Tag Archives: Indian doctor

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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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

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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).

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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 Power

The Power

© Dr. Rajas Deshpande

“He is probably brain dead” said the daughter, holding back tears.

“Now we have to make a decision whether to continue treatment or not. We are not that rich. Can you help us decide?”.

Not very pleasant, nonetheless the inevitable duty of a doctor: to decide when to pull the switch off. We suffer these decisions too. I went with them.

The patient had developed a heart attack just after a supra major heart surgery, the risk was already predicted by doctors and accepted by the relatives. Now he had no visible signs of any brain function, and the doctors had updated the family so. What with film stars alleging that “some hospitals keep dead patients on ventilators”, most hospitals and doctors now are on the overprotective / overcautious drive, especially with a society that has more blind faith in cinema than in medical profession. © Dr. Rajas Deshpande

As I examined the patient, the handsome junior cardiac resident doctor, Dr. Paramjeet, standing by my side kept on informing me details. An uncorrupted mind of a resident doctor, who wants to do good to all patients, save every patient with heroic efforts was too evident in his demeanour. As in most cardiac care units, the smartest and fastest nurses were hovering around, silent angels who do such enormous complicated brilliant work without any hoopla about it!

I found some doubtful signs of life in the patient’s brain. I told the relatives “His brain is alive, we do not even have a right to think of stopping treatment at present”.

“Don’t worry, Sir, we want to continue. Make all efforts for him please, we will make arrangements too” said the daughter, with something that most doctors see every day: tears, smile and a heavy throat all at once. © Dr. Rajas Deshpande

As I instructed about the changes in prescription, I noticed that Dr. Paramjeet was tearful too.

Outside the CCU, I asked him what was wrong with him. He told me he had had an argument with his boss that morning, when the boss had told him to inform the relatives about this patient being probably brain dead. He had assisted his boss for this surgery, and was reluctant to let the patient die under any circumstance. However, the boss had seen many more seasons, and knew what was legally required, even if it was against common sense sometimes. The boss cared for the patient as much, but was aware of how things go wrong when the relatives are suspicious and faithless.

I received a call from that unit after two days again. The patient had started moving one leg. Dr. Paramjeet and the nursing staff were very excited when they told the details of his improvement. There definitely were more signs of life. The family was completely cooperative, and repeatedly assured the doctors of their trust in the on-going treatment and the staff’s efforts.

In another week, the patient opened eyes. In a month, he started speaking a few words, and standing without support. He was discharged. © Dr. Rajas Deshpande

Yesterday, the whole family came for a follow up. Dr. Paramjeet accompanied them too, happily carrying his gift bag. The patient had regained almost all his faculties, the cardiac surgery had given him a new life. The family told him once again in front of me, what all had happened. Then the wife, who was always there by the patient’s side but had never spoken a word, folded her hands and handed over to me a box of sweets and a shirt and started to speak, but choked upon her emotions. “You returned me my husband” she said. © Dr. Rajas Deshpande

Well, my mental OCD acts up sometimes too, and I told her that it was the cardiac surgeon, Dr. Paramjeet and the nursing staff who saved her husband, not me.

“Yes, but it was you who told us we must try. You doctors have powers like God” she said.

That was simple to answer.

“Tai (Sister)”, I replied to her, “Whenever a patient completely trusts the doctor, it becomes an automatic responsibility of that doctor to cross all barriers and make every effort to save that patient. That power is in your faith. We have just done our duty”.

When they left, Dr. Paramjeet showed me his gift: a wrist watch and a gold chain. “I am gifting these to my Mom and Dad, Sir, when I go home this diwali!” he told me.

I knew how his parents would feel. Every doctor knows it.

© Dr. Rajas Deshpande

Please share unedited.

A ‘Poor’ Indian Patient.

Alcohol addiction and heavy drinking for decades. Over 5 packets of Gutkha / tobacco per day for many years. Few accidents due to drunken driving, once head injury after a bike accident, without helmet. Poor diet control. Diabetes, blood pressure, heart disease, obesity. Rich landowner. Came to OPD with a personal attendant to hold his files and medicines, and carry his napkin. 8 rings, gold and platinum, with various precious stones. Thick gold necklace. Costly perfume. Arrogant to the core in behavior, artificially formal language on the verge of threatening. Age 62.

Free consultation and treatment since many years under some government scheme, so has seen almost all senior specialists in town, in different hospitals.

The consultant advised a simple diagnostic test. Patient asked for 30% senior citizen concession for that non-urgent test, which is not sanctioned free by govt. The lady technician said it is not in her authority to sanction concessions. His tone changed: “I can sue you for this.. you are delaying my emergency treatment for money”. His attendant’s face became ferocious, like a dog ready to attack.

“We will do the test now, Sir, but you will have to make the payment and get a receipt. These are hospital rules, I cannot bypass them. This is not an emergency test” the tech explained.
He sat there. “Do the test first, I will pay the money tomorrow when I collect the report. I don’t have any money right now. I will pay tomorrow” he said with a shameless diplomatic smile upon his face, winking at his attendant. The tech did the study after asking the consultant.
Next day he came with two attendants, all white linen, gold studded and sandalwood perfumed. The tech asked him to make the payment before issuing the report.
“You had agreed that I will get senior citizen concession” he said to the tech. She panicked in anger: “I never said that” she retorted. “You did, I heard it” said the doggy attendant.

She didn’t answer. Closing the door, she silently cried in anger.
After waiting a while, they went to the billing, were denied concession as per rules again, got the reports, and went to the doctor, angry at having had to pay.

“You have severe nerve damage related to alcohol and poorly controlled diabetes” the consultant told him.
“It will be completely cured, no?” he asked.
“No. only partial improvement is possible” consultant.
“But I just spent 3000 INR for the test” again six extremely angry eyes stared at the doc.
“That was for confirming the diagnosis and extent of damage” Consultant.
“Ok” said the landlord. “Now give me medicine that will cure this completely”.
“I just told you it cannot be cured completely. These medicines will control and in some cases improve the damage” Consultant.
“Are these medicines costly?” He asked.
“One of these is a little costly. It is your choice whether to take it or not” the consultant still hung on to patience.

“I know doctor.. what these drug companies do for you… TV..Foreign trip.. Hotel… Party..” then he looked at his attendants and winked, touching his nose. “You should think of poor patients like us. In earlier days, doctors always gave cheap medicines, that too without any tests”.

The consultant stood up. Other patients were waiting, and he couldn’t afford to waste time or spoil his mood.The patient didn’t get up. Sitting as comfortably, he read through all the medicines again and asked repeated explanations of the purpose of each medicine. Then, he handed over the paper to his attendant.

“Reduce and stop alcohol and tobacco, and control diabetes well. Also eat carefully as advised” said the consultant, regaining composure.
“Yes. Give me your phone number so I can call you if I need to ask something.”
“Sorry, you can call the hospital helpline, I do not advise on phone” consultant said.
“But I just paid 3000 Rs.”he said.
“That was for the test” consultant.

He got up, and looking at his attendants, commented “All doctors have become thieves now. Hospitals have become shops to loot poor patients”.

After the OPD, the consultant went out for a tea, all mentally drained with humiliation and anger, and burning inside at this hopeless situation all over India. From the cafeteria, he saw the landlord patient boarding his Range Rover, parked next to the doctor’s own Santro.

The consultant’s phone sounded a text alarm.
“Your loan installment is overdue. Please make immediate payment to avoid legal action” it said.
© Dr. Rajas Deshpande.

God help the Indian Doctor.

God help the Indian Doctor.
© Dr. Rajas Deshpande
A court recently awarded a compensation of 12 crores to a patient because that’s what she would have earned if alive, as she held a job in the US. While human life is invaluable, there has to be a logic / discipline to such punishments. What compensation was ever awarded to the families of doctors injured / killed by patient’s relatives? Given that those docs would have saved many lives in their future careers, what does the Indian legal system hold the value of the dignity, career, disability and life of a doctor?

Death consequences in India:

If a politician kills someone, his whole party and the people, media houses favoured by his/ her party, and even police officers in his / her favour will stand by him / her. In cases of rapes and murders, there are umpteen examples where even police refuse to register cases because of political interference / influence. There are extremely rare examples of someone being debarred from making laws and participating in the running of country, even as criminal trials are on against them. They are not suspended or punished in 99% cases.

If anyone among the rich and glamorous drunk-drives over and kills people on the road, their whole profession (who usually pose as social icons) stands behind them, so does almost 90 percent of the media which glorifies the good deeds of such icons in defence of the deaths they have caused. The whole system machinery works as a deaf / dumb spectator to their blatant, laughable lies in the courts of law, and many from the society actually sing praises of their “glory”. They are not suspended or punished in 99% cases, in fact the legal systems ensure best humanitarian services for them.
No judges are suspended for a wrong decision.

The law, police etc. accept openly the presence of Mafia and goon houses, media glorifies the stories of daylight murders and bloodbaths by these for ransom etc., and we seldom see anyone even arrested. “Contract murders” are a blooming eventuality, so are gangrapes. No media glorifying crimes like rapes and murders are seen even reprimanded.

With even a little social uproar, compensations are paid for the dead or other victims, in a hope to suppress their agitation against the criminal.

Now come home to this:
If a patient dies while undergoing treatment and the relatives are upset/ illiterate / goons, they can beat up the doctors, even kill them. Doctors are immediately suspended without enquiry and their careers mostly end there.

While the earlier classes of “rich and powerful murderers” dance naked all over the country, the three classes of most stressed-out servicemen : doctors, military and police are completely neglected, the value of their life being zilch for the system and society alike.

Policemen dying while fighting with terrorists get lesser compensation than sportsmen get awards from the governments. Militarymen’s families live eternal poverty after their supreme sacrifice. And doctors who die while treating patients are not even acknowledged by our society or media.

People can see the same film twice, eat the same costly dessert twice, go on unnecessary vacations to enjoy just because they afford and like it, spend on petrol and internet without thinking twice. Many now go for “complete/ whole body check-ups” even when unnecessary, but when a doctor advises investigations or charges fees, they talk of malpractice. Then again, if there is a death in the hospital, the doctor is readily sacrificed, either in career or in life, without any compensation.

One part of this tragedy is some medical professionals itself who live in a “separate paradise”, talking what public and media likes, denying the reality, pretending “All is well” and declaring how proud they are of being in the current situation, where doctors are attacked and killed every other day. They are like the legendary saints who “missed the opportunity”.

But the saddest part of this tragedy is that our non-medical (and even some medical) social intellectuals choose to keep shut when it comes to the rich and powerful, but vomit poisonously and readily bare their fangs at the medical profession.

God help the Indian Doctor.
© Dr. Rajas Deshpande