Tag Archives: Criticaldiagnosis

Doctor Arrested. Patient Died. Who’s Guilty?

(c) Dr. Rajas Deshpande

“Doctor arrested. Patient died due to a wrong surgery”.

The black headline was shining. There was a file photo of the accused doctor, and angry, crying relatives. Sad and angry, I read through the news that did not affect me directly, yet knowing that every patient who read that news will go further away from their doctor. The already delicate and dying bond will die a little more.

Is it enough to punish this doctor?

Who all is guilty here?

The parents who forced him to become a doctor because they couldn’t?

The corrupt educational boards which allowed leaking papers and increasing marks so the student could get a medical admission? (c) Dr. Rajas Deshpande

The politicians who made it possible for even the undeserving, low-aptitude students (which has nothing to do with one’s caste or religion: it’s more to do with money and power) to become doctors and play with patient’s lives?

The governments who allowed the “Medical Business” by establishment of substandard medical colleges owned by the rich and powerful, to sell medical degrees? The managements of such substandard institutes who chose the “low”quality teachers who agreed to work at low salaries and tolerate all humiliation? The teachers who didn’t care how their student was trained? (c) Dr. Rajas Deshpande

The medical councils which ignored the ‘temporary’arrangements made by such substandard institutes to just ‘Pass the Inspection’, never providing students with adequate education or experience?

The medical policy makers who made theoretical, mcq-type education more important than clinical training?

The offices of law which ignored the repeated applications and complaints of good students from such institutions about incompleteness of educational facilities?

The Universities that allow ‘manipulation’ of medical exam passing under influence of money or power?

Or the politics of allowing cross-specialty practice without adequate training, the ‘jump-over to any pathy’ decisions to please vote banks?

Or the corporate hospitals who prefer such “substandard” doctors because they can work at lowest payments? Aggressive and “market oriented” junior doctors are preferred by many commercial-headed hospitals over those with best academics and clinical knowledge. (c) Dr. Rajas Deshpande

It is indeed a reality that some doctors cannot speak a straight sentence, some cannot spell medicine names correctly, some treat even what is not their qualification skill, and some substitute knowledge with style, overconfidence and sweet talking. At various stages in their career, there are teachers who have tried to correct them, but in these unfortunate times of “pleasing one and all” including students, it is quite difficult to ‘mentally’ train a doctor to be good and perfect.

If only the doctor mentioned above is punished, leaving all others above without correction, then it will be a classic example of example of medical negligence and injustice. It will be like treating only the heart attack without treating the blood pressure and diabetes which cause that heart attack. We know the outcome in such cases.

(c) Dr. Rajas Deshpande

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The Light Divine

(c) Dr. Rajas Deshpande

The lady in the ICU appeared quite disturbed and shaken. Bewildered, she kept looking at her husband’s face, wiping her tears and his forehead with a corner of her saree.

Her husband, Mr. Mohan Vitthal Kadam, was critical, he had also gone completely blind suddenly and paralysed. While working as an electrician with a company in Jejuri, he was often noticed to have high blood pressure inspite of taking regular treatment with his family doctor. One day at work, he suddenly had a severe headache and went completely blind. Terrified, his colleagues rushed him to the nearest hospital. His blood pressure had shot up far above the dangerous levels. The local doctors gave him emergency treatment and sent him over to Pune. That’s why I had come to the ICU.

I introduced myself politely to his wife, and asked her the details. Sobbing intermeittently, she told me what all had happened. I examined Mr. Kadam. His BP was still high, but not in dangerous zone anymore. He was confused, unable to speak clearly. His left side was paralysed too. He pointed towards his head, indicating that he had a headache. His MRI showed many areas of his brain damaged due to high blood pressure. The areas which control the visual information coming from the eyes were damaged heavily. His brain was swollen dangerously. He could need an emergency surgery.

This condition, known among doctors as “Cortical Blindness” is a common but griveous condition: the patients eyes and the nerves are intact, they actually can see and carry the images to the brain, but the visual areas in the brain cannot see / read that information, because they are dead or injured. I informed this in simpler words to Mrs. Kadam.

“Will he ever see me again? Will he see our kids? How can he live the rest of his life with such blindness?” her questions came mixed with sobs and tears. I had very few answers, but I told her I was hopeful of a recovery. “We will first concentrate on reducing the swelling upon his brain, so we can avoid surgery” I told her. Their son came over and attended his father alternating with his mother. Mr. Kadam ‘s brain swelling gradually reduced, surgery was no more required. His BP was well controlled in two days. His paralysis also improved, but he still was completely blind.

Once he could understand the situation, he asked only one question: “Can I see my wife and children at leaast once in life again?”.

“We will try, I am hopeful” I replied. We had started with all the supplements that help recover brain damage. When he was discharged after ten days, he was still not able to see anything. He returned today.

“After we went to our village, many people told us to abandon allopathic treatment and go for secret herbal medicines and magical remedies. Somehow, myself and my wife decided to have complete faith in what you had told us. We continued your medicines and kept praying. The only light in my life then was the trust I had that I will get better. After two months, I could suddenly see a light bulb at night in our home. I immediately called my wife and told her so. Then onwards, there was a gradual improvement. I tried every day to see the faces of my wife and kids. In another two weeks, I could see them again That was the happiest day of my life.”. Mr Kadam became emotional. “Doctor, my company offered me a substantial sum as disability compensation, but I did not want money. I only wanted to see my family. Now that I can, I came here to thank you. Now I can even read a newspaper…but the darkness of being blind was far less hurtful than the thought of never seeing my dear ones again.. I cannot forget that. Thank you again, You are God for us” Mr. Kadam said.

I told him that I was just another doctor, that we were both cared for by the same God, that any qualified doctor would have done the same. I had not done anything extraordinary. But it is difficult to control a grateful patient.

“No doctor, we believe that doctors are God’s hands specially made to treat patients” he persisted.

I could only thank him. Thousands of doctors all over the world, all across India, do this every day, and receive blessings and gratitude that fills up their hearts with a joy that cannot be described.

Now I think there is a reason why Mr. Kadam came today. Many good and bad things happened in 2018. While making resolutions for the incoming new year, I was thinking once more what is most important in life. Mr. Kadam provided with many answers to that question. What matters is gratitude for what you have, especially health, gratitude for your family, and the ability to help others through their darkness. Who except a doctor is better placed to help others with health and life? Whatever other resolutions a doctor may make, one of them remains a universal favourite: ’ Let all my patients improve, and live happily a long life. Let me make every effort for that.’

Thank you. Mr. &. Mrs. Kadam, for allowing me to share this story.

(c) Dr. Rajas Deshpande

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“Alive Or Dead?”

(c) Dr. Rajas Deshpande

“I saw the news myself. The doctors declared her dead. They took her home. In a few hours, her son noticed her breathing, they immediately took her to another hospital, where she became conscious. Doctors are absolutely careless now a days. All doctors and hospitals work for only money..” the hefty dark man with a large moustache was telling this story loudly to a group of about eight people sitting around him, three of them quite pretty, young and attractive.

“Yes,”replied another, tall and fair, but with a shrill voice: “Doctors have become butchers now. My friend’s father suffered a head injury, and was dead on the spot. But the doctors told us he was alive and kept his dead body on the ventilator for five days, saying that his heart was beating. All for money”.

I was sitting in the cafetaria of our hospital, it was nearly ten at night. I had just attended a call for a patient of convulsion, in the recovery room , where patients are kept for a few hours after major surgeries. . The patient, who had had fits since childhood,had presented with heart failure due to a defective heart valve, and had undergone a major heart surgery to replace the valve just two days ago. He had had another fit. The cardiac surgeon Dr. Ramnath had personally called and requested me to rush and assess the patient. He was quite worried, like most surgeons are after major surgeries. After making some changes to the patient’s prescription, I called up and informed Dr. Ramnath. He was relieved “Thank you, Rajas. Will you please wait in the cafetaria? I would like to have a coffee with you” he had said. (c) Dr. Rajas Deshpande

That’s why I was waiting in the cafetaria, as usual my back towards the world. The group sitting behind me probably wasn’t aware that I was a doctor, or likely had chosen to ignore it.

In the next ten minutes, there followed many anecdotes by various members of that group: that allopathic treatment is costlly yet useless, all doctors are sold to the drug companies, that humanity has vanished from the medical profession, etc.

The most beautiful sign of growing up is not reacting to a certain type of people. I practised it, although rattled with all that I had heard.

Dr. Ramnath walked in. His trademark fast pace and smiling face brightened the small cafetaria.

“Hi, Rajas, sorry to keep you waiting. Much obliged that you could come. I have just seen him. Oh Hi..!” he said, noticing that two people from the group stood up.

“Namaskar doctor! How is our patient? ” asked a person with the moustacheo.

“He is quite stable now, all is well. I will shift him out tomorrow if everything is okay” Dr. Ramnath said.

“Then why did he have a fit? Why didn’t you tell us that could happen?”asked the moustacheo. He had found a gentleman, polite, highly educated doctor replying his questions courteously, this was his chance to misuse it to impress the three PYTs in the group. (c) Dr. Rajas Deshpande

Dr. Ramnath’s smile vanished. “I had explained to the patient’s family. May I know who you are?” he asked to the moustacheo. Even a surgeon has limits to the misuse of patience.

“I am patient’s father’s friend” he replied, his voice on an offended backfoot.

“Please see me in my office by making an appointment”Dr. Ramnath told him.

We went over to another corner of the cafe and ordered our mutual favourite Italian Roast black coffee. (c) Dr. Rajas Deshpande

Two weeks later, the patient came to my OPD for adjustment of the fits medicine. The moustacheo came too. The patient had recovered magically, now living a new life. I told the family so.

The moustacheo was not yet satisfied. He asked many questions. I had most answers. At the end of it, I asked him what he did.

“I work as a commission agent in property deals” he told me.

“If I may ask, how much are you educated, and in which field?” I asked him.

“Oh I left school after tenth standard. Why?” He was offended.

“Can you google?” I asked him.

“Yes” he said proudly.

“Please read about ‘Lazarus Syndrome’” I told him, writing it down on a piece of paper for him.

There are many examples all over the world, where a patient’s heart stops functioning, and doesn’t respond to the usual measures of CPR / resuscitation, but automatically starts beating again after a few minutes, and the patient becomes conscious later. This is called the ‘Lazarus phenomenon’. It happens because of a complicated combination of chemical, electrical and physical changes in the heart, even many minutes after it stops. This has been reported more than 38 times all over the world. However, it is only in India that doctors are beaten up, hospitals vandalised, and the media earns crores by shouting poisonous about this headline. One state government even shut close an entire superspecialty hospital because of such incidence! (c) Dr. Rajas Deshpande

On the other hand, if a doctor tries to keep the patient alive even when the brain has stopped functioning, or the heart is failing, then some of our less educated muscular bollywood heroes cry foul about the entire highly qualified medical profession, that “doctors are keeping dead bodies on the ventilator to extract money” and even slap doctors in the hospital on the screen, to impress their quality of box office. Maybe we must call these “Ëxperts of life and death” in media and bollywood to treat every patient, to perform operations, and even to certify every unfortunate death that may happen in some cases. It is because of this poison spread by these ‘pseudo heroes’ at the cost of the best doctors in the world, that even after the best outcomes at the cheapest rates, Indian doctors have to face the bitterness and wrath of our society.

Whether a patient is “Dead or Alive”? Everyone in India other than qualified doctors seems to know better!

(c) Dr. Rajas Deshpande

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The Poverty Vow

(c) Dr. Rajas Deshpande

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

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

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

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

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

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

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

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

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

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

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

“Yes?”I asked.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

(c) Dr. Rajas Deshpande

A Good Doctor’s Daughter

© Dr. Rajas Deshpande

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

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

I went and opened the door.

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

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

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

They looked at each other.

“How?” the husband asked.

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

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

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

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

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

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

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

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

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

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

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

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

© Dr. Rajas Deshpande

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Hon’ble Babaji’s Medical Interview

© Dr. Rajas Deshpande

A long fleet of luxury cars entered our big hospital. Sirens and whistles, security guards brandishing their AK 56s. and shouts of humiliation for the common men and women suddenly filled up the scene.

Hon’ble Babaji had arrived. A vacuous smile and blessing hands greeted one and all. Babaji was known to cure one and all with his blessings, secret medicines, chants, touch, and even exercises. There was nothing he didn’t treat, so he was the ultimate superspecialist with highest experience and cure rate. No deaths were ever reported among those millions treated by Babaji.

I was in the ward with some of my colleagues, a junior doctor then. The most reliable pleasure in the life of junior doctors is pretty, beautiful and handsome colleagues to work with! Rare exceptions with extreme merit are of course there.© Dr. Rajas Deshpande

A rich businessman and senior minister was admitted in emergency with a heart attack last night. Doctors had performed an emergency angioplasty, barely in time to save his life. Highest offices in the country had warned doctors to ‘do the very best’ for him, till the time he could be flown out of the country for the most advanced treatment. After the meeting of money, influence and power, we got a chance to request Babaji for a small interview to guide us inexperienced doctors. Looking at some of the prettiest faces among us, he gracefully consented. Here are some excerpts of the interview for the benefit of mundane, inexperienced new generation doctors and junta:

Doctor A ( looks OK): Namaskar Babaji! Can you tell us where you studied this art of curing all the illnesses?

Babaji: Beta this is the inheritance of generations, bestowed upon those who perform some secret rituals, it took me many years in the forest to learn it all.© Dr. Rajas Deshpande

Dr. Me ( looks ugly as you know): But Babaji, did you have patients to treat in the forests?

Angry Babaji: No. To learn this secret art you do not need to practice upon patients like your medical science. Once we know, we can directly cure everyone.

Doctor B (stunningly beautiful, common crush): Babaji, can you tell us how you treat a case of open head injury?

Babaji (with an gracefully sexy smile): Come beta, sit here, so you can hear me. We first hold some leaves hard pressed against the wounds to stop bleeding, then pray for the patient with some internal healing chants. We then call the relatives and explain them how futile and fragile life is, and ask them to accept fate. Usually they do. Some rare ones take such patients to hospitals. There too, some die and some survive. Those who survive mostly do because of the prayers. You can come to our place if you want to know how to treat all types of emergencies. We have even made some dead alive!© Dr. Rajas Deshpande

Doctor C (Meritorious. That’s all.): Babaji, there are so many poor patients dying in so many government hospitals, in small villages, everywhere. There are so many hunger deaths too. How come you and your chelas are never seen working your magical powers for such poor and needy patients? In the same time that you visit a businessman, minister or appear in a TV interview, you could treat and cure hundreds with the power you claim to have.

Babaji (red): You will not understand, because you do not have faith. Next question.

Doctor B: Babaji, you and your drug company earn in multiple billions. You are a saint yourself, and do not have material aspirations. Then where does all this profit go? Are you secretly using it to help treat poor and downtrodden?

Babaji (drinks water): There are many charities we do, but one must not tell others what charity they do. We submit the reports to the government. I am getting late, beta, it is my prayer time.

Doctor A: Just one more question, Babaji.. it is said that you cure diseases like cancers, AIDS etc which have no medical cures. Is that true?

Babaji (winks one eye): If you ask me in front of media, I will say no. Because I do not like too much attention and fame. But if you come to our place, you will see the miracles that our ancient formulas and personally researched products can make. They are all FDA approved and safe. Millions have been cured. We treat everything!© Dr. Rajas Deshpande

Babaji smiled proudly and got up.

As he walked in the lobby, many poor patients and their relatives who tried to touch his feet were pushed away by his security. Only pausing to answer questions by TV channels, posing holy, Babaji disappeared in his luxury car.

I went back to the room of the rich senior Minister to record his blood pressure. He was on the phone, talking to someone “Yes, yes, Babaji just confirmed his plan to buy another aeroplane. I have promised him that you will design the customized interiors for his new plane. Come over tomorrow”.

Then, as I recorded his notes, I politely asked the rich minister “Sir, why didn’t you go to Babaji first when you had chest pain?”

He replied what most Indian Politicians, Media personnel, and many Judicial experts feel: “You are too inexperienced about these things, Doctor”!

© Dr. Rajas Deshpande

Please share unedited. Any resemblance to any human being or animal is deeply regretted and unintentional. Praying for better logic and reasoning in all human beings.

“My Turn Now”

©Dr. Rajas Deshpande

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

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

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

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

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

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

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

© Dr. Rajas Deshpande

Neurologist, Pune

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The Medical License to Kill

© Dr. Rajas Deshpande

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

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

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

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

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

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

The Nursing Super smiled in shame.

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

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

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

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

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

Jai Hind!

Mahatma Gandhi ki Jay!

© Dr. Rajas Deshpande

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The Deadly ‘Vegetable’

The Deadly ‘Vegetable’

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

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

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

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

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

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

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

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

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

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

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

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

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

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

© Dr. Rajas Deshpande

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

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Illegal Heroes

Illegal Heroes

© Dr. Rajas Deshpande

“I was at the disco last night. We danced a lot, I exceeded my ususal capacity of 180 ml alcohol, and had two or three large pegs extra. I must have smoked a little extra too yesterday, I was too stressed”’ said the 30 year old man, who was admitted one afternoon in an unconscious state. He had had a fit in the office that morning. The MRI had shown a large bleeding / haemorrhage in his brain. This illness, cerebral venous thrombosis, is quite common among those who are dehydrated, those who have untreated sinus infections, and among those who take contraceptive pills. If not treated in time, it can quickly cause brain swelling that may lead to disability or death.

Over next three days he gradually improved. Brain swelling started to recede, and he asked for a discharge. Faster and to-the-point care had improved his condition, thanks to modern healthcare. A psychiatrist had already counselled him about deaddiction. When we sent his file for discharge, his mediclaim insurance was declined because this illness was related to alcohol consumption. Immediately, his tone became bitter, his colleagues dissected the case papers asking for justification of each test, each medicine, and also why he was even hospitalised. Gratefulness is often waived off by doctors as a lost quality among saved patients, but it is difficult to tolerate arrogant distrust. We firmly explained him what was done and why.

“We will pay your bills, we will claim the insurance later, but you must change your notes, remove alcohol and smoking from his papers” said the patient’s brother.

“We cannot change the case notes, it is illegal. Also, we have already sent copies to the insurance company, a standard procedure. You are not obliging us by paying the bills, we have provided healthcare service that saved your brother, who was about to die due to alcohol consumption” we replied.

Within an hour, a local politician, an elected member, who came in his Range Rover with his personal armed bodyguards and human doggies, started his anti-medical show that had drama, emotion, tragedy, threats of violence and revenge and everything else but truth and honesty. He spoiled the day for everyone involved, caused disruption of hospital work for over six hours, and left with a threat of “burning down the hospital soon”. When our PRO asked him whether he wants to pay the bills of this patient to help them, his reaction was the hallmark of a true politician: change of topic to how the medical profession has lost its reputation.

Almost every doctor, every hospital in India is being threatened and pressurised by our own lawmakers at almost all levels into changing facts, writing false details, extorting concessions for the rich and poor both, only to increase their own vote banks at the cost of the healthcare industry. Most politicians, many government officers instead of financially helping the patient, ask the hospital to treat free or cut off bills.

How legal is this authority? If a politician writes to a court or lawyer or hotel or an Airline to waive off fees/ bills of a poor person, will they ever? Why are the doctor’s services and hospitals taken for granted here? How sad that such illegal means make pseudo-Heroes in our country!

Everytime the politicos pressurise a doctor or a hospital to treat their paying cronies free or concessional, some other truly deserving patient suffers because hospitals, small or big, can only do a certain level of charity. How fair is it to deny healthcare to the deserving poor just because they cannot flex a political muscle? This phenomenon is ruining the whole purpose and concept of charity healthcare measures all over India.

Aren’t these elected members responsible for the disgusting state of the civil and government hospitals and healthcare all over India? That is their domain of authority. This is like messing up one’s own home and family and requesting the one with a better home and family to pay and comply for one’s own needs. How shameful is it for the elected members of different parties to have to send people, especially the poor, to the private hospitals, because their own set-ups are failing perpetually? Empty posts, inadequate staff, poorest funding, non-availability of quality technology and medicines and red tapism have created massive monuments of the healthcare failures of different lawmakers all over India, and these are the very people who come threatening to the hospitals of burning them down! Hear this, any Milord?

If the honourable Prime Minister and Health Minister invite feedback from every patient leaving every civil and government hospital, the gravity of this situation will be understood better. Many repairs “at home” are required before “the neighbours home” is raided. We as doctors and hospitals must together request these authorities and offices to protect us from such daily insults, extortions and exploitation.

The very next day, an old man, a retired Indian Military officer, was expressing himself in the OPD with tears in his eyes: “Ye desh ka kuchh nahi honewala (This country cannot progress). People here, at all levels, want corruption, legal escapes to save money, and will elect anyone who throws them petty bits. Votes are bought for such favours as alcohol, gifts and cash. Sycophants rule, criminals are seen hand in hand with some rulers. Who do you think will get elected with such means, saints? You can guess what progress we expect if the lawmakers are first in line to break laws..”

There was nothing more sinister I heard that day. I am worried about the healthcare in my beloved country. God save the future generations from such illegal heroes!

© Dr. Rajas Deshpande

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