Tag Archives: India

Can Anyone Solve The Mystery of Atmaram’s Courtroom Death?

Can Anyone Solve The Mystery of Atmaram’s Courtroom Death?

©️Dr. Rajas Deshpande

A hungry poor man named Atmaram went to a big hotel, had a nice big meal, and told he had no money to pay. He was beaten up and handed over to the police. He was released after a warning and a slap.

Next day he filled up petrol in his bike, and said he couldn’t pay. He was again beaten up, handed over to the police. Then he went to the medical shop, bought medicines and mineral water, ate the medicine, drank water from the bottle, and again said he couldn’t pay. He was now jailed for a week.

Next week his house was damaged by heavy rains, so he went and requested to be allowed to sleep in the house of the chief minister. He was arrested again, thrashed up.

As angry Atmaram shouted at the police, he was beaten up by them, another crime was added to his offences. In the court, Atmaram insulted the lawyers and judges and accused them of accepting bribes and charging too much. The judge punished him extra for his behaviour. Atmaram was angry and threw his shoe at the judge. His punishment was extended.

“You must respect the authority “ the court said.

“But I am poor, I need free food and petrol and medicines. I need sympathy too” Atmaram argued.

“You should have begged and applied for favours and eaten in places that provide charity meals. Petrol, however essential, has the same price for everyone. You can sleep on the footpath, and above all, you are not allowed rudeness and violence because you are poor and needy” The court said.©️Dr. Rajas Deshpande

When released from the jail, Atmaram drank a lot of desi alcohol, had an accident and fractured many bones. He went to the best private hospital, got operated and refused to pay his bills that crossed one lac rupees. When the hospital insisted, the operating doctors were beaten up by Atmaran’s relatives, the hospital was vandalised, the police arrested the doctor who saved Atmaram’s life, the government closed down the hospital, while the media and the society kept villainising the entire medical profession.

The headlines next day reported the sympathy expressed uniformly by wag addicted tongues: some said the entire profession was tainted, some blamed the greed of the doctors, even some doctors desperate for attention shed crocodile tears about the ethics in this profession. ©️Dr. Rajas Deshpande

In the courtroom, during the trial, Atmaram sat facing the doctor, still heavily bandaged.

The hon’ble judge, kind but surrounded by security, told the doctor accused of negligence and malpractice in the court: “You as a doctor carry more responsibility for ethical behaviour upon your shoulders. You should never turn away the poor”.

The doctor, defending himself, asked “but Milord, doesn’t our constitution insist on equality? Why do you yourself or ministers get security but not the doctor? Why isn’t everyone supposed to stick to ethics in every profession including politics, police and judiciary? Why are others exempt? How do you explain beating up of doctors while also saying that the society treated them like gods?”.

There were no answers. The kind court asked if the doctor had to say anything else in his own defence.

The doctor said

“Yes Milord, but the real answers will hurt:

Jealousy against medical professionals across society and many other professions is a reality. Why else will anyone who couldn’t qualify to become a doctor try and teach the qualified doctors what they should do?”©️Dr. Rajas Deshpande

“A culture of exploitation of non-votebank groups

and a complete failure of government healthcare with no one accepting responsibility is well known to everyone, but even judges have no courage to suo motu question this and correct it, even when they see the poor dying”. ©️Dr. Rajas Deshpande

“In a country with never ending poverty, how much free can a healthcare facility provide? For how long? This is already forcing closure of hospitals and exodus of good doctors out of the country.”©️Dr. Rajas Deshpande

“Milord, can you assure that every doctor will get his/ her fees as per his service to every patient, and if the patient can’t pay, that much charge will be exempted from the income tax of that doctor? How else do you except a doctor to meet his needs and dreams? Just because there are millions of poor patients, is the doctor’s life and hard work taken for granted? If there has to be financial sacrifice, why not have everyone contribute to it by creating a national health tax fund for treatment of poor patients? Why healthcare is subsidised only at the cost of a doctor?”

Just at this point, Atmaram, who sat in front of the judge, collapsed unconscious, almost blue black.

The shocked judge requested the doctor to examine him.

“He is no more” said the doctor.

“What could have happened ?” asked the kind but sweating judge.

The doctor told the court about three possible reasons. Two of them were scientific and medical: a sudden cardiac event or a large blood clot in the lungs common after fractures and trauma.

The third non-medical, unscientific cause made the Judge seriously ponder.©️Dr. Rajas Deshpande

“Will this court be now closed down, Milord? Will your efficiency be questioned, will you allow the relatives to attack you and understand their sad situation at the cost of your murder?”

“I understand what you mean” said the kind judge.

Needless to say, the doctor was released without a blame.

Can anyone please solve the mystery of the third non medical, unscientific possible cause of Atmaram’s death?

(C) Dr. Rajas Deshpande

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The Changing Blood Group

The Changing Blood Group

(c) Dr. Rajas Deshpande

“He is sinking” shouted Dr. Siya.

The casualty registrar rushed to the bed, checked the vitals. Pulse very fast. Blood Pressure very low. Lips and nails white, hands and feet cold. The young man, unconscious, was on the verge of death.

“He must be bleeding inside. Get an urgent sonography of his abdomen”said the registrar to Dr. Siya, and call the blood bank. He will need at least two units of blood urgently”.

It was Dr. Siya’s first week into internship, she was thrilled with the idea of actually saving lives. At the young age of 22, she was witnessing death almost every other day. Along with that she was amazed to see the darkest sides of human nature: the potential of humans to hurt each other: via rapes, accidents, murders, fights. She had decided to not let this affect her attitude, and to continue to try and save every life she could.

That late night, this young man of about her own age was brought in unconscious by someone, who had just dropped the patient in the casualty and left without leaving any identity of himself. “I found him lying unconscious on the road. I don’t know anything else about him. I am just doing my duty, I have a train to catch”said the stranger and left. The patient was reeking of alcohol. He had a visible head injury. A quick CT scan had revealed minimal bleeding due to a small skull fracture. He also had had bleeding from wounds from his hands and legs, they were sutured. The patient had no identity marks, wallet or cellphone. The policy of the hospital was to provide basic treatment and shift the patient to the government hospital. The police station was already informed. Treatment was started.

Dr. Siya requested two units of blood. The blood bank called. They had only one unit of the blood for his blood group. The registrar had the same blood group, and like many doctors working in the emergency departments, he went down to donate blood.

It was nearly midnight. The fate of the life of a young man depended upon what the junior doctor did just then. There was no one to sign any consents, the protocol was to inform the hospital’s medical director and obtain consent for emergency transfusion or procedure. Dr. Siya finished the formalities, obtained the permission, and started the transfusion. If the patient had reacted or something went wrong now, they all feared, there will be a havoc in the media: that they had let an unknown patient die because they wanted money!

Dr. Siya kept on managing the show. The angry and disturbed relatives of other critical patients kept on taunting her, speaking rude and reluctant to complete simple formalities and paperwork.

The sonography was thankfully normal.

Just as the first unit of blood was over, the patient became conscious, and revealed his name. He was quite shaken with the surrounding, but told in broken sentences about his friend’s number and address. He revealed that while returning from a party, his bike was interrupted by a bunch of goons, he had fallen down, they hit him upon the head and left with all this belongings.

The friend was called, and came in. He revealed that the patient was used to smoking weed and drinking alcohol in huge quantities. They were staying in the hostel of a famous college.

The second blood unit was started, and in a short while the patient threw a convulsion. He was immediately given injectables for controlling the convulsions, he slept off with the effect.

His parents arrived early next morning.. The shocked mother was consoled and explained about the situation by Dr. Siya. The elderly father, like all fathers, equally shocked but being a father unable to cry, kept mum, just holding hands of the boy.

When the patient woke up again, the father came to Dr. Siya, and touched her feet. Too embarrased, she told him that the registrar had donated blood for the patient. The father went and thanked the registrar, again trying to touch his feet.

As Dr. Siya had finished her night duty, she prepared to leave. “Beta, Will you come soon please?”asked the tearful mother to her. “Yes Auntie, I will be back soon. Don’t worry, he is ok now”she reassured and left.

On her way back her genius young mind tried to look at the situation sitting upon her shoulder, the little third person that resides within each one who has a conscience. That booze and weed was easily available to youngsters in almost all Indian hostels, that even educated people rode bikes without helmet, that crimes were happening almost everywhere that injured and killed people, that law and order was a laughable term in many parts ofthe country, that there was no government mechanism in place to provide emergency medical / paramedic support ambulances to raod / traffic accident victims: which one is the most responsible cause, when patients like these died? Who is responsible?

She reached home, told her proud parents what had happened, that she had helped save a life. Her mother folded her hands towards the sky, said “God, let my daughter save many lives everday”.

While having the breakfast, her father turned on the TV. A famous but ill educated political leader, in his mind-and-other- organs blowing speech in Karnataka, was explaining the illiterate public how all Indian doctors charged in excess, how they were only after money, how everyone except himself was the enemy of the millions of patients surviving from critical heart attacks, accidents, strokes and other diseases. All patients getting better all over te country was only thanks to himself and his government!

Dr. Siya’s father laughed bitterly. “Next time you need blood for any poor or unknown patient, call him” he said.

Dr. Siya replied, laughing “That kind of ëver changing blood group doesn’t match anyone, it is useless for any patient, Papa”.

(c) Dr. Rajas Deshpande

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एक आशीर्वाद का रंग (डॉ. बाबासाहेब आंबेडकर की स्मृति को समर्पित)

एक आशीर्वाद का रंग
(डॉ. बाबासाहेब आंबेडकर की स्मृति को समर्पित)
© डॉ. राजस देशपांडे
न्यूरोलॉजिस्ट पुणे

दवाई की मात्रा को सावधानी से गिनकर मैंने इंट्रावेनस सोल्यूशन तैयार किया. सुई पहले से ही लगाकर रखी थी. “मैं दवाई का इंजेक्शन शुरू कर रहा हूँ. अगर कोई भी तकलीफ हो तो तुरंत बताइये, मैं यहीं बैठा हूँ” मैंने उस बूढी औरत से कहा. अपने दर्द की परतों के पीछे से वह मुस्कुराई. उसका बेटा, मेरा लेक्चरर डॉ. एसके , वहीँ खड़ा था. उसने अपनी माँ के सर पर हाथ रखा, और कहा, “ये मेरा विद्यार्थी यहीं रुकेगा. मुझे बाकी पेशंट देखने हैं, आज काफी भीड़ हैं. तू चिंता न कर माँ, अगर कुछ जरूरत हो तो इसे बता देना”. वह चला गया.

डॉ. एसके की माँ को कैंसर के लिए कीमोथेरेपी दी जा रही थी. इसमें से एक दवाई का सॉलूशन तैयार करना और उसे इंट्रावेनस (खून की नसों में से) बराबर मात्रा में देना काफी मुश्किल काम था. मेरे गाइड डॉ. प्रदीप (पिवाय) मुळे ने मुझे कुछ दिन पहले ही इस दवाई के बारे में सिखाया था, इसलिए डॉ. एसके ने मुझे बुलाया था. मैं तब एक सरकारी दवाखाने में अपने एमडी मेडिसिन के पहले वर्ष का रेजिडेंट डॉक्टर था.

कुछ समय के बाद मैंने देखा की उस पेशंट की यूरिन बैग (पेशाब की थैली) पूरी तरह से भर गई थी. वार्ड में काम करने वाली मौसी किसी और काम से बाहर गई थी. ऐसे हालात में एक रेजिडेंट डॉक्टर को हर काम करना पड़ता है. मैंने ग्लव्स / दस्ताने पहनकर नर्स से एक बाल्टी मांगी, और यूरिन बैग से उसमें पेशाब निकलकर वार्ड के बाथरूम की तरफ चल पड़ा. तभी डॉ. एसके वापिस आ गए. उन्होंने मुझसे वह बाल्टी मांगी, कहा “मैं ले जाता हूँ” पर मैंने कहा के मैंने ग्लव्स पहने हैं, मैं ही रखकर आता हूँ. मैंने वह बाल्टी वार्ड के बाथरूम के बाहर रख दी, मौसी बाद में उसे साफ़ कर देती. © डॉ. राजस देशपांडे

जब दवाई ख़त्म हुई, तो डॉ. एसके ने मुझे चाय पीने के लिए साथ चलने के लिए कहा. हॉस्पिटल के पीछे ही एक छोटी सी चाय की दुकान थी. थोड़ा हिचकिचाने के बाद उन्होने कहा : “सुनो, ग़लतफ़हमी न हो, लेकिन जब मैंने देखा कि तुम मेरी माँ के पेशाब की बाल्टी लेकर जा रहे थे, मुज्झे अचम्भा सा हुआ. तुम ब्राह्मण हो ना? जब तुम बाहर थे, तो मेरी माँ ने भी मुझ पर गुस्सा किया, और कहा, क्यों मैंने तुम्हे वो बाल्टी उठाने दी. हम बहुजन समाज से आते हैं. तुम्हे पता भी होगा, मैं अपने समाज के एसोसिएशन का नेता हूँ.”.

मुझे पता था. डॉ. एसके के नाम से काफी लोग डरते थे. पर एक निहायत बेडर और आक्रामक नेता होने के बावजूद वो एक अच्छे दिलवाला इंसान भी था. जब भी किसी पर अन्याय होता, तोह बिना जाति-पाती के बारे में सोचे वो उसकी मदद करता. गरीबों के लिए उसे विशेष प्रेम और सहानुभूति थी. किसी तरह का भेदभाव उसे पसंद नहीं था.

मैंने कहा “सर, मैं ये सब नहीं सोचता. पेशेंट तो पेशंट ही होता है, पर यहाँ वो आपकी माँ भी हैं, जो भी उसके लिए करना पड़े मेरा तो कर्त्तव्य बनता है. मैं अपने मन में कभी जाति-पाती का विचार न करूँ, न ही कभी किसी से भेदभाव करूँ, ये ही तालीम मुझे मेरे माता पिता ने मुझे बचपन से दी है”. © डॉ. राजस देशपांडे

“ठीक है”, उन्होंने कहा, “मेरा तुम्हारे बारे में कोई पूर्वग्रह / प्रेज्यूडिस था, वो अब चला गया. अगर तुम्हे कोई भी विपत्ति कभी भी हो, तो बड़ा भाई समझकर मुझे बता देना.” . कितनी ईमानदारी और धैर्य से उन्होंने एक कठिन बात को सरलता से कहा था!
जबतक अपने आप को दुसरे भारतीयों से ऊंचा या अलग समझने वाले हर भारतीय को कोई पश्चिमी जातिवादी (रेसिस्ट) “ब्राउन / ब्लैक” कहकर नीचा नहीं दिखता, उसे भेदभाव का दर्द नहीं समझ सकता.

संयोग से, कुछ दिन बाद ही, मेरी अपने एक प्रोफेसर से कुछ तू तू मैं मैं हो गई . उन्होंने मुझे अपने चैम्बर में बुलाकर कहा ” जब तक मैं तेरा एग्जामिनर हूँ, तू पास नहीं होगा”. मैं परेशान हो गया. मेरी आर्थिक स्थिति तो खस्ता हाल थी ही, पर मेरा बेटा अभी छोटा सा था और मेरे माँ-बाप मेरे वापिस आकर उनके पास रहने कि आस लगाए बैठे थे. फेल होना मेरे लिए बहुत बड़ी मुश्किल खड़ी कर देता. © डॉ. राजस देशपांडे

मैंने डॉ. एसके से मिलकर मेरी परेशानी बताई. वो मुझे उस प्रोफेसर से मिलने ले गए. पहले उन्होंने मुझसे कहा के मैं उस प्रोफेसर से माफ़ी मांगू, बहस के लिए. मैंने माफ़ी मांग ली. फिर उन्होंने उस प्रोफेसर से कहा “राजस मेरा छोटा भाई है.इसे कभी कोई धमकी न देना. अगर ये परीक्षा में अच्छा परफॉर्म करें, तो इसे पास कीजिये, अगर नहीं, तो आप इसे भले ही फेल कीजिये. लेकिन अच्छा परफॉर्म करने के बावजूद भी अगर ये फ़ैल होगा, तो मैं जरूर आप के खिलाफ आवाज उठाऊंगा. बाकी तीन परीक्षकों से मैं पूछूंगा”.
प्रोफेसर साहब ने तब कहा के उन्होंने ज्यादा गुस्से में मुझे धमकी दी थी, उनका मुझे फ़ैल करने का कोई इरादा नहीं था. बात यहीं मिट गई.

परमात्मा कि कृपा, अच्छे गुरुजन और कड़ी मेहनत के कारण मैं अपनी एमडी मेडिसिन कि परीक्षा पहली ही बारी में ही पास हो गया. जब मिठाई लेकर मैं डॉ एसके के पैर छूने पहुंचा, तो उन्होंने मुझे अपनी माँ से भी मिलाया. उस ने अपने बटुए से सौ रुपये निकलकर मुझे दिए ही, पर बहुत प्यार से ढेर सारे आशीर्वाद भी दिए. © डॉ. राजस देशपांडे

अपने स्कूल और कॉलेज के दिनों में मेरे बहुत सारे दोस्त थे, समाज के सारे वर्गों से. विद्यार्थी कभी जाति के बारे में सोचकर दोस्त नहीं बनाते. कॉलेज के दिनों में मेरे डॉ. बाबासाहेब आंबेडकर एसोसिएशन के कार्यकर्ताओं से बहुत अच्छे सम्बन्ध थे, क्योंकि दो बार जब मैं किसी अन्याय के खिलाफ अकेला झगड़ रहा था, कोई साथ नहीं दे रहा था, तब उन्होंने मेरी बहुत मदद कि, उन्ही के कारण मैं अपनी ज़िन्दगी कि दो बड़ी लड़ाइयां जीत सका.

डॉ. बाबासाहेब आंबेडकर के पास दुनिया का सबसे प्रभावशाली अस्त्र था: फाउंटेन पेन. यह भी एक कारण है जो मुझे उनके प्रति बहुत आदर है. किसी और शस्त्र-अस्त्र कि जरूरत ही आदमी को नहीं है! समाज के दो समुदायों के बीच का कोई भी वाद-विवाद कभी भी झगड़ा या हिंसाचार से खतम नहीं हो सकता. एक-दुसरे के प्रति आदर और प्रेम दिल में रखकर साथ चलने से ही हम सारे समाधान खोज सकते हैं.

भाग्यवश, भारत में कोई भी डॉक्टर किसी भी पेशंट के बारे में सोचते हुए जाति-पाती का विचार नहीं करता. जैसे कोर्ट के आँगन में एक जज का अमल सर्वोच्च होता है, वैसे ही भारत के हर मेडिकल कैंपस में इंसानियत ही सर्वोच्च मानी जाति है. ह्रदय हो या खून, दिमाग हो या सांस, ये किसी भी जाति के अलग नहीं होते. बड़े दिमाग कि तरह ही एक बड़ा दिल भी मानव कि उन्नति का एक प्रमुख मानदंड है. © डॉ. राजस देशपांडे

मेरा सपना, मेरी प्रार्थना है कि समाज के विभिन्न घटकों के बीच में विभाजित विचारों के ये काले बादल हमेशा के लिए नष्ट हों. हम सारे एक दुसरे को अपनी जैसा ही केवल एक इंसान समझें, कोई भेदभाव न रहे. विद्यार्थियों में हर दरवाजा खोलने की, हर दीवार तोड़ने की क्षमता होती है, उनसे हमें बहुत उम्मीद है.

किसी भी भेदभाव को न मानते हुए हर पेशंट कि ज़िन्दगी और स्वस्थ्य के लिए दिन रात काम करने वाले वैद्यक समाज में से एक होने का मुझे गर्व है. अपनी प्रैक्टिस से बाहर भी, मेरा ये मानना है के जिस भी भगवान कि मैं पूजा करता हूँ, वही मिझे मिलने वाले हर व्यक्ति में मौजूद हैं.

एक पेशंट के आशीर्वाद का कोई रंग नहीं होता, दुआ कि कोई जाति यही होती. एक डॉक्टर होने के नाते मेरा धर्म, मेरी जाति, और मेरा कर्त्तव्य सारे एक ही है: सिर्फ इन्सानियत.

डॉ. राजस देशपांडे
न्यूरोलॉजिस्ट
रूबी हॉल क्लिनिक पुणे

जरूर शेयर करें.

The Colour Of Blessings

The Colour Of Blessings

© Dr Rajas Deshpande

Carefully calculating the dose and mixing it with the intravenous fluid with precision, I told the kind old lady: “I am starting the medicine drip now. If you feel anything unpleasant, please tell me.”

Through her pain, she smiled in reply. Her son, my lecturer Dr. SK, stood beside us and reassured her too. He had to leave for the OPD, there already was a rush today. “Please take care of her and call me if you feel anything is wrong” he said and left.

Dr. SK’s mom was advised chemotherapy of a cancer. It was quite difficult to calculate its doses and prepare the right concentration for the intravenous drip. Just a month ago, my guide Dr. Pradeep (PY) Muley had taught me how to accurately prepare and administer it, so when Dr. SK’s mom was admitted, he requested me to do it for her too.

The drip started. After a few hours, I noticed that her urine bag needed emptying. The ‘mausi’ supposed to do it was already out for some work. Any resident doctor in India naturally replaces whoever is absent. So I wore gloves, requested a bucket from the nurse, and emptied the urobag into it. Just as I carried the bucket with urine towards the ward bathrooms, Dr. SK returned, and offered to carry it himself, but I told him it was okay and went on to keep the bucket near the bathroom where the ‘mausi’ would later clean it. © Dr Rajas Deshpande

Once the drip was over, Dr. SK invited me for a tea at a small stall outside the campus. He appeared disturbed. He said awkwardly: “Listen, please don’t misunderstand, but when I saw you carrying my mother’s urine in the bucket, I was amazed. You are a Brahmin, right? When you were away, my mom even scolded me why I allowed you to do it, she felt it was embarrassing, as we hail from the Bahujan community. I am myself a leader of our association, as you already know”.

I knew it, to be honest. His was a feared name in most circles.He was a kindly but aggressive leader of their community, but always ready to help anyone from any caste or religion, to stand by anyone oppressed, especially from the poor and discriminated backgrounds.

“I didn’t think of it Sir! She is a patient, besides that she’s your mother, and I am your student, it is my duty to do whatever is necessary. Otherwise too, my parents have always insisted that I never entertain any such differences”. I replied. © Dr Rajas Deshpande

“That’s okay, but I admit my prejudice about you has changed,” he said. “If you ever face any trouble, consider me your elder brother and let me know if I can do anything for you”. What an honest, courageous admission! Unless every Indian who thinks he / she is superior or different than any other Indian actually faces the hateful racist in the West who ill-treats them both as “browns or blacks”, they will never understand the pain of discrimination!

As fate would have it, in a few months, I had an argument with a professor about some posting. The professor then called me and said “So long as I am an examiner, don’t expect to pass your MD exams.”

I was quite worried. My parents were waiting for me to finish PG and finally start life near them, I already had a few months old son, and our financial status wasn’t robust. I could not afford to waste six months. © Dr Rajas Deshpande

I went to Dr. SK. He asked all details. Then he came with me to the threatening professor. He first asked me to apologise to the professor for having argued, which I did. Then he told the professor: “Rajas is my younger brother. Please don’t threaten him ever. Pass him if he deserves, fail him if he performs poor. But don’t fail him if he performs well. I will ask other examiners”.

The professor then told me that he had threatened me “in a fit of rage”, and it was all over.

With the grace of God, good teachers and hard work, I did pass my MD in first attempt. When I went to touch his feet, Dr. SK took me to his mom, who showered her loving blessings upon me once again, and gifted me a Hundred rupee note from her secret pouch. © Dr Rajas Deshpande

Like most other students, I’ve had friends from all social folds at all times in school and colleges. I had excellent relations with the leaders of Dr. Babasaheb Ambedkar Association, and twice in my life they have jumped in to help me in my fight against injustice when everyone else had refused. I love the most fierce weapon of all that Dr. Babasaheb Ambedkar himself carried: the fountain pen!

No amount of fights will ever resolve any problems between any two communities, the only way forward is to respectfully walk together and find solutions. Fortunately, no doctor, even in India, thinks about any patient in the terms of their religion or caste. (© Dr Rajas Deshpande). Just like the Judge in the court premises, humanity is the single supreme authority in any medical premises. Blood or heart, brain or breathing are not exclusive to any religion or community. Just like the bigger brain, a bigger heart is also the sign of evolution.

I so much wish that the black clouds of disharmony between different communities are forever gone. The only hope is that our students can open any doors and break any walls, so long as they do not grow up into egoistic stiffs. © Dr Rajas Deshpande

I am proud to belong to the medical cult of those who never entertain any discrimination. A patient’s blessing has no coloured flags attached! Even outside my profession, I deeply believe that the very God I pray exists in every single human being I meet. If at all anyone asks me, I am happy to say that:

My religion, my caste and my duty as a doctor are all one: Humanity first!

© Dr Rajas Deshpande

Neurologist

Pune

Please Share Unedited

A Dangerous Disease Called ‘Relatives’

A Dangerous Disease Called ‘Relatives’
© Dr. Rajas Deshpande

“What all can happen, doctor?” asked the young lady accompanying her father.

He had had a vertigo for two years, now had developed headaches and had seen best of the specialists. Some of them had advised him an MRI scan, but the daughter who was “in-charge” of her father had decided to wait. They had undergone many treatments simultaneously: allopathic, Ayurvedic, Homeopathic, Herbal, Diet, plus various random suggestions by relatives (almost all patient’s relatives are experts on all medical topics except actually paying bills and donating blood).

The father, a victim of experimentation by a health enthusiast daughter whose profession was law, was visibly anxious and almost shaking.

After examining him, I told them that there were some soft signs, but also that a physical examination may often be inconclusive, hence it was wise to investigate. What must be done must be done. A true Saint, scientist, soldier or doctor will always live by those words. I must stress the need for the right investigations. I told the daughter that he must undergo a scan. © Dr. Rajas Deshpande

That’s when she asked “What are the possibilities?”
Imagine an anxious person sitting in front of you, dead scared of death or illness. He / she is praying God or providence that the doctor does not use and scary words like cancer, heart attack, paralysis, dementia, parkinson’s or early death. No one likes these words, the doctor likes them least. Almost every doctor thinks of the patient’s mental status before choosing the words in such cases. Some patients can even commit suicides if they are too stressed with the fear of long / grave disease.

However, the hyper daughter refused to be subtle.
I told her “You can ask me all the questions you want. But please remember that some answers may scare the patient, Also, I may not have all the answers at this point.’

“Can this be something dangerous? Like cancer? Can this be an emergency? Can it cause death? If so we will do the MRI today itself. Otherwise we will wait.” She said.

To protect the patient from death, suffering and disease is a doctor’s duty, but the law does not allow the doctor to protect the patient from such insensitive relatives. © Dr. Rajas Deshpande

“Madam, there are limitations of physical examination,and we cannot see inside his body. Sometimes we find things wrong inside that can be cured with the correct early treatment. That is the reason we have tests and scans”. I told her patiently.

“But what are the chances of this being a cancer or something life threatening? If at all the scan shows something dangerous, can you guarantee it will be cured?” she asked.

I gave another shot of adrenaline to my patience. © Dr. Rajas Deshpande

“How does that help you?” I asked her, “Even if the chance of a dangerous possibility is low, say 5 %, will you take a chance on your father’s life just to avoid investigations? How can I guarantee the treatment or cure of something we both don’t know yet? By the way, what is your objection to get his scans done?”

“We will do the scan if you say this is urgent” she said.

My patience kissed me a goodbye.

“It is indeed necessary, I cannot say it is urgent. Now I must see another patient.” I replied. Then looking at her anxious father, I reassured him “It is a very low chance that there will be anything dangerous. Please relax. And we have cures for many diseases now, I am with you. Don’t worry”.
“Then can we wait for the MRI?” the daughter was incurable.
“No” I replied, calling in another patient.

I received many messages for next few days from her and her invisible brother asking if the scan was really necessary, where was it done cheapest, etc. I didn’t reply.

They returned after a week. The MRI showed a tumor causing pressure effects on the vital areas of lower brain. This indeed was an urgency, if not emergency. I told the daughter so.

“How come he developed a tumor? He never had it earlier. No one in our family had it ever” she asked angrily, “Is it the side effect of all the medicines he has taken in last two years?”.

I had almost forgotten in which society I was practicing. Education does not always convert into common sense. Money, skimpiness and hatred replace logic here. © Dr. Rajas Deshpande

“In most cases, a brain tumor is not the effect of commonly used medicines. I don’t know the contents of all the medicines you tried upon him. But the delay in doing tests is one definite major factor that your father has suffered so long”. I told her. What must be said must be said!

She changed the topic, a knack every doctor must learn from some lawyers!

The patient has now undergone a surgery by one of the best neurosurgeons, and fortunately the tumor has turned out non cancerous. His headaches and vertigo have gone. However his anxiety and fear will take a long time to go, he is on the medication for that.

The daughter has changed a lot too. The last time she visited for her own headaches, I told her to get a check scan done, and she showed me the reports the same evening. They were normal, she is happy now!

Many patients suffer for years, develop disability and some die due to such dangerous relatives who experiment upon them, delaying investigations and treatment. The most common purpose is saving money, but there are also whims and illogical, dangerous treatments without the knowledge of the contents and interactions between medicines of different medical and quackery streams. The doctors who try hard to save the damage in the last moments often become victims of criticism. This dangerous disease called “Relatives” who suggest everything but disappear when the patient truly needs them has become rampant in our society!

As for my patience, I had to take it for a long night drive and feed it a lot of icecream that day to agree to return to stay with me again.
© Dr. Rajas Deshpande

(Yes, some doctors take advantage and earn money through tests. This is definitely wrong, but the price of delayed and denied tests is far more. In fact, many relatives make that an excuse to avoid spending for the tests. It is conveniently forgotten that almost all essential tests are available at govt. / charity hospitals at a negligible cost).

Please share unedited.

Advise Doctors What To Do?

 

For the hypocrites who don’t do anything to correct their own profession (almost every profession has immense corruption), but think they have the right to criticise other professions. Criticising the most intellectual profession of doctors irrespective of one’s own credibility, effort, contribution, or even intellect, has become an ugly fashion.
Here’s the answer:
(C) Dr. Rajas Deshpande

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The Paragon of Courage (My Worst Night As a Doctor)

The Paragon of Courage
(My Worst Night As a Doctor)
© Dr. Rajas Deshpande

“She is sinking. Unlikely to survive” said a doctor who had come for second opinion. The parents broke down. The father, a gentleman, held his speech as tears ran down his face, but the mother, like all mothers, could not hold her pain.
“Why Us? Is this all really happening? Why did we even do this procedure? I don’t know anything, doctor. I want my little girl back” she said, crying.

That was the worst night of my career as a Neurologist.
It was 2 AM. Dr. Anand Alurkar and myself waited on the road outside Ruby hall Clinic, Pune. We both felt extremely low, tearful. The loss of a life as a complication of treatment is the worst nightmare of a doctor. To save lives, a doctor must take courageous decisions, do the best thing for the patient. Every doctor, especially a surgeon, has to face this cruel dilemma: to not treat, let things be and leave the patient to nature’s rules and agonies, or try to save a life with the two inherent risks: a medical complication and the reality that such a complication may make the doctor an instant villain.

Three days prior, Tanushree, a 17 year old student from Manipur had gone to Pune airport to see off a friend. She suddenly fainted there and had a convulsion. Her friend brought her to my OPD. Her examination was normal, but she seemed quite aloof and had mild headache. An urgent MRI showed a bleeding in her brain. She had a bunch of abnormal blood vessels in the brain, which form a tangle. Some such blood vessels may bleed as they have thin wall, or when the pressure inside the bunch increases. In such cases the abnormal blood vessels are usually closed with a glue injected inside them. It is a standard, but very complicated procedure that requires skill and experience of years. I had called in Dr. Anand Alurkar, he had treated many such cases successfully. He opined that the girl would need such glue injection / embolization.

The procedure is risky (one must enter the brain’s blood vessels with a thin tube / catheter inserted from the leg), and other than the usual minor risks of any hospital procedure, the major risk here was a possibility of fresh bleeding in the brain, which happens in 1 percent of cases even if the procedure is correctly done. Such bleeding can even be life threatening.

Tanushree’s parents, Mr. Khuraijam RatanKumar Singh and Mrs. E. Meghabati Rani ji, were in Manipur. They arrived immediately. Mr. Khuraijam is a highly placed officer, and wanted to give her the best treatment options, they didn’t care about expenses.

We could understand that we were quite new as doctors for the family, and far away from their home, in a strange land. In view of recent bleeding in the brain, it would be risky for Tanushree to fly. We had all the necessary facilities. We explained the situation to them, including the risks. Her parents told us that they had complete faith in us. They signed the papers, consenting for the procedure. Tanushree was fully conscious, and had no complaints.

A brave teen, she went into the cathlab smiling, at 3 PM.

The procedure took over three hours, at @ 6 PM Dr. Anand confirmed that everything was done well, she was stable. She was shifted out to the ICU for observation. I saw her after the procedure, she smiled back. We went home for dinner. I planned to return to see her late night.

The nightmare began.
Just before I reached home, I got a call from the ICU team. “Tanushree complained of a severe headache, and then has become unconscious” said the panicked ICU doc.
“Get an urgent CT scan” I said as I took a U-turn. It was 9 PM.
The CT scan showed fresh bleeding.

That one major complication, known to happen in extremely rare cases despite all precautions, had happened in this 17 year old teen. The bleeding was substantial. Dr. Anand came rushing back too. We started all the emergency treatments for reducing the swelling on her brain. The parents, lost and broken, supported each other. Her mother was upset with the whole thing, and felt guilty that they had consented for the procedure. I understood her feelings, but was helpless. I knew how my mother would have reacted, and this was not different. We now prayed that Tanushree improved, and desperately hoped that her brain swelling reduced. But things went worse.

At @ 4 AM her brain swelling started to cause pressure effect on the brainstem: the area that controls heart, breathing and blood pressure. Once that area fails, the patient is unlikely to survive. She became almost comatose. In an unfortunate twist, a doctor called in for a second opinion told that parents that there were no chances of survival. The parents lost it.

I discussed with Dr. Anand. We were not willing to give up. There was a very small chance of her survival, if her skull was opened to relieve the pressure effect of the bleeding on the brainstem. But this is a major surgery, and has more risk than the earlier procedure. We explained the situation to the parents. Her mother was disturbed beyond decision making. Her father told me: “Do what you think is the best. I will leave it upto you”.

Once again, I had to risk her life in an attempt to save it. Only a doctor would understand the full implication of these words.
I called our senior neurosurgery expert, Dr. Ashok Bhanage. He arranged for an emergency surgery within a few minutes. He spoke to the parents, explained that there is risk of death even during surgery, and took her in. I waited with the parents in the waiting room.

“Save her, I beg of you” I kept telling my God.

After three hours, she was wheeled out to the recovery room, on a ventilator. In two days, the ventilator was taken off. She had developed paralysis of the right half of her body, and lost speech. In a week, she started speaking a few words. In a month, she started walking and regained almost complete speech, but her memory was still not well. She was stable. I thanked Dr. Bhanage for his timely response. Accepting the risks, he had turned the game over.

Every doctor has to play every day with these fears: of mistakes, of complications, which will ruin his / her career within moments. It is a stress beyond description, and amplified in case of surgeons. The more aggressive and distrustful the relatives or the patient, the more difficult the decision making, the higher the risk of a decision in favour of avoiding risk, even if life saving.

On the day of her discharge, Tanushree’s father and mother became emotional, and thanked our team with beautiful, heartfelt words. Her father also gifted me a Reid and Taylor suit fabric, which I will pass on to my son as my precious treasure.

In a year, Tanushree recovered nearly completely, and joined back her college. She went to London to explore possibilities of further education, and now has chosen to pursue law. In spite of some mild effects that the event has left upon her, she continues to be brave and bold, and takes on any challenge with the grit of one who has already defeated death.

When she followed up yesterday, she was smiling as brightly as she ever does! “Sir, I am sure I can defeat any problem in my life now, after what I have overcome” she told me.

Her father told me: “You are God for us”. As much as I love and respect those undeserved words, I am keenly aware that there is only one God that looks after both: the patient and the doctor.

I cringed at the thought: “What if, out of fear that night, I had decided not to advise her that second surgery?” I will never forget that being a doctor I am also assigned this extra responsibility: to take the best decisions fearlessly for my patients, to explain them well to the family, and to hope for the best.

I was lucky that my prayers were answered, and I learnt that my God also meets me in the life of my patients.
© Dr. Rajas Deshpande

PS:
Thank you, Ms. Tanushree Khuraijam, Mr. Khuraijam RatanKumar Singh, and Mrs. E. Meghabati Devi Ji, for the permission to share this story.

There must be far better doctors and teams in India and abroad, I am sure. This article is to highlight the plight of what a doctor feels when things go wrong, and to tell the world about the exemplary courage of a teen.

The Overdose of Medical Advice

The Overdose of Medical Advice
© Dr. Rajas Deshpande
“If the doctors want to go to a five star hotel, they must pay for it” said someone recently in a headline.
Well yes, like any hardworking honest professional, even a doctor may want to go to a five star hotel occasionally, and have a good time, especially given the sadness that surrounds his / her profession. There is nothing that prevents me as a doctor from wanting to go to a five star hotel once in a while, and I do not feel guilty about wanting to live a good life. Earlier, I was happy to attend some great lectures by the world’s best doctors brought to India by the pharma industry (because the government never can), now I will just pay for myself.
Whether a five star meal comes from the profit of pharma industry or the hard work of doctor’s fees, there will be objections for sure. The problem is not the five star meal, the problem is elsewhere. So the different ministries can officially host super luxurious parties on different religious / non religious occasions to woo voters via the taxpayer’s money (and the media will describe the Biryanis and Gulab Jamuns in paragraphs), but the doctor must never eat a free luxury meal!
Many non medical professions, industries, financiers, film industry people, bankers and builders host dinners / other events at five star hotels, and many government officers / ministers attend them. Do they all pay for themselves? Just because a minister attends a five star dinner, he cannot be presumed to be doing a hidden favour to some industry, likewise, a doctor attending an academic event cannot be presumed to be doing a favour to any pharma. © Dr. Rajas Deshpande
It is doubtless that some doctors may have misused this facility and overspent. But the huge advantage: giants in the different medical fields from the developed world coming and educating the doctors in India will be greatly sacrificed by such limitations.
Given the social envy and jealousy against the doctors now rampant, it is probably an inevitable but unfair step by some organisations recently to ban pharma sponsorship of certain medical events at five star hotels. It is also a good initiative to reduce drug prices. But then, can the same organisations and even the federal bodies show the same guts and ban following malpractices too:
Open sale of undergraduate and postgraduate medical seats all over India, that creates funds worth trillions, benefitting even some in the highest offices of the country? Where does this money come from, and where does it finally go? Are we innocent enough to presume that the patient is not ultimately paying for this? © Dr. Rajas Deshpande
Under the medical consumer protection act, is not the government required to make all the facilities of healthcare available at all government hospitals in our country at subsidised rates? It is argued that taxpayers are paying for the education of medical students who enter medical colleges by merit, which is wrong, because the taxpayers are actually paying for good health facilities at the said hospitals. But most of the hospitals / medical centres run by the government are understaffed and run far below acceptable conditions. How many government health set ups have been evaluated for accreditation by standard bodies, and what are the results?
The insurance companies and corporate hospitals have held the private doctors prisoners of their atrocious conditions, and even the paying patients are being provided a substandard service, thanks to a total absence of any willingness to question any of this on the part of administration.
The demand and supply of “Cheap everything” in medical profession has now gone to such a dangerous extent, that substandard staff, incompletely qualified professionals, low rate medical instrumentation and quality of service, and above all, ineffective / low quality medicines have become a horrific reality already, even at some corporate hospitals dominated and dictated by the insurance sector.
They are giving people what they want: Glittering Cheap Healthcare. It is so surprising that the patients are happy with only this one quality of service and drugs: cheapness. The day that our society will understand that like anything else, good healthcare will cost more and will obviously involve more profit-making, our health scenario will improve. © Dr. Rajas Deshpande
The IMA, while trying to play safe and readily making rules like banning sponsorship, should take a firm stand to fight against the one sided war waged upon the medical profession by some.
Written in a state of perfect peace, not frustration.
Because I am not sold out to the desire to be liked by everyone, especially those against doctors.
© Dr. Rajas Deshpande

A Medical Lesson That Still Hurts

A Medical Lesson That Still Hurts
© Dr. Rajas Deshpande

“Can’t you see I am with a patient? We can talk later. Or may be tomorrow” snapped my lecturer at Pallavi.

Pallavi was 26, had epilepsy herself, but used to sit in our OPD to help other epilepsy patients. She came from her home by local train, travelling over two hours, and went back after OPD to attend her father. She was on many medicines to control her fits and depression, still used to have frequent fits. An epilepsy surgery was not possible, my professor and lecturer who were her caretakers had explored almost every avenue for her. Some unfortunate patients do not respond well.

Obviously she could not get a job and sitting at home worsened her depression. She was quite good looking and kind. However, her father was bedridden with a paralysis attack, and had many problems, even bedsores. That stress made Pallavi cranky and always worried. With no source of income, she was dependent upon help from the staff at our municipal hospital. As she was too proud to accept money without working, my professor had eased her ego by requesting her to help other patients: OPD paperwork, forms, getting medicines, patient education and restrictions etc.

She would either consult us resident doctors or our teachers if there was anything wrong with her or her father. Sometimes her anxiety was too much to deal with, she often asked repeated questions. Some epilepsy and psychiatry patients have worst symptoms around menses, and even get combative.
Most government and corporation hospitals have a never ending line of patients. In that rush it became impossible to answer her repeated questions patiently, and someone or other usually had to either snap at her or prescribe her an anxiolytic. Sometimes being too kind or available results in more attention seeking.

“See if Pallavi is OK” my lecturer told me after a few minutes.

Sulking, Pallavi had gone to the pantry near OPD and sat alone. During our tea break myself and my colleague Dr. Sachin went there too. My thesis / dissertation submission was in final stages, where everything about it seems so pointless and meaningless. I had to submit it within two weeks. © Dr. Rajas Deshpande

“Tea, Pallavi?” we asked her as she sat in the corner.
“No, Doctor. I’ve had it. Thank you” she said. We drank our tea in an invaluable silence.

She suddenly said: “Doctor, my father has started continuously calling me names. He uses very bad language. My headache becomes unbearable when he starts shouting.” She became tearful.
While having tea, I wrote her prescriptions for herself and her father too.
“Doctor, I want to talk” she said, “I need to sort out things in my life” she said.
“Pallavi, the OPD is still heavy, we will talk after lunch, ok?” I replied. It was 3 PM already. We finished tea and returned to the OPD.

A few minutes later, I heard her crying in my teacher’s cabin. “You must learn to be patient” my teacher was trying to pacify her while attending other patients who kept angrily rushing in, demanding their own time. © Dr. Rajas Deshpande

Pallavi got a call from home and left the OPD before it was over.
I went straight to the printer after OPD for the final corrections of my dissertation.

That evening we got the news that Pallavi had fallen off a local train, killing herself. No one knew if it was a suicide.

I have never been able to overcome that till now. What if I would have spent few more minutes, talked her in kinder words, pacified her better?

I learnt one of the most important and precious lessons that every doctor learns eventually: There’s no afterwards. Answer the patient in front of you NOW. Never deny time to one in genuine trouble. A minute of a doctor’s patience can save lives.

This became clearer later, this is true about everyone, not only doctors or patients; no one ever knows which one is the last meeting between any two. Now I make sure to only part with a proper goodbye, a smile and no bad feelings: apologise if I am wrong, forgive if the other one is. Some say that feels too formal, some think it is a way to impress others, or being excessively unnecessarily mannerful. But I know what I mean. There are no guarantees in life: about myself at least. Every goodbye is potentially final.

Patients never seem to stop. Everyone is in their own hurry, tired, pissed off . The doctor is the common point of venting problems, frustrations and also anger. Most doctors acquire the saintly art of not losing patience, raising voice in the worst of situations, but it is at the cost of being inhuman to themselves. To spend 12-16 hours every day (18-20 in case of resident doctors) among the angry, suffering and accusative without losing patience is not a joke. This is one reason why patients see irate/ less interactive doctors commonly and misinterpret it as “ego / pride / snobbishness” etc.

That said, since that incidence in our OPD, I do not refuse any question from any patient in front of me. I do not end the consultation unless I have answered their last question or the patient starts taking advantage by asking repeat or unnecessary questios.

Pallavi, I feel very sorry.
Patient First, Patience Highest, Always, for Every Doctor.
Thank you for the lesson.

© Dr. Rajas Deshpande

Real Story. Identities masked. Please Feel Free To Share Unedited.

तुम देशभक्त नहीं हो सकते!

तुम देशभक्त नहीं हो सकते!
© राजस देशपांडे

ईमानदारी से अपना काम करते हो,
नेकी से घर चलाकर, परमात्मा को पूजकर
अपने बच्चों को बापू की कहानी सुनाते हो,
पर तुम्हारे पास जबतक वक़्त नहीं है नारे लगाने का..
नेता की जूती को सर आँखों पर रखकर
मेरे चुने देशभक्ति के गीत गाने का…
तुम देशभक्त नहीं हो सकते!

मेहनत कर, पढ़ लिख कर देश की सेवा में
पीढ़ी दर पीढ़ी तुम्हारी भले ही वैज्ञानिक बनी हो..
देश विदेश में भले ही तुम्हरी बुद्धि, और कला
देश की गरिमा-सी सराही जाती हो
पर तुम्हारे पास जबतक वक़्त नहीं है नारे लगाने का..
नेता की जूती को सर आँखों पर रखकर
मेरे चुने देशभक्ति के गीत गाने का…
तुम देशभक्त नहीं हो सकते!

सीमा पर लड़ता हर स्वाभिमानी जवान भले ही
लड़ रहा हो देश की खातिर, मेरी तुम्हारी खातिर,
तुम्हारे मन में भी उसके प्रति हो भाई-भगवान सी भावना
पर तुम्हारे पास जबतक वक़्त नहीं है नारे लगाने का..
नेता की जूती को सर आँखों पर रखकर
मेरे चुने देशभक्ति के गीत गाने का…
तुम देशभक्त नहीं हो सकते!

लाखों मरीजों को भले ही तुम ज़िन्दगी देते हो
करोड़ों विद्यार्थियों को पाठशाला में अपनेही बच्चों जैसे
बढ़ाते पढ़ाते हो, नेकी की राह और देशप्रेम सिखलाते हो
पर तुम्हारे पास जबतक वक़्त नहीं है नारे लगाने का..
नेता की जूती को सर आँखों पर रखकर
मेरे चुने देशभक्ति के गीत गाने का…
तुम देशभक्त नहीं हो सकते!

इंसान को रंगों में बांटकर, तलवार छुरी चलाकर
इतिहास का बदला जबतक वर्तमान से लेते नहीं हो,
तुम देशभक्त नहीं हो सकते!
उबले खून की जवान नस्लों को गजरे बाँध
सोने में लथपथ लार टपकाना सिखाते नहीं हो..
तुम देशभक्त नहीं हो सकते!
भेड़ बकरियों की तरह ऊँगली उठने पर सलाम नहीं करते हो..
तुम देशभक्त नहीं हो सकते!

शिवाजी, सरदार और नानक के देश का शेर होकर भी
तुम्हारे पास जबतक वक़्त नहीं है नारे लगाने का..
नेता की जूती को सर आँखों पर रखकर
देशभक्ति के गीत गाने का…तुम देशभक्त नहीं हो सकते!
राजस देशपांडे
© Dr. Rajas Deshpande