Tag Archives: Religion

The Dictators in Hospital © Dr. Rajas Deshpande

“Let my father die. It’s ok. I will not take him anywhere. I don’t want anyone else to treat him” said the 60 year old son loudly. His old father who could listen and understand the conversation, but could not speak or move due to a paralysis, just closed eyes. Tears emerged from the corners of those closed eyes.

Like most doctors nowadays I have learned to master personal opinions and emotional responses, especially with ill-behaved patients, but this was beyond me. Not because he had shouted at me, but because he had just stabbed his father’s heart. Loudly, so that the patient could hear, I said “I think your father should feel better soon, let us see what we can do”. Then I gestured the angry son to see me out of the room. Two other men accompanying him came out and towered upon me.

About five days prior, this son had come to me with his father’s reports. The patient was admitted at a rural hospital. He had severely compromised heart function and his heart rhythm was abnormal. This caused formation of many blood clots in the heart, which went to the brain blocking blood vessels. One such large blockage had caused paralysis and inability to speak. © Dr. Rajas Deshpande

I had asked the son not to shift the patient, as the treatment started by the rural physician was accurate, we had to just wait and watch. Still, they had brought the patient in an ambulance, travelling for over 4 hours. Naturally, the patient had worsened , becoming drowsy. His heart rhythm was dangerously worse. He was unable to swallow, there was a big risk of his saliva/ mouth secretions going to his windpipe blocking his breathing.

Whenever a patient has problems out of a specialist’s expertise area, it is mandatory that an opinion of the concerned specialty expert be obtained. I asked the best heart specialist I knew to see the patient, and also a small ENT test to see if we could initiate training for swallowing. Our physiotherapists were already working upon his hands and legs gently.

However, the son (a retired govt. officer from a very respectable post) and two others attending the patient created a big scene when my junior doctor visited the patient. They started shouting and cursing that by calling other specialists we were just “increasing the bills”, and that they did not want anyone else except me to see the patient, not even the junior doctors. © Dr. Rajas Deshpande

My assistant physician called me in panic and updated about this, asking me to immediately act to deescalate the situation. Although there were many patients waiting to be attended in OPD, I had gone to this patient’s room. I explained to them that the patient needs to be seen by a heart specialist too, as his heart condition was very delicate. I also offered them to choose any specialist or hospital they wanted, if they were unhappy here, but they could not waste time as the patient was critical. That’s when the son shouted that he would rather let his father die than be seen by any other specialist.

When they came out of the room, their body language and general disposition suggested aggression. I tried to politely reason with the son that any specialist cannot sit with the patient 24/7, that junior doctors and other specialists as required will have to be called in for the best care, but they declined. The efforts of our medical superintendent and best patient coordinator went in vain. © Dr. Rajas Deshpande

“We will not allow anyone except Dr. Deshpande in the room. Our patient must get better” the son said loudly.

“I will see him till he is under my care, but I cannot guarantee any outcomes” I told them. “Let’s see” he said. He did sign the document informing about criticality of the patient.

No doctor should treat patient under pressure, duress or threat in the interest of the patient. I went to our medical director and requested that the patient be transferred under some other specialist. The hospital offered them freedom to choose, but the relatives declined. “We have come here for Dr. Deshpande, he will have to treat the patient alone” the son said. The hospital decided to take a call next day after a meeting.

That evening as I finished the OPD, I wondered how the patient was. However much angry I may have been with the relatives, the patient was more important than my anger, pride or anything else. I went to their room and checked the patient. He opened eyes and smiled. I asked him his name, and he replied in a husky tone. He was speaking now!!

The next day again, the relatives refused to transfer the patient under someone else, and I kept the treatment on. The trustless atmosphere was quite volatile, and if something had gone wrong, things would have taken an ugly turn. In the next three days, the patient spoke well, and even accepted some sips of water. His hand and leg started moving too.

“Can we take him home now?” the relative asked on the fourth day.

Happy for many reasons, but mainly the fact that the patient had improved, I discharged the patient. I had learnt my lessons. © Dr. Rajas Deshpande

Adamant, unreasonable and illogical demands by patient’s relatives jeopardising the patient’s life is a huge medical problem in India. Illiteracy, political interference, goonda culture and media support make such horror stories a routine reality. The law still expects the best patience and non-reacting approach of medical personnel, with the onus of saving lives still upon them under this pressure. Innumerable instances of harassment and humiliation of nursing staff, especially women go unreported. Relatives, especially politically connected, behave like dictators in any hospital, threatening one and all. Unless this culture ends and doctors are at a freedom to do their best for every patient, medical care in India will always remain inaccurate, incomplete and purely financially guided rather than scientific or even legal. Doctors can actually file a complaint or take legal action in such cases, but they are too many, and no doctor has time for such legal courses. In the best interest of our patients’ lives we go on forgiving and tolerating such abuse. Because neither law nor administration wants to correct the causative factors effectively.

© Dr. Rajas Deshpande

Neurologist Mumbai/ Pune

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Young At 98. Secret?

Young At 98. Secret?

©️Dr. Rajas Deshpande

A few months ago I had received an emergency call for a stroke case. The resident doctor informed me that the patient was a lady of 98 years. Her basic tests were normal.

Worried, because stroke is a dangerous diagnosis at any age but more so at that age, I ran to her room as soon as I reached the hospital. A group of her worry-faced relatives waited outside her room.

I entered the room and introduced myself to the patient. She got up.

“Namaskar! How are you doctor? My name is Champadevi Gupta” she said with a big smile and such gusto that I wondered if she was the right patient.

“I am ok, thanks. What happened today?” I asked her.

“Nothing much. I had some giddiness but my children worry so much about my health that they rushed me here”.

Although her examination revealed only mild signs, her MRI had shown a small block in a blood vessel supplying a crucial area of the brain. I explained it to her. She laughed aloud again “I feel okay now. When you feel ok, let me go home”.

She was discharged next morning.

She came in thrice after that, every time walking in with a big smile, lighting up everything around her, keeping her hand upon my head and sumptuously blessing me, inviting for a meal at her home.

Today she came with her youngest son. She is as fit and fine as any young teenager, only happier and more content.

“She has always been like this: happy and content with whatever life brings, in good and bad times” her son Satish told me, “we are 5 brothers, we all look after her, but she still lives alone near my home. She is like a treasure and source of life for all of us”.

Indeed. A laughing, smiling, truly happy, positive and content person is probably the most precious form of human being, and so rare now, that sometimes I want to tell those running behind one thing after another, killing themselves every day: “Look at this lady’s face! This is the secret of a good life, the best health and happiness”.

It is so sad that we are evolving into a “Want more” type of materialistic, selfish, disconnected world with misplaced icons! I was amazed at the willing, involved enthusiasm with which this lucky lady’s children cared so well for her! Incidentally, I had had a tough argument with my teenager kid that morning and had left home in a slightly bad mood. After meeting Champadeviji, whose eldest son of over 80 years still visits her regularly, I was relieved. Parenting is a long term, never ending activity, and may be my own stresses of being a doctor were also distressing my kids sometimes.

As I told her that she was fine and need not visit me for another year, she held my hands, hugged and blessed me, and with mock-anger said “Now if you don’t come to my home I will come to yours without telling you “.

I am now in a true dilemma.

©️Dr. Rajas Deshpande

Mumbai Diary- 3 To The Silent Patriots

Mumbai Diary- 3

To The Silent Patriots

© Dr. Rajas Deshpande

Neurologist

Mumbai / Pune

Usually I stay in Mumbai on Sunday nights to be able to attend the OPD at Lilavati Hospital on Monday. Strolling by the sea is usually a pleasant addition to a Sunday evening. However, this time there were huge crowds as Christmas was only three days away, and people thronged to have a glimpse and seek blessings of their beloved Mount Mary. I decided to use the evening to visit my favourite Udyan Ganesh Temple at the Shivaji park.

I had my car but didn’t want to drive in Mumbai traffic that day, so I requested for a rental car. As the car came up, a perfectly dressed chauffeur in a white hat got down swiftly and held open the door, politely wishing me. He must be in his sixties. “I am Abdul, Sir” he introduced himself. I introduced myself too.

“Can you please drive me to Shivaji park?. and on the way I also want to visit the Mount Mary for a minute.” I requested.

“Sure Sir” he said.

In a few minutes, as I returned after praying at the Church, we headed towards Shivaji park. © Dr. Rajas Deshpande.

We chatted, he opened up very well, a rarity in a world full of cellphone robots. His father had retired with many honours from Mumbai Police.

“Those were the days, Docsaab! We stayed in a small society, there were three Hindu and a Christian family around us. Yet there was no awareness about religion, any child went and ate in any home. There was also no hesitation in anyone scolding any child for being naughty .. we were like a single big family. Nowadays one has to think a lot before speaking even to one’s own kids!”. I agreed with him.

I met my favourite deity at the Shivaji Park and returned. As we drove back, we crossed a building belonging to an ultra-rich famous businessman. The intention of the owner to show extremely gaudy luxury and glittery affluence in every inch of that construction was truly manifest. Passing by that building, we witnessed the state police guarding its gates.

Mr. Abdul spoke in a tone with hidden bitterness: “Every glass, every brick of this building is cursed, Doctor saab. This man has cheated and looted millions to earn this kind of money. There’s nothing against anyone being rich, I mean who doesn’t like to have a lot of money? But it should not be made by sucking people’s blood”.

In a few minutes his tone normalised. His smile returned. “Docsaab, I have worked for this company belonging to Mr. Ratan Tata Sahab for over 20 years. No one has ever seen any show-off of affluence or power from the Tata family. Once I was posted as a night-duty chauffeur at Mr. Tata’s bungalow. Sitting in my car, I dozed off by midnight At about 3 AM, I heard someone knocking on my car window. I woke up with a shock: it was Mr Ratan Tata, holding his own bag. I came out of the car shaking and apologising. He said to me: “Why do you apologise? Everyone gets sleepy at night. Not a mistake. In fact I am sorry I had to wake you up, but I must reach the airport as soon as possible. Will you be able to drive, or are you feeling sleepy? I don’t mind if you sleep in the back seat, I will drive the car to the airport and wake you up there. You can bring back the car in the morning”.

Pausing to clear his emotional throat, Mr. Abdul said “I felt that it was like meeting God. Since that day I never felt like working for anyone else. People usually show off and become mannerless when they get even little power or money, they insult and mistreat their employees, dependants and staff. But not Mr. Tata, he has the biggest heart I have known”.

That this should happen with me on the very day of Mr. Ratan Tata’s birthday was such a divine coincidence for me! © Dr. Rajas Deshpande. It provoked a different line of thought.

Soldiers, Police, Doctors, and millions of workers, labourers, watchmen work day and nightshifts, silently performing their duty while also serving the nation with their blood and sweat. Somehow people tend to think that these “true patriots” do not have a right to sleep well, eat well, and spend some good time with their families. Many think that sacrificing sleep, hunger and family time comes naturally as a duty when someone chooses such a career. As if it is a crime for a soldier or policeman to feel hungry, or a doctor to need adequate sleep. As if the children of these professionals do not need a father or a mother at home! © Dr. Rajas Deshpande. Our society thinks that, it is okay for them to sacrifise, suffer, even die in the line of duty. That is hardly a sign of an evolved, civilised or humane society!

Most people in our society get to sleep eight hours, have three square meals a day, then watch TV / entertainment, and in the remaining leisure some of them scream about Patriotism, share posts of emotional speeches about loving one’s country. There’s no better patriotism than actually working hard. Those who shout slogans and bellow speeches actually do nothing good for any country.

Through this post I would like to thank the millions of silent nation lovers: men and women from all religions, from all parts of my Great India, who show their love for their nation in their work, in their perfect execution of duty and service. May this New Year bring you immense inner happiness, exuberant health and realisation of the beauty of life.

Of Course, Happy Birthday Mr. Ratan Tata, if at all this post reaches you someday! You are one of the most respected icons in this world.

© Dr. Rajas Deshpande

Neurologist

Pune/ Mumbai

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Lost and Saved Life: The Indian Puzzle

Mumbai Diary-2

Lost and Saved Life: The Indian Puzzle

© DR. RAJAS DESHPANDE

He had a sudden, severe chest pain, so he told his office-colleague so. The colleague first called his wife and alerted her “Bhabhiji please don’t panic, I am taking your husband to this hospital, please reach there as soon as possible and give me a call once you reach”.

The cab driver grasped the situation at once and drove as fast as he could. He prayed in his heart. Just a kilometre before the hospital, there was a huge mob blocking the road. A great leader was shouting aloud about his pride for his religion and patriotism, least aware that they were all blocking many children and mothers trying to reach home, patients and doctors trying to reach hospitals. The bought crowd was eagerly listening to the violence provoking words of this rich politician, also a convict and suspect in many crimes, There was less audience at the real places of God’s worship nowadays than at political speeches giving religious sermons, mixing them with the love for one’s nation!

The cabbie honked. Two monstrous looking goons peeped in his window and started abusing him insanely, least aware about the women and children around. The cabbie was abused first for his profession, then his language, and the state he had come from, threatened to be burnt alive along with family if he honked again when the ‘great’ leader was speaking.©️Dr. Rajas Deshpande

The cabbie begged with folded hands: “Sirji forgive me, I accept my mistakes, but there’s a patient on the back seat. He looks serious, we must reach the hospital as quickly as possible. For god sake, let us go”.

One of the goons opened the back door and asked this patient his name. After he saw the chest-clutching patient almost gasping, they made way and allowed the cab to leave.

Now the patient had started profusely sweating. His face had turned bluish, and he was making efforts to even breathe well. He could not speak. As they entered the hospital, the patient’s friend noticed that the patient had stopped breathing.

He shouted in panic. The wardboy and the cabbie lifted the patient on a stretcher and ran towards the emergency room.

A frantic, fearful sound of thuds of the last heart massage was now heard, along with breaking of many glass syringes and instructions shouted by doctors and nurses. A tube to restart breathing artificially was inserted in the patient’s throat. ©️Dr. Rajas Deshpande

There was no one to cry for this patient there. His friend was sitting outside the emergency room, clutching his head, stunned. The cab driver had left without taking his bills. Religion and Patriotism stayed outside the hospital campus, they couldn’t save lives.

A young and dynamic heart specialist who had just returned to India saw the ECG of this patient. An urgent action was required. He called upon the patient’s friend to sign a consent.

The friend hesitated and refused. There were a lot of news every day everywhere about doctors fleecing patients, earning money by misuse of stents and surgeries. The friend no more believed in what this doctor told him.

“I don’t know. Wait till his wife arrives, she will be here in an hour”.

Every millisecond was crucial. The dynamic heart specialist called his medical director. “Sir, I take full responsibility for this case, he needs immediate action”. The medical director cautioned him: “Doc, if anything goes wrong, if the outcome is not good, they will file a murder case against you. Why do you want to risk your bright career at the very beginning? You must also think that you don’t have any political godfather”.

The doctor rushed the patient to the cathlab and inserted three stents in the patient’s heart, that resumed the normal blood flow to heart. The patient’s heart function returned to near normal in an hour. By the time the patient’s wife arrived, the lost life of the patient was brought back. The next day, the patient could breathe well by himself.

Now the most crucial puzzles: which state did the cabbie come from? What was the caste of this patient? To what country did the helpful friend belong? Why didn’t they go to the government hospitals run by those who criticise private doctors and hospitals? And lastly, what was the religion of the doctor who saved this patient risking his own life and career?

Any sane person with an ounce of humanity in his heart won’t ask these stupid questions. But some Indian leaders and their followers do. And it is very sad and unfortunate that the answers to these questions cannot be openly revealed in my beloved India.

©️Dr. Rajas Deshpande

Neurologist

Mumbai/ Pune

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Survival Of The Quickest

© Dr. Rajas Deshpande

This young and brilliant man, Adil Masalawala, suddenly appeared to have changed. His behaviour became different and unusual. He started mumbling and replying irrelevantly. He also had fever intermittently. His caring and worried wife Mrs. Venus consulted a physician who sent them to a psychiatrist.

The psychiatrist checked Adil and advised him admission. He started with some medicines, but suddenly Adil’s behaviour became hyper, his body started becoming stiff. Then he became drowsy, and his body started shaking violently. An MRI of the brain was reported normal. That’s when the psychiatrist advised a reference for neurologist.

When I first saw the patient, he had many features that could also be caused by side effects of some medicines. Sometimes it is impossible to conclude whether it is the disease or the medicine which is causing certain symptoms. I suggested that we stop all antipsychotic medicines. That could also be a dangerous decision. The family was counselled, and they agreed. Adil’s drowsiness improved, but he became very agitated, and his stiffness and shaking worsened.

There are many neurological diseases of the brain which start as abnormal behaviour. Strokes, some infections, tumors and swellings are examples of treatable, but there are many untreatable and dangerous conditions too. The only way was to urgently investigate the patient further. Although the family was baffled and panicked, Mrs. Venus expressed complete trust in our decisions, and allowed us to shift the patient to the ICU. I could not answer many of their questions, I did not clearly understand what exactly was happening, but this uncertainty and challenge is what medicine is all about.

There is fluid in and around the brain, which nourishes the brain and also acts as shock absorber between the skull bone and the brain. Many diseases like cancers and infections can be diagnosed by studying this fluid, which can be taken out by inserting a needle in the lower (lumbar) spine. We checked this fluid, and we got the first clue: that we were possibly dealing with a viral infection of the brain. Many more costly blood tests were required to find out which virus was causing this. The family clearly stated “Do whatever is needed in your opinion”. We sent the tests and found the answer: Adil had one of the most rare and dangerous viral infection of the brain, called Japanese Encephalitis.

About 30-40 percent of patients with this diagnosis do not survive. There is no definite treatment for this virus, but many of the manifestations can be treated and excessive care is required to avoid life threatening complications of the swelling that it can cause in the brain.

On the fourth day, Adil had convulsions. His condition worsened. We kept on treating each complication as fast as possible and tried to balance the effects and side effects of the many strong medicines that were being used to control convulsions, shaking, and the brain swelling. Besides knowledge, wisdom and experience, our major strength was the trust of patient’s family who never questioned any decisions.

Many patients who develop abnormal behaviour are mistreated as having a psychiatric problem. Most qualified psychiatrists are aware of the red flags and refer patients for a Neurologist’s opinion. However, a majority of patients with psychiatric problems in India are first taken to quacks, magic healers, mantrik-tantriks, who delay the whole process of correct evaluation, diagnosis and treatment. This leads to many deaths, and this is worst in case of cancers treatable in earlier stages.

False advertisements, some even approved by highly placed offices, celebrities and authorities attract people from all classes and cause severe delay in initiation of the correct scientific treatment. While our governments rightly pressurise allopaths to write generic medicines, they mostly turn a blind eye towards rampant misleading false advertisements claiming cures of incurable diseases and centers that flourish reaping from the hope of millions of illiterates.

We almost thought we had lost this case to a permanent disability. Adil’s body had become completely stiff, his memory had become unreliable to a great extent, and he had an incapacitating tremor. After a few days we could gradually stabilise his general condition and shift him out of the ICU. In a few weeks he was discharged, improving slowly. His family, especially his wife fought for his normalcy like a true warrior, and once he resumed his senses, Adil too made every possible effort to recover fast. One day after a few months, he was back to normal again, we declared him cured and fit, physically and mentally. He resumed his job.

Today after about ten years, Mr. Adil Masalawala and his wife Mrs. Venus came over for some trivial issue, and we recalled the horror that we went through and his victory over it. In this case, I thought it was the “Survival Of The Fastest” as the family did not waste any time in quacks, arguments, objections or mistrust, and let us doctors do the best for the patient in the fastest possible way. We are grateful to the family for this trust, and Adil’s survival and recovery itself is our reward. God bless the couple with a long and healthy life!

© Dr. Rajas Deshpande

Real Story, Real Names, With Patient’s Express Permission. Grateful to Mr. Adil and Mrs. Venus for the permission to share the story of their victorious battle.

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Robodoc

© Dr. Rajas Deshpande

“The doctor wasn’t even replying. He didn’t answer my questions” the patient, an angry lady, told me about one of my colleagues. The patient’s husband sat besides her, expressionless.

I reviewed her case in detail. She had had varying complaints for over four years, mostly severe pain at various points on her body. When a patient has symptoms (complaints) grossly disproportionate to the signs (doctor’s findings), there always is a suspicion of ‘exaggeration’ or ‘lying’. This can happen involuntarily due to stress, depression or anxiety, or voluntarily usually for seeking attention. She had seen many specialists, and had received strong doses of almost all types of pain killers and other pain control medicines, still her response after every course was ‘zero relief’. That was definitely suspicious. I looked at her husband. He appeared tired and aloof, reluctant to participate in any discussion. I had to make him talk.

“Is she stressed? Have you noticed any change in her personality?” I asked them the question that usually opens the dreaded can of worms.

“I am fed up, doctor” said the husband, “She needs continuous attention. Since our marriage four years ago there’s never been a month when we did not visit a hospital. All doctors tell her to go to a psychiatrist, but she refuses. The moment I return from office she starts complaining about her health. I don’t know what to do now, I feel I am better out of my own home” he avoided looking at her.© Dr. Rajas Deshpande.

His wife started crying, and in a shrill voice, shouted at me “Why are you speaking with him, doc? I am your patient, speak to me. No one believes me. I am suffering so much!”

I assured her that I was going to help her sort out the issue. Once she calmed down, I was able to explain to her the way stress affects human mind and body, and that it was possible to get well soon. I told her that being stressed was not a “psychiatric illness” but an overworked, burdened state of mind that needs attention, and that it can often be cured by speaking with the right person. She asked me many questions. As a special case, I made an effort to reply to each one of them, even the irrelevant ones, sometimes repeatedly. She agreed to visit an excellent counsellor colleague of mine. She drastically improved in a month after the counsellor worked upon her. However, she came back with new complaints within two months. She visited me twice more, and each time cried a lot, then when I pacified her, asked the same long list of questions mixed with new ones.

My sympathy and compassion started waning. I have promised myself never to be rude to any patient ever, and I religiously follow that. Yet my patience was wavering now.

The more compassionate, patient, sympathetic a doctor becomes towards the patient and their family, the more it is taken for granted and misused. The doctor is then expected to be an unending source of “psychological support”, mentoring and motivating, and a punching bag or a cry-to teddy bear. While in a healthy doctor-patient relationship this compassionate attitude is natural and welcome, many doctors do not know when it starts growing upon them and stressing them out. It is not easy to listen to a continuous flow of medical symptomatology especially wrapped in negative emotions. While positive outcomes do bring back life into a doctor’s motivation to do better and more, this expectation to be a listener of all sorrows until the storyteller is satisfied is unnatural and impractical. It tells upon the doctor’s health. This is now happening in almost all specialties, and wise doctors are learning to separate patients into “whimpering, chronically-dissatisfied-with-everything storytellers” versus patients with genuine medical, surgical and psychiatric issues. © Dr. Rajas Deshpande.

To concentrate upon what can be corrected, to treat what is possible should be the right priority, and here’s where a doctor’s compassion, sympathy and patience are best employed. To expect a doctor to resolve issues like ‘Swabhav’ (inherent nature) of a human being is wrong. A doctor also cannot solve the root causes of stress like poverty, unemployment, interpersonal incompatibility, overambitious, over-expectant personality or attention seeking. Many patients and families expect the doctor to resolve ‘every minor issue’ related to ageing, refusing to accept that resuming complete normalcy of health is impossible after a certain age, especially with some medical conditions. Doctors can guide patients, but cannot accompany the patient and family to fine tune every minor issue.© Dr. Rajas Deshpande.

Few paranoid, suspicious, accusative, aggressive patients and the types mentioned above have now made it necessary for the doctor to be extremely aware and alert, cautious, and to some extent emotionally aloof from the patient at least in the initial phase. Every word has to be spoken with caution. This “Robotic Doctor” or “Robodoc” is actually becoming a sad reality in the Western world where every medical consultation is considered a potential chance of litigation. A careful doctor avoids getting trapped into emotional exploitation. While this may upset some patients, much of the educated class is still happy with a proper professional consultation, diagnosis and treatment rather than only a compassionate sweet talk. Given the Indian scenario where patients are driven emotionally rather than scientifically especially in the illiterate and financially challenged echelons, a doctor needs to be better equipped for avoiding misuse of his / her compassion and sympathy, as it also converts readily into a permanent source of rewardless stress. This is unhealthy for doctors.

This is one reason ‘Robodocs’ are on a rise. A sad truth about an essential evolution in the medical profession across the world. The only thing that can change this is individualising patient care.

© Dr. Rajas Deshpande

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Cerebral Palsy and The Californian Driver

AlKhalil Mohammed Qasem was noticed to have one sided weakness shortly after birth. His parents were told that nothing can be done, they have to accept that the child will always be bedridden. They decided to fight fate. They knew that their child was intelligent, that he had only problems with movement. Cerebral Palsy is a most misunderstood, misdiagnosed and mistreated medical condition. It is best handled by paediatric / adult neurologist or a paediatrician. There are some types of cerebral palsy where the child indeed has good intellectual functions yet severe abnormal movements, stiffness or imbalance. Few have fits too.

He came to us five years ago. There was a huge language barrier, I explained to his parents through the interpreter that all the medicines I wanted to try for him had side effects, some serious. They gave me permission in good faith. We started treatment. He improved. They went to USA. AlKhalil started going to school. He topped his class always. The parents made extraordinary efforts to provide best for him. His father works as a supermarket executive.

Now AlKhalil has finished school and joined college. He is also working part time to help his father at the supermarket, and drives his own car.

He came all the way from California today for a follow up.. He showed me his driving license with a pride and smile I have seldom seen! Driving a car is such a fond dream of everyone growing up!

AlKhalil and his parents have defeated cerebral palsy!!

Most cerebral palsy patients can have a significantly better quality of life if they reach the right specialist, usually a paediatric or adult neurologist as per their age group. I found no better example.

Miracles are not only possible, they are human too!

©️Dr. Rajas Deshpande

PS

Cerebral Palsy care is a teamwork between neurologist, paediatrician, orthopaedic surgeon, speech therapist and physiotherapist.

Till I’m Alive

Over 4 years ago, a late night frantic call from the casualty baffled me. Quite a complicated case. After seeing the patient I met her anxious family and explained them my thoughts, that the diagnosis wasn’t clear yet, and that we needed to observe the patient. I had already started treatment based upon a presumption. The Mandke family, in spite of being extremely well connected socially and able to afford treatment anywhere they chose, still decided to invest their trust and faith in a junior Neurologist like me. The onus to prove them correct was now upon me.

In a few days Mrs. Madhuri Sudhir Mandke was completely cured of the transient illness she had developed, and discharged. After a few follow ups, I told her the good news: she no more required to see me.

Yet every Diwali, she comes personally or sends someone from her family with extraordinary sweets and gifts. When she came over today, I told her this was not necessary, I had just done my duty. Then she said something that moved me: “Till I am alive I you will receive these every Diwali”.

This gratitude not only increases my responsibility, it is also a perpetual reminder of how important it is for every doctor to take it upon himself/ herself to justify, to stand up to that trust which involves health and life. Every outcome may not be what one strives for, but every effort can be made genuinely to let the patient and family feel that they have trusted the right doctor. It is NEVER sweet talking, wise talking or jovial attitude alone, never pure medicolegal attitude, but a combination of scientific, ethical and compassionate care that brings home the rewards of appreciation by the patient: the highest achievement in medicine.

There’s nothing more precious to earn upon earth!

©️Dr. Rajas Deshpande

The Doctor Who Took Fees: One Star Review”

© Dr. Rajas Deshpande

False reviews and online beratings against doctors and hospitals have become a reality. However much a doctor goes out of the way to do the best for his/ her patient, following are the reasons why negative reviews are still uploaded, some of them ridiculous:

1. Denial of false certification.

2. Recording truth on paper like addiction (smoking, alcohol, ghutka, sleep medicines etc.).

3. Mentioning preexisting illnesses which the patient / family had hidden from the insurance companies.

4. Denial to falsify diagnosis, treatment and inflating bills to claim medical insurance benefits.

5. Denial to give concessions in standard billing, consultation, visit fees.

6. Advising necessary investigations.

7. Charging for follow up visits (different doctors, specialties and hospitals have different policies, all are usually mentioned in the information prior to consultation. All follow-ups are not same). © Dr. Rajas Deshpande.

8.. Waiting time: This is the saddest in India. The standard waiting times for specialists all over the world range from 30-90 minutes, sometimes longer, but it is only the Indian patients who convert this into a complaint. Sometimes earlier patients may have taken more time, asked more questions, sometimes patients cry when a sad diagnosis is conveyed, one cannot ask them to leave the room, there are incessant calls for emergencies etc. . The same traffic and weather conditions affect a doctor’s schedule too, but some are unforgiving. The fact that Indian doctors are available on usually the same day or mostly a week in spite of a heavy workload means nothing to our people, even those who have visited the Western world and witnessed that it takes months to years to get a specialist’s appointment there.

9. Behaviour of the doctor: Agreed that some doctors are indeed rude, some are in a hurry, and that is wrong. But usually doctors develop a lot of patience as they mature, dealing with all sorts of negativity continuously. Sometimes patients do offend doctors by asking illogical questions repeatedly, by challenging every word that the doctor says, or by making illogical demands. These demands include repeating long explanations about the diagnosis and treatment, requests to speak on phone with a distant relative to re-explain everything because they are too busy to come over, asking questions like “Are these medicines necessary?” etc. © Dr. Rajas Deshpande.

10. Unfair, illogical statements “I cannot tolerate any allopathic medicine” rules this section. What do you expect a physician to do?

11. Unfair, unrealistic expectations: Every drug has side effects, including vitamins, and these side effects are NOT the doctor’s fault. The doctor can alert the patient about common side effects, but cannot explain all side effects of every medicine, as it is impractical. Secondly, while some medicines act within seconds, some take effect over weeks to months. Those without patience who expect relief within few hours / one day usually upload angry reviews about both “no effect” and side effect” commonly.

12. Declining demands for admission. Investigations and OPD treatments are not covered by most insurance companies, so some patients demand admission even when not indicated. When refused, even if the patient was cured, the doctor still gets a negative review.

13. Google masters: Some patients bring a lot of irrelevant questions and conceptually wrong use of medical terms to the doctor’s table, and however politely one declines to waste time over such, a negative review is almost guaranteed. © Dr. Rajas Deshpande.

14. Habitual negative reviewers: I once found a negative review of a patient who had actually responded well to treatment and was cured. He had complained about having to pay for a follow up visit after few weeks. A small google search revealed that he had uploaded many reviews from those about railway stations to collector’s office, from autorickshaws to five star hotels, almost all negative. Unhappy man!

12. Professional Competitors- this is a new reality: doctors hiring agencies to boost their positive reviews and add negative reviews to their competition. The simple fact check of how many positive reviews over how much time reveals the truth.

Some negative reviews are indeed genuine, I have had them myself, and called and apologised to the patient, clarified my stand too. However when they were malicious, I have informed the concerned site manager and also posted a reply about reality.

How to know?

A negative review must have a legitimate name of the person writing it, and details of date and time of the visit. That way the doctor can also confirm whether it is genuine and help resolve it. A nameless review is always questionable, good or bad.

In a recent news, a National restaurant association has decided to sue people who upload negative reviews about food: just because they want more or free, just because of their mindset is negative, just because they are insatiable. Even IMA should consider suing people who upload wrong, defamatory, spiteful reviews about doctors. Even the ‘hired good reviews’ by doctors should be discouraged.

Issued in the best interests of patients and doctors.

© Dr. Rajas Deshpande

Please share unedited.

The Beautiful Secret

©️Dr. Rajas Deshpande

“I found her outside the public toilets near sassoon hospital” the lady said almost as a whisper after her daughter left the room. “She does not know. Nobody knows. Please don’t tell her ever”.

That 15 year old girl Teju was brought to me over 10 years ago, with uncontrolled fits. Not all fits / seizures are convulsions, there are many different types. Teju would suddenly behave abnormally without knowing it for a few minutes and then start crying. Her studies were affected as she had such episodes many times a day. She had been to some excellent doctors, but as she did not tolerate the medicines she had stopped them and refused to go to a doctor. Her mother Latha had somehow convinced her to meet a neurologist only once, so they were here.

Latha was a single, middle aged lady, who worked at a few homes all through the day mostly as a cook. Her husband had died long ago, and she barely managed to maintain her livelihood while living with Teju in a chawl. She narrated Teju’s history to me, but when I asked about parents having any fits or other neurological illness, Latha winked at me and said “No, I am okay, even her father was okay”. Then she asked Teju to get her a bottle of water from the canteen, and just as Teju closed the door behind herself, stunned me with her words: “I found Teju outside the public lavatory near sassoon hospital . She does not know. Nobody knows. Please don’t tell her ever”.

Then she explained in a hurry: “Doctor, you are like a brother, I will not lie to you. I had run away to marry my husband, but he was an alcoholic. He died in a road accident. I had no one left in life, and wanted to die myself. One night I was returning home from my job, and went to the public toilet on the way. There in a large heap of waste I saw this girl, only a few weeks old, almost dead. I took her to a doctor, told she was my sister’s daughter, and got her treated. Then I could not think of letting her go, I had found my purpose in life. I am a good cook and get by with salary from cooking at over 5 homes now. I want her to study well, but this epilepsy has been our curse now. I wish I was rich so I could treat her well”.

That last sentence hurt me. One, she was rich. Two, she thought good treatment needs one to be rich.

Teju had reentered, so we changed topic. I explained Teju her diagnosis in medical, scientific terms, and the reasons why this illness happens, how we can control it with the right medicines, and how her quality of life will be far better if her fits were controlled. “You will be able to look after yourself and even your mom well in the future if you are self sufficient” I used the trump card. She agreed to take treatment.

“Secondly, never worry about fees. You are a free case now onwards. You can even get discounted medicines at some pharmacies”. I told them addresses. Latha hesitated: “Doctor, we will pay, we don’t want to take advantage. We don’t want you to hush up because we don’t pay”. Their concern was genuine, and I assured them that I will do my best for them. No good doctor will turn away a treatable patient for want of money, I know many who treat poor patients free, unfortunately it never comes on record.

That was long ago. We were able to control Teju’s fits in a few weeks, and bring her drugs to a single dose of medicine. She followed up every six months regularly, each time with her mother. She gew up well, and always topped her class.

Only last month, she came alone.

“Doctor, I have a good news. I have been selected by a software giant in the USA. They have offered me a gorgeous salary too. I am leaving in a week’s time. I have come to tell you two things: first, please take care of my mother for a year, I am planning to take her with me to USA after that. Secondly, I can now pay the fees for both myself and my mom. I am rich now! So please tell your receptionist to make a bill for all my consultations till now.”

I laughed and congratulated her. “Well. I have promised your mom something, I will sort out about the fees issue later with her. As for her medical care, don’t worry I am here. I am glad you are taking her with you, many can’t”.

“Oh never! I can’t dream of leaving mom alone here. She has grown me up alone after my dad died. I know how hard she has worked for her daughter” shesaid, with wet eyes.

I had an emotional moment, a sudden urge to tell Teju the truth. But I refrained. This indeed was the truth now. Latha was Teju’s mom, and I had no right to change that. I regained my composure.

When she touched my feet, she asked “Do you want anything from the USA doc?”

“Thank you, I have everything I want with God’s grace” I told her the truth. Indeed, He had given me the ability to change lives positively, to contribute to humanity in innumerable ways, to help people live better lives, nay – the best lives they could. What more could I ask for?

©️Dr. Rajas Deshpande

Please Share Unedited.

True Story, names changed.