Tuesday, June 30, 2009

Reluctant fisherman, the final chapter

Cut back to the present:

Ayyavu on his deathbed, brought home as adviced by his doctor at the small rural hospital. As I approach his bed I can hear the laboured breathing suggestive of impending heart failure. I shift him to a safer posture so as to minimise the risk of aspiration, and give him blows over his back with a cupped hand.

Dad asking me what I thought needed to be done.

I, trying to give an answer that would sound wise and practical. And thinking some of the thoughts mentioned herein already.

I try to explain the various options before us: That we could, if we hurried, still get him to a higher centre with an ICU, where we could possibly resuscitate him; but without any assurance of being able to return to healthy living.

Or we could just let him be. As was obviously the opinion of his doctor.

I've only once met his doctor at the village hospital, and he surely has been there for a very long time. Perhaps, he had been there for far too long, having not known that he might be sued successfully for a considerable sum for having done what he did.

He didn't get what is known as 'informed consent' from the patient's party. He took it upon himself to decide on the fate of his patient, without going for a detailed discussion about the merits of the situation.

Informed Consent means the patient has the right to be completely informed about the treatment plan, and ultimately the right to choose or refuse a particular line of management.

So, a dr in a city hospital would discuss with the patient's party what i shared with my father: that we could take him to an ICU, or we could let him just die.

Now, who would want to let their father die, and do nothing?

So, shift him we would to an ICU, Where we would do many things.

And then, finally, we would go for informed consent, round two:

We would explain in some detail the measures taken so far, and how nothing seems to work. Now that the patient is hooked up to a ventilator, we will ask the son's permission to terminate treatment.

From passive spectator who didn't do enough to prevent his father's death, we would thus make him an active participant in his father's death, who gave the permission to go ahead and terminate his life, after having been duly informed that it was indeed possible to keep the patient 'alive' for an indefinite period.

Sometimes, they say enough is enough, just let him die in peace, please.

But sometimes, especially if the patient is not an elderly father but a college-going son involved in a road accident, then they sell, borrow, beg and steal all that they can to keep the circus going on for as long as they can.

What else is there to do?

Yet, at the end, all they accomplish is to delay the inevitable day of reckoning, not to avoid it altogether.

They'd still end up leaving the hospital feeling they let their son down.

That's the paradox of informed choice in life and death situations.

I could see all this unfolding before my eyes when called upon to answer that question.

And I could really think of no answer to give.

He was my grandfather after all. How could I ask my father to just let HIS father die, and not do anything about it?

What would I be telling my dad through it?

Ayyavu was a soldier who saw action in Burma during WW2. He was an artillery gunner, and machine gunner for advance patrols, alternately. During the years of my childhood, when I thought being a hero was about being a man with a gun, I would never leave his side, always hungry to hear stories about his tour of duty.

I'd, for example, listen with awe, over and over, to his stories about lying in wait for Japanese airplanes, along with a crew of 8 or 12, sometimes including British officers.

In the eye of my mind I could see the big, gleaming artillery gun, its muzzle raising its head upto the sky, not a bit of rust on its steel frame, the huge shells they would carry on mules.

I could even hear the ear-splitting boom of that mighty gun.

And each time I listened to the story, the gun just got bigger, and the boom even louder, in my vividly imaginative mind.

But there was one question that he would never answer me, no matter how many times I asked. For a boy in awe of the power of the gun, it WAS the most important question:

I asked him, over and over, if he had ever killed a man.

Each time he would avoid answering me: tell me a divertionary tale of adventure, give me a treat, or sometimes simply get angry.

Later on, when I got through medical entrances both at the biggest civilian teaching hospital in this part of the country, as also in the prestigious Armed Forces Medical College at Pune, my semi-literate grandfather did play a major role in allowing me to put things into perspectice and make the choice I did.

When I reached the stage when young people start demanding motorcycles, and I was adamant about getting an Indian Army vintage Royal Enfield, he remained aloof; but there was a twinkle in his eyes that let me know that he was secretly pleased.

He was a soldier, after all.

Just then my eldest aunt came out of the house and to the corner of the courtyard where I and dad were holding our discussion, and asked me to come to the house. By the way she asked me, I knew what it was.

Grandfather had died. In death as in life, he had decided the size of his serving.

And now I was being asked to confirm and declare death.

I went in. The eyes had turned lusture-less. The pupils were dilated and fixed, and not responding to light. A sure sign of death. I checked repeatedly, though I knew it to be pointless.

I turned and looked at my dad, a knowing look. He went out of the house. I disconnected the IV line and closed the eyes. In a practiced sombre tone, confirmed death to no one in particular. And then, not trusting myself to keep a lid over the sea of emotions roaring just beneath the surface, I went out too.



  1. This was a great post! Brought out very poignantly that end of the day doctors are human. I really feel for what they have to go through. Imagine knowing everything about an illness that has stricken a close member of the family, having the knowledge of it and yet being so helpless. Its a very sad state isnt it?

  2. It is. You are very kind to be reading all of my posts religiously and encouraging me to go on. Just in case I forget to tell this again, your attention is highly appreciated.


Thanks for giving me this moment of your life.