Tag Archives: doctor’s fees

That Order To “Stop Saving Life”..

(c) Dr. Rajas Deshpande

“Arrest! Sir… Code Blue!” the nurse shouted. The casualty was full, all eight beds had serious patients, and their relatives waited near them. Every second matters.

“Everyone out” my co-intern shouted. Some moved out, some stayed. Two other interns were already attending similar patients, two of us ran to the arrested patient. The nurse had already started the chest massage. I gave patient the position for inserting the breathing tube, as my co-intern Dr. Ajoy took over the cardiac massage. The senior medical officer, Dr. Hazare, experienced with a lot of medical wisdom, stood near the bed. He calmly gave orders for the last-attempt medicines in such emergencies.

The chest massage to save lives is rather forceful, its force has to reach the heart. The chest wall has to be pumped down 2-2.5 inches with every compression, and this has to be real fast: over 100 times a minute. It looks very traumatic, but it is useless if not done exactly like this. It is quite a disturbing scene for the relatives. The patient’s son kept on shouting “Don’t hurt him” loudly. The medical officer repeatedly asked him and the five relatives around the patient to leave. They refused.

The Medical Officer Dr. Hazare then asked us to stop the CPR. (c) Dr. Rajas Deshpande

We were baffled. How could one stop the life saving CPR?

The patient who had arrested was from a nearby slum, father of a local goon out on bail, like most goons in India. He (the patient) was in his late fifties, a chronic alcoholic and smoker, with severe liver damage. He’d had excess alcohol on the prior night. That morning, he had had a convulsion, and was brought to the casualty after many hours of delay . An arrogant, drunk, politically supported crowd posing as relatives accompanied him, a common nuisance in almost every Indian hospital.

We continued the CPR. Dr. Hazare went out.

After a direct injection of adrenaline into the heart through the chest, the patient’s heart restarted, and he started to gasp, making some movements. We quickly shifted him to the ICU. The proud feeling of saving a life gripped us. There was no time for celebration, but Dr. Ajoy kept whistling on the way for our midnight tea.

Later that night, Dr. Hazare called us. He was angry, yet calm and smiling, an ability that only the most evolved souls can have.

“Listen, we are in India. Most of the people around us are not only uneducated and ignorant, they are also quite violent and paranoid. Emotional dramas are considered a normalcy. There’s a tendency to shift the blame of delayed treatment and bad outcomes on to the doctors. You were risking your life. If the patient’s heart had not restarted, the relatives could have blamed you, even hurt you”.

“But Sir, they saw that we were desperately trying to save the patient’s life” I argued.

“YOU think so. They don’t know anything about the CPR. They refused to go out. You saw how arrogant they are. These things work only when the outcome is good. If the outcome is bad, the doctor is automatically held guilty. I told you, we are in India. People like to think that doctors are wrong, whatever you do. ” Dr. Hazare said. (c) Dr. Rajas Deshpande

We didn’t think he was right. Still, we respected him for his wisdom, so we just apologised and went on to deal with the casualty again. It was a busy night, still a very negative feeling about what Dr. Hazare had said kept shadowing my thoughts. How could such a senior doctor ask someone to stop CPR?

Dr. Ajoy went to his room at 5 AM and returned by 7 AM to relieve me. I went home at 7 AM, had a quick bath and breakfast, to return at 9 AM.

The casualty was all devastated, ruins were seen all around. Many doctors were rushing in and out. All beds were empty except one.

Dr. Ajoy was on that casualty bed, unconscious, intubated and with blood soaked bandages on his head. He had many cuts on his entire body. Our colleagues were trying to push intravenous fluids fast into his veins. Dr. Anirudh, another intern with us, told me even as he could not stop crying: “That patient we had resuscitated yesterday evening… he had another cardiac arrest in the ICU this morning… his relatives came down and attacked Ajoy. They said that the patient died because of the forceful CPR. They stabbed Ajay and hit his head with iron rods. Dr. Hazare came and tried to rescue Ajoy, they even attacked him. We were waiting for you. Do you have his parent’s contact?”.

In a state of shock, I could not speak. I reached out for my bag, got my diary and called Dr. Ajoy’s father in Calcutta.

“Why?” Dr. Ajoy’s shocked father asked when I told him Ajoy was attacked, injured and serious. How could the father of a thin built, cute, brilliant scholar ever understand that people could brutally attack his child for trying to save their loved one?

I had no answers. Dr. Hazare’s sentences kept ringing in my brain, I could not utter them. (c) Dr. Rajas Deshpande

Eventually, Dr. Ajoy recovered. He is now in the UK. His father came over last week, for a check-up. While leaving, he kept his gracious hand upon my head and said with immense love: “Save many lives beta, but take care of yourself first. I still cannot sleep well due to what happened”.

That night, I stared at the sky, and kept thinking: Actually, this is why no doctor ever sleeps well in India. Saving lives comes with the inherent risk of losing one’s own, and this happens only in our beloved motherland.

(c) Dr. Rajas Deshpande

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The Real Vertigo

(c) Dr. Rajas Deshpande

“Why did this happen to her, doc? She is so young and had no problems till now..”asked the angry husband, who had accompanied his learned wife down with severe vertigo and headache. His tone was quite accusative, and voice raised.

My elderly professor Dr. Desai did not look up, he continued to write the prescription quietly. He had just explained in detail to the patient and her husband that this was a simple positional vertigo, which happens episodically in some patients. Although it is scary because the patient feels the world spinning suddenly, it is also called ‘benign’because it does not cause any harm beyond this spinning sensation. Some other dangerous illnesses that could cause such spinning sensation (tumors, blood clots) were already ruled out by Dr. Desai, after a thorough examination and relevant tests. (c) Dr. Rajas Deshpande

“Ï just explained that to you” said Dr. Desai to the patient’s husband, “keep some patience, take rest, and take this medicine”.

“But why did this happen to her?” repeated the husband, this time louder.

“I don’t know, many factors like allergy, infection, some internal defects can cause such problems. In case of your wife this seems to be due to the viral infection she had few days ago.” replied Dr. Desai.

A long list of patients waited outside, and he had already explained courteously whatever was necessary, spending extra time instructing the patient about care to be taken to avoid such episodes, and exercises for the same.

“So this treatment will cure her permanently?” the husband asked. (c) Dr. Rajas Deshpande

Dr. Desai, known for his patience, smiled and replied “Look dear, this illness is like cough and cold. You treat it when it happens, but that does not permanently cure it for life, one may have it again and again. You just treat it when it happens. Now you must excuse me, other patients are waiting”.

The patient went outside and wrote an extremely negative internet review about Dr. Desai.

The fact that he was seeing the seniormost doctor in the specialty who had over 30 years of experience, the fact that the doctor had spent extra time to explain and instruct, the fact that the diagnosis was accurate and that the treatment was exact did not make a difference. One little unpleasant thing – that his repeated questions were not entertained – had resulted in a negative online rating / feedback for what was an almost a flawless consultation.

Some patients ask the same long list of questions every time they visit, which frustrates the doctor. Decline to answer a repeat question, and you get a negative, angry review.

It takes long years to understand some medical concepts. Ususally experienced and clever doctors devise their own simplified versions to make laymen undertand these concepts. However, to understand some concepts or diseases, it requires a lot of different basic bits of information, which it is impossible to make the patient understand. Most patients are quite happy with the simplified versions of disease, diagnosis that their doctors tell them, but some want to dissect every word and understand everything. If the doctor cannot make them understand, they simp jump over to another doctor. While smart communication is an essential for a good doctor today, this has now resulted in another dangerously funny phenomenon: doctors who don’t know much medicine, but can make such patients happy with wise wordplay. (c) Dr. Rajas Deshpande

A few days later, an old farmer from a village walked in. He had the same medical condition. After checking him, Dr. Desai started to explain him the diagnosis. He laughed, folded his hands, and said “Doctor saheb, if I had a capacity to learn medicine, I would be sitting in your chair! I have complete trust in what you do. Just tell me how to take the mediine, what I should not eat, and I will be on my way. I only understand farming well”.

Dr. Desai looked at us students, smiled, and said “When educated, we forget that the real talent lies in knowing what we cannot understand. Some people never get the fact that ‘not everyone can understand everything’. They keep circling in the same ignorant, egoistic efforts leading to frustration. That is a different vertigo, with no treatment. This farmer’s trust saves him such trouble”.

(c) Dr. Rajas Deshpande

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Slaughtering The Precious

(c) Dr. Rajas Deshpande.

At the casualty door she started shouting at me even before I went in. “We don’t want any tests. We don’t want to admit him in any critical care unit. Keep him in the general ward you have, we are now financially exhausted. Give basic medicines only “. Mrs. Julie, the patient’s daughter, went on:”We have already signed palliative care form”.

“Let me see the patient first “ I said and went in.

The resident doctor had earlier told me that the patient, an old man, was conscious, speaking quite well, aware of his illness. He was intermittently getting unconscious for a few minutes. He had high grade fever. He had lung cancer, and a brain scan a few days prior had revealed that that he had a secondary in the brain too. He had just completed his chemotherapy. The resident doctor had already started medicine for fits just now.

As I examined him, the jovial Mr. Shaw smiled back and told me that he was feeling a little giddy and tired, otherwise he had no complaints. He could even stand and walk without support. His blood pressure was normal, but the heart rate was quite high due to the fever.

“I think you have probably developed seizures due to the secondary in brain. There seems to be some infection too, we will run some tests and start antibiotics” I told him.(c) Dr. Rajas Deshpande.

“When will I feel better, doctor?” He asked, “I want to be home and spend every possible day of my remaining time with my grandchildren. I want to also finish a book I am writing. I am told I have only a few months left. How much time do I have? Six months? Four atleast?” he asked, still smiling. Only doctors know what a smiling face with a crying heart actually looks like. “Every passing moment is extremely precious for me, doc! Please cure me fast” he said.

I assured him that if the tests showed nothing serious, he could go home once fever subsided, but the fits needed long term treatment. While we were having this talk he suddenly stiffened and his body developed jerky movements, then he became unconscious.

Ordering the emergency injections for fits, I told the casualty doctor to shift him to the critical care unit.

Coming out, I explained this to the angry daughter.

“Doc, we don’t want to treat him in any ICU. We also do not want any tests now. Please give him tablets instead of injections, we want to take him home as soon as his fever goes down” she replied.

This has become very common now, relatives of elderly people admitting them in hospitals, but refusing to do any tests, use injectable / costly medicines or shifting to critical care units. A doctor cannot refuse patients in such a condition, and it is an extremely painful, stressful situation to not be able to correctly investigate, treat a patient because relatives are unwilling. Ninety Nine percent of the times, money is the only reason. There are many charity, low cost and even good government hospitals, but the relatives also want the “show”of having admitted the patient at some posh hospital. Beyond a certain level, Private

hospitals cannot go on funding tests and treatments of hundreds of such patients even on a compassionate basis, because the poverty in India is never ending.

Compassion is the most abused entity in India.(c) Dr. Rajas Deshpande.

I told her that even if they had signed for palliative care, his current condition was treatable, his fever and fits caused him distress and could be treated, but she staunchly refused to let us send any tests. We started with oral medicines after a lot of deliberation, keeping fingers crossed that he responds. He did.

On the third day, Mr. Shaw walked out of the hospital with his patent smile.

Just next week, his daughter returned to the OPD: “Doc, dad passed away two days ago. After going home he had fever again, but we decided to manage him at home. Somehow he could not get through this time. I have come to get your signature on these bills from his last medicines, we want to get reimbursed”.

“Was he seen by a doctor at home?” I asked her.

“No doc, we gave him the same medicines that he was earlier given for fever. We also searched online and ordered them. But in a way we also feel he is now relieved of all his troubles” she said, hushing up the topic.

I signed the papers, a duty and an obligation.

In every hospital, every day, we see parents rushing, crying, selling everything they have, urging doctors to save their children on one side, and grown up children urging doctors to hasten up the deaths of their parents on the other . Many sweet, politically correct and legally blurred terms are now available for masking these murders.

A patient with a terminal illness may himself sign for “non-aggressive / palliative” care (meaning pain relief, superficial / minor treatment without aggressive effort to save or maintain life), or if the patient is not in a good mental condition to sign such a consent, the relatives may sign so. However, in India where children mostly are responsible for the medical bills of the elderly, they flatly refuse to treat even treatable, reversible conditions citing “öld age” as a reason. Even in case of patients with terminal illness, to presume that someone is immediately unfit to live, or fit to die is like saying it is okay to terminate their life at someone else’s wish. This is cruel, unethical, immoral, and should stand supported in no courts of law.

However, these murders are a daily routine in India, and law has tied the hands of treating doctors and hospitals as one cannot investigate or treat a patient when the relatives haven’t given a consent. An evolution in the fraternity as well as in this society is necessary if a change is expected.(c) Dr. Rajas Deshpande.

Otherwise, when we all will eventually be old, however much we want to live on for a few more days, one day someone will decide that we don’t deserve to continue to live, without ever wanting to know what we wished.

(c) Dr. Rajas Deshpande

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Doctor Abuse: A Medical Specialty

© Dr. Rajas Deshpande

Using the doctor’s private cell / social media accounts for free consultation, second opinion and opinion about investigations. Stalking to send reports, messages whenever online. These are now getting on the nerves of many doctors. I have completely stopped replying to any medical messages on social media / whatsapp.

Relatives, family and friends seeking free medical consultations on holidays, weekends. Directly coming home for a free consultation on holidays (On one unfortunate Sunday morning, back when I was naïve, one neighbour with a Luxury car came home and discussed his old age problems for two hours, reviewed his wife’s reports, then keeping 100 rupees on my table, said “Actually in my childhood doctors would charge only two rupees for consultation, but now it has all become costly”). I have now completely stopped this, refusing politely to see anyone without appointment, except in a true medical emergency.

Expressing Anger, Bitterness, Distrust and Sarcasm towards the doctor for diagnosis (especially incurable), for advising surgery, admission or costlier treatment options (the rich are unhappy with costly medicines, the poor usually do not complain). © Dr. Rajas Deshpande. I have now started to explain in the second consult, after finalizing diagnosis, what to expect, what not to expect.

Expecting the doctor to replace the lost bonds in family because the children do not want to spend time or efforts for their parents (‘you tell him, you spend some time counseling him’). I have started to refer such patients to qualified counsellors.

Taking an advantage of compassion and kindness to save money (Cannot bring patient to hospital, patient is too old, I am too weak to travel, we are out of station etc.). A general rule is that one must be treated, especially in emergency, only after a thorough examination by a doctor. I am now refusing to be emotionally blackmailed.

Seeking free consultations: relatives, friends, classmates, staff, other doctors, watchmen, maids, neighbors, drivers: there’s an unending list who the doctors are expected to see free. Add to these political leaders, VVIPs, government officials, administrative staff etc. Sometimes the doctor voluntarily waives off charges as respect, and some of the above actually request to pay themselves, but most expect a free consultation and in fact argue about it. I have made my own rules about treating only the deserving poor free, and those who need it. I refer them to the right center for help.

Multiple free consultations. This is a paradox: that many who get free consults / treatments usually think it is “not correct or adequate”, take a paid consult somewhere, and then come back knowing that the best was already being done for them. Such patients, when they know t is free, come every week even if they are told to follow up after three months. I have now started specifyinfg that the free consultation in a non-emergency is only once in three months.

Many patients book multiple appointments on the same / consecutive days and then do not bother to cancel the unused slots. This results in heavy losses for the doctor. Some patients call multiple times to book appointments and finally do not turn up, never bothering to inform. I have started to make a list of such patients.

Lying. Many patients / relatives lie about why they did not follow up in time, why they did not take treatment, why they did not do the advised tests, about multiple treatments at the same time, about their condition being an emergency etc.. Many a times parents are abused by their children, and multiple lies are told about why basic care was being denied to the patient. The doctor is supposed to cover up and compensate for the lack of care and compassion at home. © Dr. Rajas Deshpande. I have decided not to cover-up, and to refer them to a family counsellor.

Unnecessary information: Many patients do a lot of unnecessary tests and expect the doctor to “just have a look” at those even when normal. Few understand that time is the most precious commodity for a doctor, (most efficient doctors run late because of unnecessary discussions) and when one seeks opinion, it should be a targeted exercise to resolve the immediate concern. For regular check-ups, one must prefer to visit their regular general practitioner. I have started to refuse to see tests I have not advised, if they are normal.

“Resolve all my life’s problems”: many patients, when they find the doctor caring and compassionate, expect him / her to resolve all the issues pertaining to their old age, relationship issues and spend a lot of time “listening to the sad stories” about their life, and their opinion / rants about them. While in some cases it is necessary to wholly understand the patient’s mind, this is primarily an issue to be addressed by a psychiatrist and a counsellor.

A patient in distress is often not in a position to understand the doctor’s expectations and the nitty-gritty of manners and etiquette, and while still being caring and compassionate, we doctors must learn to politely decline such abuse in the kindest words possible. Once educated, most patients follow the instructions well.

Happy Doctoring!

© Dr. Rajas Deshpande

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A Soldier’s Real Pain

© Dr. Rajas Deshpande.

“There’s immense pain, Sir, in my thigh. I cannot bear it. I want to kill myself. Please do something” said the elderly man, with tears. A proud soldier from the army, he had fought three wars with bravery, and won many medals. Once a bullet had hit him in the lower back and had caused severe injury that bruised his nerves which control the leg sensation. The back wound healed, but the leg pain had stayed. Many drugs and injections had failed.

I somehow noticed that the brave soldier avoided to look at people directly in the eyes, and there appeared to be some unknown sadness behind this. I asked him openly about it. “Yes, I feel sad, but I don’t know why” he replied.

With his consent, I added an antidepressant (they are excellent in controlling pain too). He started responding well. In about ten days, he started to walk without support. Very happy about the pain being controlled, he expressed it with heaped praises for the doctors.

Once when I visited him, he was alone in the room. He was looking at a photo album.

“Come doctor, I was just remembering you” he said, “This is an old picture when I returned to our army base after an incident. There was a firing from the other side, we were not able to see the enemy soldier. It was a dense hilly area packed with trees. We started to move sideways and formed a “V” shape, moving towards where the firing was coming from. We spotted a hidden tank, and three camouflaged soldiers hiding behind it. They would climb up the tank and fire occasionally. Once we located them, it was all easy. We shot them down one by one in few minutes. Apparently, there were two more of their soldiers hiding at some distance, they started to fire. We fired back, they were injured, but managed to ran away. We took this picture just after that victory”.

Then he kept the album down.

“I was very happy then.But last few years, as I grew old, I often think about those I killed. I have no fear or guilt. Yet I feel bad about them. They must have had families and children. They must have left home with promises to return. Their parents, spouses and children must have prayed to the same God for their safety and return. I lost my colleagues too and I know how their families suffer till date. I am second to none in patriotism, but I think we must now evolve to resolve things without having to kill people. I love my country more than any politician, but I will be happy if the politicos of any country stand with the army at the border when declaring a war, handle a gun and feel the pain of having to kill another human being. That is what makes me sad”.

I remembered what one of my neurosurgery professors had once described in frustration after a marathon 8 hour brain surgery: “It takes our team such a huge skill, investment and scary hard work to be able to remove one bullet from someone’s brain without endangering the patient’s life. I can’t believe that we live in a world that still makes, sells and uses bullets and allows killing”.

A doctor is married to humanity. No doctor in the world will speak in favour of injuring or killing someone. A live being’s body is too precious to be cut through. It is indeed necessary to eliminate terrorists who kill others indiscriminately, or to defend the country’s safety, but to be “Proud of killing” someone is difficult to understand atleast for me. Just as I cannot understand the enemy’s happiness and pride if they kill a soldier on this side.

I understood the sadness in his eyes better now. I told him he was just doing his duty, he had no choice. He laughed and replied “I wonder if the ones who ran away injured are also suffering this same pain in their country. If they are, I wish they recover too, because it is difficult to live with this pain”. I told him I appreciated his benevolent statement.

One of the most influential sentences in human history has been said by Mahatma Gandhi: “An Eye For An Eye Makes The Whole World Blind”. The likes of Einstein were in awe of this Indian who advanced humanity. There indeed are countries which have resolved issues between themselves and for decades have had peace, investing in health and development rather than defense. Patriotism and politics mixed will only pollute patriotism. If peace has a chance, it must be the only choice.

Life of every soldier is as precious as that of every decision-making politician in any two countries going to war. Many injuries last lifelong, many soldiers are disabled, many thousand are paraplegics who do not get help or healthcare access. Many a soldier’s families suffer in poverty. They have done their duty: gone ahead and fought with their life at risk, but the country does not seem to have enough resources to handle the requirements of injured soldiers, or support their families.

As in the case of every other social issue, there are thousands of “pseudopatriots” who shout and speak about their love for the country, encourage war and killing, but when told about the injured soldier’s woes, wisely avoid the topic. Every country respects a fighting soldier, but there are few countries which also take care of the injured soldiers and their families, or support a dead soldier’s family.

As doctors, we sincerely stand by those injured and suffering, and pray that there are no more injuries and deaths anywhere in the world. There is no difference in any two human beings for a doctor.

© Dr. Rajas Deshpande

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Reboot Fate, Kanika Is Here!

Reboot Fate, Kanika Is Here!

© Dr. Rajas Deshpande.

At 12 years she was on the top, an athlete who also won the scholar badge for three consecutive years and special honors at her school. Just then, a rare neurological condition played havoc in her life. She had multiple tumors, suffered a paralysis, was wheelchair bound for over two years. Then she suffered from depression, suicidal thoughts, high blood pressure, and multiple health issues which sometimes threatened her life. She had to leave school. She suffered bullying by kids her age, she had severely painful muscle tears that made it impossible to move hand and leg. Many hundred blood tests, some invasive procedures like lumbar punctures, and even a biopsy were all inconclusive. She also went through medical horrors: rude doctors, huge expenses and uncertainty. Her diagnosis is still not fully established.

But her status as a winner in the battle with fate is well established. Meet Kanika Kesri. She walked again after two long years today.

In August 2015, Kanika started having fever and severe headaches, and started becoming weak. Lot of tests were done, and she was found to have a tumor in her abdomen. A surgery was planned in Delhi, she was taken there. The specialist decided to first biopsy her tumor. The biopsy revealed a possibility of tuberculosis, so anti tuberculous medicines were started. She developed paralysis of the face and eyes, nothing could be done as the only medicines that could improve her condition – steroids- could cause dangerous worsening of her tuberculosis. In December 2015 she developed weakness in the left leg and could not walk. An MRI done then showed that she had developed multiple tumors in the brain and spine. She was then diagnosed with the most dangerous and often fatal form of tuberculosis: MDR (Multi Drug Resistant) Tb.

She was started with additional medicines and her parents were told that nothing more could be done. Her condition worsened during one of the lumbar punctures and she became bedridden, almost completely dependent. Someone told her father one of the worst medical possibilities: that this could be some form of cancer.

One of my earlier patients, Mr. Rahul Agarwal, brought Kanika’s father Mr. Pankaj Kesri to me in a devastated frame of mind. Lost in uncertainty, extremely angry at the behavior of some doctors, and frustrated with the expenses while being away from the job for a few months, he was still very polite and humble.

Her case was indeed baffling. I went through all the details, involved my colleagues at Ruby Hall Clinic, and even some of my teachers in Mumbai. The answer was almost the same everywhere: don’t know what this exactly is, but don’t stop the anti-tuberculous medicines.

Something was wrong, the girl was deteriorating in spite of taking the tuberculosis treatment. In a discussion with her parents, when her father said he had complete trust in the way we were treating her, I put forth an option: to give Kanika steroids, and if she improved, to consider withdrawing the anti-tuberculous medicines. This involved a serious risk to her life if her presumed tuberculosis worsened. With a very heavy heart, her family consented.

We started steroids. Kanika improved. We stopped the tuberculosis medicines. She continued to improve. She could now stand with a walker. Unfortunately, twice during physiotherapy sessions, Kanika tore her muscles: once in the thigh, which made it impossible for her to walk. She was bedridden again.

Till this time, Kanika was all positive, vigorously working to recover. The long illness now started to affect her mind. She became depressed, her sweet smile vanished. She tried to join school, but isolation and bullying worsened her mental agony. She started having suicidal thoughts. Very mature for her age, Kanika decided even in that condition that she was going to defeat the situation. She confessed about her thoughts to her parents. We arranged a counsellor for her. Just as Kanika started to recover from depression, the side effects of steroids started to come up: weight gain and high blood pressure. New blood pressure medicines were added. There are some alternatives to steroids, but she did not tolerate them.

Kanika wanted to study further. She joined home schooling, an excellent option made available by the central government, through NIOS (National Institute of Home Schooling).

One of the most complicated cases I have seen in this young age group, Kanika suffers from a very rare autoimmune condition. Her immune system has some dysfunction that causes multiple tumors in her body, these tumors usually resolve with steroids as they suppress immune system. The closest condition that resembles this is known as Neuro-Sarcoidosis, but some of Kanika’s tests for this were negative too.

Kanika’s parents chose to always come across pleasant and polite. “I know my daughter’s health is above all my complaints. I have chosen to concentrate on the positives” Mr. Pankaj Kesri says. Kanika’s mother Mrs. Rajni had to face a double-edged problem: while adolescent Kanika developed many ups and downs in her moods, Mr. Pankaj Kesri was transferred out of Pune. Mrs. Rajni fought alone on many fronts, while also looking after Kanika and her elder sister Kritika, who they call their pillar of strength.

It all was rewarded today, when Kanika walked without support after almost two long years. I was so happy with the miraculous moment, that I called upon my CEO, Mr. Bomi Bhote, who has always encouraged highest standards of medical care, leaving no stone unturned to bring it under his roof. He was so happy to see Kanika walk again, that he recorded the moment himself. “My wish is to see you run” he told a smiling Kanika.

We learnt a lot: many a times, some patients tolerate a lot while facing medical issues: the worst being a rude doctor. We doctors must ourselves ensure that we offer the best compassionate counseling to each such patient before we demand their faith and trust. It is never automatic. The process of medical care is an ongoing one, and it must be guided by a single principle: decision making in the best interests of the patient. A lot of study and awareness of medical advances on a daily basis is essential.

Kanika to us is an example of exemplary courage, grit, maturity, positivity and patience. She is a role model for anyone who is going through a negative medical phase. May she get back to normalcy soonest possible, may she recover completely, may she achieve whatever she sets out to achieve. She has proven many times over till now that she is a born winner.

In the beautiful moment that Kanika walked again, I found the blessings of my parents and teachers.

© Dr. Rajas Deshpande

PS: Thank You, Ms. Kanika, Mr. Pankaj and Mrs. Rajni Kesri for permission to share this story of courage.

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The Most Precious Jewels Upon Earth

© Dr. Rajas Deshpande

“Sir, next is our old free patient” my receptionist announced on the phone.

Divya, the smart young girl of 8 years jumped into my cabin, and grabbed her chair with an authority. Confidently looking at me, she questioned, “how are you today?”

Her parents, embarrassed and charmed at the same time with her sense of ease in this big hospital, facing a doctor, hesitantly stood behind her. I requested them to sit down and went through the routine questions.

“She is all good now, no fits since last two years. She has been regular in her school and has started studying well too” her father reported.

I examined her and wrote her a renewed prescription. I noticed the mother wiping tears.

“What happened?” I asked.

Quickly smiling, she just gestured with her head “nothing” and looked at her husband.

“Do we need any tests, Sir?” Her husband asked, “We will do whatever is required”. I could feel his palpitations. They were scared that I may tell them tests, and that would mean financial disaster.

He works as a pantry boy and can barely pay the home rent with his salary. His wife somehow makes ends meet, looking after this sweet daughter and a younger son.

At the age of five, Divya had had her first convulsion. Her parents had rushed her to the government hospital. They did not have the money required for Divya’s tests and medicines even at the government hospital. So they resorted to something that hurt them worst: they had to sell little Divya’s silver jewelry, which was the most precious thing in their house. Even that was not enough, so they borrowed money and started her treatment, her father worked extra hours.

That was about three years ago. Divya’s fits continued, but her parents did not give up. Their whole life had but one aim: to stop her fits. Even after being less educated, Divya’s parents decided to go with scientific treatment, ignoring all pressures to take her to different weird people including magic healers. They did not give up hope, their will power was their boon.

Two years ago, a doctor friend sent Divya to me. With some changes in prescription, her fits completely stopped, she has now become just another normal child.

“No tests are required. Please make sure that she is regular with the medicines” I told them.

As I wrote this, I got a little emotional myself, this was the first time I had heard of any parents having to sell their daughter’s jewelry for her treatment. On one side, I was proud that even after being surrounded by perpetual pits of poverty, this girl child’s parents did not skimp upon her treatment just because she was a girl child (this often happens), but on the other I felt anger and shame that my country still lacks a basic healthcare infrastructure that can offer free quality treatment to at least children.

Yet, this had taught me my lesson. Willpower and hope are the mightiest and most precious jewels upon earth, far tougher and far more beautiful than any diamonds. For there are many who own diamonds but have neither willpower nor hope.

Meeting this rich family today was joy enough, but a greater bliss was when the kiddo put her arm upon my shoulder with the same confidence. The world is indeed hers!

© Dr. Rajas Deshpande

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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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