Tag Archives: Healthcare

Illegal Heroes

Illegal Heroes

© Dr. Rajas Deshpande

“I was at the disco last night. We danced a lot, I exceeded my ususal capacity of 180 ml alcohol, and had two or three large pegs extra. I must have smoked a little extra too yesterday, I was too stressed”’ said the 30 year old man, who was admitted one afternoon in an unconscious state. He had had a fit in the office that morning. The MRI had shown a large bleeding / haemorrhage in his brain. This illness, cerebral venous thrombosis, is quite common among those who are dehydrated, those who have untreated sinus infections, and among those who take contraceptive pills. If not treated in time, it can quickly cause brain swelling that may lead to disability or death.

Over next three days he gradually improved. Brain swelling started to recede, and he asked for a discharge. Faster and to-the-point care had improved his condition, thanks to modern healthcare. A psychiatrist had already counselled him about deaddiction. When we sent his file for discharge, his mediclaim insurance was declined because this illness was related to alcohol consumption. Immediately, his tone became bitter, his colleagues dissected the case papers asking for justification of each test, each medicine, and also why he was even hospitalised. Gratefulness is often waived off by doctors as a lost quality among saved patients, but it is difficult to tolerate arrogant distrust. We firmly explained him what was done and why.

“We will pay your bills, we will claim the insurance later, but you must change your notes, remove alcohol and smoking from his papers” said the patient’s brother.

“We cannot change the case notes, it is illegal. Also, we have already sent copies to the insurance company, a standard procedure. You are not obliging us by paying the bills, we have provided healthcare service that saved your brother, who was about to die due to alcohol consumption” we replied.

Within an hour, a local politician, an elected member, who came in his Range Rover with his personal armed bodyguards and human doggies, started his anti-medical show that had drama, emotion, tragedy, threats of violence and revenge and everything else but truth and honesty. He spoiled the day for everyone involved, caused disruption of hospital work for over six hours, and left with a threat of “burning down the hospital soon”. When our PRO asked him whether he wants to pay the bills of this patient to help them, his reaction was the hallmark of a true politician: change of topic to how the medical profession has lost its reputation.

Almost every doctor, every hospital in India is being threatened and pressurised by our own lawmakers at almost all levels into changing facts, writing false details, extorting concessions for the rich and poor both, only to increase their own vote banks at the cost of the healthcare industry. Most politicians, many government officers instead of financially helping the patient, ask the hospital to treat free or cut off bills.

How legal is this authority? If a politician writes to a court or lawyer or hotel or an Airline to waive off fees/ bills of a poor person, will they ever? Why are the doctor’s services and hospitals taken for granted here? How sad that such illegal means make pseudo-Heroes in our country!

Everytime the politicos pressurise a doctor or a hospital to treat their paying cronies free or concessional, some other truly deserving patient suffers because hospitals, small or big, can only do a certain level of charity. How fair is it to deny healthcare to the deserving poor just because they cannot flex a political muscle? This phenomenon is ruining the whole purpose and concept of charity healthcare measures all over India.

Aren’t these elected members responsible for the disgusting state of the civil and government hospitals and healthcare all over India? That is their domain of authority. This is like messing up one’s own home and family and requesting the one with a better home and family to pay and comply for one’s own needs. How shameful is it for the elected members of different parties to have to send people, especially the poor, to the private hospitals, because their own set-ups are failing perpetually? Empty posts, inadequate staff, poorest funding, non-availability of quality technology and medicines and red tapism have created massive monuments of the healthcare failures of different lawmakers all over India, and these are the very people who come threatening to the hospitals of burning them down! Hear this, any Milord?

If the honourable Prime Minister and Health Minister invite feedback from every patient leaving every civil and government hospital, the gravity of this situation will be understood better. Many repairs “at home” are required before “the neighbours home” is raided. We as doctors and hospitals must together request these authorities and offices to protect us from such daily insults, extortions and exploitation.

The very next day, an old man, a retired Indian Military officer, was expressing himself in the OPD with tears in his eyes: “Ye desh ka kuchh nahi honewala (This country cannot progress). People here, at all levels, want corruption, legal escapes to save money, and will elect anyone who throws them petty bits. Votes are bought for such favours as alcohol, gifts and cash. Sycophants rule, criminals are seen hand in hand with some rulers. Who do you think will get elected with such means, saints? You can guess what progress we expect if the lawmakers are first in line to break laws..”

There was nothing more sinister I heard that day. I am worried about the healthcare in my beloved country. God save the future generations from such illegal heroes!

© Dr. Rajas Deshpande

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The Greater Squint

The Greater Squint

© Dr. Rajas Deshpande

“Why didn’t the doctor tell us? Is it allowed for the doctors to hide such information? I will sue him” the angry mother kept shouting as she cried. Her husband told her to calm down.

“I know the other doctor well, I will talk with him today. He must have his reasons” I replied.

“No doctor, we don’t want you to talk to him about this” said the father.

Their fifteen year old brilliant daughter had developed mild headache and occasional giddiness. They had first read blogs about these symptoms, and after trying out various “natural” remedies and lifestyle changes, visited their family physician. He had started with the routine medicines for headache, and advised them to visit a specialist if the symptoms persisted for a week. As the headache didn’t subside, they visited a specialist. His notes indicated a normal neurological examination, and some higher medicines for headaches and giddiness. After a week, the girl developed a squint, double vision and slurred speech suddenly, and was unable to walk. She was brought to our emergency, her MRI of the brain showed multiple sites of infection including the lower part of the brain. Although most infections are treatable, those in the lower part of the brain (called brainstem) are extremely dangerous, and can cause even coma or death. This part has all the vital centers of the body, controlling heart rate, blood pressure and respiration. © Dr. Rajas Deshpande

When I explained this and advised admission for further treatment, they had panicked. That is when the mother had lashed out at the earlier doctors.

After admitting the child, the father came back.

“Doctor, I must make a confession. My wife is quite anxious, and she was crying when we saw the last doctor. That’s why the doctor didn’t tell her everything, but asked her to wait outside and informed me that there were such dangerous possibilities as cancer, tumor or infection, and that an MRI was necessary. I requested him not to write that on paper, thinking that my wife will panic. She is very emotional. That’s why we waited for a few days, thinking that things will improve. Please understand us, doctor”. I reassured him, and treatment was started.

The inflow of blatant allegations against allopaths/ modern medical practitioners is now so wide and strong, that this has sensitized some of the best doctors. Some have started to entirely avoid mentioning the tests required for a complete evaluation of a condition, knowing that if the doctor advises any tests, the only interpretation in our society is that those are for earning more money.

“Patients themselves do so many tests and take so many medicines without consulting a doctor. But if we advises any tests, the immediate allegation is that we want to earn more money. That affects our practice. So shall we still advise tests?” asked a colleague during a recent seminar. © Dr. Rajas Deshpande

The answer is a definite, loud yes. The duty of a doctor, besides being well qualified, skillful and compassionate, is also to boldly state fact and possibilities, advise the best investigations and treatments to every patient, poor or rich, VIP or AAP, and write these all on the patient’s case paper. The workup / investigations advised should be according to the global best practice guidelines. Poverty and illiteracy are neither the faults or responsibilities of a doctor, and like other professionals or even some governments, a doctor cannot provide “low grade” service to any poor patient. From the eyes of a doctor, even a penniless beggar should get the same advice about tests, medicines and surgery that the Prime Minister of the land gets. If ministers can go to corporate hospitals or even abroad for treatment, every citizen should also be sponsored for the same benefits by the same administration through the same funds, without preaching the doctors to do more “charity”. Otherwise we are a hypocritical society. © Dr. Rajas Deshpande

Whether to do those tests or not, where to do them is the patient’s choice. Whether to take the advised medicines is also upto the patient. The doctor may suggest the best place, request concessions, and if the patient is poor, suggest options to get financial help or refer to charity. But the quality of medical advice should never change. The only exception is an accusative, angry patient who is making paranoid efforts to find faults with everything that you do. One may politely decline to accept such a patient.

If the treating doctor has not advised all the tests necessary for the evaluation of relevant diagnostic possibilities, he/ she may be found guilty of negligence. To avoid advising tests just to please the patient would also be a moral crime. One must also refrain from crossing over to other specialties and advising tests before referral to the right specialist. Some “pretending to know everything from every specialty”, doctors advise various tests incorrectly, and even attempt treatments out of their expertise without a working diagnosis. . Such dangerous doctors may add to the woes and defamation of the profession. © Dr. Rajas Deshpande

The girl above is improving, although her balance is off, and she has developed t a squint. Most likely her squint will never improve. She is missing school for over three months now. She will now onwards live a compromised life: incomplete education, compromised marriage and the condescending Indian society where shame of physical disability like squints and lisps, slurring and imbalance are the essential components of most enjoyed comedies.

However, her squint is far lesser a problem than the one that our society has, against doctors.

© Dr. Rajas Deshpande

PS: Many people comment often that “Doctors should introspect”. I do not know how many of these people introspect about their own habit of finding faults with others before self. But the article above is an honest attempt to do so.

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The Duty And The Reward

The Duty And The Reward

Highly educated and informed, Mrs. Vinodini Bapat came with a worried face about a year ago. Her MRI had shown a tumour. When I told her that it was likely a large Tuberculoma (A tumor mass caused by tuberculosis of the brain), she was naturally very worried. There was no definite way to know if it was a cancer.

After a long discussion based upon what she researched herself, helped by her loving husband and daughter, she was convinced that we can take a chance and start anti-tuberculosis medicines.

I was quite pleasantly surprised when I found that the whole family had completely trusted everything I had explained. To be very honest, doctors expect disbelief and multiple opinions mostly with the well educated and literate patients. However, although they asked many questions, tried and understood every step in the treatment, they were extremely polite and cooperative.

The test time came when her brain swelling increased, as happens with some Tb patients in the first few weeks if starting the treatment, and she threw a mini-fit. We had to admit her and treat as an emergency. Many questions popped up, but the family was as cooperative as ever, with complete trust.

The medicines caused many side effects, and we adjusted the doses to suit the patient best. She was extremely patient and tolerant in spite of so many ups and downs.

Now, one year later, Mrs. Bapat followed up today with her fresh MRI scan: the brain was now completely normal, there was no trace of tuberculosis. The tumor had disappeared!

When she handed over this beautiful note written for me, I told her that she and her husband were extremely cooperative and I was grateful for that.

Then they told me what I Wish every medical student learns: that it is important not to get annoyed with patient’s questions so long as they are relevant, to understand that it is the patient’s desire and right to know the details of their illness, treatment options and side effects, to participate in decision making, and above all, to be treated respectfully with compassion.

Educated patients who keep their faith in their doctors intact, and ask relevant questions without paranoid accusations should not be misunderstood. It is the duty of a treating doctor to honestly keep all the cards on the table and let the patient understand and participate whenever possible.

Once again my day is blessed with the ultimate rewards in medicine: a happy patient and words of gratitude.

©️Dr. Rajas Deshpande

Humanity Face / Off

Humanity Face / Off

© Dr. Rajas Deshpande

“Your father in ICU has probably had bleeding in the brain. We need an urgent CT scan” I told the son waiting outside. The old man was admitted late in the evening, although he had had severe headache and weakness on one side since that morning. His son had just returned after a “one-hour” quick meal. Besides flaunting many brands upon his person, he had already told me that he was the vice president of a well known software company.

“Yes, doctor, I am just waiting for the approval from his insurance company.” The son replied. For doctors running in and out of critical care units, the “Cool Calm” of such educated relatives is beyond understanding. Most insurance companies work office hours, approvals come at their own speed, they are least concerned about the patient outcome.

Everything was being kept on hold. Hospitals do not want to proceed with costly tests and investigations unless they are life saving, because most relatives flatly refuse to pay if the insurance company denies approval. The doctor suffers a double blow emotionally: because things are delayed and also because relatives blame only the doctor.

“This is urgent. Please consider making the payments and filing for reimbursement later, so we can make decisions faster” I told him.

“If it is urgent, why don’t you get it done? I will not pay, his insurance company will have to approve” said the son.

I thought about the patient. In the waiting room, the patient’s wife, an old lady, kept praying. I wished she was also praying for a better son. © Dr. Rajas Deshpande. I requested the hospital authorities, and as always, they agreed to help. A CT scan was done, it did show bleeding in the old man’s brain. When informed, the son winced. “How many more days in the hospital?” he asked.

“Usually it takes a week for such patients to stabilize” we told him.

“Can you discharge him? I will arrange for some nurse to give him treatment at home. Just write the medicines he needs” he said. His mother, hesitant, asked “Is it necessary to treat here, doctor? If his health is in danger, we will stay”.

Angrily, the son cut off his mom. “No, mom, this has become a business. They will extend stay even if it is not necessary. If it is only medicines, why does he need to be in hospital?” he asked me.

“Because such patients often develop excess swelling in the brain, or other complications. They can also develop convulsions or lapse into a coma if swelling worsens” I unchained my patience.

“Do you guarantee that those complications will not happen if we keep him here?” he asked.

“No. Only that he can be managed in time, if any complication develops” I replied. There’s no word called “Guarantee” in the medical dictionary. It is only a quack’s favorite trick. © Dr. Rajas Deshpande

“Then why stay here? I have a nursing home nearby, we will go there if there is any problem” the son said, turning his back upon his mother.

The open-secret was revealed soon: the insurance cover that he had bought for his father was minimal, it was over now, and he didn’t want to pay anything from the pocket.

I explained the patient’s wife about the medicines and care, updated her with the warning signs of danger in such cases. © Dr. Rajas Deshpande

“Doc, I am alone at home with my husband all day. My son and daughter in law both work and return late. What will I do in case there is an emergency?” I gave her some contacts near her home, ambulance numbers and doctors.

“Is it okay if she calls you daily to inform the patient’s condition and ask what medicines are to be given in case of an emergency?” the son asked.

“Sorry, we cannot manage patients on phone” I replied.

“Sorry doc, don’t take this personally, but there’s no humanity left in this profession now a days. No one wants to help even an old patient” he commented. I didn’t reply.

They returned in three days, the patient comatose. The brain swelling had increased to dangerous levels. Patient was operated in emergency, saved with a great effort. The son had to foot the whole bill this time. “This is quite unfortunate” he kept saying, reminding me to keep expenses “lowest” because he was paying from his pocket. Finally came the day of discharge. Knowing the questions, I explained them the medicines on discharge.

“Doc, he is a senior citizen. You must give us discounts” said the son.

“Sorry, the hospital decides the billing. My charges are already minimal”. I told him the truth.

“Just as I said, there’s no humanity left” he looked at his mother and said. It was now the time to chain my patience. I knew the right reply this time.

“Yes, Sir”, I said “ I agree. Humanity is indeed on a decline, but more in your family than in my profession”

© Dr. Rajas Deshpande

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The Goddess Of Humanity

The Goddess Of Humanity

© Dr. Rajas Deshpande

When I entered the hospital today, little did I know that I would meet someone who changes lives by example.

Then I met Mrs. Jasmine Govindji Majethia. A lady far superior than most men I ever met, a spirit with an energy to defeat ten ripped-jeans-teenagers, a soul that can only belong to a saint in any religion!

At the age of 80, Mrs. Jasmine Majethia is working 24/7, traveling alone all over India to help patients with Thalassemia get treatment in time, to generate awareness among people and even medical community. She has been doing this for over 30 years now. © Dr. Rajas Deshpande

This morning I had received a call: “Hi. I am sending an old lady to your OPD. She has done a lot for the society. She has had some episodes of unconsciousness recently” said our Pathology chief Dr. Mrs. Nita Munshi, always out to help others full throttle.

Mrs. Majethia told me that her tremors were long standing, but recently she had had some episodes of unconsciousness. It had all started after a stressful event related to one of her Thalassemia kids.

“I cannot sit at home. I have so much to do. Tell me what tests are required, tell me what medicine I should take, but I want to continue my work” the lady had an authority difficult to match. I followed her orders.

Born and raised in Calcutta, married in Mumbai, she finished her family duties and joined the LTM Medical College Sion to work as a liaison officer with Dr. Lokeshwar, who invoked her interest in Thalassemia. Witnessing the plight of children with Thalassemia and their parents, she decided to make it the mission of her life to stand up for them. She established PATUT (Parents Association Thalassemic Unit Trust) to help the affected families with financial and other support for treatments. This Goddess of humanity has thus saved many a lives, roping in doctors, hospitals, trusts, friends, rich and poor donors to help this cause.

“Zero Thalassemia Birth Rate in India by 2020 is the mission of my life. I am not ashamed of knocking doors and asking for help because it is not for myself.” said the lady with a steel resolve. © Dr. Rajas Deshpande

“There’s hardly anyone who can resist helping her cause. She is like a gentle pinch of conscience for those who have excess, to help others” said Dr. Munshi.

Thalassemia affects over 40 million people in India and kills thousands every year, it can easily be prevented with simple precautions. Even countries far backward than India have rules that make Thalassemia screening legally mandatory before / during pregnancy, and thus prevent any child births with this condition (“Zero Thal Birth Rate”). However, lack of awareness and screening, apathy on the part of our governments has continued to increase the burden of this disease in India. The treatment is extremely costly in some cases, and out of reach for most common Indians.

Mrs. Majethia spoke with the passion of a revolutionary: “So many doctors all over the country, like your colleagues Dr. Vijay Ramanan, Dr. Nita Munshi and Mrs. Trupti Thanekar always help me in my cause, whenever I request help. But the sad part is that there is almost no health awareness in our country. Even if we offer free treatment, many parents do not avail of it until it is too late and the case gets complicated.”

“Yet I like to think that God has given me in excess than what I need. Even Life. It is my duty to give some of it to those who are unlucky. I tell myself that God has selected me to do this work, because I can.” Such simple words, yet so powerful in their meaning! I really wish that she must receive best of the National Honours and medals for her work.

Every now and then, some insurance agent gives me plans to retire early and still earn well. Some tell me how people make retirement plans by age 40. Until now, I didn’t find exact words to tell them that many of us do not want to retire, that I wanted to work till my last breath. This lady was the answer, the literal personification of the words I AM MY WORK.

Across the cultures, there are Gods and Goddesses of Beauty, Fame, Love, Sport and Affluence. Rarely do we hear of a God of Work or Goddess of Humanity. In Mrs. Jasmine Majethia, I found the Working Goddess of Humanity.

My highest respect to this lady, one of the most inspiring women I ever met!

PS: She agreed to record a short message for everyone including doctors, please click this link in my comment below this article to listen to her divine voice.

© Dr. Rajas Deshpande

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To pause for respect

To pause for respect

To pause for respect

© Dr Rajas Deshpande

After completing the neurological examination, I asked Mr Harkishan Budhrani to sit down and put his shoes on. His son accompanying him got up, sat near his father’s feet and started to adjust his father’s shoes for comfort.

To pause for respect was my only choice.

Mr Harkishan Budhrani is a British citizen, and so are his sons Mr Naresh and Mr Raj. Every time one of them accompanies Mr. Budhrani for the consultation. They not only come prepared with their father’s health details, but also take notes and follow all the suggestions. Yet what is most noticeable for me as a doctor is the care and respect with which they speak to their father and treat him. There’s nothing artificial about their attitude, which makes it special! They take his permission for every change we agree to make, explain him and patiently wait for his consent and questions. They hold his hand and even ask him whether it is ok to walk ahead! Rarely do we see children from very affluent families being so careful and loving to their parents.

In an era where many a times sons and daughters accompanying their parents either bluntly ask “How long is the parent going to survive, What basic minimum can be done without much expenditure, Is it okay not to treat at all” etc., when we come across such extremely gratifying moments, I feel that all is not lost. By experience now I don’t think that this belongs specifically to Indian culture, in fact people from most cultures in the world treat their parents far better than many Indians. The very fact that Our govt and courts have to make laws and take steps for abandoned and neglected parents speaks a lot about what is happening. In fact, the more affluent a family is, the less likely that the children genuinely care for their parents.

Taking for granted that the parents do not want to live longer, deciding on their behalf that expensive treatments are useless and unwanted, oversimplifying all complaints as ‘age related’ and completely neglecting medical care are common observations in our practice.

This moment therefore brought me a beautiful ray of hope.

21st July 2018 is Mr. Harkishan Budhrani’s 85th Birthday. While I pray for his excellent health and perpetual happiness, I wish that every parent is as fortunate as him and that Mr Budhrani lives on many more hundred years as an example for all of us.

©️ Dr. Rajas Deshpande

Victim? Dr. Reena’s story

Victim? Dr. Reena’s story

© Dr. Rajas Deshpande

“I am being victimised, Sir! I have tried to do my best, but my senior has developed some prejudice against me and has started to find faults with everything I do. I don’t know, I feel suicidal sometimes” the resident doctor Reena said, breaking down. She was into medicine, one of the toughest branches for post graduation.

This was a difficult situation. It is very well known that some seniors and teachers do take advantage of the situation to mistreat and misuse their students or subordinates. It is also well known that both men and women in every profession, including medicine, have strong gender biases and favouritism. Sycophancy is so essential in India, that I wonder sometimes whether an official bachelors / masters “Chamchagiri” (sycophancy) certificate will be necessary before people are selected for their jobs.

I gave her some instructions to ignore words and minor incidences, and concentrate on doing her official duties with concentration. I also counselled her about how to handle egoistic, arrogant seniors. She was supposed to follow up next week.

That weekend, I met a colleague of mine, Dr. Anand, in the coffee shop. There was no OPD, it being a Sunday. We sipped coffee in the canteen, telling each other funny stuff about other colleagues. Medicine provides great entertainment too, in the form of various types of doctors, and we start with ourselves usually. © Dr. Rajas Deshpande

Just then, another doctor came in, Dr. Anand invited him to join us and introduced me to him as Dr. Ashwin. “Ashwin was my junior resident” said Dr. Anand, “and one of the most brilliant students. He’s a wiz. He wanted to work for the downtrodden, so he has continued to work at the govt. hospital after his MD. Most dedicated! That’s why most girls around us liked him and we all envied him”. It is rare for Anand to praise someone this much, I was quite impressed and happy.

But Dr. Ashwin appeared quite disturbed. Dr. Anand asked him if he was ok.

“No, yaar. I am facing a big problem. There’s this girl in my unit, who has made my life hell. She has filed complaints against me to the dean, my name is all mud”.

“Complain against you?” said Dr. Anand, truly surprised “Even your wife never complains against you”. He was trying to lighten up the mood. © Dr. Rajas Deshpande

“Yes. But you know how heavy our PG duties are. This girl, besides being lousy and careless, refuses to finish her work, constantly looks at the watch and doesn’t want to be corrected. How can we tolerate carelessness in medicine? There are patients in the ICU and this lady keeps busy with her cellphone! I gave her a warning that I will complain, but instead, she went ahead and complained that I was harassing her, implying serious charges. Fortunately my wife and the dean understand the situation, but you know some people in the campus would rather see me down. I don’t know what to do. I am thinking of resigning”.

“Can you share her name?” I asked, cautiously. The guess was correct. It indeed was Dr. Reena.

“I tried to talk to her, I requested her to call her parents. Apparently she has grown up as a pampered child, her parents refuse to even think that she can be wrong. They started complaining that their daughter didn’t get enough rest and good food, that she has always been a super genius kid and how many a times even her teachers could not understand her genius”.

Now the picture was clear, with the other side of the story revealed.

There indeed is, nowadays, a rampant tendency to play a victim, especially to cover up for one’s own failures, inadequacies and lethargy. Children who allege that their failures are either because of their parents being over disciplined or completely negligent, boys who hate their parents and refuse accepting that they fell short of hard work and dedication because of too many diversions, girls who sometimes lie about “sexual abuse”, and employees who underperform only to blame it upon a racist / pervert / prejudiced boss are classical examples when stress factors are analysed well. There was one girl who alleged abuse by her step father, just to tell me minutes later that it was probably her imagination, and that she didn’t know if it was a dream! It was her mother who then revealed that the girl had always used that ‘dream reality’ sequence whenever she wanted something and was refused. © Dr. Rajas Deshpande

There indeed is rampant true victimisation in all these areas, and one must always stand by the victim. But the overflow of sympathy that drowns sense and reasoning (thank you, media and some movies!) must always be avoided. Differentiating ‘true’ and ‘pseudo’ victims is never easy especially because there always will be the social biases. Most Indian men unfortunately truly look down upon women, most seniors think that juniors cannot be more intelligent, parents often mentally overpower logic when dealing with kids etc.. Still there indeed are many who hide behind the “victim” tag, just to take advantage of the sympathy and protection it offers, using it to hide their own negative side. A lot of people use suicide threats, false complaints and other pressure tactics to emotionally exploit and threaten others. When this happens in a workplace, it poisons the whole atmosphere. There is indeed no protection for the true victims here.

Next time when Dr. Reena came to visit, I told her how I chanced upon the doctor who was “troubling” her. As expected, she cried and defended her stance, but after some gentle coaxing, when I reiterated that the actual problem must be dealt with, she agreed to have a meeting with Dr. Ashwin. I called in a female counsellor too, and in a few meetings, we could sort out the issue.

Medical career is, difficult, it is important to do every single thing perfectly and with utmost care and concentration. No one else can ever replace the life-saving responsibility of a doctor on duty. A doctor who isn’t fully attentive to everything about every patient can be dangerous.

Dr. Reena agreed to go by the duties allotted and improve her performance, while Dr. Ashwin reassured her that he had nothing personal against her, that she could always compare her duties and performance with her other batchmates. He also told her that now onwards he will mind his words better. She withdrew the complaint.

Dedicated to those such who have had this horrible experience.

© Dr. Rajas Deshpande

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A Habit That Protected Me

A Habit That Protected Me

(c) Dr. Rajas Deshpande

“I cannot bear this. Help me doctor”shouted the Old man fom the waiting room, just as I entered the OPD. There were appointments before him, I requested others to wait, and most of them agreed, although a little upset. I called in the old man. He was accompanied by two of his sons, both probably professional bodybuilders.

He was a known case of Trigeminal Neuralgia, a condition that causes severe, shock like or stabbing, excruciating pangs of pain on one side of the face. This usually brings the patients to tears, and most patients come frustrated, unable to talk or eat, with the telltale sign of their hand covering that side of the face, scared to open mouth even to reply. He had had this condition over ten years now, and was quite stable, usually visiting me once a year. He had last visited only a few weeks ago, smiling and pain free. There were no new findings. He kept on shouting, saying that the pain was unbearable. This was unusual. I asked him if he had done any of the prohibited things that usually increase the pain of Neuralgia: cold drinks, icecream, shaving harshly, exposure to breezes etc. He said he had had an icecream a few days ago, but the pain had only restarted yesterday.

The sons were staring menacingly at me. “How come this has suddenly worsened doc? Is this the effect of your medicines?” one asked. I wondered why they don’t teach simple logic and reasoning in primary schools. Everyone going to a gym must, in my opinion, first be mandatorily taught normal human conversation. Otherwise they speak with their biceps. Not knowing that language, I chose not to reply him. (c) Dr. Rajas Deshpande

He was already on high doses of the medicines that controlled his pain. He also had diabetes, so I could not use the best emergency medicine for such pain: steroids. Once earlier, he had developed severe infection while on steroid, so that was out of question.

I started him on a short course of a strong pain killer. Warning him that he should take it only for three days. “His pain must stop immediately” said the other son, threateningly. “I wish so too. It should subside soon, usually it takes two to five days” I concluded the consultation.

They returned five days later. (c) Dr. Rajas Deshpande

“I am very good now, Doctor”said the old man, “The pain went away the very next day. Thank You”.

Just as I prepared to look at the musclebuckets proudly, the old man said “Doctor I need a certificate that you had advised me bedrest for five days”.

I was almost prepared to write, this appeared a justified request given what had transpired. Curious, I asked him: “But you have your own business. Why do you need this certificate?”

It was then that one of the biceps spoke: “He had a court appearacne in a criminal case on the next day of our visiting you. He could not go to the court. Now the court has asked for a certificate”.

Alarmed, I told them: “I had not advised him rest. I cannot issue a false certificate.” (c) Dr. Rajas Deshpande

They looked at each other. Then the old man said “I request you doctor. My cousin has filed a false murder charge against me and my sons. Please help us. Your certificate will save us trouble”he folded his hands.

Now the secret of why that pain had worsened suddenly had unfolded. This condition is indeed known to suddenly worsen, but when such “situations”coincide with illnesses, a doctor is the easiest to squeeze the arm of.

“But we paid your fees. His pain was actually severe that day. How can you deny us a certificate now?”asked the elder biceps.

Many video clips of daylight, open murders that happen around us daily ran through my mind. Even under the heading of compassion, was it right to help this patient, who was one of the accused? As a doctor, I am not to judge anyone and must purely decide based upon the medical merits of this case.

I had not advised him rest. I declined their request for the certificate. Angrily, the trio left my room, and on the way out, in the waiting room, loudly enough for other patients to listen, the old man said something derogatory about all doctors being heartless looters. Every new patient who walked in that day had a question mark of suspicion on their face, it took me extra effort to wipe that away in each case. (c) Dr. Rajas Deshpande

Whether it is addiction to pain killers or sleep medicine, whether it is false certificates or deceiving the medical insurance companies for claims, many patients abuse their doctors’ compassion and services. Some doctors fall easy prey to such tactics, some do it for money. Majority refuse to contribute. It is this majority that such “demanding”patients always cry against.

The doctors who help such people with such causes not only endanger themselves, but may in fact add disgrace to their profession, because it is these same patients who tell others how any doctor can be fooled, or bought with some money or threat.

As fate would have it, one of the sons came to visit me the very next month, for his wife. As I examined her and then wrote a prescription for her, I enquired about his father.

“Oh he is alright now. We got a certificate from one of our relative who’s a doctor” said the son, smiling shyly: “That’s why I brought my wife to you.. I know you will do only the right thing”.

I could only thank my teachers who had tattooed that habit upon me, and taught me that only good begets good. It is a habit that has protected me always.

(c) Dr. Rajas Deshpande

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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

ICU Seventeen

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ICU Seventeen
© Dr. Rajas Deshpande
 
11 PM. Just as I finished my OPD I received a call from the ICU resident doctor: “Sir, you have a call from ICU seventeen”. I was tired and exhausted, feeling feverish that day. I was not on call, so could request them to send this call to another neurologist who was on call.
But it was ICU seventeen. I hated going to that cabin, my legs dragged heavy, my mind exploded, but I had to. © Dr. Rajas Deshpande
 
I went there, assessed the middle aged lady on the bed. She was already on a ventilator, had been unconscious since after a head injury. She had been knocked down by a speeding drunkard while crossing the road. This was day two. Examining her, I found feeble signs that indicated that her brain was not dead. . CT scan showed many injuries to the brain. I told her relatives –the husband and the son- about this, and also explained them the uncertainty and unpredictability of outcome.
“Shall we continue the treatment or let go? We are not rich, we can try only if there are good chances of her survival” said the husband and son. The husband was visibly fatigued with the situation, the son was talking to me without looking up from his iPad.
 
“Although the outcome is unpredictable, in my opinion, you must continue to try. This is not yet a hopeless case”. © Dr. Rajas Deshpande
As expected, they were unhappy.
They wanted quick answers that would either guarantee a good outcome or enable them to bank upon a doctor’s decision to withdraw life support which would make them guilt free. I did not want to hurry a decision for their convenience. My first duty was to protect the patient’s life, not to cater to anyone else’s expectations. A doctor who does not respect life in all its depth has no right to be a doctor. Especially in case of an unconscious patient, a doctor’s responsibility peaks, and sometimes he/she has to even struggle to convince the family to continue treatment. Notions like “dead patient kept on ventilator in ICU” created and catered by some stupids add to this situation. ICU expenses are indeed high. In such a scenario, any doctor who advises to continue treatment in a hope of saving life is indeed suspected to have “financial” motives.
But even that fear was below my duty to the patient. I told them that in my opinion they should not withdraw life support. I told them to continue to try.
 
“Doctor, what would you have done if your mother was in her place?” asked the son, looking up with a cunning expression from his iPad.
The explosions in my mind restarted. © Dr. Rajas Deshpande
In this same ICU seventeen, just a few weeks ago, I had witnessed my mother’s death. For three days and nights, my own colleagues had fought to tackle the umpteen complications that took away my dearest, and I stood at the door, telling them: do whatever you must, try your best, but save her. In her earlier life, mom had always wanted to live, live longer, and be with her family every moment at any cost. There was no reason for me to presume she did not want to survive. From Geeta to Bible, ever sacred book has advised “Do unto others as you would have them do unto you”. Medicine or law aren’t yet wiser than that.
I am a middle class doctor myself, not rich. I could not afford prolonged treatment. But I was willing to even sell myself if it was required to make my mother survive, even for a day more. She would have done the same for me, even more. There is no age and illness when a mother would want her child to die, and as her dearest son, it was upon me to become her mother when she grew old.
 
One cruel night took her away. I will never overcome that feeling of standing in the door of ICU seventeen, with the resident doctor and nurse, both crying too, tried to wrestle out my mom from the claws of death. That cabin, that door, that corridor brings back those moments. I cannot show that upon my face, I am a doctor. I work at the same hospital, see these places almost every day, and carry on what I must. © Dr. Rajas Deshpande
 
I paused to contain the agitations in my mind, then replied.
‘Yes, Sir” I told the son of the iPad: “I am suggesting you exactly what I would have done for my mother”. Still trustless, he continued fingering his iPad. His father sat clutching his head. They continued the treatment, but bitterly.
A week later, she opened eyes. In ten days, I received a call again “Sir, can we shift that lady out of ICU seventeen? She is fine now, conscious and oriented, accepting orally” the resident doctor asked.
 
“Yes please”, I replied, not without a tear. We couldn’t get my mother back, I will never recover from that memory, but we had defeated death in the same room! © Dr. Rajas Deshpande
Every doctor has had such experience: illness, death and extremely disturbing memories associated with it. They still have to keep their calm and continue to try for their patients what they could not achieve for their dearest ones. It is mostly taken for granted: that doctors have no feelings, that it is so routine for them to see pain and death that they are not affected by these anymore.
 
It takes a grand courage: that of a brave soldier, to be able to walk again in the corridors of death that have taken away one’s dearest people. The same diseases, illnesses, problems affect doctors and their families too, we fight them, we win or lose, but we come back to the battleground again, every day, to protect every single life we can.
Therein lies the pride of saying “ I am a doctor”.
© Dr. Rajas Deshpande
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