Tag Archives: HealthcareIndia

Yes: The Most Powerful Word.

©️Dr. Rajas Deshpande

Mohanad, child of a small time mechanic in Yemen, developed a devastating condition called “Transverse Myelitis” which causes sudden damage to the main connecting cable from brain to the rest of the body, called “Spinal Cord”. He not only lost all sensation, but was completely paralysed below the waist, his control over passing urine was also lost. That was seven months ago. He was told that his remaining life will be in a wheelchair. He wasn’t convinced.

His mechanic father and farmer brother decided to get help and travelled with him to India for his treatment. When he came, he could not feel anything below waist and had no movement at all.

One beautiful thing about being a child is that you don’t have inhibitions, fears or anxieties like adults. One can learn from children how to be optimistic beyond par. They have more “Yes” in their minds.

When I met him for the first time, I thought the child was a little upset with his own situation. To boost his morale I told him I was going to make every effort to make him walk again, but I needed his help.

He smiled.. “Yes, I want to walk. I will walk. I will run” he said.

He worked hard. Took medicine without complaining. Never cried. Did all that was planned for him.

Today after three months, he has started to gradually improve. Most of his recovery is natural, with some supplements and nerve strengthening medicines, and physiotherapy. He came in with a cute big smile to report this improvement today. He will travel back to his country next week. He knows there’s a long long way to go before realising his dreams, but that’s the beauty of dreams: when they come true, they make you proud of yourself that you overcame all that stood between you and your dreams.

Mohanad deserves a big applause for his grit and courage. I pray that he always smiles this beautiful smile all his life! I have become a fan of his “Yes I can!”.

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The Euthanasia Named NMC

© Dr. Rajas Deshpande

Sweet Poison, Gorgeous Vamp, Philanthropist Criminal or NMC. All of these have one thing in common: the taste, the appearance is deceptive.

Just a while ago, doctors had complete autonomy and freedom to elect the best to the medical councils. They failed. Doctors had chances to unite and rectify glaring obvious malpractices in their own profession. They failed. Doctors had a freedom to pressurise elected medical council members to enforce ethics and discipline in Indian medicine, to arrest corruption. They failed. © Dr. Rajas Deshpande.

The parliamentary standing committee said something like “MCI looked only after doctor’s interests, not that of public, it is necessary to reduce the monopoly of doctors, so there should be diverse stakeholders at the helm”. The fact was that MCI looked only after its own interests, not even those of the real doctors of India: the thousands who were shouldering the actual healthcare burden especially in govt hospitals and rural areas, underpaid and unprotected. Malpractices became rampant. The general social jealousy about doctors which was earlier suppressed by respect converted into open anger and fuelled a paranoia that did not spare the best of the medical practitioners. For the sins of few, majority suffered. Patients too suffered at all levels. Govt medical services were always pathetic (and will remain so even after NMC), and there was no reign over the corporates who dominated and dictated the scene. Competition and petty egos destroyed any chances of any good unity among doctors. There could not be a deeper nadir for the profession. © Dr. Rajas Deshpande.

That fathered the NMC. Doctors will need to unite now like never before if they want to change this “Law”. Laws can be changed. But is it necessary in this case? Decide for yourself.

1. The ultimate, complete control of this “Autonomous” NMC is is in the hands of the central government. Majority members are govt. officials, a minority are to be chosen by medical professionals, and in every case, all that the central govt. decides is going to be a binding upon the NMC. That is like cutting off the wings of a bird and naming it “Independent and Free”. NMC, its advisory committee search committee or its four component boards will all be dominated by govt.’s chairs. Central Govt will also decide about the funding and salaries of the NMC members and its Chairman. We all know who sits in the top chairs of govt. institutes and how many among them can speak against the govt. So tomorrow if the govt wants to make ANY decision about ANYTHING that governs Indian Doctors, it can. Who will stop them if wrong? Such is the control of Central Govt. over this NMC, that if a doctor is unhappy about some decision of state medical council, he can go to NMC, and if unhappy about NMC’s decision, he will have to appeal to….? Courts of law? No. Something higher: the central govt!! So every medical practitioner’s career is ultimately in the hands of the central govt. Better join the party. Or quit medicine.

2. The entrance examinations are more simplified. All undergraduate examinations will be through NEET. All who have completed undergraduate course (MBBS curriculum) will appear for the Final MBBS exam which will also be common National exam (NEXT) for Medical Licence and PG admissions. Due to legal status of institutes like AIIMS, PGI, etc., they will conduct a separate PG entrance exam. Although this appears simplified, given the history of corruption (at almost all levels) in such exams and delays that waste millions of youth-years, one is worried about an undercurrent ‘sale’ of PG seats. But wait, not everyone must pass the licensing exam. You can entirely skip the difficult MBBS course, do something else, and bridge over in 6 months, without having to pass the licensing exams. That’s the third bullet.

3. Some AYUSH doctors are better than some MBBS doctors. Many who can not get into MBBS in spite of merit opt for other streams, with a hope to become a good doctor. They are actually contributing a lot to our healthcare, many of them know their limitations. One cannot object to their wish to practice allopathy if they want to study and upgrade themselves, the only objection is to exempt them from the common licensing exams. That will be very unfair to our society, most of whom will never know whether the doctor treating them has adequate experience, qualification and wisdom.

A newly passed out lawyer cannot do a “Six Month Bridge Course” to become a High Court Judge. A new recruit in Police cannot become an Inspector though a “Six Month Bridge Course”. A Municipal Councillor / Nagarsewak cannot “Bridge Course” himself into a Health Minister or Prime Minister. One needs to qualify though a common mandatory process. After MBBS, one cannot do a “bridge course” to become an MD that requires three years of intense responsibility handling, studying, treating patients under supervision and obtaining a deep insight into that subject. It is not possible in six months even for an allopath. Likewise, if an AYUSH doctor must practice allopathy, they must go through the necessary training (two to three years) and more importantly qualify the same common licensing exam before they practice the complicated allopathy.

AYUSH is an excellent idea, but it is immature as of now.

© Dr. Rajas Deshpande

4. The Doctor:Patient ratio in India is misquoted. Due to poor payments and infrastructures, very few doctors stay either in rural areas or govt. services, and the whole equation is skewed. The very purpose of AYUSH was to bring in more medical personnel, but that would work if these (3.5 lacs) “bridge” course doctors honoured the opportunity and worked only where there was a scarcity of doctors (urban and rural). What is more likely is that these additional doctors will also join the existing urban trend. Who can blame them for wanting a better life?

5. The newer policies of “more data, more paperwork, more record keeping, tighter control” over doctors will only result in private practitioners becoming more paranoid, giving up all the voluntary charity that they did every day, spending more time per case: and that will reduce numbers and spike fees. I can foresee most private practitioners closing down clinics. More rules and paperwork mean more corruption and exploitation in our country. This will turn into higher cost per consultation. Private healthcare will be out of reach for the poor. The good doctor will no more sit in his own clinic, he will turn to a safer corporate hospital. (Is that the aim?).

© Dr. Rajas Deshpande

6. The NMC bill entirely skips any word about regulating the large private healthcare sector. It does not have any provisions to protect new and good doctors from the tyranny and forces of corporate expectations. Some private hospitals have excellent policies and ethics, some corporates are very doctor and patient-friendly, but many remain to be corrected. There is no authority to the NMC over such hospitals.

7. There is no mention about improving staff and facilities at govt. hospitals, about any rules that ensure the best free healthcare for millions of poor patients in India. The ground reality that many patients suffer and die due to lack of staff, medicines, technology, tests and surgeries at government hospitals finds no mention in the reports of the Parliamentary committees that suggested the NMC. They did not mention the pathetic, unsafe and inhuman conditions in which Indian medical students and resident doctors live and work. They did not mention who will be responsible if a patient dies in a govt hospital due to lack of facilities or medicines. They appear to be more concerned about the price control of 40 percent seats in private medical colleges.

It is sad that in spite of many doctors in and around the central government, the medical field’s autonomy died with this bill. Shall we call it Euthanasia or “Physician assisted death” of the autonomy of medical profession? © Dr. Rajas Deshpande. In the era of the MCI, doctors were orphans, now in the era of NMC, they have become slaves.

The corrections in this bill will have to be put forth and pursued by a totally unified doctor’s organisation. “Painkiller Agitations” will not work. We must ask for complete release of the NMC from the cages of central government. Like in the UK, Indian NMC should be made up of 50% Senior Doctors representing all states and specialties, and the remaining 50% can be selected by the patient organisations: Judges, Media Stalwarts, Journalists, Artists, Ministers and Eminent Social Personalities. We must ask for transparency and fool-proofing of all medical entrance exams. We must ask for the right education, experience and licensing of AYUSH doctors, and welcome them once they qualify.

This article is written with my heart which bleeds for my profession and my patient alike. Bharat Maata Ki Jay!

© Dr. Rajas Deshpande

PS: Thank you Dr. Avinash Deshpande, Aurangabad, for some valuable inputs. If there are any technical mistakes, please let me know so I can correct.

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The Secret Illness Of Doctors

© Dr. Rajas Deshpande

She threw the file upon my table.

“I have no relief doctor. This giddiness is killing me. None of the medicines ever works. No doctor is able to understand my illness. Just give me some tablet and end my life” she was shouting and crying. Her parents accompanying her looked at me with anger and disdain.

She had been to many speciaalists earlier. Most earlier doctors had “wisely shuttled her off to another specialist” due to her hysterical behavior. © Dr. Rajas Deshpande.

I ordered a coffee for her and her parents, asked them to calm down, and explained that I had not found any abnormality upon her physical examination. I told them once again that sometimes we do not recognise stress playing upon our minds. We all think that we are supermen or superwomen who can tolerate any mental activity, behavior or abuse of our physical and mental capacity. Explained, they calmed down, open for suggestions. I referred them to an excellent psychiatrist colleague.

My colleague emailed me the next day after meeting them. The girl was being sweetly pressurised by her family for marriage, and the fear of having to leave the “overcaring and comfort” of her parents was stressing her out. She dramatically improved with counseling for the whole family and medicines for her. © Dr. Rajas Deshpande.

Only recently, a case of bleeding in the brain due to high BP was quite critical, and the entire family kept blaming, screaming at and in general mentally screwing the doctor’s team as the patient did not improve as quickly as they expected. Patients with bleeding in the brain may take months to improve. The worst ‘shouter’ in this case was the patient’s elder son. Many days after the patient improved, the family revealed that this elder son had had a continuous fight with his father, the patient, for many days prior over property, and on the night before admission he had slapped his father. That’s probably why the patient’s BP had shot up, causing bleeding in the brain. They had never told us this part earlier.

This is a form of abuse that almost every medical practitioner faces on a daily basis. Quarrels and stresses at home, guilts and anxieties, work pressures, irregular and atrocious lifestyles, eating habits and addictions, relationship frustrations of all kinds, personal failures and insecurities are some of the common reasons angry patients and their families unburden themselves upon the medical practitioner. Many want to avoid in-laws, pregnancy, transfers, heavy duty etc.Many do not follow medical advice and experiment upon themselves. Most of these blame doctors for their continuing ill health, little realising that the actual medicine is omitting the cause of their stress. The doctor can only help one identify this cause, suggest strategies to deal with it, but the actual action has to come from the patient and family. © Dr. Rajas Deshpande.

“Doctor Abuse” is common all over the world, but in India it also converts into frank violence. Blaming ‘compassionate communication failure” by the doctor is a joke, a society where even the closest family members do not understand each other for years, how does one expect a doctor to make someone strange ‘understand” a complicated situation? Will our courts and police “explain and communicate effectively” with criminals so that they do not commit crimes again, or will they “warn and punish” the abusers and miscreants? Abuse and violence are NEVER justified in any civil society.

The stress of such “Doctor Abuse” is phenomenal! It has now become so common, that many doctors have stopped admitting patients, many have reduced work hours, and some have even quit the profession. “Excessive stress and fear of abuse” is a secret illness of almost all doctors now!

If a doctor wanted his patients to suffer or die, why will he/ she even go to the hospital? There’s better money in almost all other intellectual professions, why would one choose to spend a lifetime amongst the sick and dying? Most doctors are doing their best for making the patient happy. A little understanding and cooperation from our society will encourage the good doctors to be better, and the bad doctors to follow their example. Violence and force will only worsen the situation. Doctor abuse must go. © Dr. Rajas Deshpande.

Always praying for the best health of patients and now, even doctors!

© Dr. Rajas Deshpande

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The Harassed Patriot

(c) Dr. Rajas Deshpande

“Sir Can I come to meet you this Wednesday? I am in Delhi right now, I will be coming to Pune on Tuesday to see my parents” Dr. Aman asked. He sounded different from his usual jovial self. I was with a patient.

“Sure! Everything alright with you?” I asked hesitantly.

“I will come and see you sir, I want to tell you something”.

I finished my OPD and went to the cafetaria, feeling nostalgic. Dr. Aman was a brilliant student from one of my earliest batches. You know, when you have just passed out Neurology DM, and you are a teacher to those 3-4 years younger to you. It’s a guarded friendly relation more than a teacher-student one. (c) Dr. Rajas Deshpande

His parents were uneducated, his father ran a grocery shop in a small town. Aman had mostly stayed in charity hostels almost all his school and college days. He had maintained a high merit but also a very polite behavior, enabling him to get support from his teachers. I met him first during his last year of MBBS, I was in the last year of my MD Medicine. We became friends because both of us were night owls, preferring to study late in peace. The city bus-stand was about two miles away from the hostel, and we went there together to snack and have tea etc. early morning at 4 AM, after having studied till then. We did not discuss anything academic, we were more into Richard Bach and Ayn Rand stuff. (c) Dr. Rajas Deshpande

Once during that 4 AM walk to the bus stand, he said “I want to do the best for my country, Dr. Rajas. My dream is to open a hospital where all poor patients can get the best treatment completely free. Not the ‘charity’class cheap and superficial treatment, but the best treatment that there can be anywhere upon earth”.

“I agree, I want to do something similar too, but where will the funds come from? World class treatment will mean world class doctors, staff, technology, set-up and even world class medicines. Who will sponsor it all?”I asked. This thought crosses the mind of almost every medical student while studying medicine, because there’s no one else other than medical students and resident doctors who witnesses the real health-related suffering of the poor. All the rants of socialists, politicos and other famous preachers die when they actually have to help from their own pockets to treat the poor. Every Indian doctor does it daily, without advertising.

Dr. Aman spoke as if thinking aloud: “Yes, I know it is difficult. But I was thinking that I will urge our society, lawmakers and others to fund my hospital for the poor by using the funds donated by people for greater purposes. The taxpayer should have a choice to directly deposit tax in a fund meant exclusively for healthcare for the poor. Highest donations in India are made for religious purposes, to various religious places. What best use for these billions than to start a free hospital? Will any God of any religion not be happy if those donations are used for the poor patient’s treatment?” he innocently asked. (c) Dr. Rajas Deshpande

That thought never left me.

After my MD I went to Mumbai for DM, and Aman came there in a year for his MD. We caught up occasionally at night in the famous tea stall opposite KEM Hospital. Dr. Aman earned himself the best reputation that a doctor needs: hardworking, studious, and very well behaved with the patients. He was already handsome enogh to be envied by his colleagues, but kindness, compassion and genius gave him an edge above others in everything. When I left Mumbai to go to Canada, he was still studying there. Upon my return, I came to know that Dr. Aman has joined a government hospital near Delhi. We almost lost contact. Then this call. (c) Dr. Rajas Deshpande

He came on Wednesday as planned. I was shocked, his handsome face had a large raw scar.

“What happened?”I asked.

“Two weeks ago, I was in the casualty, when a young lady was brought in unconscious and gasping. She was frothing at mouth, had many bruises on her body. Her husband and two others accompanying him were drunk , incoherent. There was a smell of insecticide, so I started treatment accordingly. There were no ventilators available at our hospital, we have requested the government many times but were told there were no funds. We were trying our best, but within minutes she passed away. As it was a suspected poisoning, a postmortem was necessary. We advised so, but the relatives declined. I explained them many times that a postmortem is legally necessary. Then they called a corporator, who came with his goons. One of them attacked me with a knife. The nurses tried to restrain him, but he attacked them too. Four of us were injured by the time that police arrived. They did the postmortem, the report says that lady was killed”

“That I could have survived, Dr. Rajas. But the next day we were told to withdraw police compaints which we had made against the attacker with knife and the corporator. The administration refused to stand by us”. Dr. Aman was now charged, angry and almost tearful. (c) Dr. Rajas Deshpande

“I don’t want to work here! Many times over now, I have realised that people do not want good doctors, they want chained, frightened slaves who cater to their illegal, immoral demands. I wanted to serve mother India” he now sobbed “but apparently mother India does not want the likes of me now. Last three years I had received many offers from UK and many other countries, but I had proudly declined. Now I have accepted an offer from Oman. They are paying me twenty times what I am earning here, with a two-month paid annual vacation, free housing and food. I feel bad, I don’t want to go, yet I do not want to work here now. I came to you because I have faith in your advice, you are like my elder brother. Please tell me what I should do”.

After thinking a lot, I told him: “You should do what ensures your peace of mind. You can help Indian patients from anywhere in the world, or you can help them from within India”. I did not want to force him to stay back in India, because I was sincerely afraid about his safety

Dr. Aman left the country yesterday, like thousands of brilliant doctors in last twenty years. I feel as if a part of me died when he told me his decision, and the only thing I could say to him was : “I understand. To do good to others, you must first be safe, alive and at peace with yourself. Take care”.

(c) Dr. Rajas Deshpande

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Doctors from various states are welcome to translate this article in local language without changes, and post it with their name along with the original author credit. This will help us spread the message.

I am also translating this to Marathi.

Mob IQ Versus Indian Doctors

© Dr. Rajas Deshpande

Woke up with a bad headache one morning, probably a sudden change in weather. Felt lethargic, did not want to get out of the bed. It was raining heavy, a perfect day to stay in bed and snack with a book and a huge black coffee. But the usual inhibition of a doctor: that many patients will have travelled only to see me worried me. Another important fact that I still depend directly upon my daily work, that ‘No work’ translates into ‘Zero income’ for me like for every doctor, made it more difficult. Just then the cellphone rang.

“Can you see the patient in ICU urgently?” my colleague called, “The relatives are quite powerful people. Very troublesome”.

If it was only to help the patient, I would get up from my grave, but even for a million rupees, today I was not in a mood to balance wits and swordfight my knowledge with an over-expectant crowd whose only qualification to ask me questions was that their patient was serious and I was expected to be compassionate and courteous. But then, I could feel from his voice that my colleague was exasperated. “Okay, I will see him in an hour” I said. Two hot black coffees masked the headache (please don’t try this at home) and pumped some fuel into my blood.©️ Dr. Rajas Deshpande.

I noticed a huge crowd outside ICU. I went in and examined the patient. Indeed critical, a case of stroke. Educated young man, stressful job, smoker, high blood pressure, was given medicines to control it, but did his own “gossip research”, stopped medicines, some atrocious diet, some herbals and one morning suddenly had bleeding in the brain. A story that is a routine now.

I called in the relatives, expecting two, but about 15 people walked in. Few of them had the most deadly dress upon earth: stiff white linen with gold necklaces. As I explained them with two other senior Consultants, questions poured in. If it is plain curiosity and worry about the patient, one can be compassionate, but this was more like police grilling criminals. At the end of every sentence highlighting critical situation of the patient, came the same question: “But he will become normal again no? Do anything you want, we want him to recover”.

It was like throwing a stone at the sky, it never lands there!©️ Dr. Rajas Deshpande.

Where do these people come from? How can so many people wait with the sick patient? At one end we have labourers whose families must work to pay for their treatment in even government hospitals, at the other we have doctors who must work every day without any benefit for future. The whole spectrum is otherwise dominated by these crowds. What is the source of earning for these people in crowds? If these men in hundreds are here all day looking well fed and complacent, who is working for them and their families? Is India rich enough that people can do away with work?

Crowds with patients, with leaders, shouting and vandalising, mobbing.. who is sponsoring their livelihoods? Or is it that we have authentically become a country of slave mobs that entirely depend upon their leadership to feed them? Are we encouraging poverty and dependence to the extent that this makes it easier to control a majority?

Everyone who is working hard and earning, paying taxes is being implied to be not only a fool but a villain. It has become fashionable to be poor and become a mob. Then a majority vote bank, forgiven by those in power, you can choose to break and mend laws as per your wish, still get sympathy. Poverty plus majority together can control anything in India. Beggars everywhere is Indian specialty. Not surprising then that any political party or government promising ‘free’ stuff, subsidised stuff and schemes to look after generations and generations of poor youth at the cost of taxes paid by working class will not only encourage such ‘poor mobs’ to become lethargic, expectant, unproductive slaves, but also provide them with enough time to divert their youthful energy towards the temptations of violence thrown by the powerful. All this at the cost of taxes paid by every hardworking profession who cannot even afford a holiday!©️ Dr. Rajas Deshpande.

While other professions escape the brunt of such free-monger mobs, medical professionals suffer the worst, not only because of over expectations of impractical charity, violence and vandalism, but because of the interference with treatment, duress, and most importantly the time they have to spend answering and explaining repeatedly to those who refuse to understand. Some are incapable intellectually to grasp complicated medical situations. How much time will a judge, IAS officer, minister or police officer spend with arrogant crowd explaining the same thing? Will they go on forever till the other person understands? If a doctor does not wait till the crowd understands, he / she is supposed to have not communicated effectively. Is an uneducated, illiterate, stubborn relative’s understanding and grasp a doctor’s responsibility? It is unfair waste of time. To expect every doctor to satisfy a mob of illiterates or even non-grasping literates is itself an indication of our social immaturity.

Time has come now for doctors to take a firm stand: that we will speak to only two relatives, who have signed and accepted the responsibility of patient’s medical care and expenses, that we will reply every question only once, and explain once if necessary, that whatever we say will be first written then video recorded so there is no later ambiguity or common tomfoolery of lying. Informing and explaining once is indeed a doctor’s duty, but satisfying the relatives cannot be a doctor’s responsibility. No doctor can afford that kind of time and patience. Any further cross-questioning by relatives should be a paid service consultation based upon time. ©️ Dr. Rajas Deshpande.

Our patience, compassion and understanding is not for being taken undue advantage of.

Happy Doctor’s Day!

Jai Hind!

©️ Dr. Rajas Deshpande

The Sunshine Girl

The Sunshine Girl

(c) Dr. Rajas Deshpande

The beautiful 14 year old girl was almost motionless. Her body was completely stiff, eyes fixed in one position, she could not move at all. Any attempt to speak or move would send her entire body in violent spasms. She could not even cry for the fear of this painful stiffness, but her pillow was wet with the tears rolling down her eyes. Her parents had wheeled her in on a stretcher. They had landed just yesterday in Mumbai, travelling from Iraq with her. Her father was illiterate, while the mother was a science graduate from Baghdad University. While internally torn with the condition of her daughter, the mother very calmly and peacefully explained me the condition of her daughter Khazan.

On the day of school annual function just five months ago, Khazan’s teachers in Iraq noticed that she was limping while dancing on the stage. They told her mother about this. Khazan was taken to a Neurologist there, who found that she had some neurological signs, with brown coloured rings in her eyes. This ring called a ‘KF’ring is usually found in patients who have a rare disease called ‘Wilson’s Disease’. Due to a fault in Liver, copper cannot be excreted out of body, it accumulates in the liver and in the blood, rising to high, toxic levels. This excess copper in the blood then starts damaging every organ in the body, but first it causes severe damage in the brain and eyes. If not treated, the patient becomes disabled soon and dies. The biggest problem is that many patients may worsen with treatment in the initial phase, with medicines which act fast. The cheaper medicine (Zinc) which does not cause such worsening, is too slow to act, it takes months. (c) Dr. Rajas Deshpande. Khazan was started with the first medicine in Iraq, but unfortunately, she became paralysed due to the side effects of the medicine. The Neurologist in Iraq started with the second, extremely costly drug. Her parents sold off their land, business and even home, and shifted to a rental small house to afford this medicine that had to be imported from USA. As fate would have it, Khazan reacted adversely to this too and further worsened. She became completely paralysed, could not eat or speak, and was then advised the last option, the curative treatment for this disease: Liver transplant. (c) Dr. Rajas Deshpande

They applied for loans from some charity organisations, and landed in India for Liver trasnsplantation. “We were told that the doctors in India are the best in the world, and the cost of treatment is lowest in India. So we decided to come here” her mother told. Indeed, the cost of medical as well as surgical treatment in India is lesser than half compared to the developed world. For simple appointments with specialists, the waiting list in the developed world exceeds weeks to months, and surgical appointments take years. Once, in my childhood, one of my uncles gave me some dessert, like everyday, which I didn’t care to finish. My aunt asked me with surprise: “Why don’t you eat such a delicious dessert?”. My uncle immediately said “Because he gets it so easily. Ask those who don’t get it, they will love it”.

We found that Khazan was almost skin and bones, dehydrated, and anemic. She had developed many Parkinson-like symptoms and some psychosis. I explained her condition and told her mother: that she was semi-critical, that I wanted to start with the cheaper, third medicine and give her supportive care, but it would take a long time, I could not guarantee anything. Her mother told me via the Arabic interpreter Mr. Tabrez: “Doctor, we do not want surgery for her. Do what you would have done for your own daughter. We will close our eyes and do whatever you say. We will hope she improves, but we understand you cannot guarantee anything”. Now the onus was upon me, the responsibility was mine. We started treatment. Khazan’s graduate mother knew more about Wilson’s disease than many medical students, yet she never came across as arrogant or argumentative. She politely asked doubts. A good doctor grows with every patient. (c) Dr. Rajas Deshpande

My students started helping out the family, making Khazan feel at home. Love and compassion for the patient enhances the effects of all medicines in most cases. Add the trust and willpower of the patient, and you usually have a winning prescription. From the shadows of a near-certain death, Khazan’s body and soul started to awaken to the sunlight called life. She gradually started speaking, drinking water, and in a few weeks, eating small morsels. They had to return to Iraq, and we communicated via video chats. They returned twice to India for reassessment and change in treatment.

A few months after their last visit, I received a letter. It was written in English, by Khazan. She had joined college now, and wrote that she wanted to become a doctor like me. Her mother had added in Arabic: “My girl is the sunshine of my life, thank you for bringing her back from the claws of death”. I had received my reward. Khazan is doing very well now since last three years, with God’s grace. Of course I did not forget to remind her that most of the credit of her recovery was to the unparallelled grit and efforts of her mother.

Magical, Near-supernatural, Miraculous recoveries happen every day in India. Patients, young and old, with almost nil chances of survival, walk home smiling every day, in almost every Indian town, even in the most rural areas, thanks to the efforts of thousands of doctors working 24/7. These doctors are never appreciated or rewarded. This post is dedicated to those messiahs of Indian Medicine.

(c) Dr. Rajas Deshpande

This story is real. Many doctor colleagues and physiotherapy students have helped me treat this patient over years. Wilson’s Disease can be completely cured, there are many experts working on tis in India.

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“Dev Borem Korum” (Thank You)

(c) Dr. Rajas Deshpande

As the plane landed, I called up the driver who was scheduled to pick me up from Goa airport.

“Hullo, Mr. Clement? I’m Dr. Rajas”

“Haan daktar. Tu aaya kya? Bahar nikalke miss call de mai ayega” (Have you arrived? Come out and give me a missed call, I will come there”) . He would have said the same sentence to the President as well. Goans are least hung up on artificial flowery language, they are the friendliest lot as a society. It was after a year, that the same Clement said to me: “Tere liye apun jaan bhi dega parwa nai” (“I can give my life away for you without any hassles”), when I thanked him for something.

Goa has some excellent Neurologists, and my visiting is actually redundant. Yet somehow, maybe because they keep quite busy, or sometimes patients seek a second opinion, I have been seeing a good number of patients every visit. In the very first visit, after I saw an elderly lady and explained her the treatment, she bowed and said “Dev Borem Korum Doctor”. That means “Thank You Doctor”.

Then I pleasantly noticed: irrespective of what was the diagnosis, what treatment was given, whether there was treatment for the patient’s condition or not, whether the patient improved or not, almost every patient said either “Dev Borem Korum” (Thank You) or “God Bless You Doctor”. Even if surgery was advised, even if there were side effects of medicines, even if the outcome was not as expected in rare cases, the “Thank You”and “God Bless You” never changed. It had nothing to do with any particular social class. The rich, the poor, the educated as well as the uneducated, people from every religion, every age group said it. It is a part of that culture: the Goan culture.

Late one night after the OPD, when we were driving on a beautiful long empty Goa road near the beach, I mentioned this fact to my friend Dr. Samuel (God Bless Him for the exotic dinners he takes me to!), he stopped his car and looked quite affected. “I wondered whether anyone else had noticed that. It feels so beautiful! When the patient is grateful and brings you blessings, you automatically feel responsible to do the best for them. Money never matters in that relationship. We must never take patient’s kindness for granted. So many of them actually say Thank You, God Bless you, but sometimes we are too preoccupied with work, anger, ego and other things to reciprocate and encourage that kindness”.

I told him about my late Professor Dr. Sorab Bhabha, who stood up and greeted every time a patient entered or left his cabin. The onus of initiating a good doctor-patient relationship primarily lies upon the doctor, and it is extremely essential to follow the best of manners and etiquette, kindest of language when dealing with patients.

A very sweet girl who followed up for epilepsy recently told me that she visited me not only for medical purpose but because she was inspired by the way I appear calm and composed, the fact that I never raised my voice and always spoke compassionately with everyone. I had to tell her the truth. “Thank you mam, but I am quite short tempered outside the hospital. Even the junior doctors working with me sometimes find me intimidating. But I have to change when I am with a patient. I don’t think that any patient comes to me because I am any better than anyone else in the profession. I prefer to think that they choose me because they trust I can solve their problem. Will you be rude to someone seeking your help? Then how can I get angry with a patient? Every patient coming to me has that hidden trust, which I must justify. Only rarely, if the patient misbehaves or says something insulting, do I lose my calm.”.

“That’s what I like. So humble!” she had to have the last word!

Yes! The day I bring my ego inside the hospital, I will no more be a good doctor. Even the most illiterate patient understands when the doctor is being rude or artificial. Only when it is genuine, the patient will feel the warmth of my compassion and care. It has nothing to do with sweet talking or a show of affection. The only way to do this is to actually incorporate it within one’s depths so that it becomes one’s originality. Kindness and compassion must be the original, genuine qualities of every doctor who expects gratitude from each one of his patients. It does work in most cases.

After dinner, Dr. Sam took me with two other friends to the beach and we silently stared at the luminous moon for a long time. The music of those waves matched the dance of that moonlight upon the ocean. Just as one can feel the glow of the moonlight upon one’s skin, I could feel those numerous blessings keeping my soul warm and happy.

(c) Dr. Rajas Deshpande

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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 reassured her that it was ok, and returned the gesture by touching her feet too. I told her I will try my best, and that 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 my feet, although I was 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 my 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 this 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

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That Order To “Stop Saving Life”..

(c) Dr. Rajas Deshpande

“Arrest! Sir… Code Blue!” the nurse shouted. The casualty was full, all eight beds had serious patients, and their relatives waited near them. Every second matters.

“Everyone out” my co-intern shouted. Some moved out, some stayed. Two other interns were already attending similar patients, two of us ran to the arrested patient. The nurse had already started the chest massage. I gave patient the position for inserting the breathing tube, as my co-intern Dr. Ajoy took over the cardiac massage. The senior medical officer, Dr. Hazare, experienced with a lot of medical wisdom, stood near the bed. He calmly gave orders for the last-attempt medicines in such emergencies.

The chest massage to save lives is rather forceful, its force has to reach the heart. The chest wall has to be pumped down 2-2.5 inches with every compression, and this has to be real fast: over 100 times a minute. It looks very traumatic, but it is useless if not done exactly like this. It is quite a disturbing scene for the relatives. The patient’s son kept on shouting “Don’t hurt him” loudly. The medical officer repeatedly asked him and the five relatives around the patient to leave. They refused.

The Medical Officer Dr. Hazare then asked us to stop the CPR. (c) Dr. Rajas Deshpande

We were baffled. How could one stop the life saving CPR?

The patient who had arrested was from a nearby slum, father of a local goon out on bail, like most goons in India. He (the patient) was in his late fifties, a chronic alcoholic and smoker, with severe liver damage. He’d had excess alcohol on the prior night. That morning, he had had a convulsion, and was brought to the casualty after many hours of delay . An arrogant, drunk, politically supported crowd posing as relatives accompanied him, a common nuisance in almost every Indian hospital.

We continued the CPR. Dr. Hazare went out.

After a direct injection of adrenaline into the heart through the chest, the patient’s heart restarted, and he started to gasp, making some movements. We quickly shifted him to the ICU. The proud feeling of saving a life gripped us. There was no time for celebration, but Dr. Ajoy kept whistling on the way for our midnight tea.

Later that night, Dr. Hazare called us. He was angry, yet calm and smiling, an ability that only the most evolved souls can have.

“Listen, we are in India. Most of the people around us are not only uneducated and ignorant, they are also quite violent and paranoid. Emotional dramas are considered a normalcy. There’s a tendency to shift the blame of delayed treatment and bad outcomes on to the doctors. You were risking your life. If the patient’s heart had not restarted, the relatives could have blamed you, even hurt you”.

“But Sir, they saw that we were desperately trying to save the patient’s life” I argued.

“YOU think so. They don’t know anything about the CPR. They refused to go out. You saw how arrogant they are. These things work only when the outcome is good. If the outcome is bad, the doctor is automatically held guilty. I told you, we are in India. People like to think that doctors are wrong, whatever you do. ” Dr. Hazare said. (c) Dr. Rajas Deshpande

We didn’t think he was right. Still, we respected him for his wisdom, so we just apologised and went on to deal with the casualty again. It was a busy night, still a very negative feeling about what Dr. Hazare had said kept shadowing my thoughts. How could such a senior doctor ask someone to stop CPR?

Dr. Ajoy went to his room at 5 AM and returned by 7 AM to relieve me. I went home at 7 AM, had a quick bath and breakfast, to return at 9 AM.

The casualty was all devastated, ruins were seen all around. Many doctors were rushing in and out. All beds were empty except one.

Dr. Ajoy was on that casualty bed, unconscious, intubated and with blood soaked bandages on his head. He had many cuts on his entire body. Our colleagues were trying to push intravenous fluids fast into his veins. Dr. Anirudh, another intern with us, told me even as he could not stop crying: “That patient we had resuscitated yesterday evening… he had another cardiac arrest in the ICU this morning… his relatives came down and attacked Ajoy. They said that the patient died because of the forceful CPR. They stabbed Ajay and hit his head with iron rods. Dr. Hazare came and tried to rescue Ajoy, they even attacked him. We were waiting for you. Do you have his parent’s contact?”.

In a state of shock, I could not speak. I reached out for my bag, got my diary and called Dr. Ajoy’s father in Calcutta.

“Why?” Dr. Ajoy’s shocked father asked when I told him Ajoy was attacked, injured and serious. How could the father of a thin built, cute, brilliant scholar ever understand that people could brutally attack his child for trying to save their loved one?

I had no answers. Dr. Hazare’s sentences kept ringing in my brain, I could not utter them. (c) Dr. Rajas Deshpande

Eventually, Dr. Ajoy recovered. He is now in the UK. His father came over last week, for a check-up. While leaving, he kept his gracious hand upon my head and said with immense love: “Save many lives beta, but take care of yourself first. I still cannot sleep well due to what happened”.

That night, I stared at the sky, and kept thinking: Actually, this is why no doctor ever sleeps well in India. Saving lives comes with the inherent risk of losing one’s own, and this happens only in our beloved motherland.

(c) Dr. Rajas Deshpande

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Religion? Caste? Race? Nationality?

Religion? Caste? Race? Nationality?
No, I cannot think about that.
A Bullet has shattered the skull, damaged half the brain of this young person of 22 years.
A surgeon has put together the pieces of skull, a fragment of metal is still seen deep inside the brain. This person has a whole future of decades to tackle with a severe disability. As doctors, we only think: what best can be done to repair the brain, how best to resettle the patient in their future life, how to help them overcome their disability.
”Shoot, Kill, Hunt, Enemy, Revenge” are not the words any true doctor in this world can ever like!
We can never think about the race, caste, religion or nationality of any human being. Because a Doctor is always above any sort of discrimination. © DR. RAJAS DESHPANDE
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