Half Truths: Satyamev Jayate (Doctors in trouble)

Doctors and medical frauds should concern us all. I have had some horrid experiences that made me revaluate the dependency we have on medicines. Capsules, doctors, hospitals have been a prominent part of my life. So, I was truly glad to watch yesterday’s episode of ‘Satyamev Jayate’ because there are many of us who have no option but to blindly trust our bodies with those who are qualified but treat us as organs, rather than people.

This time, the host cut down on the vicariousness and concentrated on more information. However – yes, there is a clause – for much of the show the emphasis was on how people are forced to take medicines when they do not need any. One particular example was of a man who flashed a packet of ORS and said that he could have been cured of his diarrhoea and vomiting with this at Rs. 15 instead of the few thousand he spent at two different hospitals.

There are such cases. But ORS is available over the counter or can be prepared at home. What if people start thinking that since most doctors are going to fleece you/mislead you, it would be better to self-medicate? What if it indeed turns out to be a serious illness?

The solutions were simplistic. Go to a chemist for generic medicine and you save money. This is for drugs that are expensive and for major illnesses. What about those we take for common ailments?

It would have been topical had the show also brought up the recent case of a poor man whose wife was denied admission to a hospital after an accident and his sorry tale of running from one to another to another till she died.

The tale of a village in Andhra Pradesh where all women had their uteruses removed should have been seen from the population control perspective rather than medical malpractice. Someone is responsible at a higher level; this cannot be doctors just wanting to make women sterile to earn money.

It is perturbing to know that India spends only 1.4 % of its budget on healthcare. And it was good to see the efforts made by some to use the pay-in-advance scheme, where the poor and the rest can benefit based on their capacity.

The racket and the treatment are two different aspects. Aamir Khan, it is being said with much appreciation, grilled the Medical Council of India (MCA) chief. All he managed was a schoolmaster version of extracting a promise to behave. Taking away licenses from doctors for malpractice is all very well, but how many doctors do we have with regard to ratio of population? Many people still visit quacks. Then, there is the ancillary industry of homeopaths and ayurveda, and these days they are all meshing.

I only hope that we don’t see a spurt of ‘actions taken’ and then the lull. This is an ongoing problem, a tragedy of our country.

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Let me share something I had written earlier about exposing a doctor:

A few years ago I had followed up a case of neglect that could have led to death. A wrong blood group diagnosis prior to surgery. In a chawl at the far suburb of Ghatkopar in Mumbai resided this lower middle-class family; they put all their papers and trust before me. It was late night when I left them.

Next morning I decided to meet the doctor. I entered the clinic and after a very long wait his wife, also a doctor, told me he was not in town. It was a lie for the fruit vendor outside had in fact given me the exact address and also confirmed his presence.

When I went out, I told him he wasn’t in. “Aisa kaise ho sakta hai? Hum ne khud dehka aatey hue aur unki gaadi bhi yahaan hai.” (How is it possible? I saw him enter and his car is still there.)

It was raining outside. I crossed the street and lay in wait, hoping for something. Nothing. The showers were getting incessant and I was drenched. It must have been the time of a blink of an eye when I saw THE car get out of the gate. I couldn’t move. Where would I? How? It was a helpless situation. I left. An hour later a colleague from a magazine told me that he had got a call from the doctor, he was a nice man, very influential. The message was that I should keep shut.

I did not.

What happened? Did the family get anything out of it? No. Except that they had raised their voice. No action was taken despite their case being put before the medical council.

Slowly, it was almost forgotten…a year or so later I was shocked to read that this doctor had been given some award by his own fraternity.

The media today has a greater reach, more influence. It should use it as a weapon against offenders and act as a shield for those who need protection.

As for me, that scene still haunts me of a car that escaped and the rain that wouldn’t stop. It haunts me that I could do nothing. Absolutely nothing.

Sunday ka Funda

A short history of medicine:

I have an earache.

2000 B.C. - Here, eat this root

1000 A.D. - That root is heathen, say this prayer.

1850 A.D. - That prayer is superstition, drink this potion.

1940 A.D. - That potion is snake oil, swallow this pill.

1985 A.D. - That pill is ineffective, take this antibiotic.

2000 A.D. - That antibiotic is artificial. Here, eat this root. 

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Switch:

What's up, robot?

Would you like your doctor to be a machine? I am wary about the first ever heart rhythm operation performed by a remote-controlled robot.

Dr Andre Ng, cardiologist at Leicester’s Glenfield Hospital, sat outside the operation theatre as his 70-year-old patient’s vital organ was manipulated to get his irregular rhythm back to normal. The doctor felt in “complete control” and could see and speak to the staff who were with the patient.

As a report says:

The main advantage is that the doctor doesn’t have to wear heavy radiation shields such as lead aprons, which are normally required in the operating room because X-rays are used to see inside the patient.

“Because I was sitting down in a relaxed, not having to wear a heavy lead coat, it was actually a pleasurable experience.”

I have read reports earlier about how patients prefer robot medics to unfamiliar doctors. That is different. It is more like scouring the web for information.

Science has progressed, but is technical progress enough? Doctors anyway use high-tech equipment; laser surgery has made it possible for a small incision to extract huge tumours. I do not understand the need to remove the person from the process.

It might well be asked that the patient is under sedation so s/he would not be aware of the doctor’s presence or absence. True. Yet, we need to ask a few questions:

Is the patient told prior to the surgery that it would be a robotic operation?

If something goes wrong, and our dear doctor is sitting relaxed outside, then who will rectify the situation, who will shoulder the blame? How long will it take the doc to wear his fancy superman suit and get into the OT? And if this is touted as a remote operation, then what is the big deal about other staff being inside? It only proves that human assistance will be crucial at all times.

I am seriously concerned about the possibility of this being done in cities far removed. The manner in which medical science is seen and acted upon by different cultures differs. How will a doctor in the UK liaise with the team in, say, India? What about the ego problems between the two? Again, who will accept blame for any goof-ups?

It is bad enough the way ‘specialisation’ has been promoted, but this truly is taking it too far. If robots must be used, it could be to teach doctors, to be used as guinea pigs for experiments, not to become the masters.

Has anyone given a thought to the psychological ramifications? How will the patient be affected before and after?

I understand that robots have been trained in bedside manners too in other cases. This really amounts to making the patient feel like a machine. I like my doctors with a warm touch and a smile, not some automaton advise me in a disjointed voice that I need a pill. He wouldn’t know if I just need to chill, would he?

Whose Euthanasia Is It, Anyway?

Dead Right

Whose Euthanasia Is It, Anyway?
by Farzana Versey
Counterpunch, December 21 2009

She held my hand in a firm grip the night before she died. The room where she lay in coma was airy and it was home. The doctors had given up on my maternal grandmother, but we had not. I would sit by her bedside and talk to her or just read; I was told that voices registered. She probably knew when her time was up when she gripped my arm. Early next morning I started my monologue again, touching her wrinkled skin and looking into her beautiful grey uncomprehending eyes. In the need to convey my warmth I did not realise that her body was cold. She was dead. Was it selfish love that would not let her go? She went anyway.

The reason for this personal anecdote is the Indian Supreme Court admitting an appeal to end the life of a woman lying in a lobotomised state for 36 years. There are medical, emotional and ethical issues here.

Aruna Shanbaug was a nurse at the KEM Hospital in Mumbai. On November 27, 1973, when she went to the basement after her shift, she was sexually assaulted by the sweeper Sohanlal Bartha Walmiki. He used a dog chain to strangle her, leading to loss of blood supply and oxygen to the brain. It debilitated her in so horrific a manner that she was rendered paralysed, blind and has been comatose for over three decades.

The plea to the court has asked it to direct the hospital to stop force-feeding her. A question arises out of this simple demand: Is she eating enough at all that the forced feeding would put an end to her life? She is subsisting on mashed food and chokes on liquids. Her body is skeletal, but she breathes. Perhaps it isn’t food alone that is keeping her alive. Why is there no clarity about how she should be relieved of her painful existence?

The lawyer asks, “Is not keeping the woman in this persistent vegetative state by force feeding violative of her right to live with dignity as guaranteed by Article 21 (right to life) of the Constitution? She is beyond cure. Let the court inquire about what medical science has in store for her. It appears that there has been utter indifference of medical world towards her.”

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The right to live with dignity is not merely a medical subject. The courts would have to look into other aspects of the idea of dignity. Since Aruna is not in a position to know whether her state lacks dignity, it would therefore follow that those responsible for her care ought to be granting her that dignity.

Years ago a doctor had spoken up for death by choice and said, “How many of us realise the meaning of euthanasia? It means a good death. We talk of ethics when we prolong a useless life, so where do ethics go when we carry out abortions? Even the foetus have life and we kill them happily just because it suits our convenience. Do we then pause to think that the foetus may have had a mind to live on, may have had a brain which was that of a genius? There may be thousands of Arunas in India and we keep them alive no matter what and incur massive expenses to keep a useless life ticking.”

After the reappearance of the case, there have been other points of view. Dr. Ravi Bapat, who was supposedly among the first of the team that responded to Aruna on the morning she was discovered lying under the stairway, is against the SC petition. “It is idiosyncrasy, no living cell ever wants to die…Aruna is like a mentally challenged person now. Would any parent of a mentally ill child move the court in a similar manner? It is sickening how every five years someone raises Aruna’s case just for publicity.”

Ironically, the only two parties who have not gained mileage out of this are her callous family, that did not have the means or the patience to see her alive as the symbol she was to become, and her doctor fiancé who after three years of caring for her realised that her case was closed and went on with his life.

That is what life is about – to make choices. There is no love that keeps her alive. Her family gave up on her; the rapist is free, and the hospital has kept her room locked for fear he may return. Is she in a position to give evidence?
It is crucial to point out that there is virtually no comment about the rapist. Reports mention that after his seven-year jail term he is working as a ward boy in a Delhi hospital. How do they know? Is someone in touch with him and for what reason? If he is using his real name, then were his new employers aware of his crime? He was sentenced for attempted murder and robbery – he made away with Aruna’s earrings. Why was no rape case pursued? Because he had sodomised her. It is rather strange that in a country where the law against homosexuality is only now being given a fresh look, this was not deemed as rape. Besides, sodomy is illegal in India. How did he get away with it?

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In all these years whenever the ‘story’ was covered in the media, the emphasis was on Aruna and for the most part her fight in a locked hospital room, hunger, pain, soiled clothes, stiff immobile hands and legs, the voice beastly, the brain half dead. Today at 61, the routine continues. She whines, is still afraid of male voices; we get these same dispatches in graphic detail. Aruna’s helplessness is made to appear heroic.

This is not about a lone woman’s fight nor a miracle, for it neither uplifts the spirit nor her body. She does not even recognise that she has survived.

This is not the tale of a support system. The crime was committed by a hospital staffer in the hospital premises and the authorities have a reputation to uphold. There should instead be an urgent need to look into the conditions of public hospitals and also the general wards of some private hospitals. They are in a pathetic condition. With Aruna’s case, there ought to have been a greater need to examine the level of security. By cocooning her in a room, the authorities have got away without being answerable for such a lapse. They could have fought the case against the rapist who was their employee; they could have issued notices against him being employed anywhere else.

What use is a lifeless person when the perpetrator of the offence is free? Does it drive home a point at all, least of all about the goriness of such a gruesome act? Aruna is not seen as a rape victim but a caged human kept alive.

This is not a tale of sisterhood. The nurses have rallied around for professional reasons – it could have happened to any of them. Their compassion is based on a ‘special bond’, we are told. How is it possible? Most would be a new batch, younger women for whom she is merely a publicised character.

This is not at all a story about a spectacular beginning, a meaningful middle and a fitting denouement with a moral thrown in somewhere.

And that is alarming. No ethical questions about the crime and the system are asked. Once the courts grant her the right to die there will be demands to legalise suicide by those who feel their life is not dignified enough. There will be related issues where you may not ban books that tell you the easy ways in which to meet your end. You may not prevent a discussion by the Hemlock Society. And you may not raise eyebrows over the concept of assisted death.

In societies where penury itself is a sin and avarice a virtue, the prospect of such methods being legally manipulated by poverty-stricken families and greedy relatives is frightening.

Aruna Shanbaug needs a peaceful departure and it should have been done long ago, quietly and with dignity, and not until the story was sapped off its juice. She has suffered enough – first in the basement, then in bed and then relentlessly under the media glare. She may not be aware of the latter two, which makes it worse.

What right are we then talking about when she does not even have the consciousness to know how her life is being used?