Tag Archives: Empathy

The Remedy of Trust

The Remedy of Trust
© Dr. Rajas Deshpande
I entered the ICU in a torn and angry frame of mind. An old patient had had fluctuations in heart rate and blood pressure all night, and was on the thin line between life and death. Irregular heart beats had clotted his blood and he had developed a paralysis.
I had had a terrible argument with family that morning, and had left home without a breakfast, thinking that I will catch up in the canteen if hungry. The traffic on the way was as usual bad, it further worsened my mood. Messages kept pouring in: pending bills and health enquiries that were an attempt to avoid a proper consultation. One can ignore, but sometimes ignoring is stressful too!© Dr. Rajas Deshpande
As I entered the hospital, I was told about some machine not working. The technician had commented that it was beyond repair now. New one would cost over 30 lacs minimum, and this machine was required on a daily basis. My head started pounding. Another loan now, another recovery period!
As I passed the billing counter, an imposing rogue with a group stopped me. “Sir, the bill is too high, do something”. It was an open threat worded technically as a request. The relatives who folded hands to save the patient till yesterday were standing behind that rogue, looking unconcerned, not even happy that the patient was alive and being discharged after a life threatening illness. I sent them to the charity cell.
I entered the ICU, staring into my cellphone where angry messages of argument kept pouring in, a dear friend was upset that I was not available to see his relatives in another hospital immediately. © Dr. Rajas Deshpande
The old patient was sleeping. A glance at the monitor revealed that the patient’s BP was now stable. His heart rate was regular too. What a relief!
The patient’s wife got up, she was in her 80s. Fair, all white hair, and the confidence of culture upon her face, she smiled through her wrinkles and troubles. The Kumkum on her forehead was bright and fresh. She wore a torn saree, and had no ornaments except a thin thread with black beads that made her Mangalsutra. She was bending forward due to age.
She then said “He spoke to me this morning. He is feeling better than yesterday. I know he is old, but please give him the best treatment. We have been together since childhood.” Her eyes became wet.© Dr. Rajas Deshpande
Then she made an attempt to touch my feet, something that woke me up with a shock. A tingling feeling ran through my body. I held her hand and asked her it was ok, and returned the gesture by touching her feet too. I told her I will try my best, and her husband appeared out of danger at that moment.
She gently prodded the patient: “Look, our doctor is here. He says you are getting better. Do you recognize our doctor? Say Namaskar to him”.
Confused for a moment, the old man stared first at his wife, then at me.
He then tried to lift both hands, but only one went up, which he raised to his forehead and whispered “Namaskar”.
The old couple, the age of my parents, was saying Namaskar to me and touching me feet, many decades younger to them, because I was a Doctor. They never knew me until two days ago, but had trusted everything I said. They did not question my ability or intention. I like to be professional, but that should never compromise my manners.
I switched off my cellphone.© Dr. Rajas Deshpande
I suddenly felt ashamed of the mood that I was in. They did not deserve it. Their complete faith was to me the best return and reward of my efforts of so many years to become a good doctor. No amount of money ‘thrown at me’ by those who think of ‘buying me services’ would actually be my interest or aim. This was.
I smiled at the old lady, and told her that should she have any concerns, she can ask the staff to call me anytime, I would be glad to come over. Then, to repay her for bringing my smile back, I wrote on the billing sheet: “No charges for me in the case”.© Dr. Rajas Deshpande
When I walked out of the ICU, I was feeling proud and smiling. The faith of this patient and his wife had cured me of my bad mood too. I was prepared again to forget my personal woes, to take over the faithless hundreds, still do them good, in an attempt to reach out to the really deserving faithful, who knew their doctor would only do them good. That is the essence of my profession, my education, and my intention.
A patient who trusts a doctor earns for himself the best in that doctor. Always. Although we do not expect it to be understood by everyone.
© Dr. Rajas Deshpande

A Policeman’s Tears

© Dr. Rajas Deshpande

“She was found unconscious and naked lying on the road. The baby was near her, moving when we found her, now she also looks unconscious” said the police constable. “Actually I had my civil dress in my jeep, I covered both with my clothes and got them here. Most likely an orphan roadside beggar”.

It was early morning, I had gone to the casualty for a call as a medicine resident, and was chatting with the CMO when this police constable had rushed in the mother and the baby, probably less than a year old. He and his colleague completed the formalities and left. The CMO was alone, so I stayed on to assist.

The lady had high grade fever and some bruises all over her body, only one on the thigh deep enough that it bled. She also had a contusion upon the head. Needless to say, unclean and unkempt, visibly quite weak and poorly fed body. There was a traditional tattoo on her forearm that said “Seeta” in distorted devnagari script. The baby was dehydrated and had fever too, with only minor contusions.

“Sending her to female ward, and the baby to paediatric” said the CMO. We completed the police information and Medicolegal form, the nurses had started the IV line for the lady. I accompanied the baby to the pediatric ward, handed her over to the resident doctor friend on duty and went to the female ward to attend the other admissions. Basic medicines for fever and head injury were started for Seeta. There was no CT scan facility in the hospital. Blood tests were sent.

In absence of relatives, it’s the interns, resident doctors and nurses who attend to the necessities of such patients. Administration mocks everyone sympathetic and compassionate to such patients, be it a government, private or corporate set up. My professor advised some more blood tests. Some tests were not available in the govt. hospital, we had to send them outside. As we had just received the stipend, money was not a big problem.

Next evening I went to the pediatric ward to find out what was happening with the baby.
“She has had convulsions”, the resident colleague told me. We have loaded her with anticonvulsants, but she still has fever. Dr. Jain madam (new lecturer in paediatrics) has advised lumbar puncture, but there’s the consent problem”.
I went to talk to the lecturer, she was all insulting. “Don’t teach me what to do. We will send a request to the dean, and if he allows, then the resident will do the lumbar puncture” she said, “By the way, what’s your interest in this baby? Why don’t you mind your own business? I have heard about you.. you are in the student’s union na? Don’t throw your weight around me.” She said.

The dean consented to our request, and a lumbar puncture was done. The baby had probable tuberculous meningoencephalitis (infection of the brain and its coverings). Antituberculous medicines were started.

The comments of the pediatric lecturer made me extremely angry. Most of her resident doctors hated her attitude too. Those remarks soon spread and various sick, exaggerated and vulgar jokes about me caring for that orphan baby made rounds among my colleagues. But one good thing about wanting to do good is the shameless pride and courage that comes ingrained with it.

My colleague Dr. Madhu stood by me. She often reminded me: “There are five percent good people in the world, and 95 percent bad, Einstein has said, but it is the five percent good who take the world forward, they represent human race”. That has always pumped me up against all the mockery that I ever faced for being “too sensitive and compassionate to be sane”.

The best support for the poor and helpless always comes from the poor and helpless. The pompous, actionless “blah blah” of advising others to be more kind and compassionate is usually the trademark of those who themselves rarely help anyone. The mamas and mausis (wardboys and helpers) of the ward came together to attend Seeta during their duty.

The pediatric resident told us on the third day that the baby’s health had gone bad, and she was unlikely to survive. Dr. Madhu stopped smiling. “At least can we shift the baby near her mom?” we discussed. It was of course not possible.

Dr. Oak (real name), one of our ophthalmology genius professors, learnt about this. He came over and told us in his royal tones, to tap him anytime for any help. He also left some money with us.

On the fourth day, the lady started having convulsions too. We ran around, trying to arrange whatever the professor suggested. She was gradually sinking. Tuberculosis neglected and untreated is one of the most cruel diseases. It takes over ten days for the action of Tb medicines to kick in.

On the fifth day, the baby passed away in the morning, and the lady shortly after. That coincidence was less tragic than their trolleys being rolled into the mortuary together.

“What happens now?” we asked the mortuary in charge.
“They will be cremated as orphan, unclaimed bodies after the post mortem” he told.

In a world of billions, ruled by religious, powerful and rich, a young mother and a baby girl would be cremated as orphans! We told the mortuary assistant to please keep us posted, and came out. Of course we could not sleep.

Next day we took special permission and went to attend their cremation.
On the way, we bought some flowers, a tiny dress for the girl and a saree for her mom, probably the first new clothes ever for either of them. Dr. Madhu had already brought a few bangles, a necklace and two bindis with her.

Dr. Madhu was sobbing as we returned. The rowdy looking policeman with us also wiped his eyes. He dropped us back to the medical college in his jeep.

He said in a heavy voice as we parted:
“Doctor, we see all the worst things in the society. We meet criminals day and night. But when such young girls and babies die, I feel like shooting everyone who didn’t come out to help them. People just talk, nobody helps. God bless you. You have what it takes to be a doctor. Don’t ever change.”

© Dr. Rajas Deshpande

Years later, I read about a divine human being from Chennai, one Mr. S Sreedhar, who collects unclaimed dead bodies from various hospitals, and performs decent and respectful last rites for them. Planning to meet and touch his feet one day.
Please share unedited.

Have Doctors become Mechanical?

(c) Dr. Rajas Deshpande

Sir, most of your stories you share are from your internship days. I have worked as an intern for past 10 months but almost never encountered/experienced such heart touching events and I don’t think, i am any less humane or sensitive than you must be(guessing by your posts). then why almost every intern is so mechanical about his schedule and work? Has the nature of work/ job profile of interns changed to mere mamagiri? Or Its just that, you always went the extra mile to be the awesome being you are! Awaiting your reply eagerly.. Dr. AA

Dear Dr AA, yes doctors have become more and more mechanical, also preoccupied with too many non-clinical tasks like USMLE / MRCP / pg entrance studies, digital addictions and excess non-duty work. Talking to the patients and making them open up is an extremely difficult art. Just like we don’t open up to any roadside stranger, patients do no talk much to a disinterested doctor in a hurry.

There is no one without problems, no one who does not need more love and kindness, but people will not respond if they sense “artificial” empathy. Most illiterates and even infants sense true versus artificial love. So every doctor must learn to imagine himself/ herself in the patients’ condition, and genuinely solve their problem the best they can. There also is a growing tendency to think oneself “superior” to patient or other professionals. No one talks comfortably with the “high handed”. Indeed there are many patients/ relatives more intelligent than the treating doctor, the respect for a doctor is only for his/her medical prowess and kindness.

The first hint of “trying to show off more than what you know” switches off the patient. This tendency is also increasing among some doctors, who transgress their specialty and adversely talk about other specialists or professions. Even the illiterate patients understand (may not express) your overall nature in a few minutes. One must be very polite, humble and genuinely interested and helpful to every patient to be able to connect. In many cases half the agony is the fear of the medical situation. Every doctor does not have time, but those who spend more time per patient hit it well with the patient.

Hope that answers your question. Also, I have always kept a diary. I spent my internship in quite rural and backward areas, the faith in a doctor was still young, and I loved to talk to the “patient”, so time was not an issue. Like most young doctors, I was (and am) never fond of sleep. I had another advantage: I have been a loner.

I know you are (in fact everyone is) gifted by God / Nature a golden heart with a divine song. It is up to us how to use it. The practice of Good Medicine is almost as difficult as a spiritual life: many sacrifices are required. But one should not expect the patient to “Pay Up” or bear the brunt of our sacrifices. It is a choice we have made.

Take care and use the one chance of touching every heart you meet wisely, with immense passion, forgiveness and love. The returns will not be material, but I am sure you don’t care for material gains because you asked this question.

There is no “Extra Mile” for a good doctor. Whatever Good can be done, must be done.

God bless!

© Dr. Rajas Deshpande

Reply to a question asked by Dr. Arvind Arora, Intern, India.