Tag Archives: Medical College

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 Cult of Good Blood: Superhero Medical Students

The Cult of Good Blood:
Superhero Medical Students
© Dr. Rajas Deshpande

He grew up selling vegetables and fruits grown by his mother. He went door to door and in the village market to sell those. He also walked for two miles every day to catch a bus to a school over 20 miles away. He then enrolled in a private class that waived off his fees, because he had a passion: He desperately wanted to become a doctor.

Atul Dhakne, son of a school teacher Mr. Nivruttirao Dhakne and farmer Mrs. Mandabai Dhakne, with his hard work and merit, got admission in the prestigious B.J. Medical College in Pune.

But he wasn’t satisfied. “What about those like me who are from the poor rural background, those who have no access to good classes and education, but want to become doctors?” he worried.

Good Blood speaks, whichever soul it flows in. Young medical students of different origins, studying with him, decided to resolve this. Ketan, son of a lawyer Mr. Avinash Deshmukh (who mostly handles cases for the non-affording,) wanted to do charity like his father. Farooque Faras, whose father raised a family in one small room, was burning with the desire to give. Many others joined in (names below), and the Cult of Good Blood multiplied. They all wanted to uplift the deserving.

“Lift For Upliftment” was born, formed by the superheroes among medical students.

They printed posters and went to almost all junior colleges in Pune, appealing students from poor backgrounds to join their free tuitions / classes, to prepare for the CET /NEET. In the first round, over 40 students joined. After the medical college hours, Atul and his friends took turns to teach these poor students, give them notes, set question papers, conduct exams, assess and counsel for improvement. All expenses were borne from their own puny pocket-money.

There was no fixed place for the class. One local bakery owner, Mr. Dinesh Konde, decided to help these students. He planned the logistics and took them to the corporator Mr. Avinash Shinde, who asked for only one thing in return of his help: commitment to continue this good work. The Cult agreed whole-heartedly. With him, they approached Mrs. Meenakshi Raut, Asst. Director in the education department in Pune, who helped them get two classrooms in a Municipal school after the school hours. The classes thus became regular, every day, from 6-9 PM.

The cult lacked stationery, the huge backup of notes and question paper sets for 40 students, so they approached Mr. Sanjeevkumar Sonavne from Latur, who runs many educational institutes, helps poor students, and even pays the fees of some who cannot afford college. Mr. Shelke and Dr. Harish from Sassoon Hospitals also joined hands to help.

The results were impressive: from the first such batch, 6 students qualified for MBBS, 3 for BDS, 11 for BAMS and 2 for BHMS.

No one had earned anything, but Good Blood flowed forward. Many medical students from subsequent batches came forward to teach free, imparting their fresh acquired knowledge and skills to those who could otherwise have no access to it.

There is no discrimination while accepting junior college students for their class. They have two batches now with 60 students in each. They have also started weekend classes for poor students preparing for NEET in the extremely backward area of Maharashtra, named Melghat. These medical students go to Melghat with their own expenses, teach the rural junior college students over the weekend, and return to attend the tough schedules of medical college again!

“I learned helping others from my mother. We don’t earn anything, but we learn something precious every day” tells Atul, who has now passed MBBS. Ketan Deshmukh, Abhiraj Matre and Farooque Faras help him supervise the group. Their endless enthusiasm only reminded me of how much more I can do. I came to know of this group “LFU” during the recent “Quest Medical Academy” event arranged by Dr. Sushant Shinde.

They are naturally, perpetually short of funds.
I am not rich, but I won’t feel right about myself if I didn’t contribute. They graciously accepted.

When these students came to meet me today, I offered them dinner at a good restaurant (knowing that they stay in hostels). Farooque said “Sir, we will rather use that money to print some more question paper sets”. Farooque’s father has stopped all celebrations in the family, and sends all the money he can, from his one small room home, for the torch of humanity that his son carries forward!

When they asked for an advice, I had but one small request for them: that a Doctor should be completely free of all political and religious influence at work, in teaching, and especially while treating a patient. They assured me that “Lift For Upliftment” has decided to never be affiliated to a political or religious organization, keeping humanity as their highest ideal.

There is no better lamp than the one which carries the light from soul to soul. There is no better definition of humanity than holding hands of those who need it most. I feel very happy today, that I could contribute to this beautiful, divine cause.

Long Live the Cult Of Good Blood, and may we all find it in abundance within ourselves!
© Dr. Rajas Deshpande

The group “LFU” also includes: Esha Agarwal, Shivkumar Thorat, Satyender, Tanvi Modi, Mayank Tripathi, Nikhil Nagpal, Sitanshu, Arvind Kumar, Nagesh Pimpre, all from the B. J. Medical College Pune.

PS: My heartfelt appeal to all medical students and doctors to contribute by starting similar activity in your region, by teaching poor students who want to become doctors, by joining this group and / or by donating for this cause.

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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