© Dr. Rajas Deshpande
A continuous beeping filled up the air in the ICU. Over twenty hearts kept making rhythmic sounds, the nurses kept on silencing the false alarms that rung every now and then, and informing us about the ones that needed attention.
We had kept the cake in the doctor’s room, we were waiting for the right moment. It was well past midnight, we had all wished Dr. Steve a happy birthday, but the ICU was full and busy, we waited for an opportunity to cut the cake.
A very old Parsi man, just recovering from a massive heart attack, was not maintaining his blood pressure. As his alarm sounded again, we rushed to attend him: Dr. Steve, myself and our nurse Ms. Divya. As we adjusted his intravenous drips, he asked us our names. He was funny, and always made us smile in spite of the deadly shadows that surrounded us. When we told our names, he smiled. “See, there’s a Hindu, a Christian and a Parsi happy in this small 10 by 10 room, but they cannot all stay peacefully outside in this big country!” .. Dr. Steve, always interested in one-upmanship, smiled and said, “If you want, we also have a Muslim and a Sikh doctor outside. Shall I call them in?”
With the typical instant Parsi wits, the old man replied “Arrey no no bawa, all our ********** (I did not completely understand that word) political leaders will die if people from all religions come together”.
It was difficult to say whether we were treating his heart attack or he was treating out tired minds. © Dr. Rajas Deshpande
The CMO called, there was a new patient coming up, a young lady in respiratory failure due to pneumonia. As the nurses prepared the new bed, Dr. Steve took down notes from the CMO. Ms. Divya was one of our most efficient and agile staff nurse. Very beautiful and brilliant, she took responsibility upon herself with a passion that would put to shame even some doctors. We all knew that there was something going on between her and Dr. Steve, but both of them kept mum. I knew for sure though, because Dr. Steve had once confided to me about this crush he had upon her. However, overwork always suffocates personal life in a hospital.
The stretcher rolled in, noisy with calls of panic. The patient was gasping. Urgently shifting her on the ICU bed, Dr. Steve intubated her. She coughed a lot, and both Dr. Steve and Ms. Divya were showered with blood stained secretions. Dr. Steve had his mask on, but Ms. Divya had not had the time to put hers on. He angrily shouted at her, while adjusting the patient’s tube, to wear her mask. I finished securing the IV line, and started pushing in the emergency medicines. © Dr. Rajas Deshpande
The patient was a young lady, who had suddenly developed fever, cough and cold. On the second day she had become restless, was admitted in some nearby hospital, but as she continued to worsen in spite of treatment, she was referred to us. It was a viral pneumonia, an extremely invasive and dangerous viral infection had started filling up her lungs with fluid and blood. Just as her oxygen levels improved, she developed an irregular heart rhythm: viral infections often cause severe damage to the heart, a condition called myocarditis. In two hours after admission, the lady died. Horrible moments followed, telling her broken husband and stunned kids that she was gone forever. Completing the formalities and paperwork, we returned to the grind: we were medicos: there’s no choice for us to sit down, panic, repent, mourn or run away.
No one was now in a mood to cut the cake. No one even spoke about it. Next night, Ms. Divya bought another cake, and we all silently wished Dr. Steve a belated Happy Birthday.
Jutst ten days later Ms. Divya developed fever, cough and cold. The same deadly virus, most likely. We all panicked. Dr. Steve took leave and attended her, as her family was far away in Kerala. She had come to Mumbai to earn enough for her family. In spite of all efforts, Ms. Divya passed away in just three days. The faces of her elderly parents and younger brother became one of the worst memory-scars in our lives. Shortly after, Dr. Steve developed the symptoms too, but survived.
I took him out sometimes, to bring him back from the pit of depression and shock that he had sunken in. One evening, when we sat silently on Marine Drive, he said, “I will never have a Happy Birthday again. You know, Divya’s family has no support at all. I have decided to help them out for some time, till we find an alternative”. © Dr. Rajas Deshpande
Staring at the ocean, I kept wondering: In this country, where crores of rupees are thrown almost every other day for even miniscule achievements in cricket and cinema, where millions are spent from public funds upon the useless travel, security, meetings and social dinners etc. luxuries of the super-rich MLAs and MPs, where billions are spent by every political party in elections, there are no funds for the nurses, doctors and other staff who risk or lose their lives serving their patients. If a bridge collapses and many die, if there’s a major accident due to lapses in administration, there is immediate compensation, in an attempt to seal complaining lips. But if a medico is injured or killed, the best thing our society has to say is: “This is because all doctors work for money, it must be the fault of communication on the doctors part!”
We walked that whole night, along the ocean, silently crying. Sometimes the only solace for a medico is the thought that someday someone will desperately need a good doctor or a good nurse, and not find them around. Many medicos who do extraordinary good to their patients do not get any certificates for what they do. Most don’t care. Because we carry our death certificates in our pockets every day. One last certificate that we work very hard for.
© Dr. Rajas Deshpande
Dedicated to the nurses and doctors, medical staff who suffered / died because they served patients, saving lives.
Please share unedited
Profit and Loss
© Dr. Rajas Deshpande
45 year old man. Many weeks of tiredness, then three days of fever, quack treatment. Developed convulsions, admitted in coma. Blood sugars over 500. The long term past sugar index is very high, suggesting he has had untreated diabetes for months. After stabilizing patient in few minutes, I brief the relatives about critical condition.
His brother asks: Why is his sugar so high? He never had sugar. Is it because of any of the medicines you are giving?
I explain them that he has had high sugars for long, the tests say so. Also that we are giving him medicines to control sugar.
The wife says: “We don’t know all that. I think some medicines have made him unconscious”.
When he was discharged recovered, they fought about the bills saying that wrong medicines had caused delay in recovery. They gave negative feedback because the bills were not reduced to their quotes. “We were duped, we lost so much money” the son kept alleging aloud. © Dr. Rajas Deshpande
Old man, 82. Lung cancer, under radiation. Two episodes of paralysis, diabetes, blood pressure, now has drowsiness since Tuesday. His son and daughter in law come to opd on Saturday evening. The old man needed immediate admission and MRI. I tell them so.
“What is your diagnosis?”, “Exactly why is he drowsy?” “Why admission??” “Exactly what treatment?” “What will be effect of the treatment?” and many such screwing questions (sometimes I wanna ask back: when will you exactly pee next?) later, they went home. In the interest of the life of the old man, I chose not to lose patience.© Dr. Rajas Deshpande
They come back two days later, he had become unconscious.
“Why, doctor, why? He was walking till Sunday” cried the daughter, angrily asking us. “Why can’t you make him conscious? It’s been two days”.
Not only the arrogant tone, but the open distrust was offensive. “What is the exact reason of his unconsciousness?” “When exactly will he become conscious?” “Exactly blah blah?” asked the son, as if he was a Judge, and the doctors were criminals.
I wanted to tell them exactly what they were and where they belonged, but refrained. Patient first.
The treatment was on. Three days later, the old man opened eyes. “He has always had a strong will power. We knew he would recover” told his daughter to us.
Upon discharge, they wrote very bad reviews because the bills were not reduced to their expectation.
© Dr. Rajas Deshpande
Both came for follow up later.
In both the cases, a few years ago, I would have made an effort to spend more time, compromise self respect and continue treating them. Not now. Especially when peacock-fame decision makers decide about the fates of specialist doctors. Now, I tell them to please follow up with whichever doctor they can trust.
What about the probable income from such patients? Let me quote a dialogue that only Mr. Amitabh Bachchan could have delivered, from a film ‘Trishul’ that influenced me much since my college days:
“Zindagi mein kuchh baatein faayde aur nuksaan se upar hoti hain, lekin ye baat kuchh log nahi samajhte” (Some things in life are above profit or loss, but some people don’t understand that)”.
© Dr. Rajas Deshpande
© Dr. Rajas Deshpande
“Code Blue” someone shouted.
There were sounds of rushing, muffled sobs and wails, metal trolleys banging walls and glass syringes being broken open.
He rushed fastest, asked the relatives to wait outside.
“What’s wrong with him?” insisted the patient’s brother on knowing.
“His heart has stopped. Please wait out we don’t have time”.
The nurses had positioned the patient and started the CPR.
The ugliest sound in the world: the desperate rocking of the bed during a cardiac massage, was heard outside the cabin. The high pitch beeps of the defibrillator followed by the thuds of a body due to the electric shock initiated prayers even in the hearts of strangers. The relatives of other patients in the ICU waited outside their cabins, watching the faces of those who were crying. Those who could not bear the sight went inside their cabins. © Dr. Rajas Deshpande
He went on doing the CPR, knowing that the patient was young, and may still respond. The risk of this highly fatal disease to himself and the nursing staff was taken for granted: there is no time to “dress up” for CPR. He was simultaneously ordering the injections to be given. A male nurse took turns and helped him with the cardiac massage.
It is exhausting. Giddy after some time, he looked at the watch. It was about half an hour since the event. Almost nil chances now. He asked the nurse to continue, and came out to inform the relatives.
“He has had a cardiac arrest. We are trying, but it looks difficult” he informed the patient’s brother.
“Why? How come?” the brother shouted as the rest of the family gathered. © Dr. Rajas Deshpande
“We have been informing you many times. He has been critical. His lungs were not functioning well, his brain has many TB tumors, and his kidneys have been shut due to infection for a long time. It is called multiorgan failure”.
“We don’t know all that, doctor. Save him” said the brother.
Young patient. Fever since over three months. Avoided seeing allopaths for over a month. Diagnosed as multidrug resistant tuberculosis, one of the worst and most difficult diseases to treat. By the time they reached the proper specialist through all the “money saving” channels, it was too late. Almost all Government Hospitals have experts and facilities to treat MDR TB, but somehow people think it is below their dignity to avail of services at Govt hospitals.
The ICU doctor came out after a while. “We are sorry, he could not be revived” he sadly told the relatives.
Then there was a shriek, as the patient’s brother held the doctor by his collar, and slapped him. Exactly the style of Akshay Kumar from some movie. A lady doctor tried to stop the brother, but was held by the women in the family and bestowed with blows and abuses. The security, who had allowed the relatives on humanitarian grounds, regretted it, and desperately tried to control the relatives. © Dr. Rajas Deshpande
In an hour, they all left.
He washed himself. There was no time to cry, complain, register a case or go to TV channels or press. There were 22 other critical patients in the ICU, and he was in charge. He had to forgive, forget, digest it all. And then there was a perpetual expectation of the society to “understand” the misbehavior of the bereaved.
In a few minutes, another gasping patient came in on the same bed. A young girl with continuous convulsions. He rushed and intubated her, stabilised her. He talked to and pacified her panicked parents. © Dr. Rajas Deshpande
He had forgotten the slaps, the abuses and the blows he received a few moments ago. Like filmstars who slap qualified doctors on the screen and earn crores for that “entertainment”, he did not deserve a palatial bungalow and luxury cars, but as a life saver who saved hundreds every year, he was doomed to an asylum walled by expectations, criticism, abuse and overwork. Saving lives was “just a duty” not deserving respect or rewards.
The stress that comes from handling daily CPRs, saving lives and declaring deaths for years together cannot be acted by any of the Tom Dick Harrys on screen. Most of them are not even intellectually equipped to perceive the education, hard work and traumatizing effects of daily deaths and allegations that a critical care doctor faces.
While exceptionally literate and mature film personalities like Mr. Amitabh Bachchan and Ms. Lata Mangeshkar have always praised the doctors and spoken highly respectfully about them, most other “Muttonshop” artists have only exemplified their own jealousy about the highly educated doctors, trying to show them down one way or another.
I know of some friends who spend a sad, spoilt day even when they see a funeral passing by. The doctor has to face it every day, still carry on dealing with money savers, skimpy, arrogant, abusive and violent relatives reaching the hospital at the last moment. He has to garner a calm and control possible only with great effort. This tells upon the doctor’s mental and physical health. Being blamed and held responsible for someone’s death (this has become rampant now: to presume that all deaths are someone’s fault) in spite of trying hard to save them is something no film star, judge or minister will ever understand. Very few doctors are able to enjoy a genuinely stress free happiness in their personal life.
Of all the doctors suffering today because of the illiteracy, poverty and defective policy-making in India, the critical care and casualty doctors are the worst sufferers. My heartfelt tear and salute to their unending suffering for humanity. Also a strong appeal to the press, law authorities and the government to ensure that these highly stressed doctors are not assaulted, unnecessarily criticized or abused.
Just imagine a world without casualties or Intensive care services. That is a choice which doctors still retain.
© Dr. Rajas Deshpande