Tag Archives: Stress

A Habit That Protected Me

A Habit That Protected Me

(c) Dr. Rajas Deshpande

“I cannot bear this. Help me doctor”shouted the Old man fom the waiting room, just as I entered the OPD. There were appointments before him, I requested others to wait, and most of them agreed, although a little upset. I called in the old man. He was accompanied by two of his sons, both probably professional bodybuilders.

He was a known case of Trigeminal Neuralgia, a condition that causes severe, shock like or stabbing, excruciating pangs of pain on one side of the face. This usually brings the patients to tears, and most patients come frustrated, unable to talk or eat, with the telltale sign of their hand covering that side of the face, scared to open mouth even to reply. He had had this condition over ten years now, and was quite stable, usually visiting me once a year. He had last visited only a few weeks ago, smiling and pain free. There were no new findings. He kept on shouting, saying that the pain was unbearable. This was unusual. I asked him if he had done any of the prohibited things that usually increase the pain of Neuralgia: cold drinks, icecream, shaving harshly, exposure to breezes etc. He said he had had an icecream a few days ago, but the pain had only restarted yesterday.

The sons were staring menacingly at me. “How come this has suddenly worsened doc? Is this the effect of your medicines?” one asked. I wondered why they don’t teach simple logic and reasoning in primary schools. Everyone going to a gym must, in my opinion, first be mandatorily taught normal human conversation. Otherwise they speak with their biceps. Not knowing that language, I chose not to reply him. (c) Dr. Rajas Deshpande

He was already on high doses of the medicines that controlled his pain. He also had diabetes, so I could not use the best emergency medicine for such pain: steroids. Once earlier, he had developed severe infection while on steroid, so that was out of question.

I started him on a short course of a strong pain killer. Warning him that he should take it only for three days. “His pain must stop immediately” said the other son, threateningly. “I wish so too. It should subside soon, usually it takes two to five days” I concluded the consultation.

They returned five days later. (c) Dr. Rajas Deshpande

“I am very good now, Doctor”said the old man, “The pain went away the very next day. Thank You”.

Just as I prepared to look at the musclebuckets proudly, the old man said “Doctor I need a certificate that you had advised me bedrest for five days”.

I was almost prepared to write, this appeared a justified request given what had transpired. Curious, I asked him: “But you have your own business. Why do you need this certificate?”

It was then that one of the biceps spoke: “He had a court appearacne in a criminal case on the next day of our visiting you. He could not go to the court. Now the court has asked for a certificate”.

Alarmed, I told them: “I had not advised him rest. I cannot issue a false certificate.” (c) Dr. Rajas Deshpande

They looked at each other. Then the old man said “I request you doctor. My cousin has filed a false murder charge against me and my sons. Please help us. Your certificate will save us trouble”he folded his hands.

Now the secret of why that pain had worsened suddenly had unfolded. This condition is indeed known to suddenly worsen, but when such “situations”coincide with illnesses, a doctor is the easiest to squeeze the arm of.

“But we paid your fees. His pain was actually severe that day. How can you deny us a certificate now?”asked the elder biceps.

Many video clips of daylight, open murders that happen around us daily ran through my mind. Even under the heading of compassion, was it right to help this patient, who was one of the accused? As a doctor, I am not to judge anyone and must purely decide based upon the medical merits of this case.

I had not advised him rest. I declined their request for the certificate. Angrily, the trio left my room, and on the way out, in the waiting room, loudly enough for other patients to listen, the old man said something derogatory about all doctors being heartless looters. Every new patient who walked in that day had a question mark of suspicion on their face, it took me extra effort to wipe that away in each case. (c) Dr. Rajas Deshpande

Whether it is addiction to pain killers or sleep medicine, whether it is false certificates or deceiving the medical insurance companies for claims, many patients abuse their doctors’ compassion and services. Some doctors fall easy prey to such tactics, some do it for money. Majority refuse to contribute. It is this majority that such “demanding”patients always cry against.

The doctors who help such people with such causes not only endanger themselves, but may in fact add disgrace to their profession, because it is these same patients who tell others how any doctor can be fooled, or bought with some money or threat.

As fate would have it, one of the sons came to visit me the very next month, for his wife. As I examined her and then wrote a prescription for her, I enquired about his father.

“Oh he is alright now. We got a certificate from one of our relative who’s a doctor” said the son, smiling shyly: “That’s why I brought my wife to you.. I know you will do only the right thing”.

I could only thank my teachers who had tattooed that habit upon me, and taught me that only good begets good. It is a habit that has protected me always.

(c) Dr. Rajas Deshpande

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The Higher Suffering

© Dr. Rajas Deshpande

Stuck in the heavy traffic due to rains, I tried to remain calm. The cellphone kept on ringing, patients who were waiting, those who wanted appointments, those who were to catch their ride out of station anxiously asked when will I reach. Some lost patience and raised voice. In addition, there were calls about the patients admitted in the hospital: critical decisions to be made, idiotic questions by insurance companies to be replied to. There were huge processions, the traffic was diverted, without any arrangements for ambulances. Impatient, aggressive and violent people is a reality on almost all Indian roads now. No one cares for law on the road. You are at the mercy of anyone who chooses to pick up a fight with you.

There were some issues at home too, the cook had called in sick, we had to do some emergency cooking. That had delayed my start.© Dr. Rajas Deshpande

At last, an hour late, I reached the OPD, and entered running. Faces with controlled anger greeted with cultured politeness. Prepared for bitter comments, I called in the first patient.

This was a free patient, she did not need a follow up. But being free, she visits almost religiously every month, whenever she has a fight with her husband. Sometimes, when the only guaranteed compassion is from a doctor, it can be misused. However, as I was late, I decided to respect their patience, and told them to visit a counselor. Nevertheless, my irritation heightened, that this added to the wait of other patients.© Dr. Rajas Deshpande

I certainly am impatient with meaningless waste of time, and sometimes the traffic, the sudden changes in schedules due to someone’s irresponsible behavior, and misuse of compassionate services bring me to the edge of a reaction. This was one such moment. My face must have become grim.

The next patient walked in, an elderly gentleman with Parkinson’s disease. He was accompanied by his wife. They were supposed to come back three months later, but had followed up early. I examined him, found him quite stable neurologically, but the usual twinkle in his eyes was absent. Even his usually smiling wife appeared lost. It must be the traffic, my late arrival or something likewise, I thought, and curbed my curiosity to ask them. Today was heavy and behind schedule, I must wind up fast. Yet, as I explained them that everything was stable and alright, that they need not worry, I noticed the unspoken uneasiness in their body language. A little reluctantly but keeping up with the expectation of my own heart, I asked them: “You look quite disturbed and stressed. Is anything the matter? I am sorry I came late today”.

“No, no doctor, it’s not that. But yes, he is stressed and disturbed said the wife, and looked inquisitively towards her husband. ”Shall I tell him?” she asked.

Looking down, hiding his face, the husband nodded.

“Doctor, we lost our only son ten only days ago. Someone killed him on the road. Some drunk goons dashed his car from behind, and when he got down to check the damage, they attacked him and hit him on the head with some rods. He was lying on the road for a long time, and by the time police took him to the hospital, he was gone. We came to know after a few hours. He was our only child, an engineering scholar who had returned to India with great dreams .”

The lady was silently weeping as she kept her emotions in control. The patient was sobbing, I called the receptionist to get a glass of water.© Dr. Rajas Deshpande

“We have done so much for our town and the society” said the patient, “but now I feel it was all useless. No one is safe even on the roads. We see so many rules and laws broken, so many violent and aggressive people that it has become difficult to question anyone even when they misbehave”.

I had no words to pacify them. What can pacify the parents of a dead child, that too a victim lawlessness?

The receptionist called “Sir, the next patient is shouting” she said.

“Five minutes” I requested her.

“You are busy, doc, we will leave. But I brought him here only because he feels better when he meets you. Once you reassure him, he will feel a little secure. Even I feel better when I see you. Otherwise we sit at home just staring at each other’s sunken souls. We have no relatives”.

That was a bitter eye opener to me. They had chosen me to be their lifeline in the worst times of their life, and here I was, thinking about my worries, my time, and the inevitable small happenings that block the path of every working person every day. I had momentarily ignored the fact that I must still enter the hospital with a smile, push behind myself all the negatives that pull me down. For every patient here to see me comes with a hundred fears and a thousand expectations, the least I can do for them is be compassionate and reassuring, whatever may have happened till that moment.© Dr. Rajas Deshpande

“You may see many patients in a day and listen to their troubles, doc, but you are the only doctor your patient meets in a long time. I don’t know about you, but we always feel good when we see you”. The wife added.

Yes, I had heard that earlier, in my teacher’s cabin. Once a patient develops trust in his / her doctor, they look upon the doctor as one of the most reliable resource for courage, compassion and troubleshooting, even beyond the expertise of that doctor. As doctors, we must never forget this, and stand up tall above all our personal problems to be the supermen and superwomen, the Messiahs, the Saviors that we are expected to be. Law and some idiots do push a stick in our wheels, but then the patient is far above both. A patient’s suffering is always far above that of any doctor.

I stood up, held the patient’s hand, and reassured them: that they do have a relative here in Pune. “According to the Pune tradition”, I said, “one should offer tea only when the guests are half out of the door, but I will make an exception today .”

Having them sit in the next empty room, I proceeded with the OPD. Ordering tea for everyone in the OPD waiting room, I stole a few more minutes to calm the ruffled souls of those two, and asked them to see me again, whenever they wished.

As I returned late after dark, even through the rainy night, a sweet moonlight made the raindrops glow. Just like every doctor brings back the smiles to the burning hearts of their patients!

© Dr. Rajas Deshpande

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

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

©️Dr. Rajas Deshpande

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

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

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

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

“You must respect the authority “ the court said.

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

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

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

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

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

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

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

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

The doctor said

“Yes Milord, but the real answers will hurt:

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

“A culture of exploitation of non-votebank groups

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

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

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

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

The shocked judge requested the doctor to examine him.

“He is no more” said the doctor.

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

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

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

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

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

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

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

(C) Dr. Rajas Deshpande

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The Changing Blood Group

The Changing Blood Group

(c) Dr. Rajas Deshpande

“He is sinking” shouted Dr. Siya.

The casualty registrar rushed to the bed, checked the vitals. Pulse very fast. Blood Pressure very low. Lips and nails white, hands and feet cold. The young man, unconscious, was on the verge of death.

“He must be bleeding inside. Get an urgent sonography of his abdomen”said the registrar to Dr. Siya, and call the blood bank. He will need at least two units of blood urgently”.

It was Dr. Siya’s first week into internship, she was thrilled with the idea of actually saving lives. At the young age of 22, she was witnessing death almost every other day. Along with that she was amazed to see the darkest sides of human nature: the potential of humans to hurt each other: via rapes, accidents, murders, fights. She had decided to not let this affect her attitude, and to continue to try and save every life she could.

That late night, this young man of about her own age was brought in unconscious by someone, who had just dropped the patient in the casualty and left without leaving any identity of himself. “I found him lying unconscious on the road. I don’t know anything else about him. I am just doing my duty, I have a train to catch”said the stranger and left. The patient was reeking of alcohol. He had a visible head injury. A quick CT scan had revealed minimal bleeding due to a small skull fracture. He also had had bleeding from wounds from his hands and legs, they were sutured. The patient had no identity marks, wallet or cellphone. The policy of the hospital was to provide basic treatment and shift the patient to the government hospital. The police station was already informed. Treatment was started.

Dr. Siya requested two units of blood. The blood bank called. They had only one unit of the blood for his blood group. The registrar had the same blood group, and like many doctors working in the emergency departments, he went down to donate blood.

It was nearly midnight. The fate of the life of a young man depended upon what the junior doctor did just then. There was no one to sign any consents, the protocol was to inform the hospital’s medical director and obtain consent for emergency transfusion or procedure. Dr. Siya finished the formalities, obtained the permission, and started the transfusion. If the patient had reacted or something went wrong now, they all feared, there will be a havoc in the media: that they had let an unknown patient die because they wanted money!

Dr. Siya kept on managing the show. The angry and disturbed relatives of other critical patients kept on taunting her, speaking rude and reluctant to complete simple formalities and paperwork.

The sonography was thankfully normal.

Just as the first unit of blood was over, the patient became conscious, and revealed his name. He was quite shaken with the surrounding, but told in broken sentences about his friend’s number and address. He revealed that while returning from a party, his bike was interrupted by a bunch of goons, he had fallen down, they hit him upon the head and left with all this belongings.

The friend was called, and came in. He revealed that the patient was used to smoking weed and drinking alcohol in huge quantities. They were staying in the hostel of a famous college.

The second blood unit was started, and in a short while the patient threw a convulsion. He was immediately given injectables for controlling the convulsions, he slept off with the effect.

His parents arrived early next morning.. The shocked mother was consoled and explained about the situation by Dr. Siya. The elderly father, like all fathers, equally shocked but being a father unable to cry, kept mum, just holding hands of the boy.

When the patient woke up again, the father came to Dr. Siya, and touched her feet. Too embarrased, she told him that the registrar had donated blood for the patient. The father went and thanked the registrar, again trying to touch his feet.

As Dr. Siya had finished her night duty, she prepared to leave. “Beta, Will you come soon please?”asked the tearful mother to her. “Yes Auntie, I will be back soon. Don’t worry, he is ok now”she reassured and left.

On her way back her genius young mind tried to look at the situation sitting upon her shoulder, the little third person that resides within each one who has a conscience. That booze and weed was easily available to youngsters in almost all Indian hostels, that even educated people rode bikes without helmet, that crimes were happening almost everywhere that injured and killed people, that law and order was a laughable term in many parts ofthe country, that there was no government mechanism in place to provide emergency medical / paramedic support ambulances to raod / traffic accident victims: which one is the most responsible cause, when patients like these died? Who is responsible?

She reached home, told her proud parents what had happened, that she had helped save a life. Her mother folded her hands towards the sky, said “God, let my daughter save many lives everday”.

While having the breakfast, her father turned on the TV. A famous but ill educated political leader, in his mind-and-other- organs blowing speech in Karnataka, was explaining the illiterate public how all Indian doctors charged in excess, how they were only after money, how everyone except himself was the enemy of the millions of patients surviving from critical heart attacks, accidents, strokes and other diseases. All patients getting better all over te country was only thanks to himself and his government!

Dr. Siya’s father laughed bitterly. “Next time you need blood for any poor or unknown patient, call him” he said.

Dr. Siya replied, laughing “That kind of ëver changing blood group doesn’t match anyone, it is useless for any patient, Papa”.

(c) Dr. Rajas Deshpande

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“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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The Angry Husband Pandemic

The Angry Husband Pandemic

© Dr. Rajas Deshpande

“She can’t tell properly. I will tell” said the husband when I asked the patient what were her complaints. Right from the name, it was him who had answered all the questions for her.

“Does she have a speech problem?” I asked him.

“No” he replied, then the wife started telling her complaints.

The list was typical of stress related complaints: chronic aches and pains, sleep problems, lack of interest, tiredness, giddiness: a picture also frighteningly common among the youth today.

“What do you think is the main reason for your stress?” I asked, after I found that her examination was normal. The husband offered to wait outside, and she said yes.

Once he was out, the lady regained her composure, took in a deep breath, and folded her hands. “Doc, please don’t tell all this to him. I am terrified. My husband is a very angry person, and reacts very aggressively to small mistakes or whatever is against his wish. He was not this angry earlier, but he is under a lot of work pressure himself, so whenever he comes home, I think I have to accept this anger because he has no other place to vent his feelings. Even when he calls, he snaps at the smallest of things, scolds and insults me. On weekends he wants to be left alone and if at all I try to interact he has outbursts of anger. Earlier I thought that this was the beginning phase of his career, so I tolerated. But now my whole life revolves around this fear of his reactions. He treats other women very formally and mannerfully, but treats me like dirt”. © Dr. Rajas Deshpande

She wasn’t alone. The phenomenon of wife being intimidated by anger of her husband is one of the most common relationship statuses in India. Even when 70 or 80 year old couples visit, the wife usually requests the doctor to advise her life partner of over 50 years to control his anger. Superiority and validity of anger of a man over a woman is so commonly accepted in India, that if some husband treats his wife equal, questions are raised as to his being “man-enough”. Paradox: I know of a wife who told her husband in their terminal fight before divorce: “May be you didn’t know how to handle a woman. Maybe you should have slapped and kicked me and treated me like my father treated my mom. They never had fights, because he knew how to shut her up”.

The implications of applying the Global western culture to an orthodox society are many, and mostly disastrous where human relationships are concerned. While some women proudly boast about the anger and domination of their husbands, and how ‘secure’ they feel about this ‘manliness’ that controls them, only a few realise how far away from true gender equality we all are. Growing up with “Princesses and Damsels in Distress” being rescued by “Knights In Shining Armours”, we have probably conditioned our minds too much to notice whether the Knight treated the Princess well in the “Happily Ever After”.

Let us not even talk about the “he-works-and-earns-so-naturally-tired-and-angry” type, or the “Highly-praises-his-wife-in-public-but-treats-her-like-dirt-at-home” type. The blind acceptance of what earlier generations considered normalcy and words in lieu of actions are both crimes we are all equally guilty of. © Dr. Rajas Deshpande

Implications of this angry husband? A woman who spends her life never growing up being herself, stays a slave to his whimsical outbursts of love playing a hide-and seek with humiliation and anger. Some do this while working and raising children, while some others do it sacrificing the high education and training they have taken, in the name of making a family.

Making a family also means happiness and freedom of thought, speech and action for a woman, responsibility sharing and respect towards the feelings of each other, but this is yet to dawn in many societies, where the bread winner automatically becomes the master and the remaining family members his slave. © Dr. Rajas Deshpande

To be just, one must also mention that there indeed are women counterparts of this phenomenon, where the anger outbursts of a woman hold the entire family for an emotional ransom, where the husband and kids never can feel ‘at home’ in the one where she dwells. But fortunately this is rare.

There also are rare pleasures of meeting some brilliant couples who have mannerful and respectful attitude towards each other (not a show). They hold hands, stay together, and laugh genuinely, whether in public or at home. Those are the definitions of love. An occasional tiff may be unavoidable, but there’s rarely anything that cannot be resolved when the two in a relationship know the correct balance between words and silence. © Dr. Rajas Deshpande

Sometimes some diplomatic men boast with too many chests about their success and achievements, while mentioning in their speeches how their wife was their strength and how she is an ‘equal partner’ in their success, how they could succeed because ‘she looked after the family and kids’, just looking at the wife’s face tells volumes about the reality. My stupid mind is sometimes tempted to ask “Did she choose that or was her duty taken for granted?”.

As I counselled the couple, I realised that so many times we cannot fight deep rooted socio-cultural notions of gender inequality. In the age of rabid egos where there are more break ups than patch ups, where we know more words than feelings, where winning verbal argument is considered a superior ability to healing actions, it is becoming perpetually difficult to imagine that marital relationships will evolve any further unless immediate steps are taken to educate children right from school about the correct interpretation of gender equality and the incorrectness of what is being accepted as normalcy: “Anger Outbursts” under the pretext of being stressed or busy.

For anger or the presumption that it is justified against one’s life partner as a ‘soul venting’ mechanism are both unhealthy for everyone involved: a disease that has now become a pandemic.

© Dr. Rajas Deshpande

Please share unedited if you believe in true gender equality.

The Braveheart Orthopaedic Surgeon

The Braveheart Orthopaedic Surgeon
© Dr. Rajas Deshpande

dp-final

The stunned auditorium was hijacked by shame. Nearly a thousand paralysed audience helplessly watched the ongoing horrific drama.

It was the annual day function, the only colourful evening in the year that the whole staff, the Dean, all teachers, resident doctors and students from all batches come together in the medical college. Extraordinary talents that the doctors otherwise have to sacrifice for lack of time: Singing, Acting, Music etc. resurface this one night. I was still in my first year.

Midway through, one resident doctor climbed upon the stage. He was a strong leader, a good student when sober, and had a strong political support, hence usually had his way around everyone. He was excessively drunk. He took charge of the microphone. Few of his friends, some also drunk, were guarding the doors.

“Our Dean is a drunkard. He is also corrupt, he takes bribe from everyone for everything. He is having an affair with this professor of XYZ department. I order the dean to come here on the stage and apologise after I slap him”.

This was beyond anyone’s imagination. One of the teachers requested the drunken offender to please come off stage, but received a flurry of obscene abuses. There was a silence that prayed for relief from this situation.

Dr. Devendrasingh Paliwal got up from the audience.
“Chal, bahot ho gaya drama. Main aa raha hun. Karle kya karega. This is not the place for your allegations. Get down”. Devendra was always known for his physical fitness, and had an intimidating personality. Straightforward and kind, he had almost no enemies.

He went to the stage, grabbed the mic from the offending drunk, handed it over to the MC, and brought down the drunken resident. Within a moment some others joined him to avoid the impending scuffle. The dean and many teachers felt the relief of a lifetime.

Those who anticipated fun at the cost of misery to others were of course disappointed, but at the beginning of my medical career I learnt one of the most valuable lessons of my life: It takes one man to be courageous, not a herd. If you have guts to get up and protest the wrong, there is a fair chance you will succeed. A good man’s fear is the bad man’s strength.

That night at 2 AM, after the programme I went with my friends to the hotel near the railway station for tea. Too much excitement prevailed. Devendra was sitting with his friends at a nearby table. I went to him and introduced myself. He smiled as if nothing special had happened, shook hands and told me “Kisike baap se bhi kabhi nahi darne ka (never ever be scared of anyone).”

We became good friends, we also shared a common mess. Studying at night and going to the railway station (6 kilometres away) for a tea break at 3 AM was also common, and Devendra often asked others to race him to run back those 6 kms after the tea. I can proudly say that I reached second, although a good two minutes after him!

He became an orthopaedic surgeon and started his own hospital, but his ‘Gene’ of fighting injustice and standing up for the good never left him. Stress and anger can be a big hindrance for a doctor, especially a surgeon, so he decided to drown his ‘stress-anger’ into exercise. Always a fitness icon himself, even today he does two hours of cycling and an hour of gymming. “It helps me concentrate better during my practice and surgery, and also keeps me totally fit” he says.

Few years ago, a doctor was arrested in a typical example of a hyperreactive populist system. This was illegal, but many a times the system gets away with the illegal more fluently than the citizen. Dr. Devendrasingh Paliwal was the president of the local IMA (Indian Medical Association) chapter. He took the system, police and politicos “Head On” as was his nature always. The city’s hospitals shut down. This enraged the politicos but encouraged the medical fraternity to unite like never before, and the doctor, wrongfully in police custody for 8 days, was released!

Dr. Devendra then worked to straighten out the relations with the system, and formulated a “Modus Operandi” involving the police and local politicians to protect the interests of both patients and doctors so that goons and petty politicos do not blackmail either. If only all the IMA chapters follow this lead (and I must also mention the excellent IMA unity and extraordinary leadership in Goa: Dr. Sam Arawattigi, and Kalyan: Dr. Prashant Patil), half the irregularities and injustice against doctors and patients will disappear.

“I have always kept friendship, professional courtesies and Humanity above my medical practice” Devendra says, “I take it for granted that it is my duty to treat free those who cannot pay”.

It is pathetic today to see many brilliant doctors working in perpetual fear under those who exploit them, by choice or in desperation, accepting humiliating and patient-unfriendly working conditions.. People like Dr. Devendrasingh Paliwal are a hope our profession can look upto.

All other things may change, but the value of fitness, courage in one’s heart and a kind nature that compels one to help others are some things which will never change their place as the best three human virtues.

Medical careers are drenched with excess hard work, stress and anxiety. The one training that the doctors in making must inculcate from the beginning is that of physical and mental fitness. Doctors leading a stressful life and always having to present a ‘pleasant face’ to the patients and colleagues, either suffer their negativity alone or pour it out upon their family. Daily physical exercise is an excellent remedy of many frustrations that accompany medical practice. Dr. Devendrasingh Paliwal not only sets an example by doing this, he goes way beyond his duties to bail out others from difficult situations: medical, surgical and social.

I consider myself fortunate that I met this fearless braveheart fitness icon who infused the right “mantras” of courage and fitness into me at the beginning of my medical career!
Much obliged, Dr. Devendrasingh Paliwal!
© Dr. Rajas Deshpande

The Morphine That Killed a Hospital

© Dr. Rajas Deshpande

“He fell down while checking the patient”, said the panicked Dr. Mrs. Sane about her husband, “and became unconscious”.

Dr. Sane tried to maintain his calm. A sick doctor has the curse of knowing the worst of everything, and has a perpetual feeling of sitting upon a ticking time-bomb. It was a sad feeling to see this middle aged brilliant general practitioner fighting tears.

“Sir, the OPD numbers have shot up because of these epidemics, especially dengue. I see over a hundred patients every day. The Inpatient beds are full. There are daily problems: medical, administrative and medico-legal.. those I am used to. But now there are too many politico-social and press-related issues that worry me”.

Dr. Deshmukh, a senior practitioner and a common friend, accompanied Dr. Sane. He cautiously poked him “You must tell the doctor what happened the day before”.
“Oh that’s a part of our profession” Dr. Sane replied.
I insisted that he must tell me.

Reluctantly, he disclosed: “Some goons came in with a municipal councillor and threatened to waive off the bills of a dengue patient. He was in the ICU for five days, quite bad, but went home walking. Till the time he improved, they kept on threatening us to break the hospital and thrash us if something went wrong. Upon discharge, they didn’t pay a single rupee. There’s nowhere to complain, as the hospital requires many municipal permissions”. © Dr. Rajas Deshpande

Dr. Mrs Sane lost her cool. She started sobbing. “No one blames those who dump garbage, keep their surroundings unclean. No one is blamed when epidemics spread and thousands die. No one is held responsible for failures of almost all preventive services and lack of basic facilities at government’s healthcare institutes. But the already overworked general practitioners must bear the brunt of everyone’s anger: the public and press are always free to bash the last face they see: the doctor who is actually helping every patient,.. Dr. Sane has not had a proper lunch, not spent a full day with kids in months.. That hospital has become our curse“ She broke down.

It was so logical! The offices responsible cannot even be reached. The court does not see any of these system failures that cause millions of deaths all across India, happily ordering lakhs and crores and imprisonments for doctors, for trivial mistakes.
Whom to blame? Oh yes, the doctor who has studied to treat the sick!

Anyway, in a country fond of muscular heroes and billionaire godmen, who expects a brainy analysis? © Dr. Rajas Deshpande

“I had a dream of making best health facilities available for my area. I have taken a big loan. We treat poor patients free anyway. Many rich are sent by local politicians, leaders, administrators with instructions to attend immediately and free too. Paying patients are mostly suspicious because of all the negative things publicised by press about all doctors., they also expect immediate and positive outcomes. I have not slept for many a nights. “

I examined him.He had obvious features of being fatigued mentally and physically.. A syncopal attack, where the BP drops down suddenly and makes the patient unconscious, was likely. I advised him tests and told him to take rest for there days.

“Not possible, sir! Even now the OPD is waiting” he replied. An angry Dr. Mrs Sane requested me to intervene.

“Your duty to the society does not free you from the duty towards your own health and family” I requested him. But Dr. Sane agreed only when Dr. Deshmukh offered to send over a junior doctor to his hospital to take care of the OPD.

“How have you been, Sir?” I asked Dr. Deshmukh. He is one of the most respected and busiest general practitioners in town, with a big hospital. © Dr. Rajas Deshpande

Dr. Deshmukh smiled.
“I had an angioplasty three months ago. The only risk factor was high BP and stress. There is no use fighting or explaining our situation to the society, government or press. I have closed down my hospital. I only see OPD patients now. Anyway many patients thought that I worked day and night for earning more money. Let them go to the corporate or government hospitals.”

The death of his hospital was not a surprising news, many small private hospitals and nursing homes are either closing down or converting into profit-making franchises. Many doctors are suffering high BP, cardiac and neurological problems and even dying due to excessive stress.

The meaning of this nightmare will soon unfold upon our society.
Till then, this is a heartfelt appeal to all the over-stressed doctors to rethink about their priorities, rearrange life and make sure stress does not kill.

For the morphine of “medical social service” is only good in small doses, it kills when overdone!
© Dr. Rajas Deshpande

Female Foeticide versus Lifelong Socio-cultural Sadism?

 © Dr. Rajas Deshpande

Whenever female foeticide is discussed, many self-crowned intellectuals run the horses of their pseudo-western philosophy against the entire medical profession. Some irresponsible media asks opinions of the very same majority people for whom our desi government has to run billion dollar campaigns, educating them to shit in the toilet. Might as well ask them the solutions for global warming, terrorism and corruption!

What does our society do once a female child is born (again with the help of doctors)? 

Daughter, Sister, Wife and Mother: almost every female around us (except probably a girlfriend) is taken advantage of, ordered around, made to compromise, told that she must accept the limitations of being a woman, and in general made to live an enslaved and dependant life, under sweet names of love, responsibility, security and a “bad world for women out there”. Who makes this bad world?

In many cultures, the girl child is fed poorly: typically the ghee and sweets and “costlier” food goes to the male child, especially in big poor families. Even the rich and educated are seen having many daughters in a hope to have a male child, and after having one, spending far more on that male child. The girl child has little freedom to dress by choice and play, and is forced to believe from pre-adolescence that kitchen and bedroom are her workplaces for life. Many parents are averse to the idea of their girl child going to parlours or theaters and opting for friends, hobbies or even hairstyles of her choice.

Many parents do not spend upon the education of a female child, the “prime investment” goes in educating the male child even when the female child is smarter, intelligent and hard working.  A girl wanting to pursue higher studies is mentally raped by umpteen relatives who pressurise her parents into shame if she is not “married away” before 25 years of age. (RAMP syndrome: “Relatives Affected with Marriage Psychosis). The dreams of a female child are killed every moment, almost all her active life.  Most men in all fields opt that their wives “look after the kids and home” even if equally educated or better in some cases. While some recent generations encourage equality, this is only urban. A girl is trained to think and say “ I enjoy staying at home and looking after the family as this is what a woman is supposed to do. It is okay for the husband to come home tired or drunk, hit me if angry, and in general to take me perpetually for granted”.

Let a grown up girl walk on any street in India and watch our “manly” public’s eyes following her. You will understand how many of them truly respect women. Let a woman grow socially or at work, and observe the comments of her colleagues about her character. Let a woman decide to marry for love, and there are open decrees to kill her. In a country which runs local trains with one out of ten coaches for women, and reserves four out of twenty seats for ‘ladies’ in a bus, how many people really care for equality of a female foetus and it’s life? In a country where women have to be elected by reserving electorates across male-dominant cultures, who will enforce respect of a poor girl child?

In a society which wakes up to graphic contents of rapes and murders of females aged few months to upto seventy years, how many will stand up actually when a female is being raped or murdered? It is easy to shoot hate content against an educated, civil, non-violent community of doctors. It is easy to blame an entire profession for the faults of a few greedy doctors. Do these “pseudoactivists” have enough courage to stand up against their own female-enslaving culture? Do they have courage to treat their own wives, sisters and daughters at par with men in their own family/ community?

 On every street in every metropolis, hundreds of children – girls and boys- are made to beg naked, dancing, cleaning cars and ever hungry. Where are all the activists who fight for the agony of unborn female foetus? What are your plans for the already born female children begging insecure across the country on every street? Also, one wonders about their views on “male foeticide”, a common abortion. How come male child murders are forgiven? Some of these “pseudoactivists” are like typical orthodox husbands, who flirt with their female colleagues at work talking about freedom, but take an offence when their wife talks to other men.

Female foeticide is ugly, bad blot on our society. It must end. But please stop pinning the entire blame on the medical profession. The facts mentioned above are enough proof that even without the doctor being involved, our society continues to be extremely unjust and cruel to women. Introspect. The female foetuses must be saved. But after their birth they must also be nurtured, loved, respected, treated with genuine equality and given equal socio-cultural freedom. Do these activists have guts to fight for that? There should be a precondition for every “activist” of this cause to adopt at least one girl child, and look after her proper food and education giving her complete freedom.

Activism for females should not stop once they are born.

PS: The radiologists and gynaecologists / obstetricians have a lot more practice beyond and unrelated to abortions, and are far more human in caring for women than most of the society. None of the doctors starves without this “abortion business” as claimed by some activists and media. In a country where there is huge shortage of expert doctors, it is ridiculous that they have been made the easy targets for everyone’s mudslinging.  

Jai Hind.

(c) Dr. Rajas Deshpande

 

Take a Break, Doctor!

“Are you going to Switzerland, Doctor?” asked this business-class patient with a pregnant smile upon his face.
When I told him I was on leave the next week, he thought what most patients naturally think about doctors: “Every doctor gets free luxury trips to coveted destinations sponsored by pharma industry”.
I did not explain to him that my mother had a surgery planned.
Everybody needs a leave, a break, a vacation. Sometimes for problems, illnesses etc. in family. Sometimes a cut off from the routine and mundane. Sometimes to find oneself, sometimes to lose oneself. Sometimes to run away from it all, sometimes to meet life.
A doctor cannot. Wonder why?
There are scheduled follow-ups, complicated cases, people on dangerous prescriptions, admitted patients all the year round, from which one cannot detach completely. Even when on leave, a doctor in-charge who cares about patients prefers to be somehow reachable, albeit via assistant or hospital or email.

Imagine watching a beautiful sunset or being in the arms of your beloved at the dawn, and receiving calls about critical cases, complications or prescription renewals. The moment and the life in it dies instantly.

Many specialists in fact get maximum patient communication via email, whatsapp, sms or calls on Saturdays and Sundays, thinking that the doctor will be free. The doctor, catching up with the missed life among family and children gets worst irritable on the weekends. His cellphone, kept ‘ON’ for the admitted critical cases becomes a mass communication device on weekends.

When a teacher visited recently, he asked what only a parent will ask: “Do you find time for yourself?”.
When one becomes a doctor, they almost always (rare exceptions) sacrifice any other talent they may have, like singing, music, writing, sports, research etc. Seeking solace only in patient happiness (in most cases) or financial success or fame (in some), a doctor then becomes a “Medical Practice Machine” for his / her own happiness. This is the death of the non-doctor individual in a doctor.
© Dr. Rajas Deshpande
Hence the thought: Take a break, doctor.
Many students ask in curiosity to their favorite teachers: What would you have preferred to become if not a doctor / a neurologist etc. (Formula 1 Racer, Singer, Running an infant daycare, Connoisseur of love and peace, Professor of poetry, Philosopher, Vagabond, Scientist, Monk… so many things I wanted to be have stayed within, the smoke sometimes sizzles at midnight.)

In any field when you achieve excellence, it is always at the cost of many sacrifices, especially your chances and wish of doing well in other fields. But about the doctor, the concept has a caveat: that it is no more as rewarding as it was few years ago. A patient becoming a customer has hurt both ends, and this appears irreversible. Now that this is a professional activity, successful recovery is just “buying the treatment” for most. Thankfulness sinks in the bills. So even in a great recovery, good treatment, survival and cure of a patient, the doctor is “just doing his / her job, and my insurance is paying for it” is the usual attitude.
Only the few doctors who “enjoy” the process of clinical evaluation, correct diagnosis and good treatment response or surgery can find hidden solace in this process, also passing it on to newer generations. Others run frustrated from degree to degree, hospital to hospital, or patient after patient. Add conference after conference for some. For the nonclinical and paraclinical specialties, it has become a humiliating task to apply to the business oriented set-ups and keep shifting base in search of career.

Of all the professionals, doctors are the only ones who can never get “meaningful” vacations. Even the tiny time they are on leave is polluted by interference. This practice is more so in India, where individual practice culture and “salary-less” pay structures in most big hospitals precludes the possibility of “handing over the charge” to another doctor while one can enjoy a break. This is more so as one climbs higher in a specialty, as equivalent skills become rarer. A doctor on leave anywhere in the world MUST make arrangement for someone else to attend patients in his / her absence. Why only a doctor? With millions of court cases pending, why not everyone in the judiciary? Why not everyone in all departments in the police and government, where “Sahab is on leave, come back after few weeks” is the standard answer? Why doesn’t every other department dealing with public tasks work 24 / 7 as responsibly too?

And the irony of all this is that most of the society thinks it is for “earning more via illegal means” that every doctor is busy!

There are many hidden assets within every person. Doctors should not “cage” themselves in medical practice. They must learn also to “switch off” being a doctor for atleast a few weeks every year and be a “Normal Human Being” who can stop thinking of death and disease 24/7. They should breathe in the fresh air of being oneself, work upon their own good health, family’s expectations and inner desires to “catch on with life one day”.

The scariest fact: that as general life expectancy is increasing, the life expectancy, stress morbidity and mortality among medical professionals is on a decline. Starting from 12th standard where medical entrance has a “killing” competition, the highest levels of stress in a doctor’s life NEVER go down.

Sacrificing life is not worth it, Doctor. One can definitely be a better doctor with lesser stress.

Catch Up! Take a break!
© Dr. Rajas Deshpande