Tag Archives: Suicide

Victim? Dr. Reena’s story

Victim? Dr. Reena’s story

© Dr. Rajas Deshpande

“I am being victimised, Sir! I have tried to do my best, but my senior has developed some prejudice against me and has started to find faults with everything I do. I don’t know, I feel suicidal sometimes” the resident doctor Reena said, breaking down. She was into medicine, one of the toughest branches for post graduation.

This was a difficult situation. It is very well known that some seniors and teachers do take advantage of the situation to mistreat and misuse their students or subordinates. It is also well known that both men and women in every profession, including medicine, have strong gender biases and favouritism. Sycophancy is so essential in India, that I wonder sometimes whether an official bachelors / masters “Chamchagiri” (sycophancy) certificate will be necessary before people are selected for their jobs.

I gave her some instructions to ignore words and minor incidences, and concentrate on doing her official duties with concentration. I also counselled her about how to handle egoistic, arrogant seniors. She was supposed to follow up next week.

That weekend, I met a colleague of mine, Dr. Anand, in the coffee shop. There was no OPD, it being a Sunday. We sipped coffee in the canteen, telling each other funny stuff about other colleagues. Medicine provides great entertainment too, in the form of various types of doctors, and we start with ourselves usually. © Dr. Rajas Deshpande

Just then, another doctor came in, Dr. Anand invited him to join us and introduced me to him as Dr. Ashwin. “Ashwin was my junior resident” said Dr. Anand, “and one of the most brilliant students. He’s a wiz. He wanted to work for the downtrodden, so he has continued to work at the govt. hospital after his MD. Most dedicated! That’s why most girls around us liked him and we all envied him”. It is rare for Anand to praise someone this much, I was quite impressed and happy.

But Dr. Ashwin appeared quite disturbed. Dr. Anand asked him if he was ok.

“No, yaar. I am facing a big problem. There’s this girl in my unit, who has made my life hell. She has filed complaints against me to the dean, my name is all mud”.

“Complain against you?” said Dr. Anand, truly surprised “Even your wife never complains against you”. He was trying to lighten up the mood. © Dr. Rajas Deshpande

“Yes. But you know how heavy our PG duties are. This girl, besides being lousy and careless, refuses to finish her work, constantly looks at the watch and doesn’t want to be corrected. How can we tolerate carelessness in medicine? There are patients in the ICU and this lady keeps busy with her cellphone! I gave her a warning that I will complain, but instead, she went ahead and complained that I was harassing her, implying serious charges. Fortunately my wife and the dean understand the situation, but you know some people in the campus would rather see me down. I don’t know what to do. I am thinking of resigning”.

“Can you share her name?” I asked, cautiously. The guess was correct. It indeed was Dr. Reena.

“I tried to talk to her, I requested her to call her parents. Apparently she has grown up as a pampered child, her parents refuse to even think that she can be wrong. They started complaining that their daughter didn’t get enough rest and good food, that she has always been a super genius kid and how many a times even her teachers could not understand her genius”.

Now the picture was clear, with the other side of the story revealed.

There indeed is, nowadays, a rampant tendency to play a victim, especially to cover up for one’s own failures, inadequacies and lethargy. Children who allege that their failures are either because of their parents being over disciplined or completely negligent, boys who hate their parents and refuse accepting that they fell short of hard work and dedication because of too many diversions, girls who sometimes lie about “sexual abuse”, and employees who underperform only to blame it upon a racist / pervert / prejudiced boss are classical examples when stress factors are analysed well. There was one girl who alleged abuse by her step father, just to tell me minutes later that it was probably her imagination, and that she didn’t know if it was a dream! It was her mother who then revealed that the girl had always used that ‘dream reality’ sequence whenever she wanted something and was refused. © Dr. Rajas Deshpande

There indeed is rampant true victimisation in all these areas, and one must always stand by the victim. But the overflow of sympathy that drowns sense and reasoning (thank you, media and some movies!) must always be avoided. Differentiating ‘true’ and ‘pseudo’ victims is never easy especially because there always will be the social biases. Most Indian men unfortunately truly look down upon women, most seniors think that juniors cannot be more intelligent, parents often mentally overpower logic when dealing with kids etc.. Still there indeed are many who hide behind the “victim” tag, just to take advantage of the sympathy and protection it offers, using it to hide their own negative side. A lot of people use suicide threats, false complaints and other pressure tactics to emotionally exploit and threaten others. When this happens in a workplace, it poisons the whole atmosphere. There is indeed no protection for the true victims here.

Next time when Dr. Reena came to visit, I told her how I chanced upon the doctor who was “troubling” her. As expected, she cried and defended her stance, but after some gentle coaxing, when I reiterated that the actual problem must be dealt with, she agreed to have a meeting with Dr. Ashwin. I called in a female counsellor too, and in a few meetings, we could sort out the issue.

Medical career is, difficult, it is important to do every single thing perfectly and with utmost care and concentration. No one else can ever replace the life-saving responsibility of a doctor on duty. A doctor who isn’t fully attentive to everything about every patient can be dangerous.

Dr. Reena agreed to go by the duties allotted and improve her performance, while Dr. Ashwin reassured her that he had nothing personal against her, that she could always compare her duties and performance with her other batchmates. He also told her that now onwards he will mind his words better. She withdrew the complaint.

Dedicated to those such who have had this horrible experience.

© 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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A Medical Lesson That Still Hurts

A Medical Lesson That Still Hurts
© Dr. Rajas Deshpande

“Can’t you see I am with a patient? We can talk later. Or may be tomorrow” snapped my lecturer at Pallavi.

Pallavi was 26, had epilepsy herself, but used to sit in our OPD to help other epilepsy patients. She came from her home by local train, travelling over two hours, and went back after OPD to attend her father. She was on many medicines to control her fits and depression, still used to have frequent fits. An epilepsy surgery was not possible, my professor and lecturer who were her caretakers had explored almost every avenue for her. Some unfortunate patients do not respond well.

Obviously she could not get a job and sitting at home worsened her depression. She was quite good looking and kind. However, her father was bedridden with a paralysis attack, and had many problems, even bedsores. That stress made Pallavi cranky and always worried. With no source of income, she was dependent upon help from the staff at our municipal hospital. As she was too proud to accept money without working, my professor had eased her ego by requesting her to help other patients: OPD paperwork, forms, getting medicines, patient education and restrictions etc.

She would either consult us resident doctors or our teachers if there was anything wrong with her or her father. Sometimes her anxiety was too much to deal with, she often asked repeated questions. Some epilepsy and psychiatry patients have worst symptoms around menses, and even get combative.
Most government and corporation hospitals have a never ending line of patients. In that rush it became impossible to answer her repeated questions patiently, and someone or other usually had to either snap at her or prescribe her an anxiolytic. Sometimes being too kind or available results in more attention seeking.

“See if Pallavi is OK” my lecturer told me after a few minutes.

Sulking, Pallavi had gone to the pantry near OPD and sat alone. During our tea break myself and my colleague Dr. Sachin went there too. My thesis / dissertation submission was in final stages, where everything about it seems so pointless and meaningless. I had to submit it within two weeks. © Dr. Rajas Deshpande

“Tea, Pallavi?” we asked her as she sat in the corner.
“No, Doctor. I’ve had it. Thank you” she said. We drank our tea in an invaluable silence.

She suddenly said: “Doctor, my father has started continuously calling me names. He uses very bad language. My headache becomes unbearable when he starts shouting.” She became tearful.
While having tea, I wrote her prescriptions for herself and her father too.
“Doctor, I want to talk” she said, “I need to sort out things in my life” she said.
“Pallavi, the OPD is still heavy, we will talk after lunch, ok?” I replied. It was 3 PM already. We finished tea and returned to the OPD.

A few minutes later, I heard her crying in my teacher’s cabin. “You must learn to be patient” my teacher was trying to pacify her while attending other patients who kept angrily rushing in, demanding their own time. © Dr. Rajas Deshpande

Pallavi got a call from home and left the OPD before it was over.
I went straight to the printer after OPD for the final corrections of my dissertation.

That evening we got the news that Pallavi had fallen off a local train, killing herself. No one knew if it was a suicide.

I have never been able to overcome that till now. What if I would have spent few more minutes, talked her in kinder words, pacified her better?

I learnt one of the most important and precious lessons that every doctor learns eventually: There’s no afterwards. Answer the patient in front of you NOW. Never deny time to one in genuine trouble. A minute of a doctor’s patience can save lives.

This became clearer later, this is true about everyone, not only doctors or patients; no one ever knows which one is the last meeting between any two. Now I make sure to only part with a proper goodbye, a smile and no bad feelings: apologise if I am wrong, forgive if the other one is. Some say that feels too formal, some think it is a way to impress others, or being excessively unnecessarily mannerful. But I know what I mean. There are no guarantees in life: about myself at least. Every goodbye is potentially final.

Patients never seem to stop. Everyone is in their own hurry, tired, pissed off . The doctor is the common point of venting problems, frustrations and also anger. Most doctors acquire the saintly art of not losing patience, raising voice in the worst of situations, but it is at the cost of being inhuman to themselves. To spend 12-16 hours every day (18-20 in case of resident doctors) among the angry, suffering and accusative without losing patience is not a joke. This is one reason why patients see irate/ less interactive doctors commonly and misinterpret it as “ego / pride / snobbishness” etc.

That said, since that incidence in our OPD, I do not refuse any question from any patient in front of me. I do not end the consultation unless I have answered their last question or the patient starts taking advantage by asking repeat or unnecessary questios.

Pallavi, I feel very sorry.
Patient First, Patience Highest, Always, for Every Doctor.
Thank you for the lesson.

© Dr. Rajas Deshpande

Real Story. Identities masked. Please Feel Free To Share Unedited.

Did you plan your murders and suicide at 17?

Did you plan your murders and suicide at 17?
© Dr. Rajas Deshpande

What were you doing when you were 17?
I know not all questions can be answered fully and truly. But some truth applies to all at this age. At 17, we are full of dreams of a good, respectable and if possible luxurious life. And of course of true love.
Well, what options do we have at 17 for such a rich and respectable life?
If you google-search top grossing Indian careers, you will find management, IT, Chartered Accountants, Law, Data management, Sports, Entertainment, Politics and Medicine. Which option would you choose out of these, if you are intelligent and hardworking?
A 9-5 work life with family time and regular food and sleep and holidays, with healthy, alive people around you, or one with no sleep, highest stress, no family life, always being surrounded by illness, crying and death, lifelong exposure to deadly diseases, having to study every day of your life, lifelong competition and struggle, unsure when some patient or mob or press will end your life or career?

No teenager thinks “I will become a corrupt doctor carelessly treating patients to earn all the money I can by prescribing wrong, unnecessary tests and risking my life with deadly diseases just to earn the title of a doctor, and enjoy harming and killing many many patients all my life, long after my classmates have retired..”.
There is far more money and often more respect in many other professions. Illiterate politicians at age 30 roam in Red-beacon cars, Finance, IT and management professionals at age 30 flaunt Beamers and Mercs, while most Superspecialist Doctors aged 45 drive scooters / small cars in India. Why will a talented, hardworking teenager choose at 17 to spoil his / her life by becoming a doctor? This is not for the mildly intelligent to understand.

Where does the “doctor” class come from? Usually academic, poor, middle class families, rarely from rich class. Which parent will teach their children to do bad to ill patients to earn more money? Do you teach your children at age 17 to “loot” sick people?

The govt. failed to provide enough medical colleges and doctors, allowed private colleges, and decided who will start these colleges and what fees they will charge, the courts agreed to this. How is today’s doctor guilty of this? If paying high fees for the desire to become a doctor and serve sick people and later earning enough to repay that fees is a crime, why not ban all private medical colleges and send all patients to govt. hospitals compulsorily? There always will be those who take advantage of any system where money is generated, how come all doctors are blamed?
© Dr. Rajas Deshpande

The govt. made service compulsory after graduation, made bonds, doctors complied in most cases. Those who didn’t, paid fine. After that, they do not remain “PUBLIC SERVANTS”. They become private practitioners, whose service comes under a “consumer law”, thereby the court has decided it is a business. You have govt. hospitals in every small town now. Why don’t you go there and get the cheapest treatment, with usually no tests (because they are not even available!)? No one will force you for extra money or tests or wrong treatment there. That system, where there is absolute guarantee of no “CUT PRACTICE” and referral fees, will never deny service to anyone. Most doctors there are excellent too.

No. You want premium service, best available medical facilities. You want sweet words and better guarantees. You want highly qualified superspecialists in ultramodern A/c buildings with state-of-the-art machines and tests and operation theatres and stents and medicines and catheters attended 24/7 by teams of all experts under one roof, with the best trained nursing staff. Above all you want the freedom to blame and sue someone for everything that may go wrong. “Science is so advanced, doctor, can’t you do something?” you often ask, “My cousin in USA got this same problem, they lifted him up with a helicopter and he was discharged in a week”. You forget one part of the picture entirely: the insurance premium your cousin paid, the treatment charges levied, and the doctor’s fees in those cases. Above all, you didn’t enquire how many poor / compassion / politico/ VIP / govt. servant free patients that doctor in USA sees all his life.
© Dr. Rajas Deshpande

You want the “USA class” service at “Indian” rates. You want the cheapest treatments by world-class doctors, with the ability to sue for crores. If medical tests are unnecessary, ask the govt. to ban them, or go to the people who can treat you without those tests. Ask the fulminant (google this word, my friend) anti-doctor media for the best options from the various quacks they advertise daily. If medicines / instruments / stents / catheters are costly, please ask govt. to only sell cheaper brands and use them. Why doesn’t the govt. ban all foreign medicines? Have guts to go to the doctor and say in writing “Use only Indian and cheapest medicines, catheters, instruments and procedures, I will accept the outcomes as long as the doctor is technically correct”.

No doctor will force tests or medicine. Choosing the doctor, tests and medicines are all your rights and privileges. Own the responsibility of what you do. If you think the doctor was wrong, do file a complaint with authorities, and follow the legal procedure. If you were wrong, face defamation. Just don’t pretend to be lone saints in a world full of criminals.

About the loose talk that our own brethren / doctors unleash upon social media about “most doctors being corrupt”, I think the medical councils and associations must seriously deal with such defamation of our profession. If someone has an issue with medical corruption or malpractice as a doctor, they must go to their specialty association or medical council, not general or social media, as this is just misleading the public. API / IMA must start filing defamation suits if any media plays judge in medical cases before the courts of law have convicted the doctor.

How does one choose a doctor for oneself? Cheapest or Best? How did the doctor you chose become famous / best? Never by only a degree. Of all the rich careers, the richness of a doctor is the costliest, having to toil the hardest over many years to attain that success, with no support from the society, govt. or media. Corruption may make some doctors rich, but never famous.

Let the govt. publish a book of standard tests and treatment of every medical condition and have every doctor follow it, irrespective of the outcome. Alternatively, have faith in the doctor’s education and opinion.

All malpractices in all fields must go: Political, Social, Government, Educational, Public works, Religious, Media, Entertainment Industry, Judiciary, Police and ofcourse medical.

For all those who missed the Indian medical train, enjoy your journey without jealousy! Believe me, you are lucky to not be a doctor in India. For us, the meaning of “Happy Diwali” ended for life when we entered medical college. This Diwali, put on your new clothes, pack some sweets and visit any casualty near you to know what being a doctor means. Then dare to blame an entire profession.
© Dr. Rajas Deshpande

Suicide / Homicide of Patients

Suicide / Homicide of Patients

(c) Dr. Rajas Deshpande​

Tuesday 3 pm. OPD

“She needs urgent admission and treatment.. she may be developing a stroke.” I told the relatives of this 70 some year old lady who was having recurrent episodes of tingling / numbness all over her body, with slurred speech. Otherwise healthy.

The disturbed family was displeased: a mom (patient), her son and daughter (very polished but obviously cut off from each other because they avoid talking to each other) who stay in different cities away from the patient. “You can suggest us the treatment and tests, doctor,” the US based son said, “but it is difficult to admit her as there is no one to stay with her in the hospital… I am in India only for three days, and I reached Pune only yesterday: I am very worried about Mom, so got her here today.. but I have to return as we have an important project going on, that depends upon me ”..
“I am not sure if she will agree for admission, doc,” said the daughter “she is very independent, never liked hospitals… Do you want to stay in the hospital mom?” the question had anxiety, reluctance, formality and suggestion for a negative answer, all at the same time.
The mom looked at me, with embarrassed smile, confused. “Well, if it is necessary..” she started, only to be cut off by her daughter.. “Let the doctor write the treatment and tests, Ma, then we will decide outside..”

I suggested an urgent MRI and few other tests, and gave a prescription. “Do we have to do the tests here only doc? Because we know that ‘xxxxxxxx’ trust, and it’s chairman is a very close friend of mine.”
This trust is known for free MRIs, average quality, meant to serve the poor. It takes time to get the apptts there, and some poor patient’s apptt will be cancelled because the “Chairman’s friend from US” will request an urgent MRI.
“It is your choice” I have to answer legally correct, even if I may not like this decision.
I write notes, suggest urgent admission, and start treatment.

4 days. No follow up.
Then on Saturday at 6 PM, the casualty CMO calls: “Sir you had seen this patient in OPD on Tuesday, she has come here, she is comatose, we are planning to intubate” .
I went there, anguished to the core but trained to shut up well when dealing with patients. The daughter rushed to provide details: “Doc she was not willing for admission: we did the MRI at the trust hospital yesterday morning, but she was very ‘sleepy’ since prior night. We got the report last evening..We thought she must be tired, so we waited till now.. but she is not waking up…. Then we thought that you advised admission, so we brought her here..”.

Patient had a brainstem stroke, one of the worst forms of stroke.
“When did she become unconscious exactly?” I asked
(This is how the court wants answers, ain’t it?).. but our intention was to see if she was in the “window period” for clot-busting treatment of stroke.
“The servant says about two days, but I saw her day before yest, and she said she was ok… I stay nearby only, and am in constant touch with her and the servant on phone.”
There was no point in discussion, they had all explanations about all decisions, and why things were delayed.
She required ventilator. The “busy” son kept on calling from US, and had their “Doctor Uncle in US” talk with us, conducting an accented cross-examination on phone, and telling us what we already knew.

On the third day, the family gathered its socio-financio-politico-legal experts in clever talk, and asked for a meeting. This discussion ensued, summarily:

“When exactly will she regain consciousness?”
“Can’t say”
How many more days in ICU?… Can’t say
Will she ever talk or walk again?…. Can’t say
Will she be a ‘vegetable’? …. Can’t say

One smartypants (well, smarty halfpants) asks with dismay “But Doctor, medical science has made such great advances in the USA, they say stroke patients can be treated completely, they have even done stem cell transplants etc.. and you are saying we can’t do anything”

I know a hundred hurtfully true answers that can wet the questioner. But again, my teachers shout in my mind “Shut Up”.

“At this stage, after the stroke has happened, we cannot do much”.. the technical answer.
“Doc please understand the family’s situation: how long can we continue this?”
“What can I do to help? Ask I.

The family exchanges meaningful glances . Smartyhalfpants conjures up the big courage: “We are ready to accept the inevitable. It is ok if you tell us she is not going to survive. We are prepared”.
I offend my teachers once in my mind, to answer that one. “But you all already had dumped her, killed her by delaying her treatment”. I can’t say it openly.

They waited another two days.
Then requested not to resuscitate the patient.
Besides the question “When” they were not interested in anything else. The more we tried, the more that family started hating us, alleging us, questioning us. If we advised any new medicine, the first question was “ Will it definitely make any difference?”
I will not mention when the family was seen smiling last.

So many patients die / develop disabilities because the family denies them medical care in time. Superprecious time is wasted in second opinions, finding cheaper options to everything, and idiotic presumptions and self medication. Add to this alternative medicines that are cheaper and available at home.
Many parents don’t ensure the important drugs like epilepsy medications of their own children, do not stock in advance, and take huge risks by trying on their own to stop these medicines.
Most elderly population is, to state honestly “Killed by neglect masked by beautiful sweet language and excuses”, only few exceptions are seen in real life.
Wives are taken for granted for the treatment of husbands / men / earning member in the family, however serious their health problems be.
Critical / crucial surgeries are avoided, admission notes are neglected because the patient / relatives keep on searching for the cheapest options.
Patients continue to neglect doctor’s instructions, eat sweet, not exercise, drink alcohol and smoke, drive risky quoting “It’s my life”… then why is the doctor held responsible when one develops complications of such a life?
All these delays (these are also medical negligence, dumbly ignored by the Indian legal systems) cause more deaths than medical negligence by doctors. There must be a law to record and punish these too. Hospitals must also have a registry of admissions advised, investigations suggested and in case of not being followed, report such cases for medical negligence.

They admit patients at the last moment, and want the system to be responsible for a guaranteed good outcome!

In a country where the court decides the punishment amount for doctor’s negligence by calculating how much the dead/disabled person would have earned, what else do we expect from the population? This is like open statement: if a doctor neglects the health of a non-earning, an elderly, or when the parents have many sons, it deserves lesser compensation, but if an earning member / only child is affected by negligence, the hospital / doctor pays up huge! Genius!

In hope of a good outcome.

© Rajas Deshpande