Tag Archives: Criticaldiagnosis

The Dictators in Hospital © Dr. Rajas Deshpande

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

© Dr. Rajas Deshpande

Neurologist Mumbai/ Pune

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Lost and Saved Life: The Indian Puzzle

Mumbai Diary-2

Lost and Saved Life: The Indian Puzzle

© DR. RAJAS DESHPANDE

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

©️Dr. Rajas Deshpande

Neurologist

Mumbai/ Pune

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Survival Of The Quickest

© Dr. Rajas Deshpande

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

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

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

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

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

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

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

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

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

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

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

© Dr. Rajas Deshpande

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

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The Medical Court Martial and the Punishment

The Medical Court Martial and the Punishment

(c) Dr. Rajas Deshpande

“What is the exact diagnosis?” the patient, Mr. Abhishek asked.

In his early thirties and succesful, Abhishek was anxious too. I told him that his looked like a stress headache, migraine was a possibility, the tests I had told him would help us rule out other possibilities. There is no lab test for confirming the diagnosis of migraine.

“What is each one of these medicines for?” Abhishek asked. That the doctor had an experience equalling his total age had nothing to do with his right to ask questions. He was buying the doctor’s services after all! For a moment I wished I was not a doctor, that I could tell people off by snubbing them, that I could rudely decline to reply to questions that were against common sense. But then I reminded myself: that I did not have this liberty. I must face the court martial of a doctor, a chosen punishment, every time I see a patient.

“Sir, you have told me you had a headache. These medicines are for headache” I replied, smiling.

“Is it necessary?”he asked.

“No”. I said., “As a doctor I have only three options: prescribe you medicine which I did, recommend a surgery which is not applicable in your case, or suggesst you a non-medicine path like lifestyle change” I replied. Practice makes one patient too.

“Are these steroids or antibiotics?” his wife asked.

“No” I replied, and thanked God that they believed me here and did not ask for proofs.

“Are these tests necessary?” Abhishek.

I told him the pros and cons of doing the tests, and reassured that it was not an emergency. Even if they did not trust me, I had to do them good. That’s the duty of a doctor.

“What lifestyle changes do you suggest?” he asked.

“Ensure 8 hours of sleep every day, give up cellphone use after evening, reduce screen exposure to less than three hours at a stretch, maximum eight hours. Eat fresh and healthy home cooked food three times, and eliminate fast food. Resolve relationship and work stress issues. Reduce weight by consulting a qualified dietician. Start exercising.” I told him. This simple formula for a healthy life is mostly possible for the poorest of the poor illiterates, but impossible for the educated affluent! What a paradox!

“Impossible, doc! Tell me something practical. My work needs me to use screen and cellphone over 12 hours a day. I mostly work at night, I have to use fast food or tiffins. My wife also works, she has stress of her own, we haven’t had time to even have children yet! There’s no energy left for any exercise when I return” . Abhishek was genuinely frustrated with his schedule without even knowing it.

“Then Sir, please take the medicines as prescribed, and gradually make changes that eliminate stress. Please do these tests especially if you do not have relief in next two-three days” I thought it will be over now.

I was so incorrect!

“Do these medicines have any side effects?” his wife asked.

“Yes, all medicines have side effects, these are the ones with least side effects for your condition” I started getting faster and shorter with my replies now.

“What if he develops any side effects? Can we call you on your personal number?”

How could I tell them that every doctor prescribed over 100 different medicines every day and all of them could have some side effect or other, minor or major, and that if everyone kept calling for each side effect, the doctor won’t be able to practice!

“Usually side effects are not seen with these medicines. If you have any allergic reaction, please stop these and report to the nearest doctor or hospital. I may not be reachable always” I wondered what people did before the cellphone era: how happy the doctors then must have been!

They appeared partially satisfied and left. My court martial in this case was over. “Only twenty more court martials remaining for today!!” I reassured myself.

After about two weeks, I received a call from the casualty. Abhishek was admitted in an unconscious condition. His wife was in a state of shock.

“What happened?” I asked her.

“Doc, sorry, but he did not want to take any medicine with side effects. So we went to someone who gives a herbal medicine without side effects, made at home. We took it for about five days. The headache improved first, then went on worsening. Then Abhishek had a lot of vomiting and did not eat anything for three days. Today he got up and collapsed while taking a bath”.

“Did you ask the person what was the content of his potion?” I asked while examining an unconscious Abhishek.

“No doctor, he says it was his own invention, a secret” she replied.

Abhishek was paralysed on the right side. His MRI showed many blood clots due to dehydration and a small bleeding on the left side of the brain. This is called cerebral venous thrombosis.

Many people who go on prolonged fasting, drink less water, overexert without enough hydration develop clots in the veins of the brain as their blood becomes thick. Some diseases of the blood and some medicines like hormonal preparations, alcohol, contraceptives etc. (even herbal) can exaggerate this tendency. This is a major cause of clotting, bleeding and swelling in the brain, resulting in paralysis or even death. One should never make sudden changes in diet without consulting a qualified expert.

We admitted Abhishek in the ICU. He gradually recovered over few weeks, but his speech remained patially slurred. His company ruthlessly fired him, they did not care how dedicated he was to them. The most fortunate thing was that he retained his intellect, memory and ability to move. The couple has now changed their lifestyle and are far happier although not richer. He is off all medicines now.

Almost every doctor bears the punishment for the few who overprescribe and overinvestigate: a trustless court martial, bitterness and allegations by not only educated but even totally uneducated patients. A doctor must be compassionate and kind, but the limits to how many unnecessary questions he should patiently reply to remains a dilemma.

This daily court martial of doctors must end. The doctor’s consultation time and peace of mind is as much important for the next patient as for himself. Newer generation doctors should also be taught to politely deal with such situations.

A polite reminder to ask only relevant questions, to book another appointment for more time is justified in such cases. The society should understand and accept that a qualified doctor has repeatedly proven his merit, acumen, ability and correctness before being allowed to practice.

Unlike the many we vote for.

(c) Dr. Rajas Deshpande

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The Doctor Who Took Fees: One Star Review”

© Dr. Rajas Deshpande

False reviews and online beratings against doctors and hospitals have become a reality. However much a doctor goes out of the way to do the best for his/ her patient, following are the reasons why negative reviews are still uploaded, some of them ridiculous:

1. Denial of false certification.

2. Recording truth on paper like addiction (smoking, alcohol, ghutka, sleep medicines etc.).

3. Mentioning preexisting illnesses which the patient / family had hidden from the insurance companies.

4. Denial to falsify diagnosis, treatment and inflating bills to claim medical insurance benefits.

5. Denial to give concessions in standard billing, consultation, visit fees.

6. Advising necessary investigations.

7. Charging for follow up visits (different doctors, specialties and hospitals have different policies, all are usually mentioned in the information prior to consultation. All follow-ups are not same). © Dr. Rajas Deshpande.

8.. Waiting time: This is the saddest in India. The standard waiting times for specialists all over the world range from 30-90 minutes, sometimes longer, but it is only the Indian patients who convert this into a complaint. Sometimes earlier patients may have taken more time, asked more questions, sometimes patients cry when a sad diagnosis is conveyed, one cannot ask them to leave the room, there are incessant calls for emergencies etc. . The same traffic and weather conditions affect a doctor’s schedule too, but some are unforgiving. The fact that Indian doctors are available on usually the same day or mostly a week in spite of a heavy workload means nothing to our people, even those who have visited the Western world and witnessed that it takes months to years to get a specialist’s appointment there.

9. Behaviour of the doctor: Agreed that some doctors are indeed rude, some are in a hurry, and that is wrong. But usually doctors develop a lot of patience as they mature, dealing with all sorts of negativity continuously. Sometimes patients do offend doctors by asking illogical questions repeatedly, by challenging every word that the doctor says, or by making illogical demands. These demands include repeating long explanations about the diagnosis and treatment, requests to speak on phone with a distant relative to re-explain everything because they are too busy to come over, asking questions like “Are these medicines necessary?” etc. © Dr. Rajas Deshpande.

10. Unfair, illogical statements “I cannot tolerate any allopathic medicine” rules this section. What do you expect a physician to do?

11. Unfair, unrealistic expectations: Every drug has side effects, including vitamins, and these side effects are NOT the doctor’s fault. The doctor can alert the patient about common side effects, but cannot explain all side effects of every medicine, as it is impractical. Secondly, while some medicines act within seconds, some take effect over weeks to months. Those without patience who expect relief within few hours / one day usually upload angry reviews about both “no effect” and side effect” commonly.

12. Declining demands for admission. Investigations and OPD treatments are not covered by most insurance companies, so some patients demand admission even when not indicated. When refused, even if the patient was cured, the doctor still gets a negative review.

13. Google masters: Some patients bring a lot of irrelevant questions and conceptually wrong use of medical terms to the doctor’s table, and however politely one declines to waste time over such, a negative review is almost guaranteed. © Dr. Rajas Deshpande.

14. Habitual negative reviewers: I once found a negative review of a patient who had actually responded well to treatment and was cured. He had complained about having to pay for a follow up visit after few weeks. A small google search revealed that he had uploaded many reviews from those about railway stations to collector’s office, from autorickshaws to five star hotels, almost all negative. Unhappy man!

12. Professional Competitors- this is a new reality: doctors hiring agencies to boost their positive reviews and add negative reviews to their competition. The simple fact check of how many positive reviews over how much time reveals the truth.

Some negative reviews are indeed genuine, I have had them myself, and called and apologised to the patient, clarified my stand too. However when they were malicious, I have informed the concerned site manager and also posted a reply about reality.

How to know?

A negative review must have a legitimate name of the person writing it, and details of date and time of the visit. That way the doctor can also confirm whether it is genuine and help resolve it. A nameless review is always questionable, good or bad.

In a recent news, a National restaurant association has decided to sue people who upload negative reviews about food: just because they want more or free, just because of their mindset is negative, just because they are insatiable. Even IMA should consider suing people who upload wrong, defamatory, spiteful reviews about doctors. Even the ‘hired good reviews’ by doctors should be discouraged.

Issued in the best interests of patients and doctors.

© Dr. Rajas Deshpande

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The Fairy And The Prince

© Dr. Rajas Deshpande

The beautiful radiant lady wheeled in the patient’s chair and wished me with a pleasant smile. Some smiles, however beautiful, have a tragic shade. I looked at the patient Rohan. A very well built fair young man in his late twenties, must have been very handsome in the past. He sat paralysed below the shoulders, one eye closed, face twisted, and a large surgical scar upon his head, partially covered by a cap. He could not speak. Any movement would cause violent tremors. He was wheelchair bound and had to be assisted even for toilet.

Rohan and Riya had married just two years ago, against the wish of their parents. Both from very affluent, but uneducated families. Both worked at the same office. In a few months after marriage, Rohan had developed high blood pressure, and was advised treatment. Unfortunately, he got carried away with some false claims about some herbal medicines shown on National Television channels and stopped the BP medicines. The obvious happened: one of the blood vessels in his brain ruptured due to high BP, and there was a huge bleeding. A Neurosurgeon had done an excellent job by taking this high-risk case on operation table in emergency, to suck out the blood clots and save his life. However, the damage was already done by then, much of his brain was damaged on one side. Riya had been caring for him since then. She looked after him just as a mother cares for her newborn.

“Doctor, we know his paralysis will not improve now. But he is brilliant, I know his brain thinks fast and accurate. Since this stroke he cannot speak. We have come with some hope for his speech. If he could just tell me what he feels, if something is bothering him, what he wants, etc., I will be very grateful” his wife said.

We started treatment. In a few days, Rohan could speak legibly, so she was very happy. Rohan’s parents were very happy too. © Dr. Rajas Deshpande

One day, Riya’s father came with her. He asked her to wait outside my room for a few minutes, she reluctantly left. With folded hands and tears, he spoke: “Doctor sahab, my daughter married against our wish. I have forgiven her now. But I cannot see her spending her life like this. She was the most brilliant girl in our town, she had even rejected job offers to go to America because Rohan wanted to stay in India. You can see that she is still young and beautiful. Anyone will marry her; she is one in a million. I’m not saying this because she is my daughter, but you can see for yourself from how she cares for her husband. She has become his attendant now. What is her fault? How can a father see his daughter wasting away her youth like this? They have no family life. I cannot even speak to her about this. Her mother tried but Riya refused to speak. She speaks very highly of you, so I have come with this hope. Please help us”.

This was very difficult, but a duty too. If not me, who could even attempt to resolve this?

“Let us ask her about her thoughts” I told her father and requested him not to react when she spoke. We called her in. I told her in short how her father felt. She sat straight. Her face became distorted and she wept silently. Her father kept on patting her while weeping himself.

“Papa, when Rohan could recently speak after so many months, the first thing he told me was to leave him and marry someone else. He refused to eat his medicines, saying that I should leave him. Then I promised him that I will leave him after two years. That was a lie. I know he will die if I leave. I could feel his love even when he could not speak, that’s something more precious to me than whatever you think I will get if I marry someone else. Till the day he had this bleeding in the brain, he made sure I was best taken care of. He never had his food before me. How can I spend even one happy moment with anyone else knowing that Rohan is suffering in this same world? Would you be proud of me if I did that? Did you teach me to be so selfish?” She broke down. © Dr. Rajas Deshpande. Her father did not say anything. They left.

In a few weeks, Rohan followed up again with Riya. He is now gradually learning to operate a computer. He plans to start his own online business. Riya is helping him do that, while continuing to work. They are now planning for a child soon.

This fairy I met was more beautiful than any other in the dreamy stories I had heard all through my childhood. I am glad that I am a witness to this divine fairytale.

I know even of another couple, where the girl had developed a paralysis in her college days. I had counselled her and her boyfriend about future uncertainties and a possibility of a compromised married life, given her illness. “That’s not the most important thing for us” he had said. They married. Today, about 8 years since then, they have a healthy, happy kid, and he still cares for her as much, now when she is in a wheelchair. This knight lives in a rented house, runs a small grocery store, rides a bicycle, wears the simplest of clothes, yet has a heart that would put to shame many a real princes!

My world as a doctor is full of beautiful fairies and knights, named caretakers. It is because of them that thousands of patients are surviving with dignity today. Medical care is so incomplete without them! I remember my favourite author Richard Bach’s words from “The Bridge Across Forever”: “Princesses, Knights, Enchantments and Dragons, Mystery and Adventure… not only are they here and now, they’re all that EVER lived on earth!” How true!! © Dr. Rajas Deshpande.

Among the stories of sadness and suffering, most doctors also come across best of the human hearts and minds, highest forms of love and care. Such patients and relatives reinforce our own trust and faith in the ability of human efforts to heal. Thanks to what I learn from my patients, my gratitude for being a doctor is endless!

© Dr. Rajas Deshpande

Dedicated to all caretakers, young and old, who silently sacrifice much of their life caring for their loved ones.

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A big salute to this extraordinary benchmark of values in medical profession.

On 4th August due to rain havoc and release of dam waters there was unprecedented flooding in some areas of Pune. Unfortunately this flooded the new Jupiter hospital in Baner, jeopardising the lives of a hundred patients including critical, and even a tribal baby who had had a heart transplant. Within minutes the hospital authorities reacted with an efficiency comparable only to a military task force. The staff, doctors and nurses worked in coordination to shift every patient to other hospitals in Pune, other hospitals too graciously accommodated them on an emergency basis.

It is extraordinary that Jupiter Hospital not only arranged for a safe transfer of every patient, they sent doctors and nurses with each patient to help them settle in another hospital.

Every bill for every shifted patient till their discharge from other hospitals was paid by Jupiter hospital, not a single rupee had to be paid by the patient. The entire staff and doctors stood by this effort, some offered their salaries of next six months to help this task. The administration very politely declined to accept this, and continued to care for each of their doctors and staff even when the hospital had to be shut down for nearly a week.

As the hospital reopens completely recovered from the damage caused by the calamity, I salute this extraordinary phenomenon which should be hailed by every person with their heart in the right place.

Congratulations Dr. Ajay and Dr. Ankit Thakkar for setting this fabulous example of humanity.

God, Doctor and The Killer Snake.

© Dr. Rajas Deshpande

Dattaram started breathing fast and coughing. Red skin, rashes. Pulse 140. BP not recordable. This unfortunate young labourer, bitten by a cobra only a few hours ago, had now developed severe dangerous reaction or ‘anaphylaxis’ to the only medicine that could have saved him: the injection of anti snake venom. I stopped the intravenous drip immediately and shouted at the sister to bring the crash cart. We injected him with the most powerful drug Adrenaline which we had kept ready in a syringe.

He was brought by a friend to the hospital just after 10 PM. His villager friend who had brought him directly from the farm had gone back to bring Dattaram’s family. They were not expected for a few more hours. So the patient was all ‘care-of’ me, then a junior intern at the government medical college hospital. That was the era before cellphones and ventilators in government hospitals. © Dr. Rajas Deshpande.

Some venomous snake bites cause death by paralysing the breathing muscles, while others kill by clotting the blood inside the arteries. Dattaram was bitten by a paralysing snake, and his eyelids had already started drooping, he was also having difficulty in swallowing and coughing. Other medicines were started to counter the paralysis, but the killer venom was spreading. Time was running out. I started having palpitations. I was to be the active witness to his destiny. The ward was already full, the second intern was busy too.

The only way out was to give him extremely small doses of the antivenom again, gradually increasing the dose every few minutes, till a full concentration dose could be given. This is called desensitisation. I had never done it earlier. If he reacted again to any such smaller dose, there was nothing else to do. This was dangerous, and required a written consent by patient’s relatives. There was none. His pulse was now 120, and his BP was now recordable. I kept reassuring him. © Dr. Rajas Deshpande

I called up my professor through the ward landline and informed him in short.

“Go ahead, be careful. I will take care of the stupid consent from the medical director. Call me if required” he said.

I went to Dattaram. “Listen, Dattaram, I need to use a medicine against the snake venom. Some patients may may have reaction to that medicine. I will try and do this very carefully, but sometimes it may cause problems. Is it Okay?”

In a hoarse voice, he said with great difficulty: “You are my God. Do whatever you can. Keep me alive atleast till I meet my wife and daughter”. I told him I will.

I started to inject him the antisnake venom doses. First extremely diluted, then in gradually increasing concentration. His blood pressure was stable. However, after a few minutes, his breathing became shallow. He became drowsy. His respiration was paralysed. The snake venom was winning the race. I put in a breathing tube. The nurse started pumping air in his lungs through a rubber bag. I was sweating, thinking, panicking, observing and praying all at the same time. © Dr. Rajas Deshpande

He was tolerating the antivenom well. After a few hours, I decided to give him the final big dose again. I restarted the same medicine that had almost killed him a few hours ago.

His wife and daughter arrived. I quickly explained them what had happened, as the lady kept on patting her unconscious husband’s head. The daughter, barely 12 years old, was crying muffled. There’s a state of numbing that comes after extreme shock: that is terrifying to witness. Big city and poverty on one side, hopelessness of the situation on the other. The lady suddenly got up, took out a few ten-rupee notes and extending them to me, touched my feet “I will sell everything we have, please save my kumkum (husband). Look at the face of my daughter. Where will we go without him? You are God for us” she said repeatedly.

I did not crave to be a God, I just wanted to be a good doctor. Shall I be angry that she was trying to bribe me? Never. I remembered what my grandpa had said on the day that I joined medical college: “If you want to be a good doctor, try to imagine yourself in the place of your patient”. I suddenly realised that even though I was not God, in the eyes of this lady, her husband and the daughter, I was their only hope. I have always hated wordplay, I am rather a feelings man. I understood what they meant. The life of every patient depends upon my best effort and nothing less. © Dr. Rajas Deshpande

“Tai, I will try my best. Don’t worry. Keep that money with you. You don’t have to sell anything; we have all the medicines. You can both have tea if you want, this sister will get you some. Let me please attend your husband now.” I requested.

A few hours after that, by morning, Dattaram opened eyes. He met his wife and daughter. By noon, he started to breathe by himself, so we removed the tube. By the time my professor took rounds, Dattaram appeared stable. Medical professors never openly praise students. My professor kept his hand upon my shoulder, smiling. “Too bad, this did not happen on a cricket ground or a film theater, otherwise you would be rewarded with cars and bungalows.” he said with his characteristic red-chilly-smeared wisdom.

When Dattaram was discharged, his wife got me some sweets, and invited me to their village. “Doctor, we are very poor, but I will cook for you the best meal you will ever eat” she said.

Most doctors make a genuine best effort to save the patient: who would want otherwise? Yet sometimes we win, sometimes we don’t. In this case my effort was blessed. I will perpetually be grateful to my own God, praying that he rewards the effort of every doctor trying to save a patient.

As for the cars and bungalows, who has enough time to use them when lives are to be saved?

© Dr. Rajas Deshpande

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The Euthanasia Named NMC

© Dr. Rajas Deshpande

Sweet Poison, Gorgeous Vamp, Philanthropist Criminal or NMC. All of these have one thing in common: the taste, the appearance is deceptive.

Just a while ago, doctors had complete autonomy and freedom to elect the best to the medical councils. They failed. Doctors had chances to unite and rectify glaring obvious malpractices in their own profession. They failed. Doctors had a freedom to pressurise elected medical council members to enforce ethics and discipline in Indian medicine, to arrest corruption. They failed. © Dr. Rajas Deshpande.

The parliamentary standing committee said something like “MCI looked only after doctor’s interests, not that of public, it is necessary to reduce the monopoly of doctors, so there should be diverse stakeholders at the helm”. The fact was that MCI looked only after its own interests, not even those of the real doctors of India: the thousands who were shouldering the actual healthcare burden especially in govt hospitals and rural areas, underpaid and unprotected. Malpractices became rampant. The general social jealousy about doctors which was earlier suppressed by respect converted into open anger and fuelled a paranoia that did not spare the best of the medical practitioners. For the sins of few, majority suffered. Patients too suffered at all levels. Govt medical services were always pathetic (and will remain so even after NMC), and there was no reign over the corporates who dominated and dictated the scene. Competition and petty egos destroyed any chances of any good unity among doctors. There could not be a deeper nadir for the profession. © Dr. Rajas Deshpande.

That fathered the NMC. Doctors will need to unite now like never before if they want to change this “Law”. Laws can be changed. But is it necessary in this case? Decide for yourself.

1. The ultimate, complete control of this “Autonomous” NMC is is in the hands of the central government. Majority members are govt. officials, a minority are to be chosen by medical professionals, and in every case, all that the central govt. decides is going to be a binding upon the NMC. That is like cutting off the wings of a bird and naming it “Independent and Free”. NMC, its advisory committee search committee or its four component boards will all be dominated by govt.’s chairs. Central Govt will also decide about the funding and salaries of the NMC members and its Chairman. We all know who sits in the top chairs of govt. institutes and how many among them can speak against the govt. So tomorrow if the govt wants to make ANY decision about ANYTHING that governs Indian Doctors, it can. Who will stop them if wrong? Such is the control of Central Govt. over this NMC, that if a doctor is unhappy about some decision of state medical council, he can go to NMC, and if unhappy about NMC’s decision, he will have to appeal to….? Courts of law? No. Something higher: the central govt!! So every medical practitioner’s career is ultimately in the hands of the central govt. Better join the party. Or quit medicine.

2. The entrance examinations are more simplified. All undergraduate examinations will be through NEET. All who have completed undergraduate course (MBBS curriculum) will appear for the Final MBBS exam which will also be common National exam (NEXT) for Medical Licence and PG admissions. Due to legal status of institutes like AIIMS, PGI, etc., they will conduct a separate PG entrance exam. Although this appears simplified, given the history of corruption (at almost all levels) in such exams and delays that waste millions of youth-years, one is worried about an undercurrent ‘sale’ of PG seats. But wait, not everyone must pass the licensing exam. You can entirely skip the difficult MBBS course, do something else, and bridge over in 6 months, without having to pass the licensing exams. That’s the third bullet.

3. Some AYUSH doctors are better than some MBBS doctors. Many who can not get into MBBS in spite of merit opt for other streams, with a hope to become a good doctor. They are actually contributing a lot to our healthcare, many of them know their limitations. One cannot object to their wish to practice allopathy if they want to study and upgrade themselves, the only objection is to exempt them from the common licensing exams. That will be very unfair to our society, most of whom will never know whether the doctor treating them has adequate experience, qualification and wisdom.

A newly passed out lawyer cannot do a “Six Month Bridge Course” to become a High Court Judge. A new recruit in Police cannot become an Inspector though a “Six Month Bridge Course”. A Municipal Councillor / Nagarsewak cannot “Bridge Course” himself into a Health Minister or Prime Minister. One needs to qualify though a common mandatory process. After MBBS, one cannot do a “bridge course” to become an MD that requires three years of intense responsibility handling, studying, treating patients under supervision and obtaining a deep insight into that subject. It is not possible in six months even for an allopath. Likewise, if an AYUSH doctor must practice allopathy, they must go through the necessary training (two to three years) and more importantly qualify the same common licensing exam before they practice the complicated allopathy.

AYUSH is an excellent idea, but it is immature as of now.

© Dr. Rajas Deshpande

4. The Doctor:Patient ratio in India is misquoted. Due to poor payments and infrastructures, very few doctors stay either in rural areas or govt. services, and the whole equation is skewed. The very purpose of AYUSH was to bring in more medical personnel, but that would work if these (3.5 lacs) “bridge” course doctors honoured the opportunity and worked only where there was a scarcity of doctors (urban and rural). What is more likely is that these additional doctors will also join the existing urban trend. Who can blame them for wanting a better life?

5. The newer policies of “more data, more paperwork, more record keeping, tighter control” over doctors will only result in private practitioners becoming more paranoid, giving up all the voluntary charity that they did every day, spending more time per case: and that will reduce numbers and spike fees. I can foresee most private practitioners closing down clinics. More rules and paperwork mean more corruption and exploitation in our country. This will turn into higher cost per consultation. Private healthcare will be out of reach for the poor. The good doctor will no more sit in his own clinic, he will turn to a safer corporate hospital. (Is that the aim?).

© Dr. Rajas Deshpande

6. The NMC bill entirely skips any word about regulating the large private healthcare sector. It does not have any provisions to protect new and good doctors from the tyranny and forces of corporate expectations. Some private hospitals have excellent policies and ethics, some corporates are very doctor and patient-friendly, but many remain to be corrected. There is no authority to the NMC over such hospitals.

7. There is no mention about improving staff and facilities at govt. hospitals, about any rules that ensure the best free healthcare for millions of poor patients in India. The ground reality that many patients suffer and die due to lack of staff, medicines, technology, tests and surgeries at government hospitals finds no mention in the reports of the Parliamentary committees that suggested the NMC. They did not mention the pathetic, unsafe and inhuman conditions in which Indian medical students and resident doctors live and work. They did not mention who will be responsible if a patient dies in a govt hospital due to lack of facilities or medicines. They appear to be more concerned about the price control of 40 percent seats in private medical colleges.

It is sad that in spite of many doctors in and around the central government, the medical field’s autonomy died with this bill. Shall we call it Euthanasia or “Physician assisted death” of the autonomy of medical profession? © Dr. Rajas Deshpande. In the era of the MCI, doctors were orphans, now in the era of NMC, they have become slaves.

The corrections in this bill will have to be put forth and pursued by a totally unified doctor’s organisation. “Painkiller Agitations” will not work. We must ask for complete release of the NMC from the cages of central government. Like in the UK, Indian NMC should be made up of 50% Senior Doctors representing all states and specialties, and the remaining 50% can be selected by the patient organisations: Judges, Media Stalwarts, Journalists, Artists, Ministers and Eminent Social Personalities. We must ask for transparency and fool-proofing of all medical entrance exams. We must ask for the right education, experience and licensing of AYUSH doctors, and welcome them once they qualify.

This article is written with my heart which bleeds for my profession and my patient alike. Bharat Maata Ki Jay!

© Dr. Rajas Deshpande

PS: Thank you Dr. Avinash Deshpande, Aurangabad, for some valuable inputs. If there are any technical mistakes, please let me know so I can correct.

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The Mathematics Of Kindness

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© Dr. Rajas Deshpande

“Are you coming, doctor, or shall we file a complaint? We will go to the police if you don’t come in an hour”.

It was about 12 noon on a Sunday. My sister and her family were visiting for three days, this would be our only lunch together in this year. All other days I am in the hospital at the lunch hour.

A teenager was admitted for last two days with repeated alleged episodes of fainting with unconsciousness. His friends and family were all at the hospital, calling incessantly from different numbers. They were given my cell number by a colleague as he thought it was an emergency. I had seen the patient four times in last two days, rushing from the OPD as there were alarming calls. We had done all the necessary tests and found nothing wrong with the kid, we had concluded that he was malingering / faking these episodes. A neurologist has many tricks to unmask the truth. We had explained the facts to his family, a psychiatrist had confirmed this, and scheduled a meeting with the family on Monday. Till then we had added anti-anxiety pills and told the family to be patient. All the vital parameters were normal. I had explained the family to be patient.

My boss called, he was frustrated too. “Ja ke dekh le ek bar (Go and see him once). Some minister just called for him” he said.

Excusing myself from the lunch, I reached hospital. The teenager’s girlfriend was standing in panic by his side, crying while he was ‘unconscious’. The brother and friends raised their voices: “Why is this happening, doctor, why don’t you do something? Why is he not responding to the treatment? It is three days now. He is suffering so much”.

I am trained as a doctor to tolerate anger, frustration, anxiety, stupidity, bitterness or accusations, but I refuse to tolerate drama.

“I have explained to you many times. This is not real unconsciousness. A psychiatrist will have a meeting with your family tomorrow, till then there’s nothing more we can do”.

“What if he dies? What if you are wrong?” shouted the relative. I did not have an answer. I left the ward after messaging my boss, also asking him to transfer the case under someone else. The next day my psychiatrist friend called me. The teenager’s girlfriend was from another religion, parents on both sides had opposed their marriage, and this illness was their “brilliant solution” to get the parents to change their minds and agree. Cheap drama!

There’s no mathematics to kindness, we have all been taught. Do good, be compassionate and don’t expect any returns. People take advantage, but that is Their nature, you be yourself, kind and compassionate.

I was once returning from my Goa visit, there were long queues of frustrated people. Two apparently rich Indian tourists walked in, typically dressed for a Goan vacay. They saw the long lines, changed their faces, and rushed to the front of the line. One of these approached a foreigner in the line: “Excuse me, we will miss the flight… we were stuck in traffic.. my sister is sick, I must reach Delhi in time”. The foreigner, knowing that these were blatant lies, still allowed him to go ahead of himself. Kindness is almost a compulsion. Once on the other side of security, these “line-jumping liars” had the obvious expression upon their face: “Ullu banaya tum sabko (We made a fool of y’all)”.

At the hospital entrance, I often meet a paraparetic man in his scooter for the disabled. He usually blocks the hospital entrance with his three-wheeler scooter parked there while he talks at leisure with his friends. If anyone honks, they all play this “Can’t you see he is disabled? How rude!” card, intended to make others feel guilty. Even when it is an ambulance or a doctor’s vehicle, he will intentionally slowly move from the spot.

Every doctor, almost every day, meets people who blatantly lie: to bypass waiting lines, to ‘finish off with parent’s health issues over the weekend’, or to get concesions, free treatment. Some lie to exploit kindness and compassion, some to exploit financially. There are no guidelines defining an emergency and the charges for such “pseudo emergencies”. A doctor on duty must always resopnd to an emergency, but if off duty, he should be able to refuse cases on a holiday. All government hospitals have a 24/7 emergency department, the patient can be taken there.

Recently heard that an Indian lawyer charged in crores to an Indian client stuck on an European airport for a legal advice in an emergency. There were no cries about compassion, kindness or even patriotism. What should a doctor charge for a pseudo-emergency, especially when a precious holiday is wasted?

When I discharged this case, they asked me when to follow up. I replied without hesitation: “Never with me”.

© Dr. Rajas Deshpande

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