Mediquettes!

Mediquettesis a term coined by me. It is the combination of medical aspects of life and etiquettes to be followed therein. In recent times, life expectancy has gone up. With the increase in life expectancy, people fall sick more times in their lifetime, than they would have, even 70 years back. People died much earlier in those times compared to today. Hence people were taken to hospitals less frequently. Now we are regularly required to meet a relative or a friend who is being treated at a hospital.  

There are etiquettes to be followed during hospital visitations or when we go to meet the persons taking treatment at home. To me, the protocols are to be followed by visitors as well as the medical fraternity. With an increase in life span, people face various illnesses which were not prevalent before. The treatment and the support needed in some cases are quite extensive.  

I will share my personal experience when I went through my cancer treatment five years back. I had to undergo 34 radiation sessions. My oncologists had told me that I would have a problem swallowing, after three to four weeks of radiations. Hence a feeding tube was inserted from day one through my nose to the stomach. After about four weeks, I had to take formula food through the feeding tube (8 feeds a day). Jaya had to handle this with some support in between from Sachin and sometimes Priya and Ashwini. Each feed required an hour, including preparation and cleaning, and there were eight such feeds every day. On top of this our granddaughter, Rhea was two months old; her feeds were also to be managed. Things became very hectic as Jaya had to coordinate other stuff besides my feeds. We took a decision not to receive any phone calls. We informed people that we could not receive phone calls. Most people understood that there must be a hectic schedule; hence calls were not answered. But some people were upset and said so. We informed as many people as possible by mail or WhatsApp messages. 

The first etiquette we all need to follow is to give family space and time. Don’t pressurise people by going to meet them. When in the hospital, there are hundreds of things that need to be tracked. Sometimes staff forgets to give medicines, other times they don’t come on time when the patient needs support. When a patient is in CCU/ICU, we should never go to meet them. In many hospitals, now they don’t allow visitors to meet such patients. If someone has undergone surgery, give the patient a few days to recover before going to meet them.  

WhatsApp groups have created an awkward situation. When alumni groups form, we get in touch with friends from olden times. But at my age, a lot of water has flown down the bridge. We interchange, share posts with each other. We start thinking that we know friends very well. But there are many friends on the group, whom we have never even met during college times. They become our fair weather friends now, because of their alumni contact 

A few of our friends are undergoing treatment for paralysis. In paralysis, physical functions get challenged, and patients physical activity gets restricted. In such cases, some of the patients do not like even close friends to come and meet them. Since WA groups create an atmosphere of camaraderie, many people who were unknown even in college time, go to meet the patient. Such an act is forcing something unwanted. Avoid it. Instead, try to communicate with the spouse and ask if some help is needed and give it when required. 

Some people do not know how to counsel people. In their enthusiasm to help the patient, they share some examples in which the patients worsened or died! Such instances put the patient in a sombre mood. Instead, one should hold a hand and maybe, say nothing.  

Many a time people take some food with them; avoid it. If the patient does not have a separate room, then it can become difficult even to store foodstuff. Patients generally eat food decided by the treating doctor and served by the hospital. One can take the person supporting, for a cup of tea to reduce that persons stress. Sometimes that person may want to share somethings, but the person cannot discuss such things in front of the patient. In the case of paralysis, sometimes the treatment and support are needed for a couple of years or more. During that period the persons whole family is under duress, jumping from one therapy to another, trying something different. Giving them space becomes essential rather than only meeting them. Try and take over a session or two of support, if you can. That is more helpful.  

Medical fraternity and overall hospital systems are under terrific pressure all the time because, during health issues, family members do not understand the intricacies of the treatments. They keep on probing and pushing for more information. Most of the staff and doctors manage smiling faces. But it is not easy. Medical fraternity must understand that the very nature of their job needs them to have a smiling face all the time. But many times it does not happen.  

The instructions to staff are very vague, sometimes. A patient being treated for a severe migraine attack needs peaceful sleep. But other than doctors, many people keep on disturbing the patient. Cleaning team survey team, counselling team and the list goes on and on. Every 30 minutes someone will come and make noise, put the lights on, ask the sleeping patient if she is sleeping well! Come on use common sense!  

The billing process in hospitals is one of the most distressfull methods that creates stress. Whether you are paying cash, or you are covered under cashless medical insurance, they take at least 2 to 3 hours to process your bill. I have seen an accounting staff from the hospital, soliciting the patients relatives to pay cash and the claim the payment from the insurance!  

During my treatment for Cancer, I was given a drug intravenously every Monday. It cost around Rs.6.5/ lacs. The company supplying the drug supposedly provides eight doses at a time. My body could not take more than five doses and then that treatment was discontinued and the primary purpose was served. Balance three doses, worth Rs.2.5/ lacs remained with the hospital; we suggested them to give those doses to the needy when required. No needy patient has yet turned up, even after five years! Ordering more than necessary according to me is a great shame. 

Recently, I came to know the story of a person who died. He had a heart condition and was fitted with the pacemaker. After death, the hospital staff said that they are removing the pacemaker and just took it away. 

Hospital stories can go on and on. In our culture, we feel forced to rush and meet someone who is unwell. This creates an overload on the whole medical system. The crowds that we see in hospitals are unmanageable. Medical fraternity needs peace of mind, and the patient and his supporting team of friends and family need space. We should help to create an atmosphere which will be beneficial for all. I have not touched the subject of children living in foreign countries when their parents fall sick. It would be a subject for a full blog!

 

 

 

Prakash Nirgudkar, the ever smiling Buddha! Part I

We read many stories in mythology, where someone gets a curse from a sage or a king! Then later the same person is given boon, conditions attached! In today’s world where everything you do is saved somewhere on a computer server, in text or image format! So, probably 2000 years hence there will not be any mythological story about Prakash, all hard facts are known and recorded. When unbelievable things were performed by humans, these turned into stories and such miracles were explained in terms of curses and boons! To me, such boons can be explained as courage shown by Nirgudkar family and by Prakash in particular to overcome impossible odds. The curses to me are destiny!

PakyaPhoto1

I got my Master’s Degree in Metallurgical Engineering from COEP, the famed 150 plus years old institute from Pune. One thing I learned during those two years of Post Graduate studies was to do everything sincerely and keep the commitments. Prakash Nirgudkar urf Pakya was one-year senior to me in the Metallurgy department. We used to live in the dormitory. He is a pleasant person with an ever-smiling face. He is smart and very cooperative. After our first degree, there were very few students in the Master’s course. We were both busy and still had enough time. One thing we had decided was to brush up card playing skills, mainly Rummy. We had one more partner in this endeavour, Naidu urf “Todya”! Why he was given this nick name “Todya” is still a mystery to me. Three of us mostly had our sessions, in the afternoon. We had decided that our course timings were flexible, contrary to college rules. Sometimes we erroneously committed to play cards which clashed with some course. But the commitment was a commitment, nobody ever broke it!  

Prakash had so many good things in him but I had never imagined that he would be a great fighter, a survivor. The main trait that came up during the recent catastrophe in his life, was the indomitable spirit. What a human is capable of only comes out during tough times one faces in life. The old cliché of “When things get tough, tough get going” fits perfectly to Prakash and his family. I had written about Prakash in my blog a couple of weeks back, the link for which is given below. 

https://wordpress.com/post/panvalkarpramod.wordpress.com/5910 

Yesterday, I read the book written by Kavita, his wife. The name of the book is “Surviving the toxic frostbite”. Below is the e link for the book for purchase.  

https://www.bookganga.com/R/7VXM8 

It needs downloading of book reader by Book Ganga. It can not be read on other readers.

The book is captivating, it is about the journey of Prakash when he went for a Himalayan trek; the second part is the horrendous event that happened in his life. He was a victim of severe frostbite; along with that he caught an extremely rare infection called necrotizing-fasciitis or in common language flesh eating bacteria attacked his right hand. The link about the infection is given below. 

https://www.webmd.com/skin-problems-and-treatments/necrotizing-fasciitis-flesh-eating-bacteria#2 

Even though I knew sketchy details of what Prakash went through, while reading the book I felt very tense in the second half. One suggestion! The photos of necrotizing-fasciitis shared in the book are not for weak hearted persons; I am not really sure if even many doctors have ever handled such severe infection. Obviously, the details of the treatment are all there in the book by Kavita. Hence I will not write about the details; but I am writing about human reactions, their behaviour, families and goodness of people under such tyring situations. Such good stories about humans help and support, bring back confidence in us that all is well with this world! Terrorists, accidents, economic crises are aberrations in real life!  

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Kavita, their daughter Nandita and son Prasanna have handled the major crisis in the Nirgudkar family bravely! Kavita is the person around whom the whole saga was revolving, she was the General. She was pushed into a battle which we will never hope or  want even our enemies to fight! Prakash in the initial period was as good as in trance! Even later he was so weak that Kavita was the one who held the fort! Kavita Salute! I can also understand the predicament of Prasanna who lives in the USA. He could rush for  sometime a couple of times but worrying long distance is a tough call. Nandita has handled everything with aplomb at a very young age!  

Human touch in the saga started right in the Himalayas. The team had gone twenty thousand feet above sea level, in an extremely difficult weather and terrain. At that height, Prakash had started feeling weak and his stomach problems started. Stomach issue had started draining his reserve energy really fast. As it is, at the height of 20000 feet, the body functions on reserve energy. The porters and his colleagues physically lifted him and brought Prakash down to the manageable heights. From there he was brought him into civilization in trucks and jeeps provided by ITBP. His colleagues were equally tired but had no illnesses, luckily. They rushed him to Delhi airport. During the journey, he had become so weak that his soiled clothing was required to be changed by his colleagues.  

His right hand showed a rash and had started swelling, and its colour had become ominously dark. All airlines refused to give him the boarding card. The airport doctor gave him a fitness certificate but still, he was denied boarding, looking at his hand. It was a blessing a disguise because when Delhi doctors diagnosed him for necrotizing-fasciitis, they said that air travel under these circumstances would have proved fatal. The doctors in casualty area at the hospital, where Prakash was taken were following routine procedures. The doctor from the airport came behind the ambulance on his own and told the doctors to treat the case as a serious emergency. Prakash was then put on the fast track and without even entering his name anywhere he was wheeled into Operation Theater for emergency surgery. Had this surgery got delayed, Prakash was already having a dialogue with Chitragupt; anything could have happened. This was Prakash’s first close shave with death, with many more to follow later. Airport doctor was the first of many souls who went out of their way to help Prakash. 

At this juncture, Kavita was unaware of the seriousness of the situation. She and Nandita rushed to Delhi from Pune, expecting to come back in a few days. They could never have budgeted what they had to go through even in their dreams! In terms of human goodness, the trek coordinator from Delhi, who was just an acquaintance but he went out of the way to help Kavita to get a base close to the hospital. Initially, he put them up for a few days with a lady; it was a god sent gift for them in the unknown territory of Delhi, that too under really trying circumstances.   

Delhi doctors managed to bring Prakash to the level of taking a journey to Pune. Flying was out of the question for medical reasons. They took a twenty-hour journey to Pune by train. Prakash was allowed to travel by Delhi doctors under two conditions. First was that a male nurse must accompany and second was Prakash was to be taken from Pune railway station to a major hospital! Luckily no events took place during this journey made arduous because of Prakash’s health.

I follow a rule of limiting my blogs to a certain number of words for it to remain readable. But this human saga that my friend Prakash and his family had to go through is making it difficult for me stick to my rules. I will share the concluding part of this event with you in two parts!  Tomorrow, I will publish the second part!

In the second part, I will write about Prakash getting back from the brink (his condition was still very delicate) and rehabilitation which was another journey for one plus year. 

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 Link for Part II is below!

https://panvalkarpramod.wordpress.com/2018/12/22/prakash-nirgudkar-the-ever-smiling-buddha-part-ii/

 

         

16th August 1995 to 23rd September 2018!

In my blog last week, “So long farewell, we too say Goodbye!”, I had written about how I had bid goodbye to my “home”, without realizing it. Now I am thinking of the other side of the event. Obviously, I cannot ask my parents how they felt about my moving out, as they have passed long back. I never had the strength and maturity to ask them this question. Many times, it so happens that humans, in their zest to do well in life, go ahead; follow their projected trajectory. Go out for higher education, take up jobs and do well in their life. This is the evolution of human life and that is how it is expected to happen.

But in the background, a lot of things happen, which creates an atmosphere for the progress of people. In the background, in most cases, it is the parents who take efforts to help the children to achieve what they want, create the atmosphere to reach their goals, smoothly. In some cases, parents do a lot of sacrifices too! I am not talking about what the children should give back to their parents. My views are very clear on this, children don’t have to give anything back to the parents!  It is the parent’s responsibility to make their children strong to face the world!

But in my case, it never occurred to me, what my parents must have gone through when I left home. Did they feel the vacuum? What stress they must have felt? As I was the youngest of the siblings, when I left home, my parents were the only family that remained as a unit! When I left home I was immature and later on, I became too engrossed with my college. Immediately after college, I got married. Parents were never in my thoughts even though I loved them a lot, I cared for them in my own way.

I remember a couple of incidents from those times. I used to be in the engineering college at Pune and my parents lived in Bombay. I used to go to Bombay during the holidays. My mother would be waiting for me eagerly, keeping some lovely foodstuff ready for me. My father would go to the office and send his car back home for me to spin around! Petrol tank, of course, was always full! My father was a senior police officer and a very strict one. His demeanour was that of an efficient go-getter! Once during holidays, my mother was unwell and her health deteriorated quickly by midnight. My father woke me up, I had never ever seen him so worried! I told him not to worry and with the exuberance of the youth, I spoke to the hospital and drove my parents to the hospital. After about 12 hours, my mother’s health dramatically improved. I could see the palpable relief on my father’s face. Had I not been with them at that time, I am sure my father would have easily managed everything. But I also felt that my father was relieved because I was around. It was probably emotional support that they were looking for. I went back to Pune later, forgot everything and was back in my own world! How many such incidents may have happened during those times, in my absence, is the question that comes to mind?

16th August 1995 is the date on which our son went to the USA for his further education. I remember this date for obvious reasons but there was an incident that happened on our way to Bombay. As we were reaching Bombay, something hit our car below the engine area. The car engine started making a bit of noise so I had to stop the car. We found out that a big stone had hit bracket on which the engine is mounted. Such stones are left on the roads by truck drivers when they stop their vehicles on the road for some repairs. There was no expressway during those times. We somehow were able to reach a garage which was nearby. I called a cab and reached Bombay. We had kept enough margin to reach the airport on time. Next day the family went back to Pune. I got the car repaired and the day after I took the car back to Pune.

For the next few days or months, I am not really sure, we felt the emptiness but our daughter was with us. Three of us always missed him but then the reality struck that he will be away at least for a couple of years. Slowly, we continued with our life. Two years became five; he had come back to get married in between. Then five years became ten; he moved from the east coast to west coast and this year it is 23 years since he left “home”. Of course, now he has his home, he has his own family. In between, he kept on coming back and we also went to him as and when it was possible. But the visits, both to the US and India were as visitors. Luckily, Jaya and I were quite busy in that phase so was our daughter. In the initial phase, when the social media was evolving, we used to talk on phone depending on how busy all of us were. Cell phones were in the evolution phase so we had to rely more on the landline.

During these 23 years, there was only one major health issue in the year 2013. I needed to be treated for cancer. Our son could come for a couple of weeks. I could see the unease on his face when he went back. But I look at the whole thing from a different angle. Had he been staying in Bangalore or Delhi or Timbaktu, the situation would have been the same. Once children get busy in their career and their families, the natural progression is that they get busy in their own stuff. I had mentioned in one of the blogs about intersecting circles.

Circles

Circles1The images explain this concept clearly. In the first image, the Innermost circle is the core family circle which has parents and siblings. As each sibling forms own family, parents and other siblings are moved to the outer intersecting circle. That is how the world moves, that is the name of the game, that is nature!  The second image of intersecting circles shows the complexity that can form later in life, due to the formation of new families. As the generations change, you go into a circle on the periphery.

What is the significance of the date 23rd September 2018! Our grandson completed his 12th grade and joined a University for Computer Engineering course. He moved to the dormitory! What thoughts have been going on in my son and his wife’s mind? I do not know. I am sure the thoughts will be the same as what we had. This is one training that I do not think we gave to our son. But this is very essential like all other training. This aspect of life is never taught in any course, in any college. It is learnt in the life’s school!

But there is one more angle to this scenario that we see these days. I know of a family where the mother is 90 plus and has a very serious case of dementia. Hers is an extremely difficult case to manage, and she is being nursed at home with the help of supporting staff. Her eldest son and his wife look after her. Her other younger son lives in a different country. He is also retired but they come and support the mother for a couple of months. Is it incidental? Winter is very harsh in those months in that country. Who should share such responsibilities? This is a very tricky situation and handling it is not easy. We also hear some stories about children inviting parents to their homes only when they need babysitting or some such support.

Honestly, I really do not know what the correct approach is; but to me, each one is a different case. Most of the times we hear only one sided version. It is difficult to come to any conclusion. I have heard of a story about travel by my friend. I don’t know what adjective to give to this story. Whether it is funny or horror story or a practical thing to do. They have two children staying in the US. I found that they were traveling separately on different days. The reason was two children wanted the best “monitory deal” for ticket. Does it matter that they had to travel separately? Such problems maybe faced if the parents are financially not independent!

Before India’s independence in 1947, most people hardly left their area of birth for green pastures. But with progress all around things have changed a lot. There is good Hindi word called बिरादरी; people still marry in बिरादरी! But with progress they live all over the world. Material progress and progress in our thought process need to go hand in hand. Once that is achieved, it hardly matters. To me the circles below are the true representations of today’s times. Or is it the first first image? I am confused!

Circles3

Who is the best doctor for you?

During a discussion about a surgery of a 91-year-old gentleman, a question was raised, how will his body handle this surgery? His physician was confident and his surgeon, a urinary expert, said he will perform laser surgery. The surgery was performed and a couple of days later the gentleman is recovering well. His surgery team also included an anesthetist. The surgery was nothing complex and for a younger person it would have been a routine surgery. Due to age the situation was a little more complex. But this team apparently was good, confident and more importantly must have handled such complications due to age, before. This last factor is very important.

Our body is a complex organism, on top of that, every individuals body behaves differently, reacts differently. When this surgery was discussed during a conversation with someone else, not from Pune, that person asked a question. Why with similar issues a person from their family was not being operated upon? This is a very valid question, but it also depends on the team of doctors who look after the patient. Such laser surgeries are performed in various cities now. This is not about competence of the team but there is a possibility that this team has never performed such surgeries on old patients. This other person is 80 plus and is suffering from the same issue. The surgeon may be confident, but physician may have different views. But the question is why this option is not even discussed about this patient. Performing or not performing any procedure will depend on different parameters but the most important is specific experience of the team of doctors in that area.

Another person I know about has been having heart issues since last several years. Recently when the person had major health crisis, the person was taken to a large hospital. Looking at the criticality, the experts decided to perform angioplasty as a last resort. This plasty improved the patient’s health many folds. The question arises why this procedure was not done several years back; this problem has been existing for years, but doctors in those times took a decision that angioplasty can not be done. Again, it boils down to the experience of the team to perform such procedures or it is about their opinion and decision not to perform angioplasty in that situation.

A friend of ours has been having health issues, she is same age as me. She was taking treatment from a physician. Once the friend said that she wanted to get herself checked by our physician. Checking was done, all tests were performed. Body parameters from previous tests and current tests were similar. But her previous physician had told her that everything was hunky dory though it was not. The results were so obviously out of range, even a non-medical guy could understand that she needed more control on her parameters. Why did this happen? I am sure that the previous doctor also had his views or may be his treatment is different. So, treatment again depends on the knowledge, experience of the doctors who treat you.

My father died in the year 1980 of a massive heart attack. My nephew Atul, who is a well-known physician in Pune, was a medical student at that time. Sometime recently, we were discussing about my father’s death. Atul said, “Mama, in those times the doctor’s knowledge was limited. Testing methods were also limited. So, the doctors could not judge the seriousness of his problems. I distinctly remember that he had back pain and was quite uneasy for 4/5 days before the attack.” Similar was the case of my father in law. He died a couple of years earlier than my father. He had a heart attack, was hospitalized and came home after 10 days. A few weeks after that, he was told during the follow up visit, that he was now hail and hearty and could now lead normal life. Next day early morning he died of a massive heart attack. Heart attacks are notorious for their behaviour but sometimes it also depends the doctor who is treating, his experience in handling specific cases. Was it a case of wrong judgment by the doctor?

Does it mean that our treatment and our health is based on luck? No definitely not. Doctors have good knowledge. But an individual patient may have some variant of a disease. If the treating doctor has never come across such variants, things can become complex and tricky. Most of the time, we may not take an opportunity for second opinion, even if the disease lingers on. It is sometimes good idea to take second opinion. By doing this we are just dividing the risk.

Honestly speaking, I also do not know how to handle situations discussed. Whenever required go to a good doctor. But one way will be go by the doctor’s reputation.  I know of a friend who decided to go take treatment from a certain doctor because he was near their home. There are far superior doctors available in Pune. Once you find a good doctor who could be a physician, stick to him and go back to the concept of “family doctor”, like we used to have GP’s in olden days. He or she will be your regular doctor, will know about your health in details. Any other health issue from different areas, should be treated through him by different specialists. They will work in tandem and chances of you getting superior treatment improve. Of course, the best doctor is NO doctor! But this can be only in our wish list!

 

 

Voodoo Death!

Last week an event took place in Pune in a major hospital. A 25-year-old was being treated in the ICU. She was shifted from a small private hospital where she had undergone a surgery, and things started getting out of control! The doctor who did the surgery but realized the limitations of his own and the hospital. Unfortunately, things had veered so much out of control that the lady could not survive and died. This news item came in a leading newspaper and then it became viral. Initial information was, “So and so hospital tries to cure by performing rituals by a God man!” The lady had died of multiple organ failure!

There are many issues. First is that this ritual was performed in an ICU of the major hospital. Secondly the ritual was performed by a “God man” in the presence of the doctor who had treated the patient before shifting her to the big hospital. A video was allowed to be taken inside ICU where hospital nursing staff was partially seen in the video! Initial newspaper report gave importance to the name of the hospital and it appeared as if the large hospital allowed the ritual to be performed in ICU.

So many things have gone wrong in this event that it becomes difficult whom to blame. First and foremost is the ritual! How can a trained doctor allow this, that too in someone else’s hospital? He just took a decision to do it. Second is the psychology! Probably the patient’s health had reached the point of no return. So, the act was performed in desperation! Unfortunate part is that the patients 20-year-old brother was the only relative present and doctor apparently asked him if it was ok to perform the ritual. The immature person allowed this but he himself took the video of the event! How can you allow videography in a hospital room where the patient is on the death bed? The godman performed the ritual with impunity as if it is a daily event for him. It is desperation which leads to such rituals being performed as a last resort. It is a tricky thing to pass judgment on these things.

One event and see how many wrong things have been done! Is it the problem with our society? Is it in our DNA? When I point out something which is not good in our society, some of my friends get disturbed. But I feel that once in a while we should look into mirror and be reflective. The sequence starts with God man’s ritual. It is well proven that these rituals have no effect on events in our life. Still we keep on doing the same. It is illegal to perform such rituals but we don’t care.

Who should be going in an ICU? Why a patient is kept in ICU? Intensive Care Unit is an area in any hospital where critical patients are looked after. It is equipped to handle all type of emergencies that may crop up during the treatment. To me it is an area where “nobody” should be allowed to go in except may be a person who is doing the work of an attendant. But what happens in real life? We crowd the area, we go and meet the patient even though we may be carrying some infection like cough and cold. If an unexpected person goes to see a patient in ICU, excitement may get generated. In a patient who is critically ill, excitement is not good and it can affect the patient’s health. On top of this a video was taken inside ICU! Are you trying to capture last moments of a dying patient?

Allowing this event to happen was definitely hospitals failure. There are systems and processes about who is to be allowed inside ICU area? How could there be three outsiders in that room? Of course, part of the blame is with us too! We must meet the patient, irrespective of the health condition. We will do anything and everything to get the entry. What about the Doctor who was present? This doctor’s hospital had handled the main surgery, so he was very much aware of what had gone wrong! For what he did, does he not deserve disciplinary action from the authorities? Why his license should not be revoked? Will he go scot free and keep on doing what he has done?  Newspapers also have equal responsibility in this blunder. Their first reporting indicated as if the large hospital performed this ritual. It was someone else who came and managed to perform it without the knowledge of the authority. From next day reporting changed but it is a public relations nightmare created by press due to incorrect reporting! This is totally unacceptable.

When will our society come out of this backward-looking thought processes? People may justify and say that it was the last desperate attempt to bring the patient out of difficult health condition; for some it is like going to a psychiatrist! But to me, in all this affair the doctor is the main culprit, as far as I am concerned. I will tell you an event that happened in Mumbai.

In a government hospital in Mumbai, a lady was being advised by a doctor during her pregnancy. This doctor also had her own private hospital. She convinced the patient to have delivery in her private hospital. The lady died during the delivery, as complications came up and her hospital was not equipped to handle complications. The hospital was situated in a hilly terrain and approach roads were in poor condition. So, shifting the lady during complications was next to impossible. The family of the patient took the doctor to court. The doctor argued that the lady was a tricky patient; she weighed 120 kgs. So, chances of complications were very high; death of that lady was not surprising to the doctor. The judge asked the doctor one simple question. When you knew that the case was complicated, why did you ask the patient to come to your private hospital, which was not equipped to handle emergencies. Doctor had no answer. She was jailed!

Friends, let us not do things that are not correct. Let us not look at everything for personal benefit. Let us make a better society, come out of retrograde thought process. Let us keep the traditions but apply scientific thought when we follow them. Meeting sick person is ok but meeting very sick person who is in ICU is not Ok! Let all professionals take modern scientific view of the situations rather than looking through old thinking and continue with old unproven non-scientific ways. All these actions will make a better society. It’s not only about the death of the lady but Voodoo death of the whole system!

Ignore body signals at your own peril!

Medical Illiteracy or Ignore body signals at your own peril! I was in two minds about the title for this blog. But the second option prevailed.

Not all of us are doctors by training and not all of us could have access to basic medical information, at least, during pre-internet days! It’s a highly specialized field. But in our day to day life health conditions keep on changing, as you grow older. Some changes can be discrete and some may be obvious. In our own and families interest, we should take care of having basic information and knowledge and decodify the signals our body sends.

Since this is a current ongoing medical event, I am not sharing the names, as I usually do! Yesterday, in my office I was talking to my colleague. Suddenly she said let me make an urgent call. She called and as the call progressed she sounded quite worried and anguished. After the call I asked her what happened? Her brother was not keeping well for ¾ days and she had called to find out how he was doing! She came to know all the details only after the call. He felt weak in the office; since he is diabetic and with BP issues, he asked his colleague to fetch a chocolate for him, to overcome low sugar issue, if any! He felt slightly better but decided to go home as he was uncomfortable. When he tried to use his scooter, he could not use his left hand properly; he felt very low strength in his left hand. Next day he saw a doctor who gave him some medicines and asked him to run tests. Sunday, he saw an eye specialist as he was feeling unease in the left eye!  The doctor indicated some distortion around the left eye. All signals were obvious but our friend probably lacked knowledge about the effects. I immediately coordinated an appointment with a neurologist. In next two hours he was hospitalized in a CCU. I shudder to think if my colleague had not made that call!

I will share many more such events but this particular event has made me very uneasy. It is just by chance, that I overheard a conversation and then got the wheels moving fast! There were specific indications, the person or his family did not understand the details of what was happening but can they also not understand that there was something going wrong with the body. How to inculcate this discipline in the whole family? These things are never taught in schools but these need to be picked up from someone or somewhere. A human being generally does not have detailed knowledge of most subjects other than his own subject. But health is one area which is common to all humans whether they are kings or paupers! I feel that this learning be made mandatory in school curriculum, so that people come to know basic symptoms regarding the emergency events, like heart attack, stroke and others.

In olden days there was the system of GP or general practitioners. GP’s were family friends, advisors, mentors for the whole family. I have known of GP’s who have treated four generations from families. For anything and everything related to health and not related to health too, the families would take advise of GP’s. So, they knew  most of the things about people in the family. If required, GP’s would ask the people to go to experts. In today’s times of no GP’s, I feel that a family should be going to a fixed physician and do things as per his/her advice and suggestions. Since our friend did not have “GP”, the doctors whom he saw, could not guide him properly.

It can be a good idea to guide people into basics of health management and emergency management. Basic training about patient resuscitation is one aspect but such emergencies don’t come so frequently. More than that, knowledge about basic symptoms is most essential. This will reduce time between symptoms and start of treatment. My friend Shashi has a history of stroke. A few months back when he had very high fever and felt faint, he immediately got himself checked from experts. This gave him peace of mind.

I will share one event with you to explain what I mean by lack of basic knowledge in other areas. A professor of arts with a doctorate, drove his car for two days. You will ask me what is so special about it? One of the tappets in the engine had broken and he drove the car with a lot of noise. To understand this, he did not need to know that tappet was broken but he only needed to understand that something was broken and was making loud noise. So, he should not drive the car! Period. But no! He drove on for two days accompanied by big noise! Is it so difficult to comprehend that there was something wrong with the car and not what is wrong with the car?

Two things generally happen. One is signals are simply not understood and sometimes signals are ignored. Our friend did not understand the gravity of the signals, the body was sending. However, I will tell you of someone, a few years elder than me. He apparently had good health, outwardly. He used to go to gym regularly. One day he went out, after  he came back he said that he was a bit tired and would rest for 15 min. 10 minutes later, he was dead due to cardiac arrest. He was diabetic but values were controlled. He was going to the gym regularly. Then why did this happen? When his papers were checked, the values were never good; he was informing his son, who lives abroad,  that everything was ok. He went to the gym every day; he always drove the 500 meters distance! Did minor exercise and chatted with friends, tea, have fried stuff and smoking followed. What he did was not accepting the true body condition, which further deteriorated with wrong food and smoking.

Let me assure you that our body and brain are very sharp in understanding the signals that are generated in our eco system. In young age we start knowing who our parents are, in adulthood we catch the right love signals. As we grow older, we know how to find better opportunities in jobs and in business. All this is done by capturing the signals, the indications that are emanating in our surroundings. But why can’t we catch our body signals which tell about our health? In life we master various things without formal training. Then why we cannot do it about our own health? Is it due to thought process that Cancer, Heart Attack, Strokes happen to someone else? Sudden deaths occur mostly in accidents, most other deaths  are because of ignoring the signal system created by HIM! So please keep track of these signals, it may be twitching of an eye, shaking of hand while holding a glass, heaviness in body especially on only one side, sudden sweating and so on. But at least “create” for yourself a GP system and take his/her advise as we grow 40 plus!

Cheers! Life is too beautiful to be wasted by ignoring signals from the world’s best design, “Our Body”!

Good Samaritans!!

Doctors as a group are good Samaritans. Most of them are in the service of humanity, money of course matters but of many doctors that I have met and know of, are good human beings. My friend Vijay sent me a video in which a physician was speaking about heart ailments. This doctor had a very nice way of putting things across in a humorous way. He was putting his thoughts across that heart ailments can be cured without surgery, angioplasty and invasive procedures in general. Vijay asked me if this is really possible. When he asked me this question the whole kaleidoscope of my interactions with doctors, throughout my life, passed by quickly. This made me think of two things, about doctors in general and about getting well with their help.

My first reaction was that, when  doctors treated you as individual doctors they were simply good to superb, as is natural in any group of people. They always cared for you, they would try to give least amount of medicines as possible, and try and allow the nature to take its course; they would intervene only if needed. Over a period I have observed that doctors explain things in details about your ailment. On the flip side I know a doctor who instead of explaining gives you a link to his YouTube presentation about your ailment, which I thought was very impersonal.

The personal attention however changes when you are required to go to hospitals, where you are theoretically in a corporate environment. You would expect quick and efficient actions followed by continuous tracking as would be expected, as patients go to hospitals only when such need arises. I do not know what happens in that environment but things are sometimes at the other extreme. You will see inefficiency galore, delays, late responses, doctors just not being available and so on. (Oh don’t worry the intern will take care of you!) I remember when I was required to take my father to a large hospital due to heart attack. He was admitted under a senior physician. After initial checkups I was promised that the senior physician will shortly come and see my father. After a couple of hours I was coolly told that the doctor will now come the next day as he was now busy in his consulting rooms. For me it was it was simple, if the senior doctor is too busy to see my father then I would rather go to another hospital. When I said this to the junior doctor, he said we should not do that as my father was critical! I said if he is critical then why the senior doctor is not checking him? Within 15 minutes the senior doctor came!

I remember a case of one of our relatives; he was admitted to a major hospital due to stroke. He had diabetes, he was on dialysis, and he had high blood pressure. For two days doctors would just not share details hence I was called to talk to them. Hospital was trying to force a brain surgery on the patient (had put him on ventilator) but as layman I could see that it was meaningless. I took a young doctor to side and asked him his blunt opinion; he said the patients’ brain is 85% damaged and he has no hopes; he gave a sad smile and said well looks like commercial aspects have taken over the case! We managed to remove him from that hospital to another one where we knew the doctors well. Doctors gave the same opinion and advised that he should be allowed to die peacefully! We did!

But I know of a physician who treated a friend of mine for heart ailment; my friend did not have sufficient insurance coverage to have bypass surgery. This doctor explained to my friend how this can be handled without surgery but he needs a drastic life style change. This was 20 years back; my friend and I had coffee last week!

This reminds me of a story told to me by a young doctor. He was working for a small hospital. He checked a patient and felt that no tests were needed. So he let the patient go. When the hospital owner came he asked the details. When he shared details about this patient, the owner said “Is my father going to pay installments for the new test machine?” Our friend simply said “looks like it” and calmly resigned and walked out!

A student hurt himself while playing badminton. His friends took him to a large hospital. When his parents reached the hospital this student was very upset and said “Dad lets go elsewhere”. His father told him to let the doctors handle the basics then they can move. The student said that they took x ray of his ankle and later found out that the doctor had forgotten to put the film in the machine!

The stories can go on and on! But as in life there are good doctors and there are not so good doctors. There will always be some black sheep. But why the basics change in large hospitals is beyond my understanding. Are doctors not good managers? Are good managers incapable of handling intricacies involved in running a hospital? Well hospitals these days have software to handle their administrative work. What a hospital system does is to provide services required by patients. This is very similar to running a hotel or running an automotive workshop. These two also provide services. Did you ever find that garages and hotels took 3 to 4 hours to give you or your vehicle a discharge? Why is that hospitals take so long to discharge a patient? On the other side, I have experienced an extremely efficiently run pathological lab. They are very efficient and at stipulated time you get your reports by email! But the norm is inefficiency.

Coming back to the video, the doctor aptly said that if you want to get well then the patient has to follow ALL things told by the doctor.  He gave an example saying that if a tank has 15 holes, how can you fill it up completely? It is obvious that ALL 15 holes need to be blocked to fill up the tank. A patient with liver issues says what is going happen if I take a peg or two of whiskey? Then the patient is asking for trouble. A senior physician once told me that in diabetes, most of the patients keep on having issues as they do not follow the basic discipline of diet, medicine and exercise! He said a very small percentage of patients have really erratic body responses and have a tough time as diabetes remains erratic even after following ALL instructions. He also told me a story of a disciplined patient who in yearly checkups found that he had very high diabetes. But by following the regimen to the last dot on I’s and slash on T’s, in three years’ time the patient has become non diabetic, with medicines!

Friends I wrote this blog to suggest how health issues are handled and need to be handled. These thoughts come to mind probably because I am a senior citizen now!! I will add a few more points. All “Pathys” are as good as the doctor who uses them. Each pathy has its own benefits and down sides plus limitations. When you are having jaundice there is no known cure available in Allopathy! You have to take Liv 52. Similarly other pathys also have limitations. But we should not be very rigid in our thoughts about up & down sides. That Allopathy has certain side effects is a known fact but that does not mean there are no good sides! Allopathy is the best researched pathy and offers cures to many ailments, even the toughest of the ailments. Homeopathy and Ayurved have their own advantages and limitations. What happens is after reading something about side effects of Allopathy, some people tend to just ignore it, to me at least, and it is to their own peril. There are diseases like cancer, dementia and many such tough ones. Very strong Allopathy medicines are also not able overcome such ailments. In such cases people should NOT experiment! I will share with you an anecdote about a patient with blood pressure problems. He went to the doctor and got himself checked. His BP was 200/120! Doctor suggested that he get himself admitted to a hospital or take 100% rest at home for at least four days and then prescribed to him strong medicines. The patient probably did not understand the meaning of 200/120. He asked the doctor, “I am worried about Allopathy side effects. Can you tell me the side effects and try to reduce the dose”. Doctor said, “Let us experiment later, and at this stage let us act fast”. Patient still insisted on knowing about side effects before starting the treatment. Doctor gave him all the details and said, “As against these side effects, if you do not take medicines there is only one side effect”. Patient said “what is it?” Doctor said, “You may die”. Amen!!