Tag Archives: stroke

The Sacred Duty of A Man

sacred

The Sacred Duty of A Man

© Dr. Rajas Deshpande

One night after the ward rounds, just as I left the hospital, I received an urgent call. The patient, a lady in her late 50s, had become comatose. She was admitted three days ago under a colleague for bleeding in the left side of her brain, that had caused right sided paralysis. She was drowsy since admission, but that day she had some vomitings and then became deeply unconscious.

She was already in the ICU. The most common reasons for drowsiness in admitted population above 50 years of age is either medicines or low sodium levels. Her sodium was very low, we started the treatment.

Her elderly husband walked up to me as I came out of the ICU. Extremely worried, but still maintaining his calm, he asked me “Will my wife be okay?”

I explained him the situation, and reassured him that though there was no threat to her life then, the recovery from paralysis was unpredictable.

“That is okay doctor, but she must survive. We don’t have any children, she has looked after me all her life. I will do anything for her” he said with a heavy voice.

They came from a village 5 hours away from Pune. Mr. Arvind Gandhi was a retired pharmacist, surviving on his savings, with his wife Mrs. Aparna, till this calamity hit them.

That was four years ago.

Since then, he became her complete attendant and caretaker. He took care of her in that bedridden state for over a year, cleaning her and feeding her many times every day. He took her regularly every day for physiotherapy, and brought her for consultation to Pune as frequently as required. He learnt taking care of home, cooking, housekeeping etc., and never shied from the medical expenses although his sources were limited. Thanks to his extreme dedication to her care and extraordinary will power, Mrs Aparna Gandhi has now recovered enough to independently carry out her daily routine, and also helps her husband in cooking and other tasks.

“When I saw my wife in that condition, I was heartbroken. Then I thought, it is my duty as a man to fight for and take care of the woman I married. I changed overnight and decided to win this situation rather than giving up or asking for help”. Mr. Arvind said today when they followed up.

“Looking at his dedication and love for me, and his effort to make me recover, I developed a willpower too, and decided to recover and take care of him again” his wife replied with a smile.

As doctors we commonly see that many men treat their wife and her health problems as ‘not so important” issues. Many in fact drop their wife to her parents’, to be treated and sent back after the ‘repair’. Many take it for granted that the lady’s parents should pay for all her medical expenses even after years of marriage. In fact, many even compel their sick wives to continue with cooking, housekeeping etc. shamelessly claiming that there is no option. There are no laws about any of these.

We also come across such rare ones like Mr. Arvind Gandhi, who fight with the fate with all they have with the simple yet golden mentality of caring for the woman who cares for them. All men are thankfully not the same, and there indeed are simple and humble men like Mr. Arvind Gandhi who set examples of what a man should be. In the growing market of meaty and arty men flaunting everything except culture and kindness, these examples are easily drowned. Hence this article.

While many pundits fight for the correct definitions of life and love, let us congratulate Mr. Arvind and Mrs. Aparna Gandhi for their extraordinary struggle, willpower and the victory.

©. Dr. Rajas Deshpande

PS:

Thank you Mr. & Mrs. Gandhi for permission to share this story.

Please share unedited.

Food, Sex, Addictions and Privacy: Seriously!

Food, Sex, Addictions and Privacy: Seriously!
© Dr. Rajas Deshpande

An old man of 82 was admitted in London ON once with stroke during his “regular” morning lovemaking with his contemporary wife. An accurate history and onset time is necessary so we can use a clot buster injection within 4 hours of onset. He qualified and eventually recovered too.

I was amazed at the calm, expressionless responses but courteous attitude with which everyone in the staff treated him there, the couple was never embarrassed by any of the staff or doctors. Upon discharge, the patient asked Dr. H, an authority in the world of stroke, with a cute wink if he could continue his “Morning routine”.

A smiling and about twenty years younger Dr. H replied he could, so long as he took the prescribed medicines, and joked with a return wink that he (Dr. H) envied the patient, making the patient smile!

A twenty two year old unmarried female student came for suspected Multiple Sclerosis once. “I smoke grass (marijuana) for recreation, doc. I also take oral contraceptives often. Does this affect my illness?”. Both her parents sat there without any change of expression, and did not interfere at all with any part of the consult. I couldn’t help remembering the contrast panic and beating up by parents in some of my Indian college mates I knew, whose only fault was stealing a cigarette from their Father’s pack! Also the whole-family-humiliation-screw meeting in which the traditional family-nerds irritatingly shine!

In India, people seldom relate correct history for the shame attached to it. I have witnessed some very embarrassing moments, when doctors (especially junior) openly, loudly ask sexual / urinary history or addiction details to the awkward patient, while their colleagues exchange blushed, meaningful and pregnant glances. This is an obvious turn-off, and whether it is sex, sphincters, alcohol or smoking, no patient likes “Open Questioning” about this without adequate privacy. Then too, people talk only if respectful dignity is offered by the doctor. One must ensure such privacy, but never miss to address this issue out of shame or embarrassment. A history of STD or HIV risk must be asked where important, with relevant but properly formed questions, without a condescending tone. Many doctors half the age of patients actually humiliate the patient in a hope to make him / her quit alcohol / tobacco / smoking. Such patients are irreversibly hurt by open humiliation, and this should best be left to professional / experienced counselors.

This is also why many patients (especially the older, less educated, depressed) who have had heart attacks, spinal cord problems, accidents, strokes etc. hesitate to ask a “Loud Doctor in Hurry” about physical relations and addictions. Some refrain from normal life out of unnecessary fear, which may contribute to their depression. If the patient feels embarrassed or awkward, it is the doctor’s job to reassure and address these issues. A pre-discharge counselling meeting is essential. Fortunately the younger and educated generations even in India are now quite open and frankly ask their doubts without feeling “unnecessarily” guilty.

Actually, every patient, rich or poor, deserves privacy for any health discussion. It is a sick scene to see patients in a queue in most govt. / municipal hospitals having to openly answer such questions in absence of proper space. Overworked and authorityless doctors are helpless here.
My internship days.
A civil surgeon (administrative post) took what we call “Babaji Rounds”: smiling, hand-waving rounds just to ‘show’ the patients that “I am the boss”, talking sweet to every patient and firing everyone among staff. Administrative rounds like these are medically useless, but some depressed patients feel good, and some good administrators correct the service deficiencies.

One thin built religious leader was admitted with acute shutdown/ failure of kidneys. No urine output. Blood pressure very high, we struggled to control it. When the CS came to his bed, the worried wife asked: “Sir, what should I give him to eat?
The CS beamed a big angelic laugh, patted on the back of patient and said aloud “Anything he wants.. icecream, fruit juices, milkshakes..”.
“Samosa?” asked the lady..
“Yes sure”, said the CS and told the patient: “Eat more if you want to get better soon”.
The patient touched his feet and said “You are like God Doctorsaab, my illness is half better just by seeing you”.

That diet would have killed that patient, had not our fuming medicine professor (after a caste based solid expletive for the CS) asked me to rush back and stop the excited wife from feeding all that to the patient!

The CS didn’t even know the condition, diagnosis, or other details. He never wrote anything on paper (Capital or Small in verbal instructions??), but could have severely damaged patient’s health, just by his careless advice under pretension of knowing what he didn’t.

Point:
Many unqualified people / quacks/ and some qualified doctors too advise via verbal instructions trivially. Patients blindly follow these instructions. Right from “Shudh Desi Ghee (Clarified Butter)” to herbals!
This is equally or far more dangerous than bad handwriting of a good doctor.

Advice about food, exercise, sex, work, posture, sleep, physiotherapy and lifestyle are all parts of the consult, equally important as the medicines. A good doctor’s routine will include this advice for every patient. Patients should also consult a specialist for their illness at least once in the initial stage, so he / she can plan out long term holistic plan and the regular general / family practitioner can follow it up.

Some patients take advantage and ask the same things repeatedly. In a busy clinic, a personalised printed advice can be given. In a crowded OPD, as in charity and govt. hospitals, a “general instructions for a disease” booklet will go a long way, or special group counselling can be advised.

Things are changing. Many newer generation doctors are making good friends with patients especially from their own age groups. Fortunately, even the youngest doctors still do not use colloquial phrases like “Aish Karo” (Enjoy to the hilt), otherwise some perfectionist patients may really follow it to the core!

Because “Chalte- Chalte” / hurried advice, however trivial, may prove dangerous.

© Dr. Rajas Deshpande

Who killed this patient?

Who killed this patient?

There were huge banners. People were happy, dancing to the most recent Bollywood item song, throwing colours and distributing sweets. Their big leaders, standing perpetually garlanded in a decorated open vehicle were smiling lovingly at people, returning “Namaskars (Salutations)”, and intermittently instructing the “key followers” about the whole process.

Behind this was a congregation of at least a thousand cars, buses, trucks and two wheelers, and also an ambulance, from the window part of which everyone could see the tense faces upon which tears rolled.

The intern doctor sitting besides the ambulance driver knew me. From six cars away, he shouted : “stroke, stable, in window period, three hours now” meaning that the patient may be given one injection if he/she could reach hospital within ninety more minutes, that can potentially reverse stroke, and save disability and / or life. “Time is Brain” in stroke, we are hammered, “Time lost is Brain Lost”.

The traffic police were too occupied with the procession to attend the ambulance. There were threats of bomb blasts, so they had to safeguard the VIPs. Some young students parked their bikes and started to rearrange traffic to make way for the ambulance, and gave up when they met the blank, expressionless stares of people who won’t move, often demeaningly reminding those students that they were not traffic police. The whole procession behind the celebration was that of stuck, delayed, cursing working class of all socio-economic levels, wishing that they hadn’t left the house today. Each one of them would have to apologise to many, listen to humiliating words from their bosses or miss some important assignment / meeting / interview / exams. Some would miss chances of a lifetime.

One of the most frustrating thing to witness as a doctor in India is this blockade of the ambulances, along with the working class and public transport due to morchas (processions/ mass protest) / VIP bundobast and celebrations ranging from election victories, marriages and various other socio-religious occasions. What is the fun in causing distress to someone else by blocking traffic? Why cannot these be banned on the roads meant for public transport? There are umpteen grounds / lawns and other venues in almost all cities where people can gather to celebrate saving the disinterested from a day’s distress.

There is no objection to celebration or cultural / social / religious occasions. But causing delays and discomfort to the public and those in an emergency is criminal. There must definitely be laws against causing blockage to traffic when granting permissions to such processions, but these laws are hardly any use once the processions are on the road. Also, why should the already scanty and overworked police force suffer the heavy duty management and stress of such private celebrations? This waste of manpower and public resources is enormous, if one can imagine that there are literally thousands of such events happening daily all over the country.

Political / social / religious celebrations and VIP bundobast have become the “Show of Might” events at the cost of public funds and discomfort. There must be designated areas for bigger congregations outside the city, avoiding rush hour jams that are torture and harassment to the working class.

Add to this the deafening (and often vulgar) music. What God in which religion would like it? How unpleasant are these scenes of drunken vulgar dancers on the streets, swinging and making gestures with the screeching music? That hard drinks are openly served on the road in soft-drink bottles is no secret, neither are the “special cars” serving these. How religious is this, and why the bigwigs and “Respected” people don’t talk about it? Why don’t the different sect heads / religious heads guide people that this is no way to appease any God, and God is found only within oneself, that too when one gives up causing any pain to anyone else?
The dirt left back, the mess, colours, the paper dishes, glasses, filth from burst crackers etc.. is the nightmare for the municipal workers the next day. The “clean city” initiative is thus raped virtually by many such processions.

In a country where hunger and lack of medical treatments kills thousands, where ‘beggars with sick kids on each road’ has become one of our identities, where farmers commit suicide because of loans and poverty, where the words “Lack Of Funds” star upon each page of explanations wherever the government needs to provide facilities, where does all this ‘affluence’ to celebrate in lacs / crores come from?

If only all the money involved in the “Victory, Bail, Jail release etc.” celebrations, socio-religious functions and decorations of various types, “Power demonstration procession” funds go towards the development of good healthcare facilities in India, we can provide excellent healthcare services to the millions who deserve them. That will definitely not anger any God, nor take away the “image” some leaders want in public eyes.

That intern doctor who worked at another hospital met me after about three days, with a black eye. “We reached late, sir. The patient had a convulsion on the way and by the time we reached he was gasping. The relatives beat up the casualty staff and even me. I feel like leaving this profession sir”.

If legally analysed, who is guilty here and must be punished? Many will use the words “System”, and say we are the society, we are the system, for that has become our new language now.

For we are scared to accept that there are two societies in India: The Carers and the Care-nots. The civilized and the powerful. The life of a common man can easily be sacrificed, and the blames can easily be pinned upon the hospitals.

This patient would have survived if he reached hospital in time. He deserved it. Who killed him?

As for the garlanded leaders who take public discomfort for granted to satisfy their ego-parades, some of them do really deserve those garlands. Plenty.

© Dr. Rajas Deshpande

PS: I have seen some rare traffic policemen going out of the way to clear way for ambulances. Rare.

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