Tag Archives: Elderly

“What If This Was Your Father, Doctor?”

“What If This Was Your Father, Doctor?”
© Dr. Rajas Deshpande
 
“Doctor, I want to know about this illness. I want to understand it” she said.
It had taken me an entire medical career and a lot of experience to understand this disease in steps, no neurologist in the world claims to have fully understood it. It was my duty to simplify things for her, but it was impossible to transfer years of knowledge and experience in few minutes. I decided to give it a try. If I learn to understand the patient and relative one step more, I will be a better doctor hopefully. This lady, with her Prada and Dior accessories, also appeared well educated.© Dr. Rajas Deshpande
 
“Your father has frontotemporal dementia, a condition that causes progressive loss of memory and abnormal mentation, thoughts, or behavior. This is because certain parts of his brain degenerate faster.” I started.
“One minute doctor” she interrupted “How does that explain why he starts undressing, passing urine anywhere in front of others, even children or guests? He uses such foul language sometimes”.
 
I hate being interrupted. Especially when someone butts in a second question before I finish answering the first. But I must accommodate the patient’s and the relative’s anxiety.
“That is because we have an area in the brain that controls our behavior, stops us from doing social-inappropriate things. This is why we stop from doing certain things in certain situations, while we retain the ability to do them in privacy. That is called inhibition. When those areas in the brain degenerate, there is thus a ‘disinhibition’, whereby the patient does not know what is inappropriate. Somewhat similar to losing mental control after taking alcohol”.
“So the blood supply is cut off in the brain?” she fired.
“I never said that. I said this is due to degeneration. The cells in his brain die faster. Although at this age loss of blood supply is an additional reason for worsening”. When you know too much of something, it is difficult to not confuse.© Dr. Rajas Deshpande
 
You know, I am no Mangeshkar or Tendulkar myself, but this is like asking Lataji “I want to understand music and sing that song just like you” or telling Sachin “I want to make a century like you right now. Teach me cricket in ten minutes”. What they have learnt in decades with extreme hard work cannot be taught / understood or explained in few minutes. I can explain it in a nutshell, but it is not possible to ensure that the relative or patient “completely understood” everything I knew. But then again, the better this lady understood the disease, the better she will care for her father. So I decided another approach.
 
“Ma’m, I request you to please read about this disease from these two websites. Then write down your questions and please book another appointment. We will save a lot of random discussion then.” I told her.
“Ok Doctor” she agreed reluctantly “But tell me what you would have done if this was your father. I thought that with so many advances and researchers, there must be some good cure by now for such diseases” she said. The hidden disdainful sarcasm didn’t escape me. I ignored it.© Dr. Rajas Deshpande
 
“Now please tell me the list of all medicines that your father is currently taking, and their doses” I asked her.
She emptied a huge bag upon my table, with over 20 medicines from different pathies, some unlabeled, and including some bottled oils. She started asking her father one by one, he wouldn’t reply.
“I don’t know doctor” she said, frustrated. “He lives alone near my house, and takes these medicines by himself. We lost my mom few years ago. I guess some of these oils are for his massage”.
Some of those medicines were past an expiry date. The old man hadn’t a clue what he was taking.
 
“But you just told me he has severe memory problems and cannot understand much” I questioned.
“Yes, but we thought he knew what medicines he was taking” she said.
I did not want to embarrass her further.© Dr. Rajas Deshpande
“Ma’m, wouldn’t it be better if you understood the daily necessities of your father before you questioned anyone else about his disease? You can ask the doctor any number of questions, it is my duty to answer them. But I would definitely not have left my father to look after himself in such a situation.”
“No, doc, we are looking for a care center for him already. I cannot look after him, I have my own family and the kids need all my attention”.
“Then please stop blaming the medical researchers for not finding a cure for everything. Please accept that everyone ages and needs care, the same care that you were provided as a child”.
I didn’t want her to be unhappy, it was also my prerogative to understand her situation. I reassured her:
“Please read about this well, and come back next week, I am sure that at least a few problems can be resolved. I want to help you and him”.
 
What would happen if there was a cure for everything? How many of them elderlies will be taken care of, provided for? How long will their children look after them? In most cases, even the healthiest of parents are considered a nuisance once they have grown up the grandchildren. After that, they become an irritating liability.
Then, the annoyance of having to look after them, the exasperation of even a small illness they may have, and the extreme anger to have to spend time and money for their healthcare / treatment is all unloaded upon the doctor. While we are learning to deal with this in our everyday practice, I have decided to spend an extra minute to educate the family about their own responsibilities in every such case. © Dr. Rajas Deshpande
 
As she left the room she asked “Doc, he is elderly, you must give him some concession”.
I smiled. This wasn’t a medical question. It was my turn not to reply now.
© Dr. Rajas Deshpande
 
Please share unedited.

The Sweetest Pinnacle Of Life

The Sweetest Pinnacle Of Life© Dr. Rajas Deshpande

To many students who are lost in their search for the right aims and goals in life, who trusted me enough to ask that question, I have suggested that they imagine what they actually want in their life at its Pinnacle.

Success, riches, fame, awards and accolades, a legacy, achievements are all good to show and leave behind oneself. The truth is far more than that. Love and care, affection and respect in one’s evening of life is what everyone deserves, but few are fortunate to achieve. For what good is s life that spends its aged years in desolation, isolation, despair of an uncaring, loveless family one has sacrificed much to bring up well?

Hollow words of “show- love” and “pretend care” are commonly employed everywhere, especially among the rich, educated and culture-claiming pundits of humanity.

One experience I have is worth sharing: that the poorest of the poor, like the farmer in the wheelchair here, are cared for with far more genuine love and affection than many. This family collected alms and help to get him to India, and never asked for any concessions, free treatment etc., always saying they were willing to do anything for the happiness and health of this grandpa. His son standing by his side is an illiterate farmer, but is caring for his father . quoting proudly “He brought me up!”. There is no smell of “I am obliging my parent” in his behaviour.

I have met hundreds of Arabic Muslim patients who care for their parents, sons and daughters equally well, willing and with total faith in the treating doctor. It does not change with their financial status. They insist on the parents staying with them, ask questions about their food, exercise, medicines, happiness and comply strictly with the given instructions.

They naturally do not know the words “Culture, Rights, Medicolegal, Elderly care, Nursing Homes, Mercy Killing etc.”. Rarely have I seen them unemotionally “okay” with a bad diagnosis of a parent.

This old man, in my personal opinion, is one of the luckiest human beings upon earth!

© Dr. Rajas Deshpande

Thank you, Mr. Naser Ali, Mr. Abdul Hakim Mohd. Al Malahi, Mr. Majdi Jamil Aiselwi, Mr. Ahmed Anwar Aqlan!

The Tortured Beloved

The Tortured Beloved
© Dr. Rajas Deshpande

“I want to kill my father, Doc. Is there any way?” said the polished lady.

Used to a life full of shocks, cruelty and in general many negative shades of human behaviour, we learn to mask emotions to avoid turning off the patient /relative from telling us the whole truth.
This was a googly, and I made a conscious effort to retain my composure.

Thirty-something, very posh and from a high class cultured family, this lady was one of those who automatically garner respect of people around them. What she said didn’t fit in with the mental image she had impregnated upon my mind. Could she be one of the “PSY” cases?

“I live with two daughters aged 9 and 14. My mom passed away 10 years ago. My husband stays away as he cannot tolerate my father. My father was a military officer, retired with many honours. About 5 years ago he started forgetting things. We took him to many doctors all over India, they said he had dementia. Two-three years ago he started abusing in the worst filthy and obscene language we never thought he could use. He also started getting naked anywhere, and doesn’t care if myself, daughters or neighbours are around. He passes urine deliberately when in public and around us. He also makes attempts to sexually abuse us all, and tried more than once to grope the maids, who then left. We had a hard time when a maid filed a police complaint. I could not dump him as no one else can look after him. So I nursed him at home, and my husband who could not tolerate this daily abuse left us to stay in another state.” She started sobbing. All I could offer was a few tissues and a coffee.
I waited for her to speak again.

“I am sorry”, she said in a wet, guilty, embarrassed and one of the most pained voices I have heard. “I love my father as much as I love my husband. I could not dump my father. But then I cannot let my daughters go through this every day. They are terrified and have started behaving strange. We took him to many psychiatrists, and they gave medicines which kept him calm, but he developed too many side effects and could not move out of bed. Now he refuses to take any medicines and if we force him, he gets violent.” Again amongst sobs, she showed me her blue-black swollen shoulder.
“I have to tie him up to his bed and lock his room at night, but he keeps shouting. Our neighbours have started asking us to either dump him or move out of the society. The old age homes do not accept such patients.”
“I am a personality development counsellor, but my work is suffering now, I have lost my smile. I have lost my life. I cannot die, I have two kids to grow up. So I want my father to die. Is there any legal / medical way to kill him?” and then a volcano of unvoiced pain of years wailed out through her throat. She kept her head on the table and cried.

It was unprofessional, but I had to get up and pretend to wash hands just to be able to wipe tears in my own eyes.

Fronto-temporal Dementia, a cousin of Alzheimer’s dementia is a condition in which along with progressive memory loss, there is abnormal behaviour, delusions, sexual inappropriateness etc. It happens due to degeneration in some parts of brain. Progressive for about five-12 years, till patient develops some fatal complication.

This was not totally new. I remember many patients who are tied up at home, beaten up cruelly by their family, and left to die due to this kind of behaviour. This tragic management is also commonly meted out to many psychiatry patients who are burnt, injured with sharps, shackled and tied to beds / trees, kept with head under running water and even poisoned / sedated with herbal or even allopathic medicines to ensure safety of those around them.
Few years ago, one family of bodybuilders (all five brothers in land business) admitted their father with the complaint “he burnt himself with hot water in bathroom”. There were many bruises too. “He fell at home.” They told. When the sons left, the servant told the resident doc: “They (patient’s sons) threw boiling water upon his genitals after tying and beating him, because he tried to touch his eldest daughter in law”. This patient had severe parkinsonian features too, so was not able to move much due to stiffness. They had beaten him up and burnt him in that condition!

The lady in front of me regained her calm in few minutes. I explained her what many Neurologists and Psychiatrists may have earlier told her many times, about such being the nature of this disease. However, we have many safer medicines to control psychosis now. I wrote her a prescription and promised her that I will try and locate a “Care center” for such patients with this severe level of psychosis. There were none in that city. The next option was to hire a male servant and rent a small single room apartment with attached toilet nearby where she could shift her father. Sedatives (sleep medicines) at night were required.
Her husband shifted back. The family appeared to gradually recover from the mad-bad days.

As much as we need the doctors to explain the family about such illnesses, we also need to educate the society about such conditions, and care homes for these patients. Inhuman beating up, tying down, injuring, poisoning etc. humiliating fates by one’s own children is probably the worst that can happen to a human being.

When the lady came to visit with her daughters few months later, her cute daughters wished me mannerfully. We all grown-ups avoided the topic of “Sick Grandpa”. However, the 9 year old, while leaving, boldly asked her mom’s permission to ask me a question.

Then, looking straight in my eyes, the kid asked me “Doc, why did God do this to my Grandpa? Is it possible to cure him? We used to enjoy so much together, I was his dearest. It is ok if he hurts me, I want him back”.

I cursed my stunned wits. “He will get better soon, dear” I lied to the cutie.

© Dr. Rajas Deshpande

The Brain-Alive Heart-Dead.

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