Death in lockdown

Dealing with death is one of the hardest things to do,

Young or old, rich or poor, him or her, me or you,

We all are affected equally you see, it doesn't discriminate,

It doesn't see the time or situation, it just doesn't wait!

On a regular basis, we somehow find a way to cope,

With friends and family, there's always someone to give hope;

but how, just how can you deal with it during these times,

when the world is on lockdown and dying seems a crime!

There is but one person allowed to accompany the dead,

The ambulance drivers and helpers filled with dread;

Was it the big bad scary virus that did the person in?

Was this a way for repenting for all their sins?

What if it was just an existing disease that ran its course?

What if it was those sudden things coming down with force?

All you want is for the dead to pass on towards heaven in peace,

All you need is some support, a certificate and some ease!

Before you go getting all depressed about what happened,

Spare a thought for those passing on for a minute;

Do you think they are sad if they know they're about to go,

Or just relieved that their long life has finally played out just so.

With young deaths, I can understand the feeling of confusion,

We run around seeking a reason for what seems a delusion;

The fact that we are in the state we are makes it worse,

People eyeing you with suspicion, weary eyes and what seems a curse!

It could be more difficult for those in the public eyes,

to have some dignity when one of those famous dies;

Everyone starts bringing up the reasons for the demise,

justifications, deliberations, judgements and words from the wise.

If only he did this, if only she did that, if they didn't listen or do,

The rumour mills start working overtime like feeding at a zoo;

At times like these, we require some faith and kindness,

but all we get from the public is apathetic blindness!

If you've the misfortune of dealing with someone dying or close to it,

turn it on its heels and use all your courage, strength and wit;

Make the most of the time you have at home with the ones you love,

You never know when they will get the call from above!

Spend quality time, enjoy each others company and trials,

Work out your problems, forget the past and look forward to the smiles;

Each minute is precious when you don't know when you might go,

Make every second count, stay positive and never give up hope!

If it does actually happen, try and change the way it always is,

Celebrate the joyous life that was, instead of the death that you diss;

Raise a toast to the departed and take solace in the fact that no matter what happens you are never alone, 

your real friends will somehow always find a way to reach you via a message, a chat, video call or the phone!   

Euthanasia, who decides?

In the follow up to the last post on Euthanasia, let's get into some more details. Do read this only if you have gone through the previous post and feel that you understand the terms involved. This is not being condescending but is vital to the debate that is bound to arise from the next few paragraphs.

I got a fair amount of responses from who I consider intelligent people. Most of them still seemed unsure of the side they were on but there was one common theme emerging. End suffering and allow death if there is no chance of a near normal life. As far as DNR goes, it is another discussion altogether and will be taken up in the next post.

The biggest dilemma in this case is, who decides? Do you leave the decision with the person directly affected by euthanasia? Do you leave it to the Doctor you trust implicitly? Do you even trust your Doctor that much in today's time? Do you leave it to your relatives? (we've heard enough horror stories of loving relatives turning on their loved ones). Do you leave it to the courts (by which time you've probably been reborn only to die again)?

A friend emailed me her father's living will in response to the last post detailing his wishes on the control over his final days. He made it plainly clear that he was not to suffer for more than 48 hours, not spend more than a certain amount of money on care, and not receive life support if there is no chance of reasonable survival.

The begging question here is who gives you 48 hours to live? Certainly no Doctor in his right mind will predict death to within 48 hours, at least on the record! How do you know for certain that you won't recover in the 71st hour of ventilation? How do you assume that once you are in a comatose state, you will never wake up normal again? Why do you think that there will be no or less chance of recovery after 48 hours?

These are grey areas in medicine and will continue to remain grey for time immemorial. I firmly believe that life is unpredictable. Yes, as people of science, we have guidelines that increase the probability of us being right, but honestly, we've been proved wrong on more occasions than any of us are comfortable with.

The issue of pain in certain illnesses keep creeping in to this discussion. However, pain is a very subjective sensation with different levels of tolerance for different people. Also, it is the most easily feigned emotion. All the world's pain scoring charts cannot tell if the patient is truly feeling the pain that is expressed. How much of morphine can you give while under the pretext of alleviating suffering? How close is that administration to assisted suicide?

A dear friend mentioned that someone who is terminally ill with no cure in sight or someone with prolonged suffering should have the right to due process. I agree. It's time this discussion reached the decision makers because the quicker we discuss this, the faster the law will come, either for or against. The point of discussion  here will be the contention that there is no cure in sight? For how long? For ages, there was no treatment against the pox. Now, it's eradicated. There was hardly any treatment for HIV just a few years ago. Now, those patients live near normal lives right up to the expected age of mortality for the given population. There are new cures being found everyday.

In continuation to the above, another friend messaged that if the person was too old and the physical body has no more strength to combat the disease process, they should be allowed Euthanasia. Why can't we recover that strength in the times to come. I've recovered from paralysis and have run a marathon! Who decides what is too old? Is 70 too old? I've seen people in their 90's running and exercising. Is 90 too old, I've seen 100 year old grannies laughing with their grandchildren!

There was also mention of quality of life being a factor. This single line condemns almost everybody below the poverty line to death simply for lack of quality of life. Imagine a footpath dweller with an illness showing up to the hospital demanding death because they have no hope for recovery and have a dismal quality of life. Remember Hope?

                                

By the above paragraphs, would you condemn to death, a patient of Alzheimer's disease, HIV patients, Multiple Sclerosis patients, patients with Chorea, patients with widespread paralysis. Remember Stephen Hawking. He's still kicking ass while most people in his position would probably have chosen death!

Switzerland has taken the bold step to form laws and clear the path to euthanasia. It has become the destination of choice for a peaceful death! There are numerous British citizens opting to choose the country for their euthanasia needs. It is a raging debate in the UK right now, as it rightly should be in the rest of the world.

This all boils down to the argument of the right of the patient. Unfortunately, this also leads to the state of mental health of the patient while asserting these rights. Do you think you should have a right to decide when to live and when to die? The most likely answer is Yes! Fair enough.

Honestly now, with a deep thought, do you think you are emotionally controlled enough as a human being to not abuse this right when all the chips against you are down and you slip into a depressive state, which is where all the suicidal thoughts come in? Have you ever felt the need to end it all during one particularly disturbing event in your life, only to end up living life to the fullest thereafter? Would your assertion to right to death then be the correct decision you make?

It's all good and welcome to write out a living will and starting the will with the line saying of sound mind and body, but that is a state of mind at that point of time. What is the mindset when you really decide to end it all? These are the complications we must address before we take the high moral ground and say end all suffering.

Maybe it looks like the easy way out as of now when we aren't under any pressure to think about it. I've seen patients and their relatives deal with death. I wouldn't wish it on my worst enemy. It is an intense, blood curling time which *#^#^* your brains. I've seen people watch the people they love, die! I've seen the emotions in their eyes when they're loved ones are close to death. I've seen the immense relief when the person comes back to life. 

Think about all that before you say I support it or I don't. If you still do, you are a hell of a strong person. Even then, when the time comes, you will shake, you will tremble, you will falter. Stay strong, write it down somewhere so when the time comes you have something to reaffirm your decision, make peace with it early. 

I personally feel the law must come. There is no choice. Either make it legal or people will do it anyway in a hidden manner. Making suicide illegal isn't making it stop. Neither will the choice to die.

Dealing with Death

Everyone dies. 

Sooner or later, everyone will. Everyone deals with it differently. Every death is a learning experience, an emotional one, but one that can make you so much stronger. Sometimes, you hear about deaths that don't concern you on a personal level and we pay no heed to these. Until the moment that you get informed that someone you know was involved. In the blink of an eye, it becomes an experience.

I wanted to say God works in mysterious ways, but perhaps it is more apt to say the creator works in mysterious ways. Right from a very young age we are exposed to death. 

While we are kids, if we are lucky, we get to see death take away our grandparents and great grandparents. If we are unlucky, parents leave, uncles and aunts, cousins. 

A little older and we see parents leaving, either ours or our friends'. Uncles and Aunts that we are fond of. Relatives from far off places (the ones you wouldn't be told about if you were younger). 

Once we're adults, we have more parents leaving, in laws, acquaintances, co-workers taken away too early. 

Once we're parents, the morbid fear of losing your children, the intense pain of hearing about other children and instantly checking on your own, the realization that our parents aren't going to be around forever, the understanding that if we are fortunate to still have our grandparents, it's only a matter of time. 

Once we're over a certain age (this is relative), it's acceptance and the wait for the inevitable either for our loved ones or ourselves.

 If we break up the ages when we deal with death, it would roughly come out as follows:

Below Teens : Too young to understand, too young to worry about it, listen to what's being told to you, accept it because you're too small to do anything else and somehow move on. The younger you are the easier it is to move on

Teenage Years: Old enough to understand, not wise enough to react well. Most teenagers will try to hide their emotions and try and be cool and show that they are taking it in their stride. In my opinion, this age group is the worst affected by death. They need to be spoken to but aren't ready to ask for help. They need to grieve but don't want to show emotions as it would portray them as weak.

20's to 30's: We're beginning to come to terms with the fact that death is a permanent fixture of life. (If no one has ever said this before, I'm staking claim to this as a wise man once said kind of line)

Young adults do unbelievably well in handling death. They have just the right amount of emotion showing through along with just enough wisdom to speak only when required and use non verbal communication most effectively (a nod of the head, a blink of the eyes)

40-60: The phase when you have seen enough death to not have to deal with the emotional component. You now become a facilitator in all that has to be done post death. You know its coming for you, you pray it staves off from the younger family members, you readjust your faith.

60+: You count away the people you know, with each one bringing you closer to your own time. There is no more fear, only the motivation to make the best of the rest of your time. If you are lucky, you have loving family around you helping you with everything you want to do and to achieve what you've wanted but missed out on because you were too busy before.

80+: You start to crave death while you still can. No one wants to go as a dependant. Everyone wants to go while they can still take care of themselves, while they are not a burden (or so they think). A dignified death is top priority. No trouble for the rest of the living. Peaceful death is a bonus.

What we are told about death while we are too young to understand, in my personal opinion, does not have any bearing on how we will deal with death later on. Once we are exposed to death, the education begins. With each death that we are a part of, we grow to understand how to behave, what to say, what not to say, when to smile, when to be blank, what to offer and how to offer it, how to support and how to accept support. Each death makes us wiser.

Every death that involves you personally would make the next one just a little bit easier to deal with. This is nature's way of preparing you for the inevitable death of your loved ones. A little pain at regular intervals dulls the final blow.

Over the years, I've lost many people I've cared about. 

My grandparents when I was very young. I didn't understand much then but reflecting on those times now, I guess I did. 

My friends' parents/grandparents. At first, I didn't know what to say, what to do. I would stand there and just be! With each passing, I learned. Now, I am able to offer a sentence or two in condolences. 

My uncles and friends. I could offer support to their families. I could be there for them to talk to.

My relatives and cousins. I could feel the pain that was not there with non relatives. It is different. You react differently to each death.You learn.

Death is inevitable. I know that now. I am still not ready for my parents to leave but I know I must be. There is no way to calculate how much time is left. There is, however, time to calculate how much we can enjoy each other. There is enough and more time to repair old hurts, to renew old friendships, to review life and make a bucket list, to tick things off for others.

Each generation should teach the next one about dealing with death. It would make the world a better place. I'm hoping somewhere in the future, my children read this post and understand why I never protect them from painful situations. If someone dies, they will be told they are dead. No fairy tale stories about heaven and better places and long sleeps. They will come to terms with it and be stronger for it in the future.

No pictures on this blog, no humour. Just feelings!

Life is not fair

Something terrible happened last month. Something I wouldn't even wish on my worst enemy. It was a tragedy. There are no other words to describe it, nothing that would do it justice. Justice, that's a funny word, because it seems there is no justice in this world. A world that allows the passing of a little girl to the heavens for no fault of her own. Fault can't even come to play a role because what happened was beyond anyone's control, no matter what one says. And what can you say, when a 3 year old girl falls off the window on the 3rd floor. I think this will be written over twice. One would be the Doctor in me remembering what happened. The next one to follow would be me, a father, a friend, a relative, a human recounting the horror!

It happened in Pune. We were informed and left the next day. We reached the hospital (fortune had it that it belonged to someone I know closely). She was lying in the ICU bed. No external injuries. Eyes closed with gauze and sticking plaster to prevent damage to the cornea. All injuries were internal we were told by the attending consultant (also a good friend of mine)

She had multiple fractures of the skull, ping pong fractures and depressed fractures, bleeding in the brain, blockage of the ventricles (which plays a role in absorption of CSF) and was unconscious. The situation was grim and there was nothing much we could do but wait it out and watch for how she would progress.

Over the days, some levels of consciousness were regained. She would respond to her parents calling out to her, hands and legs would move. To a lay person, this meant improvement. To the consultant, he was more practical. He warned me about some levels of spasmodic contraction remaining on the right side. She was moving but how much was voluntary. Her eyes were opening slowly, but were they able to see. There was serious doubts about sight since the haemorrhage in the brain was compressing the optic nerve.Days passed into weeks, CT scans and MRI's were performed. Physiotherapy started. All that could be done was being done. She was on the ventilator, but a tracheostomy was imminent.

The last scan showed increasing pressure onto the brain and a decision for burr hole surgery was made. Tracheostomy was very much in the piping but was postponed to respect the wishes of the parents. It was decided to give the burr hole a chance to see if drastic improvement occured and the need for tracheostomy could be averted.

The neurosurgeon was kind enough to do it in the night itself so no time would be wasted. He infomed me when it was over. However, he was not too happy with the surface of the brain. In his own words, "It's not pulsating as much as it should after evacuation of the CSF". He was not too happy, but was optimistic as was the need of the hour.

Over the next day and a half, she developed respiratory infections. It was time for a tracheostomy, whether the relatives agreed or not. It simply could not be postponed any longer. It was done the next day. Suctioning was carried out regularly. The child seemed to be losing the battle, though.

Then, at 3.30 a.m. the call came. Middle of the night calls are almost always bad news. This was too.

She was no more!