Tag Archives: Writing

To pause for respect

To pause for respect

To pause for respect

© Dr Rajas Deshpande

After completing the neurological examination, I asked Mr Harkishan Budhrani to sit down and put his shoes on. His son accompanying him got up, sat near his father’s feet and started to adjust his father’s shoes for comfort.

To pause for respect was my only choice.

Mr Harkishan Budhrani is a British citizen, and so are his sons Mr Naresh and Mr Raj. Every time one of them accompanies Mr. Budhrani for the consultation. They not only come prepared with their father’s health details, but also take notes and follow all the suggestions. Yet what is most noticeable for me as a doctor is the care and respect with which they speak to their father and treat him. There’s nothing artificial about their attitude, which makes it special! They take his permission for every change we agree to make, explain him and patiently wait for his consent and questions. They hold his hand and even ask him whether it is ok to walk ahead! Rarely do we see children from very affluent families being so careful and loving to their parents.

In an era where many a times sons and daughters accompanying their parents either bluntly ask “How long is the parent going to survive, What basic minimum can be done without much expenditure, Is it okay not to treat at all” etc., when we come across such extremely gratifying moments, I feel that all is not lost. By experience now I don’t think that this belongs specifically to Indian culture, in fact people from most cultures in the world treat their parents far better than many Indians. The very fact that Our govt and courts have to make laws and take steps for abandoned and neglected parents speaks a lot about what is happening. In fact, the more affluent a family is, the less likely that the children genuinely care for their parents.

Taking for granted that the parents do not want to live longer, deciding on their behalf that expensive treatments are useless and unwanted, oversimplifying all complaints as ‘age related’ and completely neglecting medical care are common observations in our practice.

This moment therefore brought me a beautiful ray of hope.

21st July 2018 is Mr. Harkishan Budhrani’s 85th Birthday. While I pray for his excellent health and perpetual happiness, I wish that every parent is as fortunate as him and that Mr Budhrani lives on many more hundred years as an example for all of us.

©️ Dr. Rajas Deshpande

Victim? Dr. Reena’s story

Victim? Dr. Reena’s story

© Dr. Rajas Deshpande

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dedicated to those such who have had this horrible experience.

© Dr. Rajas Deshpande

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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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MEDICARDIA: A Doctor’s Diagnosis.

PP.jpg
© Dr. Rajas Deshpande

Rimless spects, ipad, T-Shirt and denims. Brilliant face, thinning hair. Attitude. A face carefully wiped off of any expression. The typical new age intellectual waited outside the ICU. Body language: severe anxiety.

“Doctor, do whatever you must, his convulsions must stop” said Mr. Prasad. His father was having continuous fits for over three hours, he was just admitted directly in the ICU after all the home remedies had failed. His oxygen levels had dropped to dangerous levels. Patient had ready aspirated during his convulsions. His food had regurgitated and entered his windpipe.

The last treatment for continued fits is completely paralysing the patient with general anesthesia, intubating and starting artificial respiration with a ventilator. There is risk, but lesser than if the patient continues to have fits. Every doctor, for every patient, must make a decision based upon the risk-benefit ratio. Every treatment, medicine or surgery, also has potential risks. The decision that can potentially cause someone’s death is not easy to make. Every doctor lives on the edge of this risk.
Add distrust and suspicion, and we are dealing with law more than with medicine. Welcome to the medico nightmares! © Dr. Rajas Deshpande

The critical care team had already explained the risk to the Mr. Prasad. He had signed the consent, including understanding of the critical condition. We intubated the patient and ventilator was started. The fits stopped. A chest physician was also involved in the treatment. Monitoring of the brain waves still showed abnormal currents in his brain, so he was kept paralysed next two days.

On the third day, the patient developed fever, most likely he had developed a chest infection, so common after aspiration. His condition worsened, his blood pressure dropped. We informed the family.

“Why didn’t you prevent this?” asked Mr. Prasad.
“Sir, have you ever had any cough, cold, fever?” I asked.
“Yes, many times. What has that to do with my father’s infection?“ he replied.
“Why couldn’t you prevent it?” I asked, “Anyone can develop an infection or a heart attack anywhere outside the hospital and it is ok, but if it happens inside a hospital, why does it suddenly become a doctor’s fault? Hospital acquired infections are possible in spite of all precautions, in the best of the hospitals across the globe. The elderly population is especially more prone for infections.”
This being a routine question, there was no reason for me to lose my patience. © Dr. Rajas Deshpande

Our team worked hard to maintain the unconscious patient alive. His heart rate fluctuated, blood pressure dipped to non-recordable sometimes, blood sugars went high, liver and kidney functions were deranged, but we kept on playing the “Medical Chess”, where one doesn’t know what move nature will make next, the only possible next step is to accurately, promptly and wisely counter that complication.

His lungs started failing, the chest physician advised steroids. At this stage steroids could either be life saving, or could cause havoc by worsening the infection. Mr. Prasad was explained the situation.

“What are the chances of survival and complete recovery?” he asked.
“Unpredictable, Sir” I replied.
“Then why use steroids?” he asked.
“If we don’t, the chances are less than if we do”. I replied.

Steroids were added. The patient stabilised and then started improving gradually. Over next five days there was a dramatic recovery. Steroids were stopped.. Mr. Prasad remained expressionless, questioning every move. Three days later, once he started breathing by himself, the ICU team informed me that the patient could be extubated- the tube for ventilation could be taken out. I was in the OPD, I okayed the decision.

In a few minutes, Mr. Prasad rushed into my OPD.
“Doc, my father cannot speak. He has lost voice”. He was quite angry and anxious.

“Let me check” I said and went to the ICU.
The patient was otherwise fine. The throat tube inserted for ventilation sometimes causes swelling in the throat, involving the vocal cords, and such “hoarseness” or loss of voice is common after this procedure. Using steroids facilitates recovery, but in this case, it was now risky to use steroids. We explained the situation to Mr. Prasad. © Dr. Rajas Deshpande

“When will he recover from this?” he asked.
“Usually two weeks, but still one cannot say exactly” I replied.

“Why didn’t you tell this to us earlier? This is atrocious. I will file a complaint. We will go to the court. My friend is a reporter. I will also write on social media about this, that because of the treatment here my father lost his voice” he started shouting.

He did file a complaint with the hospital. Everything was on paper, everything was medically and legally correct. Still the administration must ask me questions and I must reply. Many long emails and documentations followed. One reporter called and enquired about the case, I explained her the situation.

I didn’t sleep well those five nights. Medicolegally we were safe, but who was to deal with the media allegations, the resultant defamation, irresponsible hurtful comments by every TDH on the social media?.

The patient was still under my care. I saw him daily, he was making good recovery. His voice became normal in next three days. He was shifted to the wards and then discharged. He was advised to continue anticonvulsant medicines. Mr. Prasad did not say a goodbye, didn’t write a feedback, he didn’t withdraw his complaint. They just disappeared, and did not follow up. I kept on dealing with the paperwork for a few days even after discharge. I still had a thin bleeding layer of patience left. © Dr. Rajas Deshpande

About a month later, at late night, I got a call from the casualty. The same patient was convulsing. Mr. Prasad had requested to call me.

He revealed that after the discharge he had searched for ‘the best’ neurologists in India, took his father to two of them, and was advised to continue exactly what we had advised. Then he researched internet, found an “ancient remedy” for epilepsy rediscovered recently by a famous baba, that guaranteed complete cure. They had stopped the anticonvulsants advised by me three days ago, as the Baba’s site blasted all modern medicine and the dangerous effects of allopathic drugs.

My remaining patience was destroyed, However, the patient was my first responsibility. I advised the treatment, we intubated the patient and started ventilation again.

“What are the chances, Sir?” asked the rimless eyes with expressionless face.

“We have started with the emergency treatment, the patient will be shifted to the ICU. I cannot accept this case, please admit your father under another specialist” I said. © Dr. Rajas Deshpande

“Look doc, I am sorry if you felt bad about last time. We paid full bills and we will pay again, we have mediclaim. I want you to treat him” he said.

“I don’t work for the mediclaim companies. You cannot pay me for the damage you caused to my peace of mind, the waste of time you caused by writing falsified complaints. You cannot pay me for the sleepless nights because of your threats” I told him.

His face changed. Panic appeared on that expressionless face. He folded hands. There were tears in his eyes. “Doc, I am sorry. I got carried away by what people say about modern doctors. I will do whatever you want. Please save him. I promise I will immediately write an apology to the hospital ”.

Needless to say, a doctor’s heart has many hard scars, but it is the easiest to melt. It did, once again!

© Dr. Rajas Deshpande

Real experience, some facts changed to mask identity.
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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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The Colour Of Blessings

The Colour Of Blessings

© Dr Rajas Deshpande

Carefully calculating the dose and mixing it with the intravenous fluid with precision, I told the kind old lady: “I am starting the medicine drip now. If you feel anything unpleasant, please tell me.”

Through her pain, she smiled in reply. Her son, my lecturer Dr. SK, stood beside us and reassured her too. He had to leave for the OPD, there already was a rush today. “Please take care of her and call me if you feel anything is wrong” he said and left.

Dr. SK’s mom was advised chemotherapy of a cancer. It was quite difficult to calculate its doses and prepare the right concentration for the intravenous drip. Just a month ago, my guide Dr. Pradeep (PY) Muley had taught me how to accurately prepare and administer it, so when Dr. SK’s mom was admitted, he requested me to do it for her too.

The drip started. After a few hours, I noticed that her urine bag needed emptying. The ‘mausi’ supposed to do it was already out for some work. Any resident doctor in India naturally replaces whoever is absent. So I wore gloves, requested a bucket from the nurse, and emptied the urobag into it. Just as I carried the bucket with urine towards the ward bathrooms, Dr. SK returned, and offered to carry it himself, but I told him it was okay and went on to keep the bucket near the bathroom where the ‘mausi’ would later clean it. © Dr Rajas Deshpande

Once the drip was over, Dr. SK invited me for a tea at a small stall outside the campus. He appeared disturbed. He said awkwardly: “Listen, please don’t misunderstand, but when I saw you carrying my mother’s urine in the bucket, I was amazed. You are a Brahmin, right? When you were away, my mom even scolded me why I allowed you to do it, she felt it was embarrassing, as we hail from the Bahujan community. I am myself a leader of our association, as you already know”.

I knew it, to be honest. His was a feared name in most circles.He was a kindly but aggressive leader of their community, but always ready to help anyone from any caste or religion, to stand by anyone oppressed, especially from the poor and discriminated backgrounds.

“I didn’t think of it Sir! She is a patient, besides that she’s your mother, and I am your student, it is my duty to do whatever is necessary. Otherwise too, my parents have always insisted that I never entertain any such differences”. I replied. © Dr Rajas Deshpande

“That’s okay, but I admit my prejudice about you has changed,” he said. “If you ever face any trouble, consider me your elder brother and let me know if I can do anything for you”. What an honest, courageous admission! Unless every Indian who thinks he / she is superior or different than any other Indian actually faces the hateful racist in the West who ill-treats them both as “browns or blacks”, they will never understand the pain of discrimination!

As fate would have it, in a few months, I had an argument with a professor about some posting. The professor then called me and said “So long as I am an examiner, don’t expect to pass your MD exams.”

I was quite worried. My parents were waiting for me to finish PG and finally start life near them, I already had a few months old son, and our financial status wasn’t robust. I could not afford to waste six months. © Dr Rajas Deshpande

I went to Dr. SK. He asked all details. Then he came with me to the threatening professor. He first asked me to apologise to the professor for having argued, which I did. Then he told the professor: “Rajas is my younger brother. Please don’t threaten him ever. Pass him if he deserves, fail him if he performs poor. But don’t fail him if he performs well. I will ask other examiners”.

The professor then told me that he had threatened me “in a fit of rage”, and it was all over.

With the grace of God, good teachers and hard work, I did pass my MD in first attempt. When I went to touch his feet, Dr. SK took me to his mom, who showered her loving blessings upon me once again, and gifted me a Hundred rupee note from her secret pouch. © Dr Rajas Deshpande

Like most other students, I’ve had friends from all social folds at all times in school and colleges. I had excellent relations with the leaders of Dr. Babasaheb Ambedkar Association, and twice in my life they have jumped in to help me in my fight against injustice when everyone else had refused. I love the most fierce weapon of all that Dr. Babasaheb Ambedkar himself carried: the fountain pen!

No amount of fights will ever resolve any problems between any two communities, the only way forward is to respectfully walk together and find solutions. Fortunately, no doctor, even in India, thinks about any patient in the terms of their religion or caste. (© Dr Rajas Deshpande). Just like the Judge in the court premises, humanity is the single supreme authority in any medical premises. Blood or heart, brain or breathing are not exclusive to any religion or community. Just like the bigger brain, a bigger heart is also the sign of evolution.

I so much wish that the black clouds of disharmony between different communities are forever gone. The only hope is that our students can open any doors and break any walls, so long as they do not grow up into egoistic stiffs. © Dr Rajas Deshpande

I am proud to belong to the medical cult of those who never entertain any discrimination. A patient’s blessing has no coloured flags attached! Even outside my profession, I deeply believe that the very God I pray exists in every single human being I meet. If at all anyone asks me, I am happy to say that:

My religion, my caste and my duty as a doctor are all one: Humanity first!

© Dr Rajas Deshpande

Neurologist

Pune

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The Cult of Good Blood: Superhero Medical Students

The Cult of Good Blood:
Superhero Medical Students
© Dr. Rajas Deshpande

He grew up selling vegetables and fruits grown by his mother. He went door to door and in the village market to sell those. He also walked for two miles every day to catch a bus to a school over 20 miles away. He then enrolled in a private class that waived off his fees, because he had a passion: He desperately wanted to become a doctor.

Atul Dhakne, son of a school teacher Mr. Nivruttirao Dhakne and farmer Mrs. Mandabai Dhakne, with his hard work and merit, got admission in the prestigious B.J. Medical College in Pune.

But he wasn’t satisfied. “What about those like me who are from the poor rural background, those who have no access to good classes and education, but want to become doctors?” he worried.

Good Blood speaks, whichever soul it flows in. Young medical students of different origins, studying with him, decided to resolve this. Ketan, son of a lawyer Mr. Avinash Deshmukh (who mostly handles cases for the non-affording,) wanted to do charity like his father. Farooque Faras, whose father raised a family in one small room, was burning with the desire to give. Many others joined in (names below), and the Cult of Good Blood multiplied. They all wanted to uplift the deserving.

“Lift For Upliftment” was born, formed by the superheroes among medical students.

They printed posters and went to almost all junior colleges in Pune, appealing students from poor backgrounds to join their free tuitions / classes, to prepare for the CET /NEET. In the first round, over 40 students joined. After the medical college hours, Atul and his friends took turns to teach these poor students, give them notes, set question papers, conduct exams, assess and counsel for improvement. All expenses were borne from their own puny pocket-money.

There was no fixed place for the class. One local bakery owner, Mr. Dinesh Konde, decided to help these students. He planned the logistics and took them to the corporator Mr. Avinash Shinde, who asked for only one thing in return of his help: commitment to continue this good work. The Cult agreed whole-heartedly. With him, they approached Mrs. Meenakshi Raut, Asst. Director in the education department in Pune, who helped them get two classrooms in a Municipal school after the school hours. The classes thus became regular, every day, from 6-9 PM.

The cult lacked stationery, the huge backup of notes and question paper sets for 40 students, so they approached Mr. Sanjeevkumar Sonavne from Latur, who runs many educational institutes, helps poor students, and even pays the fees of some who cannot afford college. Mr. Shelke and Dr. Harish from Sassoon Hospitals also joined hands to help.

The results were impressive: from the first such batch, 6 students qualified for MBBS, 3 for BDS, 11 for BAMS and 2 for BHMS.

No one had earned anything, but Good Blood flowed forward. Many medical students from subsequent batches came forward to teach free, imparting their fresh acquired knowledge and skills to those who could otherwise have no access to it.

There is no discrimination while accepting junior college students for their class. They have two batches now with 60 students in each. They have also started weekend classes for poor students preparing for NEET in the extremely backward area of Maharashtra, named Melghat. These medical students go to Melghat with their own expenses, teach the rural junior college students over the weekend, and return to attend the tough schedules of medical college again!

“I learned helping others from my mother. We don’t earn anything, but we learn something precious every day” tells Atul, who has now passed MBBS. Ketan Deshmukh, Abhiraj Matre and Farooque Faras help him supervise the group. Their endless enthusiasm only reminded me of how much more I can do. I came to know of this group “LFU” during the recent “Quest Medical Academy” event arranged by Dr. Sushant Shinde.

They are naturally, perpetually short of funds.
I am not rich, but I won’t feel right about myself if I didn’t contribute. They graciously accepted.

When these students came to meet me today, I offered them dinner at a good restaurant (knowing that they stay in hostels). Farooque said “Sir, we will rather use that money to print some more question paper sets”. Farooque’s father has stopped all celebrations in the family, and sends all the money he can, from his one small room home, for the torch of humanity that his son carries forward!

When they asked for an advice, I had but one small request for them: that a Doctor should be completely free of all political and religious influence at work, in teaching, and especially while treating a patient. They assured me that “Lift For Upliftment” has decided to never be affiliated to a political or religious organization, keeping humanity as their highest ideal.

There is no better lamp than the one which carries the light from soul to soul. There is no better definition of humanity than holding hands of those who need it most. I feel very happy today, that I could contribute to this beautiful, divine cause.

Long Live the Cult Of Good Blood, and may we all find it in abundance within ourselves!
© Dr. Rajas Deshpande

The group “LFU” also includes: Esha Agarwal, Shivkumar Thorat, Satyender, Tanvi Modi, Mayank Tripathi, Nikhil Nagpal, Sitanshu, Arvind Kumar, Nagesh Pimpre, all from the B. J. Medical College Pune.

PS: My heartfelt appeal to all medical students and doctors to contribute by starting similar activity in your region, by teaching poor students who want to become doctors, by joining this group and / or by donating for this cause.

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The Babaji Doctors

The Babaji Doctors
© Dr. Rajas Deshpande

“Today’s young doctors of today don’t know anything” the famous Senior Surgeon told her, smiling bitterly, “You have nothing wrong. Go home and take a pain killer, you will be fine tomorrow.”
The next day, at 2 AM in the morning, she was comatose, as my Neurosurgery professor in Mumbai prepared to operate her brain. She was found to have a huge tumor in her middle part of brain, that was about to kill her in few minutes.

This student, a girl aged about 21, came to me with a severe headache and mild imbalance. A senior physician was accompanying her as a local guardian, as her parents were in Mumbai. I had found that she had some warning signs, and told her to go for an urgent MRI. This is a standard protocol for any headache with neurological dysfunction. The accompanying physician told her in front of me “We will go and have a second opinion from the famous senior doctor. He is my friend”. I was not offended at all, this is the right of every patient. A senior doctor would definitely have better experience if not knowledge or specialty training. But I did feel sad about the ease with which this senior physician had underplayed my opinion. That he didn’t understand something did not give him a right to challenge it. © Dr. Rajas Deshpande

Next morning the girl messaged me that the F.S. doctor had told them “Nothing was wrong, that new doctors advised unnecessary tests, told her to take a painkiller and go to college next day.’

She went home and rested that night. The headache was a little less by morning, she texted me so. By afternoon, in the college, she started feeling drowsy and had a vomiting. Her local guardian physician asked her to travel to Mumbai to her parents and take rest. On the way to Mumbai by car she became unconscious. Her friend accompanying her called me (the F.S. did not pick up their call). I advised them to immediately contact my Neurosurgery professor in Mumbai for further help. I called him and informed so too. They reached Mumbai late evening. Her MRI showed a large brain tumor that was blocking the flow of fluids around the brain, and causing compression on the lower part of the brain. She was minutes away from death. My professor decided to operate her immediately.

Starting new practice, in the beginning weeks in India after three years of fellowships in Canada, I had far less patients, and more time to spend with each one. Very proud, I was also somewhere pleased by the brilliant competition I faced, and the fact that malicious bitterness was usually a certificate of good work. According to a saying, critics help one thrive. So long as I set my practice standards high and respected them myself, I wasn’t interested in any competition, nor feared any. Silence was the best weapon and I used it freely in many situations especially when refusing to be dragged in low level gossips and backbiting, not uncommon even in the medical world. © Dr. Rajas Deshpande

“Say what you must. Make your point twice and move on. Don’t argue, because then you presume everyone is equally intellectual. The greatest rule of all is that truth will prevail.” Dr. Sorab Bhabha, my professor had taught me. I follow that to date, but I fail in the test of tolerance sometimes.

Many times, to impress the patient more than one’s competitor, some doctors resort to quite unfair and unethical means. To cunningly use patient’s dissatisfaction, reluctance and doubt about medical expenses and to say ‘immediately pleasing and gratifying’ things to make the patient happy is an art which some (senior and junior) doctors wisely incorporate into their practice.
“Don’t do surgery that the other doctor advised you, Those tests were all unnecessary, We will take a second opinion because I am not sure about this doctor, etc.” are the common tricks used. This gets them the instant faith of the unsuspecting frightened patient. This can then be gradually used to drive home the same advise as of the first doctor, but in different words that please the patient. © Dr. Rajas Deshpande

I am not against unnecessary sweet talking, although I don’t want to ever do that. Most doctors of my generation don’t believe in it. The patient must be told the truth compassionately, in the least hurting, non-frightening way, and any queries / doubts that may arise should be realistically addressed. Patients should be told the good and bad of every treatment option, and they should be encouraged to make informed decisions.

A doctor is a scientific, intellectual and compassionate service provider, and should refrain from being a pleasing-gratifying, patronizing or clownish entertainer at the cost of patient’s health by making compromised healthcare decisions, just to keep his/ her “Famous and beloved” status.

Some doctors also think of patients as their “personal property” and when they refer such patients to the specialist, they send a list of instructions and interfere with the specialist’s planned strategy. Some admit under their care patients who do not belong to their own specialty, then pay a good specialist for the correct diagnosis, and then google-treat the patients from standard treatment protocol sites (harmful, because the same treatment protocols do not apply to each patient). This unhealthy practice, mainly based on referral / cuts, will hopefully reduce with laws against cut practice.

Any intellectual will understand this: that with the vast expanse of medical field and research, no doctor can claim to “know it all”. One can only be proficient in one’s own specialty. Where a specialist is not available, or in emergency (this is the term most misused in such cases) one can use the best of one’s knowledge to treat the patient. Unfortunately, India is full of illiterate and poor (and also educated paranoid) patients who will only believe what is most financially suitable to them, will easily fall prey to the magical sweet talking abilities of a doctor, and blindly follow what is told, without ever knowing right or wrong. That is the reason of a rise in the “Babaji Doctors” in this country with so many Godmen in almost all religions! © Dr. Rajas Deshpande

These medical equivalents of “Baba”s will have a benevolent smile, talk very reassuringly, speak only what the patients like to hear, and wisely try to convey that they know better than any other doctor, even the best specialists who have had excellent training in very specialized areas. Quite fortunately, younger generation patients are far wiser than to be affected by these pseudos: sweet talking without a reason is an immediate turn off for most intellectual young.

The hierarchy of education, qualification and specialised training is always superior to the hierarchy of experience. An MBBS passed out 50 years ago cannot be better than a MD passing out today. The ones with higher qualifications and training, even if far younger / junior, must be treated as above one’s expertise in their respective field. Yes, if the degrees and training are equal, then experience matters. © Dr. Rajas Deshpande

“ I don’t agree with your diagnosis, I don’t think that this patient has Parkinson’s disease” a senior surgeon once told me in front of a patient he had referred.
I know no one can be perfect, and I can be wrong. But I also know who is qualified to say that I am wrong.
“With all due respect, Sir, you are not qualified to comment in this specialty, just as I cannot challenge your diagnosis in yours” I replied. Age that does not match its behavior need not intimidate me, especially where a patient’s diagnosis is concerned. A doctor’s first duty is to tell the truth to his patient, and a part of that truth is what the doctor does not understand.

Pretending expertise in medicine may be fatal for a patient, no true blooded doctor can accept that.

As for the girl who was operated that midnight, she is now married and has two kids. She called a few months later to tell me she was doing well.

I continue to meet patients every other day, who have visited the F.S. doc, and tell me how he told everyone else was wrong.
Unfortunately, the only treatment in such cases is awareness.

© Dr. Rajas Deshpande

PS: Most doctors follow the ethics of not criticizing other doctors, which is required by the Medical Council. However only very few senior doctors have a heart big enough to welcome competition. This causes immense difficulty to the newer generations of specialists. Hence this article.
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