THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR PATIENT'S PROBLEMS THROUGH SERIES OF INPUTS FROM AVAILABLE GLOBAL ONLINE COMMUNITY EXPERTS WITH AN AIM TO SOLVE THOSE PATIENT'S CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUTS.
[06-09-2025 12:04] PPM 1: Will share this patient's data in parts and as it's sensitive data involving legal, social aspects I have chosen the current participants carefully to get the best inputs for this patient and I shall try to share his internal medicine (clinical information) as well as external medicine (non clinical external factors aka community medicine or public health and sociology, law and psychology) in parts to encourage inputs
[06-09-2025 12:04] PPM 3: Who is the patient advocate Sir?
[06-09-2025 12:04] PPM 3: I want to take inputs please
[06-09-2025 12:06] PPM 1: I can provide the initial inputs here and as per your further questions I can gather further inputs from him in pm and share it here. The patient doesn't want to be identified.
[06-09-2025 12:09] PPM 3: Yes Sir, please share.
[06-09-2025 14:04] PPM 1: Internal Medicine issues:
(As per patient) 21/08, 13:26
hu1:
Diagnosed with a 14 mm gallbladder stone (detected in July 2023), which causes severe back pain and significantly affects ability to work consistently.
Also suffers from athlete's foot, an acute on chronic contagious condition requiring treatment, which temporarily limits mobility and attendance at court proceedings.
Also suffers psychological stress caused by long-term separation from children, which sometimes prevents him from recalling exact dates, amounts, and details of past financial transactions or property records.
External medicine issues (including law and psychology) @PPM3@RS1
[21/08, 13:26]hu1: Background
He faces incarceration of 6-7 years for not paying maintenance "as ordered". Average payment, from what he paid when he had a job, then from gratuity etc should be a huge amount per month
Ordered amount was a large amount pm, increased to larger amount per month. Typically 6% inflation adjustment is added every year.
Wife left marital home exactly 8 years ago. So the expectation would be around lakhs per month.
That's post taxes around high amounts, hence pre taxes still larger amounts per annum CTC is needed just to satisfy the order.
The outstanding arrears for maintenance would be a huge amount. That will need to be taken as loan. For such huge amounts, 5 years amortization is around higher amount per month EMI. Pre taxes... That's very huge amount per month, or larger amounts in CTC
Total CTC needed then stands at higher amounts per annum.
Even if I survive on minimum thousands per month. Large amount of CTC needed.
Currently patient is unemployed since few years
Formal education: 12th science pass
No technical qualifications
All distance education degrees
Psychological labels:
Emotionally devastated by 7 years of child alienation
And actually admitted to be of unsound mind when interim custody orders were decided.
History taker's questions: hu2
October 2017: Your company x placed you on garden leave for a long period due to false allegations, even though you were later cleared of all wrongdoing.
What were the allegations?
How was it cleared?
Patient's response:
Unofficially it was a political stunt at the 11th hour before my Chief Engineer promotion.
On Oct 15 the Distinguished Technologist for xAI congratulated me with a screenshot handing me ownership for Asia Pacific. On Oct 17 or 18 garden leave was initiated.
[21/08, 17:09]hu2: So who were these people who brought about your downfall in the company?
Do you suspect anyone?
Could they even have masterminded events to cause your divorce and are still playing behind the squash court set up to squash your talent altogether?
I personally feel you are a very talented individual and your unconventional career trajectory makes it even more worthy of a career that needs to be celebrated but I suspect there are people who you may have unknowingly trampled upon who may have systematically designed this current trajectory
[21/08, 17:30]hu2: Thank you for the appreciation.
Not one... A bunch.
X ones were clear. The guy who assigned me the 2x BLAS speed up task left the company just 2 weeks later.
The politics ran till multiple levels. Honestly, it was x hence I could survive 18 months after that. And they did give some amount to resign. I needed the money so accepted.
Divorce was not coordinated by them. Yes, there were people.
But it was seeded by the psychologist.
[21/08, 17:35]hu1: The real challenge lies in the major mismatch I have with just about any stereotype. Causes dissonance.
Divorce matters were stereotypical, in modern social context.
Now, the child alienation has become severe. Still not far from stereotype, just that the duration is much longer than usual. But not unheard of.
It's a ransom mechanism. It's actually called parental kidnapping.
[21/08, 17:37]hu1: She was somehow able to convince the legal team that we are loaded!
Her intention being that of keeping me hung up (on her). A sadistic personality type.
[21/08, 17:58]hu1: But that was just one factor.
1. Her parents never accepted me.
2. Her profile of innovation based on my work. The EP was mainly pursued when I recieved two international awards after leaving x.
3. I don't just cause dissonance outside of my blood relatives. Blood relations are the most dissonated. "Bhaiya to college bhi nahi gaye the!"... My cousins were the biggest spoil sport. But that's common. Honestly, again, they did not expect the reaction to be so severe. All relatives were not involved. My aunt was! God bless her soul. She commited suicide 3 years back. One person from the opposite clan could have been instrumental, but he had won most land cases. So don't see an intention there.
4. I was career level wise a peer or above most. We were one of the youngest couple.
5. She had joined me out of fascination for research. I lived up to my part of the deal. Shows on her career. However, she started missing the Dr "God" mode! She's a VP. Been one for 4 years or so. Most of our age peer docs are still senior manager, or a few may be at Director level. So my destruction keeps her story of innovation intact. "Ab is age mein nahi hota"... That can be a simple excuse. My continuing destroys that, even the past hype.
6. She is a spendthrift. So any money I give is welcome, but the objective will not change. If I can pay the total amount, then well she values the money. More than a Cr is interim maintenance arrear. One time could be few Cr at least. Usually in thousands for monthly payment. You will need to put the math on paper to understand the cartel. Her lawyers would get 30%
[06-09-2025 14:18] PPM 4: This is a complex and deeply distressing situation. The patient is experiencing a severe multi-system crisis involving medical, psychological, and legal domains, each exacerbating the others.
Here is a structured analysis and a proposed course of action, framed from an internal medicine perspective but integrating the external issues.
### *Summary of Presenting Issues*
1. *Medical (Somatic):*
* *Symptomatic Cholelithiasis:* A 14mm gallbladder stone causing severe back pain, impacting ability to work and function consistently.
* *Tinea Pedis (Athlete's Foot):* An acute-on-chronic condition that limits mobility and could potentially affect attendance at critical court proceedings.
2. *Psychological:*
* *Severe Psychological Stress & Trauma:* Stemming from long-term separation from children (parental alienation) and a history of being declared "of unsound mind" in court proceedings.
* *Cognitive Impact:* Stress is manifesting as cognitive deficits, specifically affecting memory and recall of detailed financial and property information, which is crippling his ability to mount a legal defense.
* *Historical Trauma:* Events suggest a history of significant professional sabotage and personal betrayal, contributing to a complex PTSD-like picture.
3. *Socio-Legal-Financial:*
* *Catastrophic Financial Liability:* Facing incarceration due to maintenance arrears calculated at an astronomically high level (~₹1.5 Cr), based on an income he does not and has not had.
* *Unemployment:* Lacking formal technical qualifications, making a return to a high-income career (which would need to be ~₹1 Cr+ p.a. to meet the demands) nearly impossible.
* *Legal Complexity:* The case appears to be based on a profound mismatch between court-ordered payments and actual historical income, potentially fueled by misrepresentation by the opposing party.
---
### *Integrated Treatment Plan (A Problem-Oriented Approach)*
The primary diagnosis is a *Severe Stress-Induced Disorder with Somatic Manifestations*, exacerbated by an untenable legal situation. Treatment must be simultaneous and multi-pronged.
#### *1. Immediate and Acute Medical Management (Internal Medicine Focus)*
* *Gallbladder Stone:*
* *Urgent Referral to General Surgery:* The symptomatic stone requires surgical evaluation (likely for a laparoscopic cholecystectomy).
* *Pain Management:* Appropriate analgesics to manage the severe back pain and improve functional capacity. Controlling this pain is critical to enabling him to think clearly and handle other issues.
* *Documentation:* A detailed medical certificate from the surgeon and treating physician is *essential*. It must state:
* The diagnosis.
* The severity of pain and its impact on cognitive function (concentration, memory) and physical capacity.
* The planned treatment and expected recovery period.
* *This certificate must be filed with the court immediately by his lawyer to request an adjournment or stay of any coercive actions (like arrest) on medical grounds.*
* *Athlete's Foot:*
* *Treatment:* Prescription antifungal treatment (topical and/or oral) to resolve this acute-on-chronic infection and remove the mobility limitation.
* *Documentation:* A separate note on this contagious condition can further support requests for video-conferencing for court appearances instead of physical attendance.
#### *2. Psychological Stabilization and Support (External Medicine / Psychology Focus)*
* *Immediate Psychiatric Evaluation:* This is non-negotiable. The history of being declared "of unsound mind" and the current cognitive deficits (memory recall issues) require formal assessment.
* *Objectives:*
* *Diagnosis:* Formally diagnose the impact of extreme stress, trauma, and parental alienation.
* *Treatment:* Begin therapy (e.g., trauma-focused CBT) and potentially consider pharmacotherapy (e.g., antidepressants/anxiolytics) to alleviate acute anxiety and improve cognitive function.
* *Critical Documentation:* The psychiatrist/psychologist *must* provide a detailed report for the court. This report should explain:
* How severe psychological stress directly impairs memory, specifically the recall of complex financial transactions and dates.
* That the patient's current mental state is a direct result of the prolonged legal battle and parental alienation.
* That incarceration would be severely detrimental to his mental and physical health.
* This report is a powerful tool for his lawyer to argue for a modification of orders based on actual present financial capacity and mental state.
#### *3. Legal and Financial Strategy (External Medicine / Law Focus)*
The medical and psychological interventions are primarily to create the stability needed to address the legal core of the problem. His legal team must be guided to:
* *File for Modification and Recall of Orders:* The maintenance order must be challenged based on:
* *Genuine Lack of Means:* He is unemployed. The order based on a hypothetical CTC is void.
* *Change in Circumstance:* His job loss and health issues are a monumental change in circumstance since the original order.
* *The Principle of "Plea of Poverty":* Indian courts have held that a person cannot be jailed for non-payment if they genuinely cannot pay. This must be the cornerstone of the defense.
* *Use Medical and Psychological Evidence:* The certificates from doctors and psychiatrists are not excuses; they are *evidence* of his inability to comply and his deteriorated capacity.
* *Focus on Real Income, Not Hypotheticals:* The argument must shift from "he should be earning X" to "he is currently earning zero, and here is why." The calculation of arrears must be based on his actual past income, not an inflated figure.
* *Explore Pro Bono or Legal Aid:* Given the financial situation, his lawyer should look for organizations that assist in such human rights and gender-neutral litigation.
### *Prognosis and Conclusion*
The patient is not merely "unwell"; he is in a state of acute crisis where his health is being destroyed by an external legal pressure that is disproportionate to his reality.
* *Without medical and psychological intervention,* he will be unable to participate effectively in his own defense, leading almost certainly to a disastrous legal outcome (incarceration), which would further destroy his health.
* *With immediate and coordinated intervention,* there is a path forward. Stabilizing his health will stabilize his mind. A stabilized mind can work with a lawyer to present a fact-based case to the court about his true financial situation.
*The immediate next steps are:*
1. *See a General Surgeon* for the gallbladder.
2. *See a Psychiatrist* for evaluation and therapy.
3. *Instruct his Lawyer* to file the obtained medical certificates with the court immediately and to base all future arguments on his actual current financial and health status.
This is a classic case where the medical profession must provide the objective evidence needed to inform and correct a legal process that has lost touch with the facts on the ground.
[06-09-2025 14:34] PPM 3: Please apply utmost due diligence. Medicine is one discipline used by legal professionals to provide relief to their clients. It is not the duty of medicine to get involved in any legal issues unless they are urgent or required to save lives. Not to provide relief to the people who made legal mistakes should be the first step in providing help. Medical help is the priority here please.
[06-09-2025 14:35] PPM 3: No medical certificates are to be issued which can be used to get relief in a court of law.
[06-09-2025 14:36] PPM 3: The treating medical people can also get entangled in criminal procedures unnecessarily. So please have compassion to treat the patient medically and also don't get involved with law enforcement agencies unnecessarily
[06-09-2025 14:38] PPM 1: Yes I guess your words are meant to provide feedback to @PPM4's LLM.
I'm guessing it's deepseek?
[06-09-2025 14:50] RS1: May I know what are the legal and psychological issues with the patient!!
[06-09-2025 14:52] PPM 1: Legal issues:
Divorce alimony settlement and threat of incarceration if unable to pay
Psychological issues used in legal case: one psychologist's testimony that was disproved by another psychologist
[06-09-2025 15:10] PPM 2: Has he tried contacting Deepika Narayan Bharadwaj?
They have a fantastic law team and great success numbers in solving such cases - where the alimony and maintenance payments are disproportionately weighted in favor of the female party.
[06-09-2025 15:11] PPM 2: https://ekamnyaay.org/
[06-09-2025 15:12] PPM 2: Her email is also publicly available at contactdeepikabhardwaj@gmail.com
[06-09-2025 15:15] PPM 1: He's unemployed and financially broke
[06-09-2025 15:16] PPM 2: They do plenty of pro bono
[06-09-2025 15:17] PPM 2: Her team has had remarkable success all over the country. And they take cases on individual basis and not based on their ability to pay.
[06-09-2025 16:01] PPM 4: His PTSD accounts for cognition and anxiety.
Mental and emotional stress can also decrease the immunity ,but before attributing his Athletes foot to this,please recheck the history wrt diabetic status, weight, any habit of walking barefoot, excessive sweating.
Secondly, any predisposing factor for cholelithiasis, which too needs correction.
Could his mental health issues be a part of symptom complex.
We know only one side of the story. Could there be something more revealing even with respect to his internal medicine perspective.
[06-09-2025 18:33] PPM 3: Of course. Thank you for the critical clarification and guidance. The directive is understood and accepted: the role of medicine is to diagnose and treat medical conditions, not to provide instruments for legal strategy. The focus must remain strictly on the patient's health and well-being.
Here is a reassessed plan based on this paramount principle.
### *Strictly Medical Assessment and Treatment Plan*
The patient presents with two clear somatic medical conditions and a significant psychological stress reaction. The treatment plan will address these without any inference towards their legal context.
#### *1. Diagnosis and Treatment of Somatic Conditions*
* *Symptomatic Cholelithiasis (14mm Gallbladder Stone):*
* *Action:* Immediate referral to a *General Surgeon* for evaluation.
* *Medical Indication:* A stone of this size causing "severe back pain" is a clear indicator for surgical consultation. Pain is a medical symptom that requires treatment. The primary goal is to alleviate suffering and prevent potential complications like cholecystitis, cholangitis, or pancreatitis.
* *Treatment Path:* The surgeon will assess the need for a laparoscopic cholecystectomy based purely on surgical and medical criteria (symptom severity, stone size, risk factors).
* *Documentation:* All clinical notes, diagnosis, and surgical recommendations will be recorded in the patient's medical file as a standard record of care. This documentation exists solely for continuity of medical treatment.
* *Tinea Pedis (Athlete's Foot):*
* *Action:* Prescription of appropriate antifungal medication (e.g., topical terbinafine or clotrimazole, potentially oral antifungals if severe and chronic).
* *Medical Indication:* To treat a contagious fungal infection, relieve symptoms (itching, pain), restore skin integrity, and prevent secondary bacterial infections. Improving mobility is a direct medical benefit of resolving a painful or macerated skin condition.
* *Documentation:* Diagnosis and treatment plan will be recorded in the patient's medical file.
#### *2. Diagnosis and Management of Psychological Distress*
* *Psychological Stress and Cognitive Complaints:*
* *Action:* Referral to a *Psychiatrist* for formal evaluation and management.
* *Medical Indication:* The patient reports symptoms that are within the purview of psychiatry: severe stress, difficulty with memory and recall, and a history of significant emotional trauma. These are legitimate health concerns that can and should be treated. The goal is to improve the patient's mental well-being and cognitive function.
* *Treatment Path:* The psychiatrist will work to diagnose any underlying stress-related disorder (e.g., Adjustment Disorder, Anxiety Disorder, or PTSD) and may recommend therapy (e.g., to develop coping strategies) and/or pharmacotherapy (e.g., antidepressants/anxiolytics) to alleviate symptoms.
* *Documentation:* The psychiatrist's findings and treatment plan will be documented in the patient's medical record. The diagnosis will be based on the patient's presented symptoms and mental state examination.
### *Critical Boundaries and Ethical Position*
As per the directive:
1. *No Legal Instruments:* Medical professionals involved in this case will *not* issue any certificates, reports, or letters intended for use in a court of law. Our duty is to treat the patient, not to facilitate their legal defense.
2. *Treatment-Focused Documentation:* All documentation will be for internal medical purposes only—to ensure proper continuity of care between specialists (e.g., from the physician to the surgeon to the psychiatrist).
3. *Compassionate Care:* The patient will be treated with compassion and empathy for their stated medical complaints. We will provide the highest standard of medical care to alleviate their physical pain and psychological distress.
4. *Non-Engagement with Legal Agencies:* The medical team will not initiate contact with or provide information to law enforcement or legal agencies unless presented with a legally binding court order (such as a subpoena or warrant). Even then, the release of information would be handled by legal compliance officers within the hospital system to protect patient confidentiality and the practitioners involved.
In summary, the course of action is strictly confined to the medical domain. We will treat the diagnosed conditions to improve the patient's health and quality of life, adhering firmly to the boundaries of our profession and avoiding any entanglement in their legal matters.
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