Tag Archives: emergency

The Higher Suffering

© Dr. Rajas Deshpande

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

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

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

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

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

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

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

Looking down, hiding his face, the husband nodded.

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

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

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

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

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

“Five minutes” I requested her.

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

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

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

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

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

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

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

© Dr. Rajas Deshpande

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

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

©️Dr. Rajas Deshpande

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

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

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

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

“You must respect the authority “ the court said.

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

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

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

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

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

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

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

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

The doctor said

“Yes Milord, but the real answers will hurt:

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

“A culture of exploitation of non-votebank groups

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

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

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

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

The shocked judge requested the doctor to examine him.

“He is no more” said the doctor.

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

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

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

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

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

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

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

(C) Dr. Rajas Deshpande

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A Medico’s Last Certificate

IMG_20180322_171029_Bokeh

© Dr. Rajas Deshpande

A continuous beeping filled up the air in the ICU. Over twenty hearts kept making rhythmic sounds, the nurses kept on silencing the false alarms that rung every now and then, and informing us about the ones that needed attention.

We had kept the cake in the doctor’s room, we were waiting for the right moment. It was well past midnight, we had all wished Dr. Steve a happy birthday, but the ICU was full and busy, we waited for an opportunity to cut the cake.

A very old Parsi man, just recovering from a massive heart attack, was not maintaining his blood pressure. As his alarm sounded again, we rushed to attend him: Dr. Steve, myself and our nurse Ms. Divya. As we adjusted his intravenous drips, he asked us our names. He was funny, and always made us smile in spite of the deadly shadows that surrounded us. When we told our names, he smiled. “See, there’s a Hindu, a Christian and a Parsi happy in this small 10 by 10 room, but they cannot all stay peacefully outside in this big country!” .. Dr. Steve, always interested in one-upmanship, smiled and said, “If you want, we also have a Muslim and a Sikh doctor outside. Shall I call them in?”

With the typical instant Parsi wits, the old man replied “Arrey no no bawa, all our ********** (I did not completely understand that word) political leaders will die if people from all religions come together”.

It was difficult to say whether we were treating his heart attack or he was treating out tired minds. © Dr. Rajas Deshpande

The CMO called, there was a new patient coming up, a young lady in respiratory failure due to pneumonia. As the nurses prepared the new bed, Dr. Steve took down notes from the CMO. Ms. Divya was one of our most efficient and agile staff nurse. Very beautiful and brilliant, she took responsibility upon herself with a passion that would put to shame even some doctors. We all knew that there was something going on between her and Dr. Steve, but both of them kept mum. I knew for sure though, because Dr. Steve had once confided to me about this crush he had upon her. However, overwork always suffocates personal life in a hospital.

The stretcher rolled in, noisy with calls of panic. The patient was gasping. Urgently shifting her on the ICU bed, Dr. Steve intubated her. She coughed a lot, and both Dr. Steve and Ms. Divya were showered with blood stained secretions. Dr. Steve had his mask on, but Ms. Divya had not had the time to put hers on. He angrily shouted at her, while adjusting the patient’s tube, to wear her mask. I finished securing the IV line, and started pushing in the emergency medicines. © Dr. Rajas Deshpande

The patient was a young lady, who had suddenly developed fever, cough and cold. On the second day she had become restless, was admitted in some nearby hospital, but as she continued to worsen in spite of treatment, she was referred to us. It was a viral pneumonia, an extremely invasive and dangerous viral infection had started filling up her lungs with fluid and blood. Just as her oxygen levels improved, she developed an irregular heart rhythm: viral infections often cause severe damage to the heart, a condition called myocarditis. In two hours after admission, the lady died. Horrible moments followed, telling her broken husband and stunned kids that she was gone forever. Completing the formalities and paperwork, we returned to the grind: we were medicos: there’s no choice for us to sit down, panic, repent, mourn or run away.

No one was now in a mood to cut the cake. No one even spoke about it. Next night, Ms. Divya bought another cake, and we all silently wished Dr. Steve a belated Happy Birthday.

Jutst ten days later Ms. Divya developed fever, cough and cold. The same deadly virus, most likely. We all panicked. Dr. Steve took leave and attended her, as her family was far away in Kerala. She had come to Mumbai to earn enough for her family. In spite of all efforts, Ms. Divya passed away in just three days. The faces of her elderly parents and younger brother became one of the worst memory-scars in our lives. Shortly after, Dr. Steve developed the symptoms too, but survived.

I took him out sometimes, to bring him back from the pit of depression and shock that he had sunken in. One evening, when we sat silently on Marine Drive, he said, “I will never have a Happy Birthday again. You know, Divya’s family has no support at all. I have decided to help them out for some time, till we find an alternative”. © Dr. Rajas Deshpande

Staring at the ocean, I kept wondering: In this country, where crores of rupees are thrown almost every other day for even miniscule achievements in cricket and cinema, where millions are spent from public funds upon the useless travel, security, meetings and social dinners etc. luxuries of the super-rich MLAs and MPs, where billions are spent by every political party in elections, there are no funds for the nurses, doctors and other staff who risk or lose their lives serving their patients. If a bridge collapses and many die, if there’s a major accident due to lapses in administration, there is immediate compensation, in an attempt to seal complaining lips. But if a medico is injured or killed, the best thing our society has to say is: “This is because all doctors work for money, it must be the fault of communication on the doctors part!”

We walked that whole night, along the ocean, silently crying. Sometimes the only solace for a medico is the thought that someday someone will desperately need a good doctor or a good nurse, and not find them around. Many medicos who do extraordinary good to their patients do not get any certificates for what they do. Most don’t care. Because we carry our death certificates in our pockets every day. One last certificate that we work very hard for.

© Dr. Rajas Deshpande

Dedicated to the nurses and doctors, medical staff who suffered / died because they served patients, saving lives.

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The Unforgettable Compliment

The Unforgettable Compliment
© Dr. Rajas Deshpande

All six casualty beds were full, the room was full of noises: nurses, fearful and angry patients, relatives, and wardboys trying to move stretchers and wheelchairs in and out. This chaos didn’t affect my concentration anymore. It was late night, heavily raining, my colleague Deepa and myself were the only two doctors- interns then- in the civil hospital casualty. She was finishing the paperwork in the side room. Behind a curtain, I was trying to remove a metal piece stuck in the back of a kid who had blown a firecracker bomb with a tin container covering it. I started stitching the gaping wound once the metal piece was out and cleaning was complete. © Dr. Rajas Deshpande

Just then a girl walked in, all wet and panicked, with another small girl upon a stretcher. I recognized her instantly: she was a classmate from my junior college, Ruta. As the patient was shifted to the bed, Ruta frantically shouted, enquiring for doctors. The nurses had already started checking her patient’s vitals. I finished bandaging the stitched wound, and came out from behind the curtain, removing my gloves. She saw and instantly recognized me too. “You are Rajas, right? Remember me? I am Ruta, your classmate.” She started sobbing, now that she met a familiar face. Her sister, about 15 years old, had had a head injury, falling from a bike, and had just vomited. She was woozy, irritable and confused. I ordered an X ray (CT scan was not available in that civil hospital) of her head and neck. IV line was started and necessary drugs injected. I reassured Ruta that her sister was stable, and continued with other patients.

My subconscious kept on playing memories of the past on some deep screens.
Ruta was exceptionally beautiful and vivacious. She had many fans. I liked her too, but there was no interaction: her group unlikely to engage with nerds like myself. They were a group of happy-go-lucky, good looking and muscular guys and stylish, good looking girls. They were mostly into movies, masti, dance, gymming, rides and food. I was not only preoccupied with a lot of classes and study, but also too shy to belong to such a group. Somewhere I envied those boys, they had so much advantage interacting with girls, with all the time and money they had. However, muscles are not my kind of statement, although (Thank God!) I have always enjoyed excellent health and fitness. © Dr. Rajas Deshpande

Once we finished the junior college, I never saw them. Medical courses hardly allow any time for extracurricular activities. The only silver lining was that there still were beautiful and intellectual girls in the class, and some of them respected and liked nerds too!

As Ruta waited by her sister, I kept on attending the cases that came in. From women in labour to heart attacks in shock, from bullets in the chest to rapes, one night in a casualty shows more pain than many know in a lifetime.

A foreigner couple came in, with their small boy bitten by a bee, he had developed severe reaction, his breathing was obstructed because of the throat swelling from inside. They kept on weeping as we all rushed to inject steroids and other medicines to the child. In some time the kid stabilized. © Dr. Rajas Deshpande
Then the police brought in a drunk driver who had rammed his Bullet bike into another’s. Our duty was to perform a detailed examination, collect blood sample and opine whether he was drunk or not. I was shocked: he was my schoolmate. He recognized me too. “Raja? Dekh yaar ye log mujhe andar kar rahe hain (Look these people are jailing me) he said, “Tu kuchh kar yaar (please do something)”. This was difficult. He was going to hate me for life probably, but I had no choice. I wrote his report. I felt sad, but there was no time to express it.
A snake bitten farmer and a newly wed woman with over 70 percent burns were brought in almost together, both gasping. Deepa and myself ran around to stabilize them, the medical officer came in too, but the burns woman had arrested just as they entered the casualty. We intubated the farmer, who was sinking, while we struggled to get things right. He was shifted to the ICU upstairs. We started finishing the paperwork. © Dr. Rajas Deshpande

It was about 4 AM, now there was a relative calm in the casualty. Sleepy relatives had found corners to doze off. All six patients were relatively stable.

“Excuse me Rajas, Is there a canteen nearby where I can get some tea?” Ruta asked.
“Yes, across the road, in the lane opposite the gate” I replied.
“Will you please join me?” she asked.
Borrowing an umbrella from a ward boy, and informing Deepa, I walked Ruta across the street. We stood sipping the hot tea by the side of the road, under the beautiful rain.

“I have a confession to make” she said suddenly: “I never knew there was this side to life: I only thought my life was to be enjoyed without a worry. If someone had given me a million rupees yesterday to stay up all night listening to other people cry, see wounds and deaths all night, I would have declined and ran away. I cannot stand anyone whining, and here you all are, listening to nothing else, fighting not only death but also expectation, anger and uncertainty. We made fun of nerds like you, and today I meet one, saving lives! I don’t know if I will ever save a life, and here you are saving many every day! I feel how superficial I was! I respect you and what you do. I now think you docs are superheroes”.
We are used to such overwhelmed compliments by patients just relieved of fear. I just smiled. She read my face. ” No, I am not saying this because my sister is admitted today, but because I feel it inside after seeing what happened here”. © Dr. Rajas Deshpande
I thanked her, adding that it was not wrong to have fun and look good, confessing that medicos often secretly miss those things, none of us gets any time for that.

Needless to say, I walked back thanking God, and feeling proud. This was one simple closure, yet so essential!

My co-intern Deepa gave me the expected wicked mischievous smile when I returned.
“Today the tea must have been very tasty na?” she asked, sarcasm overflowing from a face deliberately made over-innocent.
“Solid” I replied with matching sarcasm; “Oxytocin-Dopamine waali chai thi (It had oxytocin and dopamine)”.

We discharged Ruta’s sister the next day. After two days, I received a handmade greeting from Ruta, in which she had written the most unforgettable compliment I ever received:

“You healed more than what was injured. Thank You!”

© Dr. Rajas Deshpande
Dedicated to all medical students, interns and resident doctors.
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The Changing Blood Group

The Changing Blood Group

(c) Dr. Rajas Deshpande

“He is sinking” shouted Dr. Siya.

The casualty registrar rushed to the bed, checked the vitals. Pulse very fast. Blood Pressure very low. Lips and nails white, hands and feet cold. The young man, unconscious, was on the verge of death.

“He must be bleeding inside. Get an urgent sonography of his abdomen”said the registrar to Dr. Siya, and call the blood bank. He will need at least two units of blood urgently”.

It was Dr. Siya’s first week into internship, she was thrilled with the idea of actually saving lives. At the young age of 22, she was witnessing death almost every other day. Along with that she was amazed to see the darkest sides of human nature: the potential of humans to hurt each other: via rapes, accidents, murders, fights. She had decided to not let this affect her attitude, and to continue to try and save every life she could.

That late night, this young man of about her own age was brought in unconscious by someone, who had just dropped the patient in the casualty and left without leaving any identity of himself. “I found him lying unconscious on the road. I don’t know anything else about him. I am just doing my duty, I have a train to catch”said the stranger and left. The patient was reeking of alcohol. He had a visible head injury. A quick CT scan had revealed minimal bleeding due to a small skull fracture. He also had had bleeding from wounds from his hands and legs, they were sutured. The patient had no identity marks, wallet or cellphone. The policy of the hospital was to provide basic treatment and shift the patient to the government hospital. The police station was already informed. Treatment was started.

Dr. Siya requested two units of blood. The blood bank called. They had only one unit of the blood for his blood group. The registrar had the same blood group, and like many doctors working in the emergency departments, he went down to donate blood.

It was nearly midnight. The fate of the life of a young man depended upon what the junior doctor did just then. There was no one to sign any consents, the protocol was to inform the hospital’s medical director and obtain consent for emergency transfusion or procedure. Dr. Siya finished the formalities, obtained the permission, and started the transfusion. If the patient had reacted or something went wrong now, they all feared, there will be a havoc in the media: that they had let an unknown patient die because they wanted money!

Dr. Siya kept on managing the show. The angry and disturbed relatives of other critical patients kept on taunting her, speaking rude and reluctant to complete simple formalities and paperwork.

The sonography was thankfully normal.

Just as the first unit of blood was over, the patient became conscious, and revealed his name. He was quite shaken with the surrounding, but told in broken sentences about his friend’s number and address. He revealed that while returning from a party, his bike was interrupted by a bunch of goons, he had fallen down, they hit him upon the head and left with all this belongings.

The friend was called, and came in. He revealed that the patient was used to smoking weed and drinking alcohol in huge quantities. They were staying in the hostel of a famous college.

The second blood unit was started, and in a short while the patient threw a convulsion. He was immediately given injectables for controlling the convulsions, he slept off with the effect.

His parents arrived early next morning.. The shocked mother was consoled and explained about the situation by Dr. Siya. The elderly father, like all fathers, equally shocked but being a father unable to cry, kept mum, just holding hands of the boy.

When the patient woke up again, the father came to Dr. Siya, and touched her feet. Too embarrased, she told him that the registrar had donated blood for the patient. The father went and thanked the registrar, again trying to touch his feet.

As Dr. Siya had finished her night duty, she prepared to leave. “Beta, Will you come soon please?”asked the tearful mother to her. “Yes Auntie, I will be back soon. Don’t worry, he is ok now”she reassured and left.

On her way back her genius young mind tried to look at the situation sitting upon her shoulder, the little third person that resides within each one who has a conscience. That booze and weed was easily available to youngsters in almost all Indian hostels, that even educated people rode bikes without helmet, that crimes were happening almost everywhere that injured and killed people, that law and order was a laughable term in many parts ofthe country, that there was no government mechanism in place to provide emergency medical / paramedic support ambulances to raod / traffic accident victims: which one is the most responsible cause, when patients like these died? Who is responsible?

She reached home, told her proud parents what had happened, that she had helped save a life. Her mother folded her hands towards the sky, said “God, let my daughter save many lives everday”.

While having the breakfast, her father turned on the TV. A famous but ill educated political leader, in his mind-and-other- organs blowing speech in Karnataka, was explaining the illiterate public how all Indian doctors charged in excess, how they were only after money, how everyone except himself was the enemy of the millions of patients surviving from critical heart attacks, accidents, strokes and other diseases. All patients getting better all over te country was only thanks to himself and his government!

Dr. Siya’s father laughed bitterly. “Next time you need blood for any poor or unknown patient, call him” he said.

Dr. Siya replied, laughing “That kind of ëver changing blood group doesn’t match anyone, it is useless for any patient, Papa”.

(c) Dr. Rajas Deshpande

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The Overdose of Medical Advice

The Overdose of Medical Advice
© Dr. Rajas Deshpande
“If the doctors want to go to a five star hotel, they must pay for it” said someone recently in a headline.
Well yes, like any hardworking honest professional, even a doctor may want to go to a five star hotel occasionally, and have a good time, especially given the sadness that surrounds his / her profession. There is nothing that prevents me as a doctor from wanting to go to a five star hotel once in a while, and I do not feel guilty about wanting to live a good life. Earlier, I was happy to attend some great lectures by the world’s best doctors brought to India by the pharma industry (because the government never can), now I will just pay for myself.
Whether a five star meal comes from the profit of pharma industry or the hard work of doctor’s fees, there will be objections for sure. The problem is not the five star meal, the problem is elsewhere. So the different ministries can officially host super luxurious parties on different religious / non religious occasions to woo voters via the taxpayer’s money (and the media will describe the Biryanis and Gulab Jamuns in paragraphs), but the doctor must never eat a free luxury meal!
Many non medical professions, industries, financiers, film industry people, bankers and builders host dinners / other events at five star hotels, and many government officers / ministers attend them. Do they all pay for themselves? Just because a minister attends a five star dinner, he cannot be presumed to be doing a hidden favour to some industry, likewise, a doctor attending an academic event cannot be presumed to be doing a favour to any pharma. © Dr. Rajas Deshpande
It is doubtless that some doctors may have misused this facility and overspent. But the huge advantage: giants in the different medical fields from the developed world coming and educating the doctors in India will be greatly sacrificed by such limitations.
Given the social envy and jealousy against the doctors now rampant, it is probably an inevitable but unfair step by some organisations recently to ban pharma sponsorship of certain medical events at five star hotels. It is also a good initiative to reduce drug prices. But then, can the same organisations and even the federal bodies show the same guts and ban following malpractices too:
Open sale of undergraduate and postgraduate medical seats all over India, that creates funds worth trillions, benefitting even some in the highest offices of the country? Where does this money come from, and where does it finally go? Are we innocent enough to presume that the patient is not ultimately paying for this? © Dr. Rajas Deshpande
Under the medical consumer protection act, is not the government required to make all the facilities of healthcare available at all government hospitals in our country at subsidised rates? It is argued that taxpayers are paying for the education of medical students who enter medical colleges by merit, which is wrong, because the taxpayers are actually paying for good health facilities at the said hospitals. But most of the hospitals / medical centres run by the government are understaffed and run far below acceptable conditions. How many government health set ups have been evaluated for accreditation by standard bodies, and what are the results?
The insurance companies and corporate hospitals have held the private doctors prisoners of their atrocious conditions, and even the paying patients are being provided a substandard service, thanks to a total absence of any willingness to question any of this on the part of administration.
The demand and supply of “Cheap everything” in medical profession has now gone to such a dangerous extent, that substandard staff, incompletely qualified professionals, low rate medical instrumentation and quality of service, and above all, ineffective / low quality medicines have become a horrific reality already, even at some corporate hospitals dominated and dictated by the insurance sector.
They are giving people what they want: Glittering Cheap Healthcare. It is so surprising that the patients are happy with only this one quality of service and drugs: cheapness. The day that our society will understand that like anything else, good healthcare will cost more and will obviously involve more profit-making, our health scenario will improve. © Dr. Rajas Deshpande
The IMA, while trying to play safe and readily making rules like banning sponsorship, should take a firm stand to fight against the one sided war waged upon the medical profession by some.
Written in a state of perfect peace, not frustration.
Because I am not sold out to the desire to be liked by everyone, especially those against doctors.
© Dr. Rajas Deshpande

Emergency: The Doctor Is Not In

Emergency: The Doctor Is Not In
© Dr. Rajas Deshpande

“It’s an emergency, doctor” shouted the angry son at my OPD door at closing time, around 11 PM. We rushed to the casualty. It indeed was an emergency. His father had developed a stroke, and was found to have a moderate sized bleed in his brain.

His younger son who had done some medical diploma in some yet-unrecognised pathy had stopped his father’s blood pressure and diabetes medicines three months ago. “I was observing him at home. The BP was high and the sugar was around 300, but I was trying my own medicines, as I don’t have faith in allopathic medicines” the son told me without a trace of shame or guilt.

“How long has your father had these high BP and sugar levels?” I asked him, impatience choking me.
“May be a month” he had replied coldly.
The treatment initiated by the casualty doctors had stabilised the patient. © Dr. Rajas Deshpande
As we returned to OPD, the angry resident doctor with me said “He should be booked for attempted murder”.

Within three days of the admission, both the sons of this patient decided to take him home. Patient had still not recovered his consciousness well, and was being fed via a feeding tube. “We will manage him at home. We will call you if anything is required” they told me.

Grown up by now, I replied “I am not available on phone. Please see your local doctor or take him to the nearest hospital should he have any problem”. © Dr. Rajas Deshpande
“What if it is an emergency? He is under you care” the elder son asked aloud, in a threatening voice.
“He is not under my care once discharged. We will advise him medicines and give other instructions. I am not your paid servant. I am not available for consultation on cellphone” I told them my working hours. I had not become a doctor to be abused by those who wanted to save time and money. © Dr. Rajas Deshpande

Then over four months later, the two brothers entered my room at 9 PM.

“Doctor, our father is having vomitings with blood since yesterday morning. He is not responding well when we speak. Can you prescribe something?” the elder brother asked “He is at home, we thought we will first give him some medicine and try”.
“Why didn’t you admit him even when he had bloody vomiting yesterday?” I asked, almost knowing the answer.
“We thought it will stop. Also, there was nobody to admit him. We both have our office jobs.
“I cannot prescribe anything without seeing such a serious patient. You must take him to the nearest hospital with a gastroenterologist. Please treat this as an emergency” I told them. © Dr. Rajas Deshpande

However their calm was unruffled.
“We will take him to some hospital near our home. They will treat him immediately no?” asked the younger one.
Before I could reply, the elder brother raised his voice again: “They will have to. Or we will show them. This is an emergency. If something goes wrong, we will bring down the hospital”.

In two days, we read the news of a small nursing home ransacked and destroyed, doctors manhandled by relatives because this patient had died. The doctors who tried to save him were arrested under an allegation of “attempted murder”.

The word “emergency” is as familiar to every doctor as his own name. Hundreds of deaths in casualty are related to delayed admission at the terminal moment, and no one looks at the gruesome ignorance, neglect and delay behind the scenes, which equals murder by the patient’s own friends/ relatives. © Dr. Rajas Deshpande. Addicted to thoughtless emotional outbursts, our society usually reacts without logical thinking except few intellectuals who do not constitute a vote bank.

Drug reaction? Beat up the doc!. Patient in casualty or hospital died? Beat up the doc! Arrest them! Jail them! If the same patient is killed due to wrong treatment by his relatives, or dies at home because he was never taken to the hospital by family members: it’s okay!

Many who are advised right tests don’t do those. Many who are advised right medicines do not take them. Many do not undergo the correct procedures / surgeries advised. Because the patient is “King consumer!” Then when their health deteriorates. It is suddenly the medical profession that becomes responsible for everything that goes wrong.

Time has come for IMA to demand an enquiry into the circumstances few hours / days / weeks prior to every death in casualty and emergency where the doctor / hospital was blamed. Right from neglect, ignored medical advice to hidden information, many skeletons will tumble out. An IMA legal cell should start filing cases of culpable homicide in every such case. Then alone, equality principle will prevail.

Time has come when small hospitals, nursing homes and clinics, which were earlier trying to rescue serious patients in emergency, will display this board after the regular OPD hours:

“Emergency services not available. Doctor NOT in campus”.
© Dr. Rajas Deshpande

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The Morphine That Killed a Hospital

© Dr. Rajas Deshpande

“He fell down while checking the patient”, said the panicked Dr. Mrs. Sane about her husband, “and became unconscious”.

Dr. Sane tried to maintain his calm. A sick doctor has the curse of knowing the worst of everything, and has a perpetual feeling of sitting upon a ticking time-bomb. It was a sad feeling to see this middle aged brilliant general practitioner fighting tears.

“Sir, the OPD numbers have shot up because of these epidemics, especially dengue. I see over a hundred patients every day. The Inpatient beds are full. There are daily problems: medical, administrative and medico-legal.. those I am used to. But now there are too many politico-social and press-related issues that worry me”.

Dr. Deshmukh, a senior practitioner and a common friend, accompanied Dr. Sane. He cautiously poked him “You must tell the doctor what happened the day before”.
“Oh that’s a part of our profession” Dr. Sane replied.
I insisted that he must tell me.

Reluctantly, he disclosed: “Some goons came in with a municipal councillor and threatened to waive off the bills of a dengue patient. He was in the ICU for five days, quite bad, but went home walking. Till the time he improved, they kept on threatening us to break the hospital and thrash us if something went wrong. Upon discharge, they didn’t pay a single rupee. There’s nowhere to complain, as the hospital requires many municipal permissions”. © Dr. Rajas Deshpande

Dr. Mrs Sane lost her cool. She started sobbing. “No one blames those who dump garbage, keep their surroundings unclean. No one is blamed when epidemics spread and thousands die. No one is held responsible for failures of almost all preventive services and lack of basic facilities at government’s healthcare institutes. But the already overworked general practitioners must bear the brunt of everyone’s anger: the public and press are always free to bash the last face they see: the doctor who is actually helping every patient,.. Dr. Sane has not had a proper lunch, not spent a full day with kids in months.. That hospital has become our curse“ She broke down.

It was so logical! The offices responsible cannot even be reached. The court does not see any of these system failures that cause millions of deaths all across India, happily ordering lakhs and crores and imprisonments for doctors, for trivial mistakes.
Whom to blame? Oh yes, the doctor who has studied to treat the sick!

Anyway, in a country fond of muscular heroes and billionaire godmen, who expects a brainy analysis? © Dr. Rajas Deshpande

“I had a dream of making best health facilities available for my area. I have taken a big loan. We treat poor patients free anyway. Many rich are sent by local politicians, leaders, administrators with instructions to attend immediately and free too. Paying patients are mostly suspicious because of all the negative things publicised by press about all doctors., they also expect immediate and positive outcomes. I have not slept for many a nights. “

I examined him.He had obvious features of being fatigued mentally and physically.. A syncopal attack, where the BP drops down suddenly and makes the patient unconscious, was likely. I advised him tests and told him to take rest for there days.

“Not possible, sir! Even now the OPD is waiting” he replied. An angry Dr. Mrs Sane requested me to intervene.

“Your duty to the society does not free you from the duty towards your own health and family” I requested him. But Dr. Sane agreed only when Dr. Deshmukh offered to send over a junior doctor to his hospital to take care of the OPD.

“How have you been, Sir?” I asked Dr. Deshmukh. He is one of the most respected and busiest general practitioners in town, with a big hospital. © Dr. Rajas Deshpande

Dr. Deshmukh smiled.
“I had an angioplasty three months ago. The only risk factor was high BP and stress. There is no use fighting or explaining our situation to the society, government or press. I have closed down my hospital. I only see OPD patients now. Anyway many patients thought that I worked day and night for earning more money. Let them go to the corporate or government hospitals.”

The death of his hospital was not a surprising news, many small private hospitals and nursing homes are either closing down or converting into profit-making franchises. Many doctors are suffering high BP, cardiac and neurological problems and even dying due to excessive stress.

The meaning of this nightmare will soon unfold upon our society.
Till then, this is a heartfelt appeal to all the over-stressed doctors to rethink about their priorities, rearrange life and make sure stress does not kill.

For the morphine of “medical social service” is only good in small doses, it kills when overdone!
© Dr. Rajas Deshpande

Negligence cases deserving severe punishment.

Negligence cases deserving severe punishment.
© Dr. Rajas Deshpande

A police sub inspector in civil dress, his wife and three kids aged 8, 5 and 1 were brought to casualty. All profusely bleeding. My job as an intern was to secure IV line and stop bleeding. As the CMO questioned the PSI, we all realised as suspected from the stink that the police officer was drunk. He had run into a braking truck from behind. One kid and the wife died the same night. He created a ruckus in his drunk state, threatening to kill everyone in the casualty. “If my wife dies, I will see to it that your life is ruined” he threatened to the CMO. The CMO kept on doing his duty, stressed and hurt. We were all real scared next few days. Everyone sympathises with such a loss. No one will aid or enjoy anyone’s death in a hospital.
Then why this curse of blames?

“This happened due to that doctor’s wrong treatment” : common words now heard in many clinics daily. Who causes maximum deaths due to negligence? Can only a doctor cause medical negligence? No.

These medical negligence cases must be punished too, with bad press, crores of rupees in fines, and public humiliation. You be the judge who is guilty:

Teenager son of an MLA. Played with wild snakes as a hobby, proudly encouraged by this MLA. Bitten by a cobra, landed in icu critical. A patient on ventilator was ‘shifted out early’ to accomodate the MLAs son.

Doctor advised a blood thinning medicine to prevent clots after diagnosing clotting disorder,. Patient went with her husband to a quack, took unknown herbal medicine and stopped blood thinner. Developed strokes, now in a vegetative state.

Patient advised to quit alcohol,,as it caused fits. Counselled with family and friends. In a week had alcohol with same friends, had fits, died in casualty.

Diabetic, told to control diet, continued to binge-eat sweets, lovingly cooked by wifey. Landed in coma due to very high blood sugars.

Pet dog, unimmunised, bit many on the same day, the dog died in three days. One diabetic patient bit by this dog died of sepsis / infection (not rabies). Immense horror among the ten-odd families of bitten members till date after a year.

Kid aged 14, parents allowed him to ride two wheeler on road without licence, killed on spot colliding with a truck. Toddler unwatched on the road died, run over by a truck.

60 year old Mother has giddiness for three days, son and daughter in law not free till fourth day to take her to hospital. Dies in casualty due to stroke.

Patient advised not to fast as it may increase chances of having fits. Fasted and landed in ICU with status epilepticus (a series of continuous fits).

Traffic police at a crowded junction busy with his “routine” away from his spot. Head on collision, two dead.

Unfortunately, in almost all above cases, the treating doctors were beaten up, casualty staff and hospitals vandalised, doctors sued, bad press judged an entire profession almost like a criminal, for not saving the victim.
© Dr. Rajas Deshpande

Often the relatives refuse to take patients to higher centers, expecting “big, advanced treatments and impractical outcomes” from low-cost, small nursing homes not equipped with specialty facilities, then end up vandalising or blaming such set-ups upon inevitable disappointment. Missed medicine, overdose, unobserved children, helpless neglected elderly parents, smoking, alcohol, traffic accidents all cause millions of deaths. So do delayed admissions, some herbals and “unknown” medicines, hunger, poverty, stress at home and workplace.

But it is the “death in hospital” that alone matters, and by default the blame is pinned upon the doctor!

Some actors can kill, rape, go naked, smoke, drink, race, gamble, pee in public, set records for drunken misdemeanours on and off screen, knowing that most illiterate and immature populations imitate them blindly. But they will tell the nation how the medical profession (for which they themselves did not opt in spite of excellent merit in school or in some cases even college) should behave and treat patients!

The few honourable judges who have now realised the “blackmail potential” of medical negligence cases, have fortunately started referring these cases to panels of medical experts before concluding and fixing charges. The only maturity issue that remains is about local goons and politicos with flitting loyalties looking for publicity at the cost of the harmless and intellectual population of doctors. These goons turn the helpless frustration, panic reaction towards tragedy and poverty of our society into anger against doctors and hospitals. As long as there are sane people in the responsible media, there is good hope.

Doctors must start recording without bitterness, any hostile tendencies, lies, deviation from duties towards the patient, advised and declined tests and treatment, neglect and avoidance patterns to provide adequate care for the patient by the relatives. Also the exact circumstances of onset of the problems (patient was drunk / drugged / under medication effect / fasting / missed medicine) etc. and relevant past that may have contributed to the event. This will minimise the allegations and misrepresentation of facts.
© Dr. Rajas Deshpande

Ofcourse the doctors must also discharge their duty with the highest standards of practice possible in their set-up. They must communicate well and explain the condition atleast once to the concerned relatives. They must behave courteously, sympathetically and try to understand and forgive the panic states of relatives within the sphere of civilised behaviour. We all love our patients. But like in every other relationship, we fail to say it aloud and make it clear with our behaviour, thanks to heavily stressful and inadequate lives we lead. Let us make an effort on our side to take one more step in the direction of kindness and understanding, in a hope of saving this profession from defamation at the hands of middlemen.

Let us make a greater effort to tell the society that it is only a doctor who will never intend harm. The only reliable rescue from the clutches of death, even a doctor fails sometimes. The effort has to be recognised if not always rewarded, but never suspected.

Negligence, you see, is easy to pin only upon the doctor.
All others are forgiven any number of deaths in all other types of negligence.
© Dr. Rajas Deshpande

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The Lawless Side of Medicine

The Lawless Side of Medicine
© Dr. Rajas Deshpande

A well educated businessman driving in his car with his family had an accident. He had some bleeding wounds, but was fully conscious and alert after the accident. A few young college-going students stopped to help, picked him up, hailed an autorickshaw and took him to the hospital. The patient’s wife and child followed in another.The junior surgical and orthopedic residents examined the patient, stitched his bleeding wounds and started medicines. The wardboys and other staff carried the patient to the CT scanner, and shifted him to the casualty after the scan. Patient’s wife accompanied him throughout. When the senior surgeon came over and asked the details of his prior health status, the patient requested privacy and revealed that he had recently been diagnosed with HIV infection, and was taking some traditional medicine for that. Atleast 4 College students, the autorickshaw driver, and 2 wardboys had been exposed to direct contact with his blood by then. The treating doctors had their gloves on, but not the complete gear expected to be worn while treating such patients. He himself or his wife had not cared to tell helping hands to protect themselves.
There are many blood-borne diseases, some fatal and some dangerous. While the courts merrily write orders about help to the victim (which is must), no one cares about the risk to the helper’s life while executing such help. No court has ever ordered the government to make Universal precaution gear mandatory in hospitals, especially govt hospitals where thousands of budding doctors, nurses, wardboys, techs are exposed to blood contact daily, without knowing the infective status of the patient. No court has ever ordered the govt to implement precautionary measures to avoid accidents, drunk driving, or emergency roadside assistance. People can drink, drive reckless, cause accidents, govt can do away with wrong licencing, zero roadside assistance, but everyone including the press will pounce upon the treating doctor for a bad outcome! No court ever questioned the authority which issued licence to a driver involved in traffic accidents!

Another. A lady of 60 brought to the casualty unconscious, with drunk “mob” led by her son. The son tells that she never had any health problem till that evening, when she had convulsions. They demand immediate admission in ICU and treatment, and declare that they have no money. The hospital obliges and admits her as a free patient as an emergency as per court rules. Next morning the recovered lady revealed: that she had had convulsions till few years ago, was advised regular medicine, but stopped it many months ago. She was also an alcohol addict and had taken alcohol on the prior night. On the day of convulsion, her husband had had a big showdown with her. Upon questioning the same son next day, he replied to the junior doc: “I never said she didn’t have any health problem, and you never asked if she was addicted to alcohol”. They also didn’t have the BPL card they claimed they had.

Fortunately she went home all well, but one shivers at the idea of what would have ensued had she not improved. Probably another cruelly beaten up doctor and voluptuous bad press against the medical fraternity in general.

It is the responsibility of the doctor to be good, perfect and true in everything he / she does. But if the whole action / decision making of this doctor is based upon what the patient tells, any lying / hiding of information by the patient is then likely to impair the outcome. To presume that all patients always tell the truth is a joke. Many hide addictions. Many hide stigma-illnesses like Tuberculosis, Epilepsy etc. Many hide that they were beaten up by a family member. Many do not tell their drunk status during accident (some traffic accident deaths for which the casualty doctors are so often beaten up by relatives may likely be related to the patient being drunk).

The most dangerous patients are those who have themselves or because of family pressure neglected the disease until the time it has reached a critical level, often beyond cure. When something happens to such patients in the hospital, our society is quite impressed with only an innocent sentence: “The patient was completely alright till admission”.

Some patients do not tell that they missed medicines. Some do not follow precautions. Some take additional herbal / traditional / quackery-born medicines along with the standard treatment, without revealing it. The entire responsibility of outcome in every case in any hospital is pinned down upon the treating doctor.

While compassion and the art of “extracting” the correct details are essential for every doctor, it is not mandatory for the patient to tell the complete truth. In this medicolegal age in a mostly illiterate, superstitious society, it is essential to educate people about telling the truth and taking precautions while helping others.

If you have an open wound / cut / injury over your own skin, please refrain from touching a bleeding patient. Avoid blood contact of any person unless you are in a position to save life by taking that risk. It is wise to keep a box of gloves in your car / four wheeler, or carry a pair in your purse / office bag for such an emergency.

While it is expected that every doctor, irrespective of how busy he / she is, writes detailed notes and prescriptions in capital letters for every patient, there is no responsibility assigned to the patient. If the patient is a consumer and the doctor liable for even tiny mistakes or unfavourable outcome, then the clinical-legal responsibility of patients must also be defined. It must be mandatory for every patient to write the details of their health, prior conditions, all medicines, etc. in legible handwriting and sign it with witness to submit to the doctor / hospital, before treatment is begun.

Many patients, educated or not, know this responsibility and carefully, truly detail the doc about everything asked for. They also mostly respect the outcomes. They usually do not blame others / doctor for either their illness or addiction-complications.

However, there is a surge now a days in “blame it all upon the medic or the hospital”. It is high time some wise judges recognize these issues before deliberating a judgement.

Till then, the Indian Medical Profession is at the mercy of press-interpretation.

© Dr. Rajas Deshpande
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