughter. By noon, he started to breathe by himself, so we removed the tube. By the time my professor took rounds, Dattaram appeared stable. Medical professors never openly praise students. My professor kept his hand upon my shoulder, smiling. “Too bad, this did not happen on a cricket ground or a film theater, otherwise you would be rewarded with cars and bungalows.” he said with his characteristic red-chilly-smeared wisdom.

When Dattaram was discharged, his wife got me some sweets, and invited me to their village. “Doctor, we are very poor, but I will cook for you the best meal you will ever eat” she said.

Most doctors make a genuine best effort to save the patient: who would want otherwise? Yet sometimes we win, sometimes we don’t. In this case my effort was blessed. I will perpetually be grateful to my own God, praying that he rewards the effort of every doctor trying to save a patient.

As for the cars and bungalows, who has enough time to use them when lives are to be saved?

© Dr. Rajas Deshpande

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The Secret Illness Of Doctors

© Dr. Rajas Deshpande

She threw the file upon my table.

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

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

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

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

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

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

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

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

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

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

© Dr. Rajas Deshpande

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The Sunshine Girl

The Sunshine Girl

(c) Dr. Rajas Deshpande

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

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

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

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

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

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

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

(c) Dr. Rajas Deshpande

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

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A Doctor’s Meditation

©️Dr. Rajas Deshpande

Religion and medicine should never be mixed. Yet it is extremely necessary that a good doctor understands the mindset of a patient, especially a frightened, disturbed patient, and holistically plan the treatment rather than just writing a prescription for an ailment. To calm the mind of an irate patient, it is necessary that the doctor has that ability and self restraint, acceptance and compassion. A doctor who thinks in terms of religion and has a resultant bias can never understand patients even from his own religion as there’s no single path in any religion.

Science has to think of human body and mind only logically, with a sharp reasoning and on the basic presumption of equality. Genes may differ across races, but their numbers, function and dysfunction are the same across the human species. Racism is a serious disease of human mind. ©️Dr. Rajas Deshpande

I have always lived a parallel, isolated life to evolve mentally to be able to understand myself better. Only if I understand myself, my fears, my wants, necessities and my preoccupations, my expectations from others and my thought processes well, will I understand other human beings- in my case, the patient. This inward journey makes me a better doctor than knowledge, experience and information alone. This understanding is superior to even medical and social wisdom.

To achieve this, I have kept acquiring insights and inspiration from various religious texts and their translations, commentaries on religion and philosophy across cultures, and of course many scientific analyses of human mind. This of course comes after the dedicated time reserved for studying scientific medical sites and texts on a daily basis. ©️Dr. Rajas Deshpande

One prominent requirement of today’s doctor is to advise on meditation as many patients seek that from their treating doctor. I cannot advise something impractical or anything which I have not found myself to be useful. Researching this, I came across a beautiful article written by an army officer about the essence and technique of meditation. He had suggested this book above as an ‘Ultimate’ commentary on the science and practice of meditation. It has nothing to do with religion, it is an effort to delve into the depths of human nature. I reiterate, when I go to the hospital (and outside my home in general), I don’t see myself as belonging to any religion. I truly believe in the equality and beauty of every human being. Starting to read this immensely complex book today, hopefully it will help me and my patients too.

©️Dr. Rajas Deshpande