Tag Archives: Poverty

The Deadly ‘Vegetable’

The Deadly ‘Vegetable’

“How is my mother, Doctor?” The smiling politician, a tower of patience, surrounded by his impatient bouncer cronies, and a drooling doctor, asked me at the door of the critical care unit.

I examined the patient, a case of a large bleeding that had caused severe damage in the brain. Inputs were whispered in my ears by the cautious doctors of the unit. The poor lady had been treated by many excellent doctors in Mumbai and Delhi, as the family of that politico had that free facility. However, she had stopped the blood pressure medicines as some “Herbal Baba” had criticized them on National TV. © Dr. Rajas Deshpande

“She is conscious, but cannot understand or respond at all. Her heart is beating well, blood pressure is holding up, and her breathing is fine too. She can move her hands and legs, but it all appears meaningless movement. This may last for weeks or months, and in some cases, even permanently”.

The ‘doctor’ with that group authoritatively asked “That means she is a vegetable now?”.

“The correct word is ‘Vegetative’, the medical condition is called ‘Persistent Vegetative State’, and I cannot say as of now if this will be persistant. There are some chances of recovery” I replied with a carefully acquired masked face.

“Is there anything we can do anywhere in the world to make her brain normal again? I can take her to the best centers in the world” said the Politico. The drooling doc came forward again. His desperation to be significant was almost killing him. “Are there any medicines that can make her recover faster? We can afford anything” he asked.

I knew the exact words to reply him with.© Dr. Rajas Deshpande

“No Sir. Just as you cannot shorten the period of pregnancy, you cannot convert it to three months in the best of the hospitals , however rich you may be, the recovery of brain happens at its own speed. The medicines that can help her are already on”. This usually stops further discussion in that line, it did.© Dr. Rajas Deshpande

I went to the cafeteria to cool down. I couldn’t understand whether it was the tail-wagging doctor or the politico with ‘everything exists to serve me’ attitude that irritated me more. A cyclone of the big picture started rising in my mind.

The state of our “Government run” healthcare, is more or less the same: Vegetative. Big plans, big declarations, more investment, more land and buildings, more equipment, all surfaces, especially during elections. But the brain: good doctors in the system: is dead. No good healthcare system can be created or run by those appointed without merit, without quality. Thousands of huge set-ups declared and erected by the various governments are lying vacant, or serving far below their purpose because there are no good doctors/ technicians in most. The last battalion holding the flag of good healthcare: good medical teachers in medical college are on the verge of extinction. Best of the government-run hospitals and services are often reserved for those in power and their families. The shameless orders for “reserving ICU beds and ventilators, operation theaters etc.” for a patient known to a politician are a daily affair, they least care if someone else without an influence dies.© Dr. Rajas Deshpande

Appointments of drooling, medal-hungry shoelickers on various key medical posts has crippled the system. The real poor and deserving are thrown from one window to another to submit documents and applications to claim the benefits that they deserve.

The whole blame of a this deadly “Vegetable” healthcare is cunningly shifted upon those who refuse to work as ‘personal servants’ to the government, those who go into private practice, and private hospitals. Now almost all doctors complete their bonds, yet there is a gaping hole in the system that cannot retain specialists for long. Only the compromised, beginners, and failures stay for long in adverse, sycophancy based, low-cost environments. The very politicians who say “Don’t worry about money” when asking treatments for their own family, accuse the doctors of being “greedy”, when they leave govt. services.© Dr. Rajas Deshpande

The simple solution, the recovery of the brain, i.e induction and retaining of good, meritorious, non-shoe-licking and highly qualified specialists in the government-run healthcare departments and set-ups will probably change this scenario. But this looks impossible, now that even many doctor’s organisations have started losing their autonomy, self respect, to fall in line with the glorified slogans and to lick the bottoms of those who run such failed healthcare systems. The addictions to blow up any tiny good news, modify data to appease masses, hide the blaring failures, deficits and corruption in the healthcare have become a norm, and even our society seems to be ecstatically happy to just hear loud speeches of big plans rather than facing ground realities.

Indian Healthcare run by various governments, except for very few honourable exceptions, has become a brainless “Persistent Vegetative Healthcare System”. A ‘deadly vegetable’, for the understanding of the drooling docs. Unless someone sane and responsible in healthcare department acts quickly, we will lose this healthcare battle.

© Dr. Rajas Deshpande

PS: During the writing of this article I received over 20 phone calls from patients, and 12 of them dropped, cut, hanged. This is our technical progress. Before we send men in space, can we deal with this?

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Illegal Heroes

Illegal Heroes

© Dr. Rajas Deshpande

“I was at the disco last night. We danced a lot, I exceeded my ususal capacity of 180 ml alcohol, and had two or three large pegs extra. I must have smoked a little extra too yesterday, I was too stressed”’ said the 30 year old man, who was admitted one afternoon in an unconscious state. He had had a fit in the office that morning. The MRI had shown a large bleeding / haemorrhage in his brain. This illness, cerebral venous thrombosis, is quite common among those who are dehydrated, those who have untreated sinus infections, and among those who take contraceptive pills. If not treated in time, it can quickly cause brain swelling that may lead to disability or death.

Over next three days he gradually improved. Brain swelling started to recede, and he asked for a discharge. Faster and to-the-point care had improved his condition, thanks to modern healthcare. A psychiatrist had already counselled him about deaddiction. When we sent his file for discharge, his mediclaim insurance was declined because this illness was related to alcohol consumption. Immediately, his tone became bitter, his colleagues dissected the case papers asking for justification of each test, each medicine, and also why he was even hospitalised. Gratefulness is often waived off by doctors as a lost quality among saved patients, but it is difficult to tolerate arrogant distrust. We firmly explained him what was done and why.

“We will pay your bills, we will claim the insurance later, but you must change your notes, remove alcohol and smoking from his papers” said the patient’s brother.

“We cannot change the case notes, it is illegal. Also, we have already sent copies to the insurance company, a standard procedure. You are not obliging us by paying the bills, we have provided healthcare service that saved your brother, who was about to die due to alcohol consumption” we replied.

Within an hour, a local politician, an elected member, who came in his Range Rover with his personal armed bodyguards and human doggies, started his anti-medical show that had drama, emotion, tragedy, threats of violence and revenge and everything else but truth and honesty. He spoiled the day for everyone involved, caused disruption of hospital work for over six hours, and left with a threat of “burning down the hospital soon”. When our PRO asked him whether he wants to pay the bills of this patient to help them, his reaction was the hallmark of a true politician: change of topic to how the medical profession has lost its reputation.

Almost every doctor, every hospital in India is being threatened and pressurised by our own lawmakers at almost all levels into changing facts, writing false details, extorting concessions for the rich and poor both, only to increase their own vote banks at the cost of the healthcare industry. Most politicians, many government officers instead of financially helping the patient, ask the hospital to treat free or cut off bills.

How legal is this authority? If a politician writes to a court or lawyer or hotel or an Airline to waive off fees/ bills of a poor person, will they ever? Why are the doctor’s services and hospitals taken for granted here? How sad that such illegal means make pseudo-Heroes in our country!

Everytime the politicos pressurise a doctor or a hospital to treat their paying cronies free or concessional, some other truly deserving patient suffers because hospitals, small or big, can only do a certain level of charity. How fair is it to deny healthcare to the deserving poor just because they cannot flex a political muscle? This phenomenon is ruining the whole purpose and concept of charity healthcare measures all over India.

Aren’t these elected members responsible for the disgusting state of the civil and government hospitals and healthcare all over India? That is their domain of authority. This is like messing up one’s own home and family and requesting the one with a better home and family to pay and comply for one’s own needs. How shameful is it for the elected members of different parties to have to send people, especially the poor, to the private hospitals, because their own set-ups are failing perpetually? Empty posts, inadequate staff, poorest funding, non-availability of quality technology and medicines and red tapism have created massive monuments of the healthcare failures of different lawmakers all over India, and these are the very people who come threatening to the hospitals of burning them down! Hear this, any Milord?

If the honourable Prime Minister and Health Minister invite feedback from every patient leaving every civil and government hospital, the gravity of this situation will be understood better. Many repairs “at home” are required before “the neighbours home” is raided. We as doctors and hospitals must together request these authorities and offices to protect us from such daily insults, extortions and exploitation.

The very next day, an old man, a retired Indian Military officer, was expressing himself in the OPD with tears in his eyes: “Ye desh ka kuchh nahi honewala (This country cannot progress). People here, at all levels, want corruption, legal escapes to save money, and will elect anyone who throws them petty bits. Votes are bought for such favours as alcohol, gifts and cash. Sycophants rule, criminals are seen hand in hand with some rulers. Who do you think will get elected with such means, saints? You can guess what progress we expect if the lawmakers are first in line to break laws..”

There was nothing more sinister I heard that day. I am worried about the healthcare in my beloved country. God save the future generations from such illegal heroes!

© Dr. Rajas Deshpande

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The Illiterate Man with Brain Tumors, Fits and Common Sense.

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The Illiterate Man with Brain Tumors, Fits and Common Sense.
 
“I have brain tumors. Is it possible to treat? Will I survive?” asked the worried man as his wife tried to hide her fear of the answer.
 
10 years ago, as I sat in a peripheral small hospital outside Pune, a simple couple had walked in, carrying their poverty in obvious signs upon them. Mr. Sakharam Pawar worked as a mason, mainly repairing foundation and floors. He had recently had a convulsion, and his Brain MRI had shown multiple tumors with swelling around them.
 
One of his relatives staying with him had had tuberculosis in the past. His clinical examination revealed signs of increased pressure within the skull. After a few simple tests, I told him that the tumors looked like tuberculosis growth (called tuberculoma or Tb Granuloma), and there was a good chance that they would respond to medicines, if he took the medicines regularly without missing for a single day. He agreed. An anti-convulsant was also started.
 
The course was prolonged, over a year, and the drugs were known to be notorious. Mr. Sakharam did not ask me a single question. When I updated him about the serious side effects like liver failure or vision or hearing loss that could result because of some his medicines, he replied “Doctorsaheb, I am sure you know what is best for me. If a side effect develops, it is my fate. I know you will help me there too. I leave all the choices to you”. I was amazed at this compliance and trust. He was barely literate (can only sign his name), but his choices spoke of an excellent common sense. In an age where even the well-educated resort to all kinds of Babas, Gurus, Herbals, Net claims, ,self-treatment and even black magic, this illiterate couple was making scientific choices!
 
He did not even seek a second opinion! A doctor’s responsibility multiplies when his / her patient completely trusts them, no doctor abandons the best interest of such a patient.
 
A year later, his Brain MRI showed that all the tumors had vanished, only a small scar remained. His medicines were stopped, except for the anticonvulsant which he will have to take lifelong. He takes this single tablet regularly, and we try and make it available for him at lowest cost by requesting the pharmacy. He hasn’t had any convulsion since many years now. He visits me once a year, and brings me words that make my day. This poor, illiterate man has defeated a high-fatality disease by making the right moves in time!
 
Today I asked Mr. Sakharam if I could tell his story to the world. He agreed. Then he mused and replied “I want to tell everyone that when I was first diagnosed with this dangerous illness I thought it was the end of the world. Then I discussed with my wife and we decided to fight this with proper treatment rather than superstitious decision making. The most difficult part was that I had to keep working in spite of severe headaches and the nausea caused by medicines, as we have no other source of income. But I am happy that I have defeated such a dangerous form of tuberculosis. I would like to appeal to people to go to the doctor in time, take scientific medicines and do not fall in the hands of quacks”.
 
Indeed, we see many cases of tuberculosis, tumors and so many other diseases of the brain that reach us too late to be saved or treated. Many (even highly educated) patients resort to unscientific options and waste precious time. Many a paranoid literates would have questioned every single thing right from the necessity of an MRI to the medicines used, and threatened their doctors with legal action for adverse effects of medicines. What this uneducated, illiterate couple demonstrated really questions whether education brings common sense to all.
 
Our medical director Dr. Sanjay Pathare assured Mr. Sakharam of all the help for the future.
 
The happy couple left with blessings upon their lips. A doctor’s day was thus blessed!
© Dr. Rajas Deshpande
 
PS:
Due permissions obtained from the patient for publishing this educational post. There are thousands of great doctors all over India, even in the biggest private hospitals,, who diagnose and treat poor patients without charging fees. The purpose of the post is to spread awareness that all brain tumors do not need surgery, that most tuberculosis cases can be cured completely, and also that with proper compliance, convulsions can also be controlled completely.

Can Anyone Solve The Mystery of Atmaram’s Courtroom Death?

Can Anyone Solve The Mystery of Atmaram’s Courtroom Death?

©️Dr. Rajas Deshpande

A hungry poor man named Atmaram went to a big hotel, had a nice big meal, and told he had no money to pay. He was beaten up and handed over to the police. He was released after a warning and a slap.

Next day he filled up petrol in his bike, and said he couldn’t pay. He was again beaten up, handed over to the police. Then he went to the medical shop, bought medicines and mineral water, ate the medicine, drank water from the bottle, and again said he couldn’t pay. He was now jailed for a week.

Next week his house was damaged by heavy rains, so he went and requested to be allowed to sleep in the house of the chief minister. He was arrested again, thrashed up.

As angry Atmaram shouted at the police, he was beaten up by them, another crime was added to his offences. In the court, Atmaram insulted the lawyers and judges and accused them of accepting bribes and charging too much. The judge punished him extra for his behaviour. Atmaram was angry and threw his shoe at the judge. His punishment was extended.

“You must respect the authority “ the court said.

“But I am poor, I need free food and petrol and medicines. I need sympathy too” Atmaram argued.

“You should have begged and applied for favours and eaten in places that provide charity meals. Petrol, however essential, has the same price for everyone. You can sleep on the footpath, and above all, you are not allowed rudeness and violence because you are poor and needy” The court said.©️Dr. Rajas Deshpande

When released from the jail, Atmaram drank a lot of desi alcohol, had an accident and fractured many bones. He went to the best private hospital, got operated and refused to pay his bills that crossed one lac rupees. When the hospital insisted, the operating doctors were beaten up by Atmaran’s relatives, the hospital was vandalised, the police arrested the doctor who saved Atmaram’s life, the government closed down the hospital, while the media and the society kept villainising the entire medical profession.

The headlines next day reported the sympathy expressed uniformly by wag addicted tongues: some said the entire profession was tainted, some blamed the greed of the doctors, even some doctors desperate for attention shed crocodile tears about the ethics in this profession. ©️Dr. Rajas Deshpande

In the courtroom, during the trial, Atmaram sat facing the doctor, still heavily bandaged.

The hon’ble judge, kind but surrounded by security, told the doctor accused of negligence and malpractice in the court: “You as a doctor carry more responsibility for ethical behaviour upon your shoulders. You should never turn away the poor”.

The doctor, defending himself, asked “but Milord, doesn’t our constitution insist on equality? Why do you yourself or ministers get security but not the doctor? Why isn’t everyone supposed to stick to ethics in every profession including politics, police and judiciary? Why are others exempt? How do you explain beating up of doctors while also saying that the society treated them like gods?”.

There were no answers. The kind court asked if the doctor had to say anything else in his own defence.

The doctor said

“Yes Milord, but the real answers will hurt:

Jealousy against medical professionals across society and many other professions is a reality. Why else will anyone who couldn’t qualify to become a doctor try and teach the qualified doctors what they should do?”©️Dr. Rajas Deshpande

“A culture of exploitation of non-votebank groups

and a complete failure of government healthcare with no one accepting responsibility is well known to everyone, but even judges have no courage to suo motu question this and correct it, even when they see the poor dying”. ©️Dr. Rajas Deshpande

“In a country with never ending poverty, how much free can a healthcare facility provide? For how long? This is already forcing closure of hospitals and exodus of good doctors out of the country.”©️Dr. Rajas Deshpande

“Milord, can you assure that every doctor will get his/ her fees as per his service to every patient, and if the patient can’t pay, that much charge will be exempted from the income tax of that doctor? How else do you except a doctor to meet his needs and dreams? Just because there are millions of poor patients, is the doctor’s life and hard work taken for granted? If there has to be financial sacrifice, why not have everyone contribute to it by creating a national health tax fund for treatment of poor patients? Why healthcare is subsidised only at the cost of a doctor?”

Just at this point, Atmaram, who sat in front of the judge, collapsed unconscious, almost blue black.

The shocked judge requested the doctor to examine him.

“He is no more” said the doctor.

“What could have happened ?” asked the kind but sweating judge.

The doctor told the court about three possible reasons. Two of them were scientific and medical: a sudden cardiac event or a large blood clot in the lungs common after fractures and trauma.

The third non-medical, unscientific cause made the Judge seriously ponder.©️Dr. Rajas Deshpande

“Will this court be now closed down, Milord? Will your efficiency be questioned, will you allow the relatives to attack you and understand their sad situation at the cost of your murder?”

“I understand what you mean” said the kind judge.

Needless to say, the doctor was released without a blame.

Can anyone please solve the mystery of the third non medical, unscientific possible cause of Atmaram’s death?

(C) Dr. Rajas Deshpande

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Respect: The Depreciating Indian Salary

Respect: The Depreciating Indian Salary
© Dr. Rajas Deshpande

“Over 1.5 Crore Every Year! That becomes more than ten lacs per month! Wow!!” my student showed me the news that some brilliant engineering students passing out from India were hired by some software biggies in Campus Interviews, “They will start their careers at that salary. That’s life!”

I felt proud, as always, these news and similar have always made me feel that the Indian academic talent has always been looked up to and rewarded by the developed world. The tiny speck of jealousy that we earlier felt for our classmates who went for engineering and had their own homes and cars while we were still finishing internships has faded away long ago. The only regret that sometimes peeps out from the past is that of never having fully enjoyed our teens and youth. The fact that most doctors from India also earn huge salaries in the west as well as the middle east speaks a lot about the flaws in our “Indian” thinking.

“Doctors get respect and that is the best that you can get in life. People think of doctors as Gods. You should never think about money” told every sore-throated, pot bellied and self proclaimed socialist who did not become a doctor, and mostly had no doctor in family. This ranged from our own classmates to the highest administrators in the country.

Over the years, I now feel that even the engineering or other stream’s graduates are almost in the same boat. I cannot wish upon the newer generations what we went through.
What is really making us proud here? That India cannot afford to use its own best talent in any field? That the best in all fields are taken away, because what the best Indian companies can offer them is nowhere near what the world outside offers them? That the best salaries in all government jobs are reserved for bootlickers above the age of 55? That in no field can the government find the young talents superior to white haired yes men? © Dr. Rajas Deshpande

Or boast with a shameless pride that the most revered Satya Nadellas and Sundar Pichais made in India cannot find career scope in their own country?

Or, while proclaiming “Vasudhaiv Kutumbakam” (The World Is My Family) on one hand, are we going to perpetually cry the same song of socialism and patriotism, expecting all of them to only follow the examples of the rare (and respectable) ones who chose to shed material life for the country? India needs a million good volunteers in every field who will live and die poor while serving the society. But to force this upon all those who graduate from India is to invite them to leave the country. From politics and administration to Judiciary and lawyers, we need people who will work free or low cost, because the main disease: poverty and illiteracy, is a never ending curse in India. These are the people who choose the governments who throw “low cost everything” crumbs at the society, rather than uplifting the society to respectable self sustaining, paying capacity. © Dr. Rajas Deshpande The lifelong perks of representatives elected for even five years, from any political party are regularly updated, but the salaries and pensions of doctors and other employees who work lifelong are never upgraded without agitations and then only with allegations of greed!

No doctor wants to be a bad doctor, but no doctor wants to spend life in poverty and insecurity.

If at all a doctor decides to do charity and see all patients free/ concessional all his / her life, not only will they be lost to poverty and anonymity, but our government or media will never notice them. All they get is more paperwork to comply with every day, fear of suspension humiliation by the administrators and a salary that’s a shame given their talent and hard work.

There is this curious tendency in India: to force or to beg in the name of charity, social service or patriotism rather than rewarding the talent. There are very few examples of honesty, hard work and talent rewarded without political connections. © Dr. Rajas Deshpande

Are the medical students any less talented than their counterparts in engineering or other streams? Don’t they study equally hard and work 24/7 many more years before they qualify? Even after that, the highest salary that the government offers the starting doctor (even engineer) is laughable, and if they wish to work at a private/ corporate hospital, they cannot decide the rules of payment strategies. If they must start their own set up, they need huge investments, over fifty permissions, many recurring, every one requiring bribe in some form or other. And whichever one they choose from the three career options above, from day one the society and media will have already presumed them guilty of extracting money from patients, the government and even some judges urging them to understand the feelings of relatives beating up doctors. I wonder how many ministers , judges or media bosses would like to understand the feelings of those who beat them up for something their client/ petitioner didn’t like. The most pathetic part is that while all of the above officers are inaccessible to common man, they still have armed security, and the junior most doctor who faces armed relatives is denied security even by law! © Dr. Rajas Deshpande

Most top medical graduates and postgraduates, like almost all other streams from India are leaving voluntarily because of this situation. To deal with this, the best options that some governments came up with were long term bonds to force govt. service (without telling anyone where the govt. spends so much on medical education), and canceling permissions to leave India even after the bond is completed. Bravo! © Dr. Rajas Deshpande

The Hon’ble PM has time and again declared many institutes like AIIMS to be opened across India. This is welcome, but we must also look at the state of conditions and staff in the existing health institutes run by the government. That needs billions for repairs, facilities and hiring better staff. Unless the salary structure for young and talented medical specialists increases , there are no chances of any AIIMS-like institutes running efficiently, they will soon become dirty buildings with low budget staff, where desperate patients are chronically dissatisfied and mobs find chances to vent anger.

Earlier I had immense respect and pride for every doctor who decided to return to India with a positive attitude and a wish to serve the society, their only expectation being living a modestly good life. Now I doubt if they are doing justice to themselves or their family, by choosing a life of financial and personal compromises, where they not only sacrifice, but are still looked upon as “looters”, face a violent society and a prejudiced government.

Ten years ago, I would have told this student of mine “let go of a good life, stay in India, we have a lot to do for our country”. Today, I don’t interfere with their decisions to make a career outside India. Because I love my India as much as any soldier would,and I also love the talented people in it.

Jai Hind!
© Dr. Rajas Deshpande

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My Earning As A Doctor

My Earning As A Doctor
© Dr. Rajas Deshpande
 
It was an emergency night, and we were trying to cope up with the excessive load that every government hospital must accommodate. One of my early postgraduate emergencies. The living, the dead and those in between were being rushed in continuously, and we were dealing with the emotional ups and downs at an almost impossible pace. In the same moment we were Gods and heroes for some, and devilish villains for others.
 
Nature, age, illness, delays, illiteracy and poverty are easy to fight with sometimes, but not what people expect from a doctor.
 
I was writing on the ward desk, filling up the necessary paperwork, an irritating interruption in a clinician’s life. Trying to recall something, I stared for a moment at the long stretch of that huge ward. My senior resident Dr. Sunil was performing a procedure called pleural tap, where fluid is removed from the chest. He was from a very poor and rural background, but had excellent merit. Most people made fun of his looks and language, that made him silent and aloof. © Dr. Rajas Deshpande
 
An old man came out of the toilet, accompanied with his wife. He was about 80, was admitted and had recovered from a stroke. He was scheduled to be discharged next morning.
While walking to his bed, this old man suddenly collapsed, his wife unable to hold him. He was about 10 metres away from me. Sunil and myself reached there immediately, shouting for the crash cart, and started resuscitation. We tried for many minutes, as the patient’s wife stood a few metres away, sobbing.
 
He was dead. He had had a sudden cardiac arrest.
It was the third death in the ward that day, among the thirty emergencies admitted.
 
Dr. Sunil went to the patient’s wife. and informed her. He got her some water, and sat with her for some time. Then when he resumed the paperwork, I noticed he was feeling sad and tearful too, like myself. The old man and his wife had both been so nice to us. © Dr. Rajas Deshpande
Only a doctor knows the traumatic feelings of having to resuscitate someone who was talking to them a few moments ago. Believe it or not, almost every death certificate makes a scar on a sensitive doctor’s mind. The trauma is perpetual, hidden, but also real.
 
As we arranged for their transport (the couple had no relatives and were from a nearby village), the old lady sat by her husband, touching his face and crying. When she left, she said “God bless you, you people still tried so much. We are both old, what can you do! This is my destiny. I hope God takes me up quickly too, I have no purpose in life now”.
 
Sunil went to the doctor’s room and broke down. This was unusual. I tried to console him, myself feeling very sad. Then, Sunil looked out of the window and said in a heavy voice: “My mother died exactly like this, in a hospital ward, when I was a child. I was with her. That is when I decided to become a doctor and save lives. At such times I feel very hopeless”.
 
“Oh”, I said, not knowing how to react, “Where is your father now?”
“He passed away long before my mother, he had fever, but they did not have money to take him to a hospital. He died at home.” Said Dr. Sunil.
In some time, we went for a tea and composed ourselves again. The night was to bring many more who needed us stable, so we returned in few minutes.
 
The next day, we presented to our professor the forty two cases admitted in emergency, a usual count at most medicine emergencies. Going home after over 36 hours, I could not eat that day. A doctor should not be too emotional, but then no one makes themselves, one can only control reactions. © Dr. Rajas Deshpande
 
Fast forward to the future: my father, one afternoon at home, collapsed suddenly and was taken to the nearest hospital three minutes away, but could not be resuscitated. I was in Mumbai, far away from him. That phone call still rings in my ears. Sometimes I have to sit down at the memory of that call, it breaks me.
 
I did not curse that doctor to whom my dad was taken. I did not blame anyone. I did not go to the press or police. I did not think that the doctor was wrong or was working for money when someone was dying. It is impossible. One who thinks that a doctor will think of money in the face of a dying patient is probably also the one who never fully believed in God, and also questioned their own mother’s love for themselves!
 
Like almost every sensitive doctor, like Dr. Sunil, the only way for me to forget the agony of losing my dear ones was to prevent this from happening in anyone else’s life.
 
So what if most of them think I worked for money, so what if they refuse to ever acknowledge gratitude in words or in deed. So what if they only look at the money I earn through my hard work.
 
My real earning, like that of every sensible doctor, is the reduced burden of suffering in the human world. The tax I pay is my blood and sweat. Those who do not use these currencies will never know their value.
 
© Dr. Rajas Deshpande
 
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The Remedy of Trust

The Remedy of Trust
© Dr. Rajas Deshpande
 
I entered the ICU in a torn and angry frame of mind. An old patient had had fluctuations in heart rate and blood pressure all night, and was on the thin line between life and death. Irregular heart beats had clotted his blood and he had developed a paralysis.
 
I had had a terrible argument with family that morning, and had left home without a breakfast, thinking that I will catch up in the canteen if hungry. The traffic on the way was as usual bad, it further worsened my mood. Messages kept pouring in: pending bills and health enquiries that were an attempt to avoid a proper consultation. One can ignore, but sometimes ignoring is stressful too!© Dr. Rajas Deshpande
 
As I entered the hospital, I was told about some machine not working. The technician had commented that it was beyond repair now. New one would cost over 30 lacs minimum, and this machine was required on a daily basis. My head started pounding. Another loan now, another recovery period!
As I passed the billing counter, an imposing rogue with a group stopped me. “Sir, the bill is too high, do something”. It was an open threat worded technically as a request. The relatives who folded hands to save the patient till yesterday were standing behind that rogue, looking unconcerned, not even happy that the patient was alive and being discharged after a life threatening illness. I sent them to the charity cell.
I entered the ICU, staring into my cellphone where angry messages of argument kept pouring in, a dear friend was upset that I was not available to see his relatives in another hospital immediately. © Dr. Rajas Deshpande
 
The old patient was sleeping. A glance at the monitor revealed that the patient’s BP was now stable. His heart rate was regular too. What a relief!
The patient’s wife got up, she was in her 80s. Fair, all white hair, and the confidence of culture upon her face, she smiled through her wrinkles and troubles. The Kumkum on her forehead was bright and fresh. She wore a torn saree, and had no ornaments except a thin thread with black beads that made her Mangalsutra. She was bending forward due to age.
She then said “He spoke to me this morning. He is feeling better than yesterday. I know he is old, but please give him the best treatment. We have been together since childhood.” Her eyes became wet.© Dr. Rajas Deshpande
 
Then she made an attempt to touch my feet, something that woke me up with a shock. A tingling feeling ran through my body. I held her hand and asked her it was ok, and returned the gesture by touching her feet too. I told her I will try my best, and her husband appeared out of danger at that moment.
She gently prodded the patient: “Look, our doctor is here. He says you are getting better. Do you recognize our doctor? Say Namaskar to him”.
 
Confused for a moment, the old man stared first at his wife, then at me.
 
He then tried to lift both hands, but only one went up, which he raised to his forehead and whispered “Namaskar”.
 
The old couple, the age of my parents, was saying Namaskar to me and touching me feet, many decades younger to them, because I was a Doctor. They never knew me until two days ago, but had trusted everything I said. They did not question my ability or intention. I like to be professional, but that should never compromise my manners.
I switched off my cellphone.© Dr. Rajas Deshpande
 
I suddenly felt ashamed of the mood that I was in. They did not deserve it. Their complete faith was to me the best return and reward of my efforts of so many years to become a good doctor. No amount of money ‘thrown at me’ by those who think of ‘buying me services’ would actually be my interest or aim. This was.
 
I smiled at the old lady, and told her that should she have any concerns, she can ask the staff to call me anytime, I would be glad to come over. Then, to repay her for bringing my smile back, I wrote on the billing sheet: “No charges for me in the case”.© Dr. Rajas Deshpande
 
When I walked out of the ICU, I was feeling proud and smiling. The faith of this patient and his wife had cured me of my bad mood too. I was prepared again to forget my personal woes, to take over the faithless hundreds, still do them good, in an attempt to reach out to the really deserving faithful, who knew their doctor would only do them good. That is the essence of my profession, my education, and my intention.
 
A patient who trusts a doctor earns for himself the best in that doctor. Always. Although we do not expect it to be understood by everyone.
© Dr. Rajas Deshpande
 
 

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

Hide, Don’t Seek

Hide, Don’t Seek
© Dr. Rajas Deshpande

We are all experts in this.

Mr. SP suffered a stroke, lost his job. Still has to run a family that has kids in engineering college. Since last six months he is looking for work, and is freelancing as an interior designer. To go to work he needs special vehicle. To buy it he needs loan. Bank does not give loan because he does not have a job. RTO will not issue license unless the vehicle is in his own name. He is ineligible for a handicapped- job opportunity because he cannot get a certificate, because there is a huge line for the same in only one center in a large city like Pune, where the handicapped people are expected to queue up starting 4 AM in the morning, without a place to sit or a shade. He has been in this queue for umpteen times, but could not reach the clerk as only limited number of people are taken in. He keeps on spending on the autorickshaw fares, his own medicines, physiotherapy, and limps his way through life cursing his fate. He has already decided that his children will not settle in India.

All that India has learnt in it’s recent evolution is to address him as “Man with special needs” or “Physically challenged” instead of handicapped.

Now he awaits Mr. Mark Zuckerberg or Mr. Tim Cook or Mr. Obama to digitally reach out and solve his problem.

In our evolution as the strongest and the most invested nation, we have shoved below the carpet the facts that we have highest number of unhealthy people who cannot reach or afford basic medical care, hunger deaths, a government-run healthcare system that is worse than dysfunctional at best, a valley of inadequate resources created by senseless laws / rules / red-tapism that mock the possibility of a comfortable living of an honest citizen, where bribe is the basis of any function at almost all levels. Traffic kills not only those on the road, but also those in an ambulance.

This even as we pay one of the highest income tax, and probably the highest duties on almost everything.

Neither women nor children are safe, the political backing encourages hooligans to do away with all the eve-teasing they want. Richest of the rich revel in their 100 and 500 crore successes, multimillion ventures and billionaire statuses in Forbes, while there is no answer to innumerable suicides of poverty ridden populace.
Now we will digitally connect them.

We have learnt the western language in an attempt to impress the western press. With our huge population, there always are enough positive numbers to impress the world, while we hide the negative numbers from the world’s eyes. We have learnt perfectly the eternal art of beautifully colouring a home from outside, while there still are decaying crimes, mountains of unsolved legal / procedural basic issues that eat up the lives of those who live within. The rich-poor gap is at its worst, and the onus is upon the citizen to find legal / illegal solutions to their problems. Audacious corruption stinks in almost every govt. office, but we will sing songs of our own greatness and history. We will die to establish an arrogant historic fact rather than help a dying needy in the present.

We need human connections first. We need internal reforms first.

What will an old sick parent “thrown up by children” do with internet? What will a heart attack patient stuck in traffic do with digitalisation, when there are no sufficient paramedics, and they can’t reach him? How will internet, another “profit-based” venture, provide for food and medicines to those who don’t have money?

Will all this internet access / digitalization solve the issues like rehabilitation of thousands of orphans in the country, rehabilitation of women who have suffered rape, whistle blowers being beaten up and killed in open daylight, a perpetually deficient healthcare scenario with increasing gap between doctor and patient, further widened by draconian laws against the tiny number of remaining doctors?

Just Hide, Don’t Seek answers.

Let us all dress up our best for our new girlfriend: the affluent, civilized western world.

© Dr. Rajas Deshpande

PS: I am strongly pro-digitalization, but it is the wrong God to bank upon for a positive change in our country.