Walking alongside Danphe Care

First picture with ourselves.Together,we look awesome.

‘Thank you for saving my life.I wouldn’t have made it if I hadn’t joined Danphe Care on time.’

‘Danphe Team has a family.We have been a part of this family since the day we got enrolled in Danphe Care after we were diagnosed with COVID-19.’

‘Lets meet up for a coffee.Let us have a picnic with our team who helped us completely during this harsh time.COVID-19 had made me restless and anxious.How easily did I and my family cruise through despite so much of fear on Day one of diagnosis?’

‘I was admitted with your referral letter.I needed oxygen therapy unto 15 liters/minute.See, I am back.Thank you for saving me and my family.’

Danphe Care…5/5

‘You made me realize that voice and counseling heals.Constant care of Anu sister was no less than a care of mother.’

And it goes on……..

There are plenty. Visit
https://www.facebook.com/danphecare/reviews for more.

After more than a year of telemedicine service to COVID-19 patients, there has been a lot of accumulation of good words in my favor. Initially helping my community, Changunarayan municipality,Bhaktapur with free services was how my COVID-19 journey began.Emotional since childhood, I have seen sufferings. I have seen how saving lives matter. I have seen how helping heals.A life lost in a family, means the family has lost everything,their whole world and let me be honest, the family won’t be able to stand on their own feet for a long time. 

Nothing compares to the  joy of  caring for those who need us the most,with our own hands. An adrenaline rush, the sense of winning a battle in emergency department, providing what we can with the knowledge we have,shall stay long, for the lifetime. Learning with love from seniors and helping juniors learn and sharing ideas with colleagues, in physical appearance is what everyone aspires for. Well, sinnce long time, we are unable to be physically present. There can be restrains, for sure, as not everything goes in our favor,in our life.But, we have to continue to make a positive difference in everything we are a part of. And then, the physical  journey of Dhulikhel Emergency Department, a home,came to a halt. Oh, how much I miss my family over there! 

Lets now shift our talk to the absence of physical presence. Will the impact of care be  still the same? I would’t reply positively to the question,for sure.It is because the touch, feel and see compares to nothing in the world. 

But, will it make a difference in people’s life, health and outcome?

You can find the answer yourself in first few lines of the blog. 

In a developing nation like Nepal, the true essence of telemedicine hasn’t been realized to the core. After joining Danphe Care, I have personally looked after hundreds and hundreds of patients where they couldn’t afford to visit a doctor.It could be due to financial burden or geographical hindrances. Thanks to Danphe Care, which as an NGO, provides free telemedicine services-clearing the hurdles.Let me thank the local health care providers and authorities to provide me with helping hands to help those in real need. Rural areas of Pyuthan, Bajura and Dhading has weekly telemedicine services from Danphe Care, where I am joined by Dr. Amrita Upadhyay and Dr. Anushruti Parajuli. A special helping hand from Dr. Suyash Timalsina in every once in a while can not be ignored. Trust me, I have seen people of so much diversities in their thoughts, care and way of lives in the places I served, as a part of free telemedicine service from this NGO.

I have seen traditional healers,’Jhakris’ puncturing and extending wound of  snake bites and applying tourniquet such that the blood flow is compromised. I have seen that the local health care centers lacks even the basic medicines, despite government claiming to increase the lists of essential medicines. Trust me, I felt deeply touched when I couldn’t even provide a tetanus toxoid injections to those with dirty wounds,deep enough to have potential Tetanus. I was sad to know that the health centers weren’t even provided with the basic minimal of a pulse oximeter. Do I need to tell you that I can’t even do a complete metabolic panel to those who really need it? And I can’t even perform an Xray to rule out potential intestinal perforation of a chronic alcoholic presenting with severe abdominal pain.Well, all I can do is serve them with the best of my judgement and refer for further care. There are a lot of stories, like this..I can go on..for long..and write long..

But,let me shift my words towards COVID-19 care. I joined Danphe care since December 2020.But my COVID experience was way earlier than that with a lot of online webinars from WHO, UK Public Health,Medscape and so on.My direct first hand experience was as a part of volunteering service to Changunarayan Municipality. It was nice experience. Danphe Care gave me ample varieties of patients,mostly from the hearts of Kathmandu or other city hubs.Well, the horizon expanded to the rural of Dang, Surkhet, Kalaiya till Malaysia, UAE and so on.Just some reviews were what was presented in the beginning of the blog.

Oh, yes! Telemedicine was switched to Tele consultations for those beyond geographical borders of Nepal.

Another dimension! NRNA and Danphe jointly provides free tele consultation services those Nepali migrant workers in foreign lands. I,along with Reshma Shahi,registered nurse, have consulted a lot of cases from Japan, UAE,Saudi Arab,Qatar etc. Triaging,counseling and potential referral was what we mostly did. So, you can understand how much it means to those who have been toiling abroad,in foreign soils, to look for their families back in Nepal.

Back then, with the existing PM KP Oli, where our COO Kabin dai was explaining about free Telemedicine services to rural area of Nepal and its Impact.

There has been a lot of research activities, webinars, patient-centred care activities in Danphe Care. It might make you feel that I am presenting you with so much of positivities that I am sounding as if this is my own NGO.Well, in most part yes! This is my own, our own. Let us not forget to thank Dr. Prabhat Adhikari who conceived Danphe Care in his mind and practice and made a foundation with others alike his mindset to work of the benefits of others.Our COO Phr. Kabin Maleku has also worked for days to make Danphe care stand amid its competitors. A sense of family is what binds us, together. A sense of satisfaction is what keeps us going.Everyone admires praise and feels happy that their effort is counted on and is valuable.Here, the team works days and nights to care for those in needs. I can present you  a lot of stories for COVID care too.But have a look at it,by yourself. The link is:  https://www.facebook.com/danphecare/reviews

A part of the review.

A little message to the team:

Danphe care is ours. We have worked hard, equally, to serve those in need. A guidance for the betterment of society, an educational platform and a rarity of humanity amid the selfishness the world  serves. We shall make it go long,long ahead and collaborate with more safer hands. Special thanks to RN Reshma, RN Anu, RN Sujata,Dr.Suyash,Dr.Divya,Dr. Anushruti,Dr.Amrita,Rebecca, RN Rubina,Anu,Kabin Dai and Prabhat dai. As a  team member, I love you all. And I can proudly say, I am being loved.

Stay safe.

unexPRESSED FEELINGS…

“And if kindness had a face,

I assure you that it would look like you…”

How can someone be so humble?

How can someone love so much?

How can someone give so much,without an expectation of any return?

Holding arm for the first time, and then it has been so,ever since! Thank you for everything.

Sometimes, I ponder on these things alone.I think of you,and then I get my answer:All these are possible,because it is you. You are who you are.

‘Journey of Souls’, a book by Dr. Newton gives a message that our souls recognize each other and then, the recognition has specific dimension and importance. If I start thinking about Dr.Newton’s thoughts, I can understand exactly what he meant. Hundreds of thousands miles apart,in another continent, yet so near. 

Different origins…

Yet more closer than the kins…

Ever since we met, you had never left me alone,in my joys and in my sorrows.Sorrows more, as you would have less happy days for any long term pain survivor.

It is so difficult to grow in an Asian culture, as I couldn’t openly say, I miss you,I love you,I send you my kisses and I wish I was there to hug you tightly.Can I blame the culture,in general? May be not! The fault that Iies in me, one that I had embraced since my childhood.

I wish I could reply to these messages you tell me over our telephone calls every time.Blame this to my upbringing in this culture where there are less expressions.We,Asians, want people to look into our eyes and understand whatever we feel. Yet, you fulfill this requirement too.You ask for a picture of my eyes and understand what I am going through. Don’t you feel that this requires so much passion? A lot of skills to understand the depth of feelings through eyes. Something that I read in Paulo Coelho’s book: Look into someone/something intensely, you will understand everything you need to know.So do you!

I have always been in a comfort zone, supported,surrounded and protected by my loved ones.Amongst them, someone I have always found the nearest,ever since I met,is you. I had called you my sister since then.Sister protect.They provide everything.But what has the deepest impact on me is when you told me, ‘Though I tell you my brother,you are a son to me’. There can never be anything more important for a mother than her children.I have always realized it,always.So, I know what it means to me, and I have always known  my place in your heart. The room in your apartment makes me feel like I am living there.More importantly, I know I live in your heart,alongside the love of your life.Thank you for the statement you made about our relationship.It means the world to me. 

And when your mom asked you about your desire for a birthday present,you simply wanted me alongside you.The question, whether Naresh would want to come here, gave me a smile! I would love to be there,in the family,together and near!!!

Can I ever repay all these? Never,you have always made me feel so special and close,every time. I wish I could tell you how much of a goosebumps these emotions bring in me. I feel that I am there,with you…..In the Rhodes..In the castle…in the apartment in Milan…In the beech…Sometimes in the office,along with Stefania. 

For all the love that I am showered with, I am extremely grateful to have met you and Massimo,here on Planet. I really appreciate all that I am given.Here, On your birthday, I want to wish you the best in everything,every step you take in.I wish you smile,forever, and live peacefully and calm.I wish all the good health and prosperity. You are kind, and you are beautiful. You are the most beautiful relation I have,dearest one:Sister with the name,mother in the care.Marta,you deserve happiness and love.Proudly, I can say, I love you,like you do.May be less, for your care is incomparable…I miss you,like you do. Then, the tung tung of my Whatsapp said, ‘Love you Bhai!!!’ Did you know I was typing this?

HAPPY BIRTHDAY MARTA! BEST WISHES! SMILE, YOU OWN IT!

DIFFICULT QUESTIONS..HAPPY FATHER’S DAY

‘I will send this greeting to my dad through temple,even if he is not here any longer’, Aayan said. He had been telling me about the upcoming father’s day ,which is today,on September 7 ,this year,in Nepal.

Love expressed to Yam,from Aayan !

Sometimes, his questions leave me in deep memories of my brother and dad. He once said to me, ‘‘Like your dad,Krishna Prasad Grandfather is not here, My dad is also not here.Both of them passed away.” How do thoughts like these prevail in a 10 years old’s mind? He wasn’t even born when my dad passed away.He has heard it, and so he remembers it.


May 7 was the last time he saw his dad,when Yam was taken for hospitalization due to COVID-19,never to return again. On September 7, he writes, ‘I love u,father.Happy father’s day’.

I have never encouraged him to talk about Yam. He hears about Yam when I talk to Mom, Grandfather,Laxmi,Francesco or Sylvia.Me and my sister in law,Puja never talk about Yam in front of him,as we don’t know when we are full of tears when we start talking about Yam.

Aayan has recently started to talk about Yam more frequently.Something that I am happy about.Like Francesco says,’Aayan needs to know all the things about his dad.All his goodness,kindness and nature must be shared with him, when it is the right time.’ I agree to him completely.I was waiting for him to speak out.He has now started to share his stories about Yam. A sign which is good, for him and his soul. Liberation is necessary. Sylvia was and is always worried about Aayan’s reaction to the acute event of loss of Yam. Aayan was what we always talked about, his psychological recovery is what we seek for. 

Five days back, all of a sudden, he questioned me, ‘Uncle, who made you a doctor, your brother or your father.’ I kept quiet,pretended not to understand the question.He didn’t stop asking me.He redirected the question, telling, “I meant, your brother means my dad.” I smiled and told him, Your dad and my brother made me everything what I am today. He looked at me, then thought for a while,gestured, Oh!Ok.

Last Friday, Aayan,me,Rabin and my brother in law went for a hair cut.The barber knows us,as we are kin to Yam. Stupid barber, with knowledge of Yam’s demise he still questioned Aayan about Yam, where Yam was. I didn’t hear barber say that,but Rabin informed me about the incident later. Aayan replied the barber, to avoid further question, telling Yam was in Italy, to roam around. This sometimes make me wonder how mature he has been despite such a mental trauma. Next time, I shall avoid that particular barber place to cut our hairs. Such an insensible person around!

11 am,September 6. As usual,I was with Aayan for his online class.His Mathematics teacher was talking about father’s day. His friends started talking about the gifts to give to their father,including a greeting card. He looked at me, then said,sadly, ‘What can I do now?I don’t have my father around?Who shall I give greeting card?’ You can understand how much it breaks,me and my soul.I then told him, gulping the tears within, ‘You can give it to our great grandfather.’

Sometimes, I wish those questions related to father to be skipped in his classes.I wish for that,so that he is not dragged into the mental state where his loss is not reminded.But,this is a grief,he and he along with me shall bear this, in every steps of our lives.

He talks about so many things,Yam. Many things could be within him, left to be expressed.He misses you, like I do. Grant me the strength to answer his questions, without tears dripping off my eyes.

Sometimes, I look ahead, a long journey. Then, I remember this life, in your absence.You can embrace what I feel. It is taking a lot of me.Your physical absence hurts,sharper and deeper everyday.A lot of nostalgias, a lot of questions!!

I know you are happy,looking down at me.I know dad is with you too,his most beloved son. Dad left me young, I was in grief,a lot of grief.Now, You have left me, Yam.You have left Aayan,too young.Will anything hurt more than this?My neuropathic pain hurts 10/10 sometimes, needing Tramadol to soothe.But, a thought of your absence and this long journey tears me apart,completely.

I shall never ask anything for the so-called God or Aayan’s temple.I never had faith in them previously, so do I now, as I completely lost the faith when you were sick.Never did I called God in my life, for anything, but,I had asked the so-called God, to heal you,not to have you lost. A long path, your live memories and strength to carry on….

HAPPY FATHER’ S DAY YAM AND DEAR DAD.

I LOVE YOU BOTH.

Picture speaks louder and better than words.
It doesn’t feel right, without you.To lose you physically aches a lot,more everyday.
You must be happy with Yam.I wish you both were here,with us.I love you both.

A positive energy

And when I shall arrive to your new place, I shall be the happiest to fill that empty embrace of yours,dear brother.
We shall smile and cry,at the same time.The day awaits..

One afternoon, I find myself on a small passage of a hospital-Name unknown.I am with people I am not familiar with.I heard someone tell that Yam was just taken to the same hospital,where I was standing in.It occurred to my subconsciousness that he had already left us physically for this life time.Yet,I rush.I run,as hard as I could, to meet him. 

There, he was, in a medical bed, being pulled by doctors, to shift him to another ward. The doctor who studied in the same medical school as I did, was one amongst them. He told me that my brother was alive and that his death was not true.

I saw Yam sleeping peacefully initially. Then all of a sudden, he saw me,standing besides him.He smiled at me first, then he saw my tears.I went near his bed.The bed had its head end to the East and the foot end to the West. i was standing to the right of him.I couldn’t speak. He could see that. He began the conversation with the assurance that he wasn’t dead.He informed me that he had gone to other hospital for treatment.The body that I saw,wrapped wasn’t his.The hospital sent someone else’s body and told that it was his.As we weren’t shown his face or body in Pashupatinath Temple,he asked me to trust him.

I didn’t want to remember the pain when he was all there with me.He then gently held my hands and talked as calmly as he could. ‘I have seen you in a lot of pain after the news of my demise,every moment. All the tears and pain you are going through is immense.I have always trusted your abilities and capabilities,but a lot of agony is what I see now.”, he told.

He continued, ‘Everything is fine,I am always here,besides you.You are all I have,I am all that you have.So, you are wrong to believe that I have left.’ He could sense that this conversation made me sad again. 

Like in those days in ICU, he asked me some fruit salad mixed with cucumber. I rushed to bring them for him, because it was so long that I hadn’t fed him, with my own hands. 

Suddenly, my eyes were wide open. I forced myself to sleep again so that we could continue our time together. 

Rare, yet true, we were together,exactly in the same place where we were before. He ate, I fed,I watched, he smiled. ‘ I don’t want to see you in pain, brother.I want you to believe that all those things I’ve entrusted upon,is what you are capable of.I have no worries for anything as long as you are there-for Home,Family,Francesco and Planet.It is a long process.It will take time, but you shall accomplish all,slowly.I am always with you,like now,holding your hands.’

I was awake again. Could I fall asleep again? No. 

Yet, I was extremely happy for our long time and talks. I could feel a lot of positive surge of energies,within. 

Days still pass, but nights are silent and lone. I always question Destiny, “Why him? Why Yam? Why so soon? Why?”I shall always question. I always question Yam, “Why did you leave us so early?I need you,return back,not only emotionally, but also physically.I am not able to bear your departure.” I shall always question.

So, have these questioned changed after the dream? Not really. The questions are still the same. 

Did the dream lift some pain that was buried deep? 

To be honest, it really did. 

Will I be able to walk with on those paths that he has shown to me,always? For sure,because he has promised me that he is here with me….With my words and my tears as I write.

Dear Dai, I love you. 

Please smile! My tears signify my existence in your presence.All I am is, All you are. Lets meet again, in a better place, for a longer period…for the eternity.’

POST COVID

The term “Post-COVID Conditions” is an umbrella term for the wide range of physical and mental health consequences experienced by some patients that are present four or more weeks after SARS-CoV-2 infection, including by patients who had initial mild or asymptomatic acute infection.These consequences include both general complications of prolonged illness as well as hospitalization and post-acute sequelae of SARS-CoV-2 infection (PASC), which are more specific to effects of SARS-CoV-2 infection.

The frequency of long-term symptoms and conditions following SARS-CoV-2 infection varies widely in the literature, ranging from 5% to 80%.

Multiple possible onset patterns for post-COVID conditions have been identified that further exemplify their heterogeneity, including, but not limited to: 

  1. persistent symptoms and conditions that begin at the time of acute COVID-19 illness; 
  2. new-onset late sequelae following asymptomatic disease or a period of acute symptom relief or remission; or
  3. an evolution of symptoms and conditions that include some persistent symptoms (e.g., shortness of breath) with the addition of new symptoms or conditions over time (e.g., cognitive difficulties). 

Some presentations may share similarities with other post-viral syndromes, such as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), dysautonomia (e.g., postural orthostatic tachycardia syndrome [POTS]), or mast cell activation syndrome (MCAS).

Types of Post-COVID Condition

Long COVID

Long COVID is a range of symptoms that can last weeks or months after first being infected with the virus that causes COVID-19 or can appear weeks after infection. Long COVID can happen to anyone who has had COVID-19, even if the illness was mild, or they had no symptoms. People with long COVID report experiencing different combinations of the following symptoms:

Tiredness or fatigue

Difficulty thinking or concentrating (sometimes referred to as “brain fog”)

Headache

Loss of smell or taste

Dizziness on standing

Fast-beating or pounding heart (also known as heart palpitations)

Chest pain

Difficulty breathing or shortness of breath

Cough

Joint or muscle pain

Depression or anxiety

Fever

Symptoms that get worse after physical or mental activities

Multiorgan Effects of COVID-19

Multiorgan effects can affect most, if not all, body systems including heart, lung, kidney, skin, and brain functions. 

Multiorgan effects can also include conditions that occur after COVID-19, like multisystem inflammatory syndrome (MIS) and autoimmune conditions. MIS is a condition where different body parts can become swollen.

 Autoimmune conditions happen when your immune system attacks healthy cells in your body by mistake, causing painful swelling in the affected parts of the body.

It is unknown how long multiorgan system effects might last and whether the effects could lead to chronic health conditions.

Effects of COVID-19 Treatment or Hospitalization

Post-COVID conditions also can include the longer-term effects of COVID-19 treatment or hospitalization. Some of these longer-term effects are similar to those related to hospitalization for other respiratory infections or other conditions.

Effects of COVID-19 treatment and hospitalization can also include post-intensive care syndrome (PICS), which refers to health effects that remain after a critical illness. These effects can include severe weakness and post-traumatic stress disorder (PTSD). PTSD involves long-term reactions to a very stressful event.

Assessment and Testing

Before ordering laboratory testing for post-COVID conditions, the goals of testing should be clear to the healthcare professional and to the patient. Laboratory testing should be guided by the patient history, physical examination, and clinical findings.

Medical  Management

For most patients, the goal of medical management of post-COVID conditions is to optimize function and quality of life. 

Ideally, healthcare professionals, in consultation with the appropriate specialists, should develop a comprehensive management plan based on their patients’ presenting symptoms, underlying medical and psychiatric conditions, personal and social situations, and their treatment goals. 

Many post-COVID conditions can be improved through already established symptom management approaches (e.g., breathing exercises to improve symptoms of dyspnea). Creating a comprehensive rehabilitation plan may be helpful for some patients and might include physical and occupational therapy, speech and language therapy, vocational therapy, as well as neurologic rehabilitation for cognitive symptoms.

Optimizing management of underlying medical conditions might include counseling on lifestyle components such as nutrition, sleep, and stress reduction (e.g., meditation).

FDA-approved or over the counter medications as well as vitamin or electrolyte supplements may be helpful for indicated illnesses (e.g., headache, anxiety) or documented deficiencies (e.g., vitamin deficiency) after carefully weighing the benefits and risks of pharmaceutical interventions.

The information might change as we go on learning about COVID-19. This blog is just replicated to circulate informations on POST COVID.All the materials has been copied from CDC. For the detailed information,kindly visit the link in the source.

Source:

https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/post-covid-index.html

#POSTCOVID #COVID19 #LONGCOVID #CDC #WHO #MISC #SARSCoV2

We shall smile, for us…

And then, I gently touch your motorbike. Will your motorbike replicate your presence? May be not, but it gives me a sense that you reside in here,with me, forever.

Do you feel my tender touch,dear brother?

And I touch the replica with much love,again,more than ever.It makes me a more complete Naresh, Yam’s Naresh. 

I look for you,in everything. I search for you,everywhere.

I want to revive and relive all the memories, for I see no reason to believe that you have left me, alone.

Can you feel me ,dear brother,like the way I do? Can you feel that I walk beside your footsteps,those that you took when you were physically present? I walk besides them,like always and I shall walk besides them, forever.

Sooner or later, in that field of existent super energy, you shall wait for me,to guide my footsteps,when I shall reach there, exactly like the way you did for me, down here. Won’t you?

Until that journey,let’s walk together,besides each other. Me with my mortal self and you,with your immortal existence.

I love you.

Let’s smile together,dear brother. For, heaviness deep down in the chest has never been settled with those tears that we have cried,may be together,in each others’ absence.…

We shall smile,for us.

Thank you everyone!

Please smile wherever you live now.We love you alot.

Today is the 13th Day that Yam has left us. This shall end his 13th day’s Hindu Ritual and a beginning of other rituals to follow, which shall be performed by me until we perform Aayan’s Bratabanda.

I had promised to  write about his hospital stay, for I needed to thank many. The very first respondent to our health,Yam’s health was Dr.Bikram and Dr.Hema; my little family in every joy and sorrow. They had called me every time when Yam was at home and hospital; advised me medications,investigations and procedures.I shall always be grateful to this little family of mine.

After we admitted Yam, Puja’s brother Surya stayed at hospital. Thank you Sandesh to respond first with help, emotional and financial both,at very critical time. Surya brother  stayed at hospital,waiting outside as visitors weren’t allowed inside COVID ward. Yam stayed in general COVID ward for 2 days. His oxygen was maintained well above 90% in high flow nasal canal of 40 liters on day 1 and 2. But, to monitor better, we shifted Yam to Intensive care unit (ICU). Yam had difficulty to breath, hence he refused HRCT chest 1st day, but on 2nd day,we asked him for HRCT Chest. When I got HRCT film on my messenger early morning the next day, it was hard for me. I was completely shattered into pieces as I could clearly see extensive infiltration, severe COVID pneumonia. I first informed Puja that Yam had pneumonia. In the lobby of Planet,I couldn’t hold any longer and broke into tears. Bishnu supported me and told not to cry as Puja might see me into tears. But, when Puja saw my face and tears, she couldn’t hold either. We cried,hiding from each other. We managed to go to hospital ,I went to ICU and saw Yam. He was in high flow oxygen. His oxygen was maintained on 1st day in ICU.His blood workup wasn’t that bad either.I fed him lunch.He asked me who were outside. I said Puja,Surya,Rabin and Rajaram. He asked me how Aayan, Mom, Grandfather and Laxmi were. He then inquired about Francesco and Silvia. I told him that everyone were fine. I hadn’t told Francesco about Yam’s HRCT and ICU admission until then.nNeither did Grandfather and Mom knew about his critical condition. He always talked about Rudra brother. He was very close to him. I stayed the whole day in ICU that day.It was very hard for me, to see him suffer though he never told me he had difficulty .We returned early that day after I fed him his dinner. He ate fruit juice,Real. He loved that.

Then, the next day, I was told by Yam that there was no oxygen supply at night. I was shaken in disbelief. I asked nurse what was the reason.She told he had difficulty to breath,so he felt that there was no oxygen.Then, I was with him. His oxygen was above 83% all the time.But, the next day, Yam told me he had severe shortness of breathe and was rescued by doctors. He asked me to stay longer tonight and not to go earlier. I know how I had felt and what i have gone through to hear that. He told there was no oxygen supply at night. I asked Rabin and Rajaram to arrange oxygen cylinders immediately. I fed him and went in search of oxygen.We had arranged one already when Yam was sick. We got it to hospital from Planet. Then we looked immensely and gathered five cylinders that day. We went to hospital and I saw Yam’s oxygen was above 85% all the times. It was past 2 am,we went home then. Silvia had asked me to tell about Yam’s condition to Francesco. So,i told everything. You can imagine how difficult it was for me to tell about my brother’s condition to an ill father with cancer. That night, neither Puja nor me could sleep. We both along with Rabin and Rajaram slept in the same room with Aayan after Yam was admitted.Both of us were in tears throughout the night that day.

We went the next morning.Yam’s oxygen was above 75%  only. I asked him if he was in pain or difficulty to breath. He told he didn’t have any. He wanted fruits ,cucumber and rice along with fruit juice Real. He had difficulty to pass urine, he had no strength. I helped him, then I asked the duty doctor to catheterize him with a foley’s catheter. I told Yam not to worry about oxygen, we had arranged 15 cylinders in total for him. Thanks to family and friends for the effort. Special thanks to Marta,Massimo, Stefano, Silvia, Vincenzo, Guido and Nicoletta in this effort to arrange oxygen cylinder. Francesco, Marta, Silvia, Massimo, Vincenzo, Nicoletta, Guido, Dr Bikram, Dr.Hema, Rudra dai, Senator Kalyani , Ram Kumar dai and Army Major Santosh dai never left me alone during all these days. I am indebted to you all. 

Yam’s oxygen was just around 65-70%. Doctor had suggested for intubation. I called Francesco. He was very worried, so were us. Then,I called Dr. Bikram . He asked me all about Yam’s parameter. He suggested me not to intubate and wait. We waited till 2 am. His oxygen was above 75%. Then we went home,back at planet.I was all in tears. Puja asked me to rest.I couldn’t rest. I was suffering. I was in pain. I couldn’t cry aloud as Puja wouldn’t be able to control her tears. She cried silently, so did I. 

The next morning, it was a battle for me to enter the ICU. With little courage, I went in. I was very happy to see his oxygen to 92% but he was in CPAP. He asked me for his lunch. I fed him. During feeding, he was in reservoir bag,his oxygen being around 85%. He told me to let the nurse feed him as it was difficult for my left hand to grab and hold stuffs. The nurse fed him.  I watched him with joy as his oxygen was maintained. He asked me about everyone,then told me about a doctor named Laura. Then he told he would talk to her once he was well. He had wanted me to talk to her initially.  He then told that he shall be fine in 5-6 days and be shifted in general ward and would talk to her by himself. We talked for sometime then. Then, i let him sleep. His oxygen was maintained. I went out and told Puja that his oxygen saturation was maintained. We were both happy.

I always sent Francesco,Silvia,Vincenzo,Guido,Nicoletta and Marta updates. If I am little late, Francesco would call me in my mobile from Italy. I could understand his worries and anxiety. That is what a father does,isn’t it?

I entered again, fed him soup and then  told about Francesco’s update in Facebook’s group. I told him, not to worry; that he shall be fine. He told me that the management at hospital wasn’t good. With good doctors, we also need good management for better outcome. He also told me that it was around 20 days that he couldn’t see mother and grandfather and take their blessing. He told me, The situation is difficult brother,take me back home’. I told him, I shall look for a better hospital. It was peak course of COVID in Nepal. Even though we had money, there was no ICU bed available anywhere. I was helpless, hopeless. He had always found me the best places, I could find none for him. I counseled him. I had been talking with Dr Bikram,Dr. Hema and Dr. Nimesh. They had been talking to other doctors. But there was no ICU beds,not in HAMS,Medicity,Norvic, Grande,Metro,Patan,KMCTH,Teaching,Bir,none!

The next day, his oxygen was above 85%. Yam told that he hadn’t eaten anything since yesterday. The nurse informed me that in an effort to feed,his oxygen dropped. Since Yam insisted in eating solid food, I asked on duty consultant Dr.Rujan. He told me to try in reservoir mask and feed. Yam told me that oxygen might decrease. I told him that the on-duty doctor suggested. As soon as I loosened the stripes of CPAP, his oxygen saturation dropped to around 70-60-50 %. You can imagine how a doctor and a brother felt at that moment. I then told Yam to go on for liquid food for some days. He asked me,until when? It was hard for me to be strong. I told him,you shall eat when you shall be fine,in 2-3 days.  Then, from the right corner,I passed the pipe,straw and feed him soups, lentils and real juice. After that, i went out,with just half my heart. 

It was painful that he wanted to eat but couldn’t. He who always fed everyone craved for solid food in his last days. I had suggested for NG feeding tube but that might cause leaking in CPAP, so the idea was dropped by on-duty doctor. 

The next morning, his saturation was above 90%.I was happy. Doctors thought he was recovering, so did I. I was very happy to feed him, liquids. We talked. Then, the day was a happy day as his oxygen saturation was maintained. We also ate some food that day. At night,his saturation was 68-70% again, checked the CPAP,rearranged the setting. The oxygen saturation increased. I gave him soup,medicine and milk from the right corner, using the straw. Then,Yam asked what the time was.I told him, it was 10pm. He told me he would rest and asked me to go home. I asked him if he was feeling fine. He told me he was feeling fine. I told the nurse and doctors what to do if his oxygen dropped .I told them I shall come early next morning and left Yam to sleep with his oxygen saturation above 90%. I had asked Rajaram to check for oxygen saturation hourly and inform me. He had informed me that his saturation was 92% after an hour.

I was happy and content. We ate dinner that day,in planet, in 9 days after Yam’s admission in ICU. We were always worried and always late. Then we went to bed.

At 3 am, I got a call from Rajaram. He told Yam needed intubation and mechanical ventilation. I told him to do whatever needed, but keep my brother alive. I was unconscious then. I got another call from Rajaram, but Dr Gopal spoke from other end, he told me that Yam’s heart had stopped and they were performing CPR since 30 minutes. It was 6:28 am and the world was apart for me. I asked him to continue trying. I told Amrit,he is going, maybe in 30 minutes. Amrit broke to tears. I went home. Grandfather didn’t know Yam was in ICU. I told him about his demise. He couldn’t bear it. Laxmi was too young to handle, she fainted in tears more than 10 times that day. Mom and Puja were in the same state as Laxmi. Ayaan couldn’t see us crying. He told Puja not to cry. He requested Bishnu to help his mother stop crying. She couldn’t stop crying, how could she? Who could? No one! I stayed with Aayan. His question shattered me more. “How can dad die? He is in hospital.If he has died, whom shall I call dad? Where shall I stay? What shall we do without him? I had always asked him to stop chewing Parag? What will happen now? “and so many naive questions? I had no answers. Like him, I had lost a father,more than a brother. He tendered me like a son. Ayaan was too young to comprehend what had happened. He was too naive to understand how injustice was served to the one who always did the justice.

I posted in my Facebook-a message telling Yam to smile wherever he was. I called Francesco at around 10:30 am. We both cried, what more could we do? We went to Pashupatinath, the place where he had been hundreds of times. This time, he was wrapped in gray colored bag. We could only offer flowers from distance. We couldn’t touch him, we couldn’t see him.I knew how he was a night before in hospital. I had wished to stand looking at him forever and wished he wasn’t taken to be burnt. I had wished that he stayed with me forever. How can I believe in God when he took my brother away? Puja had always wanted to see him during hospital days. Yam had always told not to bring her inside as she shall break looking at him in that condition. She shall cry and be hurt. She won’t be able to see him suffer. I was helpless then, i am helpless now.He left her, he who didn’t want her to see him suffer left-in all the sufferings of world. How could you, dear brother? Come back if you can. He had wished Planet stand firm. His wishes and words shall be fulfilled. He shall always stay with me,w ith Puja, Aayan, Francesco,Mom,Laxmi, Grandfather and Planet’s family. He shall stay with Planet’s big family around the world, who came here as a guest and left as a family. With tears, I want to say again, to you my brother, Please Smile wherever you are now. You have given me everything,with love, always. I want to thank you for being born as my brother and if reincarnation persists, i want you to be my brother again, but with much longer life for you.

With gratitude and in tears, I write and thank you to all those who have written about Yam before and after he left us.I am indebted to all of you. Please continue writing about my brother and help us stand firm again.I am proud of him and he is worth more than it. I express my sincere gratitude for all the help offered to everyone, during our hard time.

THANKYOU

YAGYA,PUJA,FRANCESCO,AAYAN,GRANDFATHER,MOM, LAXMI,SISTERS AND PLANET’S FAMILY

REST IN PEACE DAI.

I LOVE YOU, LIKE ALWAYS.

THANK YOU DAI FOR THE BIRTHDAY WISHES

COVID-19 has shattered millions of families around the globe. One of them happened to be mine, or say ours, ‘Planet’s Bhaktapur’s family”. ‘Yam’ , in Sanskrit means the ‘God of Death’ but he lost his battle with Severe Pneumonia due to COVID-19.

It all began after he and grandfather went to a funeral in Terai without my awareness. Both of them were vaccinated with the first dose,Yam-Vero cell vaccine; Grandfather-COVISHIELD. Unfortunately, a relative with symptoms of COVID-19 sat in Yam’s car. Can i ever forgive that family? Bitter and harsh, but i shall write what i felt and what Yam felt,all in true words. I can never forgive the family, as this incident happened only after that. It could be incidental, but a brother can not forgive them.

Thank you dai. You will always remain with me, forever. Never said, but i want you to know, I love you forever.

On April 30, Yam called me and told me he had fever, body ache and sore throat. I told him medications but advised for RT-PCR.We went for RT-PCR on May 1,2021. That was the day when Yam posted ‘Happy Birthday Bhai’ with our picture together,his last message in Facebook for me. I was so preoccupied with COVID-19 that I couldn’t even reply with a thank you to him.But, he knew, how much I cared when he or someone else was sick. As a doctor, I was looking after COVID-19 patients online during those days.

The reports arrived at 9 pm that day, Positive for SARS-CoV-2. He was very worried. I had already bought pulse oximeter, thermometer, multivitamins and other medications as I was almost sure for his symptoms. I assured him and asked him not to worry. But, those reading this shall know Yam’s nature,he gets very worried. He couldn’t fall asleep.

On May 2,2021, I called for home collection of samples for RT-PCR as there were members of more than 15 families residing in Planet. 14 of us in total were positive for SARS-CoV-2 including me, Aayan and Puja.Yam was the one who asked us to say together,help each other, eat a lot of food, drink a lot of liquid from Day 1. He was worried for Aayan and me, as I had preexisting disease. Bitter, one of the Planet’s staffs appeared to be very insensitive and blamed Yam’s carelessness for their disease.I shall never forget the guilt that plunged in Yam’s soul at that moment. I shall never forget those words too. Yam then, said, he couldn’t resist going to funeral as he always gave a company to those who were in pain. It hurt him,deep down. Yam was always Yam. Caring and kind by nature.

Yam had continuous fever, hence I called upon Lab’s personnel at Planet to collect our blood sample. Yam’s and my blood workup were deranged, hence we began with steroids immediately. His oxygen dropped to 91%. We arranged for oxygen and then looked for hospital beds immediately. There was none available. On a relative’s assurance, we went to Civil hospital for hospital admissions. Frail and helpless, I requested for a bed for Yam and one for me, next to him, so that i could look after him. I pleaded for more than 3 hours, I couldn’t find one. Yam was in car with his oxygen, he was sleeping.

Once I told Yam the situation, he asked to take him back home. We went home pathetic. On the way, he had fever and was worried. I gave him medications then, we went back at planet helpless. I have already treated thousands of patients and admitted hundreds of them in hospital but I was unable to find a bed for my own brother. Yam, Puja, Aayan ,me and Rajaram, all of us slept in the same room with Yam. I was also having continuous fever, but i wasn’t worried for my own health as Yam meant world to me.

If anyone who has stayed the longest to him after his birth, it was me. He brought me with him when i was 9 and with illness. On that night, Puja wiped the sweat he had after his fever, and i checked oxygen and temperature. Neither Puja nor I could sleep that night. He used to make ‘Umm’ sound in sleep and that used to break my heart. It is never easy to be a doctor and a brother. My brother was the one who made me a doctor.

Next morning, we took him to Manmohan Hospital following recommendation from PM’s advisor as our lawyer, say our family Rudra brother called him. We couldn’t find a single bed in the so-called best hospitals of Nepal despite so much of calling, asking and pleading. I was ashamed of being a doctor at that moment.

The course of hospital was very harsh. Yam’s condition was never stationary. I shall write the journey of hospital soon,may be in his 13th day of Hindu ritual. Today is the 11th, 11th day is one of the longest ritual day in Hindu tradition. So, I tried to pen down, though words can never reveal all those emotions we had during those days. Also, tears can never wash way feelings. If it could, my tears should have stopped while I am typing these.

In this journey, many people had called me and wrote me constantly many times a day, from Italy and Nepal.They had asked me every moment how Yam was and always told they had prayed for him. Thank you so much. I shall write about you all in my coming days too.

I thank you all and please let me know about your memories with Yam if you haven’t written. I have read many of them. I shall read more. The more I read, the more I am proud of my brother. I love him alot.

Thank you

Love and regards,

Yagya, Yam’s Brother

Francesco, Yam dad after Dad’s demise (many of you know that already)

Yam’s Family (Grandfather, Mom, Puja, Aayan,Laxmi, Planet’s family)

Prime Minister Of Nepal And His Silence Amid My Telemedicine Session for Danphe Care

So, an event was organized to demonstrate how telemedicine services provided free of cost by Danphe Care, to rural areas of Nepal, was having an impact in people’s life.

His Honorable Prime Minister KP Oli along with Finance Minister Bishnu Paudel, Agriculture and live stock development minister Ms.Padma Aryal came, sat besides me, and watched keenly on how it was conducted.

Surprisingly, even prior to the end of history taking, he left on the gesture from a person(may be his assistant), even without talking to the Paramedic from Pyuthan, the patient or any of us (may be he hadn’t wanted to interrupt our session, which had already started an hour before his arrival).

So, I am still thinking, what could he haved understood in that 10-15 minutes sessions between the patient and me, along with other experts in live telemedicine?

In the end, the event ended (didn’t even last for a couple of hours). I completed examining all the available patients; during the same period, the first computer scientist of Nepal Muni Shakya sir,our project lead and co-medical officer were interviewed by TV channel regarding Telemedicine.

We returned, and here, we are again, providing free telemedicine services in rural area of Nepal,from Danphe Care,IMark Digital.

#TeamDanphe #PMOLI #imarkdigital #RuralNepal #DoctorOnDuty

The formal one
Me, explaining the PM about how telemedicine takes place, before resuming the session again!
Cancelling the noise and focussing on patient, again!
Your team is your gem.
PM,Finance minister,AGRICULTURE AND livestock minister and our team in the same frame.
I love them all.