The Gift of Perspective: Four Years at Gleneagles and Beyond

This blog post has been long due—partly because life has become extremely hectic off late with work, family, and kids, and partly because of a lack of motivation to put those emotions into words… until life sent me on a forced short vacation—being admitted to the same hospital where I work, with an infection and its small complication (which could have gotten much worse).

Maybe it’s the beautiful Mumbai weather today, with light rain and the energetic Ganpati dhols playing below… maybe it’s the serene view of the Arabian Sea and the sailing ships from my room window… maybe it’s because I’m feeling emotional after so many colleagues personally came to wish me a speedy recovery over the last three days… maybe it’s because I’m overwhelmed with the firsthand experience of the extraordinary level of clinical care in the ward… or maybe it’s just the Meropenem and other drugs kicking in.

Whatever the reason, I didn’t want to miss the chance today to capture the flow of my thoughts—to be grateful for life, and thankful to God for everything.

I just completed four years with Gleneagles Hospital on 1st August this year. The move in 2021 was surely sudden and drastic—from a 24-bedded department with a team of 60, to a much smaller 6-bedded department and a team of 20. But it wasn’t a difficult decision, especially after spending many days in the ICU due to COVID and sepsis. Fast forward four years, and I realize it was all part of God’s bigger, more beautiful plan.

Steve Jobs once said, “The only way to do great work is to love what you do.” And I still feel the same love for Emergency Medicine that I did 15 years ago. I may be confined to my room now as a patient, but I still wish I could go down to the A&E and be amidst the action—managing patients. Call it passion, call it craziness, or call it obsession!

Looking back, what a journey it has been with Gleneagles Hospital—having the independence to personally introduce so many new forms in the department and hospital, defining new SOPs, clinical protocols, audits, and quality parameters, building a new team every time medical officers left, raising the quality bar, conducting trainings, mentoring juniors, organizing CMEs, awareness talks, and workshops, arranging departmental treats, hospital meetings (often being very vocal and blunt, without sugarcoating), being part of committees, managing complex emergencies, upgrading to a bigger 10-bedded department, achieving NABH Emergency certification, NABH accreditation, JCI accreditation, NABH Stroke certification, fostering strong friendships with fellow consultants, enjoying parties, on-stage singing and guitar performances, winning sports events, increasing revenue—the list goes on, but all feels as fresh as if it happened yesterday.

I believe I’ve been successful so far in my constant quest to save and touch many lives. I sleep in peace every night, satisfied that I’ve put everything I learned over 15 years into my department and for my patients. (Sometimes while managing difficult emergencies, I almost feel like Neo from The Matrix—fighting Agent Smith in slow motion after realizing he is The One).

Looking forward to many more years of growing with this organization, treating my patients, learning, setting higher benchmarks—and maybe, just maybe, being a little less obsessed with work… until I resume soon.

Road to Success - Always Under Construction

A young 20 year old male patient was brought to our emergency with complaints of sudden onset chest pain, profuse sweating, hypotension (low BP), Hypoxia (low Oxygen concentration). ECG was suggestive of Sinus Tachycardia (a fast heart rate).

Based on his clinical evaluation, a quick bed side clinical diagnosis of a massive Pulmonary Embolism was made. Though I have only seen only 4 such cases in the last more than a decade of my practice in Emergency, I was 99 % sure that I would not be wrong, and did not write any other provisional / differential diagnosis on his emergency notes.

Knowing that Pulmonary Embolism is a life threatening Emergency where a patient can suddenly go into cardiac arrest and die, we needed to make quick clinical decisions and interventions.

The family was counselled regarding the seriousness and fatality of the illness, if not treated in time. His father and mother both started crying inconsolably; the patient was counselled regarding the possible diagnosis and he too started crying looking at his parents, with that feeling of impending doom of whether he will survive or not.

A quick CT Pulmonary Angiography was done, which confirmed the diagnosis of a Pulmonary Embolism. With our Emergency team which worked with clockwork precision, we were able to give him the definitive treatment in the Emergency itself, within 38 minutes of arrival, and by the time the medication infusion was over in 2 hours, he had stabilised completely - Chest pain gone, BP picked up, Oxygen levels up and he was much more comfortable.

His father stood by the bedside throughout the life-saving medication infusion. At the end of it, with tears in his eyes, the patient said, “Thank you doctor…” which made me emotional.

Hearing this, the father told him, “Ha doctor dev manus aahe, kahitar honar nahi tumhala (This doctor is God present in the form of a human, nothing will happen to you)…” and I was left speechless.

A reason why I wanted to write & document about this case was because it was one of the most well managed cases of my career, and highly satisfying considering the lifesaving interventions done in a timely manner.

The Head of the radiology department and the cardiologist (under whom the patient was admitted) were all praise for the quick diagnosis and treatment in the emergency, moments which make you feel good to be a part of a Team where we celebrate each other’s success. Also, it reminded me that I still get the same adrenaline rush and kick by saving someone’s life in emergency, like I used to since 2006 when I was a 2nd year medical student and first exposed to the EMS at Sion Hospital.

Over the last few weeks, we’ve had some really interesting and exciting cases wheeled in to our Emergency Department, and as a Head / Team leader, I really feel proud of the phenomenal work that my team is able to accomplish, and we’re growing together.

Emergency Medicine – My Love, my passion & everything in between my Vows.

They say, “You have to be crazy to be a goalkeeper”. I say, “You have to be crazier to be an Emergency Physician!”

My interest in Emergency Medicine started very early, in the 2nd year of MBBS itself to be precise. The EMS & the Trauma centre at Sion hospital, Mumbai where it all started is among the best in the country, dealing with the entire spectrum of medical and surgical emergencies.

I still distinctly remember and smile, thinking about the time spent as a medical student / intern putting hundreds of IV lines, collecting blood samples, inserting Ryle’s tubes, Foley’s catheters, collecting ABGs, taking ECGs, accompanying trauma patients to CT scans, counseling patients, etc. Whenever I was free after daily lectures or while taking a break from the library, I would hang around in the EMS. I would look forward to the ‘Emerg-Double Emerg-and Triple Emerg’ where the unit in which you were posted had the call day for the weekend and the following weekday/s and you would end up continuously working 56-60 hours at a stretch in the EMS.

No matter how busy it got, the Doctors, nurses, the mamas and maushis, security continued to do their best – day after day.

Over time, I realized that being a government hospital, with the limited resources and the financial capability of most patients presenting there in the EMS, they were not being offered the best modality of treatment, nor was the treatment protocol based– Eg. There was no PAMI for an acute STEMI or thrombolysis for an Acute Stroke, no management of trauma patients as per ATLS protocol, procedural sedation, drug assisted intubation, etc.

At the same time, there was lack of communication skills, compassion, empathy & sympathy towards patients and their relatives by the resident doctors.

There were many instances during treatment by my peers which shook me and had a huge subconscious impact – seeing amputation of the hand being done under local anaesthesia with the patient howling in pain, pneumothorax while doing blind central lines, breaking multiple teeth while intubation, intubating awake patients with just a shot of Midazolam, patients requiring emergency surgery spending hours for an OT slot, etc to just name a few.

I had kind of made my mind then and there - the people deserve good Emergency care, which does not include only the medical aspect, but of the overall patient experience, satisfaction and quality in terms of ethical and affordable treatment, protocol based, supported by the latest equipment and cutting edge technology. I had vowed to practice ethically, not being money oriented, for the best interest of the people and provide them with the highest level of care. Not even once did I ever think of working abroad where it is possible to earn 4-5 times more money than in India, just because people here too deserve good emergency care.

Over the last 15 years, I have worked exclusively in the Emergency Departments of the top hospitals in the country, commissioned 4 Emergency Departments so far (seen them evolve over time into Centres of Excellence, and 2 of them receiving the coveted NABH Emergency certification), being actively involved in the teaching and training of young doctors, nurses and healthcare professionals. And the journey has been satisfying. More so because I have seen myself grow and learn, everyday.

Even to this day, I remain excited and enthusiastic about going to work. I look forward to the patients I would be seeing in my department. A well managed resuscitation, a smooth intubation, emergency procedures, STEMI, strokes, and everything in the Emergency – THE DRAMA, THE TRAGEDY, THE WORK PRESSURE, THE STRESS & THE URGENCY still excites me like it used to 19 years ago and keeps me going.

If ever I feel low, there are 2 feedbacks that reverberate in my ears. One was by my security guard who after seeing the many post CPR ROSCs said, “Sir, aap toh murda ko bhi zinda kar dete ho” and the other by another hospital staff, “Sir, God forbid, kabhi mujhe ya mere kisi family wale ko kuch ho gaya, I wish you are present on duty in the emergency”.

My current focus is on developing Emergency Medicine as a specialization, providing world class-quality care to my patients and to train healthcare professionals of tomorrow – of integrity, passion, honesty and discipline.

I now have confidence in my Emergency department, our current protocols and policies, the excellent team of Consultants and staff at our hospital, that in a life and death situation, if we can’t save a life, nobody else can!

What's your biggest achievement ?

“Sir, I stayed back just because of you.”

“Sir, you took care of everyone like a cocoon.”

“Sir, whenever you’re there on duty with me, I know nothing will go wrong, no matter how serious the patient may be.”

These were some of the words from my residents during an impromptu get together of my department last week, which was also a farewell treat for 2 of my residents who had worked in our A&E for more than 1-2 years.

As sad and emotional I am (which I don’t express) to see them leave for personal (marriage) / professional growth, there is a sense of pride that wherever they go, I’m sure they will excel with the knowledge, training and experience they’ve gained with us.

I will soon be completing 3.5 years with my current organization, and I was left wondering what the biggest achievement for me would be here, and in the other organizations where I’ve set up the A&E departments from a relatively clean slate – was it the protocols, the paperwork, the SOPs, the policies, the increase in revenue, improvement in quality of care, the awards, the trophies, etc?

But nothing seems to come close to the satisfaction & sense of TOUCHING LIVES, being successful in CREATING AN ENVIRONMENT, A CULTURE IN THE DEPARTMENT which is friendly, positive, educative, calm; an environment where your juniors feel valued, supported, feel safe, their mental health, their physical health, their family time, leaves are taken care of; with a clear vision that they learn, train, grow, up-skill themselves for their future and move forward in their journey with pride and gratitude towards their mentor, and know that they can always fall back on for guidance. This is surely the biggest achievement for a Head / Guide !!

है कोई जवाब?

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।

 
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कहां छिप गए वो मुफ्त कंसल्टेशन माँगने वाले,
कहां छिप गए वो व्हाट्सएप पे 25 पन्नों की लैब रिपोर्ट भेजने वाले,
कहाँ छिप गए वो मुफ़्त मेडिकल सर्टिफिकेट माँगने वाले,
और कहां छिप गए वो खुद को दोस्त बताने वाले

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 टीवी के न्यूज़ चैनलों 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 ।।

Save the Saviour !!

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 theatres 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 serve 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 realise 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 31 year old resident doctor who was raped and brutally murdered in the seminar hall of her medical college – principal being appointed to another medical college within hours of resignation – goons attacking protesting resident doctors and vandalising the medical college - silence of most politicians and so called 'celebrities' on the issue 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.

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. 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 14 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.

Khota hua Bachpan

Kahan kho gaya woh samay,
Jab zameen pe tippe maar kar nali mein padi hui ball saaf ho jati thi,
Dusri society k ladkon k sath cricket k match hua karte the,
Jab chappalon, ya pattiyon se lakir kheech football k goalpost banaye jate the,
Jab garden mein hath pakad sakli kheli jati thi,
Ek k upak ek pathar rakh lagori kheli jati thi,
Jab Buildingon mein bacche chor police and chupam chupai khelte the,

Aj sunsaan pade hain who jhule, jinke liye kabhi line hua karti thi,
Aj buildigon mein khelne ki jagah gaadiyon ne leli hai,
Aur doston-khilonon ki jagah mobile ne leli hai,
Mobile ek aisa yantra hai jisne bacchon se unka bachpan cheen liya,
Usne Camera, Ghadi, music player ko toh khatam kar hi diya hai,
Par dukh ki baat toh yeh hai ki wah rishton ko bhi khatam karta ja raha hai.

Professional Rules for happy life

More than 70 % of my colleagues / juniors from Emergency Medicine are working in UK, and the others too who chose to work in India seem to be making frequent job changes where they're prioritising 'Career Growth over loyalty'. 

Employee attretion has over the years also become an issue in the country, especially in the healthcare sector. This can also to attributed to the fact that there has been a change in the way the current generation wants to lead there life. The generation of our grandparents worked for 'Survival', the generation of our parents worked for 'Standard of Living', and the current generation works for 'Quality of life & work-life balance'.

Over the last few days, I have often wondered if based on my experience in various organisations, if there were any pearls of wisdom I'd like to share with youngsters / freshers / budding doctors of tomorrow / working professionals. 

Today, I decided to jot down my PERSONAL PERSPECTIVE on what should be the professional rules for a happy life.

Note: No offence to anyone. You're free to have your own perspective.

1. Work with Honesty – Dedication – Devotion – Discipline - Sincerity. Always do the right thing, even if no one is watching. Remember, there are no shortcuts to success.

2. Avoid gossiping about work or any colleague with anyone – not at work, nor at home. Come – do your Job – Get Paid - Leave. (This includes any informal chats on Whatsapp with colleagues; screenshots are often being used as evidence these days).

3. Be Punctual – Come on time, leave on time. Don't get into the habit of working overtime. It will only increase your work, not your salary package.

4. Do not take work back home. Learn to disengage & disconnect as soon as you step out of your workplace.

5. Do not work to please an individual or for appreciation. Let your results talk for themselves.

6. Do not get involved or affected by workplace politics. It exists, it will always exist. But always stand up for what is right and against your core values & principles.

7. Do not always be a ‘YES’ man. Sometimes, you have to say ‘No’ also to maintain discipline, dignity & self-respect.

8. Never get involved in relationships at workplace. It will always backfire one day.

9. Do not trust everyone at work. Not everyone is your friend, or wants good for you.

10. Do not share personal problems with colleagues at workplace. Half of them will want to know only because they’re curious, rest will be glad you have them.

11. Subordinates / acquaintances should be considered a Team – Not family. Correcting people or taking difficult decisions can often become difficult then.

12. Unless urgent, do not call or message your colleagues for work related queries, out of official working hours.

13. Never stop involvement in training & academics. Pass on your knowledge and skills to youngsters, you’ll grow with them.

14. No matter how busy you get, take out 1 hour of your every day, for your health, hobbies and personal space.

15. Plan and utilise your paid leaves – travel – go on vacations. It is extremely important to unwind and energise yourself.

16. Never be afraid to take the risk - go where you are appreciated and valued. There are brilliantly talented people everywhere who aren’t receiving the recognition and reward they deserve. But once they feel confident, start valuing themselves and leave from an environment that isn’t serving them, they thrive and grow. 

17. Never end on a sour note with your previous organisation / boss / Colleagues. You never know when you might need them for guidance or future references.

In the end, nothing matters except family, friends, home, health, work life balance and peace of mind.

I’ve found my inner peace, are you searching for yours?

The Gift of Blood, Is the Gift of Life.

A young 17 year old student going to college for an exam was rushed to the Emergency after an accident on the highway, with a truck running over his pelvis and both lower limbs.

A young 25 year old, brought to the Emergency with a history of gunshot wound to the abdomen, and bleeding profusely.

A 65 year old elderly female, wheeled into the Emergency with profuse bleeding from a cancer which had spread to a large artery in the neck.

A young 29 year old female, recently married, rushed to the Emergency with acute pain in abdomen and diagnosed to be a ruptured ectopic pregnancy with massive hemoperitoneum (pregnancy outside the uterus, with large blood collection in the abdominal cavity).

A 53 year old male, local politician brought to the emergency after vomiting large quantity of blood.

All of these above mentioned patients are just few of the examples of the clinical cases I’ve witnessed and managed over the years, and are a common daily routine for Emergency departments all across the world.

A thing common to all of them was that they were all brought in a very critical condition – either with a very high or a low heart rate, low or non recordable blood pressure, breathing difficulty, confusion (alterations in mental status), cold limbs, and other clinical signs – all pointing towards varying degrees of life threatening shock – which can rapidly become fatal, even with immediate medical attention.

Another thing common to them was that they all survived – because they all received the timely ‘Gift of Life’ – Blood.

Every year millions of lives are being saved because of donation of blood and blood products. Apart from life threatening conditions like accidents & trauma, blood donation supports various major surgical, complex medical procedures (like patients with cancers related procedures such as chemotherapy, pregnancy complications, and those with blood disorders like sickle cell anemia, thalassemia and hemophilia), etc.

To state few facts about the requirement of blood in India - At every 2 second someone somewhere needs the blood - Every day more than 38,000 blood donations are needed - Each year a total of 3 crore blood components are transfused - On an average, we requires 5 crore units of blood every year. Unfortunately, only a meager of 2.5 Crore unit of blood is available.

Patients always thank doctors, appreciate hospitals. But seldom do we recognize and appreciate the vital role of the unsung heroes when in need – The Blood Donors and the Blood Bank staff.

On this occasion of ‘World Blood Donors Day’ today, I would like to take this opportunity to personally thank all of them, without whom it would not be possible to save the many lives that we do in emergency (and in hospitals), and encourage the masses to be a blood donor.

After all, there is no substitute present for human blood.

Donate blood, save a life.

Patient Safety in India

We all know that 'To err is human', but did you know that a recent study by the Harvard University showed that more than 50 lakh patients die in India every year due to medical errors triggered by lack of practical knowledge among the doctors and nurses to handle patients when brought to the hospital.

India is an economy where government spends less than 2% of its GDP on health (with government hospitals characterised by chronic overcrowding, under-funding, and facilities perpetually stretched to the limit), lack of access to hospitals, lack of awareness, there is poor doctor-patient ratio (less than one doctor per 1,000 people), ill-equipped hospitals, insufficient number of labs and diagnostic facilities, absence of medical records of patients, etc. The picture of other healthcare workers, including nurses, is equally appalling.

Though most of us are well aware of these ills plaguing the healthcare sector in India, what is not often talked about are adverse events in ‘patient safety’.

Patient Safety is defined as a freedom for a patient from unnecessary harm or potential harm associated with provision of health care, including hand hygiene, surgery, injection, medication, blood transfusion, infection control and hospital waste management.

Not only in India, it is increasingly being recognized as an issue of global importance. 100s of incidents compromising patient care occur daily in hospitals across the country, but I personally believe that less than 1% of such potential harm actually get reported.

Let us look at few examples (which are just few of the incidents from the best of hospitals across the country I’ve worked with / know about), which I’m sure you’d have read nothing about, in any newspapers or on social media.

• A young patient operated for an abdominal surgery comes back to emergency after 5 days with pain in abdomen. Patient is sent for X-ray abdomen to rule out intestinal obstruction or perforation. X ray technician sees a scissor in the abdomen – informs emergency doctor – informs surgeon – patient is counseled for emergency surgery, without counseling for the diagnosis – No X-ray abdomen showing the scissor is handed over at time of discharge.
• An overzealous emergency physician thrombolysed a patient with an acute infarct, without waiting for the full MRI scan which shows a ‘hemorrhagic transformation’ & patient dies after a massive bleed in the brain – MRI cuts showing the hemorrhage on the initial MRI are not handed over the relatives.
• 2 patients die after ‘colorless’ Chlorhexidine is given as flush, instead of normal saline after inserting a central line.
• Patient becomes hypoxic and dies due to wrongful intubation in the esophagus, instead of the trachea.
• A young patient gets his arm amputated as a result of wrongful ‘direct’ injection in the ‘artery’ instead of a vein without the use of IV cannula.
• A patient has a urethral rupture after a young resident inflates the bulb of the catheter without inserting the catheter till the ‘Y’.
• An elderly patient’s gangrenous hand is amputated under local anesthesia (instead of general anesthesia) since the anesthesiologist on call will take some time to come and the surgery resident does not want to miss out on the 'cutting'.
• A senior doctor’s son, freshly graduated, is allowed to insert a central line. He inserts the guide wire all the way inside the jugular vein. CVTS Surgeon is then called to troubleshoot.

Such cases where patient safety is compromised hardly get reported by ANY hospital, unless patient files a medical negligence case against them. Things are only retrospectively discussed in internal hospital disciplinary or morbidity / mortality committees but never acknowledged, to avoid any dent in hospital's reputation and medico-legal litigation.

Hospital staff also voluntarily do not report errors or adverse events (with doctors themselves being reluctant participants), because when things go wrong news spreads fast like wild fire, and the search to find who is at fault is on. This can all too easily develop into a witch hunt, with the blame game shifting culpability from one person to another, who might then feel threatened in reporting such events.

Most of the Quality Accreditation bodies in the country also have their primary focus on checking only for policies, systems and documentation in the hospitals, with ignorance towards patient safety, and are slowly losing their credibility. In the private sector, attention to promotion of quality of care has been mainly driven by the business interest.

Also, external committees incorporated to investigate ‘medical negligence’ cases can usually be manipulated, and are often unfair & biased in their report due to the ‘contacts’ of hospitals & doctors.

Over the last few weeks, I’ve been thinking a lot about focusing on some of the PRACTICAL SOLUTIONS rather than the problem, and decided to jot them down.

• Delineation of patient safety and Quality, as they are both empirically different from each other.
• Once a problem is recognised, it needs to be talked and openly discussed amongst all the stakeholders - doctors, nurses, technicians, internal committee as well as the staff at all levels in a health facility up. The solutions are likely to emerge from sustained communications and dialogues.
• Every facility should develop a plan for training of staff, with regular workshops and training on Infection Control, hand hygiene and Patient Safety.
• A culture of reporting, discussion and learning from mistake needs to be developed at hospitals. We need a system for reporting errors and lapses of discipline even when no adverse event has occurred.
• Ensuring that patient safety processes are clearly communicated to patients and caregivers prior, during and after the medical intervention using different communication means such as videos, mobile apps, etc.
• Introduction of anonymous reporting system in healthcare facilities to be used by healthcare facility staff, students, residents, patients and families, or with the use of a ‘Ballot box’.
• Integration of web-based grievance system and toll-free helpline for Patient Safety.
• Implementation of standard treatment guidelines and treatment flows.
• The training need on patient safety for graduate curriculum for various cadres of health staff including doctors, nurses, laboratory technicians and pharmacists.
• Accreditation of healthcare facilities and strengthening quality assurance mechanisms.
• There is a shortage of trained medical personnel in rural areas. The only way to address this is to greatly increase the number of government medical colleges, increase government financial allocation and spending.
• Establishment of a safety culture and improving communication, patient identification and handing over transfer protocols in healthcare facilities. Mistakes are common and can be devastating when they occur.
• Robust analysis of the data and feedback mechanism on what is happening after implementing accreditation / quality improvement activities in relation to care and safety.
• In India, the Consumer Protection Act serves as a check / incentive to modern medical practitioners to provide high quality health care. Unfortunately, even this legal mechanism is not accessible to the poor.
• The ill-advised move of the government of India to allow graduates in Ayurveda to practice surgery must be stopped. It is impossible for Ayurveda to incorporate surgical techniques while ignoring the other domains of modern medicine. An epidemic of catastrophic complications, disproportionately affecting the poor can be expected if surgical procedures are performed by the poorly trained.
• Also, today’s medicine is increasingly becoming technology driven. New technologies create new methods for producing errors and constant vigilance is required to track these.

In the last 10 to 15 years, many initiatives have been taken by the Government of India and hospitals to improve quality of healthcare services and strengthen patient safety, yet, a lot still needs to be done.

By and large, patient safety errors occur because of bad systems and not bad people.

When the above measures are part of daily practice in an organisation, we can say the seed for a culture of patient safety in an institution is sown.

We must not forget that, patient safety is knowledge, it’s intentional, it’s a habit, it’s a way of life, and when it influences a group behaviour, it becomes a culture.

The Miracle

“You have to come back…. Where will I go with the 2 kids?” urged the sobbing wife clenching hard to her husband’s chest as he was being rushed in to the Cath lab, and I was still pushing some lifesaving drugs in him. Dramatic scenes which I don’t think I will ever forget in my life.

The 37 year old was brought to my department last month with history of sudden onset chest pain 30 minutes prior to arrival, followed by unconsciousness en route to hospital. On arrival, he was gasping, there was no pulse, spontaneous breathing, or recordable blood pressure with pupils which were non-reactive to light – no signs of life.

We immediately started CPR, initial rhythm was a ventricular fibrillation and he was shocked immediately, intubated and all life-saving drugs were given as we frantically tried to revive him.

After a gruesome 22 minutes, his heart started again and we immediately rushed him for an angioplasty as his ECG and bedside 2D Echo were suggestive of a massive heart attack.

His elder brother, sister in law, wife were all in tears and disbelief with lots of questions – we were also in a situation where we only could do our best and leave it to God, pray that the brain survives those precious minutes of CPR and that the heart does not go into sudden arrhythmias again.

I followed up with our critical care team that night and I was elated to know that he asked for his mother, he asked for water – signs that he was well protected neurologically - news which fills us with joy and satisfaction of saving that young life.

Against all odds, this patient WALKED BACK home from the hospital after a few days, with no neuro-deficit. He was clinically dead for 22 minutes, but miraculously, doctors brought him back to life, a tale nothing short of a medical miracle.

Today, the patient and his brother came to meet me and say thank you - a very emotional and heart touching experience which I will never forget in my life.

During our conversation, I also showed them my blog posts & Facebook posts, how even we at the hospital wished and prayed for his recovery.

When I told them that they should be thankful to God, I was left tear eyed when his brother said, "The only God we knew that day was you." I was left speechless.

"Can we have a photo of you with him? Please add his photo to your articles", he added.

Not a day goes by that I don’t thank God for all the miracles he does every day, and we’re happy to play a small role in them.

Note: Due to lack of awareness about bystander CPR in India, less than 5-7 % of patients suffering from out of hospital cardiac arrest actually survive. Not everyone is lucky like that patient. Hence, bystander and first responder resuscitation become extremely crucial. CPR effectively keeps blood flowing and provides oxygen to the brain and other vital organs, giving the victim a better chance for a full recovery.

CPR saves lives! Get trained – You have the power to save a life.

Be a Life Saver !

 

Sudden cardiac death from cardiac arrest is the most common cause of death worldwide. Cardiac arrest is defined as the cessation of cardiac activity as confirmed by the absence of signs of circulation.

Cardiac Arrest occurs suddenly, disrupting the blood flow to the brain and other parts of the body. With a cardiac arrest which is left untreated, irreversible brain damage occurs within 3-8 minutes and death rapidly follows. About 90 percent of people who experience an out-of-hospital cardiac arrest die.

Even in patients who are resuscitated (revived) from cardiac arrest, post-cardiac arrest brain injury is the main cause of death, and the main cause of long-term disability in those who survive the acute phase. This is attributed to the fact that even though the brain constitutes only 2% of body weight, it receives 15–20% of total blood volume pumped by the heart for its normal functioning.

Brain tissue viability strongly depends on consistent supply of oxygen and glucose, and cessation of blood flow to the brain results in an immediate interruption of brain activity, causing a hypoxic brain injury – similar to that of comedian Raju Shrivastava after suffering a heart attack.

A young 37 year old male was brought to Global Hospital Emergency last week with a history of sudden onset of chest pain 30 minutes prior to arrival, followed by unconsciousness. On arrival, the patient was gasping, there was no pulse, spontaneous breathing, or recordable blood pressure with pupils which were non-reactive to light – no signs of life – in cardiac arrest.

The team of experts immediately started cardio-pulmonary resuscitation (CPR), his initial rhythm was a ventricular fibrillation and he was shocked immediately, intubated and all life-saving drugs were given as the medical team frantically tried to revive him.

After a gruesome 22 minutes, his heart started again, he was immediately rushed for an angioplasty as his ECG and bedside 2D Echo were suggestive of a massive heart attack.

Against all odds, this patient walked back home with no neuro-deficit. He was clinically dead for 22 minutes, but miraculously, doctors brought him back to life, a tale nothing short of a medical miracle.

Not everyone is lucky like that patient. Hence, bystander and first responder resuscitation become extremely crucial. CPR effectively keeps blood flowing and provides oxygen to the brain and other vital organs, giving the victim a better chance for a full recovery.

CPR saves lives! Get trained – You have the power to save a life.

Need of the hour !

‘0 percentile can get super speciality medical seat’ – A shocking but real truth which shows the mirror to the wrong policies in medical education in the country.

With close to 750 super-speciality course seats going vacant this year, and 100s of seats going vacant every year even in premier institutes, the government and authorities surely need to relook at the current prevailing policies.

Even after 4 rounds of admission this year including 2 regular rounds, mop up round and a special mop up round, 100s of seats out of the 4500 super-speciality course seats lie vacant, causing a loss of close to 800 crore to taxpayer money.

The government must understand that post graduate doctors can’t be treated like bonded labour. Asking doctors to serve a compulsory 3 -10 year service bond in rural areas or pay 2-5 crore to the government for opting out of the bond service, after a 3 year super speciality training is the main reason behind doctors not wanting to opt for a super-speciality course, and that too at around 30 years of age (after post-graduation) when everyone would like to professionally settle down and start earning like their peers.

At the same time, practising broad specialisation gives a better career and money compared to extra years spent pursuing the super speciality course. Other reasons include inadequate seats in popular courses, in-service reservation, introduction of NEET-Super Speciality Exam and problems in transfer or choice of service location, to name a few.

The Supreme Court too declined to consider a plea recently to limit service bond period for super speciality course uniformly in all states to maximum of 2 years and a discontinuation penalty of Rs. 20 lakhs.

We are already going through tough times when more than 70 % of the doctors I know not wanting their children to pursue medicine now, and the remaining wanting their child to go abroad after their medical graduation in India.

The far fetched effects of such faulty government policy might not be palpable immediately, but it will surely be detrimental to the Indian Healthcare system in the years to come with lack of adequate number of good doctors & super specialists in the country.

Count your Blessings - My COVID Story

 

It was exactly a year back on 19th May when I was rushed to the hospital with complaints of breathlessness due to COVID, and oxygen saturation of 84% at home.

 
I had just landed in Mumbai on 12th May after 1.5 -2 months in Delhi, when my brother who came to receive me at the airport told me that my voice was a bit hoarse. There was no fever, no cough, but surprisingly I developed a 102’F fever the next day. Though I knew at the back of my mind that after treating more than 10,000 patients (over the past 14 months in my last organisation), I too would have contracted the virus. Akhir bakra kab tak khair manayega !!

On the 14th of May, my test came back positive and I started myself on the same treatment regime that I had started all my patients on, and who had done extremely well to recover on home isolation. 

When my oxygen saturation started dropping, I knew that it was getting serious! I was in the second week of the illness, probably in cytokine storm and suffering from severe pneumonia – a stage which I knew not many people were recovering from. Unlike the 1st wave where most of the casualties were the elderly, in the 2nd wave of COVID, it was common to see people in their 30s and 40s dying. The trend seen all over the country then was that patients who mandated admission to the ICUs, especially on high flow oxygen or ventilator, were not coming out of the ICU alive.

While I was being taken to the hospital, there were only negative thoughts racing in my mind - if I would even survive, if I would ever get to see my family again, or if they would get to ever see me again (dead bodies were packed in body bags then, and families were not allowed to even have a last glimpse of their patient), would I even come back home, or be directly taken to the crematorium from the hospital, etc.

I felt like crying but still held onto my tears. My brother was my biggest strength then. My initial workup showed a Chest CT severity score of 16/25 (staged as severe bilateral pneumonia, with dense consolidation), WBC counts of 25,000 plus and Lactate of 7, to mention a few reports – all pointing to a poor prognosis. I was then moved to the ICU. Those 5.5 days spent in the ICU were something I would really not want to remember ever again.

There were 23 other COVID patients in the unit, and it was easy for me to make out if there was a CPR happening on one of the beds, if someone had deteriorated enough to need invasive ventilation, I could even hear the doctors discuss the case next to me, etc.

It was the time when I realised that the ability to even be able to take a breath, eat your own meal, drink water, able to pass urine or stools on your own can be such a blessing.

As days progressed, my oxygen saturation held up and I was recovering, I knew it was probably all the prayers and blessings of my family, friends and those the patients I had successfully treated over the years, because which I made it out alive. While I was being wheeled out to the ward from the ICU, my bedside nurse told me, “Sir, you’re the first patient who has been SHIFTED OUT of the ICU in many weeks and months!”

I finally spoke to my parents once I was in the ward. Fearing for the worst, they hadn’t slept for days while I was in the ICU, hardly eating anything, too dumbstruck to even talk to anyone and continuously praying. All I did on video calls from the ICU was show my hand that I’m alright, and would smile from behind the oxygen mask, asking them to take care of themselves at home.

After spending another 2.5 days in the wards, and a total of 8 days in the hospital, I was finally set to be discharged home on 26th May. The nurses, doctors and all those involved in my treatment, because of whom I’m still alive (and writing this story of mine), are all in my prayers every single day.

“Mohit, bahut hua Delhi… ab Mumbai mein hi job karo. Humein nai pata ki aage COVID kaisa hoga, hum bhi bachenge ki nai”, was my emotional mother’s ultimatum.

I had applied for a job in my current organisation a day after landing in Mumbai, and my interview was scheduled for 22nd May, which was subsequently rescheduled for 29th May. I remember being breathless even during my interview, not able to talk in long sentences. Against the wishes of my parents (since I had not recovered completely), on 1st June, I flew back to Delhi to continue our fight against COVID.

With the clear intent to come back home to Mumbai, on 3rd June, I decided to put down my papers there. On 16th June I received my offer letter from here at Global Hospital, and the rest has been my best professional and personal decision to be back in Mumbai, and be associated with this organisation that I’m so proud to be a part of.

Though it was the toughest time of my life then, COVID completely changed my perception and priorities in life. I’ve realised that we all keep running behind money, professional success, fame, etc – but that truly IS NOT THE ANSWER.

Learn CPR - Save a Life - Be a Hero

 

A young 44 year old female was brought to our Accident & Emergency 8 days back, in a drowsy state with no recordable blood pressure. She had been having pain in abdomen since 2 days prior to arrival, and was diagnosed to have a ureteric calculus causing hydroureter and hydronephrosis (a kidney stone stuck in the tube / ureter connecting the kidneys to the urinary bladder, causing swelling in the tube and in the kidney).

Looking at her poor neurological status, her family was counselled regarding the need for immediately putting her on a ventilator, to which they reluctantly agreed to after a gruelling 20 minutes.

By the time patient was brought to us, she had already been drowsy in the government hospital for more than 4.5 hours, and was in full blown sepsis with pulmonary edema (fluid collection in her lungs) and early ARDS (Acute Respiratory Distress Syndrome). Within few minutes of securing her airway (after intubating her - putting her on a ventilator) and starting all resuscitative measures (with intravenous fluids and drugs to support pumping of her heart), her heart slowed down and suddenly stopped beating.

Immediate lifesaving CPR (cardiopulmonary resuscitation) was started, lifesaving drugs given, and we were able to revive her heart within few minutes.

There are always chances of brain getting permanently damaged if it doesn’t get blood supply for 3 - 5 minutes, in her case it was too early to predict if there was any.

Her husband and sister were distraught as they saw her getting wheeled out to the ICU with all the tubes in her body, IV lines, monitor, ventilator, drug infusion pumps, etc. Only thing they could do now was pray and hope.

Over the next few days, the husband would spend a lot of time in our Emergency waiting area, waiting to just talk to me regarding his wife – I knew that the clinical updates were given by our team of doctors upstairs in the ICU, but he wanted to share his grief too. I would also daily visit the ICU to check on her.

5 days after she was brought to us in that state, she was well on her path to recovery.

3 days back, she was off the ventilator, was given food orally the next day, and today she will most likely be moved to the wards.

This news itself gives such a sense of satisfaction and calm, feelings which can be felt only the heart, and I just thought that stories like this need to be told.

There can be no better reward for we doctors, nurses, and the entire team involved in patient care to see our patients doing well, and come out on top. It always is a great feeling to see the smile on the faces of patients & their relatives as they are being wheeled out from the ICU to the ward, and from the hospital to their homes.

What makes such patient recovery stories special for me is that for a country like India, the survival to discharge percentage for patients suffering an In-Hospital cardiac arrest (heart stopping) will ‘practically’ be less than 15 – 20 %, and I’m glad she will be one of them.

It really has been satisfying to train thousands of healthcare providers and lay persons over the last decade in CPR, as part of ‘Be a Life Saver’ campaign, an initiative I wish to continue in my healthcare journey with the sole objective being – TO SAVE LIVES.

A Hypocrite With No Conscience.

Dear Aamir,

I would not like to begin this by highlighting your professional achievements (like your media dogs do) – but will come straight to the point.

I was really surprised to see you featuring on the advertisements of PharmEasy, and it suddenly hit me that you have signed up as its brand ambassador !! How shameless can you really get?

Episode after episode, season after season, you ridiculed, defamed and constantly showed in bad light on your social reforming STUNT show ‘ Satyamev Jayate’, the hardworking healthcare workers, even claiming they received kickbacks from the same pharmaceutical companies and diagnostic centres that you now chose to endorse.

Where is the intellectual actor who advocated social responsibilities and moral obligations hiding now, when doctors are making a mockery of your double standards on social media? Don't you want to come clean or share any words of wisdom or encouragement with your half baked knowledge and selective outrage, like you did in your show?

Even during the pandemic, where had you disappeared, my friend? Enjoyed in your cosy farm house, going about with your daily life, waiting to get back to your vanity van, to be back on the big screen - while the medical fraternity around the world struggled to deal with the deadly virus. I was sad that we didn’t get to see you clapping or beating your utensils at your balcony to appreciate the healthcare workers (not that it really mattered to me).

The same healthcare workers you ridiculed on your show were the real heroes, serving the nation – Doctors, Nurses, housekeeping staff, etc along with the police and the essential service providers, who were out there – working – trying to save people’s lives – risking their own lives, working tirelessly, mostly without PPEs, without caring for their own families – the wounded healers.

Forget the appreciation that doctors and nurses deserved in times of crisis when they were the front line warriors in the pandemic, in the past too you have never ever spoken when the doctors were assaulted, nursing homes or hospitals vandalized, when Indian doctors have done breakthrough surgeries or research, when doctors have protested against the government for their rights, etc. Only your acting is an art, medical science is not?

Why? Because it will not generate TRPs, or it will not make you rich (I heard you used to charge 3 crores for 1 episode and 2 lakhs per 10 second ads of the series). Had you even thought about donating a small amount out of it when the country needed it the most? Akshay Kumar had donated Rs. 25 crore to the cause; at least Rs. 20-25 lakhs from you would not have brought down your monthly rashan budget.

Let me show you the mirror, the real "Satyamev Jayate", from the perspective of every Doctor, Nurse, and a healthcare worker who felt offended by your comments over the years – you are nothing but an insensitive coward, a low life, self centered guy who likes to be called Mr. Perfectionist (you have never asked media or your friends to not address you as that). In your eyes, your work and profession as an actor is unparalleled, heavenly, pure and honest hard work – the rest can go f*** themselves. You are nothing but Aamir the actor, nothing more than that. A hero with no conscience. Your hypocrisy stands exposed. Shame!!

Doctors across the country are having the last laugh now, and the joke is on you !!

I really hope this article reaches you soon and #GharBaitheBaithe'YOU'TakeItEasy

- From An honest, hard working, ethical, committed Emergency physician: for whom every single life matters, every single day.

The Vicious Cycle of the Congress

Over the past many years, we have seen the shameful performance of the crippling and almost finished ‘Grand Old party’. The only thing constant has been the following pattern of events, which have become monotonous like the daily TV soaps:

1. Election announced many months in advance.
2. Pappu (Raoul) will be off for an international vacation, with zero interest in the upcoming elections.
3. Sister Bianca will then go to some poor women’s house in the election going state and come up with some senseless political slogan eg. Ladki hun, lad sakti hun.
4. Meanwhile, Pappu will come back and be a silent spectator to the aggressive rallies and preparations of the other political parties and leaders, only looking for opportunity for any blame game on Twitter.
5. Election comes, party is disastrously wiped out.
6. Senior leaders will show dissent, but will not say anything against the leadership publicly.
7. After every poll debacle, ‘Alakaman’ & working committee will announce a 'Chintan Manthan / shivir, a brainstorming session they call ‘post-mortem of results’ to introspect the reason for party’s defeat.
8. Familiar scenes of workers raising slogans to show support for Pappu to lead while the meeting is on.
9. Mummy, beta or beti will then offer to resign from their post, and entire focus will shift to who’s going to be the net party president.
10. The working committee, chaired by mummy, will then unanimously accept responsibility for the electoral loss, and not blame it on the moronic leadership.
11. The committee will then "unanimously reaffirms" its faith in Mummy’s leadership and requests her to lead from the front and address the organisational weaknesses (after all, the moolah of the 70 years of loot is with her and she’s the chief financier of the elections).
12. Mummy will then claim to take up corrective measures to "revamp and re-strengthen" the organisation and nothing will ever happen till next election comes.
13. No work is done on ground for the people and public welfare for next 5 years.

Vicious cycle repeats starting from point number 1, and will forever continue till we have a ‘Congress mukt Bharat’ or a ‘Gandhi Mukt Congress’ !!

My 'memorable patient' story.

With Omicron driving India’s 3rd COVID wave, and cases continue to surge in the country, there seems to be no respite in sight for the healthcare workers.

Unlike the 2nd wave, though the the number of COVID patients requiring ICU admission at hospitals, or dying from it are less, but we surely cannot let our guard down.

Looking back at the past close to 2 years of COVID in the country, there were multiple heart wrenching moments I witnessed as a doctor on the frontline, which I would really love to forget.

Following is one such conversation with the son of a patient, which has been hard to erase from my mind.

It was the last week of April' 21, the 2nd wave was at its peak and there was a shortage of hospital beds and oxygen as India battled COVID.

Though my work in the Emergency involves catering to all types of medical or surgical cases coming to the department, over the last decade, I had never admitted any patients under my care as the primary treating physician.

It so happened that the chief consultant in a small 25 bedded hospital (near to my last place of work) had to go on a week-long leave for his brother’s wedding, and the owners approached me to cover for him temporarily.

For the 1st time in my life, I was responsible for treating and saving the life of 22 COVID patients admitted under me, 5 of whom were on high flow oxygen requirement.

A young 30 year old male brought his 62 year old mother to the hospital with complaints of breathlessness and she had been diagnosed as severe COVID pneumonia, with a CT severity score of 17/25.

I explained to him that it was better that they admit her in a bigger hospital since she needed admission to the ICU, and might clinically deteriorate over time.

“Doctor, main abhi shamshan ghat se aa raha hun apne father ka cremation karke. Meri mother aur sister dono hi COVID positive hai. Sab jagah dekh liya, kisi bhi hospital mein bed nai hai. Agar koi bhagwan sach mein hai, toh ab aap hi ho mere aur mere poore pariwar k liye. Please kuch bhi karo, meri mummy ko bacha lo, warna main anath ho jaunga (Read: Doctor, I'm just coming back from the crematorium after performing the last rights of my father. My mother and sister are both COVID positive. We have looked everywhere, but there are no beds in any of the hospitals. If there is really a God, right now, it is only you for me and my family. Please do anything but save my mother's life, or else I will become an orphan)”, he said with both hands folded in front of me, and tears flowing down his eyes.

Hearing this, his sister and mother also started crying, and I couldn’t control my emotions as well (my eyes got wet then, they’re wet now too as I write this).

Every day, during my patient rounds in the morning and evening, every time I would enter her room, she would just bow down with hands folded as say, “Thakur ji aa gye (Read: God has come)”.

Over the next 7 days, I did everything to care for those 22 patients to the best of my abilities. I truly consider it as a miracle / God’s blessings that all of them recovered well (except 1 patient whom we referred to a higher centre as soon as an ICU bed with a ventilator was available for him). That feeling to see the smile on the faces of patients on their path to recovery, to see their oxygen requirement come down gradually, see their happy and relieved relatives and to finally write ‘Patient can be planned for discharge today’ on their file, is something that I cannot completely express in words.

Seeing her getting discharged from the hospital was a really emotional moment for me (her daughter too recovered with oral medications on home isolation). The son did not say a word as I bid her goodbye - just folded hands, tears in his eyes and he bowed down. That said it all.

On her follow up visit to my clinic after a week, he said, "Kash hum pehle hi aapke paas aa jate, shayad aaj papa bhi zinda hote (Read: I wish we had come to you earlier, may be my father would have been alive today)", and I was at loss of words.  

It was God doing his miracles all this while, I was only a medium.

Over the last more than 10 years, I would have treated 1000s of patients, but she will remain one of my most memorable patients, just due of the sense of responsibility and the burden on my shoulders that the son had put – I had to save her at all costs. Those words from him when he got her on the day of admission reverberate in my ears even today.

Till date, I still receive a Whatsapp forward every morning from her, just showering her blessings and expressing her gratitude.

Love defined...

It so happens that over the years, I happen to find loose papers (treasures) in my cupboard, drawers & shelves with small random lines & thoughts scribbled on them; thoughts which I would have intended to publish on my blog later but forgot about them in the day to day life.

Following is one such piece I had written during my post-graduation (residency) which I found, so thought of publishing it now, before I lose it again.

WHAT IS LOVE?

Love is living for each other… caring without boundaries… the early morning talks… the late night discussions… planning the future together… travelling together… going on an adventure trail… enjoying the craziness of life… cherishing every moment… laughing together… crying together… sharing secrets... respecting each other’s needs… giving equal contribution to the relationship… standing rock solid ever in all the highs and lows… knowing when to draw the line… sharing dreams together… the fights, the arguments… forgiveness… accepting each other’s flaws… complementing each other… doing household chores together… playing games… enjoying music… dancing… communicating… constructive criticism… keeping in touch with family members… buying small gifts… surprises and movie tickets… spontaneous shopping… mutually respecting each other… walking on the beach together… enjoying the sunrises and sunsets… pulling each other’s leg… pulling pranks on each other… watching old videos and photographs together… buying flowers… experimenting with cooking… and the list goes on (I will try to continue to build it up).

It really doesn’t cost much to really love someone!!