Tag Archives: Critical

The Changing Blood Group

The Changing Blood Group

(c) Dr. Rajas Deshpande

“He is sinking” shouted Dr. Siya.

The casualty registrar rushed to the bed, checked the vitals. Pulse very fast. Blood Pressure very low. Lips and nails white, hands and feet cold. The young man, unconscious, was on the verge of death.

“He must be bleeding inside. Get an urgent sonography of his abdomen”said the registrar to Dr. Siya, and call the blood bank. He will need at least two units of blood urgently”.

It was Dr. Siya’s first week into internship, she was thrilled with the idea of actually saving lives. At the young age of 22, she was witnessing death almost every other day. Along with that she was amazed to see the darkest sides of human nature: the potential of humans to hurt each other: via rapes, accidents, murders, fights. She had decided to not let this affect her attitude, and to continue to try and save every life she could.

That late night, this young man of about her own age was brought in unconscious by someone, who had just dropped the patient in the casualty and left without leaving any identity of himself. “I found him lying unconscious on the road. I don’t know anything else about him. I am just doing my duty, I have a train to catch”said the stranger and left. The patient was reeking of alcohol. He had a visible head injury. A quick CT scan had revealed minimal bleeding due to a small skull fracture. He also had had bleeding from wounds from his hands and legs, they were sutured. The patient had no identity marks, wallet or cellphone. The policy of the hospital was to provide basic treatment and shift the patient to the government hospital. The police station was already informed. Treatment was started.

Dr. Siya requested two units of blood. The blood bank called. They had only one unit of the blood for his blood group. The registrar had the same blood group, and like many doctors working in the emergency departments, he went down to donate blood.

It was nearly midnight. The fate of the life of a young man depended upon what the junior doctor did just then. There was no one to sign any consents, the protocol was to inform the hospital’s medical director and obtain consent for emergency transfusion or procedure. Dr. Siya finished the formalities, obtained the permission, and started the transfusion. If the patient had reacted or something went wrong now, they all feared, there will be a havoc in the media: that they had let an unknown patient die because they wanted money!

Dr. Siya kept on managing the show. The angry and disturbed relatives of other critical patients kept on taunting her, speaking rude and reluctant to complete simple formalities and paperwork.

The sonography was thankfully normal.

Just as the first unit of blood was over, the patient became conscious, and revealed his name. He was quite shaken with the surrounding, but told in broken sentences about his friend’s number and address. He revealed that while returning from a party, his bike was interrupted by a bunch of goons, he had fallen down, they hit him upon the head and left with all this belongings.

The friend was called, and came in. He revealed that the patient was used to smoking weed and drinking alcohol in huge quantities. They were staying in the hostel of a famous college.

The second blood unit was started, and in a short while the patient threw a convulsion. He was immediately given injectables for controlling the convulsions, he slept off with the effect.

His parents arrived early next morning.. The shocked mother was consoled and explained about the situation by Dr. Siya. The elderly father, like all fathers, equally shocked but being a father unable to cry, kept mum, just holding hands of the boy.

When the patient woke up again, the father came to Dr. Siya, and touched her feet. Too embarrased, she told him that the registrar had donated blood for the patient. The father went and thanked the registrar, again trying to touch his feet.

As Dr. Siya had finished her night duty, she prepared to leave. “Beta, Will you come soon please?”asked the tearful mother to her. “Yes Auntie, I will be back soon. Don’t worry, he is ok now”she reassured and left.

On her way back her genius young mind tried to look at the situation sitting upon her shoulder, the little third person that resides within each one who has a conscience. That booze and weed was easily available to youngsters in almost all Indian hostels, that even educated people rode bikes without helmet, that crimes were happening almost everywhere that injured and killed people, that law and order was a laughable term in many parts ofthe country, that there was no government mechanism in place to provide emergency medical / paramedic support ambulances to raod / traffic accident victims: which one is the most responsible cause, when patients like these died? Who is responsible?

She reached home, told her proud parents what had happened, that she had helped save a life. Her mother folded her hands towards the sky, said “God, let my daughter save many lives everday”.

While having the breakfast, her father turned on the TV. A famous but ill educated political leader, in his mind-and-other- organs blowing speech in Karnataka, was explaining the illiterate public how all Indian doctors charged in excess, how they were only after money, how everyone except himself was the enemy of the millions of patients surviving from critical heart attacks, accidents, strokes and other diseases. All patients getting better all over te country was only thanks to himself and his government!

Dr. Siya’s father laughed bitterly. “Next time you need blood for any poor or unknown patient, call him” he said.

Dr. Siya replied, laughing “That kind of ëver changing blood group doesn’t match anyone, it is useless for any patient, Papa”.

(c) Dr. Rajas Deshpande

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The Morphine That Killed a Hospital

© Dr. Rajas Deshpande

“He fell down while checking the patient”, said the panicked Dr. Mrs. Sane about her husband, “and became unconscious”.

Dr. Sane tried to maintain his calm. A sick doctor has the curse of knowing the worst of everything, and has a perpetual feeling of sitting upon a ticking time-bomb. It was a sad feeling to see this middle aged brilliant general practitioner fighting tears.

“Sir, the OPD numbers have shot up because of these epidemics, especially dengue. I see over a hundred patients every day. The Inpatient beds are full. There are daily problems: medical, administrative and medico-legal.. those I am used to. But now there are too many politico-social and press-related issues that worry me”.

Dr. Deshmukh, a senior practitioner and a common friend, accompanied Dr. Sane. He cautiously poked him “You must tell the doctor what happened the day before”.
“Oh that’s a part of our profession” Dr. Sane replied.
I insisted that he must tell me.

Reluctantly, he disclosed: “Some goons came in with a municipal councillor and threatened to waive off the bills of a dengue patient. He was in the ICU for five days, quite bad, but went home walking. Till the time he improved, they kept on threatening us to break the hospital and thrash us if something went wrong. Upon discharge, they didn’t pay a single rupee. There’s nowhere to complain, as the hospital requires many municipal permissions”. © Dr. Rajas Deshpande

Dr. Mrs Sane lost her cool. She started sobbing. “No one blames those who dump garbage, keep their surroundings unclean. No one is blamed when epidemics spread and thousands die. No one is held responsible for failures of almost all preventive services and lack of basic facilities at government’s healthcare institutes. But the already overworked general practitioners must bear the brunt of everyone’s anger: the public and press are always free to bash the last face they see: the doctor who is actually helping every patient,.. Dr. Sane has not had a proper lunch, not spent a full day with kids in months.. That hospital has become our curse“ She broke down.

It was so logical! The offices responsible cannot even be reached. The court does not see any of these system failures that cause millions of deaths all across India, happily ordering lakhs and crores and imprisonments for doctors, for trivial mistakes.
Whom to blame? Oh yes, the doctor who has studied to treat the sick!

Anyway, in a country fond of muscular heroes and billionaire godmen, who expects a brainy analysis? © Dr. Rajas Deshpande

“I had a dream of making best health facilities available for my area. I have taken a big loan. We treat poor patients free anyway. Many rich are sent by local politicians, leaders, administrators with instructions to attend immediately and free too. Paying patients are mostly suspicious because of all the negative things publicised by press about all doctors., they also expect immediate and positive outcomes. I have not slept for many a nights. “

I examined him.He had obvious features of being fatigued mentally and physically.. A syncopal attack, where the BP drops down suddenly and makes the patient unconscious, was likely. I advised him tests and told him to take rest for there days.

“Not possible, sir! Even now the OPD is waiting” he replied. An angry Dr. Mrs Sane requested me to intervene.

“Your duty to the society does not free you from the duty towards your own health and family” I requested him. But Dr. Sane agreed only when Dr. Deshmukh offered to send over a junior doctor to his hospital to take care of the OPD.

“How have you been, Sir?” I asked Dr. Deshmukh. He is one of the most respected and busiest general practitioners in town, with a big hospital. © Dr. Rajas Deshpande

Dr. Deshmukh smiled.
“I had an angioplasty three months ago. The only risk factor was high BP and stress. There is no use fighting or explaining our situation to the society, government or press. I have closed down my hospital. I only see OPD patients now. Anyway many patients thought that I worked day and night for earning more money. Let them go to the corporate or government hospitals.”

The death of his hospital was not a surprising news, many small private hospitals and nursing homes are either closing down or converting into profit-making franchises. Many doctors are suffering high BP, cardiac and neurological problems and even dying due to excessive stress.

The meaning of this nightmare will soon unfold upon our society.
Till then, this is a heartfelt appeal to all the over-stressed doctors to rethink about their priorities, rearrange life and make sure stress does not kill.

For the morphine of “medical social service” is only good in small doses, it kills when overdone!
© 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

Negligence cases deserving severe punishment.

Negligence cases deserving severe punishment.
© Dr. Rajas Deshpande

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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The Good Doctor is on Ventilator Now.

The Good Doctor is on Ventilator Now.
© Dr. Rajas Deshpande

You reach the top of academic pyramid after a tooth-and-nail competition and the worst mental, emotional and physical hardwork. You learn humanity and humility in the broadest perspective. No one else can understand the worth of your work. Then you are told this is your lifelong cross. Your “Obsession and Compulsion” to help solve health issues is held as a gun to your own crown. Being good does not mean getting a good life or income. Now you must live to the wish of many others and not your own, or quit in disgraceful depression. These many other are insurance companies, corporates, people you treat, governments and other organisations made up of people with self-obsessed power agendas, even some colleagues who lust fame.

Ever drove a new car in an Indian city, following all traffic rules? You stand out as an ultimate idiot. People honk crazy when they collectively jump a red signal and you don’t. People hit your car from behind and still beat you up. The worst, some (esp. autorickshaw drivers) will challenge you by driving their vehicles into your path and looking at you with “What can you do?” face. All in the face of traffic police. Well, Indian Doctors are facing the same issue: You are expected to follow all traffic rules while others continue to screw your journey, scratch your car any which way they want. Leave aside the government, even the politically oriented doc’s organisations are busy making unilateral rules / regulations which increase the doctor’s work and further worsen the litigation liability.

Political desperation leads to compromising merit “to increase numbers of doctors” (by charging crores) in India. So the class of real good and meritorious doctors is now mixed with those who can buy everything, including fatalities due to their own medical mistakes. Many of the doctors from private colleges are good, and not all from govt colleges are good. Every passing doctor does not hold the same clinical acumen. No one is perfect. But when you allow money to run the system, only the ones with money will get away with it all. The will to control merit and corruption lacks from the highest administrative offices.

There is a huge difference between a Doctor and a Good Doctor.

The social anger is conveniently misdirected to the practicing doctors. The real players encouraging, cultivating and reaping from medical corruption stay hidden. People get to question, argue with, thrash and litigate the practicing doctor who earns a few thousand every day, but those who earn many lacs, even crores everyday remain behind the screen. Any doctor raising his / her voice against them is thrown out of a system which must work collectively.

The tragedy of perpetually having to face the illiterate poor or arrogant rich, both with political backing to threaten and assault, and expecting charity-priced superhuman service of all doctors is eating up the morale of those who take their professional duties seriously. Add to this a glamour driven primitive legal system which takes upon itself to define Indian culture, which thinks that a rich earning life is costlier than a poor man’s. Add also the semi-literate law makers who think of this profession as “Granted Inherited Slaves” to serve their vote banks.

A good doctor is proud of that good, and will not stay long where his / her pride is raped every day. This is why many many superbly talented doctors have left India, and the few remaining are gasping for dignity, which is their life.

The good doctor is on ventilator now.
© Dr. Rajas Deshpande

Who killed this patient?

Who killed this patient?

There were huge banners. People were happy, dancing to the most recent Bollywood item song, throwing colours and distributing sweets. Their big leaders, standing perpetually garlanded in a decorated open vehicle were smiling lovingly at people, returning “Namaskars (Salutations)”, and intermittently instructing the “key followers” about the whole process.

Behind this was a congregation of at least a thousand cars, buses, trucks and two wheelers, and also an ambulance, from the window part of which everyone could see the tense faces upon which tears rolled.

The intern doctor sitting besides the ambulance driver knew me. From six cars away, he shouted : “stroke, stable, in window period, three hours now” meaning that the patient may be given one injection if he/she could reach hospital within ninety more minutes, that can potentially reverse stroke, and save disability and / or life. “Time is Brain” in stroke, we are hammered, “Time lost is Brain Lost”.

The traffic police were too occupied with the procession to attend the ambulance. There were threats of bomb blasts, so they had to safeguard the VIPs. Some young students parked their bikes and started to rearrange traffic to make way for the ambulance, and gave up when they met the blank, expressionless stares of people who won’t move, often demeaningly reminding those students that they were not traffic police. The whole procession behind the celebration was that of stuck, delayed, cursing working class of all socio-economic levels, wishing that they hadn’t left the house today. Each one of them would have to apologise to many, listen to humiliating words from their bosses or miss some important assignment / meeting / interview / exams. Some would miss chances of a lifetime.

One of the most frustrating thing to witness as a doctor in India is this blockade of the ambulances, along with the working class and public transport due to morchas (processions/ mass protest) / VIP bundobast and celebrations ranging from election victories, marriages and various other socio-religious occasions. What is the fun in causing distress to someone else by blocking traffic? Why cannot these be banned on the roads meant for public transport? There are umpteen grounds / lawns and other venues in almost all cities where people can gather to celebrate saving the disinterested from a day’s distress.

There is no objection to celebration or cultural / social / religious occasions. But causing delays and discomfort to the public and those in an emergency is criminal. There must definitely be laws against causing blockage to traffic when granting permissions to such processions, but these laws are hardly any use once the processions are on the road. Also, why should the already scanty and overworked police force suffer the heavy duty management and stress of such private celebrations? This waste of manpower and public resources is enormous, if one can imagine that there are literally thousands of such events happening daily all over the country.

Political / social / religious celebrations and VIP bundobast have become the “Show of Might” events at the cost of public funds and discomfort. There must be designated areas for bigger congregations outside the city, avoiding rush hour jams that are torture and harassment to the working class.

Add to this the deafening (and often vulgar) music. What God in which religion would like it? How unpleasant are these scenes of drunken vulgar dancers on the streets, swinging and making gestures with the screeching music? That hard drinks are openly served on the road in soft-drink bottles is no secret, neither are the “special cars” serving these. How religious is this, and why the bigwigs and “Respected” people don’t talk about it? Why don’t the different sect heads / religious heads guide people that this is no way to appease any God, and God is found only within oneself, that too when one gives up causing any pain to anyone else?
The dirt left back, the mess, colours, the paper dishes, glasses, filth from burst crackers etc.. is the nightmare for the municipal workers the next day. The “clean city” initiative is thus raped virtually by many such processions.

In a country where hunger and lack of medical treatments kills thousands, where ‘beggars with sick kids on each road’ has become one of our identities, where farmers commit suicide because of loans and poverty, where the words “Lack Of Funds” star upon each page of explanations wherever the government needs to provide facilities, where does all this ‘affluence’ to celebrate in lacs / crores come from?

If only all the money involved in the “Victory, Bail, Jail release etc.” celebrations, socio-religious functions and decorations of various types, “Power demonstration procession” funds go towards the development of good healthcare facilities in India, we can provide excellent healthcare services to the millions who deserve them. That will definitely not anger any God, nor take away the “image” some leaders want in public eyes.

That intern doctor who worked at another hospital met me after about three days, with a black eye. “We reached late, sir. The patient had a convulsion on the way and by the time we reached he was gasping. The relatives beat up the casualty staff and even me. I feel like leaving this profession sir”.

If legally analysed, who is guilty here and must be punished? Many will use the words “System”, and say we are the society, we are the system, for that has become our new language now.

For we are scared to accept that there are two societies in India: The Carers and the Care-nots. The civilized and the powerful. The life of a common man can easily be sacrificed, and the blames can easily be pinned upon the hospitals.

This patient would have survived if he reached hospital in time. He deserved it. Who killed him?

As for the garlanded leaders who take public discomfort for granted to satisfy their ego-parades, some of them do really deserve those garlands. Plenty.

© Dr. Rajas Deshpande

PS: I have seen some rare traffic policemen going out of the way to clear way for ambulances. Rare.

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The Brain-Alive Heart-Dead.

The Brain-Alive Heart-Dead. (c) Dr. Rajas Deshpande “We don’t want her to suffer. We don’t want any ventilator etc. treatments”. Said the calm son, no traces of emotional tones in his speech. His mother was admitted last night with stroke. Quite a sophisticated family, this son owning a company of repute. His teenager daughter was sitting by her grandma in the ICU, patting her unconscious forehead. “Can she hear us doctor?” the distraught daughter asked. “Sometimes, only when she is a little more conscious”.. It is difficult for me to be emotionally rude. “Because I want to talk to her only once more.. to say sorry.. I was sulking after a fight with her when this happened.. I should never have fought with her…” the sweet soul broke down. Her father tried to calm her. This is where I received the first shock. His pacifying his own daughter had a formality. It did not suggest “I am proud of your emotional bond with my mother”… It rather suggested “Grow up, you stupid, these things happen”. As I walked out of the ICU, his wife wished me. “How is Ma, doc?” she asked, accompanied by her brother. I told her the truth: “Fluctuating, but critical still”. Then the expected question: “How long, doc? We don’t want her to suffer too much”. “Sorry, can’t say at present”. If I myself ever had an accident, I want to live. I want my doctor to try the best to make me survive, to give me one more chance to see and touch and hear my dear ones. I want to say sorry to those I may have offended, and also to say proper goodbye to those who love me. I will not want my family to decide whether the doctors should try their best for me or not. I have asked this very question to some people I have faith in the sanity of. The answer rarely was “Don’t save me if it took a lot of effort”. Some classified further: “If I was to remain in a vegetative state permanently, then alone let go”. Most of my old / very old patients explicitly state that they want to live as much as they can, with as much health that they can get. Nobody except the depressed / frustrated actually say that they want to die, a statement in itself contradictory to their being in the hospital. I have had differences with some colleagues who “Let Go” and encourage the willing family to make the same decision. It is useless, they argue, to spend so much and try for such a small possibility of meaningful survival. Patient must be able to choose dying with dignity, they advocate. Many of my colleagues differ like myself, and for a reason: if the patient has expressed a wish prior in complete senses that he / she wants no resuscitation / effort to be made for their survival, then a doctor must respect that. But I think NO one else can make that decision on behalf of the patient after they have lost senses. An unconscious patient is still alive until he / she is brain dead, and it automatically becomes a duty of the doctor to make all efforts to try for the best outcome. There are many sweet excuses people quote, including suffering, dignity, torture, tubes, pain etc. to justify “letting the patient die”. The real reasons often are: expenses, time, hard work, stress, uncertainty associated with an elderly being ill and the perceived “uselessness” of a debilitated / old / disabled person in the family, adding to the future bills. Elderly do not even have emotional value in many families now. We are in a world where people have learnt the tact of carrying out entire discussion hypocritically, knowing that both are actually lying, but still pretending to understand each other. Such discussions decide the fates of hundreds of unfortunate old and unconscious patients who then become victims of “Lacklove” decisions made by the very people they gave birth to and grew up! Expenses can be reduced by offering care in smaller nursing homes / govt. hospitals. The decision of whether the patient will live or not should not be open to discussion about patients who have NOT written a will against their own treatment. If the patient is “Brain-Alive”, treatment must continue. For no team of Neurologists / experts in the world will guarantee the outcome on the bad side: there are always chances of regaining meaningful consciousness in every patient who is not brain dead. And we the living who attempt every day taking whatever tiny chances we get to survive, to grope more and more of life we can should be the last people to say “Let Go” when it comes to someone else’s life. It would morally amount to a murder. “We hear some doctors keep dead bodies on ventilator in the ICU just to extract more money” said one “business minded” friend to me once. We doctors are trained against violence as it hurts the very human body we are meant to guard. So I answered him verbally only: “With all hospitals almost running full, critical patients in waiting areas why would any hospital keep on ventilating the dead?”. There are monitors, files, paperwork, and many doctors, nurses, other staff in each critical care unit: how can people imagine that the dead will be kept on machines in such units? Or is it just another social trick to mask the mirror of reality? A small question: If the hospitals start declaring who all chose to “SHUT DOWN” life support systems upon their own relatives / parents, took such critical patients home, admitted them late beyond life-saving period, will the society be happy about it? Then why make such gruesome allegations against a whole profession who even bring some dead back with immense effort, without even knowing them? Why do you think thousands of “Code Blue” teams run without caring for their own life when someone is dying, anywhere in the world? God knows how many doctors pay patient’s bills, especially in emergency. So many doctors start the treatment in corporate hospitals, accepting the responsibility for patient’s bills as relatives come unprepared (no corporate hospitals move without advance or insurance except in emergency). There are also many relatives who don’t sleep, don’t even eat till their patient regains consciousness. There are many who silently suffer with the patient. Many sell their belongings to pay hospital bills and still tell the doctor “Try your best doctorsaab, don’t worry about anything. I will pay every bill”. These, unfortunately, are the illiterate, poor, rural and real human beings. These two: the doctors and relatives who try to save the critical, especially old patient desperately are both being classified under “Impractical, Stupid” people gradually. Because our society has matured to money. As I met the patient next day, still in the twilight zone between life and death, there was no one with her except the granddaughter with swollen eyes. She exclaimed, smiling through her tears: “Doc, she opened her eyes and looked at me for a few seconds… She didn’t say anything, but I knew she recognised me and she was happy to see me.. I know her eyes.. she was awake in that moment” and she broke into sobs. Mercy in the skies often comes alive only with love. The patient regained her senses in a week. As she asked for discharge, holding her grand-daughter’s hand, she looked at her son standing by, and proudly told me “Doc, this is my son.. He owns the XYZ company.. He takes very good care of me”’ Avoiding eye contact with anyone, he hugged his mother and said “I love you Ma”. His teenage daughter kept staring at the floor. I looked at her face. I don’t wish to see that extremely scary expression again. © Dr. Rajas Deshpande

The “token” gift, and the “real” punishment!

The “token” gift, and the “real” punishment!
(Things doctors don’t get time to say!)

© Dr. Rajas Deshpande

Wherever possible, and whenever they deal with “mature and understanding” relatives, most doctors explain and predict about the patients, but the moment they sense accusive, legality oriented, halfbaked googlecakes, doctors have no option but to turn on their guards in self-protection against stupid misinterpretations of what is being said in good faith.

Within minutes of admitting an unconscious patient in the emergency, or having just checked in OPD for headache, the relatives or patients naturally ask the doctor “So what is the exact reason?”. In most cases they will not be satisfied when the doctor says we need to investigate / run some tests. So the doctor has two options: to tell tentative causes based upon only the examination (clinical / working diagnosis) or to honestly admit that it is difficult to conclude diagnosis before running few tests. In either case we have to respect the relative’s choice whether they want to proceed with tests or not, and start treatment according to most likely possibility. This is still “presumption”, and may sometimes be wrong. Every medical textbook will mention standard test protocols for any medical condition, and these are also available on the internet freely. Most doctors limit their tests to confirm the “working diagnosis” and “critical / correctable other possibilities / life threatening possibilities”, knowing that most patients suspect that most doctors do tests to earn more money. However, many patients have more than one diagnosis (i.e. diabetes +blood pressure+ heart disease +stroke + kidney failure + asthma + allergies to medicines), in which case the complications geometrically increase, both for disease and its treatment.

There are over 50 causes of unexplained unconsciousness.
There are more than 40 types/ causes of headache.

Every Court / police / bank / government needs proof for everything you say / claim / did (including your existence!), nobody takes your word or understands readily. None of these will answer anything immediately (except a “NO”). Even the mechanic does not tell you what is wrong with the car unless he / she opens it up and verifies. So why is the big objection and suspicion about a doctor wanting to investigate? Some doctors may earn cuts and that is NOT acceptable, but the fact remains that the tests are required in most cases.

One can of course give in writing that “I do not want to do any tests, and want to try medicines at my own risk for the working diagnosis which is tentative”.. Gone are the days when the medical science in India was primitive, and a big smile, a reassuring pat on the back and a goodwill prescription based upon presumptive diagnosis did the trick. In that case if the patient died or suffered complications, no one questioned the intentions of a doctor. Today the first response is in the breaking of hospital, violence towards doctors, news in press, police cases, then the medical enquiry of correctness of allegations. Today, when a patient walks into the doc’s chamber all mixed up with suspicion, disbelief, improper net-based knowledge / research and media-fuelled prejudices, it is difficult for the doctor to freely speak and advise, as almost every word is google-scrutinized, and every intent to do tests is questioned. Like all fields, there are huge quality differences in various test centers, not all pathology labs/ imaging centers do things as per standards/protocols as many ‘short-course” doctors are being created. Cheaper does not convert into better.
(c) Dr. Rajas Deshpande

No doctor starts his / her day with the thought of ending someone’s life or looting patients. There is so much huge, unimaginably vast knowledge and advances to be remembered 24/7, so many drugs, their reactions, so many thousand medical conditions one needs to be aware of, so many complications that happen without any warnings, so many reactions of medicines that one must know, that there is a continuous extreme intellectual pressure / stress that occupies a doctor seriously practicing his science. Things can go wrong with any human being anywhere and when people die elsewhere in the world nobody objects, but when that happens in a hospital or while under treatment, the doctor is immediately blamed. If a patient rides a bike without helmet, drunk, and sustains head injury, nobody minds, but if the same patient slips on a hospital wet floor and sustains same head injury, there will be a hoopla about poor care in hospitals and damages in crores, with addition by some crying film star how the hospital’s doctors purposefully kept the floor wet for getting more patients!

Agreed there are other scientific fields where high intellectual performance and vast knowledgebase is required, but none of them is directly related to human health or death so intimately via a mistake. The stress of a mistake in medical field surpasses the same in any other field. And doctors, being humans, are not free of mistakes. To presume it was voluntary is the problem.

In surgical situations, the risk multiplies, and the stress a surgeon / anesthetist undergoes inside the OT is comparable only to a soldier in enemy camp. Patients are known develop reactions to anesthetic medicines, common painkillers , paracetamol, antibiotics etc. almost anything used, some rare and some common. There are unexplained heart related complications, worsening of neurological problems, stroke, heart attacks, shock which can happen without a warning, more common in the elderly but also in the young age group, in spite of prior checkups and care. Blood pressure may go very high or low without any apparent reason. Such complications are very well known, documented, studied and even accepted in the western world, but their acceptance in Indian society is poor. Of course in case of a suspicion one may ask questions and investigate, but the Indian investigation of a medical issue usually starts in media and parliament before it can reach the medical councils. I fail to understand how relations between patients and doctors will ever improve with some media running such vehement anti-doctor news based not upon the court’s judgment, but patient’s allegations and incomplete investigation.

Doctors are becoming curt / speaking in least possible words and explaining more in a legal language than compassion to the patient. This was inevitable. With the human body so unpredictable (can you exactly predict when next your mood will be sad, exactly how many of your favorite sweets you will eat, which new medicine will not suit you, which night you will not sleep well, when next will you have headache and how severe, what food will affect your digestion badly, after walking exactly how many steps your knee will hurt etc. about your own body?), one must refrain from expecting definite predictions from a doctor , and also accept the complications as a part of human health, not always as a doctor’s mistake.

By no means anyone will justify a preventable mistake committed by a doctor. But our extensive training (in most cases) usually ensures that “avoiding bad” comes equally high as “doing good” in our actions while making patient-care decisions.
(c) Dr. Rajas Deshpande

A doctor is as human as yourself. He / she feels bad when someone cries, when a patient suffers, when someone dies, or when things go wrong. There are stresses that a non doctor will never understand: seeing dead bodies, cries, helpless deaths, torn and tortured human bodies, blood and urine and stools around one for most of the day, panic, shock, cancers, tragedies every single day of your life for years, for decades is not an easy choice: it does not take away our sensitivity, it only makes us more and more aware of the futility of material world. Nobody knows better than a doctor how cruel, unexpected and sudden death may kill someone apparently healthy. The only solace in this profession is the ability to help, to relieve someone’s suffering and agony. How can then a doctor start his / her day thinking “I will complicate someone’s health, I will cause some deaths, I will extract more money from the helpless poor today”???… It requires immense courage even to survive this mental trauma of living all your life among tragedies, too see all this and still come home and smile for your kids.

We do have to put up a brave face always. If we cry for every bad thing we feel, we won’t be able to practice. If we don’t speak stern, people will harm themselves with self neglect. Every doctor has dealt with the situation of telling someone a very bad news at one moment and minutes later having to congratulate someone else for a newborn or survival. Both cannot be avoided. That does not mean we do not have emotions. We learn better self control (except few idiots like myself who need to explain this all to everyone!!).

There are many who get completely better, many who go home smiling, many who live all their life happily thanks to some doctor’s correct effort / treatment. There are many who survive only because a team / a doctor reached them in time risking his / her life driving fast, sacrificing most precious moments of his / her own life. Many a hospitals, corporate or otherwise, have saved near-impossible cases through heroic team / individual efforts.
One should never mention returns of saving a life. The following is mentioned only with the purpose of unmasking the social hypocrisy..

We are trained to remember everything, BUT NOT THE GOOD WE DO TO PATIENTS.
We do not expect any great gifts, but this also is a reality: that there are hundreds of examples of punishments in crores for the negligent doctor, but there are no examples of someone gifting the doctor in crores for saving a life. All the respect and love society claims to bestow upon the doctor suddenly goes mute and vanishes when some press/ media/ politician bashes medical profession/ doctors or goes violent. Of the so many intellectual characters speaking and writing everywhere in the media, rarely is someone seen acknowledging the contribution of doctors/ medical profession to Indian health care full of inadequacies in the system. The poor and uneducated actually gift the doctors costlier gifts than the affluent who do away with anything but money / expenses for doing good / saving lives. God knows how many “millionaires and billionaires” whom doctors save walk away with a shameless smile, sending a box of sweets later as thanks. Or greeting. Or something that is emotionally multimillion but financially broke.
We really do not crave / want gifts / thanks / or news for being good. But please also stop this hypocrisy: that mistakes are amplified and punishable in hard cash / defamation and loss of degree, while all the good done, lives saved are rewarded in words and small “tokens”.

Why not a “token” punishment, too, for a doctor’s mistake?

(c) Dr. Rajas Deshpande

Do share unedited with credits.

Suicide / Homicide of Patients

Suicide / Homicide of Patients

(c) Dr. Rajas Deshpande​

Tuesday 3 pm. OPD

“She needs urgent admission and treatment.. she may be developing a stroke.” I told the relatives of this 70 some year old lady who was having recurrent episodes of tingling / numbness all over her body, with slurred speech. Otherwise healthy.

The disturbed family was displeased: a mom (patient), her son and daughter (very polished but obviously cut off from each other because they avoid talking to each other) who stay in different cities away from the patient. “You can suggest us the treatment and tests, doctor,” the US based son said, “but it is difficult to admit her as there is no one to stay with her in the hospital… I am in India only for three days, and I reached Pune only yesterday: I am very worried about Mom, so got her here today.. but I have to return as we have an important project going on, that depends upon me ”..
“I am not sure if she will agree for admission, doc,” said the daughter “she is very independent, never liked hospitals… Do you want to stay in the hospital mom?” the question had anxiety, reluctance, formality and suggestion for a negative answer, all at the same time.
The mom looked at me, with embarrassed smile, confused. “Well, if it is necessary..” she started, only to be cut off by her daughter.. “Let the doctor write the treatment and tests, Ma, then we will decide outside..”

I suggested an urgent MRI and few other tests, and gave a prescription. “Do we have to do the tests here only doc? Because we know that ‘xxxxxxxx’ trust, and it’s chairman is a very close friend of mine.”
This trust is known for free MRIs, average quality, meant to serve the poor. It takes time to get the apptts there, and some poor patient’s apptt will be cancelled because the “Chairman’s friend from US” will request an urgent MRI.
“It is your choice” I have to answer legally correct, even if I may not like this decision.
I write notes, suggest urgent admission, and start treatment.

4 days. No follow up.
Then on Saturday at 6 PM, the casualty CMO calls: “Sir you had seen this patient in OPD on Tuesday, she has come here, she is comatose, we are planning to intubate” .
I went there, anguished to the core but trained to shut up well when dealing with patients. The daughter rushed to provide details: “Doc she was not willing for admission: we did the MRI at the trust hospital yesterday morning, but she was very ‘sleepy’ since prior night. We got the report last evening..We thought she must be tired, so we waited till now.. but she is not waking up…. Then we thought that you advised admission, so we brought her here..”.

Patient had a brainstem stroke, one of the worst forms of stroke.
“When did she become unconscious exactly?” I asked
(This is how the court wants answers, ain’t it?).. but our intention was to see if she was in the “window period” for clot-busting treatment of stroke.
“The servant says about two days, but I saw her day before yest, and she said she was ok… I stay nearby only, and am in constant touch with her and the servant on phone.”
There was no point in discussion, they had all explanations about all decisions, and why things were delayed.
She required ventilator. The “busy” son kept on calling from US, and had their “Doctor Uncle in US” talk with us, conducting an accented cross-examination on phone, and telling us what we already knew.

On the third day, the family gathered its socio-financio-politico-legal experts in clever talk, and asked for a meeting. This discussion ensued, summarily:

“When exactly will she regain consciousness?”
“Can’t say”
How many more days in ICU?… Can’t say
Will she ever talk or walk again?…. Can’t say
Will she be a ‘vegetable’? …. Can’t say

One smartypants (well, smarty halfpants) asks with dismay “But Doctor, medical science has made such great advances in the USA, they say stroke patients can be treated completely, they have even done stem cell transplants etc.. and you are saying we can’t do anything”

I know a hundred hurtfully true answers that can wet the questioner. But again, my teachers shout in my mind “Shut Up”.

“At this stage, after the stroke has happened, we cannot do much”.. the technical answer.
“Doc please understand the family’s situation: how long can we continue this?”
“What can I do to help? Ask I.

The family exchanges meaningful glances . Smartyhalfpants conjures up the big courage: “We are ready to accept the inevitable. It is ok if you tell us she is not going to survive. We are prepared”.
I offend my teachers once in my mind, to answer that one. “But you all already had dumped her, killed her by delaying her treatment”. I can’t say it openly.

They waited another two days.
Then requested not to resuscitate the patient.
Besides the question “When” they were not interested in anything else. The more we tried, the more that family started hating us, alleging us, questioning us. If we advised any new medicine, the first question was “ Will it definitely make any difference?”
I will not mention when the family was seen smiling last.

So many patients die / develop disabilities because the family denies them medical care in time. Superprecious time is wasted in second opinions, finding cheaper options to everything, and idiotic presumptions and self medication. Add to this alternative medicines that are cheaper and available at home.
Many parents don’t ensure the important drugs like epilepsy medications of their own children, do not stock in advance, and take huge risks by trying on their own to stop these medicines.
Most elderly population is, to state honestly “Killed by neglect masked by beautiful sweet language and excuses”, only few exceptions are seen in real life.
Wives are taken for granted for the treatment of husbands / men / earning member in the family, however serious their health problems be.
Critical / crucial surgeries are avoided, admission notes are neglected because the patient / relatives keep on searching for the cheapest options.
Patients continue to neglect doctor’s instructions, eat sweet, not exercise, drink alcohol and smoke, drive risky quoting “It’s my life”… then why is the doctor held responsible when one develops complications of such a life?
All these delays (these are also medical negligence, dumbly ignored by the Indian legal systems) cause more deaths than medical negligence by doctors. There must be a law to record and punish these too. Hospitals must also have a registry of admissions advised, investigations suggested and in case of not being followed, report such cases for medical negligence.

They admit patients at the last moment, and want the system to be responsible for a guaranteed good outcome!

In a country where the court decides the punishment amount for doctor’s negligence by calculating how much the dead/disabled person would have earned, what else do we expect from the population? This is like open statement: if a doctor neglects the health of a non-earning, an elderly, or when the parents have many sons, it deserves lesser compensation, but if an earning member / only child is affected by negligence, the hospital / doctor pays up huge! Genius!

In hope of a good outcome.

© Rajas Deshpande