Dealing with Death.

        Dr D Bhandare asked me to write on how “people don’t accept death easily nowadays”.

I knew what he was talking about. (In a previous avatar I worked in a hospital.) One doctor I knew got into trouble when he tried to resuscitate a patient who was brought into Casualty with no pulse. The process of trying to start the heart is horrid to watch even when you know what’s happening. The patient is on a trolley, there are people in white-coats doing a tribal dance around him (for ease of typing I use the masculine gender, no offense to women readers), banging fists on his chest, giving him electric shocks, pumping a soccer-ball shaped balloon on his face, poking him with injections, sometimes even shoving a tube into his mouth, throwing wrappings and cotton on the floor, shouting at the top of their voices. The patient I was referring to didn’t ‘come alive’; the relatives thought the doctor had beaten him to death. The relatives’ angry reaction could have been avoided by drawing a screen around the ‘action’ area.

The more famous a doctor (jaacho haat baroh aasaa) and the more a family spends (udka bashen paishe ghaale), the higher the expectations that a ‘miracle’ will occur.

An acquaintance spent his last hours/days in the ICU, on a ventilator. His well-placed and highly educated friends had prayer meetings for ‘his full recovery’. Considering that he was definitely breathing his last breaths, on artificial life-support, pumped with chemicals, there were still messages on his Facebook wall: “fight, fight, fight”. No doubt those friends gave valuable support to the wife. But not one wrote about counseling for her to deal with que sera sera.

Miracles happen, people say. So do funerals.

        A generation ago, death was taken in one’s stride. Now that we have the means and the know-how to stretch life, we take ‘delaying tactics’ to be the norm. Families ‘don’t want to give up’. People borrow money for medicines knowing that there will be no outcome. (Fighting for life is important; acceptance of death is also important. The crux is: where and when to draw the line).

        We don’t mind forcing uncomfortable catheters into our beloveds, injecting them with drugs to raise the blood pressure, force the kidney liver or lung to work… so the person can spend a couple of more hours/days uselessly on a bed, with several professionals tending to his/her ‘needs’.

Kind relatives/friends must guide the next of kin to cope with the loss-to-happen, help arrange finances, deal with legal hassles, and stay as a support system in the grieving months ahead.

Learning to let go is easier said than done? Of course. That’s why the best time to discuss our ‘living wills’ is when we’re in good health and spirits.

        There are pain issues, non-pain issues, psychiatric and spiritual issues. Living wills allow one to decide whether one wants to die at home, not be kept on life-support, donate organs should that be feasible, etc. Some of the things one asks for may not be possible. “Please kill me” is one of those.

No one speaks of palliative care. Palliative care manages pain, discomfort, nausea. It doesn’t bring on or hasten the end. Even treating doctors may be uncomfortable with end of life care. This homework should be done well in time so that when the family or the family doctor has to execute the (living) will, it’s done smoothly.

        Hours before dying of a dreaded disease, a close relative phoned us to say she was ‘going’. Our response: “Don’t be afraid.” Her reply: “What’s there to be afraid of?” She died at home, surrounded by husband, children and grandchildren. At this end of the planet, we waited for the news, sadly, but knowing she was going the way she wanted. Reassurance and peaceful environments help the transition from here to who-knows-where. A dying patient may not be suffering, just going through a normal physiological function.

        I’ve witnessed this.

Doctor to family: “X is dying.”

Family to Doctor: “Do something.”

Ambiguous words. Did the ‘something’ refer to curing the illness or hastening the process?

        We all believe that dying happens to others… and we all know that’s not true. Fears have to be acknowledged, addressed, talked about. Do you want to die with your children around you? Do you want to be in an ICU fighting till the end? Either is ok. You are entitled to dignity, to treatment, you can choose.

        What might come as a surprise to many is that physicians, nurses and other healthcare workers also grieve over lost patients, but that’s another story.