The Doctor Gene: What Everyone Must Know About Doctors

THE DOCTOR GENE

WHAT EVERYONE MUST KNOW ABOUT DOCTORS

DR. RAJAS DESHPANDE

Copyright © 2016 by Dr. Rajas Deshpande.

ISBN:      Hardcover      978-1-4828-7107-4

                Softcover        978-1-4828-7106-7

                eBook             978-1-4828-7105-0

All rights reserved. No part of this book may be used or reproduced by any means, graphic, electronic, or mechanical, including photocopying, recording, taping or by any information storage retrieval system without the written permission of the author except in the case of brief quotations embodied in critical articles and reviews.

Because of the dynamic nature of the Internet, any web addresses or links contained in this book may have changed since publication and may no longer be valid. The views expressed in this work are solely those of the author and do not necessarily reflect the views of the publisher, and the publisher hereby disclaims any responsibility for them.

www.partridgepublishing.com/india

CONTENTS

Disclaimer

Before We Meet

SECTION I

THE PATIENT

Chapter 1 The Redeemed Devil

Chapter 2 A Mother Who Killed the Wife

Chapter 3 The Suicide Note of a Doctor

Chapter 4 Humans?

Chapter 5 Homicide of a Patient

Chapter 6 This Cruel Dilemma

Chapter 7 The Tortured Beloved

Chapter 8 The Last Medicine

Chapter 9 The Rental Goons Whose Father Had AIDS

Chapter 10 The Brain-Alive, Heart-Dead

Chapter 11 Sex? Shut Up!

Chapter 12 The Journey in Pain

Chapter 13 A Murderer Who Almost Killed Us

Chapter 14 The Madman

Chapter 15 The Shocking Illness

Chapter 16 The Beauty and the Horror: Part I

Chapter 17 The Beauty and the Horror: Part II

Chapter 18 The Most Horrible Days as a Doctor: Part I

Chapter 19 The Most Horrible Days as a Doctor: Part II

Chapter 20 The Suffering after Death

SECTION II

THE DOCTOR

Chapter 21 Medical Angels I Met upon Earth: Part I

Chapter 22 Medical Angels I Met upon Earth: Part II

Chapter 23 Medical Angels I Met upon Earth: Part III

Chapter 24 Medical Angels I Met upon Earth: Part IV

Chapter 25 Medical Angels I Met upon Earth: Part V

Chapter 26 Medical Angels I Met upon Earth: Part VI

Chapter 27 Medical Angels I Met upon Earth: Part VII

Chapter 28 The Master

Chapter 29 The Doctor the Developing World Needs Most

Chapter 30 The Mystique

Chapter 31 The Radiating Principle

SECTION III

THE PRACTICE

Chapter 32 Wealth Is Health

Chapter 33 The Humanity Cult: Doctors and Religion

Chapter 34 Why Can't the Doctor Be More Compassionate, Spend More Time with the Patient?

Chapter 35 Drug Quality, Price, and Risk

Chapter 36 Do We Have a Parenting IQ?

Chapter 37 The Unsafe Pilot/Driver: We Don't Even Grasp the Threat!

Chapter 38 The Secret Ingredients of a Healing Touch

Chapter 39 The Poisonous Medicolegal Brew

Chapter 40 The Guarantee of Life

Chapter 41 Cure This Headache

Chapter 42 The Lawless Side of Medicine

Chapter 43 The Curse of Real Heroes

Chapter 44 The Suffocated Medical Future of India

Chapter 45 The Silent, Deadly Medical Blackmail

Chapter 46 When Once I Met God

Chapter 47 Question from a Young, Fresh Indian doctor

Chapter 48 Milord, Please Don't Try This Medicine!

Chapter 49 The Beauty Called Brain

Chapter 50 Beware of This Dreadful Disease

Chapter 51 A Modern Doctor's Curse: Sisyphean Old-Age Oaths and Ethics

Chapter 52 The Best Moments in a Doctor's Life

To

my patients, teachers, students, and friends,

every doctor, nurse, and paramedic upon earth:

thank you.

To

my parents, Dr Kalidas and Dr Usha Deshpande;

my children, Yash and Saarth;

Mrs Tanuja and Mr Abhijit Patki, Shweta, and Shreya;

I am blessed through you all.

Rajas

DISCLAIMER

R eferences to patient's names, locations, and in some cases, events narrated have been changed so as to guard privacy of patients or other individuals. Most of the incidences happened just as described, but I have had to make necessary changes to some events to avoid tracing identities.

True names of some doctors, teachers, colleagues, and some friends appear where relevant, a part of general knowledge.

I smoked cigarettes when I was a student to keep up late nights and quit when I qualified, realizing that it was a mistake. This reference is mentioned where relevant, but I do not support this habit. Smoking is a bad addiction and is by no means to be encouraged.

In case something I have written offends someone for any reason, I apologise in advance and beg forgiveness, also stating that this is not intentional.

Some of my personal opinions, especially in the third section, may not be applicable to everyone. I am open to growth and correction, as every doctor must be.

This is my small prayer for my proud profession.

BEFORE WE MEET

I t is indeed a proud joy, being a practising doctor, for there is no more rewarding life than to be able to intellectually solve problems and help people smile again.

There are too many things that go into the making of a doctor, each adding a rich flavour of its own but also enhancing the entire mixture. Sometimes you meet a ripe and sweet part of this mixture, sometimes pickled and sour.

I studied my medical school in India, graduating from a huge set-up with a large number of patients and good teachers but only basic healthcare facilities. It was essential to be able to diagnose based upon 'medical mind chess', deeply thinking about everything to conclude correctly, in the absence of many tests, CT scans, MRI, etc., which are available widely now. Happy that the new technologies have eased life, I feel that it still was an advantage to learn without them. Like the use of a calculator replacing the ready calculations one had in mind as a part of a learning process. A doctor with best of the set-ups in the world, where all technology is state of the art, is still quite inadequate (maybe dangerous) without this clinical training over many years that includes personal interactions with patients and teachers, self-criticism, a massive basic knowledge base, and the ability to handle hundreds of different life-and-death situations while simultaneously dealing with people who are not as educated and sometimes even malicious, angry, and overexpectant.

From the remote farmlands, where I was the only medical care and the nearest medical shop was miles away, to the final referral centres in India or Canada, where the best of the super-specialty education is imparted, all the academic ascent was based upon tough competition at all levels. At all these levels, I met medical angels: teachers and patients who made generations of good doctors. They were also the guardians of all the good principles in medical practice: ethics, morals, extreme hard work and study, best-for-the-patient decision-making, and above all, sacrifices at all levels that are expected of a doctor. This meant personal, social, financial, and mental sacrifices.

India, like most of the developing world, is medically not only backward but also primitive. Except in a few urban pockets, most of the rural population (68 per cent) in India is deprived of good healthcare. In absence of basic infrastructure like roads, transport, electricity, water, sanitation, schools, entertainment, security, and Internet in most of this rural India, the administration expects a well-qualified young doctor to practise there without any equipment, medicine, or support staff. That too at a basic minimum salary lesser than a fourth of what that doctor would earn if he practised in an urban region. There are no financial aids if a doctor wants to make his own set-up in the rural areas.

Medical insurance is not universal, and most of the patients must pay for all their medical expenses. As the cost of living increases, that of investment and equipment flares up, but the poverty-struck society keeps on expecting the doctor to provide the best possible healthcare in a decades-old payment structure. It is unnatural to expect the best talents in the region to practise for charity, capping their income via various laws and rules. There is no mechanism by which the doctor can recover charges from a patient who refuses to pay. It is common to see relatives 'dumping' serious patients in private hospitals and disappearing/refusing to pay. No wonder the helpless doctor is left with two options for a good life: commission-based incomes or emigration to a developed country. Most have chosen the second option. Many who haven't chosen either option are in a perpetual state of financial frustration.

There is no justification of any corruption in any field, including medicine, but there is also no justification for lifelong exploitation of doctors through such one-way laws.

While the society is mostly illiterate and superstitious, the judiciary is yet to awaken to the reality, too busy at present emulating the Western populist medical negligence and ethics judgements to notice the blatant reign of disease, death, lack of medical infrastructure, and the plight of this entire underpaid profession. There is no sorrow like a judiciary that lacks depth of knowledge and the ability to see the big picture. Populist judgments are the newest fashion. There are no examples of judgments reminding/penalizing the government for failure of sanitation and provision of basic healthcare infrastructure. There are no judgments about blatant defamation of the doctors by media.

Almost everywhere in the world now, millions of patients are suffering just because their doctors are making a choice that they can justify to the judicial system rather than what would be their best choice for those patients. It is just to expect to follow laws in a predictable science, but one must know that the human body is extremely complicated and unpredictable. Every doctor in the world now practises under the threat of a litigation.

There is still beauty and hope amidst all this. Many patients speak of their faith and reward their doctors with blessings and prayers, and irrespective of what a doctor earns, the joy of saving lives and treating illness is above any other material achievement. The hidden respect that the majority of society harbours for the medical practitioner is sometimes unleashed as a pleasant surprise in many social events and interactions.

I will never complain about the newer generations being less responsible, as rebellion and revolt are hallmarks of the young, and each successive generation is better equipped with faster and better resources, including their own brains. I am very hopeful that we will achieve good healthcare for everyone in the world in a few years, given the technology we have. However, the new doctors need many infusions about the ways to handle different people, understand and love them, and immense mental strength to resolve the situation rather than submit to it.

My dream is a world where all the doctors in all countries work as one autonomous merit-based organization, using technology to reach out to each individual upon earth to provide the best of medical care. There should be no scope for interference by local laws, political systems, governments, or other organisations. There, of course, must be medical courts to control negligence and other medicolegal issues. There should be wise distribution of funds in research based upon what causes maximum deaths or disability. Everyone should be covered with complete health insurance, and every doctor should be paid according to their skill, time, experience, and complications of a case.

With due respect to all involved, I have always failed to understand the need to spend billions to explore outer space for curiosity, while people here and now upon earth are dying of disease, hunger, and religious violence. Also the wars about boundaries between countries. What do we have to offer to a newfound civilization in space or to the land won by war? Poverty, hunger, wars, diseases that we cannot treat yet, obesity, HIV, beautiful animals on the verge of extinction, global warming, depleting fuel reserves? Many of our existing problems need solutions first. Thinkers are aplenty; vision among the rulers is deficient. We cannot stop infighting between our own people. We cannot unite as a planetary human civilization. What is our stand on unknown species we will encounter? Will we beg for fuel, food, intellect, or wisdom? Our society is sadly often blinded by temporary, meaningless glamour and glitter of an individual or of scientific pursuits and impotent hopes of a better future.

On the famous lists of billionaires and the beautiful, I dream to see doctors, thinkers, philosophers, scientists, environment conservation activists, and humanitarians too, for they are the real beauty of our civilization.

We desperately need more of good, compassionate, hard-working, and intelligent supermen/superwomen called doctors. We all wish for a disease-free world.

This effort is towards that aim.

Thank you, God.

Thank you, Partridge Publishing, Advocate Shrirang Choudhary, Dr Anand and Dr Uma Alurkar, Dr Deepa Muzumdar, Dr Sujata Malik, Mrs Manisha Sanghavi, Dr Susan Zachariah, Dr Joshita Singh, Dr Muthuramalingam Natarajan, Dr Sanjay Singh, Dr Dinesh Kabra, Dr Anka Arora, Dr Sachin Tapasvi, Dr Mrutyunjay Mahindrakar, Dr Nitin Pai, Dr Ketaki Bhonsle-Dhumal, Dr Mudra Parikh, Mr Santosh Kashikar, Mr Bapuguru Vaidya, Dr Malati and Dr Sridhar Vakil, Mr Arvind Deshpande, Dr Kiran Kudrimoti, Mr Rajesh Wattamwar, Dr Aditya Kunte, Dr Chandrima Chuckerbutty, Dr Chetan Puram, Dr Sachin Shah, Dr Sagar Oak, Dr Nilesh, Dr Vinil and Mr Rahil Shah, Dr Anjali and Mr Rajendra Manerikar, Mr Mahavir Shah, Dr Abhay and Dr Jayashree Pohekar, Dr Gajanan Bhalerao, Dr Prachi Jajoo, Dr Meenakshi Kadam, Dr Akshay Oswal, Dr Akshay Jadhav, and my Facebook audience, who have all made my life beautiful.

Special thanks to my colleagues at the Ruby Hall Clinic: Mr Bomi Bhote, Dr Purvez Grant, Dr Ravi Gulati, Dr Bankim Amin, Dr Ashok Bhanage, Dr Sanjay Vhora, Dr Prachee Sathe, Dr Nita Munshi, Dr Jagdish Hiremath, Dr Shirish Hiremath, Dr. Ravindra and Dr Anita Kiwalkar, Dr Lehnaz Umrigar, Dr Venkatramani, Dr Abhay Mutha, Dr Vijay Ramanan, Dr G. Rajasekhar, Dr Sudheer Rai, Dr Srikanta Mohapatra, Dr Sanjay Pathare, Dr Sandeep Karmarkar, Dr Rajesh Parasnis, Dr Surabhi Date, Dr Avinash Nanivadekar, Dr Rahoul Nagdda, Dr Ashish Atre, Dr Ashish Davalbhakta, Dr Kiran Kharat, Dr Murarji Ghadge, Dr Sheetal Mahajani, Dr Santosh Bhide, Dr Gauri Belsare, Dr Abhijit Lodha, Dr Sanjay Sagar, Dr Sanjeev Tandale, Dr Sachin Arbhi, Dr Vikrant Vaze, Dr Prashant Dev, Mr Sachin Shah (Kalyani Medicals), Mr Manohar Bhosale, Mrs Poonam Chohan, Mrs Nilofer Shaikh, Mrs Anita, all consultants, poly OPD, NTU, ICU, nursing, neurophysiology, parking, cafeteria and security staff, and Mr Pankaj Gaikwad.

Lastly, I think that 'health for all' will be possible if we unite all the healthcare resources globally, prioritise healthcare, and improve the doctor-patient relationship. Utopia was never meant for the weak or the mediocre.

Dr Rajas Deshpande

SECTION I

THE PATIENT

CHAPTER 1

THE REDEEMED DEVIL

J ust as I inserted the needle in a patient's spine to obtain the cerebrospinal fluid (brain water), I heard a cacophonic commotion at the ward entrance. The CSF started flowing out drop by drop. A man rushed towards me with a stick in his hand. The ward attendant (an old lady) and a nursing student tried to stop him, but he was too drunk to stop. It was 1 a.m.

It is a delicate procedure and dangerous if the needle hits wrong places like nerve roots or arteries. I could not afford to be physically disturbed at that moment. The assisting nursing student, Ms Reva, fortunately enthusiastic and interested in the procedure, was ready with gloves. I positioned the needle and asked her to hold it, with the sample collection bottle catching the fluid.

I received the first blow upon my shoulder just as I got up from the chair. I asked the second nursing student to help the one holding the needle. I received two more blows upon my back. It was going to take about two more minutes to collect the sample. He slapped me, as I stumbled to avoid falling upon the patient in procedure. I shouted at the ward assistant old lady to call security and engaged with my attacker, trying to restrain him. 'Collect ten ml CSF then withdraw needle with the stylet inside it,' I told the sister (nurse).

This attacker was a stout man in his fifties. His wife had been admitted a week ago in my ward, almost dying. Skin and bones, multiple bedsores and skin infections, stiff all over, high-grade fever, low BP, unconscious. There were curious marks on both wrists and legs, with multiple scars all over her body. Her husband (my attacker) had admitted her, saying that she was suffering some unknown illness for many months, probably tuberculosis, and had refused to eat. He also told she was a psychotic, under medicines. He offensively smelt of cheap alcohol and lies. He couldn't care less. He disappeared after her admission in the general ward (there was no ICU at our medical college hospital).

A CT scan showed bleeding between skull and brain, with a small fracture over the skull.

Nobody attended her next three days, except her twelve-year-old son who religiously sat crumpled mentally and physically near her. He didn't say anything.

We have an unwritten rule in medicine: the doctor is the caretaker/relative of those who don't have anyone. A true doctor never abandons a helpless patient. Anywhere in the world. It is not taught; it is the basic gene of anyone who is a doctor by heart. We requested our dean (Dr V. L. Deshpande) for a special indent of some high-end antibiotics and other medicines, which he sanctioned. My resident doctor colleagues, Dr Madhu Paulose and others, collected funds to arrange tubes/catheters for her, which were not available in the ward.

On the third day, she opened eyes and reached out to her son's head, patting him. Smiling, she lapsed into sleep again. Even in that sleep, tears rolled down from her eyes, wetting the pillow on both sides of her face.

At the end of that night, around 4 a.m., the child came to me as I sat on the stairs outside the ward, enjoying my customary stimulation that marked the end of the day.

'I want to tell you something,' he said, 'but I am scared.'

I extinguished the stimulant, threw it away.

'Please tell me,' I said, arm around his shoulder. 'Don't be scared. I am with you. I will ensure that all is well.'

'Don't say anything to my father about this. He will throw me out of the house,' he said with a frightened face. I assured him so.

'My father has kept my mom in the basement room of our house for many years now. He ties her hands and legs and even her mouth every day. I go down and give her food and water two times a day. He allows me that but tells me that