The need to let go

This morning an old and dear family friend called. It was his mother’s birthday, maybe 89th or 90th, I did not ask. It was pointless as he could not even wish her. She has advanced senile dementia and has been in a home for the last couple of years. This is a feisty Punjabi lady, who I have known for the last 2 1/2 decades, who was the focus and fulcrum of the family for many decades and had labored hard with a small home sewing business to see them through tough financial times. Many were the evenings that we spent in their spacious 1920s house just off Hazratganj, in the heart of Lucknow – celebrating birthdays (theirs and even ours) and anniversaries or just spending a relaxed evening of good food and lots of talk – politics, local gossip etc…  Food was big thing in their house, and  you were always assured of a great home cooked meal. And through many of those evenings, I heard of the stories of partition and of her own journey from Lahore to Delhi, those of others around them.

They made the move to Mumbai a little over a decade ago and since then I have spent a night with them on each of my infrequent trips to that city.  She had made the transition from Lucknow to a cramped flat in Mumbai not out of choice I’m sure, but since her husband had passed away many years ago and her only son was moving to Mumbai. On my earlier visits we would reminisce over the Lucknow days, of the food and drink and common friends. But, on later visits she had started to become frail, absent minded and I could see that she was gradually losing grasp on things. In fact, the last time I saw her, I doubt if she really registered who I was. It was with great reluctance that the family took the decision to move her to a home. Of course, they were lucky that they could find one – since these facilities are not easy to come by in out cities.

Her general health had also been declining over the last few months and she was in and out of the hospital. And for the last few weeks she was being fed through a nasal tube as she was refusing food. So, this morning’s call was to discuss the issue of withdrawl of the nasal tube!! As an older friend, they wanted some counsel and my views are not unknown. This is not an unusual situation, the person is not in a state to take the decision and life support (in this case the feeding tube, but more often the respirator) can keep up the false sense of living for as long as needed? But is it needed. I only cautioned them, that when they did decide to withdraw the tube, all three siblings should be together on the the final decision, and then no one else should matter. I am certain that they will take the right decision and I wish my friend a peaceful end, whenever it maybe!! I only wish more people would address such issues directly.

Three score and ten is not enough anymore!!

“Threescore and ten I can remember well:
Within the volume of which time I have seen
Hours dreadful and things strange; but this sore night
Hath trifled former knowings.” From Macbeth by William Shakespeare

 

As I head towards completing my allotted three score and ten, I stop and often wonder at our present attitudes to life, living and the inevitable other, the end of life and death. Of course, the adage probably is not valid today as 70s almost seems to to be the new 50s – or is it 40s??   I work closely with a senior colleague who puts in a  8-10 hr working day on a daily basis – and he is in his mid-80s. This morning I read that Ram Jethmalani, stepped off a flight from UK or USA at 3.30 am and appeared in court at 11 am for Jayalalitha in her bail plea – and he is 92!!! I am sure that many lived to ripe old age even in bygone years –  my paternal grandparents, born in the 1870s or so,  and 1900 born maternal grandmother lived to 90+. But then, a large number of others were lost to diseases, such as my maternal grandfather to typhoid in 1935, when he was in his early 40s. So, the old adage would be that longevity runs in the family – and I am sure there is a genetic component to longevity.

But, today’s longevity is a credit to modern medicine.  In spite of the deteriorating choices in life style and the increasing pressures of modern living, life spans are expanding with the assistance of chemicals (in the form of drugs), biologicals (such as vaccines, and organs to replace failing ones) and plastics (in the form of stents, pacemakers etc). And continuing advances in medicine is promising us the golden age of personalized health care – where if we get our genetic kundalis done (the full genome at what ever is the cost), treatment can be tailored to each individual, presumably ensuring further years of life.

So, it seems that 3 score and ten is out – and since the median life expectancy is 78 in USA and 66 in India, probably we are heading towards 4 score and ten.  Certainly, the median age of my acquaintances, is growing as I am. And news of the passing away of friends and acquaintances is not so uncommon any more. But what disturbs me is how rarely we hear of anyone – irrespective of age – passing away in their own beds at home. The same medical advances, and the commerce driven health care system is promising everyone eternity!! It is no longer, considered appropriate for doctors to say ‘Enough is enough’ to any patient. And this is part of a societal change, since the doctor is wary of how the kin of an elderly person for whom such an advice would be appropriate, would take it. And the kith and kin who are placed in the position of having to take such decisions are ill informed and unprepared to face the realities.

Death has become this ‘ogre’ in the room, and no one wants to face it. This leaves so many of the elderly breathing their last in some strange ICU among strangers, and the kin picking up the bills that they, very often, cannot afford. To talk of death has become unfashionable and to write a will is considered inauspicious. Medical trainees only see death in the ICUs or emergencies, there is no discussion on end of life issues. In this scenario I am happy to see that some public discourse has started on the issue of a living will. Will personalized medicine be able in the future to predict our life span?? Which way are we headed?

My father used to say in his later years “I read the Obituaries in the paper first, as I know more people in them than among the actual news makers”. And when he died 3 decades ago at the age of 73, we mourned his loss but never felt that he was too young to go. Maybe the ‘3 score and ten’ was still acceptable then –  death is a necessary part of the cycle of life. What set me thinking on this was more specifically the article by Ken Murray on why dying is easier for doctors.  Not just doctors, we all need to discuss these issues within our homes, especially in those with the elderly. We need to develop mechanisms for domestic support for the last difficult days and honor the wishes of  the elders.  It is a pity that common scene from older Hindi cinema of ‘the absentee son dashing home to give Ganga jal to the dying mother’ has now become  a part of history.  While I do hope to live many ore healthy and useful years, I think I am prepared to face what is on my plate….. but then who knows till it is actually placed before you!!! I can only hope I live iup to my own expectations of myself.

 

Reflections on loss of dear ones (26/52)

Father, brother, husband, son, son-in-law and then grandsons –  these are the important men in our lives. One expects  that fathers will predecease you,  and whether bothers do is a matter of the order of sib-ship. Each of us hopes to predecease our spouse. But things don’t work the way we want them to!

My father, Vava, like all fathers, was a great influence in my life.  He was a heavy smoker and my early memories of him are with a cigarette in hand. He had a ‘heart attack’ in 1971, when he was just 52 yrs and spent many years after that struggling to quit the smoking, succeeding in his  post-retirement life.  He was otherwise healthy, without any diabetes or blood pressure problems. He adjusted to his compromised cardiac state and lived well. His problems recurred in 1985 and he decided to get his bypass surgery done in Mumbai in 1986, at a time when people who could afford got it done abroad and the procedure was still a rarity in this country. And 6 years later, in 1992,  he died of an unusual form of cancer, a T cell non-Hodgkin’s lymphoma, at the age of 72. It is a disease for which smoking is not even listed among the risk factors and for which the 5 year survival rate at that time was far lower than the 60 -70% currently quoted. He lived for only a few weeks after the diagnosis, but in that time talked to my mother more than he had probably ever had! And he prepared her in every way to face  life alone. This she has done with remarkable strength and fortitude, of course, with my younger brother providing the support every day.

Subhash was not just my husband, but also my best friend, scientific collaborator and the ‘constant’ in my life for close to 4 decades. He was disciplined in his habits, and maintained his trim figure with a measure of pride. He was a warm and loving son, husband, father, teacher and friend. But, after this essentially healthy person vomited his breakfast in his office one morning in May, 2001,  nothing was the same again. Surgery and chemotherapy did not really work against a cancer of the stomach, which even today has a poor 5 year survival rate.  He was a few weeks short of his 58th birthday at the time, and he had only 13 months to wind up an active and productive life. He did it with such composure and cheer, that those around him dared not show remorse or sorrow.

More recently, I am slowly losing the elder of my 2 brothers (both are younger than me), to a degenerative neurological disease. Most of  our lives, we lived on separate continents. But, we had a bonding that I suppose only brothers and sisters can have. He was a caring and sensitive person. However, over just the last 24 months, his memory bank has been wiped clean of  most of his life between his early years and a few moments ago! He is physically fit and is just past 60.

Tomorrow it  will be exactly  a decade since Subhash left us and later in the month two decades since we lost Vava; my brother is just about with us. These men in my life have been taken away by illness that is varied in their manifestations, but ill understood and untreatable even today.  Unexpected and untimely death is something most of us have faced.  The loss is irreplaceable, but as time passes, we make the slow adjustments, try to come to terms with the loss and  learn to live in the changed environment, especially when  the loss is of near ones. Most of the time, I think I have done a good job of this. But then, at unexpected moments and in a flash, the decade or two seem to disappear and all the events of that period, flash past as though it was yesterday.