Tag Archives: accident

The Unforgettable Compliment

The Unforgettable Compliment
© Dr. Rajas Deshpande

All six casualty beds were full, the room was full of noises: nurses, fearful and angry patients, relatives, and wardboys trying to move stretchers and wheelchairs in and out. This chaos didn’t affect my concentration anymore. It was late night, heavily raining, my colleague Deepa and myself were the only two doctors- interns then- in the civil hospital casualty. She was finishing the paperwork in the side room. Behind a curtain, I was trying to remove a metal piece stuck in the back of a kid who had blown a firecracker bomb with a tin container covering it. I started stitching the gaping wound once the metal piece was out and cleaning was complete. © Dr. Rajas Deshpande

Just then a girl walked in, all wet and panicked, with another small girl upon a stretcher. I recognized her instantly: she was a classmate from my junior college, Ruta. As the patient was shifted to the bed, Ruta frantically shouted, enquiring for doctors. The nurses had already started checking her patient’s vitals. I finished bandaging the stitched wound, and came out from behind the curtain, removing my gloves. She saw and instantly recognized me too. “You are Rajas, right? Remember me? I am Ruta, your classmate.” She started sobbing, now that she met a familiar face. Her sister, about 15 years old, had had a head injury, falling from a bike, and had just vomited. She was woozy, irritable and confused. I ordered an X ray (CT scan was not available in that civil hospital) of her head and neck. IV line was started and necessary drugs injected. I reassured Ruta that her sister was stable, and continued with other patients.

My subconscious kept on playing memories of the past on some deep screens.
Ruta was exceptionally beautiful and vivacious. She had many fans. I liked her too, but there was no interaction: her group unlikely to engage with nerds like myself. They were a group of happy-go-lucky, good looking and muscular guys and stylish, good looking girls. They were mostly into movies, masti, dance, gymming, rides and food. I was not only preoccupied with a lot of classes and study, but also too shy to belong to such a group. Somewhere I envied those boys, they had so much advantage interacting with girls, with all the time and money they had. However, muscles are not my kind of statement, although (Thank God!) I have always enjoyed excellent health and fitness. © Dr. Rajas Deshpande

Once we finished the junior college, I never saw them. Medical courses hardly allow any time for extracurricular activities. The only silver lining was that there still were beautiful and intellectual girls in the class, and some of them respected and liked nerds too!

As Ruta waited by her sister, I kept on attending the cases that came in. From women in labour to heart attacks in shock, from bullets in the chest to rapes, one night in a casualty shows more pain than many know in a lifetime.

A foreigner couple came in, with their small boy bitten by a bee, he had developed severe reaction, his breathing was obstructed because of the throat swelling from inside. They kept on weeping as we all rushed to inject steroids and other medicines to the child. In some time the kid stabilized. © Dr. Rajas Deshpande
Then the police brought in a drunk driver who had rammed his Bullet bike into another’s. Our duty was to perform a detailed examination, collect blood sample and opine whether he was drunk or not. I was shocked: he was my schoolmate. He recognized me too. “Raja? Dekh yaar ye log mujhe andar kar rahe hain (Look these people are jailing me) he said, “Tu kuchh kar yaar (please do something)”. This was difficult. He was going to hate me for life probably, but I had no choice. I wrote his report. I felt sad, but there was no time to express it.
A snake bitten farmer and a newly wed woman with over 70 percent burns were brought in almost together, both gasping. Deepa and myself ran around to stabilize them, the medical officer came in too, but the burns woman had arrested just as they entered the casualty. We intubated the farmer, who was sinking, while we struggled to get things right. He was shifted to the ICU upstairs. We started finishing the paperwork. © Dr. Rajas Deshpande

It was about 4 AM, now there was a relative calm in the casualty. Sleepy relatives had found corners to doze off. All six patients were relatively stable.

“Excuse me Rajas, Is there a canteen nearby where I can get some tea?” Ruta asked.
“Yes, across the road, in the lane opposite the gate” I replied.
“Will you please join me?” she asked.
Borrowing an umbrella from a ward boy, and informing Deepa, I walked Ruta across the street. We stood sipping the hot tea by the side of the road, under the beautiful rain.

“I have a confession to make” she said suddenly: “I never knew there was this side to life: I only thought my life was to be enjoyed without a worry. If someone had given me a million rupees yesterday to stay up all night listening to other people cry, see wounds and deaths all night, I would have declined and ran away. I cannot stand anyone whining, and here you all are, listening to nothing else, fighting not only death but also expectation, anger and uncertainty. We made fun of nerds like you, and today I meet one, saving lives! I don’t know if I will ever save a life, and here you are saving many every day! I feel how superficial I was! I respect you and what you do. I now think you docs are superheroes”.
We are used to such overwhelmed compliments by patients just relieved of fear. I just smiled. She read my face. ” No, I am not saying this because my sister is admitted today, but because I feel it inside after seeing what happened here”. © Dr. Rajas Deshpande
I thanked her, adding that it was not wrong to have fun and look good, confessing that medicos often secretly miss those things, none of us gets any time for that.

Needless to say, I walked back thanking God, and feeling proud. This was one simple closure, yet so essential!

My co-intern Deepa gave me the expected wicked mischievous smile when I returned.
“Today the tea must have been very tasty na?” she asked, sarcasm overflowing from a face deliberately made over-innocent.
“Solid” I replied with matching sarcasm; “Oxytocin-Dopamine waali chai thi (It had oxytocin and dopamine)”.

We discharged Ruta’s sister the next day. After two days, I received a handmade greeting from Ruta, in which she had written the most unforgettable compliment I ever received:

“You healed more than what was injured. Thank You!”

© Dr. Rajas Deshpande
Dedicated to all medical students, interns and resident doctors.
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Negligence cases deserving severe punishment.

Negligence cases deserving severe punishment.
© Dr. Rajas Deshpande

A police sub inspector in civil dress, his wife and three kids aged 8, 5 and 1 were brought to casualty. All profusely bleeding. My job as an intern was to secure IV line and stop bleeding. As the CMO questioned the PSI, we all realised as suspected from the stink that the police officer was drunk. He had run into a braking truck from behind. One kid and the wife died the same night. He created a ruckus in his drunk state, threatening to kill everyone in the casualty. “If my wife dies, I will see to it that your life is ruined” he threatened to the CMO. The CMO kept on doing his duty, stressed and hurt. We were all real scared next few days. Everyone sympathises with such a loss. No one will aid or enjoy anyone’s death in a hospital.
Then why this curse of blames?

“This happened due to that doctor’s wrong treatment” : common words now heard in many clinics daily. Who causes maximum deaths due to negligence? Can only a doctor cause medical negligence? No.

These medical negligence cases must be punished too, with bad press, crores of rupees in fines, and public humiliation. You be the judge who is guilty:

Teenager son of an MLA. Played with wild snakes as a hobby, proudly encouraged by this MLA. Bitten by a cobra, landed in icu critical. A patient on ventilator was ‘shifted out early’ to accomodate the MLAs son.

Doctor advised a blood thinning medicine to prevent clots after diagnosing clotting disorder,. Patient went with her husband to a quack, took unknown herbal medicine and stopped blood thinner. Developed strokes, now in a vegetative state.

Patient advised to quit alcohol,,as it caused fits. Counselled with family and friends. In a week had alcohol with same friends, had fits, died in casualty.

Diabetic, told to control diet, continued to binge-eat sweets, lovingly cooked by wifey. Landed in coma due to very high blood sugars.

Pet dog, unimmunised, bit many on the same day, the dog died in three days. One diabetic patient bit by this dog died of sepsis / infection (not rabies). Immense horror among the ten-odd families of bitten members till date after a year.

Kid aged 14, parents allowed him to ride two wheeler on road without licence, killed on spot colliding with a truck. Toddler unwatched on the road died, run over by a truck.

60 year old Mother has giddiness for three days, son and daughter in law not free till fourth day to take her to hospital. Dies in casualty due to stroke.

Patient advised not to fast as it may increase chances of having fits. Fasted and landed in ICU with status epilepticus (a series of continuous fits).

Traffic police at a crowded junction busy with his “routine” away from his spot. Head on collision, two dead.

Unfortunately, in almost all above cases, the treating doctors were beaten up, casualty staff and hospitals vandalised, doctors sued, bad press judged an entire profession almost like a criminal, for not saving the victim.
© Dr. Rajas Deshpande

Often the relatives refuse to take patients to higher centers, expecting “big, advanced treatments and impractical outcomes” from low-cost, small nursing homes not equipped with specialty facilities, then end up vandalising or blaming such set-ups upon inevitable disappointment. Missed medicine, overdose, unobserved children, helpless neglected elderly parents, smoking, alcohol, traffic accidents all cause millions of deaths. So do delayed admissions, some herbals and “unknown” medicines, hunger, poverty, stress at home and workplace.

But it is the “death in hospital” that alone matters, and by default the blame is pinned upon the doctor!

Some actors can kill, rape, go naked, smoke, drink, race, gamble, pee in public, set records for drunken misdemeanours on and off screen, knowing that most illiterate and immature populations imitate them blindly. But they will tell the nation how the medical profession (for which they themselves did not opt in spite of excellent merit in school or in some cases even college) should behave and treat patients!

The few honourable judges who have now realised the “blackmail potential” of medical negligence cases, have fortunately started referring these cases to panels of medical experts before concluding and fixing charges. The only maturity issue that remains is about local goons and politicos with flitting loyalties looking for publicity at the cost of the harmless and intellectual population of doctors. These goons turn the helpless frustration, panic reaction towards tragedy and poverty of our society into anger against doctors and hospitals. As long as there are sane people in the responsible media, there is good hope.

Doctors must start recording without bitterness, any hostile tendencies, lies, deviation from duties towards the patient, advised and declined tests and treatment, neglect and avoidance patterns to provide adequate care for the patient by the relatives. Also the exact circumstances of onset of the problems (patient was drunk / drugged / under medication effect / fasting / missed medicine) etc. and relevant past that may have contributed to the event. This will minimise the allegations and misrepresentation of facts.
© Dr. Rajas Deshpande

Ofcourse the doctors must also discharge their duty with the highest standards of practice possible in their set-up. They must communicate well and explain the condition atleast once to the concerned relatives. They must behave courteously, sympathetically and try to understand and forgive the panic states of relatives within the sphere of civilised behaviour. We all love our patients. But like in every other relationship, we fail to say it aloud and make it clear with our behaviour, thanks to heavily stressful and inadequate lives we lead. Let us make an effort on our side to take one more step in the direction of kindness and understanding, in a hope of saving this profession from defamation at the hands of middlemen.

Let us make a greater effort to tell the society that it is only a doctor who will never intend harm. The only reliable rescue from the clutches of death, even a doctor fails sometimes. The effort has to be recognised if not always rewarded, but never suspected.

Negligence, you see, is easy to pin only upon the doctor.
All others are forgiven any number of deaths in all other types of negligence.
© Dr. Rajas Deshpande

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The Lawless Side of Medicine

The Lawless Side of Medicine
© Dr. Rajas Deshpande

A well educated businessman driving in his car with his family had an accident. He had some bleeding wounds, but was fully conscious and alert after the accident. A few young college-going students stopped to help, picked him up, hailed an autorickshaw and took him to the hospital. The patient’s wife and child followed in another.The junior surgical and orthopedic residents examined the patient, stitched his bleeding wounds and started medicines. The wardboys and other staff carried the patient to the CT scanner, and shifted him to the casualty after the scan. Patient’s wife accompanied him throughout. When the senior surgeon came over and asked the details of his prior health status, the patient requested privacy and revealed that he had recently been diagnosed with HIV infection, and was taking some traditional medicine for that. Atleast 4 College students, the autorickshaw driver, and 2 wardboys had been exposed to direct contact with his blood by then. The treating doctors had their gloves on, but not the complete gear expected to be worn while treating such patients. He himself or his wife had not cared to tell helping hands to protect themselves.
There are many blood-borne diseases, some fatal and some dangerous. While the courts merrily write orders about help to the victim (which is must), no one cares about the risk to the helper’s life while executing such help. No court has ever ordered the government to make Universal precaution gear mandatory in hospitals, especially govt hospitals where thousands of budding doctors, nurses, wardboys, techs are exposed to blood contact daily, without knowing the infective status of the patient. No court has ever ordered the govt to implement precautionary measures to avoid accidents, drunk driving, or emergency roadside assistance. People can drink, drive reckless, cause accidents, govt can do away with wrong licencing, zero roadside assistance, but everyone including the press will pounce upon the treating doctor for a bad outcome! No court ever questioned the authority which issued licence to a driver involved in traffic accidents!

Another. A lady of 60 brought to the casualty unconscious, with drunk “mob” led by her son. The son tells that she never had any health problem till that evening, when she had convulsions. They demand immediate admission in ICU and treatment, and declare that they have no money. The hospital obliges and admits her as a free patient as an emergency as per court rules. Next morning the recovered lady revealed: that she had had convulsions till few years ago, was advised regular medicine, but stopped it many months ago. She was also an alcohol addict and had taken alcohol on the prior night. On the day of convulsion, her husband had had a big showdown with her. Upon questioning the same son next day, he replied to the junior doc: “I never said she didn’t have any health problem, and you never asked if she was addicted to alcohol”. They also didn’t have the BPL card they claimed they had.

Fortunately she went home all well, but one shivers at the idea of what would have ensued had she not improved. Probably another cruelly beaten up doctor and voluptuous bad press against the medical fraternity in general.

It is the responsibility of the doctor to be good, perfect and true in everything he / she does. But if the whole action / decision making of this doctor is based upon what the patient tells, any lying / hiding of information by the patient is then likely to impair the outcome. To presume that all patients always tell the truth is a joke. Many hide addictions. Many hide stigma-illnesses like Tuberculosis, Epilepsy etc. Many hide that they were beaten up by a family member. Many do not tell their drunk status during accident (some traffic accident deaths for which the casualty doctors are so often beaten up by relatives may likely be related to the patient being drunk).

The most dangerous patients are those who have themselves or because of family pressure neglected the disease until the time it has reached a critical level, often beyond cure. When something happens to such patients in the hospital, our society is quite impressed with only an innocent sentence: “The patient was completely alright till admission”.

Some patients do not tell that they missed medicines. Some do not follow precautions. Some take additional herbal / traditional / quackery-born medicines along with the standard treatment, without revealing it. The entire responsibility of outcome in every case in any hospital is pinned down upon the treating doctor.

While compassion and the art of “extracting” the correct details are essential for every doctor, it is not mandatory for the patient to tell the complete truth. In this medicolegal age in a mostly illiterate, superstitious society, it is essential to educate people about telling the truth and taking precautions while helping others.

If you have an open wound / cut / injury over your own skin, please refrain from touching a bleeding patient. Avoid blood contact of any person unless you are in a position to save life by taking that risk. It is wise to keep a box of gloves in your car / four wheeler, or carry a pair in your purse / office bag for such an emergency.

While it is expected that every doctor, irrespective of how busy he / she is, writes detailed notes and prescriptions in capital letters for every patient, there is no responsibility assigned to the patient. If the patient is a consumer and the doctor liable for even tiny mistakes or unfavourable outcome, then the clinical-legal responsibility of patients must also be defined. It must be mandatory for every patient to write the details of their health, prior conditions, all medicines, etc. in legible handwriting and sign it with witness to submit to the doctor / hospital, before treatment is begun.

Many patients, educated or not, know this responsibility and carefully, truly detail the doc about everything asked for. They also mostly respect the outcomes. They usually do not blame others / doctor for either their illness or addiction-complications.

However, there is a surge now a days in “blame it all upon the medic or the hospital”. It is high time some wise judges recognize these issues before deliberating a judgement.

Till then, the Indian Medical Profession is at the mercy of press-interpretation.

© Dr. Rajas Deshpande
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The Bloody Negligence on Indian Roads

The Bloody Negligence on Indian Roads
(c) Dr. Rajas Deshpande

There are over 5 million patients who suffer from epilepsy in India, @ 60% do not get correct treatment (various reasons). Over 4 million of these are adults. Indian law bans anyone with even one seizure from driving (lifelong). While one sympathises with the patients and all attempts must be made to treat and rehabilitate them, one cannot neglect the risk to life: their own and many others. So there are over 4 million potentially unfit / dangerous drivers in India on roads, many with heavy vehicles, some with driving as their profession. Only the aviation industry insists upon superficial screening for epilepsy. About notifying RTO by the doctor, given the illiterate + politically backed violent lawlessness of most Indian population, the doctor’s life is at risk in doing so. Most Neurologists / other specialists educate the patient about not driving after this diagnosis. Patients still continue to drive (and parents / relatives allow them to do so), with an excuse “How else will I work?’ and other illogical arguments. If we see the pattern of heavy vehicle accidents, many are in the early morning hours (lack of sleep may precipitate seizures), and are described as “sudden loss of driver’s control over the vehicle”.

Many other medical conditions are incompatible with driving, but the drivers carry on nevertheless.. Who is responsible for the thousands of these accidents and hundreds of deaths they cause? Is this not gross open negligence, with proof everyday?

(C) Dr. Rajas Deshpande