Tag Archives: Critical

At Home? Risks and solutions.

At Home? Risks and solutions.
© Dr. Rajas Deshpande

While it is necessary that everyone stays home during this calamity, there are certain risks involved in that. Here’s a list of solutions:

Inactivity and excess fried food increases chances of blood clotting in heart and brain. Stay active even at home, and eat healthy, fresh food only. Expose yourself to good sunlight wherever possible while keeping away from others. Reduce sweet/ sugar intake especially if you have diabetes.

While working from home avoid sitting in one place at a stretch, get up and walk for 10 minutes after every two hours.

Ensure 7-8 hours of night sleep, less sleep may reduce immunity.

Staying with even your loved ones 24/7 may not be all pleasant always. We are not politicians to ‘adjust’ or change party. We fight, but the party remains the same. Take care to reduce friction, allow each member their privacy and ‘Me’ time, do not irritate others. This will help reduce friction. This phase is tense for everyone, not all can express their feelings well.

Try to overcome the media effects on your panic by reducing TV/ screen time. Continuous onslaught of fear inducing news worsens stress. If you are home away from others you are safe enough.

© Dr. Rajas Deshpande

If you have elderly members at home please make them walk or move in wheelchair, bed and reassure them that they are safe, hydrate them well and keep their medicines in stock. Prevent their exposure to shouting TV bad news. Discourage fasting as low sodium levels can cause havoc in that age group.

Reading, writing, board games, light exercises, new recipe experiences, home cleaning and reorganisation, planning life after corona, sorting out cobwebs in your mind that you couldn’t earlier because you didn’t have time are the best things to do. Good time to set priorities in life.

Government should probably look at volunteers who can collect donations: medicines, food, masks, soaps etc. for the non affording and underprivileged. Even they have elderly populations at home and desperately need help.

This is a phase in human evolution, we will emerge stronger, fitter and wiser. Till then take care.

© Dr. Rajas Deshpande

At Home? Risks and solutions.

At Home? Risks and solutions.
© Dr. Rajas Deshpande

While it is necessary that everyone stays home during this calamity, there are certain risks involved in that. Here’s a list of solutions:

Inactivity and excess fried food increases chances of blood clotting in heart and brain. Stay active even at home, and eat healthy, fresh food only. Expose yourself to good sunlight wherever possible while keeping away from others. Reduce sweet/ sugar intake especially if you have diabetes.

While working from home avoid sitting in one place at a stretch, get up and walk for 10 minutes after every two hours.

Ensure 7-8 hours of night sleep, less sleep may reduce immunity.

Staying with even your loved ones 24/7 may not be all pleasant always. We are not politicians to ‘adjust’ or change party. We fight, but the party remains the same. Take care to reduce friction, allow each member their privacy and ‘Me’ time, do not irritate others. This will help reduce friction. This phase is tense for everyone, not all can express their feelings well.

Try to overcome the media effects on your panic by reducing TV/ screen time. Continuous onslaught of fear inducing news worsens stress. If you are home away from others you are safe enough.

© Dr. Rajas Deshpande

If you have elderly members at home please make them walk or move in wheelchair, bed and reassure them that they are safe, hydrate them well and keep their medicines in stock. Prevent their exposure to shouting TV bad news. Discourage fasting as low sodium levels can cause havoc in that age group.

Reading, writing, board games, light exercises, new recipe experiences, home cleaning and reorganisation, planning life after corona, sorting out cobwebs in your mind that you couldn’t earlier because you didn’t have time are the best things to do. Good time to set priorities in life.

Government should probably look at volunteers who can collect donations: medicines, food, masks, soaps etc. for the non affording and underprivileged. Even they have elderly populations at home and desperately need help.

This is a phase in human evolution, we will emerge stronger, fitter and wiser. Till then take care.

© Dr. Rajas Deshpande

Women’s Day and A Frightening Secret

Women’s Day and A Frightening Secret
©️Dr. Rajas Deshpande

A well respected senior, a social celebrity, walked in with his daughter. Cultured, proud people. Probably highly educated and rich. While he was richly dressed in a traditional Indian attire, she wore a saree. Many phone calls had told me since a day prior that he was very important, and that I must make sure he doesn’t have to wait. They sat down cautiously, the daughter in her late twenties looking at the floor.

“Doctor, my daughter is behaving strangely, she is not speaking normally with any of us, and seems lost since last two months. She has a lot of giddiness and has not slept for many days now. We have seen many doctors, done all the tests advised, but no one has been able to tell us what’s wrong. You see her and tell me if you can help.” Somehow the father was intimidating. I asked the patient her name. The father replied. I asked her about her complaints. He replied again. It is often very difficult to make a woman speak in the Indian scenario. I politely asked the father: “Could you please let her reply?”.

She replied in single words, mostly yes or no. She appeared to have given up. It is indeed tough to deal with such ‘mentally closed’ patients. I obtained her permission for a clinical examination and found nothing abnormal.

“Are you stressed ?” I asked what was inevitable now. ©️Dr. Rajas Deshpande

The father repied promptly: “There’s nothing to stress about, doctor. She works as a lecturer at a prestigious institute, we are quite well off, and although we want her to marry soon, she refuses to meet anyone. We are okay with that too, we are in no hurry. I dont think there’s any stress here. She just needs to be mentally strong. She has lost her will power”.

At this point the daughter looked up at her father, begging him to stop.”I have done whatever you asked. I came to every doctor you took me to. I am not weak. Please stop all this now, I will recover in few days”. I sensed something wrong here. I asked her if she wanted to speak in privacy and confidence, offering a nurse to attend instead of her father. Her father was visibly annoyed at the suggestion, and terribly surprised when she said yes. With a firm face, she said “Can I speak with the doctor alone for a few minutes, Baba?”. Her father walked out. ©️Dr. Rajas Deshpande

“Doc, I don’t know what to do. I am in a terrible situation. As you see, everyone is scared of my father, so no one tried to speak to me in privacy prior. To be able to trust you, I need your word that you will never tell my father about this discussion. If you cannot keep that word, it is best that I don’t speak with you about my problem”. This was a common request. A doctor’s first loyalty is to his / her patient. I reassured her that whatever she speaks won’t go beyond me, and also told her that she should be completely honest and open, that I was not here to judge her but to help her.

She paused, embarassed. The stress and shame of what she was going to say reddened her face. She sipped some water and took a deep breath.

“Okay doc. Five years ago, I was in love with a classmate of mine. He is from a well known politician’s family, and we were very close. We were planning to marry after a few years. He had alcohol frequently, but had promised me he would stop after marriage.”

She paused again, now tears in her eyes. “Please don’t misunderstand doc, but like all other lovers of our age we exchanged naked pictures and video clips. We also recorded some of our own, making love. As my father often checked my phone, I deleted everything immediately. I told him too to delete them, but apparently he stored them. After a few months I found out that his alcohol addiction had become worse, and he was going around with another girl, so I stopped seeing him immediately. He never cared, and he married someone his parents had chosen”.

“However, three months ago, out of the blue he called me and asked me to meet at his home as his wife had left him. I refused. Now he is threatening that if I do not meet him he will upload my nude pics and videos on the internet. Their’s is a very strong and rich political family, I know he can do anything and get away with it. You just met my father, you can imagine his reaction to this. My family is proud of me, but they will never accept or forgive me for what I have done. I feel ashamed, but there’s nothing I can do about it now. I am loved where I work, my students look up to me as a teacher. All is on the verge of being lost for me now. I feel like I should permanently disappear. I don’t know what to do” and she let out all the sobs she had held for months.
©️Dr. Rajas Deshpande

This wasn’t new to me. While virtual exchange of ‘love’ in form of nudity and self recorded sex between couples is a reality of current times, it strongly contrasts with the social preparedness for it. Our society is not only orthodox, but shamefully, violently critical of anything that offends their cultural tastes that vary from family to family. An exchange of such nudity between couples in love is their personal choice and preference, no one should feel offended by it. However the dilemma of its correctness arises when situations of such blackmail as mentioned above create catastrophic consequences.

Many women (and I am sure even men) face threats of their privately exchanged nudity being exposed. This rampant blackmail that extorts anything from money, sexual favours etc. to various other compulsions are a nightmare turning into a reality now. Although the cyber-crime cells admirably track down the culprits, the victims still go through a lot of humiliation till then. Many victims do not know where to get help, and women’s organisations, NGOs need to reassuringly come forth with plans that ensure complete privacy and confidentiality of the sufferer. What offends most is the callous allegations of cheapness, wrongdoing , shame and derision with which our society criticises the victim. Some people and many in media actually take a perverted interest in exploring private nudity and sex, as if looking for certificates of their own piousness in someone else’s ‘moral adventures’. ©️Dr. Rajas Deshpande

I told my patient that we could help her, and handed over the case to a female counsellor who is well versed with such cases. Although she has proper connections in the cyber crime department, usually this is not required, as the threatening cowards usually come to their knees oncethey know that the victim has someone’s support. The last I heard, the matter is resolved.

Stronger laws to respect privacy, stronger punishments for those who use such threats to their ex-lovers and a social revolution to accept the realities of today and reassure the victims rather than shaming them are essential. A complete ban on reporting of such cases as “Spicy News”in media is awaited.

On this Women’s day, I humbly bow to the higher gender, the mother and the sister, the wife and the best friend called woman. Only what a man learns from a woman makes him the man that he is, and in that, she is the teacher: of patience, of modesty, of hard work and sacrifise, and the soul of true love.

©️Dr. Rajas Deshpande

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P.S.
Partly Imaginary story.
I truly respect a woman’s freedom, and her ability and right to defend it. My views above are to express that respect. I am not a socio-cultural legal expert and certainly not a moral judge. Never mean to offend anyone.

Doctors and Religion?

Doctors and Religion?

Abdul Majid, (middle) my classmate, stayed across my room in the boys hostel, all 5 years of MBBS. I have never seen him sleeping or eating. Whenever we saw his room door open, he was either studying or offering prayers. I have often borrowed his luna moped to go for a tea in late nights. He comes from a very humble family, and had always been among the toppers in every batch: MBBS, MD, and then DM. We have attended many cases together before he finally settled in Aurangabad and made a big name for himself. I have not seen a more hardworking doctor than Dr. Majid.
Ateeq-Ur-Rehman (Right) is another such brilliant doctor, coming from my small town called Nanded, who has scaled highest levels of education in India with sheer merit, and has now settled as a successful Neuro-Intervention specialist in Hyderabad.
While I treat hundreds of Muslim patients who come with complete faith and trust without thinking about my religion, Dr. Majid and Dr. Ateeq have also served thousands of patients from all religions including Hindus, who have complete faith and trust in their ability and acumen.
Whichever religion, state or country a doctor may come from, there never is any thought about religion or caste when we treat patients. Humanity, compassion and Scientific logic is the ground upon which medical science is based. There’s no place for any discrimination, racism or even enmity. Thousands of doctors from all religions: Hindu, Muslim, Sikh, Christians, Buddhist, and many others treat millions of
Indian patients every day. We doctors take pride in rising above all differences, thinking of all humans as one and equal, and in the trust that our patients show in us, irrespective of our names and external appearance. Inside, every doctor, whichever religion or country they may belong to, represents only one principle: the desire to do the best for those suffering.

I am proud to belong to this medical culture and tradition of unity.

© Dr. Rajas Deshpande

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An Interview With a Neurology Legend

An Interview With a Neurology Legend

Dr. Satish Khadilkar

MD, DM, DNBE, FIAN, FICP, FAMS, FRCP (London)

Dean and Professor and Head, Department of Neurology,

Bombay Hospital Institute of Medical Sciences, Mumbai.

He is a living legend, one of the best neurologists anywhere, a stunning example of what an ideal doctor should be like.

He needs no introduction to those in the medical world: he has carved his golden name in global neurosciences with his passion for Neurology and especially NeuroMuscular diseases, pioneering this specialty in India. I am grateful to Dr. Satish Khadilkar for agreeing to guide us all.

Q: How does it feel at the top?

A: Grateful to life!

In the health pyramid, ‘top’ really means ‘more useful’! And there are at least three parts to being useful: providing service, teaching and conducting research. Indeed, I am grateful to life for having provided me with the opportunities to be useful to colleagues and disease sufferers in all the three spheres.

Q: What are the most essential qualities that a doctor must possess?

A: As mentioned above; service, teaching and research are the three main pillars of medical careers. Each of these requires different virtues. Service requires patience, availability, affordability and the capacity to empathize with the sufferers. Teaching requires clarity of ideas and the ability to be inspirational to the new entrants and younger colleagues. And research requires an analytical mind to understand questions, be unbiased to design experiments in search of the answer.

Depending upon which field you choose, relevant qualities will need to be enhanced. In my mind now, as I have gone on, service has emerged as the noblest frontier for the medicine man. So the essential qualities are compassion, knowledge and the desire to help.

Q: What do you suggest we do to improve the clinical sense among newer generations of doctors?

A: Simple answer: bedside clinics by masters of clinical medicine and shadowing them to see how they utilize the limited resources.

Q: How do you deal with the ever widening knowledgebase while effectively practising as one of the busiest practitioners in the country?

A: Knowledge is of two types, one to know it yourself and the other, to know where to find it! In the present times; we have moved on to the second mode. The great thing about this era is that knowledge is freely available. We only need to develop the ability to design the search to get rapid answers to our questions. There are courses available to this effect.

While this is true for problem-based daily issues, in one’s own area of interest, one has to acquire all the manuscripts and threadbare them, assimilate them and understand them, for deeper knowledge.

Q: How do you handle the incessant negativity which doctors face while dealing with so many incurable conditions and gradually deteriorating patients?

A: Negativity in the doctor’s mind stems from the perceived personal inability to help or to provide solutions. Doctors need to appreciate that their role is limited to being knowledgeable helpers. If we keep in mind the inadequacies of medicine as a science and our restricted role, negativity is less likely to take roots.

Q: What is your take on making holidays, vacation compulsory for doctors to overcome stress?

A: Personally, I do not see the need to take holidays, as my daily work itself is a never ending holiday! I do not remember taking a holiday in last three decades. The better you gel with your work, less it stresses you and less is the need to break.

Having said that, as our work relates to human life, we have to make sure that we take adequate rest and are “on the top of our game” for the hours that we work, as our shortcomings can have consequences.

Q: What advice will you give about handling family responsibilities and duties to the new generation doctors?

A: Human relationships take very long to build and only one indiscretion is enough to undo these. So, in relationships and family, equal attention needs to be given, as you would in your profession. In today’s competitive India, we tend to take the family granted and actually end up doing the least for those who matter most!

It is best to think of this early on while planning the professional career.

Q: What best can be done to stop the exodus of doctors from India?

A: Talented Indian doctors need to be appreciated by the society and the health system in India. System needs to be more humane and responsive to the doctors’ needs. Doctors also need to understand the process of medicine, its goals, trials and tribulations. Till this happens, we shall see movement to greener pastures, where this process has evolved better.

Q: Your guiding thoughts for future Indian Doctors?

A: Let us all remember that we are in medicine to help suffering people. That is the core of medicine. We are healers and scientists. If we don’t veer from this ideal and have patience, all material wants and requirements will automatically fall in place. So to understand medicine, one must never forget that this is the noblest of all professions. I have chosen its nobility as a guiding principle for myself. I found my solace in drowning myself deep in the vast oceans of knowledge about neuromuscular disorders and using it in the service of suffering multitudes.

©️Dr. Satish Khadilkar & Dr. Rajas Deshpande

The Dictators in Hospital © Dr. Rajas Deshpande

“Let my father die. It’s ok. I will not take him anywhere. I don’t want anyone else to treat him” said the 60 year old son loudly. His old father who could listen and understand the conversation, but could not speak or move due to a paralysis, just closed eyes. Tears emerged from the corners of those closed eyes.

Like most doctors nowadays I have learned to master personal opinions and emotional responses, especially with ill-behaved patients, but this was beyond me. Not because he had shouted at me, but because he had just stabbed his father’s heart. Loudly, so that the patient could hear, I said “I think your father should feel better soon, let us see what we can do”. Then I gestured the angry son to see me out of the room. Two other men accompanying him came out and towered upon me.

About five days prior, this son had come to me with his father’s reports. The patient was admitted at a rural hospital. He had severely compromised heart function and his heart rhythm was abnormal. This caused formation of many blood clots in the heart, which went to the brain blocking blood vessels. One such large blockage had caused paralysis and inability to speak. © Dr. Rajas Deshpande

I had asked the son not to shift the patient, as the treatment started by the rural physician was accurate, we had to just wait and watch. Still, they had brought the patient in an ambulance, travelling for over 4 hours. Naturally, the patient had worsened , becoming drowsy. His heart rhythm was dangerously worse. He was unable to swallow, there was a big risk of his saliva/ mouth secretions going to his windpipe blocking his breathing.

Whenever a patient has problems out of a specialist’s expertise area, it is mandatory that an opinion of the concerned specialty expert be obtained. I asked the best heart specialist I knew to see the patient, and also a small ENT test to see if we could initiate training for swallowing. Our physiotherapists were already working upon his hands and legs gently.

However, the son (a retired govt. officer from a very respectable post) and two others attending the patient created a big scene when my junior doctor visited the patient. They started shouting and cursing that by calling other specialists we were just “increasing the bills”, and that they did not want anyone else except me to see the patient, not even the junior doctors. © Dr. Rajas Deshpande

My assistant physician called me in panic and updated about this, asking me to immediately act to deescalate the situation. Although there were many patients waiting to be attended in OPD, I had gone to this patient’s room. I explained to them that the patient needs to be seen by a heart specialist too, as his heart condition was very delicate. I also offered them to choose any specialist or hospital they wanted, if they were unhappy here, but they could not waste time as the patient was critical. That’s when the son shouted that he would rather let his father die than be seen by any other specialist.

When they came out of the room, their body language and general disposition suggested aggression. I tried to politely reason with the son that any specialist cannot sit with the patient 24/7, that junior doctors and other specialists as required will have to be called in for the best care, but they declined. The efforts of our medical superintendent and best patient coordinator went in vain. © Dr. Rajas Deshpande

“We will not allow anyone except Dr. Deshpande in the room. Our patient must get better” the son said loudly.

“I will see him till he is under my care, but I cannot guarantee any outcomes” I told them. “Let’s see” he said. He did sign the document informing about criticality of the patient.

No doctor should treat patient under pressure, duress or threat in the interest of the patient. I went to our medical director and requested that the patient be transferred under some other specialist. The hospital offered them freedom to choose, but the relatives declined. “We have come here for Dr. Deshpande, he will have to treat the patient alone” the son said. The hospital decided to take a call next day after a meeting.

That evening as I finished the OPD, I wondered how the patient was. However much angry I may have been with the relatives, the patient was more important than my anger, pride or anything else. I went to their room and checked the patient. He opened eyes and smiled. I asked him his name, and he replied in a husky tone. He was speaking now!!

The next day again, the relatives refused to transfer the patient under someone else, and I kept the treatment on. The trustless atmosphere was quite volatile, and if something had gone wrong, things would have taken an ugly turn. In the next three days, the patient spoke well, and even accepted some sips of water. His hand and leg started moving too.

“Can we take him home now?” the relative asked on the fourth day.

Happy for many reasons, but mainly the fact that the patient had improved, I discharged the patient. I had learnt my lessons. © Dr. Rajas Deshpande

Adamant, unreasonable and illogical demands by patient’s relatives jeopardising the patient’s life is a huge medical problem in India. Illiteracy, political interference, goonda culture and media support make such horror stories a routine reality. The law still expects the best patience and non-reacting approach of medical personnel, with the onus of saving lives still upon them under this pressure. Innumerable instances of harassment and humiliation of nursing staff, especially women go unreported. Relatives, especially politically connected, behave like dictators in any hospital, threatening one and all. Unless this culture ends and doctors are at a freedom to do their best for every patient, medical care in India will always remain inaccurate, incomplete and purely financially guided rather than scientific or even legal. Doctors can actually file a complaint or take legal action in such cases, but they are too many, and no doctor has time for such legal courses. In the best interest of our patients’ lives we go on forgiving and tolerating such abuse. Because neither law nor administration wants to correct the causative factors effectively.

© Dr. Rajas Deshpande

Neurologist Mumbai/ Pune

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Young At 98. Secret?

Young At 98. Secret?

©️Dr. Rajas Deshpande

A few months ago I had received an emergency call for a stroke case. The resident doctor informed me that the patient was a lady of 98 years. Her basic tests were normal.

Worried, because stroke is a dangerous diagnosis at any age but more so at that age, I ran to her room as soon as I reached the hospital. A group of her worry-faced relatives waited outside her room.

I entered the room and introduced myself to the patient. She got up.

“Namaskar! How are you doctor? My name is Champadevi Gupta” she said with a big smile and such gusto that I wondered if she was the right patient.

“I am ok, thanks. What happened today?” I asked her.

“Nothing much. I had some giddiness but my children worry so much about my health that they rushed me here”.

Although her examination revealed only mild signs, her MRI had shown a small block in a blood vessel supplying a crucial area of the brain. I explained it to her. She laughed aloud again “I feel okay now. When you feel ok, let me go home”.

She was discharged next morning.

She came in thrice after that, every time walking in with a big smile, lighting up everything around her, keeping her hand upon my head and sumptuously blessing me, inviting for a meal at her home.

Today she came with her youngest son. She is as fit and fine as any young teenager, only happier and more content.

“She has always been like this: happy and content with whatever life brings, in good and bad times” her son Satish told me, “we are 5 brothers, we all look after her, but she still lives alone near my home. She is like a treasure and source of life for all of us”.

Indeed. A laughing, smiling, truly happy, positive and content person is probably the most precious form of human being, and so rare now, that sometimes I want to tell those running behind one thing after another, killing themselves every day: “Look at this lady’s face! This is the secret of a good life, the best health and happiness”.

It is so sad that we are evolving into a “Want more” type of materialistic, selfish, disconnected world with misplaced icons! I was amazed at the willing, involved enthusiasm with which this lucky lady’s children cared so well for her! Incidentally, I had had a tough argument with my teenager kid that morning and had left home in a slightly bad mood. After meeting Champadeviji, whose eldest son of over 80 years still visits her regularly, I was relieved. Parenting is a long term, never ending activity, and may be my own stresses of being a doctor were also distressing my kids sometimes.

As I told her that she was fine and need not visit me for another year, she held my hands, hugged and blessed me, and with mock-anger said “Now if you don’t come to my home I will come to yours without telling you “.

I am now in a true dilemma.

©️Dr. Rajas Deshpande

Lost and Saved Life: The Indian Puzzle

Mumbai Diary-2

Lost and Saved Life: The Indian Puzzle

© DR. RAJAS DESHPANDE

He had a sudden, severe chest pain, so he told his office-colleague so. The colleague first called his wife and alerted her “Bhabhiji please don’t panic, I am taking your husband to this hospital, please reach there as soon as possible and give me a call once you reach”.

The cab driver grasped the situation at once and drove as fast as he could. He prayed in his heart. Just a kilometre before the hospital, there was a huge mob blocking the road. A great leader was shouting aloud about his pride for his religion and patriotism, least aware that they were all blocking many children and mothers trying to reach home, patients and doctors trying to reach hospitals. The bought crowd was eagerly listening to the violence provoking words of this rich politician, also a convict and suspect in many crimes, There was less audience at the real places of God’s worship nowadays than at political speeches giving religious sermons, mixing them with the love for one’s nation!

The cabbie honked. Two monstrous looking goons peeped in his window and started abusing him insanely, least aware about the women and children around. The cabbie was abused first for his profession, then his language, and the state he had come from, threatened to be burnt alive along with family if he honked again when the ‘great’ leader was speaking.©️Dr. Rajas Deshpande

The cabbie begged with folded hands: “Sirji forgive me, I accept my mistakes, but there’s a patient on the back seat. He looks serious, we must reach the hospital as quickly as possible. For god sake, let us go”.

One of the goons opened the back door and asked this patient his name. After he saw the chest-clutching patient almost gasping, they made way and allowed the cab to leave.

Now the patient had started profusely sweating. His face had turned bluish, and he was making efforts to even breathe well. He could not speak. As they entered the hospital, the patient’s friend noticed that the patient had stopped breathing.

He shouted in panic. The wardboy and the cabbie lifted the patient on a stretcher and ran towards the emergency room.

A frantic, fearful sound of thuds of the last heart massage was now heard, along with breaking of many glass syringes and instructions shouted by doctors and nurses. A tube to restart breathing artificially was inserted in the patient’s throat. ©️Dr. Rajas Deshpande

There was no one to cry for this patient there. His friend was sitting outside the emergency room, clutching his head, stunned. The cab driver had left without taking his bills. Religion and Patriotism stayed outside the hospital campus, they couldn’t save lives.

A young and dynamic heart specialist who had just returned to India saw the ECG of this patient. An urgent action was required. He called upon the patient’s friend to sign a consent.

The friend hesitated and refused. There were a lot of news every day everywhere about doctors fleecing patients, earning money by misuse of stents and surgeries. The friend no more believed in what this doctor told him.

“I don’t know. Wait till his wife arrives, she will be here in an hour”.

Every millisecond was crucial. The dynamic heart specialist called his medical director. “Sir, I take full responsibility for this case, he needs immediate action”. The medical director cautioned him: “Doc, if anything goes wrong, if the outcome is not good, they will file a murder case against you. Why do you want to risk your bright career at the very beginning? You must also think that you don’t have any political godfather”.

The doctor rushed the patient to the cathlab and inserted three stents in the patient’s heart, that resumed the normal blood flow to heart. The patient’s heart function returned to near normal in an hour. By the time the patient’s wife arrived, the lost life of the patient was brought back. The next day, the patient could breathe well by himself.

Now the most crucial puzzles: which state did the cabbie come from? What was the caste of this patient? To what country did the helpful friend belong? Why didn’t they go to the government hospitals run by those who criticise private doctors and hospitals? And lastly, what was the religion of the doctor who saved this patient risking his own life and career?

Any sane person with an ounce of humanity in his heart won’t ask these stupid questions. But some Indian leaders and their followers do. And it is very sad and unfortunate that the answers to these questions cannot be openly revealed in my beloved India.

©️Dr. Rajas Deshpande

Neurologist

Mumbai/ Pune

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Survival Of The Quickest

© Dr. Rajas Deshpande

This young and brilliant man, Adil Masalawala, suddenly appeared to have changed. His behaviour became different and unusual. He started mumbling and replying irrelevantly. He also had fever intermittently. His caring and worried wife Mrs. Venus consulted a physician who sent them to a psychiatrist.

The psychiatrist checked Adil and advised him admission. He started with some medicines, but suddenly Adil’s behaviour became hyper, his body started becoming stiff. Then he became drowsy, and his body started shaking violently. An MRI of the brain was reported normal. That’s when the psychiatrist advised a reference for neurologist.

When I first saw the patient, he had many features that could also be caused by side effects of some medicines. Sometimes it is impossible to conclude whether it is the disease or the medicine which is causing certain symptoms. I suggested that we stop all antipsychotic medicines. That could also be a dangerous decision. The family was counselled, and they agreed. Adil’s drowsiness improved, but he became very agitated, and his stiffness and shaking worsened.

There are many neurological diseases of the brain which start as abnormal behaviour. Strokes, some infections, tumors and swellings are examples of treatable, but there are many untreatable and dangerous conditions too. The only way was to urgently investigate the patient further. Although the family was baffled and panicked, Mrs. Venus expressed complete trust in our decisions, and allowed us to shift the patient to the ICU. I could not answer many of their questions, I did not clearly understand what exactly was happening, but this uncertainty and challenge is what medicine is all about.

There is fluid in and around the brain, which nourishes the brain and also acts as shock absorber between the skull bone and the brain. Many diseases like cancers and infections can be diagnosed by studying this fluid, which can be taken out by inserting a needle in the lower (lumbar) spine. We checked this fluid, and we got the first clue: that we were possibly dealing with a viral infection of the brain. Many more costly blood tests were required to find out which virus was causing this. The family clearly stated “Do whatever is needed in your opinion”. We sent the tests and found the answer: Adil had one of the most rare and dangerous viral infection of the brain, called Japanese Encephalitis.

About 30-40 percent of patients with this diagnosis do not survive. There is no definite treatment for this virus, but many of the manifestations can be treated and excessive care is required to avoid life threatening complications of the swelling that it can cause in the brain.

On the fourth day, Adil had convulsions. His condition worsened. We kept on treating each complication as fast as possible and tried to balance the effects and side effects of the many strong medicines that were being used to control convulsions, shaking, and the brain swelling. Besides knowledge, wisdom and experience, our major strength was the trust of patient’s family who never questioned any decisions.

Many patients who develop abnormal behaviour are mistreated as having a psychiatric problem. Most qualified psychiatrists are aware of the red flags and refer patients for a Neurologist’s opinion. However, a majority of patients with psychiatric problems in India are first taken to quacks, magic healers, mantrik-tantriks, who delay the whole process of correct evaluation, diagnosis and treatment. This leads to many deaths, and this is worst in case of cancers treatable in earlier stages.

False advertisements, some even approved by highly placed offices, celebrities and authorities attract people from all classes and cause severe delay in initiation of the correct scientific treatment. While our governments rightly pressurise allopaths to write generic medicines, they mostly turn a blind eye towards rampant misleading false advertisements claiming cures of incurable diseases and centers that flourish reaping from the hope of millions of illiterates.

We almost thought we had lost this case to a permanent disability. Adil’s body had become completely stiff, his memory had become unreliable to a great extent, and he had an incapacitating tremor. After a few days we could gradually stabilise his general condition and shift him out of the ICU. In a few weeks he was discharged, improving slowly. His family, especially his wife fought for his normalcy like a true warrior, and once he resumed his senses, Adil too made every possible effort to recover fast. One day after a few months, he was back to normal again, we declared him cured and fit, physically and mentally. He resumed his job.

Today after about ten years, Mr. Adil Masalawala and his wife Mrs. Venus came over for some trivial issue, and we recalled the horror that we went through and his victory over it. In this case, I thought it was the “Survival Of The Fastest” as the family did not waste any time in quacks, arguments, objections or mistrust, and let us doctors do the best for the patient in the fastest possible way. We are grateful to the family for this trust, and Adil’s survival and recovery itself is our reward. God bless the couple with a long and healthy life!

© Dr. Rajas Deshpande

Real Story, Real Names, With Patient’s Express Permission. Grateful to Mr. Adil and Mrs. Venus for the permission to share the story of their victorious battle.

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Doughnuts, Laddoo, Anyone?

© Dr. Rajas Deshpande

He was so cute and plump as a child, that everyone started calling him “Laddoo”. Soon this became his name. His parents were both hyper-educated, and both owned google browsers, so they studied about parenthood in-depth every day, and decided to provide Laddoo with the best parents and upbringing. They had many fights about how to do it right, but they took care that they never ever fought or argued in presence of Laddoo. They never raised their voice in front of him. Laddoo therefore grew up thinking that any arguments, disagreements or raising of voice was so uncivil and wrong. In a calm, disciplined home, he was being given the best of parenthood as suggested by the best parenting websites in the world.

Laddoo’s parents took care that he could only eat the most fresh and clean, organic food. Laddoo was proud that he did not eat garbage like other children of his age. He often envied those who could eat spicy, oily roadside food, especially the panipuri, kachori etc., but he remembered what his mom-dad had told him about the bacteria and viruses in such dirty food. So he never ate anything like that, but he started developing anger towards those indisciplined kids who could eat and digest anything they wanted. In the midst of beautiful, clean plenty, Laddoo started growing up resentful of everything around him. © Dr. Rajas Deshpande. At home though, Laddoo was always a prince. To encourage free thinking, his parents had decided never to shout at him or punish him. They chose only logical, scientific, calm explanations when he was wrong. Once a maid-servant who was cleaning their home shouted sarcastically at Laddoo: “You call yourself a grown up, can’t you keep your clothes in a little order?” Laddoo’s mom was shocked, she fired the maid immediately. “Such ignorant, stupid illiterates! These slumdwellers have no idea how to raise children!” she commented, patting Laddoo on his head.

“You are stupid, Mom, you and Dad both!” Laddoo shouted, “Why do you stay in India with such people around?” His mom was so thrilled to hear this, that she immediately WhatsApped Laddoo’s words to her friends’ group, adding “Laddoo has become so mature now, he’s speaking exactly what I think sometimes. I am so proud!”. Laddoo was pampered more. All that he wanted was being made available. If he did not get what he wanted, he would throw a tantrum, accuse his parents of cruelty, and write about his parents in his famous blog “Parents and Children’s Freedom”. He had many followers. His parents oozed with pride when they referred to their Laddoo as a “Child Celebrity Author”. His proficiency with cellphones and gadgets was their pet boast.

The thoughts that “I can be wrong, someone else can be better than me, someone else can grasp better, be more intelligent or successful” never crossed Laddoo’s mind. “What I think must be the final word” became his perpetual attitude. If at all anyone was successful in proving his mistake, Laddoo would immediately state how some fault of his parents, teachers or friends led him to commit that mistake. He freely used words that scared elders: abuse, violence, childhood trauma etc. This would usually hush up the matter, and Laddoo always kept on convincing himself and others that everything good that happened in his life was solely due to his own heroic efforts whereas everything bad that happened was the fault of someone else. His parents did not want to ever shake his self-confidence, so they never made an effort to correct him.

Once Laddoo spoke arrogantly and then argued rudely with his class teacher. She was so upset, that she scolded him in front of the class, called him stupid, and gave him a punishment of standing for an hour till the class was over. After returning home that day, Laddoo complained of severe pain in both legs and giddiness. He was taken to the best child specialist, then a neurologist. “There’s nothing major, please take him to a counsellor” they were told. © Dr. Rajas Deshpande.

“Indian doctors really cannot understand a thing” said Laddoo’s father, and sent his reports to Laddoo’s aunt in the USA. The experts there commented that the child may have suffered a mental trauma due to the scolding and punishment by his teacher. Laddoo’s parents immediately filed a police case, wrote blogs against the school and the teacher, and then also complained to the school about the teacher with threats of legal prosecution. It was only after the teacher and the school apologised to Laddoo, that the cases were withdrawn, and his pain and giddiness improved. No teacher ever scolded Laddoo throughout his career thereafter.

Now Laddoo is heading a major company in California. His useless, old parents live in an old-age home, pretending to be happy. They believe that their beloved Laddoo does not see them regularly because of their own parenting faults. They cannot express this to others, they just tell people “He is extremely busy”. Laddoos parents also truly believe that his success in grabbing a great job is the highest achievement of their life.

Laddoo does not have any friends. He only has drink-n-game partners in luxurious clubs. His first wife left him long ago (“She was ridiculously orthodox, she wanted to grow up kids and all”). His second wife owns a company in Washington DC, they meet twice a year. Both of them tell people how they are victims of childhood traumas., especially when they fail competing with those “unruly, ridiculously happy” colleagues. They have decided never to have children so as to compensate for their childhood traumas, bullying by friends, teachers and parents etc. “We cannot afford time for such traditional lives” they mutually agree. They believe, understand and cover each-other’s lies so effectively, that they find it difficult to grasp why others around them cannot accept those.

Laddoo does not like anyone arguing, asking him questions. “Geniuses like me do not owe an explanation to anyone” he says, often freely quoting the likes of Newton, Einstein and Steve Jobs. No one really wants to interact with him now a days. Just as people avoid the spoiled brats of rich fathers, knowing that they are beyond any resurrection, they avoid Laddoo too. © Dr. Rajas Deshpande.

“Thay are all jealous about me, my genius, my success” Laddoo thinks. His wife agrees. Both of them spend their time at home and work blaming the whole world, showing people down, being bitter to the happy ones, and repeating the stories of how they suffered in the past, how they struggled through those imaginary problems and how heroic they have been to reach where they are now. They compliment each other like the two halves of a doughnut.

I meet such Laddoos and doughnuts (men and women) everywhere now a days. They are frequent among Doctors, Patients, Engineers, Lawyers, Businessmen etc., but also very common in big offices, major posts in the governments and managements, professors, judicial offices, ministers and even among rulers.

Do you meet any?

© Dr. Rajas Deshpande

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