Thanatology: Death and the Doctor. . . . .My Perspective.

It was supposed to be a free weekend; one that I'd been aching for since weeks. You never expect a post double-emergency weekend to be free for a Trauma Registrar..... but, yeah, I did manage that feat in the middle of the week, thanks to people not drink-driving, falling, stabbing, hanging precariously outside locals, etc. etc. on Sunday or Monday (surprising!!!).
Anyways, today I got a call from my colleague in the wee hours of the morning that one of my patients in the Trauma ward had expired. To the best of my knowledge, I had no patient admitted under my care in the ward. So this statement raised a few eyebrows! On further probing, she was the trauma patient who I had shifted to the General ward around 2 months ago after stabilisation and had to be shifted back in view of poor general condition. Despite our best resuscitative efforts, the patient could not be revived and was declared dead.

I remember the situation around 3 months ago when this patient presented to our casualty as a case of Road Traffic Accident (RTA) with head injury. She was referred from a private hospital, intubated and on AMBU support. She definitely required a ventilator. I was the Trauma Registrar on call that day. We had no free ventilator in our Trauma Ward and I was forced to refuse the patient and asked them to take her to another public hospital where they most likely would have a ventilator available. The husband begged me to admit the patient. In such cases, we take an AMBU consent from the patient's relatives stating that they are willing to perform AMBU ventilation on their patient till the time a ventilator frees up (yes, considering it's a public hospital and with our limited resources and high volume of patients, we have to!!!). The husband appeared desperate. Apparently he had spent lakhs of rupees on her treatment in a private hospital and had run out of money and could see no results in his patient. Hence, the referral to a public hospital (a very common scenario at our hospital and hence the portrayed high "mortality-rate" despite the optimum care given).
This patient was under my care in the trauma ward for almost a month. I will not go into details of how she was resuscitated, stabilized and shifted to the ward after almost a month of being on a ventilator, being tracheostomised and then being weaned off the ventilator, undergoing a PEG (feeding procedure) etc. etc. All I can say is that I put in my best efforts to save this patient!
Shifting her to the ward after stabilisation was one of my biggest personal achievements given her co-morbid conditions as well (morbid obesity, Diabetes Mellitus, borderline hypothyroid).
To hear of her death got me thinking for a while.....

Back to this morning.......... After I heard the news, I cut the call, pondered for a while wondering what could have gone wrong and went back to sleep. Yes, that was my reaction. And, this similar non-sympathetic behaviour HAS become my reaction to the death of any of my patients! Am I heartless??? Think not.....
Death is an irreversible cessation of life- that state of the body that shows complete loss of sensibility and the ability to move..... the complete cessation of the functions of the brain, the heart and the lungs, the so-called "tripod of life" which maintain life and health. Death is a part of life and a part of my JOB. That is an unwanted reality that we as doctors have to face on a regular basis (especially in a trauma set-up). Initially, I'd be quite taken aback and found myself being emotionally involved. as a student in my MBBS days. After graduation, when I was authorised to declare death, I really couldn't bring myself to shed a few tears over someone else's loss, even if I wanted to. I gradually began to realise how and why this happened and why it mattered. As a doctor, I cannot let death take an emotional toll on my life. Yes, you may call me stone-hearted, heartless or whatever. But, I guess this is in the best interest of all the future patients that I will be treating. If I had to shed tears over every death that I have witnessed and had I let each of them shake me up emotionally, I would have given up being a doctor long ago! All I'd be thinking of were dead people! I wouldn't be able to work, to eat, to drink, to sleep..... just imagine!
Yes, I'm heartless during such situations and I have to be. I can empathise with the relatives but that's that....... I CANNOT let my emotions overcome me. And that is what my profession teaches me.......
There have been a lot many occasions like these, where I have given my all to save a patient, to see them eventually die. Frustrated, check.....Angry, check......Sad, check...... Unhappy, check. And a whole gamut of emotions- check, check and check again! Do I portray those emotions......NO! Can't get myself to either. It just dies down till I witness another death!
I can just imagine what you must be thinking but unless you're a doctor, I don't really expect you to understand.
So far, in my short surgical career (many years to go.....still), working in one of the best Trauma centres in our country, I feel as if I've seen it all. Victims of railway accidents with dismembered limbs, some carrying their own leg in their hands (YES!!!), electrocution injuries, stab victims, gun shot victims, burns with trauma, road traffic accidents with their wide gamut of presentations, month old babies falling off God-knows-what-not. (image alongside says it all, I guess. A concrete slab impacted into this young boy's skull with damage to the underlying brain matter successfully extirpated by our neurosurgery team. He was discharged, with just a scar at this site!). Lots more to see, I guess....
All I know is that those who have the strength and the love to sit with a dying patient in the silence that goes beyond words will know that this moment is neither frightening nor painful, but a peaceful cessation of the functioning of the body.
That's some food for thought, I guess. . . . . .
 

Why I think doctors deserve the money they make.....

Here's a well written piece by one of my junior colleagues.....  Sriniket. Good job, dude!
(Edited for this blog by yours truly)


     Doctor bashing seems to be the trend today. Everywhere I go, I get to hear a medical horror story about how some satanic medical practitioner had the balls to ask for 500 bucks after giving a measly injection or scribbling gibberish on a paper with his name on after asking some idiotic questions like "what did you eat on that day?"; " is it a throbbing pain or a bounding pain"(like one can make that out!) and of course the biggest sacrilege of them all "that bloody quack had the audacity to tell me where to get my xray /usg/ blood work, he must be getting a commission..... all doctors are just white coated pimps!"
         

It has been just more than a year since I have qualified to become a practicing physician but already people look at  me as if I am Ambani or at least a Birla in waiting who will very soon be driving around in a BMW bought by money which apparently we get by looting the pained, already much taxed masses. Let me make it clear at the outset when I graduated from my institute I didn't get anything other than all my SSC and HSC documents and threatening words from the office that very soon I will have become a medical officer in the govt. public health centre nearby where i will spend the rest of my days giving out malaria pills and pain killer injections to 'tatya , bandya aajibai and others' (no disrespect implied). I was told in most cases by my own batch mates we will get a princely salary of 25k. WOW!!!! I wonder which other 24 year old gets that much money at that age and then the answer came" every moron who ever graduated from college with any lame ass degree gets more than that! In fact most people who didn't bother with graduation get that". Independent sources tell me rickshaw-wallahs in Thane get more dough than that. Why should I ask for more? ALL I EVER DID WAS GET A GOOD RANK IN A HYPER COMPETITIVE EXAM AT THE THRESHOLD OF ADULTHOOD. I only gave 4 sets of freakishly subjective examinations in which my fortunes can be decided in the end by what I wore to the exam hall, my caste, my language skills, my relations with the college departments and MAYBE  by my knowledge and I haven't even begun ranting about my experiences with post graduate entrance exams!
            Let me be very clear i have nothing against any of my friends who are into any other stream, good for you guys you had the good fortune to steer away from this field by design or by accident! I am sure all of you are doing great now and you all deserve every dollar, every euro ,every pound and every rupee(for the few that still live here) that you make. Nor will i trivialize for a moment the troubles you people go through in your graduate lives. My problem here is on a whole  different level . I want to know why does the layman have a problem with a medico earning big money . of course we as medical students are also to blame here. My 66 months in Kolhapur taught me that many students are not comfortable with this idea and their ideas of success in this world come across as rather weak and limited in scope  (again a personal opinion with no disrespect implied whatsoever)  while i don't believe even for a moment that a fat pay is worth losing one's good name , I believe it's reasonable to expect reasonable remuneration for your skills , abilities , aptitude and work.
       

  Let's get the numbers straight. My information about branches other than medical and engineering is painfully limited, but i am sure that won't be a issue here. There are 18 government medical colleges in Maharashtra and around 20 private ones. Engineering- I think there were 639 in Mumbai-Thane region..... there were 620 last week and it will probably hit 700 by the end of this month. Aspirants for both fields give the same exams almost with the obvious variation being Bio and Math. Because of the sheer numbers even if i consider there are 20 great colleges in this state) that will come to a figure of at least 5000 people who end up with good quality peers , teachers , facilities and by extension good prospects. and these guys wont even be close to the best in the country. The best guys are studying in the IITs, NITs and BITS. All together this comes to around another 20 thousand students with excellent prospects. My basic point is you can expect to be Maharashtra rank 3000 and still graduate from a very good institute. What happens in the medical side of the entrance is that in Maharashtra unless your rank is within 500 you have a steep climb ahead. All those people who say all government colleges are the same and they are all good are DELUDED! The reasons are many and I won't get into them...... this write up is already too long. Somewhere around rank 700 rank you have three choices- pick up below average (read baaaad) college or take up a BDS (dentistry) seat which are even fewer and third option is give up, pick up an engineering seat which is always there or give another attempt!
My point here is that at rank 700, a medical graduate is probably studying in a very bad place where he is deprived of many facilities and opportunities. These guys are all mostly very good students,  toppers in their respective schools, cream of the milk pot that is the PCB stream. These guys are now stuck in very mediocre places for a very long time and that has an effect.. ...believe me it does!  These people are those who are within 1 percent of the state.  Even if they come out unscathed still with the fire in the belly to tackle the big monster that is PG entrances what will it lead too! Again if I consider only the popular PG choices which is about 8-10 subjects..... each has not more than 20 seats in our state....maybe 30. And again this includes the who's who of crap such as Nanded, Akola, Yavatmal and Ambejogai! To complicate matters further there are about an equal number of people arriving at the starting line from the private colleges which have hundreds of seats but all off which are auctioned to the highest bidder! People put their life savings to get their children into these courses....for what?...... private colleges where there are no patients and government colleges where there are no facilities and almost no teachers.
                 So once again, there is a cohort formed by 1 percent of the population and among these only 2 percent can move to the next level! Now you go and do the math! I am sure this is the equivalent of doing your engineering from the BIG SEVEN IITs and then wanting to get into one of the IIMs! These are the odds the very best off the PCM stream have.....each and every medical student has to go through the same odds to get even the most pathetic seat in the worst possible college. If I talk about the odds of doing the medical equivalent of a IIT + IIM. the odds get mind numbingly small!
              We as a society are so used to throwing money , " ooh he is a consultant , he did his B.E from VJTI and MBA from IIM-A ' he should obviously get 40 lakhs per annum, he deserves it!!!" What is the salary that a surgeon passing from KEM can expect.. I will be damned if it's more than 40-50 thousand and he is still not done with his studies, mind you ! And that's the best possible outcome! The guy is 28-29 years old, he hasn't slept properly for the last 4 years at least! He has cleared India's second most difficult exam (IAS tops the chart obviously) with  flying colours and he has sacrificed his whole youth. He basically smells of phenyl ! Also bear in mind that Infosys and TCS are not waiting around to hire this guy. His only option is to stick with a government seat if the decision he took as an 18 year old has to make any financial sense in the long term. When this guy finally turns 35 and decides I need to start enjoying the good things in life and enter private practice, he comes upon people saying "If you wanted to make money, you shouldn't have become a doctor(thank you very much Aamir! I am sure the next batch of people who believe you and stick to dialysis for years thinking transplant is a luxury and not a necessity in renal failure will remember you in their prayers as they hurtle towards their painful and inevitable ends!)".
             

So my appeal to all my non-medical friends.....never question a doctor's fees if you are satisfied with the outcome. You are paying remuneration for the struggles and sacrifices he makes in his youth. You are paying for the fact that he depended on his parents for basic living expenses well into his late twenties and in spite of being among the best in the state he gets treated like something that fell off a garbage truck! As for my medico friends- let's stop selling ourselves short, we are an elite bunch and it's time people realize it! Expecting to get good money for the efforts is not a bad thing. And let's be frank......the pay for interns , residents even super-specialist residents is pathetic. Let's change our outlook!
                    -DR. SRINIKET RAGHAVAN


PS: Check out this blog too..... http://doccartoon.blogspot.in/

I'll be back..... and here I am!!!

Been a long three years.....
I started this blog when I was preparing for my Post-Graduate Entrance Examinations as a distraction. Although updated infrequently, I tried to incorporate as much of my personal & professional experiences in this blog.

What have I been doing for the past 3 years?
That is another amazing journey........ which I shall share with you in due course of time.
Here's a peek: I secured admission to a branch that I love and wanted to pursue......at one of the premier medical institutions for that particular branch. I have been pursuing M.S. (General Surgery) at LTMMC & LTMGH, Mumbai a.k.a. "Sion Hospital"!

 

 

Hoping to update the blog more often......!