Tag Archives: Women empowerment

The Last Bullet For Indian Private Healthcare


© Dr. Rajas Deshpande

Many doctors, nurses and other staff, police officers are dying due to corona exposure. Recently the quarantine period of doctors was cancelled. To add to this, very ridiculously, doctors’ salaries were reduced, and covid funds were deducted from even frontline warriors’ salary. This is like taking money from a soldier’s paycheck to fund the army!!

When I recently heard some people shouting about excess bills in hospitals, doctors not working etc., I felt like shouting back too, but one cannot argue with a sold TV screen.

For decades India has had
Excess urban crowding,
Very poor hygiene.
Very high poverty and illiteracy.
Lack of town-planning for slums.
Severe lack of state/ national healthcare infrastructure.
Tiniest budget for healthcare.
Perpetually under-functioning government hospitals. Every season hundreds die due to epidemics.

Where were you till before the pandemic? Who is responsible for all of the above? Do you want to discuss these factors which are responsible for the pandemic chaos today? Or now you just blame it all upon Doctors and Private hospitals?© Dr. Rajas Deshpande

Only private doctors with small nursing homes and dispensaries, clinics were shouldering all healthcare needs that government hospitals could not provide. They had low profits and catered to middle and lower class. These were destroyed in last few years because of too many stringent regulations and costly licensing. Many closed down. Legal troubles by relatives, politicos supporting them and vandalising hospitals forced many private doctors to stop admitting patients. Protection to doctors was denied by almost all governments till before this pandemic.

Indian poverty is never ending, and charity cannot run anything perpetually unless there’s a strong fund generating mechanism supporting it. If someone expects that doctors charging 2 rupees fees are the ideal healthcare for all our medical needs, they should happily go to such a doctor. We highly respect them too, but it is their choice and there are obvious limitations to that. To develop advanced healthcare in India, higher profits were necessary for higher investment. Corporates, some businessmen and the likes of Mr. Ambani pitched in. Advanced healthcare with heart and liver transplants, complicated brain surgeries, cancer treatments came to India because of these investors. They accepted all the conditions of governments to accommodate over twenty percent poor, nonpaying patients via various schemes. The payments for running these schemes were delayed by various govts for years, and the hospitals were arm-twisted in still continuing to treat everyone. The only source of profits was private and some insurance patients who were paying a higher fees for facilities: from air-conditioning, food to choice of specialists. Higher quality of staff, especially nursing and technicians who can operate high end machinery and robotics requires very high salaries. Maintenance costs are heavy. A specialist cannot do much without such a very good team. Each of these requires good if not great salaries, as they are continuously invited by developed countries who pay far higher.

But then every patient wants the highest facilities, best staff and specialist team, with no payment or basic payment. There’s no concept of billing beyond actual price of medicines and room charges. Service and maintenance is considered a ‘free right’. © Dr. Rajas Deshpande
Even in this modern era of equality, a higher class Indian officer like a minister gets a higher room, better food and other facilities, even higher medical bill sanctions, whereas the labourer from his department gets minimum basic facilities and bill eligibility only for general ward. Law allows higher healthcare’s standards and payments for higher officials. Why do they even have classes in railways and airplanes? If a “Gareeb bechara” migrant wants to fly home, should we offer him road transport or compassionate air travel? Why don’t we do for all the poor something that you all expect doctors and hospitals to do?

We don’t mind if basic and emergency healthcare is uniformly cheap or free for everyone. But when you force a high-end medical commodity (skill-time-investment-staff) to be sold at a loss or extremely marginal profit, you kill the system.

Doctors do not differentiate when making a diagnosis or treating anyone from any financial/ power background. But the private hospitals must be allowed to cater to different classes, earning their profits. That is their only stimulus to grow forward, engage best personnel and bring advanced healthcare to India. Different governments have failed at maintaining high standards of healthcare in their respective set-ups (with some proud exceptions- but because that’s where our powerful go). Some hospitals indeed take more bills for better class of services, including staff, but none of them forces a patient to come to them. Even these hospitals never deny free emergency treatment to anyone.

“But isn’t healthcare a charity? Haven’t you taken oaths to serve?” our loudmouth hypocrites ask.

Yes we have taken an oath to serve everyone rich and poor equally, but no, we have not taken any oath to neglect our own health and well being. Yes we have taken an oath to serve, but we have not taken any oath to live in perpetual poverty and financial stress. Yes we are under an oath to do our best for every patient, but we will not be bending backwards to fulfil their unreasonable demands. Yes we want to save every life, even if it is dangerous , but we will not unnecessarily endanger our own life because someone forces us. We haven’t taken an oath to abandon our families. The Hippocratic oath does not ask any doctor to stay hungry, work without sleep, and do the unscientific because various governments cannot pay for adequate number of doctors. Still we are doing all this already. Let us be clear: we proudly and intellectually serve our country, but we refuse to be considered slaves of either the system or the society. © Dr. Rajas Deshpande

Capping bills in private hospitals will be the last bullet for all advances in healthcare development in India. Be prepared to go back to the chaos of ancient times in that case. Quality will suffer most: right from specialists to nurses to medicines. You can of course force one generation of doctors to work like this, under low cost and excess work. People aren’t fools to send their children to such hells of social slavery. Yes you read that right. There’s a difference between service and slavery. Do not attempt to turn medical service providers into slaves. It will backfire very sourly.

Instead of this, the government can invest in existing private healthcare players to create low cost infrastructure alongside their private hospitals, or privatising its own healthcare institutions with increased capacity. Our governments do have friends in very high places who can invest.

We love India. We are not against any particular government, and this post is not against any leader or party. But we do feel very strongly that healthcare decisions must be made involving everyone concerned, that this people-pleasing for short term will turn out to be a huge disaster in long run, and it will be irreversible. If any government thinks that cancelling hospital permits and doctors’ licences in a country with severe shortage of medical services is the right way forward, God help it.

If private and corporate hospitals start shutting down now, it will be permanent. India will then have to mostly rely upon prayers alone for healthcare. And of course those who think they know medical science more than doctors. India has no dearth of such “fatally self-medicating” ignoramuses.

Jai Hind

© Dr. Rajas Deshpande

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Disoriented


© Dr. Rajas Deshpande

“Doc, he appears confused. He has delusions. He was very methodical and logical earlier. He had excellent deduction and was considered a genius among his colleagues. Yet now he himself does not understand that he is making gross mistakes in making simple decisions. He appears completely disoriented…” the lady gave me an update in a deeply concerned voice. The devastating fear of mental, intellectual decline of a beloved is not grasped by all. For want of simplicity, we term it dementia. However, the meaning of this term is far broader and deeper than what most people can grasp, and the mental agony that the spouse goes through is beyond many a people’s emotional basket too. Infections and low sodium levels can often worsen the mental-cognitive personality of the elderly. I advised her a few tests to be done urgently and returned to my quarantine chores.

Her words kept on echoing for some time in my mind. This pandemic has challenged what the humanity perceived as truth till date. Disoriented, demented, illogical, delusional: isn’t that what the whole humanity has become today? Hasn’t this virus uncovered our intellectual, emotional limitations and selfish vulnerabilities? Have we not become exactly what the best human souls taught us never to become: money minded selfish humanoids hiding behind facades of clever and intelligent, politically correct wordplays, fatally attracted to glamour and clamour, emotionally cut off from the world, concentrating upon our families, cults, religions and regions? And of course, intermittently well-crafting the social service façade by donations, our signature face on every penny.

Financial success and numbers have become the new, hidden definition of life. Some wisely hide the word ‘Financial’ in the prior sentence. We won’t be able to name any financially unsuccessful / poor geniuses from the fields of medicine, science, art and even sports. I do not hate capitalism, in fact I believe that wealth creators are the ones who fuel the world. But among these are the compassionate and human who would rather be a million short of their billion rather than destroying a competitor and his/ her business. Squeezing-twisting every arm in the giant machinery that governs laws to finish everyone else and engulf everything with a gluttony that is hailed as business acumen is a real tragedy unfolding right now. We very gladly become the proud cogwheels of such ‘man-eating’ giant machineries that bleed competitors to a certain death.

While never being able to make peace with our neighbours we speak of world peace. We cannot bring ourselves to acknowledge the good in our competitors and enemies, we cannot deal with those with a different religion or country, come what may! While excepting ourselves from laws and rules we blame and blast those others who break laws. While secretly cultivating the filthy “money is all that matters” gene in our next generation, we encourage blindness towards the moral, ethical bypasses required to earn humungous money. The amount of real happiness, truth and honesty that needs to be sacrificed to be extremely rich is the worst inheritance our next generations will have to suffer from. Clever Wordplays is the sociopolitical success mantra of today!

I had never thought that I will witness anything more emotionally traumatic after seeing the hundreds of dead bodies and bleeding, broken-bone victims during the Killari earthquake. Today’s migrant crisis appears to cause deeper wounds than that upon our soul. This is a very tragic question, but what causes more hurt: witnessing dead bodies or extreme suffering of the living? Millions of migrants facing the worst wrath of fate, walking under a scorching sun towards a faraway home with their children, some dying, some delivering on the roads, strong men and women labourers breaking down and wailing – will be a shameful and guilty memory which I will carry for the rest of my life. We have excess caps and shoes; they are walking in rude heat bare headed and barefoot for hundreds of miles. We are discovering new cooking skills, they are discovering new depths of hunger. We are complaining about broken air conditioners, they are gasping for a glimpse of their beloveds in their zuggi-zopdi. We are too comfortable and grateful knowing that we are not them.

That India is overpopulated appears to be our strength on social media. We can show how many million fans, hits and likes there are, but we cannot speak a word about a tragedy which happens right in our backyard. We are scared of the worst: socio-political ostracisation, defamation, destruction of a hard-earned reputation and closure of financial support for survival. An intellectual is more scared of losing freedom of creativity, giving his best to the world and so mostly decides to be a silent spectator around strongmen with their invisible socio-political weaponry. Society as a whole has never protected or rewarded its intellectuals, especially in backward countries.

This pandemic will go. Few will have changed their perceptions of the world. Few understand that anything requiring a crowd must please a crowd’s intelligence quotient. Because crowds gather for hate easier than for love. Look at what content gets the best response: hate mongering, roasts, nudity, vulgar language and sloganeering. None of these is a proud achievement of humanity, yet these are the top hits. Pleasing a crowd can entertain, can earn one money, fame and votes too, but cannot ever bring this world health, happiness or peace. Entertainment, although critically essential for a stress-free mind, although soul-awakening, will never be among the first essentials of reducing hunger, pain, disease and suffering. There indeed was a time when entertainment was creative, with art, literature, acting, music and sports, fulfilling for the soul, but now only the superficial, jaded antics and the gaudy glitter with numbers remains the identity of most entertainment forms.

We indeed are disoriented. Yes, I too am guilty of some such disorientation. I have consciously decided to change. I do not have all answers right now, but I better appreciate the bigger picture now. My perceptions of what matters most have further changed. My faith in human nature has been deeply wounded, but my hope has always won, and I will help it heal even now. The current crises just told me what human race truly needs. My wish to make everyone understand has decided to take a back seat. My wish to do what I can is in the driving seat now. My contribution will be probably too small, but I have started.

I want to be well oriented for the rest of my life.

© Dr. Rajas Deshpande

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The Beautiful Secret

©️Dr. Rajas Deshpande

“I found her outside the public toilets near sassoon hospital” the lady said almost as a whisper after her daughter left the room. “She does not know. Nobody knows. Please don’t tell her ever”.

That 15 year old girl Teju was brought to me over 10 years ago, with uncontrolled fits. Not all fits / seizures are convulsions, there are many different types. Teju would suddenly behave abnormally without knowing it for a few minutes and then start crying. Her studies were affected as she had such episodes many times a day. She had been to some excellent doctors, but as she did not tolerate the medicines she had stopped them and refused to go to a doctor. Her mother Latha had somehow convinced her to meet a neurologist only once, so they were here.

Latha was a single, middle aged lady, who worked at a few homes all through the day mostly as a cook. Her husband had died long ago, and she barely managed to maintain her livelihood while living with Teju in a chawl. She narrated Teju’s history to me, but when I asked about parents having any fits or other neurological illness, Latha winked at me and said “No, I am okay, even her father was okay”. Then she asked Teju to get her a bottle of water from the canteen, and just as Teju closed the door behind herself, stunned me with her words: “I found Teju outside the public lavatory near sassoon hospital . She does not know. Nobody knows. Please don’t tell her ever”.

Then she explained in a hurry: “Doctor, you are like a brother, I will not lie to you. I had run away to marry my husband, but he was an alcoholic. He died in a road accident. I had no one left in life, and wanted to die myself. One night I was returning home from my job, and went to the public toilet on the way. There in a large heap of waste I saw this girl, only a few weeks old, almost dead. I took her to a doctor, told she was my sister’s daughter, and got her treated. Then I could not think of letting her go, I had found my purpose in life. I am a good cook and get by with salary from cooking at over 5 homes now. I want her to study well, but this epilepsy has been our curse now. I wish I was rich so I could treat her well”.

That last sentence hurt me. One, she was rich. Two, she thought good treatment needs one to be rich.

Teju had reentered, so we changed topic. I explained Teju her diagnosis in medical, scientific terms, and the reasons why this illness happens, how we can control it with the right medicines, and how her quality of life will be far better if her fits were controlled. “You will be able to look after yourself and even your mom well in the future if you are self sufficient” I used the trump card. She agreed to take treatment.

“Secondly, never worry about fees. You are a free case now onwards. You can even get discounted medicines at some pharmacies”. I told them addresses. Latha hesitated: “Doctor, we will pay, we don’t want to take advantage. We don’t want you to hush up because we don’t pay”. Their concern was genuine, and I assured them that I will do my best for them. No good doctor will turn away a treatable patient for want of money, I know many who treat poor patients free, unfortunately it never comes on record.

That was long ago. We were able to control Teju’s fits in a few weeks, and bring her drugs to a single dose of medicine. She followed up every six months regularly, each time with her mother. She gew up well, and always topped her class.

Only last month, she came alone.

“Doctor, I have a good news. I have been selected by a software giant in the USA. They have offered me a gorgeous salary too. I am leaving in a week’s time. I have come to tell you two things: first, please take care of my mother for a year, I am planning to take her with me to USA after that. Secondly, I can now pay the fees for both myself and my mom. I am rich now! So please tell your receptionist to make a bill for all my consultations till now.”

I laughed and congratulated her. “Well. I have promised your mom something, I will sort out about the fees issue later with her. As for her medical care, don’t worry I am here. I am glad you are taking her with you, many can’t”.

“Oh never! I can’t dream of leaving mom alone here. She has grown me up alone after my dad died. I know how hard she has worked for her daughter” shesaid, with wet eyes.

I had an emotional moment, a sudden urge to tell Teju the truth. But I refrained. This indeed was the truth now. Latha was Teju’s mom, and I had no right to change that. I regained my composure.

When she touched my feet, she asked “Do you want anything from the USA doc?”

“Thank you, I have everything I want with God’s grace” I told her the truth. Indeed, He had given me the ability to change lives positively, to contribute to humanity in innumerable ways, to help people live better lives, nay – the best lives they could. What more could I ask for?

©️Dr. Rajas Deshpande

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True Story, names changed.

The Mathematics Of Kindness

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© Dr. Rajas Deshpande

“Are you coming, doctor, or shall we file a complaint? We will go to the police if you don’t come in an hour”.

It was about 12 noon on a Sunday. My sister and her family were visiting for three days, this would be our only lunch together in this year. All other days I am in the hospital at the lunch hour.

A teenager was admitted for last two days with repeated alleged episodes of fainting with unconsciousness. His friends and family were all at the hospital, calling incessantly from different numbers. They were given my cell number by a colleague as he thought it was an emergency. I had seen the patient four times in last two days, rushing from the OPD as there were alarming calls. We had done all the necessary tests and found nothing wrong with the kid, we had concluded that he was malingering / faking these episodes. A neurologist has many tricks to unmask the truth. We had explained the facts to his family, a psychiatrist had confirmed this, and scheduled a meeting with the family on Monday. Till then we had added anti-anxiety pills and told the family to be patient. All the vital parameters were normal. I had explained the family to be patient.

My boss called, he was frustrated too. “Ja ke dekh le ek bar (Go and see him once). Some minister just called for him” he said.

Excusing myself from the lunch, I reached hospital. The teenager’s girlfriend was standing in panic by his side, crying while he was ‘unconscious’. The brother and friends raised their voices: “Why is this happening, doctor, why don’t you do something? Why is he not responding to the treatment? It is three days now. He is suffering so much”.

I am trained as a doctor to tolerate anger, frustration, anxiety, stupidity, bitterness or accusations, but I refuse to tolerate drama.

“I have explained to you many times. This is not real unconsciousness. A psychiatrist will have a meeting with your family tomorrow, till then there’s nothing more we can do”.

“What if he dies? What if you are wrong?” shouted the relative. I did not have an answer. I left the ward after messaging my boss, also asking him to transfer the case under someone else. The next day my psychiatrist friend called me. The teenager’s girlfriend was from another religion, parents on both sides had opposed their marriage, and this illness was their “brilliant solution” to get the parents to change their minds and agree. Cheap drama!

There’s no mathematics to kindness, we have all been taught. Do good, be compassionate and don’t expect any returns. People take advantage, but that is Their nature, you be yourself, kind and compassionate.

I was once returning from my Goa visit, there were long queues of frustrated people. Two apparently rich Indian tourists walked in, typically dressed for a Goan vacay. They saw the long lines, changed their faces, and rushed to the front of the line. One of these approached a foreigner in the line: “Excuse me, we will miss the flight… we were stuck in traffic.. my sister is sick, I must reach Delhi in time”. The foreigner, knowing that these were blatant lies, still allowed him to go ahead of himself. Kindness is almost a compulsion. Once on the other side of security, these “line-jumping liars” had the obvious expression upon their face: “Ullu banaya tum sabko (We made a fool of y’all)”.

At the hospital entrance, I often meet a paraparetic man in his scooter for the disabled. He usually blocks the hospital entrance with his three-wheeler scooter parked there while he talks at leisure with his friends. If anyone honks, they all play this “Can’t you see he is disabled? How rude!” card, intended to make others feel guilty. Even when it is an ambulance or a doctor’s vehicle, he will intentionally slowly move from the spot.

Every doctor, almost every day, meets people who blatantly lie: to bypass waiting lines, to ‘finish off with parent’s health issues over the weekend’, or to get concesions, free treatment. Some lie to exploit kindness and compassion, some to exploit financially. There are no guidelines defining an emergency and the charges for such “pseudo emergencies”. A doctor on duty must always resopnd to an emergency, but if off duty, he should be able to refuse cases on a holiday. All government hospitals have a 24/7 emergency department, the patient can be taken there.

Recently heard that an Indian lawyer charged in crores to an Indian client stuck on an European airport for a legal advice in an emergency. There were no cries about compassion, kindness or even patriotism. What should a doctor charge for a pseudo-emergency, especially when a precious holiday is wasted?

When I discharged this case, they asked me when to follow up. I replied without hesitation: “Never with me”.

© Dr. Rajas Deshpande

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The Sunshine Girl

The Sunshine Girl

(c) Dr. Rajas Deshpande

The beautiful 14 year old girl was almost motionless. Her body was completely stiff, eyes fixed in one position, she could not move at all. Any attempt to speak or move would send her entire body in violent spasms. She could not even cry for the fear of this painful stiffness, but her pillow was wet with the tears rolling down her eyes. Her parents had wheeled her in on a stretcher. They had landed just yesterday in Mumbai, travelling from Iraq with her. Her father was illiterate, while the mother was a science graduate from Baghdad University. While internally torn with the condition of her daughter, the mother very calmly and peacefully explained me the condition of her daughter Khazan.

On the day of school annual function just five months ago, Khazan’s teachers in Iraq noticed that she was limping while dancing on the stage. They told her mother about this. Khazan was taken to a Neurologist there, who found that she had some neurological signs, with brown coloured rings in her eyes. This ring called a ‘KF’ring is usually found in patients who have a rare disease called ‘Wilson’s Disease’. Due to a fault in Liver, copper cannot be excreted out of body, it accumulates in the liver and in the blood, rising to high, toxic levels. This excess copper in the blood then starts damaging every organ in the body, but first it causes severe damage in the brain and eyes. If not treated, the patient becomes disabled soon and dies. The biggest problem is that many patients may worsen with treatment in the initial phase, with medicines which act fast. The cheaper medicine (Zinc) which does not cause such worsening, is too slow to act, it takes months. (c) Dr. Rajas Deshpande. Khazan was started with the first medicine in Iraq, but unfortunately, she became paralysed due to the side effects of the medicine. The Neurologist in Iraq started with the second, extremely costly drug. Her parents sold off their land, business and even home, and shifted to a rental small house to afford this medicine that had to be imported from USA. As fate would have it, Khazan reacted adversely to this too and further worsened. She became completely paralysed, could not eat or speak, and was then advised the last option, the curative treatment for this disease: Liver transplant. (c) Dr. Rajas Deshpande

They applied for loans from some charity organisations, and landed in India for Liver trasnsplantation. “We were told that the doctors in India are the best in the world, and the cost of treatment is lowest in India. So we decided to come here” her mother told. Indeed, the cost of medical as well as surgical treatment in India is lesser than half compared to the developed world. For simple appointments with specialists, the waiting list in the developed world exceeds weeks to months, and surgical appointments take years. Once, in my childhood, one of my uncles gave me some dessert, like everyday, which I didn’t care to finish. My aunt asked me with surprise: “Why don’t you eat such a delicious dessert?”. My uncle immediately said “Because he gets it so easily. Ask those who don’t get it, they will love it”.

We found that Khazan was almost skin and bones, dehydrated, and anemic. She had developed many Parkinson-like symptoms and some psychosis. I explained her condition and told her mother: that she was semi-critical, that I wanted to start with the cheaper, third medicine and give her supportive care, but it would take a long time, I could not guarantee anything. Her mother told me via the Arabic interpreter Mr. Tabrez: “Doctor, we do not want surgery for her. Do what you would have done for your own daughter. We will close our eyes and do whatever you say. We will hope she improves, but we understand you cannot guarantee anything”. Now the onus was upon me, the responsibility was mine. We started treatment. Khazan’s graduate mother knew more about Wilson’s disease than many medical students, yet she never came across as arrogant or argumentative. She politely asked doubts. A good doctor grows with every patient. (c) Dr. Rajas Deshpande

My students started helping out the family, making Khazan feel at home. Love and compassion for the patient enhances the effects of all medicines in most cases. Add the trust and willpower of the patient, and you usually have a winning prescription. From the shadows of a near-certain death, Khazan’s body and soul started to awaken to the sunlight called life. She gradually started speaking, drinking water, and in a few weeks, eating small morsels. They had to return to Iraq, and we communicated via video chats. They returned twice to India for reassessment and change in treatment.

A few months after their last visit, I received a letter. It was written in English, by Khazan. She had joined college now, and wrote that she wanted to become a doctor like me. Her mother had added in Arabic: “My girl is the sunshine of my life, thank you for bringing her back from the claws of death”. I had received my reward. Khazan is doing very well now since last three years, with God’s grace. Of course I did not forget to remind her that most of the credit of her recovery was to the unparallelled grit and efforts of her mother.

Magical, Near-supernatural, Miraculous recoveries happen every day in India. Patients, young and old, with almost nil chances of survival, walk home smiling every day, in almost every Indian town, even in the most rural areas, thanks to the efforts of thousands of doctors working 24/7. These doctors are never appreciated or rewarded. This post is dedicated to those messiahs of Indian Medicine.

(c) Dr. Rajas Deshpande

This story is real. Many doctor colleagues and physiotherapy students have helped me treat this patient over years. Wilson’s Disease can be completely cured, there are many experts working on tis in India.

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The Sensitive Girlfriend and The Monster

© Dr. Rajas Deshpande.

“She is oversensitive, Doc. I try to explain to her that this is so dangerous, yet she does not want to change, and continues to suffer” said the boyfriend.

As a doctor, I am expected to be sensitive. I cannot be a phony and pretend to be sensitive while not being so. Fortunately, life and times, parents and teachers have always insisted that I remain sensitive to the core. I think that is one of the most precious quality any human being can have after peace. Naturally, I am biased towards the sensitive.

However, there is a big difference between the ‘hysterical, dramatizing’ ones and the truly sensitive.

“Can you give me an example?” I asked him, as the girl looked at him curiously.

“Yes” he said, “Her boss keeps on saying demeaning things to everyone, and she almost always comes home hurt. Even if I comment anything adverse, she gets hurt easily. Like yesterday I told her that she should be more practical and instead of asking to spend time with me, do something of her own. We had a great fight after that”.

“What were you doing when she asked this?” I asked him.

“Oh I was at home, relaxing, as I was tired from work” he said, cautiously.

His girlfriend smiled “Doc, he was playing games on his cellphone. I was tired after work too, but he refuses to spend quality time with me as he is now almost addicted to social media and games. The only time he wants me is when he is hungry”.© Dr. Rajas Deshpande.

I saw at once what was happening. I was myself quite addicted to social media once, but now I have started to de-addict myself. It is indeed difficult, but for a doctor it is quite essential, nay, life-saving. My patient’s life and health depend upon the accuracy an wisdom of my decisions, and that is possible with only a hundred percent concentration. But that wasn’t what bothered me here.

I have been told umpteen times by people in the ‘business’ that “sensitivity and kindness” comes in the way of making money and other professional goals, that people skin and eat you alive so long as you allow them to exploit your sensitive nature. ‘Sensitivity’ to other people’s feelings is considered a weakness in most business circles, and right from the student days, we meet people who take advantage when you respect their feelings. This ranges from exploiting those who are mannerful, helpful, and kind, to creating a deliberate emotional disturbance for the competitor during a competition. Surprisingly, this is taken as a normal strategy even in such a gentleman’s game as cricket.

I could not find it in myself to be insensitive to how others feel. I could not switch on and off my emotional responses and sensitivity. Yet, I never felt that it was a shortcoming or a weakness. In fact, most of the patients I connected best with have told me that they find it very reassuring when a doctor is sensitive. Hence I devised a personal strategy: to keep away the advantage takers, the drama people, the insensitive robots who are only after money without caring about the feelings of others around them. Observe behavior rather than words, and you know a person well. This helped me quite a lot. I earn a little less than I would want, but I think that is a universal feeling, and that is never the prime aim of life.© Dr. Rajas Deshpande.

It made my life beautiful. Sensitive people bring much positivity, trust, faith and contribute significantly to the inner peace of others. With them around you are assured that you will not be deceived, not taken advantage of. That brings you the highest luxury upon earth: peace of mind.

Most bosses work on the perpetual Indian Corporate Philosophy “Unless you squeeze and crush, there’s no juice”. Employees at all levels are overburdened, asked to do a lot more than their job profile, forced to finish within insane deadlines and still treated like they are easily disposable. Employee health, physical or mental, is never the concern of any boss. A fault-finding, comparing, humiliating language is usually what bosses prefer and most employees accept. This builds up a culture of rudeness that is now accepted as a ‘reality and normalcy’ of any business. Very few honorable bosses treat their employees according to their sensitivity to enhance productivity. I wonder if Human Rights commissions or agencies, federal or private, ever notice this.

I asked the girlfriend if she wanted to contribute. She said she understood that he was stressed, but she worried about a ‘mental disconnection’ so common now because of digital addiction, and wanted to destress him by making him laugh and feel loved. © Dr. Rajas Deshpande.

“I want a mental bonding with him and that is not happening, as almost all the time he is home he is occupied with his cellphone. In fact, doc, when we started dating, he used to tell me that my sensitivity attracted him most, he thought I could best nourish his soul” said the tearful lady.

I explained to the boyfriend that sensitivity, so long as it does not impair normal functioning, is a very precious attribute, that he was extremely fortunate that she was sensitive rather than insensitive. To consider her “right to companionship, dedicated time together” as an unnecessary ritual, because he wanted more time for social media browsing and gaming was the actual problem. In these days of equality, to “want her to be sensitive and enthusiastic” only as per his convenience was an unfair expectation. He assured me that he will make an effort to implement a few changes in his routine. I thanked him for accepting reason.

As they left, a fairy-like young girl of about 7 years walked in with posh parents. Her mother kept looking into the cellphone, and her father started to tell me about his continuous headache. Like every normal child, the kid pointed at my stethoscope and said she wanted it. Just before I could allow her, her father shouted at her.

“No” said the angry father, and looked at her mother with an expectation. The mother kept on looking into her cellphone. Then the father thrust his own cellphone on the hands of the kid and said “Here. Play your game, I need to talk to the doctor”.

© Dr. Rajas Deshpande.

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Reboot Fate, Kanika Is Here!

Reboot Fate, Kanika Is Here!

© Dr. Rajas Deshpande.

At 12 years she was on the top, an athlete who also won the scholar badge for three consecutive years and special honors at her school. Just then, a rare neurological condition played havoc in her life. She had multiple tumors, suffered a paralysis, was wheelchair bound for over two years. Then she suffered from depression, suicidal thoughts, high blood pressure, and multiple health issues which sometimes threatened her life. She had to leave school. She suffered bullying by kids her age, she had severely painful muscle tears that made it impossible to move hand and leg. Many hundred blood tests, some invasive procedures like lumbar punctures, and even a biopsy were all inconclusive. She also went through medical horrors: rude doctors, huge expenses and uncertainty. Her diagnosis is still not fully established.

But her status as a winner in the battle with fate is well established. Meet Kanika Kesri. She walked again after two long years today.

In August 2015, Kanika started having fever and severe headaches, and started becoming weak. Lot of tests were done, and she was found to have a tumor in her abdomen. A surgery was planned in Delhi, she was taken there. The specialist decided to first biopsy her tumor. The biopsy revealed a possibility of tuberculosis, so anti tuberculous medicines were started. She developed paralysis of the face and eyes, nothing could be done as the only medicines that could improve her condition – steroids- could cause dangerous worsening of her tuberculosis. In December 2015 she developed weakness in the left leg and could not walk. An MRI done then showed that she had developed multiple tumors in the brain and spine. She was then diagnosed with the most dangerous and often fatal form of tuberculosis: MDR (Multi Drug Resistant) Tb.

She was started with additional medicines and her parents were told that nothing more could be done. Her condition worsened during one of the lumbar punctures and she became bedridden, almost completely dependent. Someone told her father one of the worst medical possibilities: that this could be some form of cancer.

One of my earlier patients, Mr. Rahul Agarwal, brought Kanika’s father Mr. Pankaj Kesri to me in a devastated frame of mind. Lost in uncertainty, extremely angry at the behavior of some doctors, and frustrated with the expenses while being away from the job for a few months, he was still very polite and humble.

Her case was indeed baffling. I went through all the details, involved my colleagues at Ruby Hall Clinic, and even some of my teachers in Mumbai. The answer was almost the same everywhere: don’t know what this exactly is, but don’t stop the anti-tuberculous medicines.

Something was wrong, the girl was deteriorating in spite of taking the tuberculosis treatment. In a discussion with her parents, when her father said he had complete trust in the way we were treating her, I put forth an option: to give Kanika steroids, and if she improved, to consider withdrawing the anti-tuberculous medicines. This involved a serious risk to her life if her presumed tuberculosis worsened. With a very heavy heart, her family consented.

We started steroids. Kanika improved. We stopped the tuberculosis medicines. She continued to improve. She could now stand with a walker. Unfortunately, twice during physiotherapy sessions, Kanika tore her muscles: once in the thigh, which made it impossible for her to walk. She was bedridden again.

Till this time, Kanika was all positive, vigorously working to recover. The long illness now started to affect her mind. She became depressed, her sweet smile vanished. She tried to join school, but isolation and bullying worsened her mental agony. She started having suicidal thoughts. Very mature for her age, Kanika decided even in that condition that she was going to defeat the situation. She confessed about her thoughts to her parents. We arranged a counsellor for her. Just as Kanika started to recover from depression, the side effects of steroids started to come up: weight gain and high blood pressure. New blood pressure medicines were added. There are some alternatives to steroids, but she did not tolerate them.

Kanika wanted to study further. She joined home schooling, an excellent option made available by the central government, through NIOS (National Institute of Home Schooling).

One of the most complicated cases I have seen in this young age group, Kanika suffers from a very rare autoimmune condition. Her immune system has some dysfunction that causes multiple tumors in her body, these tumors usually resolve with steroids as they suppress immune system. The closest condition that resembles this is known as Neuro-Sarcoidosis, but some of Kanika’s tests for this were negative too.

Kanika’s parents chose to always come across pleasant and polite. “I know my daughter’s health is above all my complaints. I have chosen to concentrate on the positives” Mr. Pankaj Kesri says. Kanika’s mother Mrs. Rajni had to face a double-edged problem: while adolescent Kanika developed many ups and downs in her moods, Mr. Pankaj Kesri was transferred out of Pune. Mrs. Rajni fought alone on many fronts, while also looking after Kanika and her elder sister Kritika, who they call their pillar of strength.

It all was rewarded today, when Kanika walked without support after almost two long years. I was so happy with the miraculous moment, that I called upon my CEO, Mr. Bomi Bhote, who has always encouraged highest standards of medical care, leaving no stone unturned to bring it under his roof. He was so happy to see Kanika walk again, that he recorded the moment himself. “My wish is to see you run” he told a smiling Kanika.

We learnt a lot: many a times, some patients tolerate a lot while facing medical issues: the worst being a rude doctor. We doctors must ourselves ensure that we offer the best compassionate counseling to each such patient before we demand their faith and trust. It is never automatic. The process of medical care is an ongoing one, and it must be guided by a single principle: decision making in the best interests of the patient. A lot of study and awareness of medical advances on a daily basis is essential.

Kanika to us is an example of exemplary courage, grit, maturity, positivity and patience. She is a role model for anyone who is going through a negative medical phase. May she get back to normalcy soonest possible, may she recover completely, may she achieve whatever she sets out to achieve. She has proven many times over till now that she is a born winner.

In the beautiful moment that Kanika walked again, I found the blessings of my parents and teachers.

© Dr. Rajas Deshpande

PS: Thank You, Ms. Kanika, Mr. Pankaj and Mrs. Rajni Kesri for permission to share this story of courage.

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A Dark Corner In My Medical Life

A Dark Corner In My Medical Life

(c) Dr. Rajas Deshpande

“Doc, she is becoming unconscious many times since last night” said the worried husband Mr. Robert Jolly, “even since today morning, she went blank twice”.

The young Mr. & Mrs. Jolly couple was married two years ago, and both worked high-profile. Mrs. Shona Jolly reportedly never had such problems in the past, as confirmed by her mother. Just as I was asking them questions, her neck turned towards one side and she appeared to have become unconscious again. The terrifeid Mr. Jolly tried to wake her up. I asked him to step aside and checked her pulse and heart. Everything appeared fine, but she did not open eyes.

However, while I checked her, Mr. Robert Jolly’s peeping over my shoulder annoyed me, but what really surprised me was the indifference with which Mrs. Shona’s mother was standing aside, calmly watching her unconscious daughter and panicked son in law. We neurologists learn after a long experience how to differentiate whether the patient is truly unconscious or just faking it.(c) Dr. Rajas Deshpande

We are not always right, sometimes the patients indeed have unexplainable symptoms or behavior. So we try to refrain from jumping to early conclusions. I explained them that we needed to run some tests before we could finalise the diagnosis. Mrs. Shona was admitted. The husband Mr. Robert shadowed her 24/7. As the MRI, EEG and almost all other tests turned out normal, I reviewed the case and examined her again. Everything was normal. Now was the time to ask her some private questions.

“May I ask her some questions in privacy?” I asked Mr. Robert.

“”Doc, we hide nothing from each other. I am sure she won’t mind if I stay here”, he said, and looked at Mrs. Shona.

Smiling heartily, she repied “yes doc, you can ask me anything. I don’t hide anything from my husband”.

I told her that as all the tests were normal, we had to look at the possibility of psychological factors like stress, depression or personality disorders etc. , which could cause some of the symptoms she had.

“Oh no no, not at all. I am very happy, I have no stress at home or workplace. I am sure doc, this is not psychological” Mrs. Shona replied. We then had two more opinions by senior consultants. They too did not find anything abnormal. Her “attacks”continued.

On the third day, outside the ward, patient’s mother waited in the corridor, where the couple couldn’t see her. She gestured to me, and whispered hastily “Sir, I am Shona’s mother. Please refer her to a psychiatrist or a counsellor. She has had similar problem in her past, and had felt better after a psychiatrist treated her”.

This was difficult. How could I pressurise the highly educated Mrs. Shona to visit a counsellor / psychiatrist? As her husband continuously accompanied her, it would also be unfair to refer to her past illness in front of him.

I asked Mrs. Shona cautiously: “I feel at this stage we must also involve a counselor, and request her opinion about what is happening”. They both agreed, and I sent her to a counselor. Next day, I received a feedback from the counselor: that the patient definitely needs to visit a psychiatrist. I told Mrs. Shona again that I wanted to speak with her in privacy.(c) Dr. Rajas Deshpande

She quite emphatically said “Whatever it is, Doc, please say it in front of my husband”. Then I told her about the feedback from the counselor.

They went to a psychiatrist suggested by the counselor. She was diagnosed with a condition, and when they followed up to inform me, her mother disclosed in front of Mr. Robert Jolly that Mrs. Shona had been diagnosed and treated earlier for the same. She also guiltily mentioned to Mr. Robert that Shona had threatened her parents that she would cut them off in case they ever spoke about her illness to him or his family.

Once her treatment started, she improved. In a shocking turn of events, Mr. Robert Jolly chose to file for a divorce. Six monts later, I received a bitter letter from Mrs. Shona : that I had not been fair to her because I had referred her to a psychiatrist in front of her husband, that I should have kept her illness confidential and hidden from her husband. She even went on to say that in a way I was responsible for her divorce.

I had done nothing wrong, but this was indeed an emotional blow.

Patients often confess to their doctors what they hide from even their closest family members. This includes many things unacceptable to the society: drug consumption, visits to commercial sex workers, abnormal thoughts and behavior including violence, confessions about the past, extramarital affairs, porn addictions, abuse, abortions and even some diseases like AIDS, Tuberculosis and psychiatric issues as mentioned above. In the extremely orthodox and prejudiced society that we live in, even the legal, moral boundaries of what constitutes private information in such cases are not clearly defined. A husband or parents are automatically presumed to “own”the patient and every bit of information related to the patient, directly questioning the doctor and refusing to follow simple courtesies, manners or etiquettes towards their own family members. There are no presets / guidelines about privacy especially related to women or children.

A doctor’s job becomes all the more difficult when dealing with aggressive, litigant, blame-game prone patients and relatives, from both high and low educated classes. One must treat such cases extremely carefully, and our medical bodies must form strict criteria about patient information privacy that cannot be violated by even their family members.

I kept feeling sad and somewhat guilty about what had happened. But that is also what a doctor must learn to digest. One more dark corner of a doctor’s daily life.

(c) Dr. Rajas Deshpande

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Be A Woman!

©️Dr. Rajas Deshpande

A major part of the pride of being a doctor is the freedom from any discrimination between humans. Every woman or man, from any religion or country is equally important, and also equally cared for.

Yet as a doctor I have often witnessed women being stronger than men when life presents any calamities, however explosive. Women are probably more emotionally destroyed with a traumatic event, yet they pick themselves up and fight like a mother for whoever they choose to stand by and protect. And we know, a mother makes a strong army! Any patient cared for by a woman heals faster, be it a nurse, a sister, servant, daughter, wife or mother, be it a girlfriend or just a woman without any relation. In any family, it is usually the women who keep the bonds of humanity and culture alive. We have so many biases about cultures and how women are treated, but it is an unfortunate fact: that women do things men find impossible. Hence the title, Be A Woman!

We often hear from working men in the metropolises how they cannot bring a parent in wheelchair to the hospital as it would be a lot of trouble and time.

Ms. Eshrak (a psychologist) and her sister (a bank employee) brought their mother on a stretcher all by themselves, all the way from Cairo, Egypt, to Pune India, in a hope to see her walk again. To travel to another country without knowing anyone there wasn’t their biggest problem. Reaching India from the war-torn middle east is a nightmare, but once they reach, local Indians, especially police officials are very cooperative in helping out especially patients coming for treatment to India.

They found a friend in a local Arabic student Mr. Ashraf Olafi, and had him search my clinic (I am sure any good qualified neurologist could have treated them equally well!). Their mother, suffering from Parkinsons Disease, walked after many months today, so they came with the two greatest gifts for their doctor: a smiling gratitude and blessings. Of course they brought a material token!

What better proof can there be of women not being dependent upon men? If only we recognised how incomplete and incompetent humanity would be, without the strength of women!

To artificially write about gratitude for women in one’s life and to thank them superficially to impress press and public has become a fashion, few do it from their heart. I pity those “high flying, successful” men who boast about how they respect women and consider them equal, while their wives are in fact taking care of their home and children, opting for hugely compromised careers. The truth is, a man, however strong, is always indebted to some woman!

Be A Woman!

That should always have been the correct slogan..

©️Dr. Rajas Deshpande

“My Turn Now”

©Dr. Rajas Deshpande

“I don’t want to live like this. I have stopped eating since today. Please do not be angry with me for this, but I cannot see you and my children suffer because of my illness. Let me go with peace” Geetanjali said to her husband.

Eighteen years after her marriage, in her late thirties, Geetanjali suddenly lost the function of one half of her body. Her children were still in school. Her husband Gajendra Jagtap works as a school teacher and does some farming on a small piece of land they own. The whole family was shocked and shattered with this calamity that befell Geetanjali. But Gajendra Jagtap decided not to be broken down by destiny, and took his wife immediately to the best hospitals in Mumbai. They were told that Geetanjali was suffering from Multiple Sclerosis. After a few days of treatment, they could not afford to stay in Mumbai and came to Pune as it was nearer to their village. The Multiple Sclerosis Society of Pune extended its helping hand. Geetanjali was yet unable to stand up or walk. ‘This illness is totally unpredictable, anyone can develop blindness or disability anytime’ doctors told them. Geetanjali felt hopeless. She was very depressed with the thought of stressing her husband financially to provide for the treatment expenses. She also worried if her children’s education will suffer due to her illness and financial constraints. This was the reason she decided that she did not want to live any further, and gave up eating or drinking anything.

But Gajendra was not the typical Indian husband. This B. Sc. Graduate who had taken up teaching in a rural school as his profession had a big heart, and harbored principles of equality and respect for women, just like a highly educated spouse in a developed country. He told Geetanjali, ‘You have served me and our children for over eighteen years now. When I was working in the school or in the farm, you looked after the home, cooked for us and fed us sumptuously. Now give us a chance to repay for what you have done for us. It’s my turn now. I am going to take care of you just like you cared for us.’ Geetanjhali could not hold her emotions and sobbed when she narrated this story to me.

‘At that point of time, I felt like living only to help my family. I decided to use whatever few healthy days I had to make my husband and children happy.’ She started to fight her disability with a new spirit, and in a few months could walk very well again. Since then she had attacks of this disease many times, but vehemently fought it to recover every time, with the help of her husband.

Gajendra told me “I explained my children our situation. I told them that we don’t have much money left, and that they must only complete their education based upon merit. We are very fortunate that our children decided to grow up quite early in their childhood. Both of them studied very well, and my elder son is now doing his post graduation which he got through a scholarship in Delhi. Even my daughter got excellent marks and is now pursuing her post graduation by winning a scholarship. Both of them take care of their own expenses, and never bother us for money. Even I have decided that whatever our destiny presents us with, we will face it with a smile, and never accept defeat in any situation. We have to visit hospitals many times, spend on treatment and investigations, travel many times, but we do it all with a spirit of winning together. Whenever she can, she still takes care of the home, and when she can’t, I do it with the help of my daughter. But we never feel desolate or depressed”.

In the developed world, people suffering from this illness get a lot of healthcare facilities, and even income tax concessions. However, this farmer from a lower middle class background who does not receive any such help, has not only resurrected his family, but created a new life for his wife with his sheer love and determination. The most admirable thing about his love story is the respect and feeling of equality with which he thinks of his wife. Geetanjali also stood up firmly with him to conquer this illness, with all her love and might. Together, they have indeed defeated their destiny.

We sincerely pray for the excellent health, well-being and long life for each member of this wonderful and ideal family.

© Dr. Rajas Deshpande

Neurologist, Pune

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