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come, unfalteringly.

Jan 29 2008 | Views 131 | Comments (2)

Come unfalteringly &nb... Expand

Come unfalteringly

I am lying in bed in the MICU and I know that I am going to die. How do I know? It is not the way my wife’s eyes slide away from mine or the sadness in my son’s hello or the compassion in the doctor’s voice as he greets me. There is something else, something that tells a man that it is almost over. I am alone and I do not want to be. I ask the nurse to send in my son.

He comes in and I see he has been crying. “Rohit.” “Yes, dad.” “How is your mom holding up?” “Ok, I guess. We are trying to get her to sleep.”

“Can you sit here with me?” I ask. “Why?”

It is difficult to tell my son that I am scared shitless, but death has a way, somehow, of vanquishing pride. “I’m… I’m afraid.” There, the words are out and my son is looking at me, embarrassed, worried, a little unsure about how to behave in the face of this role reversal. But he is a brave boy, my teenager, and he sits on the bed next to me and holds my hand.

“Dad, does it hurt? Should I call the doctor?”

“No, Rohit, I’m ok. Just a little lonely and these monitors are maddening me.”

This white lie reassures my son. He looks around at the humming machinery keeping track of my life and grins companionably at me.

“They are all worried, dad. I wish you could see how many people have come to see you.” Rohit seems to expect me to be happy at the number of people who have come to visit but it does not really matter to me now. I am content to lie on this bed alone except for my son beside me, his hand in mine. We watch the doctor go on rounds, calm and kind. He is young but he seems to know what he is doing. I wonder, are doctors afraid of death? Having confronted and fought death so many times are they able to handle it better than the rest of us?

I finish my rounds in the intensive care unit, reach my cabin and sit down, exhausted. One of my patients is dying slowly. There are some things your training does not prepare you for. Dealing with the death of a patient is one of them. In spite of stretching to the absolute limits of your skill, the available technology, the patient’s endurance, there are times when you have to give up. It is humiliating, demoralizing.

Some one knocks on the door and interrupts my black reflection. “Mrs. Kumar, please sit down.” “You wanted to talk to me, doctor.” “Yes.” I reply, wondering how to say what I must say, gently. “We have been treating your husband quite aggressively, Mrs. Kumar, but…” “But there is not much hope, is there?” “I’m afraid not.” I pause for a moment, reluctant to speak, but this issue has to be raised. “I think it is time for us to discuss how far you want us to go.”

Mrs. Kumar is sitting very straight. “I have discussed this with my husband, doctor. He doesn’t want to be intubated or mechanically ventilated.” “Are you quite sure?” “Yes doctor, we’ve thought about it.” Her face crumples and she begins to cry. Any words I say now will be meaningless. All I can do is hold her hand until she calms down a little.

“I’m all right. Doctor, I’ll go and sit with Vasanth for a while.”

My wife has been sitting next to me pretending I will soon be okay. I want to tell her “Look I know that you know that I am going to die. Why hide from reality?”

But perhaps we have been taught for too long to utter only socially acceptable truths and I am unable to say what I am thinking to my companion of twenty years. “I’ll be back soon.” she says, leaving me alone with my thoughts and my fear and my pointless questions.

Like, for example, what have I accomplished in my forty years of life? I have written a couple of stories, cringed at bad reviews, floated on good ones. Ultimately, though, what is the use of what I have written? Perhaps I have made people think, smile, cry. It is what I aimed to do through my writing. But of what use it is in the end?

I watch my doctor at work. Now he can look back and say, “I have healed. I have relieved pain.”

I am sitting at my desk and trying not to remember Mrs. Kumar’s tears. I have studied eight years to become a physician. I have used technology and a few skills to heal people. I have been blessed by my patients, been looked up to with respect, with gratitude. I have taken all the good will as my due.

But now I am standing in the cold white of a room where my patient and his family are waiting for approaching death and I am frightened.

I remember my teacher saying “you need courage to be a doctor’ Kedar. Courage to fight for life - and to accept death.”

Courage… courage is what Mr. Kumar needs as he lies in bed and waits for that final end to pain. Where does he find it?

I am escaping in to the memory of an evening many years ago, when I was a confused teenager, full of smoky ideas of beauty and poetry that would not be written. It was on a trip to the Western Ghats.

I recall that evening so distinctly - sitting at the edge of the peak, with the velvet forests rolling below us, cloaked sometimes by the amethyst twilight mist. The air was full of the twittering of birds and insects and activity.

Then suddenly everything grew silent and it was dark. A moonless silky night fell upon us like a spell. We were all silenced by the abrupt fall of days end in to night.

I let my head fall back and felt vertiginous at the expanse of the sky around us- the sense of falling in to the stars. I remember thinking then, that I had experienced all the beauty that the world had to offer and that I would be content to die at that very instant.

I have had a few moments like that, haven’t I? Experiences that grabbed me so completely that I ceased to exist. Maybe there would have been more if I had been more aware. Aware of the patterns in the heart of the flower, of the million subtle nighttime perfumes of my village. If I had listened with more attention, perhaps I would have perceived all the hidden melodies in every song that I just half heard - a background to the white noise in my brain. I am hurting, thinking of all that I have failed to see and hear, when the doctor walks in. He examines me, asks me if there is anything I need. I smile a negative and he leaves, pausing to say “I am always on call. Buzz me if you need me.”

The calm acceptance with which Mr. Kumar faces his fear helps me a little. I am standing in the waiting room looking through the window at the lit up city below and thinking about the battles that we all fight.

I look at the people waiting. Some of them are sobbing quietly, some are gazing unseeingly in to space, some are looking resigned. Does the fact that I have tried to help them justify my existence? Perhaps not - maybe it is enough that I have never run away from a battle, never cheated and always done my best. Maybe.

I am lost in thought and I am startled when I am paged. “Bed 5 has arrested.” The nurse in charge says as I run in to the MICU. We successfully resuscitate the patient, and I watch the heartbeat reappear on the monitor, feel the pulse get stronger. I am feeling all the while that this is what I was born for, here is where I belong.

Before leaving, I pause for a moment at Mr. Kumar’s bed. He seems to be listening to music on his Walkman and I do not want to disturb him, I wonder is he is asleep.

I cannot sleep. I am listening to Mozart’s 20^th concerto. There is such grandeur in it. In the music of course, but in the process of my listening to it as well.

Consider this. Mozart heard some poetry in his brain and played it on the piano.

Four hundred years later today what is happening? Rivers plunge down mountains to rotate huge wheels and release electricity. This decodes patterns buried in magnetic dust to liberate sound that strikes my ear. Three tiny bones tremble and the sound is translated in to the language of the neuron - electricity that blurs through my brain, echoes in my head. And who knows? Maybe these words that I have written today will echo in the cathedral of another human’s mind.

I return to the MICU. I watch as an elderly social worker walks in. She stops by a patient, places her hand on his forehead and says. “You will get better child, I am sure you will. God bless you.”

The patient looks up at her with faith. Perhaps she has done more with her gentle trust than I have done with all my pills. Ah well, we all have to choose our methods of healing and I have chosen medicine.

But some times, I have doubts about what I am doing. For instance, are these advances we have made in medicine fundamentally any good? We relieve pain, prolong life perhaps. However, we also lengthen the process of dying. What was once but a single instant of anguish is now drawn in to days of waiting and hopelessly hoping and hurting.

Is it worth it? Is it not cruel to make a human go through what Mr. Kumar is experiencing now? To make a man handle an unhandleable fear? What can a man think about in these last few conscious moments?

I am thinking about the last note. Like a gymnast’s final leap and touch down, the last note summarizes the entire performance. How does the musician decide what it is going to be? Some songs end with a gentle ‘yes of course.’ some with a triumphal head flung upwards ‘yeah!’ Some are left hanging, as if the composer is trying to say that the song is not over yet.

So much music and so many, many beautiful moments.

It’s been a good life, God, and I would not ask for more. No - not even more time. Perhaps I will pray for courage as I lie in the unchanging light, waiting. Thinking about life and death, thinking about dying. Wondering, when death finally comes, how will she come?

…Unfalteringly.