Tag Archives: Compassion

The Poverty Vow

(c) Dr. Rajas Deshpande

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

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

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

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

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

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

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

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

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

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

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

“Yes?”I asked.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

(c) Dr. Rajas Deshpande

A Thumb Impression Of Our Society

© Dr. Rajas Deshpande

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

© Dr. Rajas Deshpande

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The Other Side Of Life

(c) Dr. Rajas Deshpande

“Wear your helmet” said my grandma, as I kicked my scooter “and don’t argue”.

I could have argued with the POTUS, but not with my grandma. I had come to my uncle’s house to visit my grandma, with the additional attraction of eating the delicious Diwali snacks she made. I wore my helmet and scooted back as fast as I could. My duty started at eight PM in the ICU, and the resident doctor who was on duty had warned me that she had to be with her in-laws for her first Diwali with the new family. All icu beds were full, one patient was intermittently gasping, unlikely to recover, and three others were fluctuating.

Firecrackers, lighting, happy people in new clothes were all around, yet out of mind. I parked the scooter outside the ward and ran in.

“Thank you thank you” said my predecessor, and explained me the cases and ongoing treatment.

When at the bed of the patient who was intermittently worsening, she told me “Listen he’s on dobutamine drip, we don’t have it, I have borrowed two ampoules from the medical shop outside. I will pay him later. His family has no money”. Many critical drugs were not available in the icu, a common problem even today across India.

She left.

Behind the ICU building, a political party was celebrating the festival in a pandal, with repeated announcements of its achievements. Loud lewd music was playing, less irritating than the dramatised loud repitition of the party leaders’names. (c) Dr. Rajas Deshpande

Three more heart patients came in, but the ward beds were full, there already were twelve patients on the floor. This is a common scenario in almost all government hospitals across India. We begged the ward resident doctor to help us, and he agreed to shift three of his patients to the floor. The heart patients were taken on the beds outside ICU, and their medicines were started. We struggled at every step. The student nurses, enthusiastic and energetic, virtually carry half the weight of the doctor’s work upon their shoulders. (c) Dr. Rajas Deshpande

A municipal councillor walked in drunk, and started abusing the ward resident doctor for shifting “his”patient to the floor bed. Aggressive and drunk, his language was more offensive than his personality. We tried explaining to him that there were critical heart patients, but he insisted that his patient be taken on the bed. We then requested a stable young patient, who agreed reluctantly to go to the floor bed.

While this was being done, another old man was rushed in, his bronchitis/ asthma had worsened due to the excess pollution, a common problem in modern India. He was too late, his ambulance had been held in traffic. Already blue-black, he could not be saved inspite of frantic efforts. There were no relatives with him, we completed the paperwork and sent him to the mortuary.

In a few minutes, the fluctuating icu patient had a cardiac arrest. Loud noises of emergency carts, glass ampoules being broken open, and panicked cries filled up the ward. Starting CPR, we tried best to restart the silent heart. Such moments are beyond prayers, the doctor’s heart appeals through his hands, a dead patient’s heart. After a few minutes, the best sound in the world- that of a heart beating again- could be heard. Fingers crossed, we restarted his life-supports and gently informed his wife about what had happened. She was sobbing violently. I went to the doctors’ room to wash my hands.

It was then that the political pandal music could be heard again. (c) Dr. Rajas Deshpande

“Our party has made this big decision. You will all have to pay a little extra, but we will give you a modern, advanced, beautiful India. We will make more advanced satellites, bridges, we will buy the best fighter jets in the world, more bullet trains and bigger statues shortly. We are already ranking very high in the world, we will continue to grow. The only major problem in India is other political parties” the speeches were heard loudly, with proud shouts of joy and claps from the pandal.

At about 5 AM, things settled down enough to sip some water. The nurses had made tea for themselves, the incharge sister Mrs Joseph lovingly ordered me to take a quick break and have a cup of tea. She read my face. (c) Dr. Rajas Deshpande

“Doctor, I have been in this government hospital for nearly thirty years now. Nothing changes, whichever party comes to power. No one cares about the poor patients or their life. We need millions of doctors and nurses more, we need beds, equipment, so many more medicines, but we have to keep begging to the government as if we need it for personal use. Hundreds of patients die every day due to lacknof Medical care, because they cannot get beds, medicines or critical care. I was fed up long ago and wanted to quit. I had excellent offers from middle east and even UK. But I thought, if I left, who will look after these poor patients?”. She was to retire shortly.

Thousands of excellent doctors and nurses, pharmacists, and oher hospital staff carry on caring for poor and desperate patients in government and even private hospitals all over India, they are paid peanuts, are exploited inhumanly, yet keep working through festivals and celebrations, away from their families, with a smile upon their face. Right now, millions of critical patients are being attended by thousands of doctors, nurses and other hospital staff without thinking about salary, rewards, medals, sweets, new clothes or any form of celebration. The only medical festival is a saved life.

This post is to stand up and say a heartfelt “Thank You” to these doctors and nurses who are spending this Diwali with their patients.

(c) Dr. Rajas Deshpande

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A Good Doctor’s Daughter

© Dr. Rajas Deshpande

We sat inside her home, not able to speak. It was a Sunday. The doorbell rang. My classmate Siya looked at me, indicating with her eyes to please answer it.

Siya had lost her father that early morning. We had just finished the last rites and returned with that feeling of emptiness of life which prevails at such moments. Her father was a successful pediatrician, known for his excellent diagnosis and humanitarian approach. He had passed away at a very early age due to a rare cancer. He had kept working till the day he was admitted. His devastated family was staring at a long dark tunnel.

I went and opened the door.

“Doctorsaab hai kya? (Is the doctor home?)” asked a man in his thirties. Behind him were his wife and a son, about ten years old.

“No” I replied, but his wife immediately said: “Please, my son is his patient since last ten years, he has fever since last three days, we must meet the doctor”.

I requested him to please clear the door, shut it behind myself, and whispered to him: “Doctorsaab passed away early this morning”.

They looked at each other.

“How?” the husband asked.

“He had a cancer, he had some sudden complication” I replied.

After a pause. The husband asked “ Can you suggest some good pediatrician nearby?”

I did, and they went away. © Dr. Rajas Deshpande

There was no word of feeling sorry for the doctor who had treated their son for ten years. Not even a formal gesture of condolence. Their child wasn’t very sick either, to skip the basic courtesy. For the next few days, I was at their place on and off, and somehow expected that man to return to express some form of condolence or gratitude. It never happened.

Then over a period of years, the truth gradually dawned: that this is normal. No one comes back to ask a dead or retired doctor’s family if they need any help.

Another young colleague of mine, a diabetologist, passed away recently. He had done phenomenal social work, treating many patients free, and even arranging for many patient’s education. Every time he referred a poor patient to me, he called up, requested me to see the patient free. We all gladly did. We had many common patients who followed up later with me, after his death. Unfortunately none of the patients who he had called about ever expressed anything beyond “He was a good doctor. Now I go to this doctor”.

I wonder how many of these patients will ever realize that every time this doctor had seen them free, he had taken a share of what his own children would have inherited, and given it to that patient.

I am a fan of Ayn Rand. I believe that it is nobody’s duty to help me, and that I should rely only upon myself. But unless this stands on both sides, it becomes meaningless. While the expectations from every doctor are expressed in heaps, when it comes to rewarding the good results “blessings, satisfaction of saving a life and good wishes” are conveniently considered enough. I sincerely doubt whether the future generations of doctors will be able to buy their petrol with blessings and satisfaction. © Dr. Rajas Deshpande

Why is the compulsion of “courteous, polite speaking” only applied to the doctors? Why cannot our society learn the same? The idiotic claim (often supported by some media legal officers) that ‘a patient is in distress and so doctors must accept the anger, impolite behavior, violence or abuse’ is so stupid and meaningless! Will a judge ever accept such reactions by an angry criminal? By the way, if the patient is stressed, is the doctor also not stressed for years? Is the doctor then allowed to misbehave? If the doctors can learn courtesy, why cannot others?

It is so funny that even the great politicians who keep on throwing mud and blood upon each other, use basest language of threats in public day in and day out advise doctors about how they should learn courtesy, humanity and communication.

Siya has now become a successful practitioner. After her father’s death, she wasn’t helped by the government, society or the patients that her father treated. The family had to compromise a lot to complete education of all the sibs.Yet she became an excellent doctor by her own wish, her own conviction and continues to be praised by her patients for her courtseys. After all, she is a good doctor’s daughter!

But her smile, when her patient compliments her, is hollow.

© Dr. Rajas Deshpande

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The Tribe and The Ring

(c) Dr. Rajas Deshpande

“Before coming to India, I searched a lot and bought this holy stone for you, the same one I was given as blessing for a good future. I wear exactly the same ring. As a mark of my gratitude for the treatment my son Hathim received in India, we want to make you a part of us. Please wear this ring” said Mr. Jade from Yemen.

About a month ago, he had left for Saudi Arabia, leaving his children back in India, to continue treatment. His younger son suffered from a very rare type of epilepsy (Lennox-Gastaut Syndrome) of uncontrolled fits / convulsions and was not mentally growing up well. The 16 year old elder brother cared for the younger one, as they stayed at a rental house in Pune. The case was very difficult, and I had to seek help from my teacher Dr. Sangeeta Ravat in Mumbai, who suggested crucial inputs in managing the kid. Fortunately, the fits are now controlled well, and the father arrived in India to take back the kids to Yemen.

He not only gifted a bag of perfumes, dates and sweets from his country (most Arabic patients, however poor, usually bring gifts for the doctors they visit), but also personalised the bond by bringing for me the same ring that someone had given him for a good fortune. Superstitions apart, but wishing for someone the same that one wishes for oneself is the core of almost every religious text.

Of course the major credit here is that of my teacher Dr. Ravat. I did nothing extraordinary, many doctors treat their patients with their soul, and get excellent results. The reason for this post is the pride of belonging to that tribe called “Doctors” which breaks not only the boundaries between countries, but all the walls between cultures, languages, and societies. This “Doctor”tribe has the rarest opportunity in the world: a free entry in the heart of any human being anywhere upon earth!

This ring is dedicated to that tribe: all doctors who have gifted health and life to millions.

As the beautiful kid travels back to his country, we pray for the best health and happiness for him and his entire family!

(c) Dr. Rajas Deshpande

With Mr. Jade, Master Hatham, and a friend Ms. Arwa.

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

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“My Turn Now”

©Dr. Rajas Deshpande

“I don’t want to live like this. I have stopped eating since today. Please do not be angry with me for this, but I cannot see you and my children suffer because of my illness. Let me go with peace” Geetanjali said to her husband.

Eighteen years after her marriage, in her late thirties, Geetanjali suddenly lost the function of one half of her body. Her children were still in school. Her husband Gajendra Jagtap works as a school teacher and does some farming on a small piece of land they own. The whole family was shocked and shattered with this calamity that befell Geetanjali. But Gajendra Jagtap decided not to be broken down by destiny, and took his wife immediately to the best hospitals in Mumbai. They were told that Geetanjali was suffering from Multiple Sclerosis. After a few days of treatment, they could not afford to stay in Mumbai and came to Pune as it was nearer to their village. The Multiple Sclerosis Society of Pune extended its helping hand. Geetanjali was yet unable to stand up or walk. ‘This illness is totally unpredictable, anyone can develop blindness or disability anytime’ doctors told them. Geetanjali felt hopeless. She was very depressed with the thought of stressing her husband financially to provide for the treatment expenses. She also worried if her children’s education will suffer due to her illness and financial constraints. This was the reason she decided that she did not want to live any further, and gave up eating or drinking anything.

But Gajendra was not the typical Indian husband. This B. Sc. Graduate who had taken up teaching in a rural school as his profession had a big heart, and harbored principles of equality and respect for women, just like a highly educated spouse in a developed country. He told Geetanjali, ‘You have served me and our children for over eighteen years now. When I was working in the school or in the farm, you looked after the home, cooked for us and fed us sumptuously. Now give us a chance to repay for what you have done for us. It’s my turn now. I am going to take care of you just like you cared for us.’ Geetanjhali could not hold her emotions and sobbed when she narrated this story to me.

‘At that point of time, I felt like living only to help my family. I decided to use whatever few healthy days I had to make my husband and children happy.’ She started to fight her disability with a new spirit, and in a few months could walk very well again. Since then she had attacks of this disease many times, but vehemently fought it to recover every time, with the help of her husband.

Gajendra told me “I explained my children our situation. I told them that we don’t have much money left, and that they must only complete their education based upon merit. We are very fortunate that our children decided to grow up quite early in their childhood. Both of them studied very well, and my elder son is now doing his post graduation which he got through a scholarship in Delhi. Even my daughter got excellent marks and is now pursuing her post graduation by winning a scholarship. Both of them take care of their own expenses, and never bother us for money. Even I have decided that whatever our destiny presents us with, we will face it with a smile, and never accept defeat in any situation. We have to visit hospitals many times, spend on treatment and investigations, travel many times, but we do it all with a spirit of winning together. Whenever she can, she still takes care of the home, and when she can’t, I do it with the help of my daughter. But we never feel desolate or depressed”.

In the developed world, people suffering from this illness get a lot of healthcare facilities, and even income tax concessions. However, this farmer from a lower middle class background who does not receive any such help, has not only resurrected his family, but created a new life for his wife with his sheer love and determination. The most admirable thing about his love story is the respect and feeling of equality with which he thinks of his wife. Geetanjali also stood up firmly with him to conquer this illness, with all her love and might. Together, they have indeed defeated their destiny.

We sincerely pray for the excellent health, well-being and long life for each member of this wonderful and ideal family.

© Dr. Rajas Deshpande

Neurologist, Pune

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The Medical License to Kill

© Dr. Rajas Deshpande

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

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

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

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

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

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

The Nursing Super smiled in shame.

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

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

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

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

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

Jai Hind!

Mahatma Gandhi ki Jay!

© Dr. Rajas Deshpande

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The Deadly ‘Vegetable’

The Deadly ‘Vegetable’

“How is my mother, Doctor?” The smiling politician, a tower of patience, surrounded by his impatient bouncer cronies, and a drooling doctor, asked me at the door of the critical care unit.

I examined the patient, a case of a large bleeding that had caused severe damage in the brain. Inputs were whispered in my ears by the cautious doctors of the unit. The poor lady had been treated by many excellent doctors in Mumbai and Delhi, as the family of that politico had that free facility. However, she had stopped the blood pressure medicines as some “Herbal Baba” had criticized them on National TV. © Dr. Rajas Deshpande

“She is conscious, but cannot understand or respond at all. Her heart is beating well, blood pressure is holding up, and her breathing is fine too. She can move her hands and legs, but it all appears meaningless movement. This may last for weeks or months, and in some cases, even permanently”.

The ‘doctor’ with that group authoritatively asked “That means she is a vegetable now?”.

“The correct word is ‘Vegetative’, the medical condition is called ‘Persistent Vegetative State’, and I cannot say as of now if this will be persistant. There are some chances of recovery” I replied with a carefully acquired masked face.

“Is there anything we can do anywhere in the world to make her brain normal again? I can take her to the best centers in the world” said the Politico. The drooling doc came forward again. His desperation to be significant was almost killing him. “Are there any medicines that can make her recover faster? We can afford anything” he asked.

I knew the exact words to reply him with.© Dr. Rajas Deshpande

“No Sir. Just as you cannot shorten the period of pregnancy, you cannot convert it to three months in the best of the hospitals , however rich you may be, the recovery of brain happens at its own speed. The medicines that can help her are already on”. This usually stops further discussion in that line, it did.© Dr. Rajas Deshpande

I went to the cafeteria to cool down. I couldn’t understand whether it was the tail-wagging doctor or the politico with ‘everything exists to serve me’ attitude that irritated me more. A cyclone of the big picture started rising in my mind.

The state of our “Government run” healthcare, is more or less the same: Vegetative. Big plans, big declarations, more investment, more land and buildings, more equipment, all surfaces, especially during elections. But the brain: good doctors in the system: is dead. No good healthcare system can be created or run by those appointed without merit, without quality. Thousands of huge set-ups declared and erected by the various governments are lying vacant, or serving far below their purpose because there are no good doctors/ technicians in most. The last battalion holding the flag of good healthcare: good medical teachers in medical college are on the verge of extinction. Best of the government-run hospitals and services are often reserved for those in power and their families. The shameless orders for “reserving ICU beds and ventilators, operation theaters etc.” for a patient known to a politician are a daily affair, they least care if someone else without an influence dies.© Dr. Rajas Deshpande

Appointments of drooling, medal-hungry shoelickers on various key medical posts has crippled the system. The real poor and deserving are thrown from one window to another to submit documents and applications to claim the benefits that they deserve.

The whole blame of a this deadly “Vegetable” healthcare is cunningly shifted upon those who refuse to work as ‘personal servants’ to the government, those who go into private practice, and private hospitals. Now almost all doctors complete their bonds, yet there is a gaping hole in the system that cannot retain specialists for long. Only the compromised, beginners, and failures stay for long in adverse, sycophancy based, low-cost environments. The very politicians who say “Don’t worry about money” when asking treatments for their own family, accuse the doctors of being “greedy”, when they leave govt. services.© Dr. Rajas Deshpande

The simple solution, the recovery of the brain, i.e induction and retaining of good, meritorious, non-shoe-licking and highly qualified specialists in the government-run healthcare departments and set-ups will probably change this scenario. But this looks impossible, now that even many doctor’s organisations have started losing their autonomy, self respect, to fall in line with the glorified slogans and to lick the bottoms of those who run such failed healthcare systems. The addictions to blow up any tiny good news, modify data to appease masses, hide the blaring failures, deficits and corruption in the healthcare have become a norm, and even our society seems to be ecstatically happy to just hear loud speeches of big plans rather than facing ground realities.

Indian Healthcare run by various governments, except for very few honourable exceptions, has become a brainless “Persistent Vegetative Healthcare System”. A ‘deadly vegetable’, for the understanding of the drooling docs. Unless someone sane and responsible in healthcare department acts quickly, we will lose this healthcare battle.

© Dr. Rajas Deshpande

PS: During the writing of this article I received over 20 phone calls from patients, and 12 of them dropped, cut, hanged. This is our technical progress. Before we send men in space, can we deal with this?

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The Greater Squint

The Greater Squint

© Dr. Rajas Deshpande

“Why didn’t the doctor tell us? Is it allowed for the doctors to hide such information? I will sue him” the angry mother kept shouting as she cried. Her husband told her to calm down.

“I know the other doctor well, I will talk with him today. He must have his reasons” I replied.

“No doctor, we don’t want you to talk to him about this” said the father.

Their fifteen year old brilliant daughter had developed mild headache and occasional giddiness. They had first read blogs about these symptoms, and after trying out various “natural” remedies and lifestyle changes, visited their family physician. He had started with the routine medicines for headache, and advised them to visit a specialist if the symptoms persisted for a week. As the headache didn’t subside, they visited a specialist. His notes indicated a normal neurological examination, and some higher medicines for headaches and giddiness. After a week, the girl developed a squint, double vision and slurred speech suddenly, and was unable to walk. She was brought to our emergency, her MRI of the brain showed multiple sites of infection including the lower part of the brain. Although most infections are treatable, those in the lower part of the brain (called brainstem) are extremely dangerous, and can cause even coma or death. This part has all the vital centers of the body, controlling heart rate, blood pressure and respiration. © Dr. Rajas Deshpande

When I explained this and advised admission for further treatment, they had panicked. That is when the mother had lashed out at the earlier doctors.

After admitting the child, the father came back.

“Doctor, I must make a confession. My wife is quite anxious, and she was crying when we saw the last doctor. That’s why the doctor didn’t tell her everything, but asked her to wait outside and informed me that there were such dangerous possibilities as cancer, tumor or infection, and that an MRI was necessary. I requested him not to write that on paper, thinking that my wife will panic. She is very emotional. That’s why we waited for a few days, thinking that things will improve. Please understand us, doctor”. I reassured him, and treatment was started.

The inflow of blatant allegations against allopaths/ modern medical practitioners is now so wide and strong, that this has sensitized some of the best doctors. Some have started to entirely avoid mentioning the tests required for a complete evaluation of a condition, knowing that if the doctor advises any tests, the only interpretation in our society is that those are for earning more money.

“Patients themselves do so many tests and take so many medicines without consulting a doctor. But if we advises any tests, the immediate allegation is that we want to earn more money. That affects our practice. So shall we still advise tests?” asked a colleague during a recent seminar. © Dr. Rajas Deshpande

The answer is a definite, loud yes. The duty of a doctor, besides being well qualified, skillful and compassionate, is also to boldly state fact and possibilities, advise the best investigations and treatments to every patient, poor or rich, VIP or AAP, and write these all on the patient’s case paper. The workup / investigations advised should be according to the global best practice guidelines. Poverty and illiteracy are neither the faults or responsibilities of a doctor, and like other professionals or even some governments, a doctor cannot provide “low grade” service to any poor patient. From the eyes of a doctor, even a penniless beggar should get the same advice about tests, medicines and surgery that the Prime Minister of the land gets. If ministers can go to corporate hospitals or even abroad for treatment, every citizen should also be sponsored for the same benefits by the same administration through the same funds, without preaching the doctors to do more “charity”. Otherwise we are a hypocritical society. © Dr. Rajas Deshpande

Whether to do those tests or not, where to do them is the patient’s choice. Whether to take the advised medicines is also upto the patient. The doctor may suggest the best place, request concessions, and if the patient is poor, suggest options to get financial help or refer to charity. But the quality of medical advice should never change. The only exception is an accusative, angry patient who is making paranoid efforts to find faults with everything that you do. One may politely decline to accept such a patient.

If the treating doctor has not advised all the tests necessary for the evaluation of relevant diagnostic possibilities, he/ she may be found guilty of negligence. To avoid advising tests just to please the patient would also be a moral crime. One must also refrain from crossing over to other specialties and advising tests before referral to the right specialist. Some “pretending to know everything from every specialty”, doctors advise various tests incorrectly, and even attempt treatments out of their expertise without a working diagnosis. . Such dangerous doctors may add to the woes and defamation of the profession. © Dr. Rajas Deshpande

The girl above is improving, although her balance is off, and she has developed t a squint. Most likely her squint will never improve. She is missing school for over three months now. She will now onwards live a compromised life: incomplete education, compromised marriage and the condescending Indian society where shame of physical disability like squints and lisps, slurring and imbalance are the essential components of most enjoyed comedies.

However, her squint is far lesser a problem than the one that our society has, against doctors.

© Dr. Rajas Deshpande

PS: Many people comment often that “Doctors should introspect”. I do not know how many of these people introspect about their own habit of finding faults with others before self. But the article above is an honest attempt to do so.

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