Experts declaim on death and dying

Lata Mangeshkar left us on 6th February, as Narayan Debnath did a short while ago. My deepest admiring salutations to them for the treasures they have left behind, which I hope will remain undying. But they stopped doing their best work a long time ago.

The old lady in the house opposite to mine, who must have been at least ninety, unlike the two named above a very ordinary person like most of us, completely bedridden for nearly a decade, left in charge of two caretakers by her middle aged children who only visited two or three times a year for two or three days at a time, also finally bid adieu to this world on February 2.

Their demise brought me back to an issue which has been at the back of my mind for a long time, and which an ‘international team of experts’ has recently commented upon, as per a report in my newspaper of February 1 (so important that I have saved the entire report, here, lest it should vanish from the newspaper’s archives after a while), based on a paper published in The Lancet, a top notch medical journal.

The gist of the report is this: when people are terminally ill (in the sense that they have lost most of their bodily and mental functions, and the doctors see no chances of recovery to a reasonably full life within a reasonable time frame – meaning a few weeks or at most a month or two), we should, instead of keeping them ticking in a vegetable condition for just a little while longer in hospitals (which usually subjects them to much avoidable pain, shame and despair), give them the best possible palliative care, if possible at home with professional nursing help, surrounded by wise and caring loved ones, and make their passage into heaven or the afterlife or extinction, whichever it may be, as quiet and easy as possible. This, until assisted euthanasia is easily and cheaply available everywhere, as it is bound to be sooner or later.

Dr. M.R. Rajagopal, a member of that expert panel (and chairman of Pallium India – do look up their website and donate something to the mission if you can: who knows but you will badly need their help someday) has been quoted in the report as saying: ‘Close to the end of life, when we know that a patient is beyond medical help, nothing can be more horrible or traumatic for the patient and the family than having the patient isolated in an intensive care unit, connected to tubes and medical instruments, and surrounded only by masked doctors and nurses… this is not how it should be... the last days or hours should be the time the patient and family members spend with each other, exchange words and hugs. We see bad deaths because a lot of the focus is on using medical tools to block the physiological processes that will lead to death, even when we know death is inevitable’. My views exactly (incidentally also the view of all great religions. Just for an instance, look up The Tibetan Book of the Dead), and I could not have put it better myself.

Later in the report Dr. Rajagopal further says ‘…an ICMR document on palliative care, released in 2018, summarises the role of healthcare providers: it is to mitigate suffering… to cure sometimes, to relieve often, and to comfort always. There should be no deviation from this principle when a disease is incurable and death is imminent. Healthcare providers have the duty to improve the quality of life through life and through the dying process. Unfortunately, this is not always practised*. Advances in medical technology allow us to prolong the end-of-life phase of dying patients even when it involves intense suffering. And such opportunities have suited the private healthcare sector’ (my italics – SC)

[*in the same report he has said it is estimated that less than four per cent of eligible patients in India get the sort of near-death palliative care that he is talking about]

 As I have always believed – increasingly strongly after I turned fifty myself – this is particularly necessary for old people, and above seventy five is old for most people, in the sense that they have nothing much left to stay enjoyably engaged with, nothing more to contribute to the family or the world, they are sad and lonely, often neglected, more and more out of sync with a changing world, growing increasingly senile, decrepit and fearful. They need – they and their families should be mature enough to know that they need – to be released from their mortals coils, as they used to say in the old, wiser days; they need mukti.

Now I shall not repeat a lot of things that I have written in the last three posts on this subject, but I strongly urge any serious reader to read them up before continuing to read the rest of this one (just type Meditations on death and dying in the search box and you will find all three of them).

Most of humankind has been living such unphilosophical, materialistic, hedonistic and basically aimless lives (spiritually speaking) for at least four generations now that we simply cannot quietly and unresistingly accept the absolutely unalterable fact of death any more (indeed, a very large fraction of mankind is hoping that the Silicon Valley attitude to problems will see us through, perhaps by slowing or stopping the ageing process. It is time people began seriously to think how horrible it might be to live on and on. Imagine having to listen helplessly to a family quarrel over your great-great granddaughter wishing to migrate with her robot boyfriend to one of Jupiter’s moons. Or better still, read Tennyson’s terrible poem Tithonus). Indeed, it has become the only really Dirty Word, all thoughts of which must be avoided at all costs for as long as possible, for ourselves or those close to us (I have actually heard a doctor remonstrating, when I casually mentioned the likelihood of my dying, ‘chhee chhee, o sob kotha bolte nei’, like the most silly and superstitious of her sisters). So when its shadow falls upon us, it always takes the form of the Ultimate Horror. I recently read a movie starlet lamenting over her father’s death – ‘How could it happen to me?’ No comment. Nobody else’s father ever dies, of course.

To my mind, that in turn has happened because we have been taught to believe beyond argument that there is ‘nothing more, nothing beyond’ this one life on earth (and because modern science has enabled us to live, on average, a decade or two longer than before). Therefore we must ‘enjoy’ it for as long as possible.  And ‘enjoyment’ means doing the same things over and over again: going shopping, dressing up, attending parties, gorging ourselves, participating in festivals, watching football or cricket, gossiping endlessly without boredom, boasting about our latest luxury purchases, clinging desperately even while complaining ad nauseam about how unbearable this life is, old people trying ever more frantically to ‘stay young’, often with ugly and ludicrous results,  and at last fighting like maniacs when Death finally arrives to ward it off for as long as possible, even if that means financial ruin for the family and making the dying person suffer, prolonging the all-round misery for a few more pitiful weeks or months. Also, we have ‘outsourced’ the dying process, as we have done with so many things, from education to weddings, and now measure ‘success’ primarily by how much we have spent on the dying (it is my family’s great good fortune that when my father, past 78, was diagnosed with terminal cancer, the doctor had the honesty to let us know, and we had the strength and calmness of spirit to accept, that ‘no matter whether you spend two lakhs on him or two crores, he will be gone within six months at the most’. He went in five).

This outlook has hugely suited hospitals, many doctors, and the whole healthcare sector, which is becoming more and more a corporate business indistinguishable from any other, which can best treat humans only like sausages or nuts and bolts, in faceless masses, according to standard operating protocols, mindlessly, the reward being gigantic profits for all involved – even fifty years ago, few doctors could become tycoons, leave alone ‘healthcare managers’.  They started by taking advantage of a sick mass mentality, and now that they have smelt blood, they are going all out, via the advertising industry (the most powerful of the devil’s tools), to persuade all of us that ‘there is no choice’. If they have their own way, it won’t be long before the biggest hospital chains start offering ‘death packages’, just as they are already offering so many other, from packages for having babies to some for heart attack patients. You wait and see.

Thank God that there are still sensible people around, even among mainstream (allopathic) doctors, like the ones who together penned the report for The Lancet. I hope their view gets the traction it deserves, even if that takes several decades. Meanwhile I am glad that the young man I knew through a student, who suffered a horrible accident and would have been a complete invalid the rest of his life if he lived, has died in hospital; I am sad that even five years ago I did not have the clarity and strength of mind which would have let me spare my father the last few days of meaningless suffering in the ICU, and I hope that when my time comes it might either be sudden, or my daughter will calmly do what she had always known daddy would have wanted: let me go with a prayer while I am still something like a thinking, feeling human being.

 

One last thing: nothing disgusts me more than to see people theatrically mourning someone’s passing as if life would never be the same again while those like me, whose hearts are breaking, grieve in silence, and completely forgetting the same ‘loved one’ just a few months down the line as if they had never existed. My old faithful servant, my grandfather and my old teacher Father Gilson are alive in my mind still as if they were around yesterday; I have not heard anybody else even recalling them in recent years. The one who weeps loudest is usually the most insincere. If one is to defeat death at all, it will always be only through his works, or, if he was not a great man, only in the loving, living memories of those whom he has left behind. The root of the problem there, I suspect, is that most of us guiltily know, deep in our hearts, that we lived such worthless (or even worse, insufferable-) lives that no one is likely to remember us with real affection, respect and gratitude.