Contribute whatever you can, Money, Manpower or Moral Support.
The opening line of the brochure on Pain and Palliative Care Society was tempting. I already had an inclination to work with a genuine NGO and the search zeroed in on Dr.Suresh. He was the prime mover of the well-managed palliative clinic associated with the Medical College Hospital. The unit had been selected as a demonstration project by the WHO. Terminally ill cancer patients were taken care of by them. The Pain Clinic as it was popularly known had satellite units all over Kerala. The mother unit trained doctors, paramedical staff and volunteers almost free of charge. Certificate courses with written exams, practicals and viva-voce were also available. Dr.Suresh was an intense looking man who exuded a sense of security.
Come from tomorrow, the doctor said, but come for two weeks continuously.
I agreed. The first assignment given was to observe the case-taking process. The family background of the patient was softly dug out. Things like immediately family, dependents etc. and a family tree was drawn. Then on, straight questions followed.
What are your complaints?
One query, however, was different.
Are you scared to die?
The turnout of Cancer patients was quite high ranging from five-year-old kids to old people above seventy. Newly married young men and middle-aged breadwinners were most common. Many had only begun to settle with life when the dreaded disease suddenly struck, devastating everything. They held their spouse and children close and watched the impending death, trembling. A few of them couldn’t hold back any longer and they cried, feeling like a live bait on fishing hook. After case taking and medication they slept quietly like a river. By the evening they left for home, relieved. Sadly enough I was to see the same faces again after a couple of days. People who went home with considerable repose came back perturbed and crestfallen. Everything was back to square one. Something had obviously gone wrong. I approached Dr.Suresh again.
Doctor, if you don’t mind, you’ve got to give a little more attention to the return of patients.
He obviously didn’t feel the dire need for a change in strategy.
Please complete your training first. Get a feel of the place and then we’ll see…
He talked sense. I should better restrain myself from jumping into conclusions.
The Pain clinic had a mobile unit and I joined the three-member crew, Doctor Anil, nurse Sreeja and driver Sudheer to visit the bedridden patients at their homes. The jeep crisscrossed through the country roads. Our target group was in advanced stages of Cancer and was not in a position to move out of their homes. We were supposed to visit six households spread in three different villages at the outskirts of the city. In less than thirty minutes we reached Parambilkadave and stopped by the side of a paddy field. Twenty-two year old Sakeena was awaiting death in a small house nearby. In a sparsely lighted and ill-ventilated room, Sakeena laid in coma. Her eyelids were open and the apples were quivering. The face had a blank look as if she was facing death in person. The Death which remained invisible to the rest of us. Her right breast had turned into an overgrown tragedy and Sakeena reeled under its weight. She couldn’t be operated due to subsequent complications and virtually got riveted to bed. Luckily Sakeena was quite unawares of her condition. She was in an altogether different world which was perhaps icy and dark.
Tender coconuts and banana chips were brought for us. Sreeja opened the suitcase and gave away medicines. Sakeena’s father received them with both hands. The whole family alongwith neighbours came to see us off and they kept waving till our jeep was out of sight. We proceeded to Marad beach where we had two cases. Iyyathu and Narayanan. Iyyathu’s house was not accessible by a four-wheeler and we walked up the narrow footpath to a small two-room house. Iyyathu was kept in the front portion of the house, an open space earmarked for welcoming guests. Her sons occupied the rooms inside with their respective families. Iyyathu had aged gracefully and she was looking beautiful even at her deathbed. Iyyathu too was not conscious about anything though she was not in coma. She regained her senses for a short while the previous evening when she talked about attar. She gave instruction to her younger daughter to spread attar on her body and to line her eyes with suruma after death. The lady appeared to be sleeping peacefully without any worries over enhancing her beauty. Suddenly Dr.Anil said to me,
I have a strong feeling that she is going to die.
As we were walking back to the jeep, the son-in-law escorted us. He was waiting for the doctor’s assessment.
No use giving medicines now. You can inform the close relatives.
We proceeded to Narayanan’s house which was not very far. Sixty six year old Narayanan was a daily wager doing sundry jobs of the village. He was also kept in the open front area of the house. He slept on the floor under the benign gaze of the gods hung on the wall. Narayanan’s mouth was deformed and it was a scary sight. He complained that pus was oozing out from his eyes. He was looked after well but that itself had become a source of worry. Narayanan was concerned about the inconvenience caused to others. His daughter scurried to the neighbourhood to collect chairs for us. The family was quite worried about keeping us on our feet.
Please don’t worry. We are quite comfortable.
Dr.Anil and I sat beside the patient, on the neatly folded blanket. Narayanan wanted to tell us a lot of things but he couldn’t. The pain was getting unbearable for him like the slow fire emanating from a heap of husk. He said he was not afraid of the disease. The pain was the bother. Everything was going smooth, he was hale and hearty until the day cancer felled him. He earned his bread by manual labour, one of the most honest ways of livelihood and I had the feeling that he didn’t make life difficult for anyone. The cancer got him for no reason. I looked up slowly. The gods were still smiling from their glass frames. It was only the previous day I saw an angelic girl, a leukemia patient aged four or five years at the foyer of the pain clinic. The head nurse was carrying her. The pale little hands surrounded the nurse’s shoulders and she pointed towards the aquarium. In a weak voice she asked for the neon tetras. The nurse entrapped them in a jar with considerable difficulty. I looked up for the gods. The walls were empty.
The next one on our list was Khadeeja who was suffering from blood cancer. We drove to the adjacent village Beypore when it rained unexpectedly. The smell of the earth got us elated. The buoyancy didn’t last for long. We reached in front of Khadeeja’s house very soon. She was accommodated in a clean and well-lighted room inside. Children were playing in the front yard. Khadeeja had acute constipation and the doctor was about to give enema. She still didn’t make any complaints. She was not even interested to know about her disease. Afterall, Allah had given it to her and she would accept it in toto. She knew that the disease was incurable. That was enough. She was quite detached and didn’t express any desire to lessen the acute pain. As Dr.Anil and Sreeja were easing out the blocked rectum, I slowly moved out. The children were still there admiring our jeep that had become a centre of attraction for them. A little girl, a preschooler for sure, approached me with small steps and asked me rather reluctantly,
The rains had completely stopped. Country roads turned into mud after the spell. Sixty two year old Moosa was staying in a remote place and I had to remove footwear to walk through the slippery terrain. There was no question of our jeep reaching anywhere near. In spite of the access constraints, the whole area was crowded with houses much like a slum. We walked into a neat home which had a verandah and two rooms. Moosa was put up in the main room so that he could have a vantage view of the happenings around. Moosa was tall and well built. He didn’t have even a trace of grief anywhere on his face. I doubted for a second whether he was indeed the patient. Moosa too had worked for daily wages. Nevertheless he was much ahead of Narayanan in willpower. We expected him to talk about his complaints, at least of the shooting pain. He opened his mouth only to welcome us warmly and subsequently for inviting us to have tea and snacks.
The day’s work was over. Six patients in total out of which one had died just the day before. We reached out to people at the most inaccessible places. We enquired about their well-being and nursed them. The conscious ones in our target group were not afraid of death. At least one among them had reached a plane where nothing really mattered. She had developed complete disinterestedness to the world. Another one was pleasantly waiting for death. The cancer caught all of them unawares. They were down, but not entirely out. The ghastly side of life was already familiar to those poor people, the harsh issues of livelihood and survival. Tragedies were nothing new. The attitude towards death might have helped them more than the medicines. Afterall, they were fisher folk and farmers working close to nature for their daily bread. Anxieties and fears ceased to exist as they waited for death in writhing pain.
One of those mornings I approached Dr.Suresh while he was checking his mail. I wanted to apprise him of my findings. He listened to me but disagreed in full.
Tell me, who knows about dying?
Who are we to propose a mode for dying?
Dr.Suresh cut me short.
Doctor, are you negating our right to die like the falling of a leaf?
No. That is dying up to the expectations. I’m not for it.
Doctor, do you agree that there is an internal rhythm existing in all living beings and diseases occur when it is disturbed?
Homeostasis, you mean?
Exactly. The internal rhythm does have a direct relationship with the external climate. If you could set the external climate correctly, it would help in regaining the internal rhythm. Medicines can aid the process.
Dr.Suresh couldn’t conceal his amusement. Laughing loudly, he asked
Hey, you’ve told me about one internal rhythm. Is there an external rhythm too?
He was trying to pull my leg.
Yes, I said, it is the rhythm of the universe. You can connect to it through several ways. The easiest way is through a selfless act that cultivates love for everyone.
Dr.Suresh logged off from the net and got up. He left the room without uttering a word. I waited for him. I thought he would entrust me with some work like office administration or editing the house magazine. As a volunteer, I was prepared to do anything. I waited for two days. The next morning I telephoned him.
The call didn’t get through.