Tag Archives: Society

“Is The Diagnosis Wrong, Doctor?”

“Is The Diagnosis Wrong, Doctor?”
© Dr. Rajas Deshpande

“Doctor, there is no improvement at all” said the angry husband, throwing the case-file upon my table.

Well this is not an extraordinary sentence for any doctor, one must be prepared to openly deal with this. I had been quite polite and well mannered with them, there was no reason he had to cross that line. I could understand though. When they pay my fees, they expect some result or satisfaction.

While teaching my students, I have always insisted that if the patient / relative says that there is no improvement or change with the prescribed medicine, one must first consider the possibility of a wrong diagnosis, a missed condition or a misinterpreted finding. Doctors are humans, and do commit mistakes, or misinterpret findings. This is normal, and happens with every doctor. Medicine is far more complicated than most people think they know. A good doctor knows this and learns, while all the time keeping patients safe, but a doctor with ego kills his own practice, and may cause harm to the patient.

I asked them to sit down and reassessed the case in detail. A 28 years old female. Headache, giddiness, imbalance, palpitations, breathlessness. Lack of sleep and bouts of crying. Past and family medical history not contributory. Physical examination completely normal. MRI of brain normal, Vitamin B12 and D levels low. I had started vitamin supplements, anti-anxiety medicines and an SOS for headache.

She told me all her earlier complaints had improved, but now she had a severe backache. I told the patient that I was trying my best to understand her condition, and to resolve her problem, but her findings and complaints didn’t match. She looked at her husband, and asked him “May I speak frankly to the doctor?”.

Openly agitated, the husband sarcastically offered to wait outside if she needed privacy. However he stood glued to the chair as if he knew her answer. © Dr. Rajas Deshpande

The patient thought for a moment, told him it’s ok he can wait inside, then started to talk. She revealed that she was the only child of her affluent parents, had passed engineering, but now had to quit job and stay at home to raise children. They lived in an extended family, with grand in-laws, in laws and an elder brother, his wife and two children. This patient was the ‘last in the line’ to take orders, all others being senior to her. Her husband and in-laws were perfectionists, and she was tired of their continuous expectations. She had dreamed of making a career too, wanted some free time outside home for herself, but year after year, she didn’t get even a minute for herself. She was tired of it all and there seemed no respite. © Dr. Rajas Deshpande

“I am not averse to hard work, but the continuously condescending and fault-finding attitude makes me feel that I am useless”, she said, and added cautiously: “We were in the same institute and my ranks were always better than him. Look at where I am now” she started crying.

I offered them water and coffee, and waited for her to settle down. The husband became restless and defensive, but his tone was far lower. “I understand her problem, doctor, but what can I do? I cannot leave my family. My work pressures are quite high too, the IT industry is going through a bad phase”.

“I can assure you that she has no neurological problem now’ I replied, “she should improve with lifestyle changes, counseling for the family, and adequate free time for herself. I will refer you to a good counselor” I told them.

The husband laughed. “I can understand, but my parents will not. We will see what best we can do for her”. A bitter tone in his voice didn’t escape me.

‘Sir, she told us what bothered her, and must not be held guilty for trying to speak her mind. It will only help identify and treat the problem better. Please see a counselor together and avoid discussing this at home right now” I requested the husband. © Dr. Rajas Deshpande

There are many reasons why a patient does not improve. Untreatable medical conditions, depression, seeing the wrong specialist are the most common reasons, but there also are patients who want medical leave,those who want to avoid work, who want attention, so will keep on complaining of false symptoms. They do not improve with drug treatment.
On the other hand there are many who keep on taking the wrong medicines for years, those who self-medicate, do atrocious / injudicious dieting and exercises, yoga that doesn’t suit them, and do not follow the doctor’s instructions about abstinence, who keep on indulging salt, sweet, oil, alcohol, tobacco and other drugs freely available in India. © Dr. Rajas Deshpande

A doctor remains a lifelong medical student. A doctor who thinks he / she is always correct is most dangerous. It is not uncommon to meet doctors who are angry / upset with the patient / colleagues when their diagnosis, treatment is questioned. The first thought of a doctor when the patient does not respond positively should be to consider a misdiagnosis, reevaluate the case in more detail, reassure the patient, and obtain a second opinion if necessary. All this done, one must look into other possibilities, with an approach to resolve the issue rather than trying to shove down the patient’s throat their own faults.
We all go through bad patches in life, doctors and patients. If the child is wrong, the parents correct them still with love. A doctor’s attitude should be similar, with due care to also protect themselves. If not the doctor, who will understand the patient whose family refuses to understand them? In so many ways, especially in the Indian society, the doctor must don the role of an elder brother/ sister. Although patronising is legally discouraged in medical practice, and should be refrained from in cases where trust is questionable, one can make exceptions for some cases that need reassurance where the family fails to do so.

The nobility of our profession also lies in reassuring the patients that they are well cared for by their doctor, through the thick and thin of their life.
© Dr. Rajas Deshpande

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G-Bhai, The Suicidal Intellect.

G-Bhai, The Suicidal Intellect.
© Dr. Rajas Deshpande
 
G-Bhai is an extraordinary genius, and all that he lacks in the matter of manners, culture, and grooming oneself to a neat and clean appearance is compensated for by his superb analytical abilities and internet access. He was so engrossed in Google all the time, that he was nicknamed G-Bhai by his family.
 
A few weeks ago, he went to his boss, who owned one of the biggest profitmaking multinationals upon earth. The boss was absorbed in his divine meditation about new tricks to lay off more IT personnel in pursuit of that greatest human achievement in today’s world: moolah. G-Bhai, who believed in complete equality, sat cross legged in front of his boss, and scratching his beard, told his boss where all the boss and the company could improve. © Dr. Rajas Deshpande
The boss, amused by free entertainment, asked G-Bhai where he learnt it all.
“Internet” said G-Bhai, and showed some Googled statistics to his boss.
“Thank you, you are fired with immediate effect” said the boss
.
G-Bhai wasn’t affected at all. With his oversized grey T shirt, jeans, slippers and laptop that connected him to all the internet data, he was still the king.
 
He thought of adventure, and went to the Indo-Pak border. The firing and shelling was full-on. He met an Indian soldier who asked him to hide in his shelter. The soldier, who had spent all his life upon the border, was prepared to even die for this citizen, so gave away his helmet to G-Bhai.
G-Bhai was intensely searching the internet, wearing the soldier’s helmet.
“Don’t fire the gun like that” told G-Bhai to the soldier. “This website says the right way to fire is with the gun aimed at oneself”. The soldier ignored him and continued to defend the border. Just as he held a hand grenade to be thrown, G-Bhai held his hand. “Let me search first if you are doing it correctly” he said. The soldier, now in defense of his own life risked, slapped G-Bhai tight and asked him not to interfere. © Dr. Rajas Deshpande
 
G-Bhai proceeded to write a very critical review of that soldier, saying that in his opinion, all the soldiers were doing it all wrong.
 
Then he went to the court and tried to teach the lawyers how to argue, and the Judges how to analyse cases and deliver judgments. He showed them multiple websites from which they could learn law. “We are all equals, why are you sitting so high?” he asked the judges and tried to sit on the Judge’s chair.
After six months in jail, upon his release, G-Bhai went to the police commissioner to teach her how to deal with crime and criminals, based upon internet searches from different countries. He came out limping, and refused to tell anyone why. © Dr. Rajas Deshpande
 
Due to excess stress, his health worsened. He went to the best of the doctors. He demanded that he wanted a complete check up to reach the most correct diagnosis. He was advised tests. He researched the internet and did only the tests he thought were necessary, because he thought all doctors were corrupt. He reached a very reputed doctor with the test results. The 70 year old doctor examined him, checked the reports and told him: “You are a failure in your own life, you have excess stress, and are unable to handle it. You are jealous of everyone who is doing well, and therefore you have developed a complex that everyone who does well is either corrupt or wrong. Go home, exercise, find your own life and deal with yourself” When he tried to show the experienced doctor what internet said, the doctor smiled and asked “Did you also net-teach your parents how to make you?”. © Dr. Rajas Deshpande
 
G-Bhai then went to many doctors in many pathies. Then he researched and tried many home remedies. But his health kept on worsening. He was very upset and started a blog of criticizing that all the doctors. Here, for the first time in life, he discovered success: he was an instant hit, because there was a huge population who agreed with his views. There are more buyers for poison than for wisdom in this world.
 
But unfortunately by then, his kidneys failed due to experimentation with various medicines and various pathies. Now he is undergoing dialysis and posts his anti-doctor articles from the dialysis ward. The old doctor recently visited him with his flock of medical students, and spoke with empathy to the bitter G-bhai, who tried to show the old doctor some more internet references about his treatment.
 
The old doctor then told his students: “This is what I would call a suicidal intellect”.
© 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 Music Called Life

The Music Called Life
© Dr. Rajas Deshpande

“What prize do you want”? My father asked me after I finished my tenth standard exams well.

I was desperately awaiting that question, knowing him well.

“A Sony Walkman” I replied almost instantly. I got one, the most basic Sony model, and lost myself for weeks in the stereophonic effects, collecting songs and recordings that had best quality. Right from the scratchy sound at the beginning, made by the record player needle-tip on the record disc, to the realization of different soundtracks on right and left, with separate sounds of each instrument. One favorite hobby was to select and follow only one instrument from the whole orchestra throughout the song.

Besides the music of MJ, Madonna, Beatles, the Indian stereo effect songs were a pleasure too. Ye bambai shehar haadson ka shehar hai (Kalyanji Anandji) and Pag Ghungroo Baandh, Thodi si jo pee lee hai (Bappi Lahiri) had the best stereo effects from the headphone. Kishore Kumar, Lataji, Lionel Richie, Cliff Richard, and Bee Gees became addictions. The collection grew enormously.

A cousin returning from the USA bought himself a Bose audio system, I was 18 then. I remember arranging the exact angles of the speakers, all directed towards one single chair at the center of the room, then taking turns to listen to “How Soon Is Now” (The Smiths). The strong wish that I must own the best music system for myself, make a music room in my home dawned that day, and is still thriving within me.

Much later, on a birthday, returning after ward work, I found a huge parcel at my hostel door, and the watchman told me that a fan had left it there. I had told some friends how I loved “Experiencing music”. Opening the box, I found the most advanced 8 speaker Panasonic music system, the home theatre one. That was one of the best gifts I ever received. The effectiveness of listening to music as a treatment for one’s negative moods is beyond question. I feel that good singers , those healers of soul, are better doctors than many medical degree holders,as their love songs and happy songs cure many a sad minds. © Dr. Rajas Deshpande

Recently when I listened to great music all the night with a very precious friend, a beautiful soul who understands that each instrument and even the voice of the singer has a different expression, other than the lyrics, who can feel music imprinted upon blood just as I do, I realized what I was missing in life. With this friend, the hear beats of life have become stereophonically audible again to me!

Technology has started drowning music into sounds, taking out meaning to be replaced by sound effects, we have almost lost the appreciation of the intricate fineries of meaningful music. The true feeling of listening to music is much like being underwater, if at all to compare: unless you drown yourself in it, you don’t feel it right!

Talking to patients, students, colleagues, this thought grew into a major revelation: we are losing our fineries not only about music, but also about feeling out other people: near and dear ones as much as strangers, both can have so much more meaning than the “bodies and words” that men and women have become now! There’s so much beauty in almost every human being who dares to preserve individuality without either copying anything or looking down upon anyone else.

An alert, feeling, self-aware mind that dwells upon the here and now is the best song nature has ever sung to me: and also the highest state a human mind can achieve. Unfortunately, we are lost in the digital-technology jungle, and take pride in either losing ourselves, escaping or running away from ourselves, or searching ourselves outside our own conscious reality. © Dr. Rajas Deshpande

I have decided for now: that I want to live this music experience without compromising: I want to to feel every bit and piece of the music that life brings to me, through songs and their lyrics, through the rains and the sun, through eyes, touch and silence, and above all, the resonance that it generates within me.

Only Love can match the beauty of good Music.

For the music called life is never sad, and I want to always walk towards a happy inner peace.

© Dr. Rajas Deshpande

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
 
 

Gods of Humanity

Gods of Humanity

© Dr. Rajas Deshpande

About four years ago, this brilliant young man entered my chamber. He introduced himself as

Dr. Amod Kale, veterinary practitioner, and said:

“I have a different favour to ask. I have a dog patient with a neurological problem, and am not able to find any references. Will you help me treat this dog? I am not charging anything to the owner. I am doing this as my own hobby” He showed me some videos.

The doggy had some jerky abnormal movements of both hind legs. Some human medicines helped the doggy, and I became friends with Dr. Amod.

Since then, he came with many more cases: rabbit, parrot, cats and dogs who had neurological problems. These animals were either abandoned or orphaned. Dr. Amod not only helped them find a home, but went out of his way to solve their medical problems, mostly spending his own money for everything.

This time he came with a new friend, Mr. Tushar Kale. On 9th March, Mr. Tushar was riding his bike near his home, when he witnessed that another bike ran over a stray dog. The biker who had hit the dog ran away, as the dog lay there in the middle of the road, unable to move.

Mr. Tushar Kale lifted up the injured dog and took him to a government veterinary hospital. As they could not offer much help, he brought the dog home and contacted Dr. Amod Kale. Dr. Amod examined the dog, started with basic treatment, and recorded some videos to show me as he thought that the dog’s spine was broken.

The spinal cord appeared to be severely damaged, there was no movement in the dog’s hind legs. The dog was never going to be able to walk normally again, although some effort could be made for improvement, it would take months. I told the duo so.

Mr. Tushar replied: “My mother said she will take care of this dog, whatever happens, because we cannot abandon the dog in such a condition”.

We started some medicines and supplements.

Mr. Tushar’s mother, Mrs. Mangal Kale, although not educated beyond primary school, has a heart of gold, so rare in today’s world. She has taken such excellent care, that the doggy has shown remarkable improvement now, in spite of some complications like a bedsore, which also is healing now.

In a world where many choose to abandon even their parents, where highly educated brothers and sisters fight for properties but not for taking care of parents, this example of a doctor and a middleclass family caring for a stray dog is so reassuring! An example that Gods of humanity still exist and thrive right in this desert of deteriorating civilisation, mothers like this is what the Earth needs most desperately right now!

Thank you, Dr. Amod Kale, Mr. Tushar Kale and Mrs. Magala Kale, for carrying forward the one tradition that differentiates humans from animals: Humanity.

© Dr. Rajas Deshpande

“Do you want a broken leg, Doctor?”

“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

The Lawful Massacres

The Lawful Massacres
© Dr. Rajas Deshpande

“Doctor, my brother has kidney failure, he is awaiting a kidney transplant. but the waiting list is too long, he has very less time and his health is fluctuating. We cannot afford to treat him out of India. We can pay some money if any donor is ready to donate a kidney. Please save his life, doctor, I will be your slave all my life.. What can we do?” the elder brother was begging and crying at the same time. His 28 years old highly educated younger brother is his only blood relation alive. The elder brother himself has renal compromise at an early stage.

“I am sorry. Indian Law does not allow us any other options”. I felt ashamed of what was happening. I wanted to add “Unless you are in power, unless you are stinking rich and have heavy pulls through many corridors, unless our society so eloquent about criticizing doctor’s intentions learns to come forward to donate organs, you are doomed to a long wait for any transplant”.
In fact, you are more likely to be the one among the three that die every day in India while awaiting an organ transplant. That is over a thousand human deaths every year. More like a massacre.

Because the law is always correct, it saves money, it saves against corruption, and it saves against a few wrong practices. This sacrifice of a thousand lives a year is just a small price to pay!

We are so very much against the word ‘corruption’ and the projected legal correctness of any system, that like the blinded goddess of justice, we refuse to see beyond what is the literal meaning of the law. Whether it is correct, whether it is causing more harm than benefit, and whether it discriminates (usually the rich and the powerful from poor) is something we are not allowed to think. Nor the judiciary probably. © Dr. Rajas Deshpande

Whether it is the action against some great kidney transplant surgeons that made them quit the profession and stop all transplant work, whether it is the “Kidney Racket” headlines on TV channels or in newspapers, the medical profession is already presumed guilty, and everyone seems to derive a pervert pleasure from doctor bashing, some even from within the profession. Yes there are unsuccessful, fame seeking doctors who are jealous of doctors who earn more and have a good name in their field, and most bitter losers like to point out only the bad side of the monumental achievements of such successful doctors: that the transplant teams in India have saved millions of lives of the rich and poor alike by developing transplant surgeries and performing them in a resourceless, supportless, poor country ridden with corruption is a deliberately hidden fact.

There of course are corrupt doctors as in every other profession, but one cannot blindly close all hotels because some didn’t serve good food!

Most of our society looks upon any medical money transaction over three hundred rupees (for anything) as corruption. In a country teeming with people who prefer to eat and drink an unhealthy excess and die early (while many die of malnutrition), for a country where there have to be laws for wearing a helmet, many take it upon themselves to criticise other professions without thinking.

We need many lacs of organ donors for the many dying patients awaiting transplants. We see extremely few organ donors. The only interpretation: “I don’t want to donate organs, I don’t want to help save lives, I will only criticise those who are trying to save lives by closely watching where they cross the law line, and then bash, arrest, defame, try and punish them. © Dr. Rajas Deshpande

The government must seriously reconsider the laws about organ transplant. There must be a freedom to at least donate a kidney for someone one knows, and if the recipient wants to compensate for it, it must be allowed. This can all be documented and supervised by a legal team so as to avoid forceful / illegal sale of human organs. One can also consider the possibility of a rich recipient compulsorily paying for a poor recipients’ transplant surgery, if he / she is allowed to legally ‘buy’ a kidney. That way two lives will be saved. If I sound Utopian, so was everyone who thought that the world deserves to be a better place.

The legal correctness of each transplant should be mandatorily okayed by a judge, and if something is legally wrong, it is that judge who should face the consequences. This is because doctors/ other transplant professionals cannot always interpret all laws correctly, and innocent mistakes are then blown up / misinterpreted as deliberate attempts to kill patients. © Dr. Rajas Deshpande

While the rich and powerful get their kidneys and livers fast and safe in and out of India through the similar rackets that have thrown innocent doctors into jails, it is the poor who are left to die awaiting a transplant: because the government set ups have limited facilities and resources, and the private set ups have to do it at a higher cost to safeguard innovation, technology, investment and skilled personnel. But the only highlighted aspect is the money earned by the hospital or the doctor, not the immense effort and saving of hundreds of lives. Ask hundreds of poor patients whom the transplant teams have saved, whether their doctors worked for money.

Those who choose to differ with this opinion are welcome, provided they answer this question: If your brother, son, daughter or you yourself are awaiting an organ transplant under the approaching shadow of death at a young age (God Forbid), will you choose to be legally correct and prefer to die or explore all options including illegal to survive?

As a doctor, it is very difficult to say “As per law, you must wait even if you die”.

© Dr. Rajas Deshpande

PS: These are the sincere feelings of a doctor’s soul tortured by the plight of those awaiting death thanks to the legal tangles and social apathy about organ donation. I do not support any illegal practices, but I do not also presume that all laws are perfectly correct. There is a lot of scope for improvement, and each waiting day costs us three preventable deaths. Jai Hind.

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Goodbye, Doctor

Goodbye, Doctor
© Dr. Rajas Deshpande

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dedicated to those who understood this post.

Hans Zimmer’s Discombobulate music video:

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

Stop This Anesthesia

Stop This Anesthesia
© Dr. Rajas Deshpande

“Why so Doctor? Why cannot my child be like others?” asked the angry mother.

Just as I started to reply her, the patient: a 23 year old boy, went into a flurry of jerks. His body stiffened up, his eyes rolled up, and his face turned blue. He was already on the examination bed. Me and my student tried to support him there. We activated the code blue, just in case.
But the fit stopped. The boy came to, gradually. The nurse cleaned the bloody froth from his mouth. Heart rate and BP were normal now. Patient remained confused.

The mother, silently sobbing while patting his head, showed me the many large scars upon his face, head, and elsewhere. “He falls down many times every day and often injures himself. Can you imagine, doctor, what a mother’s heart feels to see her child bleeding every day?” © Dr. Rajas Deshpande
It was a case of hypoxic brain damage. The child was born in a village, the labour was prolonged and they could not reach a bigger hospital in time. If they had facilities, the child would have been normal today. Since birth, the child had had mild mental retardation and convulsions resistant to many medicines, They refused a surgery. I tried to counsel them. In many cases, we can control fits with a good combination of different medicines. But that takes time over a few months.

“We are farmers, doctor. We cannot stay home all day, we need to work to earn. The medicines are all so costly. I can sell everything to treat my son. But please tell me this will stop” the father’s voice was quivering.
It is easy to expect a doctor to detach himself emotionally from the patient, but then it is also like denying the patient empathy and understanding so crucial to their wellbeing.
“I will try my best, and I feel we can control the fits with medicines. Also, I can arrange for free medicines for your son whenever you cannot buy them. Never worry about my fees, I will be happy to treat him free. But make sure that his doses are never missed.” My teachers spoke through me.

“What after my death? Who will care for him? Who will bring him medicines? Who will ensure he takes them?” said the hefty man, and broke down. The proud feel it most difficult to declare their agonies. He tried to hide his face. The father and the mother sobbed on either side of the patient, who wasn’t yet alert enough to grasp it. © Dr. Rajas Deshpande
“There are some help communities and groups for epilepsy patients. We will enroll him into one. They will arrange for his medicines. I will also introduce you to some pharma companies who will give him free medicines as required”.
Then, pausing to realize the unasked question, I replied “And after me too, my students, colleagues or most doctors I know will never decline to treat him free. You just have to show them this note” .
I made a small note of such a request. I have never known any of my students or colleagues refuse to see a deserving patient free.

The tension in the room was melting. The parents had stopped sobbing. A possibility of hope and reassurance destroys the worst of darkness. The father folded his hands in gratitude, but couldn’t speak. The patient had a glass of water and they left.
But my mind was on fire again. Who’s guilty here?
Shall we blame fate for the blatant failures of a system? © Dr. Rajas Deshpande

Why didn’t their village have facilities to ensure good delivery? Why wasn’t it possible for them to reach bigger hospital in time? Who is responsible for millions of children who develop lifelong preventable illnesses just because of a cruel lack of healthcare infrastructure? Patients with heart attacks and strokes and cancers die everywhere everyday, unable to afford treatment or to reach hospitals in time.

In a country that needs serious improvement in almost every area of healthcare infrastructure, the whole focus is being directed at the repeated exams for doctor’s requalification.
Do we need it at all in a country that is grappling with critical shortage of doctors, and where we are promoting every other pathy to allopathy with a six month training? We need many care homes, support systems for patients who cannot afford medicines. Many more ambulances. Many more hospitals in remote areas, Many more qualified doctors to work there while being able to afford a dignified life.

But the only decisions being made are about more exams for truly qualified doctors: why? This tranquilizer to divert attention from the main issues that need correction is the worst treatment possible for Indian Healthcare. © Dr. Rajas Deshpande

Doctors are never defined by the examinations that they pass, being a doctor is far more than passing qualifying examinations. But who will educate those who never bothered to pass any dignified exams?

Just before inducing the anesthesia, the patient is told “You will feel sleepy now. Everything is ok. Take a deep breath”. With complete faith, the patient goes unconscious. It is the doctors who ensure he / she returns safe. Some rare unfortunate patients never know that they will never wake up, because there are things a doctor cannot control.

That unfortunate patient is just like the Indian Society today.
How qualified are the healthcare policy decision makers?
© Dr. Rajas Deshpande

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