Tag Archives: Love

The Higher Suffering

© Dr. Rajas Deshpande

Stuck in the heavy traffic due to rains, I tried to remain calm. The cellphone kept on ringing, patients who were waiting, those who wanted appointments, those who were to catch their ride out of station anxiously asked when will I reach. Some lost patience and raised voice. In addition, there were calls about the patients admitted in the hospital: critical decisions to be made, idiotic questions by insurance companies to be replied to. There were huge processions, the traffic was diverted, without any arrangements for ambulances. Impatient, aggressive and violent people is a reality on almost all Indian roads now. No one cares for law on the road. You are at the mercy of anyone who chooses to pick up a fight with you.

There were some issues at home too, the cook had called in sick, we had to do some emergency cooking. That had delayed my start.© Dr. Rajas Deshpande

At last, an hour late, I reached the OPD, and entered running. Faces with controlled anger greeted with cultured politeness. Prepared for bitter comments, I called in the first patient.

This was a free patient, she did not need a follow up. But being free, she visits almost religiously every month, whenever she has a fight with her husband. Sometimes, when the only guaranteed compassion is from a doctor, it can be misused. However, as I was late, I decided to respect their patience, and told them to visit a counselor. Nevertheless, my irritation heightened, that this added to the wait of other patients.© Dr. Rajas Deshpande

I certainly am impatient with meaningless waste of time, and sometimes the traffic, the sudden changes in schedules due to someone’s irresponsible behavior, and misuse of compassionate services bring me to the edge of a reaction. This was one such moment. My face must have become grim.

The next patient walked in, an elderly gentleman with Parkinson’s disease. He was accompanied by his wife. They were supposed to come back three months later, but had followed up early. I examined him, found him quite stable neurologically, but the usual twinkle in his eyes was absent. Even his usually smiling wife appeared lost. It must be the traffic, my late arrival or something likewise, I thought, and curbed my curiosity to ask them. Today was heavy and behind schedule, I must wind up fast. Yet, as I explained them that everything was stable and alright, that they need not worry, I noticed the unspoken uneasiness in their body language. A little reluctantly but keeping up with the expectation of my own heart, I asked them: “You look quite disturbed and stressed. Is anything the matter? I am sorry I came late today”.

“No, no doctor, it’s not that. But yes, he is stressed and disturbed said the wife, and looked inquisitively towards her husband. ”Shall I tell him?” she asked.

Looking down, hiding his face, the husband nodded.

“Doctor, we lost our only son ten only days ago. Someone killed him on the road. Some drunk goons dashed his car from behind, and when he got down to check the damage, they attacked him and hit him on the head with some rods. He was lying on the road for a long time, and by the time police took him to the hospital, he was gone. We came to know after a few hours. He was our only child, an engineering scholar who had returned to India with great dreams .”

The lady was silently weeping as she kept her emotions in control. The patient was sobbing, I called the receptionist to get a glass of water.© Dr. Rajas Deshpande

“We have done so much for our town and the society” said the patient, “but now I feel it was all useless. No one is safe even on the roads. We see so many rules and laws broken, so many violent and aggressive people that it has become difficult to question anyone even when they misbehave”.

I had no words to pacify them. What can pacify the parents of a dead child, that too a victim lawlessness?

The receptionist called “Sir, the next patient is shouting” she said.

“Five minutes” I requested her.

“You are busy, doc, we will leave. But I brought him here only because he feels better when he meets you. Once you reassure him, he will feel a little secure. Even I feel better when I see you. Otherwise we sit at home just staring at each other’s sunken souls. We have no relatives”.

That was a bitter eye opener to me. They had chosen me to be their lifeline in the worst times of their life, and here I was, thinking about my worries, my time, and the inevitable small happenings that block the path of every working person every day. I had momentarily ignored the fact that I must still enter the hospital with a smile, push behind myself all the negatives that pull me down. For every patient here to see me comes with a hundred fears and a thousand expectations, the least I can do for them is be compassionate and reassuring, whatever may have happened till that moment.© Dr. Rajas Deshpande

“You may see many patients in a day and listen to their troubles, doc, but you are the only doctor your patient meets in a long time. I don’t know about you, but we always feel good when we see you”. The wife added.

Yes, I had heard that earlier, in my teacher’s cabin. Once a patient develops trust in his / her doctor, they look upon the doctor as one of the most reliable resource for courage, compassion and troubleshooting, even beyond the expertise of that doctor. As doctors, we must never forget this, and stand up tall above all our personal problems to be the supermen and superwomen, the Messiahs, the Saviors that we are expected to be. Law and some idiots do push a stick in our wheels, but then the patient is far above both. A patient’s suffering is always far above that of any doctor.

I stood up, held the patient’s hand, and reassured them: that they do have a relative here in Pune. “According to the Pune tradition”, I said, “one should offer tea only when the guests are half out of the door, but I will make an exception today .”

Having them sit in the next empty room, I proceeded with the OPD. Ordering tea for everyone in the OPD waiting room, I stole a few more minutes to calm the ruffled souls of those two, and asked them to see me again, whenever they wished.

As I returned late after dark, even through the rainy night, a sweet moonlight made the raindrops glow. Just like every doctor brings back the smiles to the burning hearts of their patients!

© Dr. Rajas Deshpande

Worse than Death

Worse than Death
(C) Dr. Rajas Deshpande

“Doctor, I have started to die. Can you help me somehow?” he asked, calmly.
In his late twenties, a handsome young man, well dressed, but with a certain painful gloom upon his face that was a mismatch to an overall nice and clean appearance. What could this be? I started thinking, hoping he was wrong.

Then his shoulder twitched, and arm had a slight jerk. A pang of suspicion bit my heart immediately. He confirmed it in few seconds. Those who take life for granted are often so full of anxiety, and here he was, who had initiated a countdown to his own death, talking to me in a low but clear voice.
“Doctor, I have been diagnosed with Huntington’s disease over 7 years ago” he said, “Till now I had only these jerky movements. Now I have started having some mood problems and also memory issues. My parents died in an accident when I was three. My uncle’s family cared for me till I could go to a boarding school. I stay alone in a rental apartment, I work in an IT company”.

Examination and review of reports established that his diagnosis was correct. There is no treatment.
This illness of brain degeneration starts with abnormal movements, then causes loss of memory and other cognitive functions, mood swings, depression, finally causing complete immobility and usually death ensues due to blockage of windpipe because of food while swallowing. A patient usually survives less than 13-18 years after the diagnosis. Some commit suicide.

What do I tell someone aged 28 who knows he will definitely die soon?
Yes there are research options and support groups. Yes I can send him to a professional counsellor. Yes I can use some mood stabilising medicines and antidepressants.
But can I emotionally detach from this event as a doctor? (C) Dr. Rajas Deshpande

Diagnose and treat with empathy, educate and move on. Don’t take home the burden of your patient’s illness. Don’t get emotionally involved in your patient’s lives and problems. Never. But is that possible?

Shall I ask him if he has any bucket list of things he wants to once experience, before he forgets who he is? Is there something there that I can help him with? Has he planned anything about his life when he is mentally or physically disabled?

I told him that some medicines can help him, and wrote a prescription. Also referred him to an expert counsellor.

What would I do in such a situation? What is it that I would like to hear from the doctor, knowing the obvious too? What is so important in life when one knows that there are only a few years remaining?

Those who have the luxury of ignorance can laugh and superficially answer. Those who answer immediately have seldom used thinking. Those who are assured of their health have changing answers.
But those who know it?

I decided to ask him. (C) Dr. Rajas Deshpande

Next time he visited, he told me that he has resigned from his job, as he had problems dealing with the responsibility. He could not ride his two wheeler too, he had sold it off.

“I am going to my ancestral village, doctor. A dharamshala (religious sanctuary) has agreed to allow me stay and food, and help me as much as they can. I am also willing to donate my body for research, so at least others don’t suffer this. But I have to finalise yet”.

In India, just as there is no scope for genuine research, there also is complete lack of any infrastructure for the care of such patients.

I decided to ask him what troubled me.
“Is there something you wanted to do?” I could not bring myself to say “before you go”.

He tried to smile. His eyes welled up as he thought about the question.
“Yes, Doctor. I wanted to feel someone loving me madly at least once. In fact I had a girl in my office whom I liked. I think she liked me too. But then my diagnosis was confirmed and I didn’t want her to suffer, so I never told her. I met her before resigning, and told her the truth”.

“Everyone will only degenerate,” he continued, “I am ready to see myself degenerate early. But the one purpose, the one good memory of life that one can wrap himself with when facing the decline, is love. Everything else only reminds of loss”.Dr. Rajas Deshpande

Then, wiping his tears and sobbing, for once, openly, without the restriction of pride, he held my hand, and said, “Thank you doctor for all your help. I came to know just now, that not having loved is what I regret most. It feels worse than death. Even if I had felt true love once, I won’t have regretted this early death”.

He had only echoed what every particle, every corner and every breath of life always reminds us of, while we keep on searching for everything else.
Dr. Rajas Deshpande

Thank you, Life; Thank You, God!

Thank you, Life, Thank You God!
photo-07-01-17-21-14-15-2
This was my first birthday without either parent, and I woke up feeling sad about it. Who knew, by the end of the day, God will have set things right, as He always does! Add to that an important message that the day left..

Knowing myself, I cannot understand how someone can like or love such an asocial reclusive loner who is obsessive, over-expectant, irritable, slightly egoistic, sarcastic, does not party or gossip, and cannot understand many people around himself.

Somehow though, the friend list is full, thousands of wishes pour in from across the world, and personalised messages and calls and prayers for happinees, health and everything good keep resounding the day with God’s grace. I did not know how many souls I am connected to, and my heart is full of joy today that so many people actually think of me!

Many colleagues dropped in to wish (in fact since two days prior!), bringing gifts (Oh I love them!). And at the end of the day came the family: my beloved students, who come with the sole aim of make me laugh, become a child again.

To deserve this love over and over again, for this is my only treasure and achievement, I must now make an effort: to be less sarcastic, irritable, obsessive, and to be always thankful for these beautiful people in my life. I will make an honest effort!

I can never forget what my friends and students love me most for: my effort to imbibe kindness and humanity and to live a life drenched in an honest culture of creative intellect and equality. On this birthday, I have promised myself to try and improve myself every which way possible, to deserve this love and affection.

Thank you, everyone who wished me today!

Thank you God, Thank you Life, for today!
(c) Dr. Rajas Deshpande


The Definition Of Love

 

The Definition Of Love
© Dr. Rajas Deshpande

claude-and-marie
How frequently do we use the phrase “True Love”! As if there existed some other form of Love..
Mr. Claude Gatien, a farmer from the city of Tours in France, decided at the age of 36 that he wants to change his career. He started to work as a music salesman, selling CDs. Eventually he got a job as an assistant to a psychotherapist in Paris.
He met Ms. Marie Briquet there. She was a social worker, dedicating all her time to the sick as a volunteer. He respected her work, and helped her often. They fell in love. She told him she was having some mild neurological symptoms, mainly tremor and fatigue.
His thinking was as innocently clear as the first rays of a rising sun. Love was the only bond and the most precious thing between them. They stayed together, and started taking care of each other.
The psychotherapist who they worked with was a spiritual man, with immense love for India, mainly for its spirituality. Like most with a heart, he followed his calling. By then, Claude and Marie had developed the same affection towards spirituality, and followed their ‘Spiritual Guru’ to India.
“We fell in love with India”, Claude told me; “because for some reason I find that my mind is at peace here. We have everything in France, still we felt happier in India, because there is so much spirituality in the region, and even among its people”.
They are staying together for over 27 years now. “We never thought of marriage as we thought it is not necessary to perform rituals to prove either love or honesty of intention” Claude said, after consulting Marie in cute French. “It was her answer, but I feel the same” he added, winking!
Multiple Sclerosis, that scary disease of brain and spine, took away Marie’s ability to walk over 5 years ago. She has become almost completely dependent and wheelchair bound. Claude attends her 24/365. “I enjoy caring for her. It gives me many more opportunities to tell her how much I love her” he says.
Mostly people swear about anything that they want others to believe. A teacher taught me long ago never to “swear or promise”, but instead keep every word, complete every commitment without using the words “Promise or Swear”. “Everything you say is actually your commitment” he infused. I met the personification of that principle in Claude.
About a month ago, Marie suddenly had to be admitted in the ICU for some serious complication. Needless to say, Claude was by her side all the time. She was unconscious for over two days. One late night I had to attend some call, and went to the ICU to check if there was a change in her condition. Claude was sitting by her side, sleepy but awake, looking at her face.
“I can wait here for some time. Do you want to take a nap?” I asked him.
“Oh no, Thank you doctor. I won’t sleep till she wakes up. If she wakes up and does not see me, she will worry about me. That may stress her. Once she opens eyes, I will tell her she is ok, make her smile, then I will sleep” he said.
That was a month ago. They came for a visit yesterday. I requested their permission to share their love story. He said he was willing, then asked for her permission.
Then I saw the beautiful smile that had made Claude fall in love with Marie.
“Yes.. She says this is all there is to share about life.” Claude told me, translating.
© Dr. Rajas Deshpande

Faster

Faster
© Dr. Rajas Deshpande
“Faster, faster, I must feel the force of wind pushing my hands back” she said, stretching out her hands. Tightening the grip and bending still forward, I squeezed the accelerator grip.
At 2.30 AM, there were no vehicles on the roads. We had completed the rounds on Worli Seaface, and were now scaling the Marine drive. The police chowkies had enough light to spot them from a distance and slow down near them.
The red Yamaha RX 100, that bike which many bikers will know becomes one with the rider’s brain and body, and picks up human feelings better than most humans can, was doing its best spell that night, purring like a wildcat only happy to be tamed. The only noise it made was the silent pleasure it infused into the riders, not the loud firing that begs for attention.© Dr. Rajas Deshpande
“I want to spend every moment of my life at this speed” she said, shouting in my ear, her joyous face lit up the rear view mirror. “I don’t want to ever slow down. I don’t want to take it easy. I want my life to be like the massive eruption of a tremendously powerful volcano and then I will be happy to not exist. I cannot simmer.”
I understood.
Not everyone is fond of a laid back, slow, long life of collecting candlelight moments. Repetition of the same still ignites many. I am in love with fast myself: speaking, working, achieving, reacting and even forgetting! The faster I am, the more life I live. More is not synonymous with longer when it concerns life. I really dislike slow. I hate repetition.© Dr. Rajas Deshpande
The huge dark blue sea had the long white wake of moonlight upon its surface that reached the shores, and appeared like an invitation to walk into it. The Sea-moon combo of blue and white is the liveliest example of ‘cool’ that we all search within us.
We stopped at Nariman point near the chaiwalla on his cycle. I feel one of the greatest social service possible in this world is making tea and snacks available for the night owls. We had the hot chai-shots fast, speaking nothing. The ocean roared and hummed pleasantly. The feel of speed was still upon our skins.
An old banarasiya spotted us together, and offered his best “Paan”, probably an ultimate gesture suggestive of romance for some past generation! I politely declined. He smiled cunningly, as if he knew we were out on some immoral trip. Looking at my embarrassed face, she asked: “Why are you concerned about what people think?”
“I am not. I am irritated when someone presumes” I replied, my anger reflected in the kick that restarted the Yamaha.
“Oh let them be! Not everyone understands that they cannot understand. Everyone can criticise, but few know they should not even analyse.”. I suddenly realised that this is what I needed to imbibe, if I wanted to live a different life than a drab set routine.
“Thank you”, I said, happy that the night had dished out a lifetime nugget of wisdom.
In my future life I met many who are far ahead of the world, far more brilliant in everything, and still far away from people: they are happy because they know they are beyond the need of certification from the slower , repetitive, attention and fame seeking mediocre hypocrites. Besides their stunning achievements, they also live a stunning, magical life. The earlier they realise that they must overcome analysis and criticism by others, they start living.
This wasa new beginning for me.© Dr. Rajas Deshpande
“Chill and Speed up, angry doc!” she said, her glorious face in my mirror again.
At the highest speed, when the bike and us became one with the road and the wind and the sea. I felt her close to my ear. I could not afford to even look into the mirror, we were that fast.
She was close enough not having to shout now.
“This alone matters”, she said, “Neither us nor people”.
© Dr. Rajas Deshpande

The End

The End
(c) Dr. Rajas Deshpande
He picked up the call he awaited desperately. She was ecstatic.. “Happy Birthday! I have been thinking about what you said. I have feelings for you too. Can we meet at the tea break around 4?” She asked. “Yes” he replied, excited.
“Oh yes and I also wanted to tell you that I got my visa yesterday”.
“Yes, congrats! See you at 4. I will wait” he said hastily, and disconnected. Another call was waiting, from the hospital. “Sir there is an admission, paralysis since yesterday. He had stopped his BP medicines two months ago. Now vitals stable, lab sent.” said the CMO.
“Get an urgent MRI, and shift to semi-ICU. I am on my way” he instructed.
He answered all the questions about “complete cure and guarantee” by relatives, and also listened to their hidden threats. He did not want to spoil his mood especially today.
He had left without breakfast, so went to the canteen and brunched a hasty sandwich and a coffee. He mused about her. After a long time he had liked someone, and wanted to take it further. She was a paramedic, and the kind of guileless straightforward, soft, smiling person he required to be with him all his life. He felt her affection in everything that she said to him. She seemed usually unaware that almost every head turned to look at her. He decided to make the best of today’s meeting. Life was going nowhere outside the hospital any ways otherwise. He had even forgotten birthday celebrations long ago.
More patients kept him busy for the whole noon. The poor had an unsaid plight coupled with their fears: of the illness, of the surgery, of the expenses, of the big city, big hospital, and even of the doctor. The rich were mostly ill-behaved, irresponsible and seeking ways of taking advantage: to avoid tests, visits, payments, vehemently reluctant to give up their addictions: alcohol, smoking, weed and money. Few kind patients realised his gloom and made an effort to soothe him with compliments, make him laugh.
He had no time to think or plan what he was going to say to her. They knew each other for over three years, but had not been able to spend quality time because both were PGs till three months ago, lucky if they had their meals and sleep. Now that they were out, they had to work harder to survive in the competition. He desperately wanted to spend his life with her. This was his last opportunity to say it properly.
Because she planned to leave India in a month, and if he didn’t speak his mind today, he would have no chance again to do so. He wondered about the coincidence that this was happening on his birthday. “She should not accept me just because of that” he thought. His inner voice said “Its ok even if it is that. You are going to make her happy in either case”.
It was 3.30 PM. There was no time to go get a rose or a greeting. He pictured for a second in his mind that he is romantically kneeling in front of her in his blue suit, holding an open box of a beautiful sapphire ring, and she, ever gorgeous, surprised and pleased, tearful and smiling, is holding his face.
The junior doctor came running. “Sir, there’s a traffic accident, head injury, unconscious, intubated in casualty”. They went to the casualty. Twenty years old, no helmet. Bike slipped and his head hit the pavement. Shocked, panicked and angry, the relatives thought everything was wrong at the hospital. As he ran to the patient, five relatives surrounded him and asked questions. He politely asked them to wait till he examined the patient. “When did this happen?” he asked the junior “Sir eight hours ago” he replied.
Pale and cold. Pupils not reacting. No Doll’s Eye movements. No spontaneous activity. No reflexes. No response to caloric tests. Heart rate high. BP low. CT scan showed large bleed, multiple skull fractures, and a compressed brainstem. Sodium already high. Beyond surgery. Beyond possibility of survival.
“Did he have any earlier illness?” He asked. The uncle replied; “He used to have fits. It was his birthday yesterday. He may have had some drinks with his friends”.
It was difficult to look at the face of his mother and father, lakes of hope, shock, trauma and expectation in their eyes. “We will make an effort, but things look quite bad as of now” he told them. “Do everything, doctor, call the best doctors. Just save my son. Don’t worry about money” said the father.
He lost his mind for a split moment. The doctor within him was crying for the lost patient. If you had all the money, why didn’t you buy a helmet for your son? Why did you allow him to drink and drive? How come his epilepsy medicine was stopped? But there was no use thinking about it all now.
He wrote the orders, and waited to answer the crying mother, who begged him to get her son back. He thought about his own mother and her anxieties for him. Helpless, he even felt at one moment that he had chosen another profession than to face this every other day. For it was not the courage or goodwill, it was not the hard work that tormented him daily, but it was the scars that each such event bruised upon his soul. For years.
He realised that the phone was ringing. It was 4.45. He ran to the canteen. She was already a little upset, but conjured a smile. “Happy Birthday” she said, and handed him the greeting and the gift. Thanking her, he sat there, the sobs of that mother in casualty still continued in his mind. “So, did you think about what I said?:” she asked, and continued: “my parents will accompany me there, stay for a week, and then return. I won’t be able to return for at least a year. The curriculum is too tough. What’s wrong with you? Are you listening?”
He told her about the near dead patient in the casualty. She became silent. He talked superficially about her travel plans, her parents and her stay there. He could not bring himself to speak of his love at that moment. Death, anyone’s, stuns most around.
They finished the coffee. With cordial words, asking him to take care of himself, and a promise to stay in digital touch, she left.

“It is your choice, your duty. You must think of the service you are doing to this society. Death, shock, trauma and illness are a daily routine for you, why does it even bother you any more? People get sick, die almost every day, and you have chosen to spend life in hospitals. Why can’t you learn to be insensitive, unemotional to medical issues?” asked a part of his mind.
The other part of his mind, stunned in an abyss of a silent agony, because a lifetime of love had just passed away, did not answer.
© Dr. Rajas Deshpande

My Religion, My Love.

My Religion, My Love.
(c) Dr. Rajas Deshpande

Once when I was studying in Medical College (MBBS), my Grandpa told me not to waste too much time in praying God, as treating patients was a superior worship. I had promised him that if there ever was a conflict between attending a patient and praying God, I will first attend the patient. I grew up to learn that most doctors all over the world do that.

It is not uncommon to receive criticism over my blogs here. Why not neglect film stars and TV shows? Why defend doctors, knowing that some are genuinely corrupt? Who except doctors will read these articles? etc.

Medicine is my religion and also my love. I have come here, like most of my colleagues, to do good by choice. I can not take it easy when the uneducated and cheap, corrupt TDH make allegations about the super-educated Indian doctors. If one has real guts, they should try merit based entry in some Indian Medical College, or just one year of residency, they will know where they stand. This does not mean that only doctors are intellectually superior, just that only those who have achieved something intellectually worthwhile must analyse/criticize this highly complicated field.

If anyone talks ill about one’s Mother, Father, Wife etc., or God or Religion, people are out with swords and guns, and will defend with blood their honor and that of their beloved and respected. It never means that everything about the criticized person or religion is right, just that it is one’s duty to guard one’s own sacred faith, and only the learned and intimate are allowed to interfere.
Not the wayfarers whose real God is public attention.

This is a scientific field which has evolved through lifetime works of Geniuses, Nobel winners and brilliant brains who changed the course of humanity over many centuries. It is made up even today of most who sacrifice their peace, safety and lifetime in serving others. It has its own control and alternative system: no one forces you to go to a specific doctor or hospital, and every hospital offers more than one doctors you can avail services of. Excess population and unhealthy country (and so the hurry) is NOT the doctor’s fault.

Doctors are the only religion-neutral intellectual profession directly in contact with general public, and there have never been any examples that Doctors compromised Medical practice for religious difference. Because this is our religion too. Whichever God patient may have, most Doctors treat that patient’s health as their God. Some speak, express, sweet talk. Others do it silently. Some others may not be well mannered. But all worship the same God in any hospital: patient’s health. Some ask money in return, some enjoy the worship itself. But most do meet their God in their patient’s health.

This amidst filth of almost completely faithless, trustless, paranoid, corrupt, illiterate, inflation-screwed and violent population (mainly in India) which expects miracle recoveries of complicated medical conditions in minimum expenses, an outdated legal system which protects the faces of rapists and murderers but does not protect the alleged doctor’s identity before trial, where laws are mainly used for exploitation, and where a successful doctor is presumed corrupt. Where research is killed at National level by policymakers.

Some choose to advise all doctors to keep calm and take it all in their stride, to project a “Social Doctor” who must accept all the ills and go on selflessly working for the good of all, “not thinking about money”. This is usually to pseudo-glorify themselves in media and public at the cost of the sufferers of injustice and violence among their own. These “Good-public-image-mongers” often speak a different language in private.

I may be wrong in writing these posts to defend my religion: Medicine, and its worshipers. But I am at least not guilty of being dishonest to either myself or my religion.

This I can vouch: I have met hundreds of Good and Bad behaved doctors, but never one who wanted to harm or neglect the patient. Even the best of the ‘moneymakers’ in Medicine keep patient safety their top priority. Some may have been wrong in their practice, and they must be tried, but everyone generally does their best to do good to the patient.

There is no other career superior in its Humanity Quotient than health services. Just because someone must throw stones at others to get attention, we will not sit back and be the target.

(c) Dr. Rajas Deshpande

The Brain-Alive Heart-Dead.

The Brain-Alive Heart-Dead. (c) Dr. Rajas Deshpande “We don’t want her to suffer. We don’t want any ventilator etc. treatments”. Said the calm son, no traces of emotional tones in his speech. His mother was admitted last night with stroke. Quite a sophisticated family, this son owning a company of repute. His teenager daughter was sitting by her grandma in the ICU, patting her unconscious forehead. “Can she hear us doctor?” the distraught daughter asked. “Sometimes, only when she is a little more conscious”.. It is difficult for me to be emotionally rude. “Because I want to talk to her only once more.. to say sorry.. I was sulking after a fight with her when this happened.. I should never have fought with her…” the sweet soul broke down. Her father tried to calm her. This is where I received the first shock. His pacifying his own daughter had a formality. It did not suggest “I am proud of your emotional bond with my mother”… It rather suggested “Grow up, you stupid, these things happen”. As I walked out of the ICU, his wife wished me. “How is Ma, doc?” she asked, accompanied by her brother. I told her the truth: “Fluctuating, but critical still”. Then the expected question: “How long, doc? We don’t want her to suffer too much”. “Sorry, can’t say at present”. If I myself ever had an accident, I want to live. I want my doctor to try the best to make me survive, to give me one more chance to see and touch and hear my dear ones. I want to say sorry to those I may have offended, and also to say proper goodbye to those who love me. I will not want my family to decide whether the doctors should try their best for me or not. I have asked this very question to some people I have faith in the sanity of. The answer rarely was “Don’t save me if it took a lot of effort”. Some classified further: “If I was to remain in a vegetative state permanently, then alone let go”. Most of my old / very old patients explicitly state that they want to live as much as they can, with as much health that they can get. Nobody except the depressed / frustrated actually say that they want to die, a statement in itself contradictory to their being in the hospital. I have had differences with some colleagues who “Let Go” and encourage the willing family to make the same decision. It is useless, they argue, to spend so much and try for such a small possibility of meaningful survival. Patient must be able to choose dying with dignity, they advocate. Many of my colleagues differ like myself, and for a reason: if the patient has expressed a wish prior in complete senses that he / she wants no resuscitation / effort to be made for their survival, then a doctor must respect that. But I think NO one else can make that decision on behalf of the patient after they have lost senses. An unconscious patient is still alive until he / she is brain dead, and it automatically becomes a duty of the doctor to make all efforts to try for the best outcome. There are many sweet excuses people quote, including suffering, dignity, torture, tubes, pain etc. to justify “letting the patient die”. The real reasons often are: expenses, time, hard work, stress, uncertainty associated with an elderly being ill and the perceived “uselessness” of a debilitated / old / disabled person in the family, adding to the future bills. Elderly do not even have emotional value in many families now. We are in a world where people have learnt the tact of carrying out entire discussion hypocritically, knowing that both are actually lying, but still pretending to understand each other. Such discussions decide the fates of hundreds of unfortunate old and unconscious patients who then become victims of “Lacklove” decisions made by the very people they gave birth to and grew up! Expenses can be reduced by offering care in smaller nursing homes / govt. hospitals. The decision of whether the patient will live or not should not be open to discussion about patients who have NOT written a will against their own treatment. If the patient is “Brain-Alive”, treatment must continue. For no team of Neurologists / experts in the world will guarantee the outcome on the bad side: there are always chances of regaining meaningful consciousness in every patient who is not brain dead. And we the living who attempt every day taking whatever tiny chances we get to survive, to grope more and more of life we can should be the last people to say “Let Go” when it comes to someone else’s life. It would morally amount to a murder. “We hear some doctors keep dead bodies on ventilator in the ICU just to extract more money” said one “business minded” friend to me once. We doctors are trained against violence as it hurts the very human body we are meant to guard. So I answered him verbally only: “With all hospitals almost running full, critical patients in waiting areas why would any hospital keep on ventilating the dead?”. There are monitors, files, paperwork, and many doctors, nurses, other staff in each critical care unit: how can people imagine that the dead will be kept on machines in such units? Or is it just another social trick to mask the mirror of reality? A small question: If the hospitals start declaring who all chose to “SHUT DOWN” life support systems upon their own relatives / parents, took such critical patients home, admitted them late beyond life-saving period, will the society be happy about it? Then why make such gruesome allegations against a whole profession who even bring some dead back with immense effort, without even knowing them? Why do you think thousands of “Code Blue” teams run without caring for their own life when someone is dying, anywhere in the world? God knows how many doctors pay patient’s bills, especially in emergency. So many doctors start the treatment in corporate hospitals, accepting the responsibility for patient’s bills as relatives come unprepared (no corporate hospitals move without advance or insurance except in emergency). There are also many relatives who don’t sleep, don’t even eat till their patient regains consciousness. There are many who silently suffer with the patient. Many sell their belongings to pay hospital bills and still tell the doctor “Try your best doctorsaab, don’t worry about anything. I will pay every bill”. These, unfortunately, are the illiterate, poor, rural and real human beings. These two: the doctors and relatives who try to save the critical, especially old patient desperately are both being classified under “Impractical, Stupid” people gradually. Because our society has matured to money. As I met the patient next day, still in the twilight zone between life and death, there was no one with her except the granddaughter with swollen eyes. She exclaimed, smiling through her tears: “Doc, she opened her eyes and looked at me for a few seconds… She didn’t say anything, but I knew she recognised me and she was happy to see me.. I know her eyes.. she was awake in that moment” and she broke into sobs. Mercy in the skies often comes alive only with love. The patient regained her senses in a week. As she asked for discharge, holding her grand-daughter’s hand, she looked at her son standing by, and proudly told me “Doc, this is my son.. He owns the XYZ company.. He takes very good care of me”’ Avoiding eye contact with anyone, he hugged his mother and said “I love you Ma”. His teenage daughter kept staring at the floor. I looked at her face. I don’t wish to see that extremely scary expression again. © Dr. Rajas Deshpande

The Yearn

The Yearn

© Dr. Rajas Deshpande

It was raining hard as I started on a Sunday noon for my escape long-drive.

Staying on the outskirts of town has the advantage of lower noise and longer roads. On one such long road I always saw an elderly couple sitting on the footpath selling vegetables, not plenty, but two-three heaps at a time. Cars stopped by frequently to buy from them. Many times they were just basking in the wait.

Today they had both huddled close under an umbrella held with one hand of each. They had covered the veggies under some plastic sheet, and with their wrinkled faces and twinkling eyes observed the rain. There also was amused expression upon those faces more likely due to the pleasure of rain rather than what it did to the people and animals around.

I felt a pang of pity, at this age in seventies such hardships may endanger their health. I cannot stop seeing/ imagining my father in every man that age.

I got down, parked the car and asked them to weigh me some vegetable. It would be so indecent and rude to offer them money without offending their pride! The old woman smiled and told me the price for what she weighed.

“60 rupees” She said.

“Can I ask you something?” I asked them.

The old man, cautious, looked at me. “What?” he said.

“How much average profit do you earn in a day sitting here?”

“Profit? Maybe three – four hundred rupees a day” he answered without any shades to those words.

“Here”.. I extended a thousand rupees note at them, and requested “Please go home and enjoy the rest of your day.. also have some nice food in hotel… can I please offer you some more money?”  I am not rich, but not poor either.

They looked at each other and smiled. I was relieved that they were not offended.

“Asu de baba (Let it be)”, said the lady: “we have everything, we have a house in a nearby town and grown up children who earn a lot and take care of us. They also have cars. But we like selling vegetables, we don’t do it to earn, just because it gives us peace. We have sold vegetables since the age of 14-15. But we can’t sell them near our house as it may embarrass our kids. So we come here and sit in this quiet place, so we can spend time together doing what we love to do together. At this age we have just one wish: to be together as much as we can and then when the end comes, we want to go together”.

She added another small “vegetable token” of gratitude to my carry bag saying “This is from us to you”.

My father also doesn’t stop talking to me through so many people.

© Dr. Rajas Deshpande