Transforming Lives through Movement: Dr. Rupam Sarkar (Part 1)

Hello! I am Dr. Rupam Sarkar. I have completed my BPT from Haldia Institute of Health Sciences, Haldia, West Bengal, India in 2019 and MPT from Sri Aurobindo University, Indore, Madhya Pradesh, India in 2022. I am currently working as an Assistant Professor and Academic Coordinator at the Department of Physical Therapy and Rehabilitation Sciences, Maharashtra University of Health Sciences, Pune, Maharashtra, India.

After passing under graduation, I used to work at a small clinic in Kolkata. Later, I moved to Ahmedabad and worked there for a few months while also searching for a good college for my postgraduate studies. I got admission to Sri Aurobindo University, where I pursued my master's degree in Cardiothoracic and Pulmonary Sciences. I had a particular interest in neurological and cardiovascular rehabilitation.

During my undergraduate studies, I had the opportunity to observe at the R.N. Tagore International Institute of Cardiac Sciences, the largest hospital in Kolkata with excellent cardiac facilities. I worked there as a physiotherapist, primarily in the intensive care unit, where we focused on cardiac rehabilitation programs.

I had to enter the hospital fully packed, wearing a double suit and a mask. It was a crucial time for me as people were dying in front of us and I witnessed them as well. People were surviving ahead of us, winning the battle. The primary objective of our system is to successfully treat the patient. "Winning" implies successfully discharging patients from the hospital by implementing cardiac exercise programs.

So basically, we need to compare various factors using the cardiac monitor and heart rate monitor, and also assess the presence of a cough using a stethoscope. If a cough is present, we proceed by administering medications like nebulin or duolin, which are liquids that are delivered through a tracheostomy. This is done for patients who have been in the ICU for an extended period. When we administer the bronchodilator, the cough and mucus become more liquid-like. We then use suction to remove the fluid, allowing the patient to breathe more easily.

After this, we record the vital signs and monitor the patient for two days. We look for specific criteria that indicate the patient is ready for extubation, which means removing the ventilator and allowing the patient to breathe on their own. This is the ultimate goal. When all the parameters indicate that the patient can survive without the ventilator, we proceed with extubation. It's similar to taking out a piece of a tooth that has been inserted in the mouth, allowing the patient to talk without the ventilator.

Once extubated, we continue monitoring the patient's vital signs. After two days, we assess whether the patient meets the criteria for ventilator weaning, which involves gradually separating the patient from the ventilator. The goal is to help the patient regain physical abilities. This includes exercises like those performed by babies and range of motion exercises. We gradually progress from sitting to standing to walking. This is how the rehabilitation process takes place. Within a six-week, the patient becomes fit enough to resume their professional activities.

When I worked at Mission Walk, a physical therapy and rehabilitation center located in Pune. I had a tenure of around 7 or 8 months. Prior to that, I had gained experience in Europe. I was assigned to the Advanced Physical Therapy Center. It was during this time that I was given a case in Pune involving a patient with a spinal cord injury at the cervical level.

The patient had no control over their body and was unable to walk or stand. They relied on a sharp caliper to support both legs, which were affected by the injury. However, I was confident in my ability to help the patient regain their mobility. I believed that by June or July, the patient would be ready to become independent.

I began working with the patient by focusing on their lumbar region, strengthening their back muscles, and improving their balance, since the patient had suffered a neck injury, their hand grip was weak, and the muscles in their biceps and triceps were also affected. I worked on addressing these issues as well.

Finally, before the 15th of month, the patient was able to walk with the assistance of a walker. We gradually progressed from using a caliper to relying on the strength of the patient's legs. This was the target I was aimed to achieve.

This case serves as a prime example of my work with adult patients.

My perspective changed when I encountered my idol, Dr. Rashmikan Shah, in Ahmedabad. He provided excellent guidance and explained the true essence of being a physiotherapist. He emphasized that we have the ability to heal and fix things with our hands, without solely relying on machines.

Dr. Shah shared valuable insights about the role of a genuine physiotherapist, which became a significant source of guidance for me. Even now, I continue to refer to his teachings for further learning. Initially, I used to visit his clinic to gain practical knowledge and education. The environment there was strict, but it was beneficial for learning purposes.

Through this experience, I gained confidence in interacting with patients and learned the correct approach to their treatment.

It is a controversial question, as the level of challenge depends on the specific patient and their condition. If the issue is significant, it may be uncomfortable for any patient, regardless of age. When it comes to pediatric cases, it may be more comfortable for the parents or caregivers to handle. Even if we consider a patient weighing 500 kg or a child, there can still be comfort in providing appropriate care.

Yes, if a child requires assistance, it is important to provide it. Similarly, in sympathetic cases, patients with good cognitive abilities tend to be more comfortable to work with. They can better understand the treatment process, making it easier to manage their condition. However, if someone has a brain injury, their behavior and communication may be affected, making it more challenging to provide care. But ultimately, our primary goal is to fulfill our duty, whether a case appears easy or difficult.

Apart from neurology and cardiac cases, yes, like cardiology and cardiovascular cases. Besides those, let's consider the patients who predominantly come with orthopedic cases in India. They often present with low back pain or mixed pain. In my experience, I have found that 50% of the pain is due to the brain's perception. By providing proper counseling and guidance, we can address this portion. We need to educate the patients about what to do and establish clear guidelines regarding do's and don'ts. This resolves around 30% of the pain, making it a total of 80% resolved.

The remaining 20% involves specific case protocols that require thorough assessment. Additionally, a home program and interventions from the healthcare team play a role in addressing the remaining 10%. Overall, a patient recovers to the extent of 100% in orthopedic cases.

In neurology cases, apart from stroke-related issues such as paralysis or injury, there are long-term cases that may take a year or two to rehabilitate. Consistency and perseverance are crucial in such cases. Even in small cases like accidents, which may fall under neurology, a similar approach is followed. Positive counseling is essential, as the patient should not lose hope and believe that they can recover and walk again. Motivation plays a significant role in such situations.

Neurological interventions also involve physical methods such as electric stimulation, which can be highly effective. Stimulation related exercises and activities are implemented, and there is also a rise in computer-based treatments, including the use of artificial intelligence. However, these treatments require time to yield results. In neurology cases, progress may take longer, whereas in orthopedic cases, improvements can be seen relatively faster.

I haven't encountered any significant issues in such situations. Yes, it does happen occasionally with my family and senior colleagues. However, I have a different approach when dealing with patients. I believe that 50% of the work is accomplished by creating a sense of familiarity with the patient. By giving them time and allowing them to express themselves, they feel more comfortable.

I make sure to adapt my approach based on the individual patient, whether they are female, male, children, or elderly. Each case requires a different approach. I avoid arrogance and only speak up when necessary.

In my current college, the main owner is ambidextrous, which is great. The future rehabilitation board also supports and emphasizes the importance of ambidextrous treatment.

There are cases where physical medicine doctors (PMRs) always want physiotherapists to work under them, which can sometimes create challenges. However, in my current setting, everyone collaborates and patients are also referred to me. I maintain my own standards and reputation while collaborating with others.

This collaboration happens naturally, and as a result, questions and cases are directed to us. The team here has expressed their willingness to work on new cases and collaborate effectively.