>> Sunday, January 9, 2011
"So live your life that the fear of death can never enter your heart. Trouble no one about their religion; respect others in their view, and demand that they respect yours. Love your life, perfect your life, beautify all things in your life. Seek to make your life long and its purpose in the service of your people. Prepare a noble death song for the day when you go over the great divide. Always give a word or a sign of salute when meeting or passing a friend, even a stranger, when in a lonely place. Show respect to all people and grovel to none. When you arise in the morning give thanks for the food and for the joy of living. If you see no reason for giving thanks, the fault lies only in yourself. Abuse no one and nothing, for abuse turns the wise ones to fools and robs the spirit of its vision. When it comes your time to die, be not like those whose hearts are filled with the fear of death, so that when their time comes they weep and pray for a little more time to live their lives over again in a different way.
Sing your death song and die like a hero going home"
Chief Tecumseh (Crouching Tiger) Shawnee Nation 1768-1813
I was doing the on calls during the Christmas week because I had to come home the following weekend.
Abdulla ( Not his real name) was brought in on Thursday night through the ER. He looked around forty years old and had severe shortness of breath. Through the middle of his struggle for air, he said it was just few days that he was feeling unwell. He had gone to Bangkok for a medical check up and just come back a week back and the doctors there had told him that “everything is fine, and there is no need to go back”. I asked him if he had any medical report with him and he said, “My doctor had gone on vacation and would send it once he is back”
The x ray chest showed he had massive fluid collection in his right chest. I shifted him to the ICU because his oxygenation was dropping. We did an immediate aspiration to remove the fluid and drained a litre and half of bloody fluid. One look at the nasty looking fluid, and I knew this was no ordinary infection, and must be cancerous. But Abdulla was confident. His wife and young son were around. He was relieved of his distress once the fluid was removed and was talking cheerfully to his family and asked his son to go home and bring his favourite food.
The next day we did a CT scan of the chest and found he had a large tumour in the lung. He also had operation marks on his chest, and the films had shown that they had resected some ribs from his chest. Everything put together was clear. I suggested a CT guided biopsy and he refused outright. By the third day he was comfortable and during rounds, he asked me permission to go home. I explained the condition to him and the need to do further tests. His family was outside the ICU. He smiled at me and took an envelope from under his pillow and handed it over to me. There was a detailed medical report stating that he had advanced cancer which was inoperable and resistant to all the chemotherapies they had tried on him. He only had limited time. He had prevented his doctor from disclosing the diagnosis to his family, giving in writing that he was taking all the responsibilities on himself.
Finally, he smiled at me and said’ Doctor, I knew from the beginning you had guessed it. Both of us know now. I know I don’t have much time left. But I want my family to be at peace till the inevitable. Isn’t that reason enough?”
Medicine exists to fight death and disease, and that is, of course, it’s most basic task. Death is the enemy. But the enemy has superior forces. Eventually, it wins. And, in a war that you cannot win, you don’t want a general who fights to the point of total annihilation. I agreed to what all he asked for.
I have seen many terminally ill patients during my career. But not a single one like him. He had tremendous guts. And a concern which is rare these days. I realised how sincerely he loved his wife and son. Love, is not only in taking, it is more in giving.
For the bonds of love are enduring and cannot be severed by death. This is the ultimate comfort in the presence of death and dying – that the bonds of love can grow roots within the heart itself, and once implanted there, are able to remain forever.
He went home the next day, promising to come back to the clinic.