“Do you want a broken leg, Doctor?”
© Dr. Rajas Deshpande
Three days after he suffered a paralysis, after having tried Voo Doo, Herbal and some other medicines, an old man of 80 was shifted to a big private hospital once he became comatose. The three sons accompanying him didn’t even touch the comatose patient, they didn’t even care about whether he was covered properly or not.
His Blood Pressure was too high, and he turned out to have a bleeding in the brain, untreated till this moment. His brain was swollen badly.
Every private hospital has free mandatory beds for poor patients. This family was asked about their preference and eligibility. © Dr. Rajas Deshpande
“We will pay everything. Don’t worry about the money. He should get the best room and facilities” his son said. They signed the necessary documents about knowing the critical condition of the patient, charging schedules, willingness to pay etc.
Then the sons came to me and said “We don’t care about the money, doctor, but he should get completely cured”.
This was expected, experience teaches a doctor about relatives as much as about patients.
“He is 80 years old and critical. At this stage I cannot guarantee anything. Complete recovery looks impossible, partial recovery may be hoped for if he responds well to standard treatment” I replied.
“But we will pay anything you want” the younger son said.
I involved the PRO, a lady who had far better patience than myself dealing with attitude and arrogance. Explained them once again, and left after the patient was shifted to our Neuro Intensive Care Unit. © Dr. Rajas Deshpande
The patient improved in five days. Started to speak a few relevant words. Out of danger, shifted to Deluxe Room as requested. The only person who ever attended the patient was a 15 year old grandson, mostly the patient was left alone.
The sons had by then submitted some documents claiming a BPL “Below Poverty Line” status, but those were found to be false. A fake letter in the name of charity commissioner was also attempted. The hospital PRO reminded the patient’s sons about the pending bills regularly.
It became clear that none of the three sons who earned well themselves wanted to pay for their father’s treatment. They had continuous fights amongst themselves, the only thing they agreed upon was not wanting their father. The request “He must get completely cured” was not because they wanted his health, but because no one wanted to take home a disabled father to care for years.
The hospital took a stern stand. The bills had exceeded two lacs rupees, nothing was paid. This indeed was burglary with blackmail.
After repeatedly asking to meet the patient’s sons for another three days who did not pick up the hospital calls, I told the attending boy very carefully to please remind his parents to settle the pending bills, also reminding him that nothing in the treatment will wait or change because of bills.
In two hours I received a call. It was a local Municipal Councilor.
“Doctor, do you want a broken leg? Are you a doctor or a businessman? How can you speak about money to a small boy? Just keep on treating. We will do something about the bills through our MLA. If you speak about bills again, remember, there will be news about your hospital on every channel”.
Do I have time, energy to waste, filing a police complaint? Will it be any use at all? © Dr. Rajas Deshpande
In no other industry, not even in govt. offices, will anyone be given anything on credit: even for a paper worth five rupees. Even the poorest of the poor cannot get free food or travel in private industry. But the entire private medical care is expected to go on working in ‘credit’ mode, for everyone who claims to be poor. Emergency is understood, and no hospital or doctor thinks about money in case of emergency. But once emergency is over, those who cannot afford a private hospital should go to a government hospital. A private hospital needs too much investment per bed, and anyone who questions this can please sponsor one bed in any ICU for a poor patient, see for themselves what the actuals cost.
Who will even address this Burglary and Blackmail that happens everyday in every private hospital in India?
There should be an online portal by government / police for doctors and hospitals to report patients dumped by family, families who refuse to pay, those who use threats and intimidation anonymously. Then the ‘other side’ of this story will be clear.
© Dr. Rajas Deshpande
Emergency: The Doctor Is Not In
© Dr. Rajas Deshpande
“It’s an emergency, doctor” shouted the angry son at my OPD door at closing time, around 11 PM. We rushed to the casualty. It indeed was an emergency. His father had developed a stroke, and was found to have a moderate sized bleed in his brain.
His younger son who had done some medical diploma in some yet-unrecognised pathy had stopped his father’s blood pressure and diabetes medicines three months ago. “I was observing him at home. The BP was high and the sugar was around 300, but I was trying my own medicines, as I don’t have faith in allopathic medicines” the son told me without a trace of shame or guilt.
“How long has your father had these high BP and sugar levels?” I asked him, impatience choking me.
“May be a month” he had replied coldly.
The treatment initiated by the casualty doctors had stabilised the patient. © Dr. Rajas Deshpande
As we returned to OPD, the angry resident doctor with me said “He should be booked for attempted murder”.
Within three days of the admission, both the sons of this patient decided to take him home. Patient had still not recovered his consciousness well, and was being fed via a feeding tube. “We will manage him at home. We will call you if anything is required” they told me.
Grown up by now, I replied “I am not available on phone. Please see your local doctor or take him to the nearest hospital should he have any problem”. © Dr. Rajas Deshpande
“What if it is an emergency? He is under you care” the elder son asked aloud, in a threatening voice.
“He is not under my care once discharged. We will advise him medicines and give other instructions. I am not your paid servant. I am not available for consultation on cellphone” I told them my working hours. I had not become a doctor to be abused by those who wanted to save time and money. © Dr. Rajas Deshpande
Then over four months later, the two brothers entered my room at 9 PM.
“Doctor, our father is having vomitings with blood since yesterday morning. He is not responding well when we speak. Can you prescribe something?” the elder brother asked “He is at home, we thought we will first give him some medicine and try”.
“Why didn’t you admit him even when he had bloody vomiting yesterday?” I asked, almost knowing the answer.
“We thought it will stop. Also, there was nobody to admit him. We both have our office jobs.
“I cannot prescribe anything without seeing such a serious patient. You must take him to the nearest hospital with a gastroenterologist. Please treat this as an emergency” I told them. © Dr. Rajas Deshpande
However their calm was unruffled.
“We will take him to some hospital near our home. They will treat him immediately no?” asked the younger one.
Before I could reply, the elder brother raised his voice again: “They will have to. Or we will show them. This is an emergency. If something goes wrong, we will bring down the hospital”.
In two days, we read the news of a small nursing home ransacked and destroyed, doctors manhandled by relatives because this patient had died. The doctors who tried to save him were arrested under an allegation of “attempted murder”.
The word “emergency” is as familiar to every doctor as his own name. Hundreds of deaths in casualty are related to delayed admission at the terminal moment, and no one looks at the gruesome ignorance, neglect and delay behind the scenes, which equals murder by the patient’s own friends/ relatives. © Dr. Rajas Deshpande. Addicted to thoughtless emotional outbursts, our society usually reacts without logical thinking except few intellectuals who do not constitute a vote bank.
Drug reaction? Beat up the doc!. Patient in casualty or hospital died? Beat up the doc! Arrest them! Jail them! If the same patient is killed due to wrong treatment by his relatives, or dies at home because he was never taken to the hospital by family members: it’s okay!
Many who are advised right tests don’t do those. Many who are advised right medicines do not take them. Many do not undergo the correct procedures / surgeries advised. Because the patient is “King consumer!” Then when their health deteriorates. It is suddenly the medical profession that becomes responsible for everything that goes wrong.
Time has come for IMA to demand an enquiry into the circumstances few hours / days / weeks prior to every death in casualty and emergency where the doctor / hospital was blamed. Right from neglect, ignored medical advice to hidden information, many skeletons will tumble out. An IMA legal cell should start filing cases of culpable homicide in every such case. Then alone, equality principle will prevail.
Time has come when small hospitals, nursing homes and clinics, which were earlier trying to rescue serious patients in emergency, will display this board after the regular OPD hours:
“Emergency services not available. Doctor NOT in campus”.
© Dr. Rajas Deshpande
Please share unedited.
© Dr. Rajas Deshpande
He tied her to the pole, abusing and insulting her.
Wielding a knife in his hand, he slapped her once more. “You are supposed to be the honest one” he shouted, “I am a man. You were talking with our neighbour. What did you say to him? Did you two fix up a place to meet secretly?” he was trembling with anger.
She looked into his eyes, and replied “Don’t you talk to other women? Doesn’t your mother talk to other men? Do you always talk about that? I was asking him about his sick wife”.
Pulling her by her hair, he said menacingly in her ears: “Look, don’t compare yourself to me. I am a man. You are supposed to be the one who gives up everything for me. Do you think I don’t know how ‘those’ women behave? You have chosen to marry me. I can do what I want”. She didn’t reply. What could she say to a paranoid, suspicious person who had one way communication? The option of violence wasn’t open for her.
As it became dark, his mood changed. He started speaking soft and sweet. He untied her from the post so she could cook. She could not eat well, the humiliation and insults, the allegations and violence wreaking havoc in her mind.
Silence fell upon the dark. The next day’s work awaited her at dawn, so she skipped the sobbing and tried to sleep.
“Make love to me” he ordered. She tried to comply.
He raised his voice “It should come from the bottom of your heart. Don’t pretend. Love me madly, deeply, and let it show in your action”.
Silently, she replied “I can’t. The only one thing that could have made me truly love you was true love from you too”. © Dr. Rajas Deshpande
This is the current scenario between the society and the good medical professional today.
Take for granted that the whole medical profession is one’s slave. Make allegations at every possible opportunity. Be suspicious and paranoid. Hold a doctor guilty for any news anywhere without logical enquiry. Make them overwork under the sacrifice tag. Disrespect them, beat them up, ask them questions as if talking to criminals. Presume every other doctor and every big hospital is a fraud.
Then, when one has a health problem, expect them to be truly, deeply compassionate, loving angels who will do the best because they are married to their principles of being good and kind to everyone.
If you expect the doctor to be truly nice and kind and compassionate to you, to make best decisions for you, ask yourself if you deserve that. No amount of money will buy you a doctor’s love and respect, no amount of hateful criticism or threats will compel your doctor to be compassionate.
A doctor’s real fees is the respect and trust you place in him / her. No amount of money is worth the value of your life. Pay with suspicion, threat and disrespect, and you destroy the compassion you truly deserve.
The doctor-patient trust is a coin with two sides, one side cannot be blank.
© Dr. Rajas Deshpande
PS: I know the word “exaggeration”. Learnt it from some movies and TV shows that criticise doctors.
Please share unedited.
The God Pendulum
© Dr. Rajas Deshpande
Dr. Aman handed over his car to the valet, and went to the rooftop restaurant, his favourite rendezvous. The captain soon brought over his favourite coffee pot and some starters.
‘The look of love’ by Kenny G started playing. It is impossible not to feel inner peace and romance while listening to that piece. Dr. Aman started to think. Yes. He had much in life to sort out.
Sunday late afternoon. The only afternoon to relax if lucky. A moment of peace so precious, that even family duties take a back seat, the mind is so tired of the heavy duty medical practice. Heavy duty because mistakes are not allowed, and seldom forgiven. © Dr. Rajas Deshpande
It is difficult to relax at home too. The society security staff, maids, some ‘sudden’ old friends from god-knows-what-stage-of past will want home consultation, and it is rude for a doctor to say no to any health queries by anyone, anytime, anywhere. Cellphones have become the worst health hazards, more so for the doctors.
He had two patients under his care in the hospital, so he decided not to switch off the cellphone, he was responsible should they have any problem in the hospital.
The phone of course rang.
“Sir, casualty. One GP has referred for you an old lady with convulsions. She is quite bad” the medical CR appeared disturbed.
“On my way” said Dr. Aman, paid his bills, and reached the hospital. On the way he kept on giving intructions to the junior doctor.
The 65 year old lady had had fever for a week, not taken to the doctor, treated by her non-medico daughter and son with home remedies. On the seventh day, yesterday, she had had many vomitings and became unconscious. The local GP gave her some basic treatment, and sent her to the city as she had no facility to treat such a critical case. Since that morning she had also had convulsions.
She was already intubated in the critical care unit when Dr. Aman reached. CT scan of her brain was normal. Her sodium levels turned out to be dangerously low. The management requires skilful vigilance, and it was already started. © Dr. Rajas Deshpande
Her daughter and son were waiting outside the ICU. Dr. Aman updated them about her condition.
The angry son asked “Why is her sodium low? Is it because of the medicines given by the doctor yesterday? I it the side effect of those medicines?”
Dr. Aman had now acquired the skills to tame his anger. He told that it was because of the vomitings, and that they should have taken her to the doctor earlier when she had fever.
The daughter started with an emotional appeal, speaking loudly “Do whatever you want, doctor, please save my mother. You are like God to us. Nothing should happen to her. We are ready to do anything. Please save her”.
“We are trying our best. Let’s hope she recovers” Dr. Aman said the legally correct thing.
“So when will she become normal?” asked the patient’s son.
“It is not predictable, we need to reassess her after convulsions stop and sodium levels are corrected” Dr. Aman replied. © Dr. Rajas Deshpande
“So why don’t you correct her sodium levels right now?” asked the son, as looking at the surrounding relatives as if he was suggesting the obvious that the doctor had missed.
“If sodium is corrected faster than a certain rate, she will develop paralysis, it can also be permanent” Dr. Aman replied, and added “Look, boss, if you do not have trust in our treatment and skills, you can please shift her to any other hospital you wish.”
“No. no doctor. We trust you. You are like God for us. We brought her here because this hospital is big and famous, and has all facilities” said the daughter. The son just kept on looking angrily at the doctors.
On the third day, the lady became conscious. On the fourth day, she was off the ventilator.
“When will she be shifted out?” the daughter asked.
“After a day of observation in the ICU” said the junior doctor.
“Why is it necessary to be in ICU now?” asked the son.
“Because she still has fluctuating oxygen levels, and needs continuous observation” replied Dr. Aman. © Dr. Rajas Deshpande
“Why cannot you observe her in the ward room? The ICU is so costly” the angry son kept muttering.
On the fifth day they requested discharge, as the patient was walking. Her weakness was still fluctuating, and her BP was low. She was discharged on request.
Within an hour, a crowd surrounded Dr. Aman.
“What is this? Is this any bill? Are you doctor or a thief?” the daughter started shouting, to a full audience of the waiting patients.
“Listen. You knew these charges when she was admitted. I do not own this hospital. The rates are standard, and so are the criteria for free or concessional patients. Please speak to the billing department.” Dr. Aman kept his tone low still. He did not want to point at the two costly cellphones that the son flaunted.
They did not qualify for free treatment as per the govt. norms.
“Doctor your fees is also there in the bill. Atleast cut that off. We cannot afford.” The son insisted. The waiting crowd surrounding them stared at the face of Dr. Aman. “Will the doctor be human and help this poor?” was the mob expression.
To save time, Dr. Aman asked the billing clerk to scratch off all his consultation fees. Saved time is more precious than earned money for the doctor.
While leaving, the daughter looked angrily at Dr. Aman and said “We never thought that doctors will be so rude and commercial. Curse upon such doctors who extract money from the poor”.
A doctor must digest all kinds. All patients who had witnessed the scene were doubtful and upset. They knew nothing about the patient and what had actually happened. They had just witnessed the last scene.
Just five days later, the whole family returned in panic. The lady had developed many convulsions as she had stopped the medicines after going home. Now she was unconscious because of the low oxygen that had damaged her brain. This could take a long time. © Dr. Rajas Deshpande
The daughter started “You are God, Doctor, please save her” etc. etc.
Dr. Aman gave instructions about the basic management to the emergency team, then turned to the daughter and said “I am sorry. I am busy with other patients, please take her to another doctor or hospital. I cannot attend her”.
“Can you refuse a patient?” asked the son, as if he had taken a special training from Mr. Ram Jethmalani.
“Yes, I can” said Dr. Aman “No one can expect a doctor to take correct decisions under duress, threats or abuse, and if I think there’s risk to my life or reputation because of ill behaved, hostile relatives, I can even refuse emergencies”.
There was no guilt in his mind when he started the car. He had become a doctor to serve the sick and suffering. Those who did not value him, his work and his profession did not deserve his service. His dignity was as important as his humanity, he would not sacrifice it for those who didn’t deserve it.
© Dr. Rajas Deshpande
A Murderer’s Family That Almost Killed Us
© Dr. Rajas Deshpande
The whole city awaited a murder, just like in the book ‘Chronicles of a death foretold’ by Mr. Gabriel Garcia Marquez. It was during my internship. I was posted in the civil hospital casualty along with Dr. Anwar and Dr. Junaid, my batchmates. The postings were phenomenal in that we got “Hands-On” experience on a variety of Medical Emergencies.
As a result of a professional rivalry between two big families, one head was shot down point-blank in cold blood on a busy street. The brother of the dead had sworn that he will kill the killer soon. It was just a question of time. We heard the progress in hushed tones during night-tea with wardboys and ambulance drivers.
One night we had our customary 2 AM tea on the street opposite the hospital, and were just re-entering the casualty when there were panicked screams outside, and a whole lot of people barged in, asking for doctor on duty. Dr. Anwar said that the medical officer was in his room, and asked about the patient.
The patient was the victim’s brother, the infamous one who had sworn to kill the murderer. He had developed vomitings and diarrhea, and had become unconscious. He also heavily smelt of alcohol. The medical officer on duty came over, a skin specialist. He examined the patient, ordered medical tests including blood alcohol levels and the analysis of aspirate from the tube inserted in the patient’s stomach. Writing the treatment plan, he told us to carry it on, and left to retire.
I looked for a good vein to start the IV fluids. Dr. Junaid recorded the pulse and BP, both a little out of range but acceptable. Got the vein. . Gave him the advised medicines. The patient was stable.
Dr. Anwar started to write the police information note. We must inform all medicolegal cases immediately to the police in hospital campus, by law. Dr. Junaid whispered to me: some relatives smelt of probably Marijuana.
We were in a cubicle, the dressing room besides inpatient casualty, made of Government-grade cheap plywood, with a wooden table and metal chair, patient bed, IV stand, and an elementary dressing cart. It had only one door, now blocked by atleast 20 relatives, all shouting angrily about why the patient was still unconscious. ‘If something happens to him you will not survive’, some of them kept on repeating. They were headed by an extremely aggressive and big lady, who said she was patient’s sister. We told her he was stable and expected to improve.
“Why isn’t he conscious yet?” she asked angrily.
We started getting anxious.
The security guards were meekly standing behind the crowd. They were both government servants, and this crowd was above them, government, and even law, in that moment.
The telephone rang. It was the hospital’s ambulance driver, our night-tea partner, calling from a ward. He said in hurried and anxious voice “Sir, they are not good people. Leave that room. I will keep the ambulance ready outside if you want to come out. Don’t argue with them:” he said.
“We cannot” I said. The relatives were right there. “We need some IV fluids” I told him.
“Yes, sir” he got it.
Dr. Anwar handed over the police information sheet to a wardboy waiting out, through the crowd.
The patient’s sister snatched it from his hand. “What is this?” she asked.
“The senior Doctor asked us to file an MLC (medicolegal case) as there is suspicion of alcohol intoxication and food poisoning.. just a routine procedure” explained Dr. Anwar, carefully choosing his words but still with hesitation. It is never easy to talk to someone angry and aggressive.
Then there was a loud noise, a wet and heavy and muffled thud. She had slapped Dr. Anwar. “My brother is dying, and you want to file police case?” she caught hold of his shirt-collar, bent and lifted him with her hand between his legs, kicking him all the while. Myself and Dr. Junaid ran to her, saying, many things that meant sorry, it was just a procedure, that we were told by our senior, her brother is not dying but stable etc. etc. You know how coherent one can be in such a situation.
We were pushed back violently by two of them. “You don’t move from here till our brother is conscious” we were told, with added expletives, a hefty man held my shirt collar and violently pushed me into the wall near the patient. I smelt the burnt marijuana too. Another stout one was tugging at Dr. Junaid’s shirt, which ripped off. Gentlest among my friends, I cannot forget Dr. Junaid’s face in that moment. Slaps continued, as the incharge sister and nurses tried to shout and try to intervene, but the crowd didn’t allow them to enter the room.
© Dr. Rajas Deshpande
The aggressive lady lifted up Dr. Anwar, and banged him on the plywood wall. It gave away, shattering also the glass within it. Dr. Anwar started shouting for help as she continued to fist and kick him with others as he lied on the floor. One relative lifted up the chair and started randomly hitting things with it: the telephone, the glass on the cubicle walls and finally aimed it at us. Five feet away from us, there stood this goon with a metal chair aimed at the two of us held to a wall by other relatives.
That moment is framed in my mind for forever. We were treating his brother, none of this was our fault, we didn’t know them at all, still, they were ready to kill us.. Not one insane person, but a whole crowd! Any legal action later on won’t matter once we die or are hurt. A doctor’s life meant nothing for those goons who had both power and money.
We begged him not to throw the chair.
He threw it with a wild gusto anyway, and as we turned away to dodge it, the chair hit us, its edges cut through Dr. Junaid’s’s ear and my arm. Pain was less of an agony than what was happening. The incharge sister outside started screaming and crying aloud.
The patient moved, and pulled out his IV line. His blood started soaking the white bed sheet. Just as I moved to get a syringe to temporarily block it (it was an open needle), someone slapped my back. “Can’t you see he is bleeding? Stop it”. Dr. Junaid reconnected the IV line with bare hands, trembling.
At this point, the Civil Surgeon entered, an old man with many political and social connections. He was accompanied by two-three police constables and the senior doctor on duty who had called them. The family knew the CS as well as the police. He pacified them, told them he will look after the patient personally, and asked them all to go to his room.
The incharge sister, a mother to all, still crying, took us to the doctor’s room, and dressed our wounds. The ambulance driver got us some coffee.
The CS never asked us if we were hurt. He kept on telling the stories of how he calmed down the crowd for ages later. He never felt responsible for what happened, nor reprimanded his “friends” for their violent behavior with his junior doctors.
The patient improved, and was discharged in three days. The whole family came to take him away again. They left without any thanks or apologies.
About a week later, our patient fulfilled what he had promised his family: He killed his brother’s murderer in open daylight, witnessed by dozens on a busy city square.
Dr. Anwar and Dr. Junaid have long left India, and are happily settled in safer countries. Twenty years down the line, I continue to read the same story almost every other day, recalling and re-living the horror.
Anyone can walk in with a crowd in any Indian Hospital and violently destroy life and property, under the pretext and excuse of being angry at anything they don’t understand or like. . A law exists now, but you know the implementation. Mandatory action against any violence/ threatening /Intimidation in any Medical Premises must be implemented, without the doctor / hospital needing to file a complaint. You know what happens to witnesses in India.
I pity the brains of those who blame doctors for “not explaining properly to the anxious relatives” thus justifying the violence and attacks. No Judge, No Govt. Officer, No police officer “explains everything “ to anyone when we go to their offices, in fact most of them treat “Junta” (everyone else / common man) as a waste. That doesn’t allow us to attack them and destroy property. This is only “softly dealt” about doctors and hospitals.
We need a concrete plan against this domestic violence mostly cultivated by those in power. Or a National Revolt against violence in Medical Premises.
© Dr. Rajas Deshpande