Life in the shadow of death !

Recently I had the occasion to read a book titled 'Being Mortal' written by Dr Atul Gawande, an Indian settled in the US, and a surgeon by profession. The book is about aging, living with the complications of terminal illness and death. The narrative touched me because I lost my wife, to cancer after a prolonged illness, recently. Modern medicine has made tremendous advances in diagnostic and curative field and the physician, for whom prolonging life has always been a challenge, is better prepared to work towards this goal. However, aging and death are being treated like one more clinical problem in need of treatment. For the aging, life and health are moving along nicely and suddenly an illness or an injury strikes and shakes the existence to its very core. If, unfortunately, it is something like cancer then the very bottom falls out from underneath. We are suddenly faced with a harsh possibility. What will it be ?   A life of pain, debility and disability ? For people with serious and terminal illness other priorities become apparent besides prolonging life. Other equally important concerns include avoiding suffering, being mentally alert and not being burden on others. The treatment, some effective, others experimental, may prolong the life and suffering while shortening the value of life. How much one is willing to go through to have a shot at being alive ?

Something similar happened to my wife ! Presenting with symptoms of liver abscess, investigations revealed presence of a tumor of the small intestines with secondaries in the liver. This was a coincidental finding. For us it was like a 'knock-out' punch. The visions of an imminent and painful end flashed before my eyes. However, my wife proved to be very brave. She felt no disposition to weep or lament, rather she bore the news stoically. She submitted herself to surgery for the removal of the growth and metastasis with great courage and calm. The result of the biopsy showed a neuro-endocrine tumor, a slow growing tumor with a long survival rate. Further treatment with chemo and radiotherapy of no proven value she decided to forego it. It was time to pick up the pieces of life and move on.

A few years passed in relatively good health. Despite some loss of weight the quality of life was good. We visited our son and his family in the US twice during this period and visited some places of religious importance in various parts of our own country. But the fear of flaring up of the secondaries present in the liver was never far from my mind. I was always afraid to think of the time when we will have to face this situation. Unlike the developed countries there is no concept of care of the terminally ill patients nor does the facility of hospice in India. At least not in the small towns. True enough the secondaries started to flare up with the attending complications such as loss of weight, loss of appetite and accumulation of fluid in the abdominal cavity. In general the relatives of the patient are deluded by a fantasy of what medical science can achieve and the physician is expected to continue the efforts to prolong the life unmindful of the suffering to the patient. "Do not resuscitate" is never an option.

We landed up in the Oncology department of the hospital where it was decided to put her on an experimental hormonal therapy. Monthly injection for a period of twelve months. For us it was undertaking a monthly round trip of 500 kilometers to the hospital and back. One year passed. The treatment had no effect on the progression of the disease. Then it was decided by the oncologist to subject her to radiation therapy which she declined as she had enough of travelling during the course of the hormonal therapy. All she wanted now was to live her life in the familiar surroundings of her home among the family and the friends and not in the hospital with tubes and line sticking into her body. However, the disease progressed relentlessly. She progressively became dependent on others for her personal care which was repugnant to her. She suffered this indignity for almost a year and wished for an end to her misery. Finally the end came on the afternoon of a October day last year. Hers was a noble life and hers was a heroic fight in the face of great odds. Her end was peaceful and she would not have wanted it any other way.

The Way We Are !

For the past some time the news papers have been reporting regularly on some worthy or the other having said something which hurt some feelings. Some people have to express themselves on every matter under the sun. For them silence is not golden but stifling. This is usually the cause of 'Foot & Mouth' disease in the homo sapiens where the speaker shoots himself/herself in the foot. We have been bestowed with many , so called, qualities that we may not be aware of. It takes others to point that out to us, like Jamwant, the mythical figure, had to remind the venerable Hanuman of his powers. While searching for Sita, consort of Lord Rama, Hanuman was required to cross the sea in one jump to Lanka but got nervous and was not sure that he could do it. At that time Jamwant reminded him of his eternal strength.

Coming to the modern times, much the same way, it was an editorial in a Chinese daily that reminded us of some of our qualities. The said editorial pointed out that we are 'spoiled', 'self-centered', 'self-righteous', 'tantrum-throwers' etc. etc. We are well within our rights to differ from their assessment but there is some ring of truth how others see us. And there is another, so called quality that is part of our persona, 'Arrogance'. We talk so much of our glorious past but our present-day behavior leaves much to be desired. The typical response to the said editorial voiced by some was a call to boycott the Chinese good coming into the country. Let us admit that many of such goods are so affordable to even to the common man and the quality is not all that bad. Even the multinational corporations are having their products made in that country. Take for instance the much-coveted electronic goods including cameras, mobile phones etc. The proper response would have been a call to the industry to make better consumer goods at the same affordable  price in this country. That would be a befitting reply to our critics. We have achieved a lot in diverse fields but we can do still better.

We are not happy following rules either. Violating traffic rules, jumping queues comes easy to us. Travelling to other lands we are not comfortable following the security protocol of the host country especially at the airports and other ports of entry. We do not realize that their rules are the same for everybody, even their own citizens. But we want to be treated differently especially if he/she happens to be VIP or from the political class because that is how we are treated in this country. Here if a rule is to be applied, such as paying toll, a long list of persons exempted is the first to be put in place. You have only to go to a toll plaza to verify this. The very people who should lead by example are first to defy the rules. We see it every day.

Are we really like this ? Deciding what others can read, write, or see. What profession others can pursue or what they can or cannot eat ? An unwritten code of conduct for the less privileged ! Intolerance for for contrary views and social and religious practices ! Are we really like this or do we need to change ! Honestly we  need to sit down and do some soul searching and if we come up short we must strive to be better than this. We do not need to be the way we are.