Tag Archives: Physician

Goodbye, Doctor

Goodbye, Doctor
© Dr. Rajas Deshpande

“Screw this satisfaction. Dump this happiness. Can you try to understand that I am fed up of both?” said Dr. Sahil. He was one of the busiest and most respected specialist in our town.

Surprised at a superspecialist doctor friend speaking this, still impressed by his ability to identify and speak the truth about himself. I let him go on.

“There’s no guilt. There’s no regret. I have done my best since school. Topped everything. I did not feel the extra effort: I finished graduation, PG and Super PG by merit alone, that too without having to make a great effort. I have practiced over 15 years now. I did some research, but don’t enjoy the kind of research that goes on in Clinical medicine now. I have practiced with all my heart, and all my time. Now I don’t want to. Repetition kills me, and I cannot see anything but that now”. He paused.

We shared the best bond between two humans: mutual respect with no curtains. Either of us didn’t feel the necessity to modify speech for political correctness or covering up naked feelings.

I replied: “I understand. But we always thought that we need to save lives, give back to the society. So many will benefit with your genius”. I realized just as I spoke, there was something hollow about that. Or did he just uncover a mirror in me?

Sahil was as calm as a meditating saint. “I don’t feel so. Nobody’s saving lives. We use scientific knowledge to try and treat the medical conditions we see, try to comfort the suffering with our kindness, and earn our bread under the continuous threat of something going terribly wrong. I have studied for fifteen years, and served the society back for more than that.”

We sipped our coffee in silence for some time. Hans Zimmer’s ‘Discombobulate’ was playing at that time in my chamber. Coincidences are too much sometimes. That heavenly symphony of all disconcerted instruments played by the expert musicians is one of the best things in human history I think (link below).

He smiled at the music. “I did not promise anyone to spend an entire lifetime doing what I don’t want to do anymore. I respect the gratitude I received, although it was rarely pure and sustained. I am sure many better than me will replace me and continue to treat patients who need care. I have never felt respected or accepted in the society, it was always with the caveat of ‘not all doctors are good’ that the people who I served looked at me, not the other way round.“

He became serious. “I don’t want now to work hard all day and night, be serious all the time, and step up my already busy schedule to reprove my abilities again and again. I am fed up of having to prove my worth and abilities to those who I do good to. When almost every illiterate as well as the educated questions my intentions, I don’t think anyone deserves an explanation. Half my time is spent now explaining the patient what is good for them, why they must do the tests and take the medicines, how I cannot predict all side effects or complications and be held responsible for them. I became a doctor to treat people, not to cover up for their suspicious ignorance with my knowledge and time”.

Somewhere deep, I understood him. But the ego of a doctor: that we have “accepted” the responsibility to serve prodded me to argue with him. I said so.© Dr. Rajas Deshpande

“Who are we serving, Rajas?” He asked. “Society? Government? People? To what end? Where do you see this service either recognized, rewarded, acknowledged or reciprocated?. Then again, where does it all end? The line of unaffording poor is unending, the complaints of affording are mounting, and I seldom get a peaceful night’s sleep, inspite of a clear conscience. I will retire without enriching my own life”.

I remembered my favourite author Richard Bach’s view: “The simplest questions in life are also the most difficult ones to answer”.

My lawyer friend, Advocate Shrirang Choudhary, had time and again pulled me out of civil hospital Nanded. I had this habit of ‘living’ inside the hospital, beyong the 12 hours duty. I would just go home to take a bath and one time meal, then return and stay to assist every consultant I could: there was such a sense of fulfillment in learning!

Shrirang would pull me out, we went to the riverbanks and he ensured that we talked for a few hours anything except medical world. “You will kill yourself if you spend all your life in the obvious negativity that is the milieu of any hospital. There’s more to life than being a good doctor. Treat yourself to the immense beauty life has to offer. You have only one lifetime, and limited active years”.

I realized how much I had wanted to pursue a career in poetry, music, philosophy and adventure. It was with such ease and passion that I had given up all of it, proud that I will be saving lives. Now after 15 years of practice I saw another valid viewpoint.

“You get used to the satisfaction and happiness, the challenges and the victories in healthcare. I can understand that some may enjoy the repetition of the same for umpteen years: in fact an entire lifetime. But can you please also understand that to me it feels like an artist who paints only one big picture or sings only one song in his entire lifetime?”

I knew what he spoke about. I was suffering the same, but had avoided to think of it.

“Do what you want in your spare time. Reduce practice. You must take a break” I suggested, “A long break.”
To lighten up the mood, I added, “Although people will immediately say that some pharmaceutical sponsored your holiday and fun”.

“I wish I cared what people thought” he smiled, “And I don’t want to run away. I don’t want to do anything half hearted. I want to walk out gracefully. Like a saint or a seer walking out upon the world and going to the Himalayas. Why is that more respectable than a doctor wanting not to be a doctor?”
I did not have an answer.
© Dr. Rajas Deshpande

Dedicated to those who understood this post.

Hans Zimmer’s Discombobulate music video:

(https://www.youtube.com/watch?v=R89UGKuyodk&index=2&list=FLHqY_yEsrcQFcedWLQUF2Pg)

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

Dr. P. D. Purandare Sir left this world today.