Tag Archives: Internship

The Nightmare

photo 19-09-16, 22 52 52

“Wake Up! Wake Up!!!” shouted the wife frantically. The husband did not respond.
We told her to remain calm.
“How can you tell me to remain calm, doctor? Are you insane? Do something.. he is dying. What will I do without him? I have a two small kids… I beg of you, doctor! Here, I touch your feet! Please save my husband!” the lady kept shouting, panic-struck.

Her husband was riding a bike with a friend just an hour ago, and was dashed by a high-speed truck. The friend had died on the spot, and this gentleman had suffered a head trauma, with fractures in the bones of one hand and both legs. He was unconscious since admission. We had sutured his wounds, the bleeding was controlled, but he had already lost a lot of blood and his blood pressure was low. He was receiving blood transfusion now. © Dr. Rajas Deshpande

I was an intern then, at the civil hospital Nanded. Our Surgery medical officer had examined the patient, and suspected a bleeding in the skull / brain. There was no CT scan or Intensive care facility available, and the nearest city with a CT scan or ICU was Hyderabad, some seven hours away. The wife decided to shift him to Hyderabad. The MO told them that travel involved risks, the patient could worsen. He also suggested that he must not travel without an accompanying doctor.

“Please come with us” the wife requested me with folded hands. I convinced another intern friend to join me. That was at about midnight, the month was December. Very cold.

We prepared the emergency kit, including various injectables, tubes and Ambu bag required in case the breathing stops. We started in a basic “Ambulance”, with a reluctant driver motivated by the obvious. The night was as chilly and dark as it could be, the road bumpy and dusty, and the ambulance, except that there was a patient and two doctors in it, had nothing else to qualify as an ambulance. The only positive thing about it was its speed. © Dr. Rajas Deshpande

The patient mumbled something and became drowsy again. We requested the wife to please not be affected by such fluctuations, common in patients with head injury. We kept on measuring the blood pressure and pulse rate manually (there were no monitors then). We also kept a watch on his pupil size, as unequal pupils are a hint for swelling or bleeding in the brain. An hour into the journey, the patient had a convulsion. We had already given him an anticonvulsant, a standard protocol, but now we also had to give him diazepam to abort the fit. The fit stopped, but the blood pressure started dropping. We used steroid injections and increased the intravenous fluids. The use of diazepam may depress breathing, but we had no choice here. © Dr. Rajas Deshpande

The patient’s wife had bouts of extreme panic and kept weeping. Her suffering was justified, we tried not to let that affect our decisions. Two other relatives who accompanied her tried to console her. A doctor cannot run away from or avoid any situation, we were learning our lessons.

By 2 AM, the patient appeared relatively stable. The relatives slept off, the wife became silent, occasionally dozing off. I’m a nocturnal animal, but my friend was feeling very sleepy.

At about 3 AM, the ambulance suddenly stopped.
“I cannot drive anymore. I am tired and very sleepy. I need to have a tea and a smoke, otherwise I will fall asleep driving” the driver said. © Dr. Rajas Deshpande
There was no choice. We saw the small tea stall by the roadside. The relatives and patient’s wife had tea, my friend intern went out and had his cigarette and tea, then he sat with the patient while I had my smoke and tea. It was only after we started again that we realized how vital it was to have taken that break! The ambulance gained speed steadily.

An hour later, the patient became quite rowdy, and started to violently throw about his hands and legs, trying to get up. We tried to restrain him, but it became quite difficult, especially because the ambulance was running high speed, and the wife was now almost in a state of shock. We had to use diazepam again. His breathing became shallow, pulse rate started rising. We prepared for artificial ventilation.

As we approached the city by the dawn, the traffic increased, and we faced many blocks. We reached CDR Apollo hospital, just as we intubated the patient and started ventilating him with the Ambu bag. Dr. Raja Reddy, Neurosurgeon there, immediately attended the patient and himself accompanied us to the CT scan room. The scan showed some contusions / injuries to the brain, but no major bleeding. Dr. Reddy reassured the patient’s family, and praised the efforts we had made, being interns. Patient was taken to the ICU.

We returned by an ST bus the same afternoon, after thanking the ambulance driver. Few days later the patient was back on duty, completely recovered. One evening when I returned from the hospital, my parents showed me a beautiful thick gold necklace.

“That couple had come. They wanted to thank you, they gifted this for your son” my mother proudly said. Although my one month son did not know anything about gold, and I do not understand metallurgy well, my parents indeed had very proud smiles for the next few days. The glitter of those smiles is the only Gold I have preserved in life, like many doctors who go through this ordeal every day!
© Dr. Rajas Deshpande

Dedicated to hundreds of doctors who carry/ transfer patients in horrible situations / conditions, risking their own life, all across India.

PS: This is a story circa 1993, the management standards and guidelines, facilities have improved a lot today. Of Course smoking is a bad habit and not justified.
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The Unforgettable Compliment

The Unforgettable Compliment
© Dr. Rajas Deshpande

All six casualty beds were full, the room was full of noises: nurses, fearful and angry patients, relatives, and wardboys trying to move stretchers and wheelchairs in and out. This chaos didn’t affect my concentration anymore. It was late night, heavily raining, my colleague Deepa and myself were the only two doctors- interns then- in the civil hospital casualty. She was finishing the paperwork in the side room. Behind a curtain, I was trying to remove a metal piece stuck in the back of a kid who had blown a firecracker bomb with a tin container covering it. I started stitching the gaping wound once the metal piece was out and cleaning was complete. © Dr. Rajas Deshpande

Just then a girl walked in, all wet and panicked, with another small girl upon a stretcher. I recognized her instantly: she was a classmate from my junior college, Ruta. As the patient was shifted to the bed, Ruta frantically shouted, enquiring for doctors. The nurses had already started checking her patient’s vitals. I finished bandaging the stitched wound, and came out from behind the curtain, removing my gloves. She saw and instantly recognized me too. “You are Rajas, right? Remember me? I am Ruta, your classmate.” She started sobbing, now that she met a familiar face. Her sister, about 15 years old, had had a head injury, falling from a bike, and had just vomited. She was woozy, irritable and confused. I ordered an X ray (CT scan was not available in that civil hospital) of her head and neck. IV line was started and necessary drugs injected. I reassured Ruta that her sister was stable, and continued with other patients.

My subconscious kept on playing memories of the past on some deep screens.
Ruta was exceptionally beautiful and vivacious. She had many fans. I liked her too, but there was no interaction: her group unlikely to engage with nerds like myself. They were a group of happy-go-lucky, good looking and muscular guys and stylish, good looking girls. They were mostly into movies, masti, dance, gymming, rides and food. I was not only preoccupied with a lot of classes and study, but also too shy to belong to such a group. Somewhere I envied those boys, they had so much advantage interacting with girls, with all the time and money they had. However, muscles are not my kind of statement, although (Thank God!) I have always enjoyed excellent health and fitness. © Dr. Rajas Deshpande

Once we finished the junior college, I never saw them. Medical courses hardly allow any time for extracurricular activities. The only silver lining was that there still were beautiful and intellectual girls in the class, and some of them respected and liked nerds too!

As Ruta waited by her sister, I kept on attending the cases that came in. From women in labour to heart attacks in shock, from bullets in the chest to rapes, one night in a casualty shows more pain than many know in a lifetime.

A foreigner couple came in, with their small boy bitten by a bee, he had developed severe reaction, his breathing was obstructed because of the throat swelling from inside. They kept on weeping as we all rushed to inject steroids and other medicines to the child. In some time the kid stabilized. © Dr. Rajas Deshpande
Then the police brought in a drunk driver who had rammed his Bullet bike into another’s. Our duty was to perform a detailed examination, collect blood sample and opine whether he was drunk or not. I was shocked: he was my schoolmate. He recognized me too. “Raja? Dekh yaar ye log mujhe andar kar rahe hain (Look these people are jailing me) he said, “Tu kuchh kar yaar (please do something)”. This was difficult. He was going to hate me for life probably, but I had no choice. I wrote his report. I felt sad, but there was no time to express it.
A snake bitten farmer and a newly wed woman with over 70 percent burns were brought in almost together, both gasping. Deepa and myself ran around to stabilize them, the medical officer came in too, but the burns woman had arrested just as they entered the casualty. We intubated the farmer, who was sinking, while we struggled to get things right. He was shifted to the ICU upstairs. We started finishing the paperwork. © Dr. Rajas Deshpande

It was about 4 AM, now there was a relative calm in the casualty. Sleepy relatives had found corners to doze off. All six patients were relatively stable.

“Excuse me Rajas, Is there a canteen nearby where I can get some tea?” Ruta asked.
“Yes, across the road, in the lane opposite the gate” I replied.
“Will you please join me?” she asked.
Borrowing an umbrella from a ward boy, and informing Deepa, I walked Ruta across the street. We stood sipping the hot tea by the side of the road, under the beautiful rain.

“I have a confession to make” she said suddenly: “I never knew there was this side to life: I only thought my life was to be enjoyed without a worry. If someone had given me a million rupees yesterday to stay up all night listening to other people cry, see wounds and deaths all night, I would have declined and ran away. I cannot stand anyone whining, and here you all are, listening to nothing else, fighting not only death but also expectation, anger and uncertainty. We made fun of nerds like you, and today I meet one, saving lives! I don’t know if I will ever save a life, and here you are saving many every day! I feel how superficial I was! I respect you and what you do. I now think you docs are superheroes”.
We are used to such overwhelmed compliments by patients just relieved of fear. I just smiled. She read my face. ” No, I am not saying this because my sister is admitted today, but because I feel it inside after seeing what happened here”. © Dr. Rajas Deshpande
I thanked her, adding that it was not wrong to have fun and look good, confessing that medicos often secretly miss those things, none of us gets any time for that.

Needless to say, I walked back thanking God, and feeling proud. This was one simple closure, yet so essential!

My co-intern Deepa gave me the expected wicked mischievous smile when I returned.
“Today the tea must have been very tasty na?” she asked, sarcasm overflowing from a face deliberately made over-innocent.
“Solid” I replied with matching sarcasm; “Oxytocin-Dopamine waali chai thi (It had oxytocin and dopamine)”.

We discharged Ruta’s sister the next day. After two days, I received a handmade greeting from Ruta, in which she had written the most unforgettable compliment I ever received:

“You healed more than what was injured. Thank You!”

© Dr. Rajas Deshpande
Dedicated to all medical students, interns and resident doctors.
Please share unedited.

Have Doctors become Mechanical?

(c) Dr. Rajas Deshpande

Sir, most of your stories you share are from your internship days. I have worked as an intern for past 10 months but almost never encountered/experienced such heart touching events and I don’t think, i am any less humane or sensitive than you must be(guessing by your posts). then why almost every intern is so mechanical about his schedule and work? Has the nature of work/ job profile of interns changed to mere mamagiri? Or Its just that, you always went the extra mile to be the awesome being you are! Awaiting your reply eagerly.. Dr. AA

Dear Dr AA, yes doctors have become more and more mechanical, also preoccupied with too many non-clinical tasks like USMLE / MRCP / pg entrance studies, digital addictions and excess non-duty work. Talking to the patients and making them open up is an extremely difficult art. Just like we don’t open up to any roadside stranger, patients do no talk much to a disinterested doctor in a hurry.

There is no one without problems, no one who does not need more love and kindness, but people will not respond if they sense “artificial” empathy. Most illiterates and even infants sense true versus artificial love. So every doctor must learn to imagine himself/ herself in the patients’ condition, and genuinely solve their problem the best they can. There also is a growing tendency to think oneself “superior” to patient or other professionals. No one talks comfortably with the “high handed”. Indeed there are many patients/ relatives more intelligent than the treating doctor, the respect for a doctor is only for his/her medical prowess and kindness.

The first hint of “trying to show off more than what you know” switches off the patient. This tendency is also increasing among some doctors, who transgress their specialty and adversely talk about other specialists or professions. Even the illiterate patients understand (may not express) your overall nature in a few minutes. One must be very polite, humble and genuinely interested and helpful to every patient to be able to connect. In many cases half the agony is the fear of the medical situation. Every doctor does not have time, but those who spend more time per patient hit it well with the patient.

Hope that answers your question. Also, I have always kept a diary. I spent my internship in quite rural and backward areas, the faith in a doctor was still young, and I loved to talk to the “patient”, so time was not an issue. Like most young doctors, I was (and am) never fond of sleep. I had another advantage: I have been a loner.

I know you are (in fact everyone is) gifted by God / Nature a golden heart with a divine song. It is up to us how to use it. The practice of Good Medicine is almost as difficult as a spiritual life: many sacrifices are required. But one should not expect the patient to “Pay Up” or bear the brunt of our sacrifices. It is a choice we have made.

Take care and use the one chance of touching every heart you meet wisely, with immense passion, forgiveness and love. The returns will not be material, but I am sure you don’t care for material gains because you asked this question.

There is no “Extra Mile” for a good doctor. Whatever Good can be done, must be done.

God bless!

© Dr. Rajas Deshpande

Reply to a question asked by Dr. Arvind Arora, Intern, India.

The Doctor India Needs Most

The Doctor India Needs Most.Photo 13-11-15, 23 58 36a

(c) Dr. Rajas Deshpande

“It’s high time you dropped a big stone upon her head” said the doctor.

Shocked to the core, I looked up to find all three of them heartily laughing: the doctor, the patient and the relative.

This was a 92 year old lady, who had seen Doctor P. D. Purandare for most of her adult life as her primary care physician. She was still healthy otherwise, but often complained of “feeling not perfect, occasional headaches, lack of sleep, reduced appetite etc.”, mostly age related and chronic complaints resistant to most commonly used medicines. The daughter in law, obedient and polite, but fed up with her “whining” mother in law, had asked doctor PDP if he couldn’t “permanently cure” her symptoms. The ever smiling, 70 year old family physician who was known to make even patients on their deathbeds laugh, had replied “It’s high time you dropped a stone upon her head”.

The old lady was unaffected. Education and “legal awareness” had not yet spoiled the friendly doctor-patient relationship by then. She touched the doctor’s face with gratitude. “I am sure I will not die as long as you are around, Doctor. Don’t teach such things to my Sunbai (Bahu / Daughter in law)” replied the old lady, laughing out of her edentulous mouth, a cute laughter that offends nobody, a privilege only of the very old.

I was on a vacation after my final year MBBS exams, and having no daytime friends (explainations later), went to one of the most favourite people in my life: Dr. P. D. Purandare, a general practitioner and family physician who practiced in the small and (then) backward / orthodox town of Nanded. His clinic was an open-for- all walk-in all 7 days, 11 AM till 11 PM. The only rule was the waiting number system. Next patient was the only VIP, whoever you happened to be.

At around every midnight, Dr. PDP dropped me home after the last patient left. There was never any haste at all, the last patient got the same fresh and relaxed doctor that the first one did. Dr. PDP lived his life in his medical practice. Once I asked him why he chose to practice in Nanded while his hometown was the big and developed famous city of Pune. His answer had no flavoured ego, pride or hypocrisy: “Because there was only one family physician here, there was a need for more, given the population” he replied.

He had studied his Medicine in Lucknow. He practiced a few years in East Africa, then returned to India. A scholar in many disciplines especially music and philosophy, extremely well read, fluent in most Indian major languages, he was the only person I have seen
who entered anyone’s hPhoto 13-11-15, 23 56 34aeart freely and spread joy there.

My parents took me to him right from my infancy for any health issues. Vaccination onwards, he had grown me up to a robust health. Whenever I had holidays while in Medical College, I went to attend his OPD. There was so much to learn about humanity and medicine from him. In spite of being a very scientific doctor and a royal human being, he treated everyone as his equal. I have never seen him disturbed or angry. Like James Bond, his humour sprung forth like a fountain in the most unlikely and disturbing situations, and it was only later that people realised that it was that humour which broke the ill spell on that moment. Never cheap but never also mild, his stinging comments usually made people blush. He donned the magic of good sarcasm that left no bruised egos.

He never asked for money from any patient. Most patients went themselves and paid to his compounder HariSingh. Regularly following up patients were supposed to make entries in their own diaries about how much they owed to the doctor and pay as and when possible. People usually paid once or twice in a year, he never saw their books. HariSingh collected the money and hande
d it over to Dr. PDP. Of course many people duped him. Even in that pre-cellphone era, people called him up on all days and nights, and visited his home for emergency and ease both, but his calm was seldom offended.

One very poor man came with his daughter of about 21, told the doctor about her constant headaches, also adding details about his financial status, that her marriage was held up thanks to his poverty. Dr. PDP wrote the prescription after examining the young girl, now visibly embarrassed by her father’s disclosure. The father pulled out his reluctant wallet from the depths of his clothes. “How much?” he asked. Dr. PDP, with no high-handed expression upon his face, said “Don’t worry.. You don’t pay.” As the hefty farmer father started sobbing out of gratitude, Dr. Purandare asked him if he can please borrow some betel nuts (supari) from him, which had accompanied the wallet from his pocket. Laughing and crying at the same time, the father gave the “supari” to Dr. PDP and touched his feet, asked his daughter to do the same, and told her “This is where they say God is”.

One of the best habits I learned from Dr. PDP was to never count the money someone handed over in good faith. Trust was his second na
ture, and patients swore by his integrity. “It will all stay here, not with you or me” he winked when anyone requested him to count the money.

A visibly shaking Sikh man, walked in, bending forwards and walking very slowly, his actions frozen intermittently, and voice almost inaudibly low. Dr PDP explained to me the classical symptoms of Parkinsonism. A decade later, learning advanced Neurology in Canada, I often wondered how exact and ahead of time was this general practitioner in a small town in India, and what a sad destiny that there was no one around him then to applaud all the talent he had! This, I know even now, is the case of so many excellent clinicians, general practitioners and family physicians in India, whose medical talent goes unnoticed and unacknowledged just because the society is yet to wake up to it.
****
“Your son is unlikely to survive”
I heard the physician (Dr. AA) tell my parents. I heard my mother wail and my father sob, and in a few minutes my mom was frantically calling one of our neighbours: “Please get a rickshaw and go to Dr. Purandare, ask him I have begged him to run here at once”. Mr. Raghvendra Katti, my father’s favourite student, went in heavy rains upon his Luna moped to fetch Dr. PDP.

It was just after my second year MBBS exam. I had developed typhoid fever, and late during recovery the fever had suddenly shot up one day, and I had become delirious. My consciousness was fluctuating, and highest antibiotics were on. There was a suspicion that something was wrong, but nobody could identify what. Three specialists had already asked my parents to shift me to civil hospital ICU, fearing bad outcome. Fever went upto 105 dF.

Dr. PDP came, all wet and tense. After going through all details and examining me, he asked the treating doctor to give me a shot of steroid. “But he may worsen with steroid” said the treating doc who had a higher degree, and refused to give me the injection. As my mom insisted, he wrote a note on paper that Dr. PDP will be responsible for any consequences. Everyone signed it. Then they gave me a shot. Within an hour, the fever started subsiding. By three hours, I was feeling better. He sat besides me, whistling.

“Chai pilao (Get me some tea)” he smiled as he told my crying parents “Ye saala wapas aagaya (This idiot has returned)”. The physician apologised to him for the “legal” note. “It’s ok, doc, he has reacted to something. Recurring typhoid fever does not shoot up this sudden”. Dr. PDP said. It was later found that the IV fluid was impure. Just changing that made a difference (The company was later banned).

He gave me his old “Savill’s” textbook of clinical medicine as a birthday gift. It is one of the most beautiful clinical textbooks I ever read!

“Har Bandar ka Madaari (A magician who handles all types of monkeys)” was his favourite expression to describe himself as a general practitioner. “You must know basic treatments of everything” he taught me. India needs many many thousand Dr. Prabhakar Purandares today, and also the same patient-doctor relationship where the patient had equal responsibility of faith and trust as the doctor, and both carried it graciously.

He initiated me during my undergraduate days into philosophy, with Jiddu Krisnamurthy, Ashtavakra Geeta, Osho Rajneesh and then Stephen Hawking. When I told him I actually met Dr Stephen Hawking, he was as happy and proud as my father would be. He still prays, meditates and laughs everyday, and makes everyone around him laugh too. He has retired, and lives happily in Nanded.

Everytime we meet, he turns into the Master once again:
“When you realize that all the diseases and diagnoses are not in the books, you become a mature doctor. The disease in mind is far more difficult to treat than that in the body. The young man knows the rules, but the old man knows the exceptions”. His teachings are etched upon my brain.

Once in a very bad, low phase of life, deserted and hurt by the way I was treated by my own, I went to him and broke down. This feeling of being isolated and tortured for being different in my thinking is unbearable. He just sat besides me, didn’t say a word till I stopped crying.

Then he said:
“Pick up the immortals among those who you want your certificates from”.

© Dr. Rajas Deshpande