Category Archives: Uncategorized

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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Soulmates, Military Grade!

Group Captain Y. S. Marwa and his wife Mrs. Gurkirat Kaur have bravely stood with each other through thick and thin. They are both above 85. They care for each other extremely delicately. Many couples do, but the noticeable difference here is the willingness, involvement and sense of duty with which they both do it. While he is the picture perfect gentleman, she compliments his personality beautifully too.

Just a few weeks ago, Gp. Capt. Marwa unfortunately had a severe heart attack. Even in the ICU, his mind was preoccupied with only one thought: “I must get better fast to take care of her”. Thanks to the efforts of doctors at the military hospital in Pune and his own willpower, he recovered completely and joined back his chosen duty.

“We had taken a vow when we got married, I am just keeping my word” he says with a handsome smile. A military man to the core, he walks straight in the face of every adversity and defeats it with his monumental determination. In a world that is stuck in superficial, glittery meanings of ‘Love’, this couple personifies the very essence of the word ‘Soulmates’.

They don’t forget to bless me every time we meet, and my day turns sunny whenever they visit. I wish them both a many grand decades of love and togetherness, health and happiness.

Dr. Rajas Deshpande

The Euthanasia Named NMC

© Dr. Rajas Deshpande

Sweet Poison, Gorgeous Vamp, Philanthropist Criminal or NMC. All of these have one thing in common: the taste, the appearance is deceptive.

Just a while ago, doctors had complete autonomy and freedom to elect the best to the medical councils. They failed. Doctors had chances to unite and rectify glaring obvious malpractices in their own profession. They failed. Doctors had a freedom to pressurise elected medical council members to enforce ethics and discipline in Indian medicine, to arrest corruption. They failed. © Dr. Rajas Deshpande.

The parliamentary standing committee said something like “MCI looked only after doctor’s interests, not that of public, it is necessary to reduce the monopoly of doctors, so there should be diverse stakeholders at the helm”. The fact was that MCI looked only after its own interests, not even those of the real doctors of India: the thousands who were shouldering the actual healthcare burden especially in govt hospitals and rural areas, underpaid and unprotected. Malpractices became rampant. The general social jealousy about doctors which was earlier suppressed by respect converted into open anger and fuelled a paranoia that did not spare the best of the medical practitioners. For the sins of few, majority suffered. Patients too suffered at all levels. Govt medical services were always pathetic (and will remain so even after NMC), and there was no reign over the corporates who dominated and dictated the scene. Competition and petty egos destroyed any chances of any good unity among doctors. There could not be a deeper nadir for the profession. © Dr. Rajas Deshpande.

That fathered the NMC. Doctors will need to unite now like never before if they want to change this “Law”. Laws can be changed. But is it necessary in this case? Decide for yourself.

1. The ultimate, complete control of this “Autonomous” NMC is is in the hands of the central government. Majority members are govt. officials, a minority are to be chosen by medical professionals, and in every case, all that the central govt. decides is going to be a binding upon the NMC. That is like cutting off the wings of a bird and naming it “Independent and Free”. NMC, its advisory committee search committee or its four component boards will all be dominated by govt.’s chairs. Central Govt will also decide about the funding and salaries of the NMC members and its Chairman. We all know who sits in the top chairs of govt. institutes and how many among them can speak against the govt. So tomorrow if the govt wants to make ANY decision about ANYTHING that governs Indian Doctors, it can. Who will stop them if wrong? Such is the control of Central Govt. over this NMC, that if a doctor is unhappy about some decision of state medical council, he can go to NMC, and if unhappy about NMC’s decision, he will have to appeal to….? Courts of law? No. Something higher: the central govt!! So every medical practitioner’s career is ultimately in the hands of the central govt. Better join the party. Or quit medicine.

2. The entrance examinations are more simplified. All undergraduate examinations will be through NEET. All who have completed undergraduate course (MBBS curriculum) will appear for the Final MBBS exam which will also be common National exam (NEXT) for Medical Licence and PG admissions. Due to legal status of institutes like AIIMS, PGI, etc., they will conduct a separate PG entrance exam. Although this appears simplified, given the history of corruption (at almost all levels) in such exams and delays that waste millions of youth-years, one is worried about an undercurrent ‘sale’ of PG seats. But wait, not everyone must pass the licensing exam. You can entirely skip the difficult MBBS course, do something else, and bridge over in 6 months, without having to pass the licensing exams. That’s the third bullet.

3. Some AYUSH doctors are better than some MBBS doctors. Many who can not get into MBBS in spite of merit opt for other streams, with a hope to become a good doctor. They are actually contributing a lot to our healthcare, many of them know their limitations. One cannot object to their wish to practice allopathy if they want to study and upgrade themselves, the only objection is to exempt them from the common licensing exams. That will be very unfair to our society, most of whom will never know whether the doctor treating them has adequate experience, qualification and wisdom.

A newly passed out lawyer cannot do a “Six Month Bridge Course” to become a High Court Judge. A new recruit in Police cannot become an Inspector though a “Six Month Bridge Course”. A Municipal Councillor / Nagarsewak cannot “Bridge Course” himself into a Health Minister or Prime Minister. One needs to qualify though a common mandatory process. After MBBS, one cannot do a “bridge course” to become an MD that requires three years of intense responsibility handling, studying, treating patients under supervision and obtaining a deep insight into that subject. It is not possible in six months even for an allopath. Likewise, if an AYUSH doctor must practice allopathy, they must go through the necessary training (two to three years) and more importantly qualify the same common licensing exam before they practice the complicated allopathy.

AYUSH is an excellent idea, but it is immature as of now.

© Dr. Rajas Deshpande

4. The Doctor:Patient ratio in India is misquoted. Due to poor payments and infrastructures, very few doctors stay either in rural areas or govt. services, and the whole equation is skewed. The very purpose of AYUSH was to bring in more medical personnel, but that would work if these (3.5 lacs) “bridge” course doctors honoured the opportunity and worked only where there was a scarcity of doctors (urban and rural). What is more likely is that these additional doctors will also join the existing urban trend. Who can blame them for wanting a better life?

5. The newer policies of “more data, more paperwork, more record keeping, tighter control” over doctors will only result in private practitioners becoming more paranoid, giving up all the voluntary charity that they did every day, spending more time per case: and that will reduce numbers and spike fees. I can foresee most private practitioners closing down clinics. More rules and paperwork mean more corruption and exploitation in our country. This will turn into higher cost per consultation. Private healthcare will be out of reach for the poor. The good doctor will no more sit in his own clinic, he will turn to a safer corporate hospital. (Is that the aim?).

© Dr. Rajas Deshpande

6. The NMC bill entirely skips any word about regulating the large private healthcare sector. It does not have any provisions to protect new and good doctors from the tyranny and forces of corporate expectations. Some private hospitals have excellent policies and ethics, some corporates are very doctor and patient-friendly, but many remain to be corrected. There is no authority to the NMC over such hospitals.

7. There is no mention about improving staff and facilities at govt. hospitals, about any rules that ensure the best free healthcare for millions of poor patients in India. The ground reality that many patients suffer and die due to lack of staff, medicines, technology, tests and surgeries at government hospitals finds no mention in the reports of the Parliamentary committees that suggested the NMC. They did not mention the pathetic, unsafe and inhuman conditions in which Indian medical students and resident doctors live and work. They did not mention who will be responsible if a patient dies in a govt hospital due to lack of facilities or medicines. They appear to be more concerned about the price control of 40 percent seats in private medical colleges.

It is sad that in spite of many doctors in and around the central government, the medical field’s autonomy died with this bill. Shall we call it Euthanasia or “Physician assisted death” of the autonomy of medical profession? © Dr. Rajas Deshpande. In the era of the MCI, doctors were orphans, now in the era of NMC, they have become slaves.

The corrections in this bill will have to be put forth and pursued by a totally unified doctor’s organisation. “Painkiller Agitations” will not work. We must ask for complete release of the NMC from the cages of central government. Like in the UK, Indian NMC should be made up of 50% Senior Doctors representing all states and specialties, and the remaining 50% can be selected by the patient organisations: Judges, Media Stalwarts, Journalists, Artists, Ministers and Eminent Social Personalities. We must ask for transparency and fool-proofing of all medical entrance exams. We must ask for the right education, experience and licensing of AYUSH doctors, and welcome them once they qualify.

This article is written with my heart which bleeds for my profession and my patient alike. Bharat Maata Ki Jay!

© Dr. Rajas Deshpande

PS: Thank you Dr. Avinash Deshpande, Aurangabad, for some valuable inputs. If there are any technical mistakes, please let me know so I can correct.

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The Mathematics Of Kindness

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© Dr. Rajas Deshpande

“Are you coming, doctor, or shall we file a complaint? We will go to the police if you don’t come in an hour”.

It was about 12 noon on a Sunday. My sister and her family were visiting for three days, this would be our only lunch together in this year. All other days I am in the hospital at the lunch hour.

A teenager was admitted for last two days with repeated alleged episodes of fainting with unconsciousness. His friends and family were all at the hospital, calling incessantly from different numbers. They were given my cell number by a colleague as he thought it was an emergency. I had seen the patient four times in last two days, rushing from the OPD as there were alarming calls. We had done all the necessary tests and found nothing wrong with the kid, we had concluded that he was malingering / faking these episodes. A neurologist has many tricks to unmask the truth. We had explained the facts to his family, a psychiatrist had confirmed this, and scheduled a meeting with the family on Monday. Till then we had added anti-anxiety pills and told the family to be patient. All the vital parameters were normal. I had explained the family to be patient.

My boss called, he was frustrated too. “Ja ke dekh le ek bar (Go and see him once). Some minister just called for him” he said.

Excusing myself from the lunch, I reached hospital. The teenager’s girlfriend was standing in panic by his side, crying while he was ‘unconscious’. The brother and friends raised their voices: “Why is this happening, doctor, why don’t you do something? Why is he not responding to the treatment? It is three days now. He is suffering so much”.

I am trained as a doctor to tolerate anger, frustration, anxiety, stupidity, bitterness or accusations, but I refuse to tolerate drama.

“I have explained to you many times. This is not real unconsciousness. A psychiatrist will have a meeting with your family tomorrow, till then there’s nothing more we can do”.

“What if he dies? What if you are wrong?” shouted the relative. I did not have an answer. I left the ward after messaging my boss, also asking him to transfer the case under someone else. The next day my psychiatrist friend called me. The teenager’s girlfriend was from another religion, parents on both sides had opposed their marriage, and this illness was their “brilliant solution” to get the parents to change their minds and agree. Cheap drama!

There’s no mathematics to kindness, we have all been taught. Do good, be compassionate and don’t expect any returns. People take advantage, but that is Their nature, you be yourself, kind and compassionate.

I was once returning from my Goa visit, there were long queues of frustrated people. Two apparently rich Indian tourists walked in, typically dressed for a Goan vacay. They saw the long lines, changed their faces, and rushed to the front of the line. One of these approached a foreigner in the line: “Excuse me, we will miss the flight… we were stuck in traffic.. my sister is sick, I must reach Delhi in time”. The foreigner, knowing that these were blatant lies, still allowed him to go ahead of himself. Kindness is almost a compulsion. Once on the other side of security, these “line-jumping liars” had the obvious expression upon their face: “Ullu banaya tum sabko (We made a fool of y’all)”.

At the hospital entrance, I often meet a paraparetic man in his scooter for the disabled. He usually blocks the hospital entrance with his three-wheeler scooter parked there while he talks at leisure with his friends. If anyone honks, they all play this “Can’t you see he is disabled? How rude!” card, intended to make others feel guilty. Even when it is an ambulance or a doctor’s vehicle, he will intentionally slowly move from the spot.

Every doctor, almost every day, meets people who blatantly lie: to bypass waiting lines, to ‘finish off with parent’s health issues over the weekend’, or to get concesions, free treatment. Some lie to exploit kindness and compassion, some to exploit financially. There are no guidelines defining an emergency and the charges for such “pseudo emergencies”. A doctor on duty must always resopnd to an emergency, but if off duty, he should be able to refuse cases on a holiday. All government hospitals have a 24/7 emergency department, the patient can be taken there.

Recently heard that an Indian lawyer charged in crores to an Indian client stuck on an European airport for a legal advice in an emergency. There were no cries about compassion, kindness or even patriotism. What should a doctor charge for a pseudo-emergency, especially when a precious holiday is wasted?

When I discharged this case, they asked me when to follow up. I replied without hesitation: “Never with me”.

© Dr. Rajas Deshpande

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Doctor Arrested. Patient Died. Who’s Guilty?

(c) Dr. Rajas Deshpande

“Doctor arrested. Patient died due to a wrong surgery”.

The black headline was shining. There was a file photo of the accused doctor, and angry, crying relatives. Sad and angry, I read through the news that did not affect me directly, yet knowing that every patient who read that news will go further away from their doctor. The already delicate and dying bond will die a little more.

Is it enough to punish this doctor?

Who all is guilty here?

The parents who forced him to become a doctor because they couldn’t?

The corrupt educational boards which allowed leaking papers and increasing marks so the student could get a medical admission? (c) Dr. Rajas Deshpande

The politicians who made it possible for even the undeserving, low-aptitude students (which has nothing to do with one’s caste or religion: it’s more to do with money and power) to become doctors and play with patient’s lives?

The governments who allowed the “Medical Business” by establishment of substandard medical colleges owned by the rich and powerful, to sell medical degrees? The managements of such substandard institutes who chose the “low”quality teachers who agreed to work at low salaries and tolerate all humiliation? The teachers who didn’t care how their student was trained? (c) Dr. Rajas Deshpande

The medical councils which ignored the ‘temporary’arrangements made by such substandard institutes to just ‘Pass the Inspection’, never providing students with adequate education or experience?

The medical policy makers who made theoretical, mcq-type education more important than clinical training?

The offices of law which ignored the repeated applications and complaints of good students from such institutions about incompleteness of educational facilities?

The Universities that allow ‘manipulation’ of medical exam passing under influence of money or power?

Or the politics of allowing cross-specialty practice without adequate training, the ‘jump-over to any pathy’ decisions to please vote banks?

Or the corporate hospitals who prefer such “substandard” doctors because they can work at lowest payments? Aggressive and “market oriented” junior doctors are preferred by many commercial-headed hospitals over those with best academics and clinical knowledge. (c) Dr. Rajas Deshpande

It is indeed a reality that some doctors cannot speak a straight sentence, some cannot spell medicine names correctly, some treat even what is not their qualification skill, and some substitute knowledge with style, overconfidence and sweet talking. At various stages in their career, there are teachers who have tried to correct them, but in these unfortunate times of “pleasing one and all” including students, it is quite difficult to ‘mentally’ train a doctor to be good and perfect.

If only the doctor mentioned above is punished, leaving all others above without correction, then it will be a classic example of example of medical negligence and injustice. It will be like treating only the heart attack without treating the blood pressure and diabetes which cause that heart attack. We know the outcome in such cases.

(c) Dr. Rajas Deshpande

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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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He woke me up again!

All through MBBS and MD, living in the hostel, one rarely had time for eating. The eternal aim was to keep awake, alert and running task to task 24/7. That needed a constant supply of stimulants: namely a tea that could bring you back from hell, and a visit to the pan-shop for You know what (bad habit, never mean to encourage, quit a decade ago).

But who had a steady supply of money? Most of us were dependent on the tiny money orders which vanished in a week, and then we depended upon the kindness of the tea-stall and pan-shop owner.

Mangesh Tea Stall at Jubilee Park, run by Inder, Gajanan and Ravi was our eternal hope and den, like that of thousands of doctors passing out from GMC Aurangabad. They fed us with snacks and tea for weeks/ months, trusting that we will pay back. Most of us did. Yet there were times when harsh and sarcastic comments were necessary to remind us of the payments due.

But the grandness of these souls was that in spite of themselves being so poor, they never ever denied to serve us snacks, tea and smokes, even when we weren’t able to pay for long. The stacked up bills must have been such a burden for them, yet they always said: “You doctors have such a heavy duty.. it’s ok”.

It was so necessary to visit them today after 20 years and say “thank you” for standing by us, supporting us in our pauper times!

The day was made again, when Inder made the same “back from hell tea”, and reminded that there’s a lot of work to finish yet!

He woke me up again! This reminder of how grateful I should be for all that I did not have then but have received now is so powerful!

©️Dr. Rajas Deshpande

Left to Right: Ravi, Myself, Inder, Gajanan, Dr. Shrinivas Gadappa.

The Parceled Sandwiches

(c) Dr. Rajas Deshpande

Entering the hospital that morning, I was wondering if I could finish early and go for a relaxed dinner with a friend who was visiting. Iwas in an excellent mood when I entered the hospital at about 10 AM. That’s when I heard the noise.

In the entrance lobby, there was a group of men, women and children, wailing, crying, shouting, pulling their hair, beating chests, and throwing their hands and legs around lying upon the floor. Few of them were shouting loudly “All doctors are looters. They robbed us and still killed the patient. How can our patient die? Catch them. Kill them. Burn the hospital” this was accompanied by abuses that cannot be mentioned. The security staff and PROs were patiently trying to tell the violent relatives that there were other patients and relatives, that there were women and children around, but the most vulgar of the abuses continued.

I walked past the abusive crowd and met my resident doctor in the ICU. The first case was that of an old man who had had a fall a week ago, but was treated at home for the first three days. Three days later, the old man had suddenly become unconscious, and on admission was found to have a large bleeding in his brain. If not operated within minutes, he would have died. Our neurosurgeons rushed in and operated him with a huge risk. Now he had just started responding, but was still not fully conscious. (c) Dr. Rajas Deshpande

“Why is he still unconscious, doc? Was the surgery not done correctly?” the son asked.

“We have repeatedly told you Sir, the delay in admitting your father has caused a lot of damage in his brain. We cannot predict when and how much he will recover. The surgery was done to prevent imminent death. In my opinion, he is steadily improving. ”I explained again.

One after another, different faces of suffering and allegations, pain and expectations kept mounting and in a few hours it became difficult to feel happy. I am seriously not the type who can keep a perpetual meaningless smile upon my face without actually being happy. However, I must keep calm and smiling, because the next patient will be coming in with a lot of hope, expectation and fear. I did my best.

But my hope of having a relaxed dinner with the friend was gone. All I wanted now was to go home, take a hot shower and try and kill the negativity that was cluttering my mind. The wails and cries of the crowd were still noisy in my heart. “Who must have died? What must their family be going through? What about their children and spouse? Was this preventable?” I was curious. (c) Dr. Rajas Deshpande

The casualty called. A young girl had come with fits. Her old farmer parents had brought her. Stabilising her, and completing the examination, I asked questions to her father. With teary eyes and folded hands, he told us “We have no one and nothing left. Please do something”. Reassuring him, I messaged my CEO, who graciously allowed to treat her as a free case. I started writing notes.

“What was the ruckus in the morning?”I asked the resident doctor standing besides me.

“Oh that!” he replied “That patient was admitted for a head injury two weeks ago. He drank too much alcohol, and his bike had slipped. We admitted him as an emergency, and treated him on compassionate grounds as he was comatose. The relatives were well aware about the poor outcome. We did everything we could. I don’t know why they reacted so. Someone told me that the local politico wanted to extract some funds from the hospital”. This was not unknown, but loss of life does cause unexpected reactions, the doctors and the hospital staff bear the brunt.

Many patients were treated that day, many came cured, many went home happy, many expressed gratitude. But the fact remained that I was unable to forget the wailing family and the accusing son of the ICU patient. Am I supposed to smile and be happy for those cured and improving, or am I supposed to feel sad about the death and suffering I see every day? The emotional highs and lows that happen in every doctor’s day are too wide, too heavy and dynamic. It is not easy to forgive and forget bitterness, thanklessness and paranoid accusations on a daily basis for years, and keep smiling in between. (c) Dr. Rajas Deshpande

My friend called. “Rajas, I am standing outside your hospital. Come let’s have a quick bite. My bus leaves in anoter one hour” she said. We entered the nearest restaurant. Her witty words indeed relaxed me somewhat, and she ordered soup and sandwiches, knownig my favourites. As the steamy soup eased my throat, I started telling her about my day. My cellphone rang.

“Is that you, doctor Deshpande? Do you remember my father Mr. Ramakant who you were treating? He passed away today. We were supposed to come to you three months ago, but as I was out of India, I couldn’t bring him. He had stopped all medicines”.

I winced. Mr. Ramakant was fairly healthy, happy and stable on medicines, they were told never to stop the treatment. How should I react?

“Very Sorry to know” I said.

“That’s okay doctor. My problem is that no doctor is giving a death certificate for him, as he had not seen a doctor since long. We need it for the funeral. If I come to you now, can you please write a death certificate for him? I will pay your charges” he said.

“Sorry, someone has to examine him and issue a certificate. Please call your neares doctor home, or take thepatient to the nearest hospital” I told him. As I kept away my cell, I avoided looking at my friend.

“What happened?”my friend asked. Looking at my face, she sensed it.

“Oh. Sorry” she asked the waiter to parcel the sandwiches.

Both of us knew that neither was going to eat them.

(c) Dr. Rajas Deshpande

Please share unedited. Please let the society know what a doctor’s day is typically like.

Snake! Snake!!

Snake! Snake!!

©️Dr. Rajas Deshpande

She felt a sudden sharp pain on her hand, as she was cutting grass in their farm. She saw bleeding from her hand, she threw away the grass and looked carefully. The head of an angry snake with open mouth, fangs popping out terrified her at once. It was a Russel’s viper, a deadly venomous snake that causes shock, bleeding, and clots the blood inside the arteries.

She grabbed her cellphone and called her husband.

There is a superstition in rural India: that husband or wife, if bitten by a snake, should not see each other’s face for eight days, or one of them will die. Her relatives told her not to see her husband, even her husband was told so.

They unheeded the superstition. He tied a rope around her bitten hand, started his bike, she sat behind him, and they rode away to the nearest rural hospital about seven kilometres away. They had only a few minutes. In a short while she started feeling giddy and had a vomiting. They reached hospital just when she was about to collapse. Her whole left hand was swollen upto the shoulder and was turning blue-black. The face had started to swell too.

The doctor there rushed her to the intensive care unit, did not wait to waste time in paperwork or financial questions, and started emergency treatment. Knowing that people don’t carry money during such emergencies, he arranged for all the medicines himself. In a few hours, her blood pressure started to return to normal. The swelling onher hand increased, causing severe pain. For the next five days, the doctor struggled to counter every problem that popped up: it is extremely difficult to treat a patient who has bleeding and clotting together.

Science won, sitting on the shoulder of the logical and determined doctor. In seven days, Mandakini was discharged, with only a minor swelling on her hand still persistent.

In any big hospital in a metropolis, this would have cost her more than a few lakh rupees. However, a doctor practicing in a rural area, just like doctors working in many government hospitals, took it upon himself to save her life without caring about money at all. With minimal expenses, he saved her life. As Mandakini is under my treatment for Parkinsons Disease, she followed up today and told me this story in te tones of a typical farmer: as if it was just another trivial deviation from normalcy “That was a snake bite last month. I am okay now”.

While the big name doctors in big cities are well publicised and noticed by the media, thousands of the rural Indian doctors, who slog day and night saving thousands of lives every day usually remain neglected and away from limelight. There must be so many hundred snake bites happening every day, so many accidents, and so many doctors practicing in rural India must be saving them. But what’s so sensational about saving lives? Instead, if the poisonous news of doctors being beaten up by violent crowds and hospitals vandalised are shown, it gets huge TRPs! There’s no treatment for the poison spread by some politicians and media against the medical professionals..

A heartfelt, respectful salute to the thousands of medical heroes practising in rural India and government hospitals, who form the base of Indian medical profession.

(c) Dr. Rajas Deshpande

PS:

Awaiting the permission of the doctor mentioned above, from a rural hospital, to publish his name😊

Marathi version:

साप साप!

डॉ. राजस देशपांडे

शेतात गवत कापत असताना मंदाकिनीच्या हाताला एकदम काहीतरी टोचल्यासारखं वाटलं, म्हणून तिनं हातातील गवत फेकून समोरील झुडुपाकडे नीट पाहिलं. जबडा वासून त्यातील विषारी सुळे दाखविणारे ते रागीट फुरसे तिच्यासमोरच डोके बिळाबाहेर काढून बसले होते. रक्ताच्या गुठळ्या आणि रक्तस्त्राव करवून काही मिनिटातच मृत्यूच्या जबड्यात ढकलणाऱ्या त्या विषारी सापाला पाहून तिचे धाबे दणाणले. तिने तिच्या नवऱ्याला फोन लावला.

ग्रामीण भागात एक अंधश्रद्धा आहे. साप चावल्यास नवरा अथवा बायकोने आठ दिवस एकमेकांचे तोंड पाहू नये, नसता एकाला मृत्यू येतो. त्यांच्या नातेवाईकांनी त्यांना एकमेकांसमोर जाऊ नका असे सांगितले. पण मंदाकिनी आणि तिच्या नवऱ्याने तिकडे दुर्लक्ष करीत आधी हाताला कापड करकचून बांधले आणि दुचाकीवर स्वार होऊन ते दोघे आठ किलोमीटर वर असलेल्या ग्रामीण दवाखान्यात निघाले. काही अंतर गेल्यावर मंदाकिनीचा हात खांद्यापर्यंत सुजला, काळानिळा पडायला लागला. तिला चकरा येत होत्या. एक वांतीही झाली. कसेबसे ते दवाखान्यात पोचले, तेव्हा तिचे ब्लड प्रेशर कमी झालेले होते.

त्या ग्रामीण दवाखान्यातील डॉक्टरने तिला ताबडतोब तपासले. कुठल्याही कागदपत्री व्यवहारात वेळ ना घालविता त्यांनी तिला आय सी यू मध्ये घेतले आणि औषधोपचार सुरु केला. पैसे, बिल, आर्थिक परिस्थिती याचा विचार अथवा चर्चा करायला वेळच कुठे होता? अशी वेळ आल्यावर पैसे घ्यायला वेळ असतो कुणाकडे? डॉक्टरांनी त्यांच्याकडीलच सर्व आवश्य औषधे वापरली. काही तासांनी तिचे ब्लड प्रेशर नॉर्मल ला यायला लागले. पण तिचा हातावरची सूज मात्र वाढली, आणि तिला प्रचंड वेदना व्हायला लागल्या. पुढचे पाच दिवस तिची प्रकृती वरखाली होत राहिली आणि डॉक्टर येणाऱ्या प्रत्येक आपत्तीशी झुंजत राहिले. आठ दिवसांनी तिला डिस्चार्ज मिळाला. फक्त थोडी हातावरची सूज बाकी राहिली होती. काही हजार रुपये बिल झाले होते, ते त्यांनी आनंदाने भरले.

कुठल्याही मोठ्या शहरात, मोठ्या दवाखान्यात तिला याच ट्रीटमेंट साठी अनेक लाख रुपये मोजावे लागले असते. पण भारतातील एका लहानशा खेड्यातील एका डॉक्टरने स्वतःच सगळी औषधे वापरून तिचा जीव वाचविला. भारतातील ग्रामीण भागातील हजारो सरकारी आणि खाजगी डॉक्टर पैशाचा विचार ना करता अत्यंत कमी खर्चात हजारो रुग्णांचे जीव रोज वाचावीत असतात, पण त्याची दखल घायला वेळ आहे कुणाला?

पार्किन्सन’स च्या आजारासाठी मंदाकिनी देवकर माझ्याकडे ट्रेंटमेन्टला अनेक वर्षांपासून येतात. या वेळेला त्यांना उशीर झाल्याने मी त्यांना सहज विचारले, तेव्हा रोजचाच विषय असल्यासारखे त्या सहजपणे म्हणाल्या “काही नाही डॉक्टर साहेब, मागच्या महिन्यात साप चावला होता म्हणून उशीर झाला”! अजूनही सुजलेला हात त्यांनी मला दाखविला.

मोठ्या शहरातील मोठमोठे डॉक्टर अनेक वेळेला टीव्ही वर दिसतात, त्यांच्या बातम्या छापून येतात, त्यांना खूप प्रसिद्धीही मिळते. काही डॉक्टर तर प्रत्यक्षापेक्षा फक्त टीव्ही आणि पेपरातच खूप चांगले काम करीत असतात! पण दुर्गम, ग्रामीण, कठीण प्रांतात राहूनही माणुसकी जपून, अखंड मेहनत करून, पैशाचा विचार न करता अनेकानेक रुग्णांचे रोज जीव वाचविणाऱ्या डॉक्टरांचे नाव क्वचितच छापून येते. या देवमाणसांची दखल वैद्यकीय व्यवसायाविरुद्ध सतत गरळ ओकणारे आपले राजकारणी आणि मीडिया कधी घेणार? माणुसकीने सेवा करून लाखोंचा जीव वाचविणे यात सेंसेशनल ते काय? त्यापेक्षा एखाद्या डॉक्टरला वेडसर जमावाने केलेली मारहाण आणि तोडफोड दाखविली की जास्त लोक पाहतात! डॉक्टरांविरुद्ध विष पसरविणाऱ्या या सापाचा मात्र काहीच इलाज नाही!

वैद्यकीय व्यवसायाचा पाया भारतामध्ये ग्रामीण भागातच आहे. माणुसकीचे सर्वोच्च आदर्श डोळ्यासमोर ठेवून रात्रंदिवस खेडोपाडी झटणाऱ्या सर्व डॉक्टरांना आमचा सन्मानाचा सलाम!

डॉ. राजस देशपांडे

न्यूरॉलॉजिस्ट पुणे

काही कारणामुळे वरील डॉक्टरचे नाव येथे देऊ शकलो नाही. त्यांची परवानगी मिळताच ते लिहीनच. .