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The Poverty Vow

(c) Dr. Rajas Deshpande

Long day. Came home. Ritual steamy hot bath to wash away the hospital feel, followed by steaming hot dinner. Switched on jazz, and I picked up the pasta. Heaven descended upon my tongue.

“How perfect this moment is!” I thought, and that’s where I was wrong. The phone rang.

“Sir, 18 year old buy, had fever since a day, took some tablets, became unconscious, now comatose. Vitals are stable, although he is coughing occasionally. No past history significant. Poor family, cannot afford treatment. Father is a labourer. What should I do?”

“Get him into the ICU, intubate if required and stabilise. Arrange for an MRI”

“OK Sir, but Sir they don’t even have a deposit. They had first gone to the government hospital, but as they were not happy there they have come here”. (c) Dr. Rajas Deshpande

“We will work something out. I am on my way” I replied.

In an hour, after examining the boy and seeing his MRI and other tests, we concluded that he had viral encephalitis. The standard medicines were started.

The boy’s father, an obvious poor slum dweller, was in a state of shock. The mother, sobbing, told me the history. I reassured them. When I explained the diagnosis and treatment they asked some questions.

“We don’t understand anything, we are illiterate and poor. Do anything Sir, Just save my son, Sir” the father folded his hands together. Private hospitals have a quota for free patients, but usually it is always overloaded. I requested the hospital management to please make this a free case, they accepted.

The next day, the child opened his eyes. On the third day he started responding. I was quite elated to have his mother speak with him. However, his respiration was still shallow, and blood presure very low. His heart rate was fluctuating due to the effect of viral infection. He was still critical. I spoke to his parents twice every day, specifically reassuring them. Poor patients must never feel that they are not equally cared for. (c) Dr. Rajas Deshpande

That evening, as I attended my patients in the OPD, the patient’s father came in, requested that he wanted to have a word. He came in with six other people. None of them could possibly be poor, given their get ups.

“Yes?”I asked.

The patient’s father looked at the giant next to him. “You ask” he said to the giant.

The giant, chewing his gutkha, askked me “What’s wrong with his son?”

“I have explained them thrice”I replied, “he has viral infection of the brain. There’s a lot of swelling upon his brain”.

“How come he is not improving? His BP was normal when he came. He did not have any heart problems. Now you tell us his heart is not functioning well” asked another medical superstar with white linen and gold teeth. (c) Dr. Rajas Deshpande

“Yes, this happens commonly with viral infections” I replied, feeling hopeless. How to teach complicated medicine to this pure- muscular class? I wondered.

“But you said he had infection in the brain. How come now he has it in the heart? Is the treatment wrong?” Asked someone similar among them, in a tone nastier than medical examiners.

I looked at the patient’s father. He was looking at the ceiling, deliberately avoiding eye contact with me.

“Listen, Sir”, I told them, “Your patient has viral infection, it has primarily affected the brain, but involvement or dysfunction of other organs is well known with such infections, this is not something new to us. We are on guard, dealing with the situation. Nothing is wrong about the treatment, in fact his brain swelling has improved, and he is conscious now. Ask his mother” I looked at her.

“I don’t know” she said, “we don’t find any improvement in my child. Nobody tells us anything”.

“Haven’t I explained you and his father patient’s condition every day?” I asked. They did not reply.

The white linen gold teeth spoke again: “We want a report. We want to show the case to another doctor”

That was a relief. I gladly wrote them a report. They went doctor-shopping all day. They returned next day. Almost everyone had asked them to continue the same treatment that we had advised, except some desperate non-specialist telling them to shift the patient immediately for a surgery at his hospital. Even our gold-toothed medical superstar understood that it was wrong! (c) Dr. Rajas Deshpande

“We will continue treatment here only. But our patient must survive” came an open threat.

”I will do my best, but I cannot guarantee you anything. You may please transfer the patient under the care of any doctor of your choice” I told them.

“No no, you continue to treat him.But if anything goes wrong, we will file a police complaint. We will ruin this hospital”said one of them.

I am allergic to threats. I don’t allow them twice from the same source in my life. How could any doctor guarantee that there could be no complications? How could I say that the patient could not react to any medicine in such a critical condition? If every patient could have guaranteed improvement, what’s the need for a doctor?

“I am sorry, I am planning for a leave next few days. I won’t be able to see your patient. I have requested our management to transfer your case to another doctor” I told them.

There was a movie “Teesri Kasam”in which the lead character, at the end of the movie, vows never to help the character of the lead actress in the movie, because the very wish and effort to help her has shattered his life, caused him regret. Most Doctors are now being forced to take such a vow. Urban Poverty is not so simple and innocent in a hospital as it appears to the media and society. Whether it is the roadside rowdiness of slum dwellers who roam around with weapons or a maid’s drunkard husband in civilised society, we all understand the misuse of poverty status well anywhere outside hospital, but somehow when this happens in a hospital, the blame is automaytically pinned upon the hospital or the doctor.

But who among the vote-mongers will speak against the majority voting bank?

(c) Dr. Rajas Deshpande

A Thumb Impression Of Our Society

© Dr. Rajas Deshpande

As the highly educated family: patient, his wife and daughter stared at my face, I bought a moment of thought by continuing to write instructions. Although the intensity of what I was going to say would affect them now, I knew what the future held a difficult and mentally traumatic, draining corridor they would have to go through in coming years. How to say this? I felt sad. Even after decades of experience, no doctor feels comfortable telling the patient or relatives about a bad or incurable diagnosis. It is a curse we must shoulder. Because someone must say it, someone must sympathize and stand by the patient and family, someone must face the anger and frustration of a family that was till yesterday living in the comfort of good health, completely oblivious to the fact that things may go wrong anytime with anyone. . © Dr. Rajas Deshpande

“You have a type of Parkinson’s disease with dementia. The Parkinson’s is causing your slowness and stiffness, and the dementia is causing the memory loss and change in personality. It is good that you have come at an early stage, we will be able to prolong lifespan with a better quality of life. With your cooperation I think we can do the best possible for the patient. I will give you some links to read from. Please read them and meet me again next week, I will be happy to answer all your queries, doubts and concerns”.

The stunned wife started sobbing. The husband closed his eyes in agony. The daughter, unable to speak, held her father’s hand. Offering them some water and coffee, I explained the daughter instructions about the medicines, tests to be performed, and asked them to see me next week. I wanted to spend more time with them, but the relatives of a critical patient in ICU were waiting outside for me.

“Dr. Rajas, my husband has been a brilliant scientist. He loves reading, writing and intellectual interactions. In fact that’s why we fell in love back then when I was his student. Intellect is his life. We will both die if that is taken away from us”. It was then that I looked at the lady carefully, because till now my mind was occupied with the patient. A very graceful, intelligent, upright and hence beautiful face, the one that tells stories about the highest culture and upbringing that there is. The grey hair added to the loving kindness of her expression. Intelligent Humility, that one element often absent from so many beautiful faces, was abundant upon hers. Somehow I remembered my mother.© Dr. Rajas Deshpande

“I understand, mam. Things are not so bad as of now, and we are still in the evaluation phase. I can give you a better idea about the future once I see the results of all the tests.

It was then that the daughter spoke: “Doctor, I am in India for only the next week. Can we complete the workup before next week, because I cannot postpone my travel back to the US. And yes, I want the best to be done for my father. ” the daughter said.

“Ok” I said. I have now come to accept the socio-cultural changes.

They came next week, the diagnosis was confirmed, I counseled them.

Then I explained the medicines and other care to the patient’s wife.

“Did you understand it well, mom?” asked the daughter, “because I will not be able to help you with this everyday”. The mother replied with her kind smile.

Three months later, the patient came back, with the daughter and her husband.

‘Doc, mom passed away with a sudden heart attack a month ago. She never told us she had any complaints”.

This happens so often: that when a family member is affected, everything revolves around their health, and the warning signs of caretaker’s disease are ignored till the last moment.

“Dad has become worse now. He doesn’t eat well, doesn’t speak with us. . We tried to encourage him to make new friends with his old age home society, but he doesn’t want to interact with others, he has always been stubborn. We have arranged for a caretaker, but dad doesn’t talk to him either.”

Looking at the patient, I realized how much emotional support he needed at that moment.

“I am sorry to know about your mother. Such a nice and kind lady!” I said.

“Thanks, doc. But now you must help us. Please help us find a good old-age nursing home for dad. I cannot stay back. We can pay well”.. she had a hint of “please let us get this over fast” in her speech.

“You said you wanted to do the best for your father. The best would be for you to be with him in these days, talk with him, connect him back with life for whatever remaining awareness he has left. There’s no other person upon earth that he will ever connect with, so this becomes your responsibility”. She knew the truth well, for she broke down. “I know doctor, but I have my family to look after. I cannot take my father with me. I am sorry”.© Dr. Rajas Deshpande

She visited again with the patient, before leaving for the US. A bank officer and a lawyer accompanied them.

“Dr. Deshpande, I need a certificate, my father cannot sign, and is in no condition to think coherent now. So we want to get his banking and legal formalities about our property completed with thumb impressions. I need you to authenticate dad’s thumb impression”.

The old man printed his thumb impression in my presence. Somewhere within, I knew he was violently crying although he must be hiding it just so that his daughter doesn’t feel bad while leaving him.

That Thumb impression, Decoded, was in fact the stark face of today’s society.

© Dr. Rajas Deshpande

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A Good Doctor’s Daughter

© Dr. Rajas Deshpande

We sat inside her home, not able to speak. It was a Sunday. The doorbell rang. My classmate Siya looked at me, indicating with her eyes to please answer it.

Siya had lost her father that early morning. We had just finished the last rites and returned with that feeling of emptiness of life which prevails at such moments. Her father was a successful pediatrician, known for his excellent diagnosis and humanitarian approach. He had passed away at a very early age due to a rare cancer. He had kept working till the day he was admitted. His devastated family was staring at a long dark tunnel.

I went and opened the door.

“Doctorsaab hai kya? (Is the doctor home?)” asked a man in his thirties. Behind him were his wife and a son, about ten years old.

“No” I replied, but his wife immediately said: “Please, my son is his patient since last ten years, he has fever since last three days, we must meet the doctor”.

I requested him to please clear the door, shut it behind myself, and whispered to him: “Doctorsaab passed away early this morning”.

They looked at each other.

“How?” the husband asked.

“He had a cancer, he had some sudden complication” I replied.

After a pause. The husband asked “ Can you suggest some good pediatrician nearby?”

I did, and they went away. © Dr. Rajas Deshpande

There was no word of feeling sorry for the doctor who had treated their son for ten years. Not even a formal gesture of condolence. Their child wasn’t very sick either, to skip the basic courtesy. For the next few days, I was at their place on and off, and somehow expected that man to return to express some form of condolence or gratitude. It never happened.

Then over a period of years, the truth gradually dawned: that this is normal. No one comes back to ask a dead or retired doctor’s family if they need any help.

Another young colleague of mine, a diabetologist, passed away recently. He had done phenomenal social work, treating many patients free, and even arranging for many patient’s education. Every time he referred a poor patient to me, he called up, requested me to see the patient free. We all gladly did. We had many common patients who followed up later with me, after his death. Unfortunately none of the patients who he had called about ever expressed anything beyond “He was a good doctor. Now I go to this doctor”.

I wonder how many of these patients will ever realize that every time this doctor had seen them free, he had taken a share of what his own children would have inherited, and given it to that patient.

I am a fan of Ayn Rand. I believe that it is nobody’s duty to help me, and that I should rely only upon myself. But unless this stands on both sides, it becomes meaningless. While the expectations from every doctor are expressed in heaps, when it comes to rewarding the good results “blessings, satisfaction of saving a life and good wishes” are conveniently considered enough. I sincerely doubt whether the future generations of doctors will be able to buy their petrol with blessings and satisfaction. © Dr. Rajas Deshpande

Why is the compulsion of “courteous, polite speaking” only applied to the doctors? Why cannot our society learn the same? The idiotic claim (often supported by some media legal officers) that ‘a patient is in distress and so doctors must accept the anger, impolite behavior, violence or abuse’ is so stupid and meaningless! Will a judge ever accept such reactions by an angry criminal? By the way, if the patient is stressed, is the doctor also not stressed for years? Is the doctor then allowed to misbehave? If the doctors can learn courtesy, why cannot others?

It is so funny that even the great politicians who keep on throwing mud and blood upon each other, use basest language of threats in public day in and day out advise doctors about how they should learn courtesy, humanity and communication.

Siya has now become a successful practitioner. After her father’s death, she wasn’t helped by the government, society or the patients that her father treated. The family had to compromise a lot to complete education of all the sibs.Yet she became an excellent doctor by her own wish, her own conviction and continues to be praised by her patients for her courtseys. After all, she is a good doctor’s daughter!

But her smile, when her patient compliments her, is hollow.

© Dr. Rajas Deshpande

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Hon’ble Babaji’s Medical Interview

© Dr. Rajas Deshpande

A long fleet of luxury cars entered our big hospital. Sirens and whistles, security guards brandishing their AK 56s. and shouts of humiliation for the common men and women suddenly filled up the scene.

Hon’ble Babaji had arrived. A vacuous smile and blessing hands greeted one and all. Babaji was known to cure one and all with his blessings, secret medicines, chants, touch, and even exercises. There was nothing he didn’t treat, so he was the ultimate superspecialist with highest experience and cure rate. No deaths were ever reported among those millions treated by Babaji.

I was in the ward with some of my colleagues, a junior doctor then. The most reliable pleasure in the life of junior doctors is pretty, beautiful and handsome colleagues to work with! Rare exceptions with extreme merit are of course there.© Dr. Rajas Deshpande

A rich businessman and senior minister was admitted in emergency with a heart attack last night. Doctors had performed an emergency angioplasty, barely in time to save his life. Highest offices in the country had warned doctors to ‘do the very best’ for him, till the time he could be flown out of the country for the most advanced treatment. After the meeting of money, influence and power, we got a chance to request Babaji for a small interview to guide us inexperienced doctors. Looking at some of the prettiest faces among us, he gracefully consented. Here are some excerpts of the interview for the benefit of mundane, inexperienced new generation doctors and junta:

Doctor A ( looks OK): Namaskar Babaji! Can you tell us where you studied this art of curing all the illnesses?

Babaji: Beta this is the inheritance of generations, bestowed upon those who perform some secret rituals, it took me many years in the forest to learn it all.© Dr. Rajas Deshpande

Dr. Me ( looks ugly as you know): But Babaji, did you have patients to treat in the forests?

Angry Babaji: No. To learn this secret art you do not need to practice upon patients like your medical science. Once we know, we can directly cure everyone.

Doctor B (stunningly beautiful, common crush): Babaji, can you tell us how you treat a case of open head injury?

Babaji (with an gracefully sexy smile): Come beta, sit here, so you can hear me. We first hold some leaves hard pressed against the wounds to stop bleeding, then pray for the patient with some internal healing chants. We then call the relatives and explain them how futile and fragile life is, and ask them to accept fate. Usually they do. Some rare ones take such patients to hospitals. There too, some die and some survive. Those who survive mostly do because of the prayers. You can come to our place if you want to know how to treat all types of emergencies. We have even made some dead alive!© Dr. Rajas Deshpande

Doctor C (Meritorious. That’s all.): Babaji, there are so many poor patients dying in so many government hospitals, in small villages, everywhere. There are so many hunger deaths too. How come you and your chelas are never seen working your magical powers for such poor and needy patients? In the same time that you visit a businessman, minister or appear in a TV interview, you could treat and cure hundreds with the power you claim to have.

Babaji (red): You will not understand, because you do not have faith. Next question.

Doctor B: Babaji, you and your drug company earn in multiple billions. You are a saint yourself, and do not have material aspirations. Then where does all this profit go? Are you secretly using it to help treat poor and downtrodden?

Babaji (drinks water): There are many charities we do, but one must not tell others what charity they do. We submit the reports to the government. I am getting late, beta, it is my prayer time.

Doctor A: Just one more question, Babaji.. it is said that you cure diseases like cancers, AIDS etc which have no medical cures. Is that true?

Babaji (winks one eye): If you ask me in front of media, I will say no. Because I do not like too much attention and fame. But if you come to our place, you will see the miracles that our ancient formulas and personally researched products can make. They are all FDA approved and safe. Millions have been cured. We treat everything!© Dr. Rajas Deshpande

Babaji smiled proudly and got up.

As he walked in the lobby, many poor patients and their relatives who tried to touch his feet were pushed away by his security. Only pausing to answer questions by TV channels, posing holy, Babaji disappeared in his luxury car.

I went back to the room of the rich senior Minister to record his blood pressure. He was on the phone, talking to someone “Yes, yes, Babaji just confirmed his plan to buy another aeroplane. I have promised him that you will design the customized interiors for his new plane. Come over tomorrow”.

Then, as I recorded his notes, I politely asked the rich minister “Sir, why didn’t you go to Babaji first when you had chest pain?”

He replied what most Indian Politicians, Media personnel, and many Judicial experts feel: “You are too inexperienced about these things, Doctor”!

© Dr. Rajas Deshpande

Please share unedited. Any resemblance to any human being or animal is deeply regretted and unintentional. Praying for better logic and reasoning in all human beings.

The Parceled Sandwiches

(c) Dr. Rajas Deshpande

Entering the hospital that morning, I was wondering if I could finish early and go for a relaxed dinner with a friend who was visiting. Iwas in an excellent mood when I entered the hospital at about 10 AM. That’s when I heard the noise.

In the entrance lobby, there was a group of men, women and children, wailing, crying, shouting, pulling their hair, beating chests, and throwing their hands and legs around lying upon the floor. Few of them were shouting loudly “All doctors are looters. They robbed us and still killed the patient. How can our patient die? Catch them. Kill them. Burn the hospital” this was accompanied by abuses that cannot be mentioned. The security staff and PROs were patiently trying to tell the violent relatives that there were other patients and relatives, that there were women and children around, but the most vulgar of the abuses continued.

I walked past the abusive crowd and met my resident doctor in the ICU. The first case was that of an old man who had had a fall a week ago, but was treated at home for the first three days. Three days later, the old man had suddenly become unconscious, and on admission was found to have a large bleeding in his brain. If not operated within minutes, he would have died. Our neurosurgeons rushed in and operated him with a huge risk. Now he had just started responding, but was still not fully conscious. (c) Dr. Rajas Deshpande

“Why is he still unconscious, doc? Was the surgery not done correctly?” the son asked.

“We have repeatedly told you Sir, the delay in admitting your father has caused a lot of damage in his brain. We cannot predict when and how much he will recover. The surgery was done to prevent imminent death. In my opinion, he is steadily improving. ”I explained again.

One after another, different faces of suffering and allegations, pain and expectations kept mounting and in a few hours it became difficult to feel happy. I am seriously not the type who can keep a perpetual meaningless smile upon my face without actually being happy. However, I must keep calm and smiling, because the next patient will be coming in with a lot of hope, expectation and fear. I did my best.

But my hope of having a relaxed dinner with the friend was gone. All I wanted now was to go home, take a hot shower and try and kill the negativity that was cluttering my mind. The wails and cries of the crowd were still noisy in my heart. “Who must have died? What must their family be going through? What about their children and spouse? Was this preventable?” I was curious. (c) Dr. Rajas Deshpande

The casualty called. A young girl had come with fits. Her old farmer parents had brought her. Stabilising her, and completing the examination, I asked questions to her father. With teary eyes and folded hands, he told us “We have no one and nothing left. Please do something”. Reassuring him, I messaged my CEO, who graciously allowed to treat her as a free case. I started writing notes.

“What was the ruckus in the morning?”I asked the resident doctor standing besides me.

“Oh that!” he replied “That patient was admitted for a head injury two weeks ago. He drank too much alcohol, and his bike had slipped. We admitted him as an emergency, and treated him on compassionate grounds as he was comatose. The relatives were well aware about the poor outcome. We did everything we could. I don’t know why they reacted so. Someone told me that the local politico wanted to extract some funds from the hospital”. This was not unknown, but loss of life does cause unexpected reactions, the doctors and the hospital staff bear the brunt.

Many patients were treated that day, many came cured, many went home happy, many expressed gratitude. But the fact remained that I was unable to forget the wailing family and the accusing son of the ICU patient. Am I supposed to smile and be happy for those cured and improving, or am I supposed to feel sad about the death and suffering I see every day? The emotional highs and lows that happen in every doctor’s day are too wide, too heavy and dynamic. It is not easy to forgive and forget bitterness, thanklessness and paranoid accusations on a daily basis for years, and keep smiling in between. (c) Dr. Rajas Deshpande

My friend called. “Rajas, I am standing outside your hospital. Come let’s have a quick bite. My bus leaves in anoter one hour” she said. We entered the nearest restaurant. Her witty words indeed relaxed me somewhat, and she ordered soup and sandwiches, knownig my favourites. As the steamy soup eased my throat, I started telling her about my day. My cellphone rang.

“Is that you, doctor Deshpande? Do you remember my father Mr. Ramakant who you were treating? He passed away today. We were supposed to come to you three months ago, but as I was out of India, I couldn’t bring him. He had stopped all medicines”.

I winced. Mr. Ramakant was fairly healthy, happy and stable on medicines, they were told never to stop the treatment. How should I react?

“Very Sorry to know” I said.

“That’s okay doctor. My problem is that no doctor is giving a death certificate for him, as he had not seen a doctor since long. We need it for the funeral. If I come to you now, can you please write a death certificate for him? I will pay your charges” he said.

“Sorry, someone has to examine him and issue a certificate. Please call your neares doctor home, or take thepatient to the nearest hospital” I told him. As I kept away my cell, I avoided looking at my friend.

“What happened?”my friend asked. Looking at my face, she sensed it.

“Oh. Sorry” she asked the waiter to parcel the sandwiches.

Both of us knew that neither was going to eat them.

(c) Dr. Rajas Deshpande

Please share unedited. Please let the society know what a doctor’s day is typically like.

“My Turn Now”

©Dr. Rajas Deshpande

“I don’t want to live like this. I have stopped eating since today. Please do not be angry with me for this, but I cannot see you and my children suffer because of my illness. Let me go with peace” Geetanjali said to her husband.

Eighteen years after her marriage, in her late thirties, Geetanjali suddenly lost the function of one half of her body. Her children were still in school. Her husband Gajendra Jagtap works as a school teacher and does some farming on a small piece of land they own. The whole family was shocked and shattered with this calamity that befell Geetanjali. But Gajendra Jagtap decided not to be broken down by destiny, and took his wife immediately to the best hospitals in Mumbai. They were told that Geetanjali was suffering from Multiple Sclerosis. After a few days of treatment, they could not afford to stay in Mumbai and came to Pune as it was nearer to their village. The Multiple Sclerosis Society of Pune extended its helping hand. Geetanjali was yet unable to stand up or walk. ‘This illness is totally unpredictable, anyone can develop blindness or disability anytime’ doctors told them. Geetanjali felt hopeless. She was very depressed with the thought of stressing her husband financially to provide for the treatment expenses. She also worried if her children’s education will suffer due to her illness and financial constraints. This was the reason she decided that she did not want to live any further, and gave up eating or drinking anything.

But Gajendra was not the typical Indian husband. This B. Sc. Graduate who had taken up teaching in a rural school as his profession had a big heart, and harbored principles of equality and respect for women, just like a highly educated spouse in a developed country. He told Geetanjali, ‘You have served me and our children for over eighteen years now. When I was working in the school or in the farm, you looked after the home, cooked for us and fed us sumptuously. Now give us a chance to repay for what you have done for us. It’s my turn now. I am going to take care of you just like you cared for us.’ Geetanjhali could not hold her emotions and sobbed when she narrated this story to me.

‘At that point of time, I felt like living only to help my family. I decided to use whatever few healthy days I had to make my husband and children happy.’ She started to fight her disability with a new spirit, and in a few months could walk very well again. Since then she had attacks of this disease many times, but vehemently fought it to recover every time, with the help of her husband.

Gajendra told me “I explained my children our situation. I told them that we don’t have much money left, and that they must only complete their education based upon merit. We are very fortunate that our children decided to grow up quite early in their childhood. Both of them studied very well, and my elder son is now doing his post graduation which he got through a scholarship in Delhi. Even my daughter got excellent marks and is now pursuing her post graduation by winning a scholarship. Both of them take care of their own expenses, and never bother us for money. Even I have decided that whatever our destiny presents us with, we will face it with a smile, and never accept defeat in any situation. We have to visit hospitals many times, spend on treatment and investigations, travel many times, but we do it all with a spirit of winning together. Whenever she can, she still takes care of the home, and when she can’t, I do it with the help of my daughter. But we never feel desolate or depressed”.

In the developed world, people suffering from this illness get a lot of healthcare facilities, and even income tax concessions. However, this farmer from a lower middle class background who does not receive any such help, has not only resurrected his family, but created a new life for his wife with his sheer love and determination. The most admirable thing about his love story is the respect and feeling of equality with which he thinks of his wife. Geetanjali also stood up firmly with him to conquer this illness, with all her love and might. Together, they have indeed defeated their destiny.

We sincerely pray for the excellent health, well-being and long life for each member of this wonderful and ideal family.

© Dr. Rajas Deshpande

Neurologist, Pune

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The Medical License to Kill

© Dr. Rajas Deshpande

The five year old girl stopped breathing. Her father shouted in a state beyond panic. With a fear of a death worse than his own, he choked upon his own shouting. It was about 4 AM. The dozing relatives of other patients in the casualty woke up startled.

The intern doctor Anu tried to insert a breathing tube in the child’s throat, but the right sized tube wasn’t available. Dr. Anu shouted at the nurse to wake up the medical officer on duty. She couldn’t: he was deep asleep, being drunk. The child started getting blue. The heartbeats became feeble. Another nurse ran upstairs, and literally dragged the junior doctor in the ICU to the casualty. He struggled and managed to insert the tube somehow, and with the breathing bag, artificial breathing was started. The child stayed unconscious, but the heart beats were heard well now. There were no beds in the ICU, so they managed her there itself, in the casualty.

Two hours later the medical officer woke up. Unclean and unkempt, stinking of alcohol and sweat and yet careless about it, he was usually seen roaming in the hospital with swollen red eyes, talking usually about the only three things so called “Men” talk about. In hating him, many diversely thinking junior doctors united. There were complaints about him: nurses, junior doctors and patients had all written to many authorities about his drunken demeanor, ill behavior, swearing and abusive language, and even a violent attitude: he was known to slap attendants, drivers, assistants, and throwing instruments in the operation theater. © Dr. Rajas Deshpande

Dr. Anu not only hated him, but was scared of him too. She hesitantly reported what had happened in the night. “We tried to wake you up Sir, but couldn’t” she said cautiously, just like all brave girls who cannot hide what they dislike. He laughed in the style of a famous ‘Manly’ hero of the times. “Such small things keep on happening in big hospitals. Don’t worry. If I wake up for every emergency at a government hospital, I will myself die. I am doing the duty for five medical officers alone. You must accept death as a part of your daily life. Don’t get emotionally involved in patients. Some will die, we can do nothing about it”. Then, without even visiting the child once, he left, as his duty hours were over. © Dr. Rajas Deshpande

The disgust and anger that flooded Dr. Anu came out in the form of tears. She went to the nurses room and sobbed. She had not dreamt of becoming a doctor like this: helpless and suppressed. The nursing Superintendent, a motherly lady, patted her. “It is good that he didn’t wake up at night. He doesn’t know even the simple procedures. He would have probably harmed the child more in that drunken state. The only thing you can do now is to quickly learn all the life saving procedures that you can, and then don’t be dependent upon anyone else to save lives”.

“I want to complain against him. How can a doctor sleep when a child is dying during his duty?” Dr. Anu asked.

The Nursing Super smiled in shame.

“My dear, who will you complain to? This drunkard is the son of a ruling minister. They own a private medical college themselves, many come to him to get medical seats there, so they have friends and defenders in almost all high offices. Whoever questions anything about him, faces not only the ire of his father’s political goons, but suffers at many other levels to. Do you think people don’t know his addictions and ill behavior? But when the government protects him, what can anyone else do?”.

Then, as Dr. Anu stared in vacuum, the Super told her one of the most beautiful pearls in medicine: “There are some bad doctors dear, but that’s where you come in. Your responsibility increases. Learn to be strong, learn to compensate for what others cannot do. Such sick doctors who pass out without learning, who come drunk to the hospital and mistreat patients are a curse to our profession. We can’t change them. The lesser number of patients they see, the better it is for everyone. You compensate for them by becoming better”. © Dr. Rajas Deshpande

The day forever changed Dr. Anu. Providence, as always, had rewarded her for her efforts in saving the child’s life only a few hours ago.

The sad fact still remains: that some students are not trained well. Some do not have the capacity or wish to become good doctors while some are ‘pushed’ by money and power. These are the people who have learned the most deadly Indian trick: to find a political godfather who protects them from anything you do, Feed his wallet and ego, lick him all over, and then retain the ‘license to medically kill’. Please check out how many ministers and political bigwigs own medical colleges, and how many use these as ‘power channels’ to make undeserving doctors, and one can easily know where the problem lies. This by no means suggests that only the doctors from private colleges are bad, there indeed are ill behaved and drunkards among doctors passing out from govt. colleges too. The point is that they are protected by some. To first satisfy all vote banks, then collect the multicrore moolah for admissions and then create yet another channel of corruption: Eligibility test! This is a nightmare for the truly willing and deserving merit holders. About this aspect of the matter, no politician ever speaks. Who protects the Medical admission scamsters? Why do not our courts act suo moto, knowing that so many lives will be at risk with doctors produced via scams? © Dr. Rajas Deshpande. The saddest part is that many corporate hospitals look for such doctors who are also financially recklessly aggressive, and then make them compete with the good and ethical doctors.

Today on the occasion of Gandhi Jayanti, many “trumpet tongues” will be heard speaking through their hats about the Mahatma. Introspection and truth are the beginnings of even knowing the Mahatma. The criminal corruption networks which produce bad, ineligible doctors by the force of money and power must go! These are the very doctors who bring a bad name and a shame to our profession. Many a good things in the profession, saving a million lives every day and sacrifices made therein bt thousands of good docs all become a waste because of such few bad doctors. Let us all stand united in improving ourselves, giving up what’s not the part of a good doctor.

Jai Hind!

Mahatma Gandhi ki Jay!

© Dr. Rajas Deshpande

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The Greater Squint

The Greater Squint

© Dr. Rajas Deshpande

“Why didn’t the doctor tell us? Is it allowed for the doctors to hide such information? I will sue him” the angry mother kept shouting as she cried. Her husband told her to calm down.

“I know the other doctor well, I will talk with him today. He must have his reasons” I replied.

“No doctor, we don’t want you to talk to him about this” said the father.

Their fifteen year old brilliant daughter had developed mild headache and occasional giddiness. They had first read blogs about these symptoms, and after trying out various “natural” remedies and lifestyle changes, visited their family physician. He had started with the routine medicines for headache, and advised them to visit a specialist if the symptoms persisted for a week. As the headache didn’t subside, they visited a specialist. His notes indicated a normal neurological examination, and some higher medicines for headaches and giddiness. After a week, the girl developed a squint, double vision and slurred speech suddenly, and was unable to walk. She was brought to our emergency, her MRI of the brain showed multiple sites of infection including the lower part of the brain. Although most infections are treatable, those in the lower part of the brain (called brainstem) are extremely dangerous, and can cause even coma or death. This part has all the vital centers of the body, controlling heart rate, blood pressure and respiration. © Dr. Rajas Deshpande

When I explained this and advised admission for further treatment, they had panicked. That is when the mother had lashed out at the earlier doctors.

After admitting the child, the father came back.

“Doctor, I must make a confession. My wife is quite anxious, and she was crying when we saw the last doctor. That’s why the doctor didn’t tell her everything, but asked her to wait outside and informed me that there were such dangerous possibilities as cancer, tumor or infection, and that an MRI was necessary. I requested him not to write that on paper, thinking that my wife will panic. She is very emotional. That’s why we waited for a few days, thinking that things will improve. Please understand us, doctor”. I reassured him, and treatment was started.

The inflow of blatant allegations against allopaths/ modern medical practitioners is now so wide and strong, that this has sensitized some of the best doctors. Some have started to entirely avoid mentioning the tests required for a complete evaluation of a condition, knowing that if the doctor advises any tests, the only interpretation in our society is that those are for earning more money.

“Patients themselves do so many tests and take so many medicines without consulting a doctor. But if we advises any tests, the immediate allegation is that we want to earn more money. That affects our practice. So shall we still advise tests?” asked a colleague during a recent seminar. © Dr. Rajas Deshpande

The answer is a definite, loud yes. The duty of a doctor, besides being well qualified, skillful and compassionate, is also to boldly state fact and possibilities, advise the best investigations and treatments to every patient, poor or rich, VIP or AAP, and write these all on the patient’s case paper. The workup / investigations advised should be according to the global best practice guidelines. Poverty and illiteracy are neither the faults or responsibilities of a doctor, and like other professionals or even some governments, a doctor cannot provide “low grade” service to any poor patient. From the eyes of a doctor, even a penniless beggar should get the same advice about tests, medicines and surgery that the Prime Minister of the land gets. If ministers can go to corporate hospitals or even abroad for treatment, every citizen should also be sponsored for the same benefits by the same administration through the same funds, without preaching the doctors to do more “charity”. Otherwise we are a hypocritical society. © Dr. Rajas Deshpande

Whether to do those tests or not, where to do them is the patient’s choice. Whether to take the advised medicines is also upto the patient. The doctor may suggest the best place, request concessions, and if the patient is poor, suggest options to get financial help or refer to charity. But the quality of medical advice should never change. The only exception is an accusative, angry patient who is making paranoid efforts to find faults with everything that you do. One may politely decline to accept such a patient.

If the treating doctor has not advised all the tests necessary for the evaluation of relevant diagnostic possibilities, he/ she may be found guilty of negligence. To avoid advising tests just to please the patient would also be a moral crime. One must also refrain from crossing over to other specialties and advising tests before referral to the right specialist. Some “pretending to know everything from every specialty”, doctors advise various tests incorrectly, and even attempt treatments out of their expertise without a working diagnosis. . Such dangerous doctors may add to the woes and defamation of the profession. © Dr. Rajas Deshpande

The girl above is improving, although her balance is off, and she has developed t a squint. Most likely her squint will never improve. She is missing school for over three months now. She will now onwards live a compromised life: incomplete education, compromised marriage and the condescending Indian society where shame of physical disability like squints and lisps, slurring and imbalance are the essential components of most enjoyed comedies.

However, her squint is far lesser a problem than the one that our society has, against doctors.

© Dr. Rajas Deshpande

PS: Many people comment often that “Doctors should introspect”. I do not know how many of these people introspect about their own habit of finding faults with others before self. But the article above is an honest attempt to do so.

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Humanity Face / Off

Humanity Face / Off

© Dr. Rajas Deshpande

“Your father in ICU has probably had bleeding in the brain. We need an urgent CT scan” I told the son waiting outside. The old man was admitted late in the evening, although he had had severe headache and weakness on one side since that morning. His son had just returned after a “one-hour” quick meal. Besides flaunting many brands upon his person, he had already told me that he was the vice president of a well known software company.

“Yes, doctor, I am just waiting for the approval from his insurance company.” The son replied. For doctors running in and out of critical care units, the “Cool Calm” of such educated relatives is beyond understanding. Most insurance companies work office hours, approvals come at their own speed, they are least concerned about the patient outcome.

Everything was being kept on hold. Hospitals do not want to proceed with costly tests and investigations unless they are life saving, because most relatives flatly refuse to pay if the insurance company denies approval. The doctor suffers a double blow emotionally: because things are delayed and also because relatives blame only the doctor.

“This is urgent. Please consider making the payments and filing for reimbursement later, so we can make decisions faster” I told him.

“If it is urgent, why don’t you get it done? I will not pay, his insurance company will have to approve” said the son.

I thought about the patient. In the waiting room, the patient’s wife, an old lady, kept praying. I wished she was also praying for a better son. © Dr. Rajas Deshpande. I requested the hospital authorities, and as always, they agreed to help. A CT scan was done, it did show bleeding in the old man’s brain. When informed, the son winced. “How many more days in the hospital?” he asked.

“Usually it takes a week for such patients to stabilize” we told him.

“Can you discharge him? I will arrange for some nurse to give him treatment at home. Just write the medicines he needs” he said. His mother, hesitant, asked “Is it necessary to treat here, doctor? If his health is in danger, we will stay”.

Angrily, the son cut off his mom. “No, mom, this has become a business. They will extend stay even if it is not necessary. If it is only medicines, why does he need to be in hospital?” he asked me.

“Because such patients often develop excess swelling in the brain, or other complications. They can also develop convulsions or lapse into a coma if swelling worsens” I unchained my patience.

“Do you guarantee that those complications will not happen if we keep him here?” he asked.

“No. Only that he can be managed in time, if any complication develops” I replied. There’s no word called “Guarantee” in the medical dictionary. It is only a quack’s favorite trick. © Dr. Rajas Deshpande

“Then why stay here? I have a nursing home nearby, we will go there if there is any problem” the son said, turning his back upon his mother.

The open-secret was revealed soon: the insurance cover that he had bought for his father was minimal, it was over now, and he didn’t want to pay anything from the pocket.

I explained the patient’s wife about the medicines and care, updated her with the warning signs of danger in such cases. © Dr. Rajas Deshpande

“Doc, I am alone at home with my husband all day. My son and daughter in law both work and return late. What will I do in case there is an emergency?” I gave her some contacts near her home, ambulance numbers and doctors.

“Is it okay if she calls you daily to inform the patient’s condition and ask what medicines are to be given in case of an emergency?” the son asked.

“Sorry, we cannot manage patients on phone” I replied.

“Sorry doc, don’t take this personally, but there’s no humanity left in this profession now a days. No one wants to help even an old patient” he commented. I didn’t reply.

They returned in three days, the patient comatose. The brain swelling had increased to dangerous levels. Patient was operated in emergency, saved with a great effort. The son had to foot the whole bill this time. “This is quite unfortunate” he kept saying, reminding me to keep expenses “lowest” because he was paying from his pocket. Finally came the day of discharge. Knowing the questions, I explained them the medicines on discharge.

“Doc, he is a senior citizen. You must give us discounts” said the son.

“Sorry, the hospital decides the billing. My charges are already minimal”. I told him the truth.

“Just as I said, there’s no humanity left” he looked at his mother and said. It was now the time to chain my patience. I knew the right reply this time.

“Yes, Sir”, I said “ I agree. Humanity is indeed on a decline, but more in your family than in my profession”

© Dr. Rajas Deshpande

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The Goddess Of Humanity

The Goddess Of Humanity

© Dr. Rajas Deshpande

When I entered the hospital today, little did I know that I would meet someone who changes lives by example.

Then I met Mrs. Jasmine Govindji Majethia. A lady far superior than most men I ever met, a spirit with an energy to defeat ten ripped-jeans-teenagers, a soul that can only belong to a saint in any religion!

At the age of 80, Mrs. Jasmine Majethia is working 24/7, traveling alone all over India to help patients with Thalassemia get treatment in time, to generate awareness among people and even medical community. She has been doing this for over 30 years now. © Dr. Rajas Deshpande

This morning I had received a call: “Hi. I am sending an old lady to your OPD. She has done a lot for the society. She has had some episodes of unconsciousness recently” said our Pathology chief Dr. Mrs. Nita Munshi, always out to help others full throttle.

Mrs. Majethia told me that her tremors were long standing, but recently she had had some episodes of unconsciousness. It had all started after a stressful event related to one of her Thalassemia kids.

“I cannot sit at home. I have so much to do. Tell me what tests are required, tell me what medicine I should take, but I want to continue my work” the lady had an authority difficult to match. I followed her orders.

Born and raised in Calcutta, married in Mumbai, she finished her family duties and joined the LTM Medical College Sion to work as a liaison officer with Dr. Lokeshwar, who invoked her interest in Thalassemia. Witnessing the plight of children with Thalassemia and their parents, she decided to make it the mission of her life to stand up for them. She established PATUT (Parents Association Thalassemic Unit Trust) to help the affected families with financial and other support for treatments. This Goddess of humanity has thus saved many a lives, roping in doctors, hospitals, trusts, friends, rich and poor donors to help this cause.

“Zero Thalassemia Birth Rate in India by 2020 is the mission of my life. I am not ashamed of knocking doors and asking for help because it is not for myself.” said the lady with a steel resolve. © Dr. Rajas Deshpande

“There’s hardly anyone who can resist helping her cause. She is like a gentle pinch of conscience for those who have excess, to help others” said Dr. Munshi.

Thalassemia affects over 40 million people in India and kills thousands every year, it can easily be prevented with simple precautions. Even countries far backward than India have rules that make Thalassemia screening legally mandatory before / during pregnancy, and thus prevent any child births with this condition (“Zero Thal Birth Rate”). However, lack of awareness and screening, apathy on the part of our governments has continued to increase the burden of this disease in India. The treatment is extremely costly in some cases, and out of reach for most common Indians.

Mrs. Majethia spoke with the passion of a revolutionary: “So many doctors all over the country, like your colleagues Dr. Vijay Ramanan, Dr. Nita Munshi and Mrs. Trupti Thanekar always help me in my cause, whenever I request help. But the sad part is that there is almost no health awareness in our country. Even if we offer free treatment, many parents do not avail of it until it is too late and the case gets complicated.”

“Yet I like to think that God has given me in excess than what I need. Even Life. It is my duty to give some of it to those who are unlucky. I tell myself that God has selected me to do this work, because I can.” Such simple words, yet so powerful in their meaning! I really wish that she must receive best of the National Honours and medals for her work.

Every now and then, some insurance agent gives me plans to retire early and still earn well. Some tell me how people make retirement plans by age 40. Until now, I didn’t find exact words to tell them that many of us do not want to retire, that I wanted to work till my last breath. This lady was the answer, the literal personification of the words I AM MY WORK.

Across the cultures, there are Gods and Goddesses of Beauty, Fame, Love, Sport and Affluence. Rarely do we hear of a God of Work or Goddess of Humanity. In Mrs. Jasmine Majethia, I found the Working Goddess of Humanity.

My highest respect to this lady, one of the most inspiring women I ever met!

PS: She agreed to record a short message for everyone including doctors, please click this link in my comment below this article to listen to her divine voice.

© Dr. Rajas Deshpande

Please share, to get this lady the respect and honour she deserves, and to spread awareness about her great selfless mission.