Tag Archives: neurologist

Living By The Words ‘Being A Doctor’.


Living By The Words ‘Being A Doctor’.


© Dr. Rajas Deshpande

“He is critical, an emergency heart surgery is planned tomorrow morning. The surgeon says there is very little chance of surviving this. I don’t know what to do. I cannot imagine this is happening to us.” Dr. Ranjeeta Joshi was crying on the cellphove, still making an effort to keep her voice even. Her squeezing agony about the sudden illness of her Orthopedician husband Dr. Sudhir Joshi reflected in each word she uttered.

This was a weird coincidence! I was not working that day, attending a court summons because a patient was being divorced for having epilepsy. On the way back I also had had a terrible argument with a very precious friend, we were both hurt. Both these had emotionally upset me badly, and so on my way back to Pune, I changed my route to visit my favourite Ganesh temple, where I usually rediscover my lost calm when life batters my patience and bludgeons my peace. Just as I entered this temple premises, I had received this call from Dr. Ranjeeta.

I knew the couple well because Dr. Ranjeeta is struggling bravely with two bad diagnoses: Multiple Sclerosis and Rheumatoid Arthritis. The fluctuations of both cripple her often, but she stands back stronger every time. I knew she was already using a walker. Dr. Sudhir is one of the most renowned Orthopaedic surgeons in Mumbai, with his own hospital at Dadar. Dr. Ranjeeta looks after the administration of that hospital.

I was shocked. I didn’t know exactly how I could help. I reassured her. I told her I was praying for both of them, and urged her to have complete faith in a good outcome. One of the best cardiac teams, Dr. Ramakant Panda, Dr. Vijay DeSilva, Dr. Tilak Suvarna and their colleagues were to operate Dr. Sudhir in few hours. I prayed for the couple, informed her so, and returned to Pune.

She kept updating me. The surgery lasted over 11 hours. Dr. Sudhir was shifted to CCU.

Dr. Ranjeeta ran the show at their Dadar hospital. The staff of their hospital refused to accept salaries that month, and told Dr. Ranjeeta: “You have always looked after us and our families. Now it is our turn to stand by”.

Every passing day was like a slow mountain of fear heavy upon the shoulders of everyone involved. While using her walker and occasionally a wheelchair, Dr. Ranjeeta successfully managed to attend all his needs as well as home and hospital. Dr. Sudhir gradually came out of critical status, in a few days started walking again, and within two months started attending his patients.

Barely after 10 weeks of this major calamity, this medical phoenix started performing major surgeries again, back to his “Doctor Normal”.

When they came today, I was quite moved to see him all back to normal. Of course the love that the couple emanated for each other is beyond words, and I will refrain from expressing what is more beautiful unsaid!

Dr. Ranjeeta, with tearful eyes and a smile, said “We are so happy and grateful to God that we won! I feel every doctor must decide to be a survivor, strive to keep fit, because so many lives depend upon him / her.” she said.

“You are such a brave motivation!” I told Dr. Sudhir.

“It is my privilege to be a doctor, not everyone is lucky enough to become one. In death no one has a choice, but in life we do. I wanted to live and practice again, because being a doctor is a special ability! I can do so much for so many. I love this so much, that this itself became my motivation to survive and become fit again.” Dr. Sudhir replied.

As I stood mesmerised by his words, a beautiful guide to every doctor, he extended something.

A Montblanc Special Edition JFK Fountain Pen, something I was window shopping for so long!

What I ever did to deserve it, I will never know. But this beautiful pen will always remind me of the great JFK,, and more importantly, how I must make the best of my own life as a doctor .

One of the most famous quotes of JFK reads: “As we express Gratitude, we must never forget that the highest appreciation is not to just utter words, but to live by them”. There are thousands of prayers involved in becoming a doctor, in surviving, in reaching where we are today, each one of us. If only we live by our words, what we promised ourselves to be, never giving up, we can defeat so many adversities that stand between us and our life-goals.

Thank you, Dr. Sudhir and Dr. Ranjeeta Joshi, for this reminder, and being a great example.

© Dr. Rajas Deshpande

The Proof Is In The Pudding


© Dr. Rajas Deshpande

Seven years ago, Srinirmala Kanduri and her doting husband Vamsi Krishna came over frustrated by what appeared to be an unending punishment: Srinirmala suffered from a common type of epilepsy called CPS (Complex Partial Seizures), and was already taking three to four different anti epileptic medicines for the same. Her fits were still uncontrolled, and she would become unconscious without warning. She also had severe panic attacks, in which sudden fear grips the person, and a feeling of doom with actual physical symptoms like sweating, breathlessness, palpitations and blackouts keep reappearing. This not only made her own life miserable, but her husband had to rush home many times as she used to be alone. Their whole existence revolved around the fear and uncertainty of her illness, even at this young age, they could not plan any future.

Her physical examination was normal, and in spite of so many issues and side effects of the medicines, Srinirmala always kept a positive attitude. “I want to overcome this. I want to defeat this illness” she said every time. Sometimes, the medicines used for the treatment of epilepsy / seizures may themselves cause / worsen seizures. That’s what was happening with her. We gradually reduced her medicines, and were able to bring her to a single medicine, although she required frequent SOS medicine for her panic attacks.

Her husband Vamsi Krishna, working with Infosys then, relentlessly cared for her like a parent. He adjusted everything in his own life to suit her requirements: job, duty hours and undeclared leaves. He was not only completely supportive and understanding, but never even showed that he was doing anything extra for her. “We married in love” he says even today with his shy smile!

Then came the great trial of a woman with epilepsy. She badly wanted to become a mother. They were quite anxious and apprehensive, like all patients of epilepsy who face this situation. Vamsi was comfortable always with her choices, and said he would even support her if she wanted to avoid having a child. This is a nightmarish situation, given the emotional attachment that the mother and father have with the child they imagine. Now a days some safe medicines are available, although there’s none with a “completely safe” profile. Epilepsy medicines taken during pregnancy, almost all, have some risk for causing adverse effects upon the baby. Adding a simple medicine like folic acid and some supplements reduces this risk significantly.

Srinirmala and Vamsi decided to bite the bullet. These are the decisions that actually make the lives of the successful. We reduced her medicine doses to minimum, folic acid was added, and Srinirmala came with the good news soon. All through her pregnancy, her husband never left her alone except for his duty. Fortunately no fits came during her pregnancy, and she warded off her mild panic attacks with courage.

Then one day, THE call.

Shanmukhapriya was born in Hyderabad, under the care of Dr. Bhagyalakshmi at the Yashoda hospital, and both mother and the baby were smiling fit!

Another battle against epilepsy was won!

“There are ups and downs. There is uncertainty, no one can escape these. Keeping patience in difficult times helped me most, and that’s what I will advise everyone who plans to go ahead with extending the family while battling epilepsy. When I explained my situation rather than hiding it (stigma associated with epilepsy among the ill educated is a curse in India), my colleagues and bosses at Infosys and later Cognizant were very supportive.” says Vamsi Krishna.

Now Srinirmala has completely recovered, and rarely needs to hit the panic button. “I think it is very important to decide once and for all : that I will live normal, I will be fearless, whatever happens. That is what helped me win my battle” she says.

Then, as she asked the cute, sweet, and beautiful Shanmukhapriya (she is my child too, I feel, and the parents kindly allow me that) to blow a flying kiss at me, she commented “The proof is in this pudding”.

© Dr. Rajas Deshpande

PS: Thank you, Mr. Vamsi Krishna and Mrs. Srinirmala for allowing me this write-up for patient education, and Thank you Ms. Shanmukhapriya, for your heart throbbing smiles!

The Arabic Gratitude

When a patient from Arabic world is happy, he hugs you and kisses you too! However much unused to we are for such a gesture, it wipes away all the dust off one ‘s mind and rejuvenates the spirit of every doctor, to thank God once again for considering one eligible for this responsibility.


The Morphine That Killed a Hospital

© Dr. Rajas Deshpande

“He fell down while checking the patient”, said the panicked Dr. Mrs. Sane about her husband, “and became unconscious”.

Dr. Sane tried to maintain his calm. A sick doctor has the curse of knowing the worst of everything, and has a perpetual feeling of sitting upon a ticking time-bomb. It was a sad feeling to see this middle aged brilliant general practitioner fighting tears.

“Sir, the OPD numbers have shot up because of these epidemics, especially dengue. I see over a hundred patients every day. The Inpatient beds are full. There are daily problems: medical, administrative and medico-legal.. those I am used to. But now there are too many politico-social and press-related issues that worry me”.

Dr. Deshmukh, a senior practitioner and a common friend, accompanied Dr. Sane. He cautiously poked him “You must tell the doctor what happened the day before”.
“Oh that’s a part of our profession” Dr. Sane replied.
I insisted that he must tell me.

Reluctantly, he disclosed: “Some goons came in with a municipal councillor and threatened to waive off the bills of a dengue patient. He was in the ICU for five days, quite bad, but went home walking. Till the time he improved, they kept on threatening us to break the hospital and thrash us if something went wrong. Upon discharge, they didn’t pay a single rupee. There’s nowhere to complain, as the hospital requires many municipal permissions”. © Dr. Rajas Deshpande

Dr. Mrs Sane lost her cool. She started sobbing. “No one blames those who dump garbage, keep their surroundings unclean. No one is blamed when epidemics spread and thousands die. No one is held responsible for failures of almost all preventive services and lack of basic facilities at government’s healthcare institutes. But the already overworked general practitioners must bear the brunt of everyone’s anger: the public and press are always free to bash the last face they see: the doctor who is actually helping every patient,.. Dr. Sane has not had a proper lunch, not spent a full day with kids in months.. That hospital has become our curse“ She broke down.

It was so logical! The offices responsible cannot even be reached. The court does not see any of these system failures that cause millions of deaths all across India, happily ordering lakhs and crores and imprisonments for doctors, for trivial mistakes.
Whom to blame? Oh yes, the doctor who has studied to treat the sick!

Anyway, in a country fond of muscular heroes and billionaire godmen, who expects a brainy analysis? © Dr. Rajas Deshpande

“I had a dream of making best health facilities available for my area. I have taken a big loan. We treat poor patients free anyway. Many rich are sent by local politicians, leaders, administrators with instructions to attend immediately and free too. Paying patients are mostly suspicious because of all the negative things publicised by press about all doctors., they also expect immediate and positive outcomes. I have not slept for many a nights. “

I examined him.He had obvious features of being fatigued mentally and physically.. A syncopal attack, where the BP drops down suddenly and makes the patient unconscious, was likely. I advised him tests and told him to take rest for there days.

“Not possible, sir! Even now the OPD is waiting” he replied. An angry Dr. Mrs Sane requested me to intervene.

“Your duty to the society does not free you from the duty towards your own health and family” I requested him. But Dr. Sane agreed only when Dr. Deshmukh offered to send over a junior doctor to his hospital to take care of the OPD.

“How have you been, Sir?” I asked Dr. Deshmukh. He is one of the most respected and busiest general practitioners in town, with a big hospital. © Dr. Rajas Deshpande

Dr. Deshmukh smiled.
“I had an angioplasty three months ago. The only risk factor was high BP and stress. There is no use fighting or explaining our situation to the society, government or press. I have closed down my hospital. I only see OPD patients now. Anyway many patients thought that I worked day and night for earning more money. Let them go to the corporate or government hospitals.”

The death of his hospital was not a surprising news, many small private hospitals and nursing homes are either closing down or converting into profit-making franchises. Many doctors are suffering high BP, cardiac and neurological problems and even dying due to excessive stress.

The meaning of this nightmare will soon unfold upon our society.
Till then, this is a heartfelt appeal to all the over-stressed doctors to rethink about their priorities, rearrange life and make sure stress does not kill.

For the morphine of “medical social service” is only good in small doses, it kills when overdone!
© Dr. Rajas Deshpande

Best Moments In a Doctor’s Life

  Best Moments In a Doctor’s Life.

© Dr. Rajas Deshpande

1. The sound of restarting heartbeats when resuscitating a patient.

2. Closure after a difficult surgery where only the surgeon knows how he has saved a life.

3. A perfect surgery / procedure / stenting without complication.

4. Seeing the beautiful cute face of a healthy newborn.

5. Managing a major bleeder successfully.

6. Reversal of paralysis after thrombolysis (clot-buster injection).

7. Termination of Status Epilepticus (non-stop fits / convulsions / seizures).

8. Control over infection. Every infection is life threatening potentially.

9. Waking up of a comatose patient.

10. The genuine “Thank You” of a patient relieved of pain / stress / illness.

11. When someone random recognizes you in public and thanks you in front of your kids / family.

12. When the poorest of the poor collect enough money and gift you sweets for treating them free.

13. When a patient too educated to believe your truth goes to your professional competitors and many others, and is told the same, so returns to you with greater faith.

14. When you can answer all questions asked by students after a lecture / clinic (without Herapheri / bluffing).

15. When a student performs well and patient gives a good feedback about them.

16. When you silently prove your clinical argument with good results.

17. When anyone at work says “Take some rest now.. You have been working too much”.

18. Qualifying for a medal/degree/publication of significant repute.

19. When you know that it’s not only the medical skills, but also your passionate involvement, speed and coordination that saved the patient.

20. When traffic police “Let you go” for minor offences just because you are a doctor, especially on the way to an emergency.

21. When someone says “I want to become a Doctor like you”.

There are many more. Every day is filled with both tears and smiles, and the doctor has to balance these by using his/her soul as the fulcrum. At the end of the day, death humbles everyone, but it is the doctor who stands to defend everyone else’s life without thinking if they are good or bad, friend or enemy.

Who will believe that money, home, family, cars, looks, luxury, and even love, romance are secondary joys for most doctors, after they have attended all their patient’s issues? This pride is precious. The suffering a choice.The rewards immaterial.

A good doctor is the best a human being can be!

© Dr. Rajas Deshpande

The only way towards a solution: A 13 point charter for Doctors

The only way towards a solution:
A 13 point charter for Doctors
Happy Doctor’s Day!
© Dr. Rajas Deshpande

1. If we want to survive without being exploited and improve healthcare, we must forget all our differences and unite for this cause. We must be able to overcome all personal differences to realize what great strength we are. This is the only solution for ourselves and our dear patients!

2. We must form specialty-wise groups of doctors in each city / state and elect a steering committee that will decide the regional regulations. The charging system for consults, procedures and investigations according to “gradation” of hospitals (facilities, location, quality of advanced care, nursing) etc. should be devised by these regional steering committees alone. State committees should elect a National Medical Steering Committee.

3. The specialty groups in each town must include all consultants from that specialty, and decide the correct fees for consultation, procedures, intensive care, emergency availability and surgeries based upon seniority, qualifications, skill, time, complications and other factors intrinsic to that specialty. This schedule must be binding upon all the small and big hospitals in that region, insurance companies and private practitioners. Sharing fees must be the doctor’s prerogative.

4. There should be no free cases, except those below poverty line and in emergency. Doctors should get tax benefits for every free patient (CGHS /CSMA/ ECHS or BPL in India) treated by them, as per the regional schedule. There should be a regional coordinator for all the Free beds in private hospitals, which are often misused by rich officials. Every consultant must see free patients one day in a month by appointment.

5. Govt. must provide all cost of prescribed medicines, surgeries, equipment, medicines and manpower for the treatment of free patients. This should happen real time, as sometimes the dues are not paid to hospitals by govt. for decades. All existing dues should be settled immediately, so hospitals can provide better care. In patients who cannot afford costly treatments / medicines / surgeries, the funds allotted to the local representative (MLA / MP) may be used by priority. Also allow the pharmaceuticals to pay for the poor patients upon request by the treating doctor.

6. Every hospital must provide free available treatment for all the consultants working for that hospital and their families. All doctors should be collectively insured against: illness, disability, death, accident, loss of job, medicolegal cases and violence induced damage (mental and physical). This must be done at state / national level. The medical insurance companies which earn billions by eating from the doctor’s plates must insure them against all these calamities. Also the corporates and other healthcare giants should be answerable to the regional committees.

7. Any medicolegal case / negligence issues must first be presented to these committees, which will refer it to the national committee, whose decision will be recommended to the courts of law. The current compensation system based upon inequality of “value of life” should be eradicated. All patients are equal, and the compensation value of every life must be the same. If one expects “Indian rates of Treatment”, one must accept “Indian rates of Compensation”. In cases of patients treated free, the govt. should pay the compensation to the patient, otherwise no private doctor will want to treat free patients and invite more legal liability (the misuse of medicolegal cases by the poor and political is an emergency in waiting for future generation doctors). Patients should also have an option of committing complete faith in the doctor and signing a “No Legal Liability” bond, which will make it easier for the doctor to do his best for the patient, unaffected by legal fears. Also, any interference in patient care including intimidation, threats etc. must be punishable by law.

8. Doctors must collectively develop a national medical research funding by compulsory contribution, and start advanced centers for research which are not imprisoned by the lack of initiatives , funding, or intellect. This should be autonomous and purely merit based, with no interference from govt. or anyone else. We should also find practical solutions to accessibility and excellent rural healthcare system. Only we can, govt. never will.

9. There should be revamping of medical education: MBBS in four years, internship, one year bond of rural service, then PG, SuperPG, Fellowship and then practice. This is long enough. All other bonds must be cancelled. Payment structures of all Medical officers, Teachers should be compatible with highest in the govt: IAS / IPS, as these doctors deal with life and death everyday, saving millions. PG exams must be conducted on time, and court interference must be avoided, the decisions of National committees must be final. This will save millions of youth-years of generations of doctors. PG seats should increase every year, there must be unified national payment strategy for PGs. They must also get free food, hostel and internet, and compulsory 8 hours daily sleep time.

10. Doctors must also introspect and improve wherever they are really lacking in the social eye: proper compassionate communication, dignified behavior (avoid this talk of the town when someone overdrinks especially in conferences). We must also start “Positive Connection” strategies with patients, and limit / improve upon the existing crisis of faithlessness by encouraging and rewarding trust. There should be doctor-patient coordination committees in every town to facilitate this.

11. A unified “Paperwork and SOP” National committee of doctors must make such paperwork available on the internet for all doctors to use. The laws governing hospitals must be freed from the innumerable “NonMedico” interferences, red-tapism, corruption etc. roadblocks and must be common all over India.

12. Violence against doctors/ hospital staff must be severely punished. All govt. hospital deans must request 24/7 casualty police.

13. All practicing doctors must receive a compulsory paid vacation at least one month in a year to de-stress, and if the govt. or their own hospital cannot pay for it, let other parties willing to pay be discussed without objections or paranoid suspicions. All said and done, it is extremely stressful to be a doctor. Yearly paid vacation is only human.

This is a sweet dream. But what’s life without a dream? Don’t we wish each other sweet dreams? I mean it this time. Let us work to wake up in this dream. We are a great force, let us overcome our differences and become the Great Doctors who ably carry the Nation’s healthcare like Pros, not slaves.

This seems to be the only way. Happy Doctor’s Day
© Dr. Rajas Deshpande

The Tortured Beloved

The Tortured Beloved
© Dr. Rajas Deshpande

“I want to kill my father, Doc. Is there any way?” said the polished lady.

Used to a life full of shocks, cruelty and in general many negative shades of human behaviour, we learn to mask emotions to avoid turning off the patient /relative from telling us the whole truth.
This was a googly, and I made a conscious effort to retain my composure.

Thirty-something, very posh and from a high class cultured family, this lady was one of those who automatically garner respect of people around them. What she said didn’t fit in with the mental image she had impregnated upon my mind. Could she be one of the “PSY” cases?

“I live with two daughters aged 9 and 14. My mom passed away 10 years ago. My husband stays away as he cannot tolerate my father. My father was a military officer, retired with many honours. About 5 years ago he started forgetting things. We took him to many doctors all over India, they said he had dementia. Two-three years ago he started abusing in the worst filthy and obscene language we never thought he could use. He also started getting naked anywhere, and doesn’t care if myself, daughters or neighbours are around. He passes urine deliberately when in public and around us. He also makes attempts to sexually abuse us all, and tried more than once to grope the maids, who then left. We had a hard time when a maid filed a police complaint. I could not dump him as no one else can look after him. So I nursed him at home, and my husband who could not tolerate this daily abuse left us to stay in another state.” She started sobbing. All I could offer was a few tissues and a coffee.
I waited for her to speak again.

“I am sorry”, she said in a wet, guilty, embarrassed and one of the most pained voices I have heard. “I love my father as much as I love my husband. I could not dump my father. But then I cannot let my daughters go through this every day. They are terrified and have started behaving strange. We took him to many psychiatrists, and they gave medicines which kept him calm, but he developed too many side effects and could not move out of bed. Now he refuses to take any medicines and if we force him, he gets violent.” Again amongst sobs, she showed me her blue-black swollen shoulder.
“I have to tie him up to his bed and lock his room at night, but he keeps shouting. Our neighbours have started asking us to either dump him or move out of the society. The old age homes do not accept such patients.”
“I am a personality development counsellor, but my work is suffering now, I have lost my smile. I have lost my life. I cannot die, I have two kids to grow up. So I want my father to die. Is there any legal / medical way to kill him?” and then a volcano of unvoiced pain of years wailed out through her throat. She kept her head on the table and cried.

It was unprofessional, but I had to get up and pretend to wash hands just to be able to wipe tears in my own eyes.

Fronto-temporal Dementia, a cousin of Alzheimer’s dementia is a condition in which along with progressive memory loss, there is abnormal behaviour, delusions, sexual inappropriateness etc. It happens due to degeneration in some parts of brain. Progressive for about five-12 years, till patient develops some fatal complication.

This was not totally new. I remember many patients who are tied up at home, beaten up cruelly by their family, and left to die due to this kind of behaviour. This tragic management is also commonly meted out to many psychiatry patients who are burnt, injured with sharps, shackled and tied to beds / trees, kept with head under running water and even poisoned / sedated with herbal or even allopathic medicines to ensure safety of those around them.
Few years ago, one family of bodybuilders (all five brothers in land business) admitted their father with the complaint “he burnt himself with hot water in bathroom”. There were many bruises too. “He fell at home.” They told. When the sons left, the servant told the resident doc: “They (patient’s sons) threw boiling water upon his genitals after tying and beating him, because he tried to touch his eldest daughter in law”. This patient had severe parkinsonian features too, so was not able to move much due to stiffness. They had beaten him up and burnt him in that condition!

The lady in front of me regained her calm in few minutes. I explained her what many Neurologists and Psychiatrists may have earlier told her many times, about such being the nature of this disease. However, we have many safer medicines to control psychosis now. I wrote her a prescription and promised her that I will try and locate a “Care center” for such patients with this severe level of psychosis. There were none in that city. The next option was to hire a male servant and rent a small single room apartment with attached toilet nearby where she could shift her father. Sedatives (sleep medicines) at night were required.
Her husband shifted back. The family appeared to gradually recover from the mad-bad days.

As much as we need the doctors to explain the family about such illnesses, we also need to educate the society about such conditions, and care homes for these patients. Inhuman beating up, tying down, injuring, poisoning etc. humiliating fates by one’s own children is probably the worst that can happen to a human being.

When the lady came to visit with her daughters few months later, her cute daughters wished me mannerfully. We all grown-ups avoided the topic of “Sick Grandpa”. However, the 9 year old, while leaving, boldly asked her mom’s permission to ask me a question.

Then, looking straight in my eyes, the kid asked me “Doc, why did God do this to my Grandpa? Is it possible to cure him? We used to enjoy so much together, I was his dearest. It is ok if he hurts me, I want him back”.

I cursed my stunned wits. “He will get better soon, dear” I lied to the cutie.

© Dr. Rajas Deshpande