Tag Archives: violence

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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“I Swear”

I Swear
© Dr. Rajas Deshpande
 
“Have you forgotten your oath, doctor?” asked the Hon’ble minister to Dr. Prasad.
 
The fat elderly reporter accompanying the Hon’ble minister laughed. “We must teach these doctors a lesson” he said.
Being a doctor, good language and behavior is essential. So Dr. Prasad swallowed the immediate reaction that had sprung to the tip of his tongue, one that involved references to some passionate human interaction.
 
He then smiled.
“Sir, did you attend any school?” he asked the Hon’ble minister innocently.
The Hon’ble minister was offended. He had not had a respectable academic record. © Dr. Rajas Deshpande
“What does that mean? Do you know who you are talking to?” the accompanying reporter raised his voice.
“Yes, I know I am talking to a patient. A human being with the same organs as me, but not the same merit or intentions” said Dr. Prasad.
 
Before the cunning reporter and the Hon’ble minister could formulate a reply, Dr. Prasad continued:
“Sir, all over India, for ten years, everyone who has attended any school has recited every morning, the National Pledge. That is our promise to our beloved nation. Let me remind you of some sentences in that prayer:
I shall give my parents, teachers and all elders respect and treat everyone with courtesy.
To my country and my people, I pledge my devotion.
In their well being and prosperity alone lies my happiness.
Tell me Sir, are all politicians, ministers, media persons, businessmen, lawyers, and other professionals following this oath that they have recited every day for ten years? If yes, where does violence come from? Not only in hospitals, but in every other home, against children, against womenfolk, against even the elderly”.© Dr. Rajas Deshpande
 
“But you are a doctor, you have taken an oath to serve” said the defiant Hon’ble, expert in the art of diverting discussions.
 
“No, Sir”, replied Dr. Prasad firmly, “I have not taken any oath to tolerate violence or abuse, or to risk my own life or limb. I have not taken any oath to feed with my blood and sweat the deficient and perpetually corrupt healthcare systems. I have not taken any oath to be nice and kind to attacking, drunk, abusive or irresponsible people who enter the hospital with an almost dead patient at the last moment and then expect the doctor to perform miracles. I have never taken any oath to treat Judges and Ministers and Rich VIPs above the poor, really deserving patients. I have not promised anyone that I will neglect my family or my own health”.
 
“I have only taken an oath to honestly treat the sick with dignity, not thinking about money. That most doctors do, some who fail are common in every field. My oath is to help a patient recover. If I fail, try me in a court of law. Send me to a court that understands law better, and appeals people not to be violent, tells governments to protect everyone against violence, rather than asking doctors to tolerate violence as a part of their duty. It is exactly as backward as like asking a wife to tolerate her husband’s atrocities as a part of her duties”. © Dr. Rajas Deshpande
 
The restless tail barked again: “But the public pays for your education”
 
“I beg to differ, sir. No one is obliging anyone by paying for doctor’s education. The country needs many more thousand doctors. And we pay taxes too, to be protected. People pay taxes for a good and cheap healthcare system, please give them that, rather than them having to depend upon private hospitals. A doctor is just a small component in healthcare. Don’t blame him for expecting the same protection that every citizen expects. The infrastructure and policies are pathetic, and an intelligent taxpayer will one day understand that the doctors are not taking home any money as their alms. Everyone knows who gets richer with taxpayer’s money, Certainly not the doctors”.
 
“As for your allegation, respected reporter sir” said Dr. Prasad calmly to the tail, “You are educated, you have a responsibility to heal social ills, not widen the bleeding wounds and survive on that flowing blood. There are so many good examples of reporters / media persons who bring immense good to our society. The ability to sit in one’s chamber with all controls, and bark at everyone, manipulate speech cunningly, distort facts pretending to be holier than others, while your seat is dipped in hidden honey is not reporting”.© Dr. Rajas Deshpande
 
“Doctor, you have too much ego” said the angry Hon’ble.
 
“No sir, intolerance to stupidity is not ego. Every religious ceremony, every professional oath makes us repeat the good we must do, including a minister’s oath of office. . Very few actually do it, but everyone thinks it is only the doctor who must follow his oath” said Dr. Prasad.
 
He then checked the Hon’ble Minister and wrote him a prescription that included weight reduction and abstinence from alcohol.
 
Without a Thank You or a payment, the powerful duo left.
 
“I swear” said Dr. Prasad, smiling to himself, “I will never give them the joy of taking it lying down”.
 
That is the basic oath of every self respecting human being.
 
Jai Hind
© Dr. Rajas Deshpande
 
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The Price Of Love

© Dr. Rajas Deshpande

He tied her to the pole, abusing and insulting her.
Wielding a knife in his hand, he slapped her once more. “You are supposed to be the honest one” he shouted, “I am a man. You were talking with our neighbour. What did you say to him? Did you two fix up a place to meet secretly?” he was trembling with anger.
She looked into his eyes, and replied “Don’t you talk to other women? Doesn’t your mother talk to other men? Do you always talk about that? I was asking him about his sick wife”.
Pulling her by her hair, he said menacingly in her ears: “Look, don’t compare yourself to me. I am a man. You are supposed to be the one who gives up everything for me. Do you think I don’t know how ‘those’ women behave? You have chosen to marry me. I can do what I want”. She didn’t reply. What could she say to a paranoid, suspicious person who had one way communication? The option of violence wasn’t open for her.
As it became dark, his mood changed. He started speaking soft and sweet. He untied her from the post so she could cook. She could not eat well, the humiliation and insults, the allegations and violence wreaking havoc in her mind.
Silence fell upon the dark. The next day’s work awaited her at dawn, so she skipped the sobbing and tried to sleep.
“Make love to me” he ordered. She tried to comply.
He raised his voice “It should come from the bottom of your heart. Don’t pretend. Love me madly, deeply, and let it show in your action”.
Silently, she replied “I can’t. The only one thing that could have made me truly love you was true love from you too”. © Dr. Rajas Deshpande
This is the current scenario between the society and the good medical professional today.
Take for granted that the whole medical profession is one’s slave. Make allegations at every possible opportunity. Be suspicious and paranoid. Hold a doctor guilty for any news anywhere without logical enquiry. Make them overwork under the sacrifice tag. Disrespect them, beat them up, ask them questions as if talking to criminals. Presume every other doctor and every big hospital is a fraud.
Then, when one has a health problem, expect them to be truly, deeply compassionate, loving angels who will do the best because they are married to their principles of being good and kind to everyone.
If you expect the doctor to be truly nice and kind and compassionate to you, to make best decisions for you, ask yourself if you deserve that. No amount of money will buy you a doctor’s love and respect, no amount of hateful criticism or threats will compel your doctor to be compassionate.
A doctor’s real fees is the respect and trust you place in him / her. No amount of money is worth the value of your life. Pay with suspicion, threat and disrespect, and you destroy the compassion you truly deserve.
The doctor-patient trust is a coin with two sides, one side cannot be blank.
© Dr. Rajas Deshpande

PS: I know the word “exaggeration”. Learnt it from some movies and TV shows that criticise doctors.

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The God Pendulum

The God Pendulum
© Dr. Rajas Deshpande

Dr. Aman handed over his car to the valet, and went to the rooftop restaurant, his favourite rendezvous. The captain soon brought over his favourite coffee pot and some starters.

‘The look of love’ by Kenny G started playing. It is impossible not to feel inner peace and romance while listening to that piece. Dr. Aman started to think. Yes. He had much in life to sort out.

Sunday late afternoon. The only afternoon to relax if lucky. A moment of peace so precious, that even family duties take a back seat, the mind is so tired of the heavy duty medical practice. Heavy duty because mistakes are not allowed, and seldom forgiven. © Dr. Rajas Deshpande

It is difficult to relax at home too. The society security staff, maids, some ‘sudden’ old friends from god-knows-what-stage-of past will want home consultation, and it is rude for a doctor to say no to any health queries by anyone, anytime, anywhere. Cellphones have become the worst health hazards, more so for the doctors.

He had two patients under his care in the hospital, so he decided not to switch off the cellphone, he was responsible should they have any problem in the hospital.

The phone of course rang.

“Sir, casualty. One GP has referred for you an old lady with convulsions. She is quite bad” the medical CR appeared disturbed.

“On my way” said Dr. Aman, paid his bills, and reached the hospital. On the way he kept on giving intructions to the junior doctor.

The 65 year old lady had had fever for a week, not taken to the doctor, treated by her non-medico daughter and son with home remedies. On the seventh day, yesterday, she had had many vomitings and became unconscious. The local GP gave her some basic treatment, and sent her to the city as she had no facility to treat such a critical case. Since that morning she had also had convulsions.

She was already intubated in the critical care unit when Dr. Aman reached. CT scan of her brain was normal. Her sodium levels turned out to be dangerously low. The management requires skilful vigilance, and it was already started. © Dr. Rajas Deshpande

Her daughter and son were waiting outside the ICU. Dr. Aman updated them about her condition.

The angry son asked “Why is her sodium low? Is it because of the medicines given by the doctor yesterday? I it the side effect of those medicines?”

Dr. Aman had now acquired the skills to tame his anger. He told that it was because of the vomitings, and that they should have taken her to the doctor earlier when she had fever.

The daughter started with an emotional appeal, speaking loudly “Do whatever you want, doctor, please save my mother. You are like God to us. Nothing should happen to her. We are ready to do anything. Please save her”.

“We are trying our best. Let’s hope she recovers” Dr. Aman said the legally correct thing.

“So when will she become normal?” asked the patient’s son.

“It is not predictable, we need to reassess her after convulsions stop and sodium levels are corrected” Dr. Aman replied. © Dr. Rajas Deshpande

“So why don’t you correct her sodium levels right now?” asked the son, as looking at the surrounding relatives as if he was suggesting the obvious that the doctor had missed.

“If sodium is corrected faster than a certain rate, she will develop paralysis, it can also be permanent” Dr. Aman replied, and added “Look, boss, if you do not have trust in our treatment and skills, you can please shift her to any other hospital you wish.”

“No. no doctor. We trust you. You are like God for us. We brought her here because this hospital is big and famous, and has all facilities” said the daughter. The son just kept on looking angrily at the doctors.

On the third day, the lady became conscious. On the fourth day, she was off the ventilator.

“When will she be shifted out?” the daughter asked.

“After a day of observation in the ICU” said the junior doctor.

“Why is it necessary to be in ICU now?” asked the son.

“Because she still has fluctuating oxygen levels, and needs continuous observation” replied Dr. Aman. © Dr. Rajas Deshpande

“Why cannot you observe her in the ward room? The ICU is so costly” the angry son kept muttering.

On the fifth day they requested discharge, as the patient was walking. Her weakness was still fluctuating, and her BP was low. She was discharged on request.

Within an hour, a crowd surrounded Dr. Aman.

“What is this? Is this any bill? Are you doctor or a thief?” the daughter started shouting, to a full audience of the waiting patients.

“Listen. You knew these charges when she was admitted. I do not own this hospital. The rates are standard, and so are the criteria for free or concessional patients. Please speak to the billing department.” Dr. Aman kept his tone low still. He did not want to point at the two costly cellphones that the son flaunted.

They did not qualify for free treatment as per the govt. norms.

“Doctor your fees is also there in the bill. Atleast cut that off. We cannot afford.” The son insisted. The waiting crowd surrounding them stared at the face of Dr. Aman. “Will the doctor be human and help this poor?” was the mob expression.

To save time, Dr. Aman asked the billing clerk to scratch off all his consultation fees. Saved time is more precious than earned money for the doctor.

While leaving, the daughter looked angrily at Dr. Aman and said “We never thought that doctors will be so rude and commercial. Curse upon such doctors who extract money from the poor”.

A doctor must digest all kinds. All patients who had witnessed the scene were doubtful and upset. They knew nothing about the patient and what had actually happened. They had just witnessed the last scene.

Just five days later, the whole family returned in panic. The lady had developed many convulsions as she had stopped the medicines after going home. Now she was unconscious because of the low oxygen that had damaged her brain. This could take a long time. © Dr. Rajas Deshpande

The daughter started “You are God, Doctor, please save her” etc. etc.

Dr. Aman gave instructions about the basic management to the emergency team, then turned to the daughter and said “I am sorry. I am busy with other patients, please take her to another doctor or hospital. I cannot attend her”.

“Can you refuse a patient?” asked the son, as if he had taken a special training from Mr. Ram Jethmalani.

“Yes, I can” said Dr. Aman “No one can expect a doctor to take correct decisions under duress, threats or abuse, and if I think there’s risk to my life or reputation because of ill behaved, hostile relatives, I can even refuse emergencies”.

There was no guilt in his mind when he started the car. He had become a doctor to serve the sick and suffering. Those who did not value him, his work and his profession did not deserve his service. His dignity was as important as his humanity, he would not sacrifice it for those who didn’t deserve it.

© Dr. Rajas Deshpande

A Policeman’s Tears

© Dr. Rajas Deshpande

“She was found unconscious and naked lying on the road. The baby was near her, moving when we found her, now she also looks unconscious” said the police constable. “Actually I had my civil dress in my jeep, I covered both with my clothes and got them here. Most likely an orphan roadside beggar”.

It was early morning, I had gone to the casualty for a call as a medicine resident, and was chatting with the CMO when this police constable had rushed in the mother and the baby, probably less than a year old. He and his colleague completed the formalities and left. The CMO was alone, so I stayed on to assist.

The lady had high grade fever and some bruises all over her body, only one on the thigh deep enough that it bled. She also had a contusion upon the head. Needless to say, unclean and unkempt, visibly quite weak and poorly fed body. There was a traditional tattoo on her forearm that said “Seeta” in distorted devnagari script. The baby was dehydrated and had fever too, with only minor contusions.

“Sending her to female ward, and the baby to paediatric” said the CMO. We completed the police information and Medicolegal form, the nurses had started the IV line for the lady. I accompanied the baby to the pediatric ward, handed her over to the resident doctor friend on duty and went to the female ward to attend the other admissions. Basic medicines for fever and head injury were started for Seeta. There was no CT scan facility in the hospital. Blood tests were sent.

In absence of relatives, it’s the interns, resident doctors and nurses who attend to the necessities of such patients. Administration mocks everyone sympathetic and compassionate to such patients, be it a government, private or corporate set up. My professor advised some more blood tests. Some tests were not available in the govt. hospital, we had to send them outside. As we had just received the stipend, money was not a big problem.

Next evening I went to the pediatric ward to find out what was happening with the baby.
“She has had convulsions”, the resident colleague told me. We have loaded her with anticonvulsants, but she still has fever. Dr. Jain madam (new lecturer in paediatrics) has advised lumbar puncture, but there’s the consent problem”.
I went to talk to the lecturer, she was all insulting. “Don’t teach me what to do. We will send a request to the dean, and if he allows, then the resident will do the lumbar puncture” she said, “By the way, what’s your interest in this baby? Why don’t you mind your own business? I have heard about you.. you are in the student’s union na? Don’t throw your weight around me.” She said.

The dean consented to our request, and a lumbar puncture was done. The baby had probable tuberculous meningoencephalitis (infection of the brain and its coverings). Antituberculous medicines were started.

The comments of the pediatric lecturer made me extremely angry. Most of her resident doctors hated her attitude too. Those remarks soon spread and various sick, exaggerated and vulgar jokes about me caring for that orphan baby made rounds among my colleagues. But one good thing about wanting to do good is the shameless pride and courage that comes ingrained with it.

My colleague Dr. Madhu stood by me. She often reminded me: “There are five percent good people in the world, and 95 percent bad, Einstein has said, but it is the five percent good who take the world forward, they represent human race”. That has always pumped me up against all the mockery that I ever faced for being “too sensitive and compassionate to be sane”.

The best support for the poor and helpless always comes from the poor and helpless. The pompous, actionless “blah blah” of advising others to be more kind and compassionate is usually the trademark of those who themselves rarely help anyone. The mamas and mausis (wardboys and helpers) of the ward came together to attend Seeta during their duty.

The pediatric resident told us on the third day that the baby’s health had gone bad, and she was unlikely to survive. Dr. Madhu stopped smiling. “At least can we shift the baby near her mom?” we discussed. It was of course not possible.

Dr. Oak (real name), one of our ophthalmology genius professors, learnt about this. He came over and told us in his royal tones, to tap him anytime for any help. He also left some money with us.

On the fourth day, the lady started having convulsions too. We ran around, trying to arrange whatever the professor suggested. She was gradually sinking. Tuberculosis neglected and untreated is one of the most cruel diseases. It takes over ten days for the action of Tb medicines to kick in.

On the fifth day, the baby passed away in the morning, and the lady shortly after. That coincidence was less tragic than their trolleys being rolled into the mortuary together.

“What happens now?” we asked the mortuary in charge.
“They will be cremated as orphan, unclaimed bodies after the post mortem” he told.

In a world of billions, ruled by religious, powerful and rich, a young mother and a baby girl would be cremated as orphans! We told the mortuary assistant to please keep us posted, and came out. Of course we could not sleep.

Next day we took special permission and went to attend their cremation.
On the way, we bought some flowers, a tiny dress for the girl and a saree for her mom, probably the first new clothes ever for either of them. Dr. Madhu had already brought a few bangles, a necklace and two bindis with her.

Dr. Madhu was sobbing as we returned. The rowdy looking policeman with us also wiped his eyes. He dropped us back to the medical college in his jeep.

He said in a heavy voice as we parted:
“Doctor, we see all the worst things in the society. We meet criminals day and night. But when such young girls and babies die, I feel like shooting everyone who didn’t come out to help them. People just talk, nobody helps. God bless you. You have what it takes to be a doctor. Don’t ever change.”

© Dr. Rajas Deshpande

P.S.
Years later, I read about a divine human being from Chennai, one Mr. S Sreedhar, who collects unclaimed dead bodies from various hospitals, and performs decent and respectful last rites for them. Planning to meet and touch his feet one day.
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Abyss, c/o my country.

 

© Dr. Rajas Deshpande

Bruises everywhere, black, blue, purple, red and swollen. Especially groins, buttocks, thighs, breasts, back, neck and face. One cut on the forehead. Dried blood on lips.
She was sobbing, speaking in a muffled voice: “Can you imagine they beat up a woman like this?”

Single postgraduate woman, staying alone in a metropolis, in a building near the police station. Operated for a brain tumor, on medicines, occasionally gets spells of abnormal behavior and symptoms like staring, imbalance, speech arrest, slurring or passing out. Disowned by family because she had fallen in love outside their caste. The guy later abandoned her, married in his own tribe.
She is jumping jobs, never accepted for long at one place when they realize she gets such spells. Being young, tall, beautiful and fluent in English, she usually gets too much attention from men. She quit some jobs because her bosses made advances.

She often faced lewd comments and received “offers” from men in and around her society, whenever they found her alone on the stairs , elevator etc. Her angry responses and retorts offended many. Her “seizures” or blank spells were thought to be ‘witchcraft’. Her window panes were broken down, the landlord refused to help, asking her to leave. She could see faces in her windows at all times, especially at night.

Once when a local lady politician’s husband tried to hold her hand, she slapped him, unable to control anger. Within a few minutes, the politician, along with some other women and men, mobbed her flat. She ran out.

There in the open area outside society building, they all beat her up : grown up men and women together, alleging her of witchcraft, of theft, of ‘stealing their men’, of ‘luring men and children’ etc. This continued for about twenty minutes.
She limped to the police station. She was arrested as someone had just registered a complaint against her. The mob reached the police station with the politico, who alleged her of theft, violence and use of foul language. She was taken to the government hospital, After dressing her wounds and splinting her hand, she was locked up. Released next morning with a warning.

She had come to the our hospital next morning, asking for a new prescription as she was scared to go to her own apartment.

After the nurse offered her water and a tissues, I examined her. The wound mark of the brain tumor surgery was not affected, but there were bruises around it.

“Did you have vomiting? Did you become unconscious?” I asked.
“No, but my body is aching everywhere. I don’t have any money left, you had told me not to miss any doses of antiepileptics. So I am here”.
I offered her free admission in the hospital (My boss usually helps). She refused. She also refused to do any tests or to let me call her brother living in a nearby town.
“If he didn’t understand my love, he won’t understand my pain” she said, “ I will leave this city in a short while, that politico lady has threatened me with more thrashing if I am seen around again”.

As we arranged for the medicines for her, she sat there, hands around her legs, intense anger in eyes, chin resting upon the knees, her sobs shaking our faith in humanity.

On the day prior to her major brain surgery, she had said “Doc I am not afraid of death at all, it is people who scare me.” I understood it now.

We all are grown up with almost similar training: that civilized men never hit women. Our parents, teachers all always taught us the same thing. Where does it all vanish? How is it possible to kick the delicate parts of a woman, knowing that it will inflict agonies worse than death? The men and women who beat her up were almost all from a middleclass society, at least half must have been educated. In a country that worships so many goddesses, how can women be treated like this by mobs? Every single woman, whether normal or suffering from mental or physical illness, risks lust and violence even among the most educated and civilized. Where do we start to stop the mob cultures? Women’s Empowerment has remained caged in the umpteen videos and messages that circulate all over, while women are abused by the “Manly Men” and mobs alike.

The nurse and receptionist packed her some food, a month’s dose of medicines, and we offered to arrange a taxi to drop her home. With single depressed patients, the doctor must always think of a possibility of a suicide. I urged that she please call her brother or mother.

“No thanks Doctor”, she said with the most bitter smile I have seen: “I will not kill myself because people are bad. I want to live and enjoy life. I will go where people will understand and accept my illness… and respect me as a woman”.

She limped away accompanied by her own sobs.
I wondered for many a restless nights: where can she go?

© Dr. Rajas Deshpande

Negligence cases deserving severe punishment.

Negligence cases deserving severe punishment.
© Dr. Rajas Deshpande

A police sub inspector in civil dress, his wife and three kids aged 8, 5 and 1 were brought to casualty. All profusely bleeding. My job as an intern was to secure IV line and stop bleeding. As the CMO questioned the PSI, we all realised as suspected from the stink that the police officer was drunk. He had run into a braking truck from behind. One kid and the wife died the same night. He created a ruckus in his drunk state, threatening to kill everyone in the casualty. “If my wife dies, I will see to it that your life is ruined” he threatened to the CMO. The CMO kept on doing his duty, stressed and hurt. We were all real scared next few days. Everyone sympathises with such a loss. No one will aid or enjoy anyone’s death in a hospital.
Then why this curse of blames?

“This happened due to that doctor’s wrong treatment” : common words now heard in many clinics daily. Who causes maximum deaths due to negligence? Can only a doctor cause medical negligence? No.

These medical negligence cases must be punished too, with bad press, crores of rupees in fines, and public humiliation. You be the judge who is guilty:

Teenager son of an MLA. Played with wild snakes as a hobby, proudly encouraged by this MLA. Bitten by a cobra, landed in icu critical. A patient on ventilator was ‘shifted out early’ to accomodate the MLAs son.

Doctor advised a blood thinning medicine to prevent clots after diagnosing clotting disorder,. Patient went with her husband to a quack, took unknown herbal medicine and stopped blood thinner. Developed strokes, now in a vegetative state.

Patient advised to quit alcohol,,as it caused fits. Counselled with family and friends. In a week had alcohol with same friends, had fits, died in casualty.

Diabetic, told to control diet, continued to binge-eat sweets, lovingly cooked by wifey. Landed in coma due to very high blood sugars.

Pet dog, unimmunised, bit many on the same day, the dog died in three days. One diabetic patient bit by this dog died of sepsis / infection (not rabies). Immense horror among the ten-odd families of bitten members till date after a year.

Kid aged 14, parents allowed him to ride two wheeler on road without licence, killed on spot colliding with a truck. Toddler unwatched on the road died, run over by a truck.

60 year old Mother has giddiness for three days, son and daughter in law not free till fourth day to take her to hospital. Dies in casualty due to stroke.

Patient advised not to fast as it may increase chances of having fits. Fasted and landed in ICU with status epilepticus (a series of continuous fits).

Traffic police at a crowded junction busy with his “routine” away from his spot. Head on collision, two dead.

Unfortunately, in almost all above cases, the treating doctors were beaten up, casualty staff and hospitals vandalised, doctors sued, bad press judged an entire profession almost like a criminal, for not saving the victim.
© Dr. Rajas Deshpande

Often the relatives refuse to take patients to higher centers, expecting “big, advanced treatments and impractical outcomes” from low-cost, small nursing homes not equipped with specialty facilities, then end up vandalising or blaming such set-ups upon inevitable disappointment. Missed medicine, overdose, unobserved children, helpless neglected elderly parents, smoking, alcohol, traffic accidents all cause millions of deaths. So do delayed admissions, some herbals and “unknown” medicines, hunger, poverty, stress at home and workplace.

But it is the “death in hospital” that alone matters, and by default the blame is pinned upon the doctor!

Some actors can kill, rape, go naked, smoke, drink, race, gamble, pee in public, set records for drunken misdemeanours on and off screen, knowing that most illiterate and immature populations imitate them blindly. But they will tell the nation how the medical profession (for which they themselves did not opt in spite of excellent merit in school or in some cases even college) should behave and treat patients!

The few honourable judges who have now realised the “blackmail potential” of medical negligence cases, have fortunately started referring these cases to panels of medical experts before concluding and fixing charges. The only maturity issue that remains is about local goons and politicos with flitting loyalties looking for publicity at the cost of the harmless and intellectual population of doctors. These goons turn the helpless frustration, panic reaction towards tragedy and poverty of our society into anger against doctors and hospitals. As long as there are sane people in the responsible media, there is good hope.

Doctors must start recording without bitterness, any hostile tendencies, lies, deviation from duties towards the patient, advised and declined tests and treatment, neglect and avoidance patterns to provide adequate care for the patient by the relatives. Also the exact circumstances of onset of the problems (patient was drunk / drugged / under medication effect / fasting / missed medicine) etc. and relevant past that may have contributed to the event. This will minimise the allegations and misrepresentation of facts.
© Dr. Rajas Deshpande

Ofcourse the doctors must also discharge their duty with the highest standards of practice possible in their set-up. They must communicate well and explain the condition atleast once to the concerned relatives. They must behave courteously, sympathetically and try to understand and forgive the panic states of relatives within the sphere of civilised behaviour. We all love our patients. But like in every other relationship, we fail to say it aloud and make it clear with our behaviour, thanks to heavily stressful and inadequate lives we lead. Let us make an effort on our side to take one more step in the direction of kindness and understanding, in a hope of saving this profession from defamation at the hands of middlemen.

Let us make a greater effort to tell the society that it is only a doctor who will never intend harm. The only reliable rescue from the clutches of death, even a doctor fails sometimes. The effort has to be recognised if not always rewarded, but never suspected.

Negligence, you see, is easy to pin only upon the doctor.
All others are forgiven any number of deaths in all other types of negligence.
© Dr. Rajas Deshpande

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