Stop This Anesthesia
© Dr. Rajas Deshpande
“Why so Doctor? Why cannot my child be like others?” asked the angry mother.
Just as I started to reply her, the patient: a 23 year old boy, went into a flurry of jerks. His body stiffened up, his eyes rolled up, and his face turned blue. He was already on the examination bed. Me and my student tried to support him there. We activated the code blue, just in case.
But the fit stopped. The boy came to, gradually. The nurse cleaned the bloody froth from his mouth. Heart rate and BP were normal now. Patient remained confused.
The mother, silently sobbing while patting his head, showed me the many large scars upon his face, head, and elsewhere. “He falls down many times every day and often injures himself. Can you imagine, doctor, what a mother’s heart feels to see her child bleeding every day?” © Dr. Rajas Deshpande
It was a case of hypoxic brain damage. The child was born in a village, the labour was prolonged and they could not reach a bigger hospital in time. If they had facilities, the child would have been normal today. Since birth, the child had had mild mental retardation and convulsions resistant to many medicines, They refused a surgery. I tried to counsel them. In many cases, we can control fits with a good combination of different medicines. But that takes time over a few months.
“We are farmers, doctor. We cannot stay home all day, we need to work to earn. The medicines are all so costly. I can sell everything to treat my son. But please tell me this will stop” the father’s voice was quivering.
It is easy to expect a doctor to detach himself emotionally from the patient, but then it is also like denying the patient empathy and understanding so crucial to their wellbeing.
“I will try my best, and I feel we can control the fits with medicines. Also, I can arrange for free medicines for your son whenever you cannot buy them. Never worry about my fees, I will be happy to treat him free. But make sure that his doses are never missed.” My teachers spoke through me.
“What after my death? Who will care for him? Who will bring him medicines? Who will ensure he takes them?” said the hefty man, and broke down. The proud feel it most difficult to declare their agonies. He tried to hide his face. The father and the mother sobbed on either side of the patient, who wasn’t yet alert enough to grasp it. © Dr. Rajas Deshpande
“There are some help communities and groups for epilepsy patients. We will enroll him into one. They will arrange for his medicines. I will also introduce you to some pharma companies who will give him free medicines as required”.
Then, pausing to realize the unasked question, I replied “And after me too, my students, colleagues or most doctors I know will never decline to treat him free. You just have to show them this note” .
I made a small note of such a request. I have never known any of my students or colleagues refuse to see a deserving patient free.
The tension in the room was melting. The parents had stopped sobbing. A possibility of hope and reassurance destroys the worst of darkness. The father folded his hands in gratitude, but couldn’t speak. The patient had a glass of water and they left.
But my mind was on fire again. Who’s guilty here?
Shall we blame fate for the blatant failures of a system? © Dr. Rajas Deshpande
Why didn’t their village have facilities to ensure good delivery? Why wasn’t it possible for them to reach bigger hospital in time? Who is responsible for millions of children who develop lifelong preventable illnesses just because of a cruel lack of healthcare infrastructure? Patients with heart attacks and strokes and cancers die everywhere everyday, unable to afford treatment or to reach hospitals in time.
In a country that needs serious improvement in almost every area of healthcare infrastructure, the whole focus is being directed at the repeated exams for doctor’s requalification.
Do we need it at all in a country that is grappling with critical shortage of doctors, and where we are promoting every other pathy to allopathy with a six month training? We need many care homes, support systems for patients who cannot afford medicines. Many more ambulances. Many more hospitals in remote areas, Many more qualified doctors to work there while being able to afford a dignified life.
But the only decisions being made are about more exams for truly qualified doctors: why? This tranquilizer to divert attention from the main issues that need correction is the worst treatment possible for Indian Healthcare. © Dr. Rajas Deshpande
Doctors are never defined by the examinations that they pass, being a doctor is far more than passing qualifying examinations. But who will educate those who never bothered to pass any dignified exams?
Just before inducing the anesthesia, the patient is told “You will feel sleepy now. Everything is ok. Take a deep breath”. With complete faith, the patient goes unconscious. It is the doctors who ensure he / she returns safe. Some rare unfortunate patients never know that they will never wake up, because there are things a doctor cannot control.
That unfortunate patient is just like the Indian Society today.
How qualified are the healthcare policy decision makers?
© Dr. Rajas Deshpande
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The Epic Struggle Against Epilepsy
(C) Dr. Rajas Deshpande
In a war-torn city, she kept on having fits almost every other day: convulsions and seizures of different types. 21 years old and home-bound, she had suffered with epilepsy since childhood. Dreams of a beautiful life that must adorn the life of a young woman were shattered due to a devastating and humiliating illness.
Her elder brother could not bear to see her suffer. He decided to take risks and enquired. Someone told him to take his sister to India for treatment. The airports in his country were destroyed or closed. All doors to India appeared locked.
Without any clues about future, he took her by sea to a nearby country Djibouti, a small African country. From there they traveled to Ethiopia. Then to Kenya. Finally they reached Mumbai and searched for the lone contact they hoped to meet: Mr. Abdul Aleem Alakeli, who works free to help patients. That was two months ago.
She reacted badly to two of the best medicines used for treating epilepsy, but their faith and determination were extraordinary. The brother and the sister had made a final decision: come whatever may, they wanted to defeat epilepsy.
Today as they left with complete control of seizures, I told the sister what she already knew: that she had an extraordinary brother. I congratulated her for her strong will power too.
Her brother was smiling after a long time, and her pride was obvious.
We wish her and her brother the most beautiful and healthiest life ahead. May God bless them and ensure their safety on the way and back home.
(C) Dr. Rajas Deshpande
The Bloody Negligence on Indian Roads
(c) Dr. Rajas Deshpande
There are over 5 million patients who suffer from epilepsy in India, @ 60% do not get correct treatment (various reasons). Over 4 million of these are adults. Indian law bans anyone with even one seizure from driving (lifelong). While one sympathises with the patients and all attempts must be made to treat and rehabilitate them, one cannot neglect the risk to life: their own and many others. So there are over 4 million potentially unfit / dangerous drivers in India on roads, many with heavy vehicles, some with driving as their profession. Only the aviation industry insists upon superficial screening for epilepsy. About notifying RTO by the doctor, given the illiterate + politically backed violent lawlessness of most Indian population, the doctor’s life is at risk in doing so. Most Neurologists / other specialists educate the patient about not driving after this diagnosis. Patients still continue to drive (and parents / relatives allow them to do so), with an excuse “How else will I work?’ and other illogical arguments. If we see the pattern of heavy vehicle accidents, many are in the early morning hours (lack of sleep may precipitate seizures), and are described as “sudden loss of driver’s control over the vehicle”.
Many other medical conditions are incompatible with driving, but the drivers carry on nevertheless.. Who is responsible for the thousands of these accidents and hundreds of deaths they cause? Is this not gross open negligence, with proof everyday?
(C) Dr. Rajas Deshpande