Tag Archives: heart attack

Lost and Saved Life: The Indian Puzzle

Mumbai Diary-2

Lost and Saved Life: The Indian Puzzle

© DR. RAJAS DESHPANDE

He had a sudden, severe chest pain, so he told his office-colleague so. The colleague first called his wife and alerted her “Bhabhiji please don’t panic, I am taking your husband to this hospital, please reach there as soon as possible and give me a call once you reach”.

The cab driver grasped the situation at once and drove as fast as he could. He prayed in his heart. Just a kilometre before the hospital, there was a huge mob blocking the road. A great leader was shouting aloud about his pride for his religion and patriotism, least aware that they were all blocking many children and mothers trying to reach home, patients and doctors trying to reach hospitals. The bought crowd was eagerly listening to the violence provoking words of this rich politician, also a convict and suspect in many crimes, There was less audience at the real places of God’s worship nowadays than at political speeches giving religious sermons, mixing them with the love for one’s nation!

The cabbie honked. Two monstrous looking goons peeped in his window and started abusing him insanely, least aware about the women and children around. The cabbie was abused first for his profession, then his language, and the state he had come from, threatened to be burnt alive along with family if he honked again when the ‘great’ leader was speaking.©️Dr. Rajas Deshpande

The cabbie begged with folded hands: “Sirji forgive me, I accept my mistakes, but there’s a patient on the back seat. He looks serious, we must reach the hospital as quickly as possible. For god sake, let us go”.

One of the goons opened the back door and asked this patient his name. After he saw the chest-clutching patient almost gasping, they made way and allowed the cab to leave.

Now the patient had started profusely sweating. His face had turned bluish, and he was making efforts to even breathe well. He could not speak. As they entered the hospital, the patient’s friend noticed that the patient had stopped breathing.

He shouted in panic. The wardboy and the cabbie lifted the patient on a stretcher and ran towards the emergency room.

A frantic, fearful sound of thuds of the last heart massage was now heard, along with breaking of many glass syringes and instructions shouted by doctors and nurses. A tube to restart breathing artificially was inserted in the patient’s throat. ©️Dr. Rajas Deshpande

There was no one to cry for this patient there. His friend was sitting outside the emergency room, clutching his head, stunned. The cab driver had left without taking his bills. Religion and Patriotism stayed outside the hospital campus, they couldn’t save lives.

A young and dynamic heart specialist who had just returned to India saw the ECG of this patient. An urgent action was required. He called upon the patient’s friend to sign a consent.

The friend hesitated and refused. There were a lot of news every day everywhere about doctors fleecing patients, earning money by misuse of stents and surgeries. The friend no more believed in what this doctor told him.

“I don’t know. Wait till his wife arrives, she will be here in an hour”.

Every millisecond was crucial. The dynamic heart specialist called his medical director. “Sir, I take full responsibility for this case, he needs immediate action”. The medical director cautioned him: “Doc, if anything goes wrong, if the outcome is not good, they will file a murder case against you. Why do you want to risk your bright career at the very beginning? You must also think that you don’t have any political godfather”.

The doctor rushed the patient to the cathlab and inserted three stents in the patient’s heart, that resumed the normal blood flow to heart. The patient’s heart function returned to near normal in an hour. By the time the patient’s wife arrived, the lost life of the patient was brought back. The next day, the patient could breathe well by himself.

Now the most crucial puzzles: which state did the cabbie come from? What was the caste of this patient? To what country did the helpful friend belong? Why didn’t they go to the government hospitals run by those who criticise private doctors and hospitals? And lastly, what was the religion of the doctor who saved this patient risking his own life and career?

Any sane person with an ounce of humanity in his heart won’t ask these stupid questions. But some Indian leaders and their followers do. And it is very sad and unfortunate that the answers to these questions cannot be openly revealed in my beloved India.

©️Dr. Rajas Deshpande

Neurologist

Mumbai/ Pune

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Food, Sex, Addictions and Privacy: Seriously!

Food, Sex, Addictions and Privacy: Seriously!
© Dr. Rajas Deshpande

An old man of 82 was admitted in London ON once with stroke during his “regular” morning lovemaking with his contemporary wife. An accurate history and onset time is necessary so we can use a clot buster injection within 4 hours of onset. He qualified and eventually recovered too.

I was amazed at the calm, expressionless responses but courteous attitude with which everyone in the staff treated him there, the couple was never embarrassed by any of the staff or doctors. Upon discharge, the patient asked Dr. H, an authority in the world of stroke, with a cute wink if he could continue his “Morning routine”.

A smiling and about twenty years younger Dr. H replied he could, so long as he took the prescribed medicines, and joked with a return wink that he (Dr. H) envied the patient, making the patient smile!

A twenty two year old unmarried female student came for suspected Multiple Sclerosis once. “I smoke grass (marijuana) for recreation, doc. I also take oral contraceptives often. Does this affect my illness?”. Both her parents sat there without any change of expression, and did not interfere at all with any part of the consult. I couldn’t help remembering the contrast panic and beating up by parents in some of my Indian college mates I knew, whose only fault was stealing a cigarette from their Father’s pack! Also the whole-family-humiliation-screw meeting in which the traditional family-nerds irritatingly shine!

In India, people seldom relate correct history for the shame attached to it. I have witnessed some very embarrassing moments, when doctors (especially junior) openly, loudly ask sexual / urinary history or addiction details to the awkward patient, while their colleagues exchange blushed, meaningful and pregnant glances. This is an obvious turn-off, and whether it is sex, sphincters, alcohol or smoking, no patient likes “Open Questioning” about this without adequate privacy. Then too, people talk only if respectful dignity is offered by the doctor. One must ensure such privacy, but never miss to address this issue out of shame or embarrassment. A history of STD or HIV risk must be asked where important, with relevant but properly formed questions, without a condescending tone. Many doctors half the age of patients actually humiliate the patient in a hope to make him / her quit alcohol / tobacco / smoking. Such patients are irreversibly hurt by open humiliation, and this should best be left to professional / experienced counselors.

This is also why many patients (especially the older, less educated, depressed) who have had heart attacks, spinal cord problems, accidents, strokes etc. hesitate to ask a “Loud Doctor in Hurry” about physical relations and addictions. Some refrain from normal life out of unnecessary fear, which may contribute to their depression. If the patient feels embarrassed or awkward, it is the doctor’s job to reassure and address these issues. A pre-discharge counselling meeting is essential. Fortunately the younger and educated generations even in India are now quite open and frankly ask their doubts without feeling “unnecessarily” guilty.

Actually, every patient, rich or poor, deserves privacy for any health discussion. It is a sick scene to see patients in a queue in most govt. / municipal hospitals having to openly answer such questions in absence of proper space. Overworked and authorityless doctors are helpless here.
My internship days.
A civil surgeon (administrative post) took what we call “Babaji Rounds”: smiling, hand-waving rounds just to ‘show’ the patients that “I am the boss”, talking sweet to every patient and firing everyone among staff. Administrative rounds like these are medically useless, but some depressed patients feel good, and some good administrators correct the service deficiencies.

One thin built religious leader was admitted with acute shutdown/ failure of kidneys. No urine output. Blood pressure very high, we struggled to control it. When the CS came to his bed, the worried wife asked: “Sir, what should I give him to eat?
The CS beamed a big angelic laugh, patted on the back of patient and said aloud “Anything he wants.. icecream, fruit juices, milkshakes..”.
“Samosa?” asked the lady..
“Yes sure”, said the CS and told the patient: “Eat more if you want to get better soon”.
The patient touched his feet and said “You are like God Doctorsaab, my illness is half better just by seeing you”.

That diet would have killed that patient, had not our fuming medicine professor (after a caste based solid expletive for the CS) asked me to rush back and stop the excited wife from feeding all that to the patient!

The CS didn’t even know the condition, diagnosis, or other details. He never wrote anything on paper (Capital or Small in verbal instructions??), but could have severely damaged patient’s health, just by his careless advice under pretension of knowing what he didn’t.

Point:
Many unqualified people / quacks/ and some qualified doctors too advise via verbal instructions trivially. Patients blindly follow these instructions. Right from “Shudh Desi Ghee (Clarified Butter)” to herbals!
This is equally or far more dangerous than bad handwriting of a good doctor.

Advice about food, exercise, sex, work, posture, sleep, physiotherapy and lifestyle are all parts of the consult, equally important as the medicines. A good doctor’s routine will include this advice for every patient. Patients should also consult a specialist for their illness at least once in the initial stage, so he / she can plan out long term holistic plan and the regular general / family practitioner can follow it up.

Some patients take advantage and ask the same things repeatedly. In a busy clinic, a personalised printed advice can be given. In a crowded OPD, as in charity and govt. hospitals, a “general instructions for a disease” booklet will go a long way, or special group counselling can be advised.

Things are changing. Many newer generation doctors are making good friends with patients especially from their own age groups. Fortunately, even the youngest doctors still do not use colloquial phrases like “Aish Karo” (Enjoy to the hilt), otherwise some perfectionist patients may really follow it to the core!

Because “Chalte- Chalte” / hurried advice, however trivial, may prove dangerous.

© Dr. Rajas Deshpande