Tag Archives: Critical

A Habit That Protected Me

A Habit That Protected Me

(c) Dr. Rajas Deshpande

“I cannot bear this. Help me doctor”shouted the Old man fom the waiting room, just as I entered the OPD. There were appointments before him, I requested others to wait, and most of them agreed, although a little upset. I called in the old man. He was accompanied by two of his sons, both probably professional bodybuilders.

He was a known case of Trigeminal Neuralgia, a condition that causes severe, shock like or stabbing, excruciating pangs of pain on one side of the face. This usually brings the patients to tears, and most patients come frustrated, unable to talk or eat, with the telltale sign of their hand covering that side of the face, scared to open mouth even to reply. He had had this condition over ten years now, and was quite stable, usually visiting me once a year. He had last visited only a few weeks ago, smiling and pain free. There were no new findings. He kept on shouting, saying that the pain was unbearable. This was unusual. I asked him if he had done any of the prohibited things that usually increase the pain of Neuralgia: cold drinks, icecream, shaving harshly, exposure to breezes etc. He said he had had an icecream a few days ago, but the pain had only restarted yesterday.

The sons were staring menacingly at me. “How come this has suddenly worsened doc? Is this the effect of your medicines?” one asked. I wondered why they don’t teach simple logic and reasoning in primary schools. Everyone going to a gym must, in my opinion, first be mandatorily taught normal human conversation. Otherwise they speak with their biceps. Not knowing that language, I chose not to reply him. (c) Dr. Rajas Deshpande

He was already on high doses of the medicines that controlled his pain. He also had diabetes, so I could not use the best emergency medicine for such pain: steroids. Once earlier, he had developed severe infection while on steroid, so that was out of question.

I started him on a short course of a strong pain killer. Warning him that he should take it only for three days. “His pain must stop immediately” said the other son, threateningly. “I wish so too. It should subside soon, usually it takes two to five days” I concluded the consultation.

They returned five days later. (c) Dr. Rajas Deshpande

“I am very good now, Doctor”said the old man, “The pain went away the very next day. Thank You”.

Just as I prepared to look at the musclebuckets proudly, the old man said “Doctor I need a certificate that you had advised me bedrest for five days”.

I was almost prepared to write, this appeared a justified request given what had transpired. Curious, I asked him: “But you have your own business. Why do you need this certificate?”

It was then that one of the biceps spoke: “He had a court appearacne in a criminal case on the next day of our visiting you. He could not go to the court. Now the court has asked for a certificate”.

Alarmed, I told them: “I had not advised him rest. I cannot issue a false certificate.” (c) Dr. Rajas Deshpande

They looked at each other. Then the old man said “I request you doctor. My cousin has filed a false murder charge against me and my sons. Please help us. Your certificate will save us trouble”he folded his hands.

Now the secret of why that pain had worsened suddenly had unfolded. This condition is indeed known to suddenly worsen, but when such “situations”coincide with illnesses, a doctor is the easiest to squeeze the arm of.

“But we paid your fees. His pain was actually severe that day. How can you deny us a certificate now?”asked the elder biceps.

Many video clips of daylight, open murders that happen around us daily ran through my mind. Even under the heading of compassion, was it right to help this patient, who was one of the accused? As a doctor, I am not to judge anyone and must purely decide based upon the medical merits of this case.

I had not advised him rest. I declined their request for the certificate. Angrily, the trio left my room, and on the way out, in the waiting room, loudly enough for other patients to listen, the old man said something derogatory about all doctors being heartless looters. Every new patient who walked in that day had a question mark of suspicion on their face, it took me extra effort to wipe that away in each case. (c) Dr. Rajas Deshpande

Whether it is addiction to pain killers or sleep medicine, whether it is false certificates or deceiving the medical insurance companies for claims, many patients abuse their doctors’ compassion and services. Some doctors fall easy prey to such tactics, some do it for money. Majority refuse to contribute. It is this majority that such “demanding”patients always cry against.

The doctors who help such people with such causes not only endanger themselves, but may in fact add disgrace to their profession, because it is these same patients who tell others how any doctor can be fooled, or bought with some money or threat.

As fate would have it, one of the sons came to visit me the very next month, for his wife. As I examined her and then wrote a prescription for her, I enquired about his father.

“Oh he is alright now. We got a certificate from one of our relative who’s a doctor” said the son, smiling shyly: “That’s why I brought my wife to you.. I know you will do only the right thing”.

I could only thank my teachers who had tattooed that habit upon me, and taught me that only good begets good. It is a habit that has protected me always.

(c) Dr. Rajas Deshpande

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The Higher Suffering

© Dr. Rajas Deshpande

Stuck in the heavy traffic due to rains, I tried to remain calm. The cellphone kept on ringing, patients who were waiting, those who wanted appointments, those who were to catch their ride out of station anxiously asked when will I reach. Some lost patience and raised voice. In addition, there were calls about the patients admitted in the hospital: critical decisions to be made, idiotic questions by insurance companies to be replied to. There were huge processions, the traffic was diverted, without any arrangements for ambulances. Impatient, aggressive and violent people is a reality on almost all Indian roads now. No one cares for law on the road. You are at the mercy of anyone who chooses to pick up a fight with you.

There were some issues at home too, the cook had called in sick, we had to do some emergency cooking. That had delayed my start.© Dr. Rajas Deshpande

At last, an hour late, I reached the OPD, and entered running. Faces with controlled anger greeted with cultured politeness. Prepared for bitter comments, I called in the first patient.

This was a free patient, she did not need a follow up. But being free, she visits almost religiously every month, whenever she has a fight with her husband. Sometimes, when the only guaranteed compassion is from a doctor, it can be misused. However, as I was late, I decided to respect their patience, and told them to visit a counselor. Nevertheless, my irritation heightened, that this added to the wait of other patients.© Dr. Rajas Deshpande

I certainly am impatient with meaningless waste of time, and sometimes the traffic, the sudden changes in schedules due to someone’s irresponsible behavior, and misuse of compassionate services bring me to the edge of a reaction. This was one such moment. My face must have become grim.

The next patient walked in, an elderly gentleman with Parkinson’s disease. He was accompanied by his wife. They were supposed to come back three months later, but had followed up early. I examined him, found him quite stable neurologically, but the usual twinkle in his eyes was absent. Even his usually smiling wife appeared lost. It must be the traffic, my late arrival or something likewise, I thought, and curbed my curiosity to ask them. Today was heavy and behind schedule, I must wind up fast. Yet, as I explained them that everything was stable and alright, that they need not worry, I noticed the unspoken uneasiness in their body language. A little reluctantly but keeping up with the expectation of my own heart, I asked them: “You look quite disturbed and stressed. Is anything the matter? I am sorry I came late today”.

“No, no doctor, it’s not that. But yes, he is stressed and disturbed said the wife, and looked inquisitively towards her husband. ”Shall I tell him?” she asked.

Looking down, hiding his face, the husband nodded.

“Doctor, we lost our only son ten only days ago. Someone killed him on the road. Some drunk goons dashed his car from behind, and when he got down to check the damage, they attacked him and hit him on the head with some rods. He was lying on the road for a long time, and by the time police took him to the hospital, he was gone. We came to know after a few hours. He was our only child, an engineering scholar who had returned to India with great dreams .”

The lady was silently weeping as she kept her emotions in control. The patient was sobbing, I called the receptionist to get a glass of water.© Dr. Rajas Deshpande

“We have done so much for our town and the society” said the patient, “but now I feel it was all useless. No one is safe even on the roads. We see so many rules and laws broken, so many violent and aggressive people that it has become difficult to question anyone even when they misbehave”.

I had no words to pacify them. What can pacify the parents of a dead child, that too a victim lawlessness?

The receptionist called “Sir, the next patient is shouting” she said.

“Five minutes” I requested her.

“You are busy, doc, we will leave. But I brought him here only because he feels better when he meets you. Once you reassure him, he will feel a little secure. Even I feel better when I see you. Otherwise we sit at home just staring at each other’s sunken souls. We have no relatives”.

That was a bitter eye opener to me. They had chosen me to be their lifeline in the worst times of their life, and here I was, thinking about my worries, my time, and the inevitable small happenings that block the path of every working person every day. I had momentarily ignored the fact that I must still enter the hospital with a smile, push behind myself all the negatives that pull me down. For every patient here to see me comes with a hundred fears and a thousand expectations, the least I can do for them is be compassionate and reassuring, whatever may have happened till that moment.© Dr. Rajas Deshpande

“You may see many patients in a day and listen to their troubles, doc, but you are the only doctor your patient meets in a long time. I don’t know about you, but we always feel good when we see you”. The wife added.

Yes, I had heard that earlier, in my teacher’s cabin. Once a patient develops trust in his / her doctor, they look upon the doctor as one of the most reliable resource for courage, compassion and troubleshooting, even beyond the expertise of that doctor. As doctors, we must never forget this, and stand up tall above all our personal problems to be the supermen and superwomen, the Messiahs, the Saviors that we are expected to be. Law and some idiots do push a stick in our wheels, but then the patient is far above both. A patient’s suffering is always far above that of any doctor.

I stood up, held the patient’s hand, and reassured them: that they do have a relative here in Pune. “According to the Pune tradition”, I said, “one should offer tea only when the guests are half out of the door, but I will make an exception today .”

Having them sit in the next empty room, I proceeded with the OPD. Ordering tea for everyone in the OPD waiting room, I stole a few more minutes to calm the ruffled souls of those two, and asked them to see me again, whenever they wished.

As I returned late after dark, even through the rainy night, a sweet moonlight made the raindrops glow. Just like every doctor brings back the smiles to the burning hearts of their patients!

© Dr. Rajas Deshpande

Can Anyone Solve The Mystery of Atmaram’s Courtroom Death?

Can Anyone Solve The Mystery of Atmaram’s Courtroom Death?

©️Dr. Rajas Deshpande

A hungry poor man named Atmaram went to a big hotel, had a nice big meal, and told he had no money to pay. He was beaten up and handed over to the police. He was released after a warning and a slap.

Next day he filled up petrol in his bike, and said he couldn’t pay. He was again beaten up, handed over to the police. Then he went to the medical shop, bought medicines and mineral water, ate the medicine, drank water from the bottle, and again said he couldn’t pay. He was now jailed for a week.

Next week his house was damaged by heavy rains, so he went and requested to be allowed to sleep in the house of the chief minister. He was arrested again, thrashed up.

As angry Atmaram shouted at the police, he was beaten up by them, another crime was added to his offences. In the court, Atmaram insulted the lawyers and judges and accused them of accepting bribes and charging too much. The judge punished him extra for his behaviour. Atmaram was angry and threw his shoe at the judge. His punishment was extended.

“You must respect the authority “ the court said.

“But I am poor, I need free food and petrol and medicines. I need sympathy too” Atmaram argued.

“You should have begged and applied for favours and eaten in places that provide charity meals. Petrol, however essential, has the same price for everyone. You can sleep on the footpath, and above all, you are not allowed rudeness and violence because you are poor and needy” The court said.©️Dr. Rajas Deshpande

When released from the jail, Atmaram drank a lot of desi alcohol, had an accident and fractured many bones. He went to the best private hospital, got operated and refused to pay his bills that crossed one lac rupees. When the hospital insisted, the operating doctors were beaten up by Atmaran’s relatives, the hospital was vandalised, the police arrested the doctor who saved Atmaram’s life, the government closed down the hospital, while the media and the society kept villainising the entire medical profession.

The headlines next day reported the sympathy expressed uniformly by wag addicted tongues: some said the entire profession was tainted, some blamed the greed of the doctors, even some doctors desperate for attention shed crocodile tears about the ethics in this profession. ©️Dr. Rajas Deshpande

In the courtroom, during the trial, Atmaram sat facing the doctor, still heavily bandaged.

The hon’ble judge, kind but surrounded by security, told the doctor accused of negligence and malpractice in the court: “You as a doctor carry more responsibility for ethical behaviour upon your shoulders. You should never turn away the poor”.

The doctor, defending himself, asked “but Milord, doesn’t our constitution insist on equality? Why do you yourself or ministers get security but not the doctor? Why isn’t everyone supposed to stick to ethics in every profession including politics, police and judiciary? Why are others exempt? How do you explain beating up of doctors while also saying that the society treated them like gods?”.

There were no answers. The kind court asked if the doctor had to say anything else in his own defence.

The doctor said

“Yes Milord, but the real answers will hurt:

Jealousy against medical professionals across society and many other professions is a reality. Why else will anyone who couldn’t qualify to become a doctor try and teach the qualified doctors what they should do?”©️Dr. Rajas Deshpande

“A culture of exploitation of non-votebank groups

and a complete failure of government healthcare with no one accepting responsibility is well known to everyone, but even judges have no courage to suo motu question this and correct it, even when they see the poor dying”. ©️Dr. Rajas Deshpande

“In a country with never ending poverty, how much free can a healthcare facility provide? For how long? This is already forcing closure of hospitals and exodus of good doctors out of the country.”©️Dr. Rajas Deshpande

“Milord, can you assure that every doctor will get his/ her fees as per his service to every patient, and if the patient can’t pay, that much charge will be exempted from the income tax of that doctor? How else do you except a doctor to meet his needs and dreams? Just because there are millions of poor patients, is the doctor’s life and hard work taken for granted? If there has to be financial sacrifice, why not have everyone contribute to it by creating a national health tax fund for treatment of poor patients? Why healthcare is subsidised only at the cost of a doctor?”

Just at this point, Atmaram, who sat in front of the judge, collapsed unconscious, almost blue black.

The shocked judge requested the doctor to examine him.

“He is no more” said the doctor.

“What could have happened ?” asked the kind but sweating judge.

The doctor told the court about three possible reasons. Two of them were scientific and medical: a sudden cardiac event or a large blood clot in the lungs common after fractures and trauma.

The third non-medical, unscientific cause made the Judge seriously ponder.©️Dr. Rajas Deshpande

“Will this court be now closed down, Milord? Will your efficiency be questioned, will you allow the relatives to attack you and understand their sad situation at the cost of your murder?”

“I understand what you mean” said the kind judge.

Needless to say, the doctor was released without a blame.

Can anyone please solve the mystery of the third non medical, unscientific possible cause of Atmaram’s death?

(C) Dr. Rajas Deshpande

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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

Critical

Critical
© 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