After 'Khichdification', WhiteCoat Jr Kids to treat patients.

Mumbai: In another major development after the recent notification for the 'khichdification' and mixopathy of medical education / practice by giving surgery nod to AYUSH practitioners, the Council of Indian Medicine (CIM) announced today the launch of WhiteCoat Junior, an online app based platform to teach medicine to kids, and urge them to set up their own hospitals or polyclinics.

In an exclusive interview with the Quackdoses, Dr. Kabhi Mat'bann, President if CIM said, "WhiteCoat Jr is an edutech start-up that will focus on imparting medicine lessons for kids who own a plastic doctor's set and have experience of playing doctor-doctor with their siblings. Such trained kids can be extremely useful as additional manpower in the COVID centres that the state governments wish to open over the next few months, and also help improve the poor doctor-population ratio in the country."

The Indian Medical Allopathy Association (IMAA) meanwhile condemned the move and demanded withdrawal of the app from Google Play, describing it as a step which is "ridiculous” since the right age to be wasted studying medicine should be the best years of your adult life from 17-30 years, and not since childhood.

Unconfirmed sources have claimed that citing lack of job opportunities due to the current COVID pandemic, and with investors in his app fighting for refund outside his house, 6 year old Chintu of WhiteHat Jr fame (who was to replace Google's Sunder Pichai) has now decided to join WhiteCoat Jr instead and start his own Quackhospital soon.

The Music Of Applause

“Dr. Mohit, a 55 year old male patient with complaints of breathlessness is rushed in your Emergency Department, please attend to him immediately”, an announcement made on the hospital PA (Public Announcement) System.

I and my team of 5 Emergency Medicine residents (medical students) immediately sprang into action, attending to the patient and started our history taking / clinical evaluation.

“Hello Sir, I’m Dr. Mohit, what happened to you?” I asked.

“I have been having fever, cough and breathlessness for last 3-4 days,” was the reply.

“Don’t worry Sir, me and my team will take care of you,” I assured to the patient.

What followed next was a classic and systematic clinical approach to the patient, starting from role allotment to each member – airway and oxygenation, applying monitor, securing an IV line for medications and blood sample collection, recording in chart, etc. At each intervention, the patient was re-evaluated for any improvement or deterioration, inputs were taken from the team for what they would do next, all elements of good team dynamics as per the American Heart Association (AHA) were encouraged and implemented, and all medications including bronchodilators, antipyretics, steroid, antibiotics, etc were ordered along with the relevant investigations – a typical Emergency Text Book management of a patient with breathlessness, mixed with my experience as a AHA instructor.

In spite of all our efforts, the patient did not improve, and I ordered my team to prepare for intubation (to put on a ventilator) of the patient.

“Dr. Mohit, we have another patient who has just crashed in the ICU, we need your expert consult immediately”, another announcement on the PAS, and I rushed out of the room.

“Mohit, you are just flawless in your approach, let the residents think and learn, you wait outside” said the senior ER Consultant who had been monitoring and evaluating the entire case scenario, from the control room of the Simulation Lab, at George Washington University Hospital, where I had gone for an observership during my residency.

I stood outside the simulation room, anxiously looking through the tinted window, as the patient’s vitals on the monitor started deterioration – respiratory rates high, oxygen saturation low, and my team of residents is left clueless on what drugs (and dosages) to be given to perform Drug Assisted Intubation / Rapid Sequence Intubation, and their next course of action without their team leader.

“Rush inside, go help your team save this patient,” said the Consultant.

I was once again at my best, quickly ordering drugs, after the consent for intubation was taken, and making sure the procedure was done smoothly by my team member in-charge of the airway, and I gave follow up instructions for the settings on the ventilator, to optimize ventilation. 

This was followed by calling up the ICU in charge to inform about the patient, a debriefing (and feedback from my team members) on the entire case management, to check if we had missed out on anything, and if we could have managed the patient better.

“The patient has been shifted to the critical care area (ICU), you may stop the simulation now”, another announcement on the PAS.

What followed then was something that gives me goosebumps as I write this, a complete silence in the room for few seconds – in awe and disbelief, which was slowly followed by a standing ovation, by more than 30 residents from different countries, lasting almost 2-3 minutes – the sound of which still reverberates in my ears when I think about it. There surely is nothing better than the sweet music of applause.

The words of appreciation by my team (who were completely unknown to me, before the simulation), members in the audience, the other Consultants in the room are something that I still cherish.

By God’s grace, I have had a pretty eventful and successful professional education and career so far, but among all my many achievements, this event will remain the most memorable for me (till date).

A standing ovation is a form of applause where members of a seated audience stand up while applauding, after extraordinary performance of a particular high acclaim, and is considered to be a special honour – an honour I was lucky to receive by a group of budding doctors, where nationality, religion, culture, race, etc did not matter, and the only language was MEDICINE and GOOD PATIENT CARE.

है कोई जवाब?

क्या आपको अंदाज़ा है की PPE कीट पहनकर काम करना कितना मुश्किल होता है?
क्या आप जानते हैं की सभी डॉक्टर अपनी जान को दाव पे लगाके आज मरीजों का इलाज कर रहे हैं?
क्या आप जानते हैं की अब तक 500 से ज्यादा डॉक्टरों की कोरोना से मौत हो चुकी है?
और कया आप जानते हैं की कितना मुश्किल होता है हमारे लिए किसी की मौत देखना, खासकर एक डॉक्टर की।
फिर भी ईस विषय पर सोसाइटी में शर्मसार करने वाला एक सन्नाटा है, जिसके लिए मैंने कुछ चंद पंक्तियाँ लिखीं है।
**********

कहाँ हैं वो थाली बजाने वाले,
कहाँ हैं वो कैंडल जलानें वाले,
कहाँ हैं वो हॉस्पिटल पे फूल बरसाने वाले,
और कहाँ हैं वो डॉक्टरों को भगवान बतलाने वाले।। 

कहाँ मर गए वो नारे लगाने वाले,
कहाँ मर गये ट्विटेर पे वो झूठे आसुं बहाने वाले,
कहाँ मर गए वो अवार्ड्स लौटाने वाले,
और कहाँ मर गए वो TV पे चिल्लाने वाले।। 

क्या डॉक्टर आज बन गए हैं इतने लाचार,
की नहीं मच रहा उनकी मौत पे कोई हाहाकार,
क्यों नहीं हो रहा सोशल मीडिया पर इसका भी प्रचार,
और क्यों नहीं लगाता अब कोई सरकार से गुहार ।। 

अभी भी नहीं जागे तुम, तो देश एक दिन रोयेगा,
एक एक करके जब वो अपने, काबिल डॉक्टरों को खोयेगा,
अगर मरते रहे युहीं सबकी जान बचाने वाले,
तोह कैसे कोई इंसान यहाँ सुकूँ की नींद सोयेगा,
तोह कैसे कोई इंसान यहाँ सुकूँ की नींद सोयेगा ।।

Orthopedic resident shows up wearing stethoscope, receives memo on 1st day of residency.

Ideal Orthopedic residents

Mumbai: In an incident which has sent shock waves in the medical fraternity, a DNB resident Deepak Kumar Singh was issued a memo by his Orthopedic HOD on the 1st day of his residency, after he showed up with a stethoscope around his neck in the OPD.

It is a known stereotype in medicine that Orthopedic Surgeons are considered rough, heavy drinkers, and with zero knowledge in internal medicine. Orthopedics as a branch has a reputation of not being a cerebral field but more of a mechanical job, with the only instruments needed by the surgeons being drills, hammers, chisels, screwdrivers and other metal hardware.

In an exclusive interview with the Quackdoses, Dr. Haddi Todjodkar – the HOD said, “In a career spanning 25 years, never have I seen an orthopedic resident with a stethoscope. Orthopedic surgeons, ECGs, stethoscopes can never be friends! What was he thinking; is he a dentist from the TV advertisements that he needs to show people that he is a doctor, or did he want to hear the patient’s heart sounds? For a real orthopedic surgeon, heart is only a soft tissue organ which keeps pumping antibiotic in the body. Even if he wanted to use it to give fitness for surgery to patients, for me, the only patient unfit for any bone surgery is a dead body.”

Unconfirmed sources have claimed that the resident after receiving the memo was later seen playing games on mobile with the anesthesiologists in the OT, and gossiping about female residents from Physiotherapy, Dermatology and Psychiatry.

The Gift of Life

A 30 year old male, with an alleged history of poisoning, was brought by his brother and father to my emergency department recently. For the 1st time in my life, I read someone’s suicide note (which fell out of his pocket during resuscitation). Trust me, the experience of reading someone’s last words, and his helpless elderly father holding my feet in a public area of the hospital to somehow miraculously save his young son, was mentally traumatic.

Over the past 10 years of being an emergency physician, I have seen a 11 year old boy hang himself when asked to study by his father, a 22 year old female slash her wrist after a break up, 13 year old girl drink 'Harpic' when stopped by parents to use Facebook, 17 year old with cocaine intoxication, etc, just to mention a few, among the many suicidal cases which I have seen so far, and will continue to see in years to come.

I write this because I get deeply disturbed by such instances of people, including children act GOD. They have no right to take away the happiness of their loved ones. Why has life suddenly become so cheap? Why is it that people foolishly & impulsively decide to end their lives? Why be so selfish? It is the worst thing in life for a parent to give a ‘kandha to the arthi’ of their own child. Where do people get that kind of heart and strength from? In most cases, it is just 1 moment of stupidity or a fit of rage.

A few facts straight from my psychiatry book - A person commits suicide every 6 minutes in India - Method: Poisoning > hanging > throwing oneself in front of a train - Incidence: Males > females - Age group 18-30 years.

Though some might argue that it takes courage to take away your own life, in my eyes such people were cowards who leave their family mourning and struggling, looking at the lifeless bodies and an irreparable future. It is disappointing to see the current generation of kids and young adults growing up with social Media, computer games, movies, relationships, sex, drugs, etc spoiling the naïve mentality and innocent childhood of most of them.

Before people do stupid things that can threaten life, I wish they could come to a hospital, and visit the Emergency Department or the ICU to see what DEATH can be like. You can see the fear of death in many patients’ eyes. They know it is coming; it is just a matter of when. While some prefer to cry with the relatives, some look out of the window in hope of a new world, and others prefer to stare at God’s image and chant prayers written next to it, and so on. I understand that man is mortal, we all have the same destination, but for those who don’t value their existence, is life so painful that death is like a garnish on the celebration?

Yes, one fine day our world will collapse, the present will become past, people will move on and all that will remain will be memories. We all will grow old, get weak, become dependent on others; it is a natural progression from being a carefree child, to an independent adult, to an old person requiring support again, before the party is over. It is my sincere request to everyone reading this. PLEASE VALUE WHO YOU ARE AND APPRECIATE WHAT YOU HAVE. VALUE THIS GIFT CALLED LIFE AND MAKE THE MOST OF IT. IF YOU EXPECT MORE FROM LIFE, WORK HARD. There are no shortcuts to success.

The solution in many cases is ‘communication’. Mental health is nothing to be ashamed of. Neither is talking about it. If this article can make even a single person think again before taking that drastic step, my intention to write this will be rewarded.

Radiologist does not ask to 'co relate clinically', Surgeon suffers Neurogenic Shock.

Mumbai: In a never before incident in the history of modern medicine, a famous city based surgeon was admitted to the ICU in neurogenic shock after repeatedly receiving Ultrasonography (USG) reports with accurate diagnosis, without asking him to ‘co relate clinically’.

It is a well known fact that radiologists around the world when asked to do USG to look for appendicitis or a renal calculi usually give a ‘diplomatic‘ report that there was probe tenderness, internal organs obscured by bowel gas, most likely a recently passed stone, tubular organ seen, appears to be possible, borderline, indeterminate, suspected, cannot be ruled out, etc. It is a standard practice to then advise CT abdomen - to the patient, and ‘to co relate’ clinically - to the surgeon.

In an exclusive interview with the Quackdoses from his hospital bed, Dr. Kutting Chahiye said, “In my career spanning 25 years, I have never received USG reports with the accurate pin point diagnosis. I had become so used to co relating clinically that I have now read Harrison’s Principles of Internal Medicine more number of times than my MD medicine wife. I have never seen a more committed radiologist whose eyes would literally light up when the patient would say that their bladder is full.”

Scared that surgeons might start writing ‘to co relate radiologically’ on the USG requisition form (instead of the provisional diagnosis), the Radiology Society has issued a notification asking all radiologists to not deviate from the standard USG reporting template.

The Untold Truth...

The following is a story from my under graduation days, written more than 10 years back while I was posted in the Medicine ICU, the place to learn the ABCs of intensive care.

Though there are stories everyday which can be told, a case that I distinctly remember to this day was that of a 23-year-old engineer, male patient of mine. He was perfectly alright 2 days prior to the onset of symptoms, which began with lower limb weakness. He was admitted in a private nursing home and was referred to the government hospital when he deteriorated and was brought to the EMS in a gasping state (fighting to take breaths, another sign of cardiac arrest). Deficiency of oxygen for even a few minutes due to the absence of blood flow, the brain can get permanently damaged - hypoxic-ischemic encephalopathy. It deteriorated further, he became brain dead… in just 2 days!

Nothing new? Well, the catch is that he was sent IN AN AMBULANCE FROM THE PRIVATE HOSPITAL WHICH HAD NO OXYGEN CYLINDER IN IT. This is the only petty reason that young man will lose his life.

Imagine the rest of the post – like a movie – in the present tense.

Sitting in the MICU, I can only watch as the relatives come and see him… Old parents come to his bed, pray, apply a ‘tika’ on his forehead every morning in the hope that maybe it will help him back to life. Mother trying to hold his hand, crying, asking her son to talk to her, continuously speaking, reminding him of old days spent together. Maybe he is hearing her, maybe he can hear his mother’s cries. Brother, father, grandparents, everyone there- it is really disheartening to see them crying. I can’t look in their eyes at times. I do not want to see their hopes die, looking in my eyes... I too get very emotional at times...

The family has not yet been informed about the braindead status of the patient. They will not be able to face it in such a short interval of time. Who should be held responsible for his death? The private hospital doctor or the lack of proper ambulance services in the country, for being so irresponsible to send a critically ill patient without a basic oxygen? Why should the family not be told about this? Why should the truth be hidden from them? It was not the patient’s disease that will eventually claim his life but the unpardonable mistake on the part of that doctor to send him without OXYGEN!

Because I cannot stand against anything that is wrong, I decided to argue with my senior that the relatives had every right to be told about this. But the only reply I got was that we don’t put our colleagues into trouble- apparently, a MEDICAL ETHIC! I better remain quiet. Is it right, I still question?

Our next line of management says, "Keep the patient on the ventilator for a few days till the family gets an acceptance of the poor prognosis, eventually declare the patient braindead," and then ENCOURAGE THE RELATIVES FOR ORGAN DONATION.

Sad. I can’t help much. But it has left an impact on me. It's very sad, even for us as doctors to look into the eyes of a relative and tell them that the patient is no more. And here we had something more to say, an answer to all their questions… the truth… which will never be told. The truth... which will be cremated with the patient.

कोरोना का कहर।

क्यों आया वो सरहद पार से,
दिल रोये हैं उसके वार से,
घरों के बुझ गये चिराग ये,
क्यों फैली है अब ये आग रे।

जिंदगी हो गयी है अब सस्ती,
क्यों  बेबसी पे मौत है हस्ती,
आँसुओं की नदियाँ हर जगह थी फैली,
कोरोना की गूँज जब ज़ोर से बोली।

कंमुनिलिसम् क्या उन्हे यही सिखाता,
कौन है जो उन्हे ज़हर पिलाता,
जग में ये विनाश नहीं हो पाता,
काश ' वायरस बनाने वाले ' को कोई इंसान बनाता,
काश ' वायरस बनाने वाले ' को कोई इंसान बनाता।।

The Fighter In Us.

The war is still on, how can we stop,
Our blood is still warm, how can we stop,
Our mission is undone, how can we stop,
The battle is not won, how can we stop…

COVID has taken its toll, we are in pain,
Yet unbroken with the shackles and chain,
Our eyes are in tears, but spirit intact,
The fire in us still burning has its effect…

The fighter in us is raring to go,
We don’t have the time to feel a bit low,
Our hearts still beating, we must move on,
As front line warriors we continue to perform…

PPEs and masks we must carefully don,
And fight until the threat is all gone,
God will favor the mighty is our belief,
Until we breathe our last sigh of relief…

Sarvodaya Hospital In Times of Corona…

With the country grappling with the unprecedented changes brought by the Covid 19 pandemic, the last couple of months have forced major changes in the healthcare sector. Though the entire world realized that we had underestimated the destructive capability of the virus, and were left unprepared, India showed resilience and courage to boldly face the grim situation.

The realization that it is not a matter of ‘if’ but ‘when’, the pandemic was going to hit the country, compelled us to think long and hard, requiring activation of a disaster like situation, with hospitals getting very little time to prepare. Sarvodaya Hospital & Research Centre in Faridabad, was one such corporate hospital which was at the forefront in Delhi-NCR region, in terms of its preparation to deal with the current crisis.

It all started with creation of a Covid Core Committee comprising of experts from all clinical & non clinical fields to brainstorm on the way forward including laying down the policy, resource management and delegation of work.

The 1st step was creation of a Flu Corner outside the 2 main entrances of the hospital for thermal screening of patients & their relatives. Patients presenting to the Emergency department were then triaged again, using a specially created visual triage checklist, based on their symptoms at a triaging desk manned by a trained emergency physician. A separate isolation area was created within the Emergency, with a dedicated nurse and separate portable Xray, ECG and Sonography machine. Standard treatment sheet for Out patient & In patient management of suspected patients was created, so that patients could be treated based on whether their symptoms were mild, moderate or severe. At the same time, patients who were advised home isolation were handed over specially designed patient education & awareness brochures from the Emergency & the OPDs. A specially designed sample collection booth was also made, to collect the swab samples of patients, thereby ensuring zero contact with aerosols & minimizing risk to the nurse collecting the samples.

A separate Isolation ward was created, and the High Dependency Unit (HDU) was converted into the Corona Care Unit for admitting suspected cases. Patients were transferred from the Emergency Isolation room to the respective IP areas directly through designated lifts. Patient wards which were not needed were also closed, to provide a backup reservoir if there were too many cases.

Since the OPDs were closed initially and all non essential services had to be stopped, the hospital made arrangements of video consultation and tele-consultation for the patients with their primary physicians. Once the OPDs were permitted for few hours a day, the hospital made all arrangements to restrict the number of visitors with the patients, introduced a token system to meet the doctor and also the waiting area seats were numbered to follow social distancing norms. Similar process was followed at the other support service areas like the pharmacy, laboratory & the radiology departments. The security department in the hospital was proactive to make sure that there was a smooth movement of patients and that they were guided properly. The Consultants were also provided Level 2 PPEs and maintained social distancing while attending to OPD patients.

To keep the hospital machinery functional, similar arrangements were made for the Operation theatres, Endoscopies, Labor room where doctors & nurses were provided with complete protective equipment. Patients were counseled & screened for COVID before undergoing any procedures.

Under the watchful eyes of the Microbiologists and the infection control nurses, a detailed COVID infection control policy was also made which was regularly updated as per the dynamic government guidelines. The department was also responsible for training and monitoring of all hospital staff for compliance of the policy. Their other responsibility was tracing of all reports, everyday, from the government approved laboratories that the hospital had tied up with for COVID sampling. The patients whose test came positives were immediately referred to the ESI hospital & Medical College as per the guidelines of the state government, in the hospital ambulance, where even the driver and support staffs were provided with Full PPE hazmat suits.

The hospital was very prompt in its actions and was successful in the mammoth task of procuring the recommended N 95 masks, 3 ply masks, PPE kits; even to the extent of procuring raw materials and having in house tailors stitch protective gear, round the clock. Thankfully, there has been no dearth of any protective equipment to any of the hospital staff. A lot of credit should be given to the purchase department which went out of the way to procure things, day in and day out, since the supply chain of the hospital was broken due to the lockdown.

All hospital staff was also allotted duties on a rotational basis so that a backup team was always ready, if an entire team on a shift needed to be quarantined. The hospital also made all arrangements to quarantine the doctors and nurses in isolation rooms within the hospital premises and the hostels.

Regular patient education and awareness information, training videos were created for the patients and widely shared on the hospital’s social media platforms as well.

Understanding the importance of mental health, the hospital has continued regular counseling of all the frontline staff, conducting stress management activities to keep the morale high of all its employees in such testing times.

Though it is sad that it took a pandemic to lay bare our vulnerabilities and forced us to radically revamp the way healthcare is delivered, but we must look towards the future. We, at Sarvodaya Hospital & Research Centre, Faridabad, are fully prepared and committed to providing the best care to all our patients in times of this pandemic. We sincerely hope that our collective efforts shall not go in vain and the lessons learnt from this pandemic will eventually make our systems more resilient in its aftermath. Hopefully soon.

The Truth Behind the Numbers.

A 35 year old male is brought dead to the Emergency Department with history of fever since 2 days, associated with cough and breathlessness. The doctor in the emergency explain to the patient's relatives that a Medico-legal case needs to be made, since it is unnatural for a young patient without any co-morbidities to suddenly die, and the body might be sent for post mortem by the police. Scared, the relatives decide to take the ‘body’ to a government hospital, as they know that there would be less chances of going through these legal hassles to get a ‘Non-Covid’ death certificate.

It is not a fictional story my friends, it is a real life incident, with similar instances happening daily, all across the country.

I was surprised to read a news article today, about another young death. “He died due to cardiac arrest and not by coronavirus, though he had tested positive for the infection,” a spokesperson for the hospital told – read one of the paragraphs.

And I thought that the truth needs to be told, the truth about the inhumane side of this pandemic – the big fudging of numbers. It is just the tip of the iceberg.

Similar to the above mentioned incident, I'm sure there are hundreds and may be thousand others all across the country, EVERYDAY, who are SHOWN as dying of cardiac arrest / cardio respiratory arrest / Acute myocardial infarction / pneumonia / infective exacerbation of COPD, Asthma or ILD (lung pathology), etc on their death certificate - because people in India will not die of the coronavirus even after testing positive for it. This is precisely how actual number of deaths is being and will continue to be manipulated. Hospitals are being directed to not write COVID as cause of death, and those deaths which are being reported as COVID need to be 'audited' by a government committee first before inclusion in official numbers released by the state. A notice from the Bengal government was widely shared on social media which clearly asked doctors to NOT WRITE COVID 19 on the death certificate of patients.

If a private hospital reports a death due to COVID, it will be sealed by the government, leading to shut down of the facility. All existing admitted patients need to be discharged within 48 hours or referred to other hospitals, most staff will then be placed under 14-21 day quarantine, patients will be scared to come to that hospital once it reopens, etc – causing huge financial losses to an already hardly hit healthcare sector, where revenue has reduced by almost 70 % due to reduced patient load and reduced surgical procedures. This is the crux of the death certificate.

There are instances when positive reports are not disclosed to the family members, attending doctors and nurses treating these patients to avoid panic among other staff members and patients. Reports are repeated again and again, claiming that the original report was a ‘false positive’ and subsequent repeated report, which actually may be a ‘false negative’ will then be considered as the final report.

The other aspects of this harsh truth for the hospitals is, if they write death due to COVID on the death certificate and the body needs to be taken out of the district for the last rights, the police does not give the mandatory No Objection Certificate (NOC) for transport as it will then increase their work to trace contacts. If the hospital asks for a post morten to ascertain the cause of unnatural–suspected death due to COVID, police again make the doctor write ‘something’ at least in the death certificate to avoid handling and roaming around with a dead body, arrange for a COVID test of the death body, and wait to complete paperwork formalities till the test results come.

Many a times, there are tie ups of the policemen with few general practitioners / quacks who issue such death certificates (off course for a charge), in case a hospital refuses to give one. This reduces the hassles for the police as well, especially when we are dealing with a time when even the relatives are also scared of taking away a dead body.

Besides, not even 10 % of the actual funds released by the government for supporting healthcare facilities or the poor would actually be percolating, with major portion of it ‘disappearing’ between the middleman and the babus.

Without such tactics, it truly would be IMPOSSIBLE for a densely populated country like ours, and with the MORONIC CITIZENS (who can forget the thalis, talis, diwalis, etc), to have such low fatality rates.

Maa, Meri Maa...

On Mother's Day, sharing the story of my patient admitted in the ICU and her young son while I was posted in the ICU as part of my residency many years back.

It has been days since she was brought in an unresponsive state, found to be in asytole...CPR given...had a Ventricular tachycardia...Given DC shock...reverted...intubated...and shifted to the ICU...now ALIVE..with tracheostomy, on life support...but sadly her neurological outcome is poor.

The son could not see his mother suffer anymore, and signed the DNR (Do Not Resuscitate) yesterday...All these days, it was heart touching to see him try talking to her, get his cheek near her lips so that she could give him one kiss like she always used to before...an ideal loving, caring son...This note placed next to her says it all.

The reason I share this is because there is so much we have to express to a person we love, be it out Grandparents, Parents, Siblings, Friends, Lover, etc....but we never do or we never feel the need to, as it is understood or we take it for granted...it is only after they go far away or we lose them that we realize we had so much to say to them.

Friends, if this touches you, make sure to TELL the people who you love what they mean to you (instead of updating your status on FB on those Mother's/ Father's Days, etc)...how much you care for them..how beautiful life has been with them..see old photo albums together..relieve the memories..laugh..cry..cherish the moments..and LET THEM KNOW HOW MUCH YOU LOVE THEM...before its too late...and all you are left with is guilt or regret that, "I wish I would have told..."

This is what it says:
MOM YOU ARE SPECIAL.
You have been the essence of my life even before I opened my eyes to this beautiful world. You tender touch and loving gestures still make me feel warm, secure and dearly loved. Mom, as I look back upon the years gone by, life has always been blissful in the shade of your love.

Today, I would like to thank you for all your little acts of greatness, when you added your magical touch to my small but significant steps in life. You've always encouraged me and lent a helping hand whenever I lost my confidence and instilled the thought that I could overcome just about everything.

You make me realize that I could count on you anywhere, anytime. I may not have thanked you enough but I want you to know that you are my most prized gift from God. You are my divine angel.

I LOVE YOU MOM.

In Solidarity with the Doctors...

“We, the unwilling, led by the unknowing, are doing the impossible, for the ungrateful. We have done so much, for so long, with so little. We are now expected to do anything, with nothing.” – A Doctor on the frontline.

The insensitive videos being shared on social media from my Alma Mater - Sion Hospital in Mumbai, about dead bodies being kept in the ward area where patients are treated is deeply disturbing. The politics and blame game we are seeing now rubs salt on the injuries of my fraternity – The Doctors & Healthcare Professionals – who are The wounded healers.

I and my fellow colleagues no longer wish to be called a corona ‘warrior’. A warrior is taken care of by his command, but unfortunately, all I see here is threat and intimidation by the government, the media and the people who have been mere silent spectators over the last few weeks.

The writing is clear on the wall, it is time now for us to brace for the worst. Looking at the way the numbers are increasing, every day, and the government being absolutely clueless on how to deal with the situation, only a miracle can save us all now from the impending doom.

Where were all the ‘warrior’ calling people when doctors and healthcare professionals were attacked week after week, year after year? Where were those, when doctors complained of the pathetic living conditions, poor facilities at the government hospitals, long working hours, being mistreated by seniors, etc. Silently going along with your own life, because it did not matter to you? And yes, the attacks on doctors, police and CRPF jawans have continued till date.

Now, when we are all on the back foot, what do the people do? Hail the courage of the very doctors who till now were their punching bags and enemy number 1 for everyone, right?

Fact is, like me, most of my doctor colleagues are also scared. And those who say they’re not, ARE LYING.

I want everyone reading this post to seriously think about a few things -

1. With poor quality PPEs on the offering and unavailability of proper N95 masks, do you think doctors and nurses would really want to join the combat, unarmed, like a scapegoat? Do you think anyone likes to endanger their own lives and killing themselves, just for money?

2. What responsibility is the government taking of resident doctors who test positive for the coronavirus while being on the frontline? We have all seen images and screenshots of doctors begging to be admitted in hospital after testing positive.

3. Resident doctors are being denied tests for themselves, even if they show symptoms and are forced to continue to work, putting hundreds of others are risk.

4. The government has not even taken care of the basic food requirement of doctors and nurses on COVID duties. They are not being given a decent meal, the food of the corona patients is better than what the doctors and nurses receive.

5. Where are all the hidden AYUSH doctors who were till now claiming to be equivalent to MBBS doctors? We need you to come join us in the screening of patients, collecting their throat swabs, providing emergency and critical care to the positive patients in government and private hospitals. Why have 99 % of you not applied to the job openings issued by the government in various newspapers?

6. It is simply STUPID to read how the AYUSH ministry wants to conduct research on this pandemic when the world population is fighting to survive. Do you really believe ayurvedic, homeopathic or herbal medicines have a cure for this?

The government has also been misguiding people, having their priorities wrong. Jal Shakti Ministry wants ICMR to conduct clinical trials on use of Ganga Water to treat COVID patient, wow…really?

7. Rs. 50 crore is spent in the fly past on a single day to salute the Corona Warriors by showering flower petals? Who gives all these dumb ideas? The money could have been used for providing food to the poor, PPEs to HCWs, transporting migrant workers, etc. The way it was planned, with people standing in a pattern, raising their 1 hand, looked like another scripted marketing gimmick, and copied from the US.

8. How many agree of the decision by the government to open wine shops across the country? We all have seen how social distancing has gone for a toss, and people are standing in 3-4 kilometer long ques to get booze. Give us one good reason why we should risk our lives to save these morons.

9. I am also interested to know how the donations to the tune of Rs. 7000 crores in the PM Cares fund are being spent. Why is the government reluctant for an audit of the donations in it, by now calling it a private fund? It is all civilian money and we have the right to know. Was there really a need for a separate fund when there were hundreds of crores already lying unused in the PM National Relief fund?

10. And to make things work, the government wants to mandatorily, not voluntarily, deduct salaries of the doctors working on the front line towards the PM cares fund.

11. The government ‘watch dog’ keeps claiming we are not in the stage of community transmission. With close to 4000 positive cases reported a day, all over the country, what else would count as community transmission. Why are we living in this denial being portrayed by the government? Another bottomline is that we are not testing enough! Period.

12. Where is Anjan Om Kashyap? I really want to see you reporting live from a COVID ICU how relatives are not being allowed to meet their patients, and how doctors are not attending to patients. It sure will boost up your TRPs. And do remember to wear the precious PPEs that you and the sold media morons like you are using to report live.

13. No food was or is being provided by the government to the migrant workers? All I see are NGOs and individuals rising to the occasion. The Shramik express trains have been now stopped in many states – the reason, it will be difficult for the economic revival of the state post lockdown, factories will not restart, construction worker will stall, etc. Why did you not act on it earlier, migrant workers walking hundreds and thousands of kilometers to their native place, some even dying on the way, was for everyone to see. And the central government claims that they paid 85 % of the travel cost, and the state government paid 15 %, really? You think we are fools?

14. Medical colleges in South India have hiked post graduation fees by almost double, to cover the cost of the loss due to sparse number of patients. Why? Where do you think students will be able to pay up, with everyone’s source of income coming to a standstill?

15.  And to make matters worse, doctors are not being allowed to stay in their own homes, with their own families, as scared society members have given ultimatum to find temporary accommodation near place of work. These are the same people who would call up the doctor in society, even at odd hours, for prescriptions or free medicine samples.

It is really sad to see such things and still no one has the guts to question the action by the central or the state governments. It is easy to now blame the hospital administration and play the dirty politics for the state government’s own failure.

It is high time they realize that they need to focus on education and healthcare 1st in all their future political agendas, and not Hindu Muslim vote bank politics.

The Murdered Suicide.

Warning: Graphic Image. 

Some stories remain untold, and there are some stories which trouble your subconscious mind, so much so that it would be a crime if the truth is buried.

We doctors, especially those working in the Emergency deal with medico-legal cases on a daily basis, and are used to clicking photographs of the injuries or identification marks of our patients (including those brought dead) to capture them in detail on our doctor notes and the police information report, or to send them to the surgeons on Whatsapp to give them a rough idea of what they would be operating on, before we dress the wounds.

Though I had deleted this photograph multiple times in the past, I’m not sure how I always find it in my old unused phones, computer backup, cloud, etc - as if the dead wants me to tell the truth, the harsh reality of his life.

A 17 year old male was rushed to my Emergency Department in an unconscious, unresponsive state with no recordable pulse, blood pressure or any spontaneous respiration, pupils were bilaterally 5 millimetre dilated and non reactive to light, with his T-shirt soaked in blood.

But since his body was warm, we started with immediate resuscitation (all life saving measures) including Cardio Pulmonary Resuscitation (CPR-Chest compressions), Intubation (putting a tube through the mouth, directly in the wind pipe, to give breaths) and life saving drugs. And I realized that with every chest compression, the soakage on the T-shirt was increasing. I asked my nurse to lift the T-shirt, and what we then saw were 3 stab marks on the chest and abdomen.

To control the further loss of blood, I thought of plugging the stab wound (closest to the chest) from which blood clots were coming out of, during each chest compression. I then put my gloved index finger in it, and I knew immediately that it was all the way INSIDE HIS HEART.

I then ordered my team to immediately stop resuscitative attempts, as we knew that no matter how hard we tried, the patient was dead and there was no way he could be revived.

While the nurses were taking out an ECG, which would show a FLAT LINE (to declare the patient dead), I came out from behind the curtains to talk to the scared father, to counsel him regarding the prognosis, and the mandatory documentation including the process of informing the police.

“I’m a professor at ______ (a very prestigious institute in Mumbai) and he is my adopted son. My elder daughter and he had a fight over her social media posts after which in a fit of rage, she stabbed him with a kitchen knife. We took him to a nearby private nursing home, but looking at his condition, they referred us to your hospital. My daughter accompanied us to that hospital, don’t know where she is now”, the panicked father said, without me even inquiring what had happened.

I asked him to calm down, gave him a glass of water. By this time, I had the Flat Line ECG in my had which showed that there was no activity of the heart, and I pronounced him dead – a news that I always hate to break to relatives of any patient, and especially to a parent about their young child. I then proceeded to complete my paper work.

By this time, more of his family members had gathered in the Emergency waiting area, counseled the grieving father.

After 15 minutes, the father again came to me, this time with 2 other gentleman in their 60s, and they wanted to see my hospital documentation. I explained to him that all I had documented was the patient’s clinical condition on arrival, his injury marks, details of our resuscitation efforts, and not the history that he had told me.

“I never told you anything, what are you talking about?”, said the father and I’m left shell shocked.

Knowing that it was the job of the police to investigate, I did not argue much. I informed my medical director of the developments, and he too asked me to leave it to the police to investigate.

When the police came, I handed them the copy of all the relevant documents, informed them verbally of what the father had initially told me, and they reassured me that they would conduct a fair investigation. The body was handed over to them for further formalities and a post mortem at a nearby government hospital.

3 days later, I called up the investigating officer, to inquire about the progress of the case, and I received another shock. He told me that the child was suffering from depression and had committed suicide. Case closed.

And to this day, I can't stop thinking about precisely these things :-

a) The Professor changed his statements after being coached by his family and friends. Now that his son was already dead, did he want the daughter to land up behind bars for many years?

b) Was it because the son was adopted and not his real son, that the father did not even shed a tear, while he was busy thinking how he would brush the truth under the carpet?

c) The police would have been paid off well, to do what they are best known for… (will leave it to the imagination of the reader. A pointer can be the similar investigation, like that of the famous Salman Khan hit and run case) – a clear case of murder was converted into a case of suicide.

d) You do not have to be a forensic medicine specialist to know that it is IMPOSSIBLE to stab yourself like that, THRICE, to commit suicide.

e) Because of a system that can be manipulated, bribed and bought easily, a MURDERER IS OUT ON THE LOOSE.

My version of this story will NEVER CHANGE; as I know what I had heard that day from the father.

I really hope that the photograph no longer find its way back on any of my screens this time, but would want it to show up on your screens, so that the real story and the harsh truth of the boy can be told and shared with the world.

All we have is Now...

The ‘Wuhan - Chinese Virus’ pandemic is unprecedented, with its impact which has been extraordinary across the globe, including India. The danger posed by this disease is real, imminent, and something that the world has never dealt with before.

All across the world, the front line warriors against this deadly disease have been the healthcare workers (HCWs) – doctors & nurses who have been ‘selflessly’ working in this combat.

But what makes the global situation different in India is the way doctors and nurses are being treated, by the government and by the common man of the country.

Isn’t it perplexing that it did not even take hours for the ‘shameless’ general Indian population to shift gear from ‘clap mode’ to ‘slap mode’.

The news of HCWs being accused of ‘negligence’ when an elderly patient dies of the virus, being beaten on declaring death of a COVID 19 patient, being stone pelted and ‘chased out’ of resident locality while going for screening camps or to quarantine patients, to be thrown out of their rented accommodation & hostels due to the fear of being carriers, not being provided with even decent meals while actively attending to COVID positive patients, getting defamed to be the actual source of contagion for many patients in a facility, etc should really put the country to shame.

And to top it off, very less has actually been seen of the government’s ‘hollow’ actions for the front line warriors which are only on paper and in news conferences, not at the grass root level.

Is it wrong for doctors and nurses to demand PPE kits? And how does the government respond – using threats - to terminate employment contracts, or by cancelling registrations to practice medicine, or by not giving graduation degrees to interns after completion of their MBBS, and of using their last resort ‘brahmastra’ - the Essential Services Maintenance Act (ESMA) by which HCWs can be imprisoned for up to a year in case they refuse to work; and by false reassurance on national television that we are well prepared?

And to add more insult, they come up with regularly updated ‘loosened’ guidelines to reuse and sterilize the N95 masks, thereby increasing risks to the HCWs – not because the government wants you to be safe, but to make sure the we continue to work !

The official COVID 19 positive patient numbers (which have been decently low are increasing at snail’s pace) is because of the less testing available, the 40-50 % false negatives of the currently available kits, maximum cases being those with mild symptoms who are asymptomatic carriers and not being tested at all, less virulent strain of the virus in India, etc – while we HCWs are aware that the actual numbers might be 25-30 times the official numbers.

Is there any transparent explanation of the way the money donated to the government is being spent? With unspent money in millions already lying in the PM National Relief Fund, thousands of crores is received from ‘civilians’ in a separate fund and the ‘PM Cares’!

Nevertheless, I will only pray that this pandemic ends soon and normalcy is restored – because Corona or No Corona, the common Indian man’s attitude towards the medical fraternity will never change, unless the government takes stringent measures.

I would like to end this article by a poem dedicated to all healthcare workers – Head Held High.

When time tests you in its war,
People taunt you for who you are,
Things fall apart, you don't know why,
Never look down, hold your head high.

When success evades you, failures you see,
Learn to move on, let it be,
Aim higher next time, for the limitless sky,
Never look down, hold your head high.

Every strong man is tested, before his greatness,
Accept the truth, keep the heart hate less,
We will be victorious, it sure ain't a lie,
So never look down, and hold your head high.

Save the Savior !!

Yes we are nerds…we are geeks…we are those hard working, selfless doctors who have sacrificed a lot and gone through hell to be one. For as long as I remember, we are those who have burnt the midnight oil all through childhood, teenage years and early adulthood…been hardworking toppers, disciplined, brilliant winners throughout.

Right from getting into medical college after cracking the entrance exams (in 1,2 or 3 attempts), we give our best so that we can live up to the dreams and hopes in our parents’ eyes. Slogging hard, going through innumerable exams, vivas and more exams, we have no social life at all except restaurants and theaters near the medical college. We miss out on our family lives, cousin’s marriages, family functions, new year celebrations, festivals like Diwali, Navratri because we are always busy studying for the mid-term, ward exams, prelims or the university exams.

Unlike engineering and commerce courses requiring 2 months of studies just before half yearly and final exams, for us time literally comes to a standstill for approximately 6-7 years studying 365 days a year during M.B.B.S to become a doctor. The medical college becomes our home, our playground and fellow students our family. Even after completion of M.B.B.S, we stand nowhere in the current scenario. The days of a General Practitioner are over.. Then we start preparing for a second rat race and we go back to what we are best at…Sitting and studying for post-graduation….having the most boring, frustrating, and sedentary life one can imagine. By the time we get our graduation degrees, most of our contemporary friends are already done with their Masters. And then there is the ‘Rural MOship’ where you are supposed to waste 1 more year in some village or tribal area just because we chose to be a ‘ Life saving Doctor’ or pay an impossible amount of money to the Government.

Sitting and studying for 1-2 years preparing for post-graduation, not necessarily getting into the branch of your choice and compromising in life, and then living life like a dog for 3 years during post-graduation is so saddening. And then we start our lives when our school and college friends are well settled living their lives happily after marriage with their children. And when we do come out of the long dormant period, all we realize is the true meaning of life…it is not in money, fame…but in small little things of everyday life, being with family…. Yes, we doctors do get rich eventually but at the age when we cannot enjoy their own money, because the time we should have been ‘alive’, we were stuck in our books.

Looking at the shocking news of a Chennai Neurosurgeon who died battling the coronavirus – denied a respectable burial – mob protesting and attacking the ambulance personal – dead body being left in the middle of the road – later buried by another doctor who had to himself dig the grave of his friend, rocks me to the core. What kind of a savage society are we really living in?

Though I’m a very passionate emergency physician with complete dedication to my work and my patients, with the way things are (and only getting worse), I’m inclined to wonder if it is really worth the grind? Should hard working youngsters be discouraged to even look at medicine as a career option in India…for people who think being a doctor is cool, noble, respectable and would want to be one…. think again, the typical Indian mentality, the politics, the laws in this country will never change…it is not worth risking YOUR OWN LIFE.

Webinars are painful waste of Time: Study.

Webinar Specialist Doctor evaluating Chest X-Ray of a COVID 19 patient.

Mumbai: In a jaw dropping study which has put a question mark on the integrity of the medical fraternity, it has been revealed that most doctors conducting webinars and giving interviews on news channels about Coronavirus are those who have never treated a viral infection in their entire career and have zero understanding about Epidemiology.

While infectious disease specialists are busy working on the front lines, doctors having degrees and expertise in Dermatology, Cardiovascular Surgery, Neurosurgery, Endocrinology, etc have suddenly become experts on COVID 19 and have been lecturing others on live Webinars and from television studios. The study also highlighted the fact that 70 % of the attendees of the webinars are implanted pawns of the organizers who are not only forced to attend, but are also given pre decided questions to ‘stupidly’ ask during the webinar to make it interactive.

In an exclusive interview with the Quackdoses, Dr. K’abhi Matbann, a plastic surgeon who has so far conducted more than 50 webinars said, “Jo dikhta hai, who bikta hai…. After reading all the forwarded guidelines and policies from Whatsapp University, it is not so difficult to impart knowledge on such platforms, which is mostly on use of PPEs only - not available in the country anyways. We are actually not concerned about solving queries, but are simply more concerned about the number of people present during the live webinars”.

Unconfirmed reports claimed that 2 webinar experts Dr. Munna & Dr. Circuit were secretly overheard saying, “Arre tere ko aur mere ko Corona kya hai, ghanta malum hai?”, to which the other one replied, “Bhai, webinar dekhne walon ko bhi ghanta malum hai”.

मेरा पैगाम, देश के नाम।

एक बीमारी बड़ रही आगे,
नाम सुनते सभी दूर भागे,
COVID -19 है वो कहलाती,
नहीं देखती वो धर्म और जाती।

आओ मिलकर हाथ बड़ाओ,
देश को अपने सक्षम बनाओ,
साथ बड़ाओ अपने कदम,
संग सभी तो जीतेंगे हम।

भारत देश हमारा प्यारा,
कोरोना के प्रकोंप का है मारा,
ज़ोर देकर सोचो सभी,
‘सोशल डिस्टन्सिंग’ करनी होगी अभी।

कोरोना ने देश को भी बनाया है अपना घर,
खासने, छिंकने और छूने से फैला मगर,
आज हज़ारों देश वासी है इसका शिकार,
लॉकडॉन रखने से ही है इसका उपचार।

अन्न है हम सभी को खाना,
गंदे हाथों से बीमारी को क्यों साथ ले जाना,
संक्रमण की दरें कम होंगे तभी,
जब हाथ धोके खायेंगे सभी।

बच्चों - बड़ों को भी यही समझाना,
सरकार के निर्देशनों को ज़रूर निभाना,
बनेंगे भारत के भविष्य तभी,
जब मास्क पहन कर बचेंगे अभी।

डॉक्टर- नर्स- पुलिस- सफाई कर्मी साथ हैं,
बस कुछ समय की और बात है,
कोरोना का प्रकोंप होगा कम्,
प्रगति की राह पर होंगे हम।

सेहत का पैग़ाम फैलाना है हम सभी का धर्म,
इस जंग में साथ देके तुम करो अच्छे कर्म,
ये पाठ याद रख इंसान, बने तो इंसान बन फिर चाहे,
डॉक्टर को मत बना भगवान,
डॉक्टर को मत बना भगवान !

Unethical to not give alcohol prescriptions, say AYUSH doctors body.

Bengaluru - A day after the Indian Medicos Association criticized the Kerala government's move to provide alcohol on a doctor's prescription, AYUSH practitioners have come forward to offer their services and have demanded that this rule should come into effect throughout the country.

The controversial decision had been taken by the state government after suicide reports of those who couldn't deal with withdrawal symptoms due to the unavailability of alcohol during the 21-day countrywide lockdown starting March 25.

Ever since the COVID 19 pandemic has hit the country, doctors practicing the alternate systems of Indian medicine, who were till now claiming to be equivalent to MBBS, have been sitting idle at home. Even PM Modi in his recent interaction with the AYUSH Ministry only praised them in promoting #YogaAtHome to de-stress the mind and in spreading awareness about social distancing, rest of the news reports looked liked answers to PSM long answer questions of just beating around the bush to fill exam supplements.

In an exclusive interview with the Quackdoses, president of the AYUSH Placebo Association, Dr. Hakim said, “We disagree with the Indian Medicos Association’s argument that Alcohol is not a medicine, and that it would be unethical for any doctors to prescribe it. The government has every reason to push liquor sale, not least for its significant revenue implications, but because we have been prescribing both Dava & Daru to patients since ages. We would be happy if World Health Organization (WHO), or at least the Medicos Council of India (MCI), makes the alcohol on doctor’s prescription only rule mandatory permanently.”

The AYUSH Placebo Association has announced that they will sit at home wearing black badges on Tuesday to protest, if the government does not agree to their demand.

उपकार का प्रचार।

गरीब के जीने मरने की चिंता,
भला आजकल कौन करता है,
ऐसे अचानक लॉकडॉन की घोषणा से,
सबसे पहले गरीब ही तो मरता है।

ऐसी परेशानी के पलों में,
मृत्यु की चिंता किसे होती है,
हमारी सरकार से अपील तो बस,
पेट भरने के लिए २ वक़्त की रोटी है।

कुछ लोग इलाके में आये थे कल,
देख शायद हमारी दुविधा को,
जब कैमरा दिखे, तब एहसास हुआ,
वो आये थे अपनी सुविधा को।

आये फिर वो अस्थायी झोपड़े में हमारे,
थैलियों में लेकर बिस्कुट, रोटी और दाल,
एक आस उठी मन में,
शायद ये पूछएंगे हम गरीबों का हाल।

शर्मनाक मंज़र चलता रहा,
दुख से मैंने आँख मीच ली,
मजबूत थी उनकी पकड़- छूटी न थैली,
जब तक १० फोटो उन्होंने न खीच ली।

Decided to pen down these few lines to address the way many self sufficient people showcase their contribution towards the poor & needy just for posting on social media these days.

The Prayer That Counts...

This is an appeal to every reader of this article – to take out 1 minute of your time to thank your doctor and to pray for those innumerable selfless souls who have taken over as the ‘messiah’ to screen and to treat patients suffering from this global pandemic with repercussions of unthinkable proportions, that has hit upon us all.

When countries have gone into lock down, hospitals are struggling to cope with the sudden surge in patient volume, global economy hitting rock bottom, thousands of people dying every day, and a thousand others becoming infected; when most offices and companies have shut shop and have asked their employees to work from home, there are countless other healthcare workers who are nothing less than soldiers now, risking their very own life to save someone else’s.

A virus has done what nothing could do – unite countries to fight together, put behind their differences and cooperate; have taught people that when temples & mosques have closed their doors, hospitals have opened them to help people; and that the fear of death is the same to all people, the man made Gods do not favor anyone.

I would be lying if I would say that we as doctors, nurses, healthcare workers, hospital management, etc are not scared of the prevailing condition, that we are not concerned for our own or our family’s safety, for whom we can become asymptomatic carriers of this dreadful disease, elderly grandparents, parents, young children who can become prone to the infection.

It might not be your immediate family member at risk- who may be a doctor, a nurse, a security or the housekeeping staff of a hospital, or non clinical staff members who help the hospital function daily, but remember that there those who are standing at the frontline, who do not have the option of working from home or go into lockdown are also someone’s father, mother, brother sister, son, daughter, etc and your one heartfelt prayer for everyone’s safety might count somewhere.

The entire healthcare community has come together and all efforts are being made by the fraternity, collaboration with the government to tide over this crisis.

I write this because since the last many weeks, ever since Corona virus has hit the country, a day has not passed that my parents have not told me every morning , “Beta tu apna dhyan rakhna…”, and there are countless betas and betis who would be hearing the same from their family – who need your support, blessings and prayers.

The Great Indian Healthcare Jugaad.

Scenario – A 35 year old male gets admitted from Emergency with acute cholecystitis for a planned cholecystectomy. 3 days after the surgery, patient dies of post-operative complications, an uncommon but a possible event in hospitals all across the world.

Anything abnormal? So here is the catch. Patient got admitted under the disguise of the name of his elder brother, a central government employee. He had already been counseled by his family physician that the patient would require surgery. To save money, patient got admitted using the central government employee insurance scheme of his elder brother to undergo surgery for free. The death certificate of the patient had the name of his elder brother, who lost his central government job after his ‘alleged’ death, and got slapped with a case of cheating & fraud against himself after pleading with his seniors, to save his job and to explain the truth.

The above incident is not uncommon – and is just the tip of the iceberg of how people in India come up with ways to not buy insurance (to avoid paying the yearly premium), but at the same time utilize someone else’s policy to get admitted to top corporate hospitals.

After working for 10 years in corporate, following are my observations about the ultimate Indian Healthcare insurance Jugaad.

1st type - Most patients who come to the emergency department / OPD purposely give only their first name on their registration (saying that they don’t write a surname) and fill the address as the name of the village, stating that they do not have a house number. ID proofs can be manipulated easily at the time of admission or people in rural / semi urban areas deny having any ID card made.

All family members in similar age group and gender then use the same policy for getting admitted in the hospital, similar to how most people in a family use a single paid subscription of Amazon Prime, by giving a disguised identity.

2nd type - Purely for money making purposes – patients give their policies to hospitals and nursing homes, who make fake admission papers and hospital records, similar to how many pharmacists give their B.pharma degrees to chemists to use as a license for dispensing drugs. The money gets credited to the account from the insurance companies and is shared by the hospital & the policy holder.

3rd type – Many patients with insurance get admitted to a hospital, without any clinical indications, just so that the yearly premium does not go waste. They want to get admitted to get a complete body checkup with all possible blood investigations, Sonography, X rays, MRI, etc

4th type – Iatrogenic, You did not say anything, we did not hear anything. In spite of knowing that the patient is a known case of preexisting conditions, on regular medications, the existing diseases are not mentioned in the past history / medication history by the doctor as it will lead to rejection of the mediclaim. The cycle continues for years, the patient / relatives do not declare it in the renewed policy to avoid the higher premium rates – doctors don’t declare it on their case papers – and I see patients up to even 75 years old, on regular medications for years together, but no record of the same in insurance policy.

If investigated, I’m sure that this jugaadu medical insurance ‘racket’ will cost thousands of crores in healthcare fraud in India… and the system will never be cleaned completely, as in most instances, the insurance company agents are themselves a part of it and manipulate documents to get the claim passed, and have a share of their own.

Most Shaheen bagh protesters suffering from NASH, gastroenterologists & liver surgeons cheerful.

New Delhi: In a mouth watering news for the gastroenterologists & liver transplant surgeons, a study concluded at the Quackdoses multispecialty hospital has claimed that most people who have been protesting at Shaheen Bagh area since 15th December are now suffering from end stage Nonalcoholic steatohepatitis (NASH), an inflammation and damage of the liver caused by a buildup of fat.

Experts have claimed that the continuous supply of free and unlimited Chole Bhature, Samosas, wadas and biryani, along with sedentary lifestyle of the protesters over the past 1.5 months is the reason behind the sudden surge of fatty liver disease among the ‘hungry’ protesters.

In an exclusive interview with the Quackdoses, Aslam Toofani, a prominent Shaheen Bagh protester said, “The Kudrati Khana (Miracle food) from Allah just miraculously and naturally appears in the morning; we just pick it up for distribution. Had we known that the food is not so ‘kudrati’ after all and is rich in cholesterol, we would have prayed for diet food instead. I was here only for the 72 virgin houris, yeh fatty liver kahan se aa gaya? It hurts to see that many cross dressing males who have been posing as females and protesting with us have also developed man-boobs now.”

Unconfirmed reports have claimed that the worst hit Swiggy and Zomato delivery apps have decided to up the ante and have announced that their company will continue to offer ‘free food’ and ‘non political cash backs’ beyond 8th Midnight, after which Allah’s free food coupons are likely to be discontinued, as soon as Delhi's Legislative Assembly elections are over.

Doctors unhappy at not being invited to Modi’s ‘Pariksha pe charcha’, demand apology.

New Delhi: In unexpected developments after PM Modi’s ‘Pariksha Pe Charcha’ recently, the Delhi chapter of the Indian Medicos Association (IMA) expressed their dissent in retaliation to PM’s omission of the medical fraternity, which only gives ‘Pariksha’ for most part of their lives.

Doctors, who consider themselves veterans of ‘Pariksha’ givers, were visibly upset that they were not chosen by Modiji, to ask Modiji, the pre recorded questions chosen by Modiji, to be answered by Modiji, and only school students appearing for board exams were selected for the task. A press release by the association drew attention to the comparison between a child in 1st standard of school and a medical student in 1st year of MBBS – when the child grows up to give his medical entrance exam, the medical student is still giving his PG passing ‘Pariksha’ (food for thought).

In an exclusive interview with the Quackdoses, IMA President Dr. Deepak Kumar (name changed) said, “Medical education has become like Mumbai Metro project, doesn’t seem to come to an end even after years of hard work and regular exams. Because of these continuous ‘Parikshas’, there is hardly any time to even meet my girlfriend. And Modiji lectures to cut down the time spent on phone by 10% to spend time with family. I fail to understand why he separately conducts ‘Chai pe Charcha’ and ‘Pariksha pe Charcha’. Like we doctors, he can easily do ‘Chai pe Pariksha ki Charcha’ and save crores of innocent tax payer’s hard earned money spent on these marketing gimmicks.”

IMA Doctors did however reiterate Modiji’s thoughts to medical students that they must not think that appearing for exams are the end of the world, as there are better things waiting for them in life – like scoring the passing 35 % in the ‘Pariksha’.

Kejriwal releases ‘guarantee card’; promises jobs in USA for Mohalla Clinic Doctors.

New Delhi: Delhi Chief Minister and AAP national convenor Arvind Kejriwal on Sunday guaranteed job placements in John Hopkins, Cleveland Clinic and Mayo clinic for doctors working in the much hyped & scam tainted mohalla Clinics, as he released a "guarantee card" listing 10 promises that AAP will deliver on if it is elected to rule Delhi again.

The 'Kejriwal ka Guarantee Card' was released by the Chief Minister at the Aam Aadmi Party office here and included promises of job placement to the premier hospitals for doctors working at the mohalla Clinics, who gradually become experts in making ‘false entries’ of patients, giving them useless medications to ensure revisits, and ‘good incomes’ for themselves.

In an exclusive interview with the Quackdoses, Kejriwal said, "Though most of the mohalla Clinics are ailing themselves, have become dysfunctional, are a total waste of public money with locals using the space as garbage dumping site, and are frequented by goons and drug addicts, I am assuring that the international job placement of mohalla Clinic doctors that we announced in this tenure will continue in the next five years. These are big guarantees and will take time to be implemented.”

Kejriwal also signed the card after announcing the guarantees, saying "he will fulfill these promises in the next five years”, a claim downplayed by BJP with the rebuttal that the Kejriwal government had earlier too promised to establish 1,000 mohalla clinics in Delhi, but not even 200 clinics were opened over the last 5 years.

Jubilant about the governments guarantee, the Mohalla Clinic Doctors Association released a statement that it would not be a major cultural shift for them from Delhi to USA, as it will involve only getting used to hearing “KYA Tu janta hai mera baap kon hai?” from “Tu janta hai mera baap kon hai?”

"JNU Students study more than Doctors", claims Deepika.

New Delhi – A day after being slammed on social media for going to Jawaharlal Nehru University (JNU) amidst the ongoing turmoil to promote her new movie Chhapaak, Deepika Padukone has clarified that she only expressed solidarity with the students after realizing that JNU students studied even more than allopathic doctors.

In an exclusive interview with the Quackdoses, Dippy said, “I had gone to my doctor for some ladies problem after which he said I will need a PR. I googled PR and it connected me to a Public Relations agency in Delhi which told me that JNU was ‘the’ place for publicity stunt and making money as producer. It was only after reaching there did I realize that doctors only falsely sulked for having to study 10-12 years, while most JNU students studied in the same university for more than 20 years. Aap chronology samjhiye…”

The Indian Medicos Association (IMA) issued a strongly worded statement condemning her remarks, and questioned whether the JNU students were treated by Quacks or Deepika’s make up artist. Images of university students with dressings over Hijab / jacket, and blood soakage of dressing roll far away from alleged injury site have gone viral over medical groups.

Unconfirmed sources have claimed that after watching her crocodile tears at the launch of the trailer of Chhapaak, Joaquin Phoenix who won the Best Actor award for Joker at Golden Globes 2020 recently has decided relinquish the trophy to Deepika.

(P.S - For my non medico friends, PR in medical lingo means per rectal examination.)

Honor your patients as teachers...

It was one of those odd nights during my posting in the ICU at Kokilaben Hospital.

I am a hard core emergency physician, without much inclination towards critical care, which is a totally different ball game all together, most of it due to the fact that I’m impatient by personality and my attention span on a single patient will not be beyond 2-3 hours from their arrival.

The registrar on duty had called in sick (another regular ‘bahana’ for not showing up for work) and it was left for me, and my senior Dr. Santosh to manage the 26 bedded critical care unit.

It is a well known fact among the medical fraternity, how hard it hits a resident doctor when he/she comes to know their reliever is coming late, or not coming at all and they are asked to continue working another overtime shift. So I already knew that it would be a difficult night for me, because I had to put down the rounds for all 26 patients, make their treatment sheets, monitor few patients bedside – all the typical ‘symptoms’ of no sleep that night!

Little did I know that one night (in the 1st week) of my 1st critical care posting – which I was grumpy and skeptical about, would leave an ever lasting impact.

Unfortunately (or may be fortunately), there were 2 patients who suddenly deteriorated simultaneously. 1 of them on Bed 2 was an elderly lady who was crashing requiring intubation, urgent HD Catheter, IABP, etc and Dr. Santosh being the team leader and the senior doctor on duty got busy there.

And I was left to manage on my own, a 47 year old female, Mrs. Srivastava (full name withheld) – educated, English speaking, upper society lady, suffering from CKD, who developed sudden onset breathlessness, worsening ABG, requiring URGENT dialysis – and I had never put a dialysis catheter before (though the technique was similar to a central line, which also I had not done unassisted before). The nervousness and the lack of confidence became very obvious on my face and I called Dr. Santosh for help.

“Tu USG machine leke daal, main blind daal lunga mere patient mein, nurses will help you out, I know you will manage”, he said, as he got engrossed trying to save that patient of his.

I came back to Mrs. Srivastava, who even in her restlessness did understand that I was a junior trainee doctor & not so confident with procedures.

“Dr. Mohit, I want you to go ahead with the procedure and insert the dialysis catheter on me. If young doctors like you don’t learn now and step up your game in critical situations, you will never”, she said after slightly pulling out her Non Invasive Ventilation BiPap mask.

Such words from a patient, and a senior doctor was enough to ignite that fire, considering that there was no other option, and I had to rise to the occasion. I washed up immediately – cap – mask- gown – gloves – USG machine – triple lumen HD catheter, and I felt like the Arnold Schwarznegger from the movie Commando, determined to complete the task.

Luckily, there were 2 senior nurses on duty that night– Anuradha and Nidhi who came to my rescue – stood by me – guiding me through the entire procedure, which in the end was done flawlessly, in my 1st attempt, a feat which still will be the best among my many achievements. I also kept talking and reassuring to Mrs. Srivastava during the entire 15 minute procedure – dialysis was started immediately and she settled down well, over the next few hours.

The night which started with a negative mindset, turned into my memorable ones, which I think about often till date.

Mrs. Srivastava and I kept interacting every day, whenever I took rounds, talking about things other than medicine, developing a ‘subconscious’ friendship.

Few days later, she was taken to Lucknow in an air ambulance, as she would require extended intensive care, and she wanted to be close to her family.

I enquired about her with the Nephrologist after 2 weeks, who broke the news that Mrs. Srivastava had expired 2 days back due to a pneumonia, sepsis and DIC – something which still brings tears to my eyes. I wanted her to live, I wanted to meet her again, and wanted to THANK HER for giving me that opportunity to learn one of the most important lessons in life – from a patient – to take the (‘t) out from you can’t do it to, you can do it!

Dr. Santosh, and I are still good friends, considering that we haven’t met in the last 5 years, but are a part of ‘Men will be Men’ whatsapp group of KDAH doctors. My respect for the nursing profession also increased, after all they are the ones who play a major role in the patient’s recovery more than the doctors (Anuradha, Nidhi and Tinu sister, you guyz rocked in ICU 6). Last but not the least, no words can express my sincere gratitude towards all MY patients – for giving me an opportunity to serve them.