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।

 
**********

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.

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.

Emergency Trauma Management - Life In The Fast Lane.

A 17 year old boy is wheeled in to the Accident & Emergency Department after being run over by a truck. The patient is rapidly assessed, given essential life saving emergency care including blood transfusions and is immediately rushed in to the operation theater for a suspected pelvic (hip bone) fracture. Two weeks later, the patient is sent back home, alive and hearty - one of the many success stories where prompt emergency management saved a life.

So what does a person involved in a motor vehicle collision or a fall, a child who breaks a bone, and a physical assault victim should do? They all must seek emergency treatment for their trauma-related injuries.

Trauma refers to a bodily injury resulting from the application of an external physical force. It is the leading cause of death under the age of 45 years all over the world, with majority of victims being young males. Motor vehicle accidents are the major culprit of these types of fatalities; in children too under the age of 18, trauma is the leading cause of death above all other diseased conditions combined. Surprisingly, the number of years of life lost before the age of 65 due to trauma exceeds those lost from heart disease and cancer put together. There is a massive additional social burden from disability affecting survivors as well.

While the word may have a fairly simple and standard definition, when it comes to treatment of trauma patients, there is nothing uniform or standard about it. Traumatic injuries can range from minor isolated wounds to complex injuries involving multiple organ systems. The trauma can be blunt or penetrating - like a stab or a gun shot wound.

Majority of deaths occur either at the scene or within the first four hours after the patient reaches a trauma center. Relatively, fewer patients die after the first 24 hours have passed following the injury. Most preventable deaths are due to excessive blood loss.

Regardless of the cause or type of trauma, the ultimate goal of treatment is to minimize the disability and deaths associated with the injury. It involves reducing the deaths associated with the 2nd peak period which occurs in the hours shortly after the injury.

A systematic approach toward the trauma patient allows for rapid assessment and stabilization of the victim. This maximizes outcomes and reduces the risk of undiscovered injuries. Established protocols within an organization allow physicians to evaluate the patient in a logical, algorithmic (ATLS) manner and treat injuries in the order that has the greatest chance to prolong life and also minimizes long term consequences from the injury.

Global Hospital, Mumbai is a Level 1 trauma centre providing a multidisciplinary, extensive emergency medical service to trauma patients with the highest level of care, and is capable of offering definitive treatment for any type of injury.

Apart from an Accident & Emergency department which is manned by emergency physicians who specialise in this field of practice, it also boasts of availability of all surgical sub-specialties and advanced imaging capabilities. The hospital operates on a “team approach” whose staff includes emergency physicians, general surgeons, orthopedic surgeons, neurosurgeons, reconstructive surgeons and anesthesiologists who are experts in treating trauma victims.

We also have a 24 hour functioning blood bank and a NABL accredited laboratory, apart from a 24X7 Radiology department for carrying out emergency X-rays, Ultrasound, CT scans and MRI. The hospital also has 24x7 operation theatres equipped to carry out all life and limb saving emergency surgeries.

With our comprehensive trauma care and emergency medical services, we are able to care for the most life threatening emergencies at a moment’s notice.

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.

Seize the golden moments after a heart attack.

The sudden death of singer KK today was a shocking news for music lovers and his fans across the world. What was even more shocking was that he showed the typical symptoms of a heart attack including sudden onset chest uneasiness and profuse sweating, which was not recognised in time. Off course he could have survived if the all important ' PAL - In the Golden Hours' would not have been wasted. Read on to find out more.

Heart Diseases are the number one killer in India. A Heart attack is caused when a clot completely blocks a blood vessel in the heart.

Worldwide, people fail to identify heart attack symptoms on time or seek appropriate medical help.

Post a heart attack, the heart muscle starts to die within 60-90 minutes after it stops getting blood, and within six hours, almost all the affected parts of the heart could be irreversibly damaged.

As a consequence of damaged heart muscles, either the heart can go into a sudden complete standstill, or into abnormal heart rhythms called “ventricular tachycardia” and “ventricular fibrillation” where the heart muscles contract at a rapid rate, without any active pumping of blood from the heart – called as a cardiac arrest. A person with a cardiac arrest will be unresponsive, will not be breathing and will not have a pulse.

Cardiac arrest occurs suddenly, disrupting the blood flow to the brain and other parts of the body. Lack of oxygen causes irreversible damage to vital organs, and within minutes, patients die.

Most patients don’t get another chance if heart attack is not treated in time.

The first hour of definitive medical care is called the “golden hour”. Nearly 47 % of deaths occur due to cardiac arrests during this period, even before an individual reaches the hospital. It is a window of opportunity to the patients, their families, and doctors to take appropriate and quick actions, thereby impacting a patient’s survival and quality of life following a heart attack.

Reaching a hospital, which has an in-house cardiac cath lab, within this Golden Hour period, provides emergency physicians and cardiologists ample time to perform ECGs, appropriate diagnostic tests and scans on the patient to ascertain the occurrence of heart attack and the extent of damage, and take necessary steps to reinstate proper blood flow to the heart immediately.

A person who reaches the hospital and gets treated within this period can expect near-complete recovery.

Hence, “Golden Hour” becomes “the game-changing event” in saving the life of the patient.

Note: Global Hospital, Mumbai provides multidisciplinary, extensive emergency medical services to all patients, with the highest level of care, and is capable of offering definitive treatment for any type of cardiac emergencies. We have a 24 hour functioning Cath lab, Operation theatres, blood bank, NABL accredited laboratory and Radiology department.

With our comprehensive emergency medical services, we are able to care for the most life threatening emergencies at a moment’s notice.

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.

Pulmonary Embolism: Beware of a possible clot risk when binge- watching television

A young 20 year old patient was rushed to the Accident & Emergency Department of Global Hospital, Parel, Mumbai last week with complaints of sudden onset chest pain, profuse sweating, hypotension (low BP), Hypoxia (low Oxygen concentration).

Doctors were quick to make a bed side clinical diagnosis of a massive Pulmonary Embolism, a life threatening Emergency where a patient could have suddenly gone into cardiac arrest and died.

With clockwork precision, he was gives 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 stabilized completely - Chest pain gone, BP picked up, Oxygen levels up and he was much more comfortable.

Cause of this life threatening Emergency - Binge watching television.

Yes, it’s true! Binge-watching television, more than 4 hours a day, not only causes brain rot — it can also lead to blood clot, raising the risk of life-threatening blood clots in the legs or lungs by almost 35%.

Watching back to back episodes of your favorite web series online or too much screen time during work from home may have become be a fab these days, but binge watching of TV, which involves prolonged sitting in cramped positions for long periods of time, has been linked with an increased risk of developing a venous thromboembolism (VTE). This is a condition where a blood clot forms in a vein. It includes deep vein thrombosis (DVT) and pulmonary embolism, which is when a clot travels to the lungs – which can be serious or even fatal.

DVT’s tend to form in the leg and are more likely to occur when you spend long time sitting down. When you’re sitting, the normal circulation of blood through the legs and feet is impaired
and slows down, so it is more likely to pool and start to clot. When you move your legs, the action of your calf muscles helps to squeeze the blood back up towards your heart. Some people do not know they have a DVT until the clot moves from their leg or arm and travels to their lungs.

Even individuals who regularly engage in physical activity should not ignore the potential harms of prolonged sedentary behavior such as TV viewing. Exercise can reduce the risk of death in relation to time spent sitting, but exercise doesn’t seem to reduce this risk as much in people who watch a lot of television. The increased risk could also be due to unhealthy eating habits often associated with watching TV (an unhealthy diet can also increase your risk of blood clots).

Hence it becomes extremely important that whether you’re watching TV or working at your computer, it’s a good idea to frequently get up and take breaks from sitting still. One should try to move around every time there’s an ad break, at least stand and stretch every 30 minutes, or be involved in other physical activities whilst watching to ensure you are staying active.

What are the symptoms of DVT?

A DVT usually forms in one leg or one arm. Not everyone with a DVT will have symptoms, but symptoms can include:

1. Sudden or slowly developed swelling of the leg or arm
2. warmness or pain in the swollen limb
3. Pain or tenderness in the leg on standing or walking.
4. Redness or discoloration of the skin
5. Veins near the skin’s surface are prominently seen

What are the symptoms of pulmonary embolism?

1. Sudden shortness of breath or fast breathing
2. Sharp chest pain that often comes with coughing or movement
3. Pain in the back
4. Cough - with or without bloody sputum/phlegm
5. Sweating more than normal
6. Fast heartbeat
7. Feeling dizzy or fainting

Mile Sur Mera Tumhara....

On occasion of World Kidney Day today, sharing a small jingle that I had written for a NGO - Women for Nephrology, dedicated to creating social awareness on prevention of Kidney Diseases and organ Donation.

Mile sur mera tumhara,
Toh sur bane hamara

Awareness kidney disease ki, har disha se
Behke logon tak, pahuche

Diabetes, BP, Smoking control se,
CKD ruke, halke halke

Mile sur mera tumhara,
toh sur bane hamara

Sandesh angdaan ka, Marne k baad,
Hum se logon mein, faile

Transplant ka, roop lekar,
CKD se, theek ho, badte badte

Mile sun mera tumhara,
toh sur bane hamara

Majhya Tumchya Julta Tara
Madhur Suranchya Barasti Dhara (Marathi)

Tomaar Shoor Moder Shoor
Srishti Koroor Koi Ekshoor (Bangla)

Male Sur Jo Taro Maro,
Bane Aapno Sur Niralo (Gujrati)

Tera Sur Mile Mere Sur De Naal
Milke Bane Ek Nava Surtal (Punjabi)

Mile sun mera tumhara,
toh sur bane hamara...

Jingle to promote awareness for kidney transplant

This was written to promote organ donation, on occasion of the foundation day of Narmada Kidney Foundation (NKF), an NGO with which I've been associated with since 2005.

Jab creatinine out of control,
Transplant ka rasta khol,

Dhink ka chikda….
Dhink ka chikda….

Transplant ka rasta khol,
Goodbye dialysis ko bol

Dhink ka chikda….
Dhink ka chikda….

Jab creatinine out of control,
Transplant ka rasta khol,
Transplant ka rasta khol,
Goodbye dialysis ko bol

All is well….

Doctor hain jane transplant se kya hoga,
Dialysis rukegi, Patient k muh pe smile hoga
Relatives na mane itni jaldi fine hoga,

NKF tu aa, Guidance tu paa
Transplant kara k bol,

Bhaiya all is well,
Papa all is well,
Mummy all is well,
Your bacchu is well.

Acute Stroke Management - A Race Against Time

Did you know that every 3.3 minutes someone dies of stroke, or that stroke is the third leading cause of death and adult disability worldwide!

In India, 1 person suffers from stroke every minute.

The word Stroke (Paralysis or lakva) is derived from the word ‘Strike’ – an analogue to the sudden, severe attack with which it affects the patient and changes their mortality and morbidity completely, if not treated in time.

It is caused by the interruption of the blood supply to the brain, usually because a blood vessel bursts (hemorrhagic) or is blocked by a clot (Ischaemic). This cuts off the supply of oxygen and nutrients to the brain, causing damage to the brain tissue. Ischaemic strokes account for approximately 85% of all strokes whereas 15 % are hemorrhagic strokes.

Treatment of Acute Ischaemic stroke and its outcome is time dependent. Every second a person has stroke symptoms, brain cells die. As seconds tick away, permanent cognitive (mental process involved in knowing, learning, and understanding things) and physical abilities are lost, and the risk of death looms. A stroke can have a profound effect on patients, their spouses and other family members.

Rapid injection of recombinant tissue-type plasminogen activator (r-tPA – a thrombolytic / clot dissolving injection) in blood is the early treatment. It should be administered within 3 – 4.5 hours of onset of above mentioned symptoms. International guidelines recommend a ‘door-to-needle time’ of 60 minutes or less (the time from entry of patient in emergency to administration of drug).

Lack of knowledge about stroke among the general public delays the initiation of immediate management of stroke. Delay in arrival of patient to the hospital, delayed consent by relatives for thrombolysis and unavailability of emergency ambulance services (especially in rural India) are the major reasons of treatment delay. The proportion of stroke patients reaching hospital within 3 hours in India is only 15%. Less than 20% of the general physicians are aware that r-tPA should be administered within the first 3 to 4.5 hours of stroke onset.

New drugs, advanced surgical techniques and interventional neuro-radiology procedures are among the effective new medical options available for stroke patients. These therapies have the potential to reverse the effects of stroke, significantly reduce permanent disability from stroke and lead to an optimal recovery, if administered within the first few hours after the onset of stroke symptoms.

On recognizing symptoms of stroke, patients should be rushed to any nearby hospital equipped to provide care for stroke management - 24/7, with a stroke team, 24 hour MRI / CT imaging facility, a laboratory and a Cathlab. A Stroke Team is a highly specialized, multidisciplinary team working round-the-clock to combat stroke emergencies. It includes the Emergency Physicians, Neurologists, Neurosurgeons, Neuro-Intervention radiologists, Intensivists, Rehabilitation specialists and the nursing team.

Unfortunately, in India, most patients present to the Emergency Departments beyond the 3 - 4.5 hour guideline from symptom onset, thereby missing the important brain and life-saving treatment.

Stroke is a life-changing event that affects not only the person who may be disabled, but their family and caregivers. This year, stroke will affect 4 out of 5 families in India - don't let yours be one of them.

The Golden Hour

Heart diseases are major causes of mortality and disease in the Indian subcontinent, causing more than 25% of deaths. It has been predicted that India will be host to more than half the cases of heart disease in the world within the next 15 years.

In urban India, over the last few years, the prevalence of coronary artery disease in young adults and the incidence of young deaths due to heart attacks (myocardial infarction) have significantly increased. It can be attributed to the stressful lifestyle in the city, and also evolving risk factors like smoking, diabetes and Hypertension in the younger population.

50 % of the heart damage occurs within the first 2 hours of heart attack where there is risk for sudden cardiac death, arrhythmias, and permanent damage to the heart. In an Acute ST elevation myocardial infarction, every 30 min delay from symptom onset to percutaneous coronary intervention (PCI) increases patients’ risk of dying by 7.5 %.

Hence it becomes extremely important that the symptoms of heart attack are best recognized within the ‘Golden Hour’ – the first hour of definitive medical care where the patient’s medical fate is sealed.

Most people do not plan for a medical emergency, although everyone will have one at one time or another. Also, lack of knowledge and self-denial about cardiac emergencies among the general public delays the initiation of immediate management. It is unfortunate that most people take their symptoms lightly and think that symptoms may be due to ‘acidity’ or an upset stomach.

So next time you or your relative suffers from a sudden onset chest pain or heaviness, breathlessness, sudden profuse sweating or fatigue, visit your treating doctor or the nearest Hospital’s Emergency department immediately.

Global Hospital, Mumbai, is equipped to provide cutting edge care for cardiac emergencies – 24/7. Our team of trained emergency physicians, cardiologists and CTVS surgeons, critical care specialist, rehabilitation specialists, nurses and technicians are committed to providing the best treatment for emergency management, and we value every passing second and minute.

Most patients will be sick enough to know when they are in the golden hour and most of them will miss it when it is gone.

Rising number of heart attacks

COVID has changed the world and especially the healthcare industry forever.

A striking feature during COVID was the disappearance of the cardiovascular emergencies, including heart attacks and strokes.

Since the beginning of the pandemic, all emergency visits and admissions to hospitals in the country for heart related ailments had declined drastically by 40-60 % compared with pre-pandemic data.

Much could have been attributed to the fact that people were apprehensive and were delaying receiving prompt care for heart attacks or strokes due to fear of contracting COVID at the hospital, without realising that untreated heart attacks could lead to long-term serious complications. Researchers concluded that people were more than twice as likely to die from a heart attack when compared with pre-pandemic times, probably because they were less likely to be hospitalised.

In various studies over the last few months, it has been found that COVID evolved as a major risk factor for heart attacks and strokes. It is fatally affecting a large number of young people with no pre-existing heart ailments or any traditional risk factors like diabetes, hypertension or high cholesterol. Also, the risk of heart attacks and strokes is increased three-fold in the first two weeks following COVID, with patients suffering a heart attack even after seven to eight weeks of recovery from COVID. Unfortunately, we saw a large number of patients in emergency between the age of 20 to 25 years suffering a massive heart attack and succumbing to it.

Off lately, there has been a sudden rise in cases of cardiovascular diseases presenting to the emergency. We can only ponder if it can be due to COVID?

It has now been established that Coronavirus does on occasions infect and damage the heart muscles directly. Studies have shown that up to 1 in 5 patients with the illness end up with heart damage. Heart failure has been the cause of death in COVID patients, even those without severe breathing problems.

Since people with COVID-19 can have symptoms similar to those of a heart attack, including chest pain, shortness of breath and changes on their 2D echocardiogram, or ECG, we will never be able to tell whether the large number of dead bodies which were brought to the Emergency Departments across the country were fatalities due to COVID lung infection or due to a heart attack caused by COVID.

Another undeniable truth is that the pandemic has lead people into developing the very lifestyle factors that cause heart disease over the long term. We’re a country which eats too much unhealthy food, exercises too little, fails to undergo regular health checkups - and with the lockdown for more than a year, the drivers of cardiovascular diseases only got worse. The American Heart Association (AHA) has predicted a surge of heart attack and strokes in the months and years to come as a lagging indicator of the lifestyle changes and stress forced upon the world by the pandemic.

With the ongoing battle against COVID, we need to combat perceptions that everyone must stay away from the hospital. People should not avoid seeking care for life-threatening, yet treatable, conditions like heart attacks and strokes.

Life begins at the end of your comfort zone.

Fitness is a buzzword nowadays, and we live in an age where everyone wants to be fit. A lot of Indians are hitting the gym with an aim of well-toned muscles and a lean six-pack, apart from staying fit and maintaining a healthy weight. With information freely available on the internet, people are also adopting to various types of diets. To act as a catalyst, various fitness apps on your phone, fitness bands, health startups and other technologies have been driving the market.

However, just because someone looks fit on the outside, does it mean that the person is healthy on the inside too? Fitness and health, though closely associated and often used synonymously, should not be confused to be the same. Even if you are fit, you may not be healthy. Why? – Read on.

The World Health Organisation (WHO) defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

A slim and muscular body signifies that a person is physically fit. However, if the person is eating lots of unhealthy food and burning calories with a disciplined exercise regime to maintain their physique, or being a chain smoker or consuming high levels of alcohol, is not an indicator of good health.

Too much exercise is also not good for the body as it may lead to injuries, exhaustion, depression and anxiety, apart from possible cardiac arrhythmia or sudden cardiac arrest.

So how often should one workout? Studies have shown that 30 minutes of moderate aerobic physical activity each day, totalling a minimum of 150 minutes of moderate exercise each week with 1 days break, or a minimum of 75 minutes of intense exercise each week is ideal. Moderate aerobic exercise includes activities such as brisk walking or swimming. Vigorous aerobic exercise includes activities such as running and aerobic dancing. Strength training can include use of weight machines, your own body weight, or activities such as rock climbing.

Even in patients with pre-existing heart diseases, regular exercise is extremely important. Apart from making heart muscles stronger, it may also help patients be more active without chest pain or other symptoms. Exercise helps lower down the blood pressure, lower blood cholesterol levels, and help control the blood sugar, and in reducing weight – thereby controlling most major risk factors associated with heart diseases.

Along with regular physical exercises, nutrition plays an extremely important role in having a healthy heart. Healthy food choices can reduce your risk of heart disease, heart attack and stroke as well as food related risk actors like obesity, high blood pressure and uncontrolled diabetes.

A regular exercise routine along with a healthy diet can substantially reduce the risk of developing heart disease.

Is it important for young adults to do their heart check ups at regular interval ?

Did you know that 1 in 4 deaths in India are due to cardiovascular disease, with heart disease and stroke responsible for 80 % of this burden? It has been predicted that India will be host to more than half the cases of heart disease in the world within the next 15 years.

Most Indians assume that there is no need to visit a doctor until something is wrong.

Gone are the days when Heart attacks were common only in the aged. Over the last few years, there has been a worry some tread of heart diseases and deaths due to heart attacks in the young population. Much of it can be attributed to the several lifestyle-related issues such as lack of exercise, stress, inconsistent eating habits, and also evolving risk factors like smoking, tobacco use, diabetes, Hypertension, obesity and high cholesterol in the younger population.

As our nation’s number one killer, the risks associated with cardiovascular disease cannot be overstated.

The key to maintain a healthy heart and best possible long term prognosis is dependent on early detection & treatment. Heart Checkups performed in young adults can give doctors & patients a great insight into their overall heart health; and help safeguard them from any potential heart problems, before serious health complications occur.

A healthy lifestyle and routine monitoring of heart health factors are more than just recommendations; they are necessities for long-term well-being. It’s a small measure but one that may be life-saving.

On crossroads between Life and Death.

Did you know that Heart Attacks and Paralytic Strokes have beginnings, which can best be treated within a “Golden Hour”?

An Emergency Can Strike Anyone, Anywhere, Anytime - an undeniable universal truth where few minutes can mean the difference between life and death, and the only thing standing between it is timely medical care. Most people do not plan for a medical emergency, although everyone will have one at one time or another.

The first hour of definitive medical care is called the “golden hour”. It is usually this first hour where the patient’s medical fate is sealed and is very important in situations such as trauma, heart attack or stroke, where time is heart or time is brain. In general, the faster the medical care is rendered, the better is the patient’s chances of survival and ultimate ability to function.

The Accident & Emergency (A&E) department is the “shop window” and insight mirror for a hospital. It is the part of the hospital most closely in contact with the public as it offers the most informal access. Today, modern emergency departments not only are capable of providing round-the-clock lifesaving care in individual emergencies and disasters, they also conduct timely diagnostic workups and serve as the “safety net of the safety net” for millions of patients. Also it is surrounded by so much drama, tragedy, and media interest.

The A&E at Global Hospital, Mumbai is an 8 bedded state of the art facility dealing with a wide spectrum of patients with acute emergencies for initial evaluation, resuscitation, treatment, investigation, stabilization, monitoring and disposition. The dedicated team of trained emergency physicians, nurses and other health professionals provide an extraordinary level of knowledge, skill and compassion to the full spectrum of patients we serve at the Hospital.

Most patients will be sick enough to know when they are in the golden hour and most of them will miss it when it is gone. When seconds and minutes count, count on us!

It all starts with you...

A 65 year old female was brought to my Emergency Department yesterday with a history of sudden collapse and breathlessness just outside Tata Memorial Hospital, Mumbai.

She had been recently diagnosed with a tumor of the thyroid gland with metastasis to the lungs. Unfortunately, the tumor was also pressing onto her trachea (wind pipe). She had gone to Tata Memorial to get few blood tests done as advised by the oncologists. Since the doctors there informed that due to heavy patient load, they might have to wait for a while before emergency treatment could be initiated, attendants decided to get her to our Emergency.

After all life saving measures and stabilizing the patient, I called for the attendant to take a detailed clinical history. Unlike the patient who looked extremely poor and frail, the attendant was a very well dressed, educated middle aged male.

Hi, Good Morning, I’m Dr. Mohit. How are you related to her?”, I asked.

“She has been working in our office as a cleaner for the past many years and has no family here in Mumbai. She only has a distant cousin, but he stays far off in some place in interior Maharashtra”, he replied.

“Her initial blood work is not good. There is acid build up in her body, she’s on high flow oxygen and will need ICU admission for further workup and management”, I informed.

“Doctor, please go ahead with whatever is best for her”, was the reply.

“Do you wish to find out any hospital charges before we proceed ?”, I curiously inquired.

“What has to be done, has to be done, at whatever cost. I cannot abandon my employees in such testing times, especially when we are dealing with such a life saving decision”, was the reply I got, and he proceeded to get the admission formalities completed.

I reason I write about this is not only to appreciate people like the employer in this case, but for all readers to contemplate. How many of us would do something like that, for any of our lowest level employees including peons, drivers, cleaner, and others? Lending money is one thing, but to be physically present when someone is in need, is something I have not seen often, and especially not during this COVID time when everyone is facing financial crisis.

I feel that the world would be a better place if we all yearn for a sense of meaning and purpose in life. Every single thing we do with the intention of ‘doing good’, no matter how small, does make a difference.

This incident has also reinforced my belief in Sir Richard Branson’s famous quote, “Clients do not come first. Employees do. If you take care of the employees, they will take care of the clients.”

The Right in the Wrong.

An elderly 67 year old female, diagnosed case of a metastatic cancer was a regular patient coming to my emergency department. She would often present with complaints of pain, constipation, low blood sugars, low blood pressure, neutropenic sepsis, and all sorts of post chemo therapy complications. She used to regularly call for our Ambulance services to bring her to the hospital, and also had a caretaker with her 24x7.

Since her husband was a retired army officer, her treatment was free of cost at the designated Army Hospital in Mumbai. Hence she never got admitted to my hospital, but would always prefer to be shifted to the Army hospital for further management, after taking primary treatment in my emergency.

There were also instances when there were requests made for a hospital ambulance to be sent and when my team would reach her home, her husband would request the ambulance to be taken directly to the army hospital 40 kilometers away, a service which most corporate hospital ambulances do not provide with their own ambulance, but provide outsourced ambulances with whom they have a tie up.

I had myself attended to & treated her on multiple occasions and could palpate the agony and frustration on the face of the elderly, frail husband. Children had settled abroad leaving the elderly couple to fend for themselves, grappling with struggle every single day.

The husband had many times requested me for a prescription of injectable sedatives, which I always turned down, and told him that she will need to be under monitoring in the hospital if administered the same (overdose of sedatives can cause respiratory depression, circulatory collapse and death). Such prescriptions are always given by a registered medical practitioner with their stamp and registration number.

It so happened that on one of night duties, the husband came to my Emergency department, alone, and was attended to by a young, freshly passed MBBS graduate doctor, who was unaware of the background history of his patient, and the possible complications of such drugs. The senior doctor with her on duty had gone to shift a patient to the ICU, and got busy there after the patient crashed in the ICU and needed resuscitation.

Sensing an opportunity, the old husband started crying and begging the young doctor for the prescription of the injectable sedative, saying his wife could not sleep due to the pain. Initially she refused, but subsequently gave in to her emotions seeing an elderly man crying like that. Call it immaturity, or lack of experience & far farsightedness, she wrote him the prescription for a vial of the sedative.

Within 2 hours, the patient was brought dead to my Emergency! And one need not be a doctor to guess the cause of death.

I refused to issue a death certificate, knowing that it was MOST LIKELY due to the sedative overdose, which the patient would have been administered, by the husband, or by the attending caretaker at the insistence or instigation by the husband (you don’t have to be a healthcare worker to know how to load drugs in a syringe and press its plunger), which would count as a murder in a court of law. At the same time, knowing her case, I did not initiate medico-legal formalities. There was neither any visible evidence for me to do that, nor did I see a point in making the old man suffer any further.

She was then taken to the same Army hospital, where her treating doctor, unaware of the entire plot, issued a death certificate which read – Metastatic Cancer, as the cause of death.

Till date, I don’t have an answer: Who was right and who was wrong? The husband or me?

But whether I find out or not, I continue walking the tightrope of medical ethics every day.