Thirteen weeks

Date of admission: 2nd Sept 2022 (Friday)

Date of Surgery:     5th September 2022 (Monday)

Date of demise:      2nd December 2022 (Friday)

Length of hospital stay: 13 weeks (91 days)

82 years old gentleman with no significant medical history was admitted for an elective Anterior Decompression of Cervical Canal Stenosis. He wanted to regain his confidence in walking and return to playing golf. He was not on any regular medications. He was not overweight, diabetic or hypertensive. He had no history of heart or lung disease. He lived independently with his wife in their flat on the second floor of a building that had no lift. He went out at least once or twice every day without much difficulty. He was an ardent and proficient bridge player. He drove his car to a friend’s birthday party one week before he was admitted to hospital.

He underwent an uneventful surgery but afterwards he lost power in all his limbs. They took him back to re-operate and make more space for the spinal cord that had swollen up, according to the MRI. That didn’t make any difference. His lungs were unable to work properly as the muscles of his diaphragm became weak. The domes of the diaphragm separate the chest from the abdomen. They play an important part in effective breathing and coughing.  Yes, surprisingly, the nerves to the diaphragm, originate from the neck (C3,4,5). They stopped conducting electricity. His lungs became unsupported.

His doctors said he’ll get better. It was just a matter of time. We needed to be patient. He needed help with his breathing so his windpipe was hooked on to a machine with numbers and waves and graphs and bleeps. He could not speak. No air came through his vocal cords.

Over the next few weeks he regained the sharpness of his mind and found that he was unable to breathe or speak, move or eat, turn from side to side in bed or have any control over his environment. He couldn’t really tell if it was day or night. The machines in the ICU made mad beeping sounds throughout the day and night and no one cared.

Patience wasn’t one of his best qualities but he was patient. Over the next few weeks he regained some strength in his forearms, enough to wave us hello and bye. Enough to blow us kisses and indicate that he was enjoying the music we were playing for him. Enough to bring his hand up to my ears and mouth the words “Nice ear-rings.” He learnt to communicate through his lip and arm movements. He said thanks to everyone who came to see him. He also said, “I love you” more than ever before. He smiled a lot despite his predicament.

His younger son is a writer and a storyteller. He told him a story of two well-known writers of modest means who visited a super-rich investment banker about something. In conversation the banker said he had great wealth, what did these two measly writers have? One of the writers said, we have something you will never have. “Really. What might that be?” He asked with a smirk.

“We have enough.”

After a moment, this patient father on Bed number 19 formed these words with his smiling lips, “I have enough.”

His lungs got infected five times in three months and the morale of his family went up and down like a yo-yo with him. No one knew what would happen next. In between, there were good times – going for a spin on a wheel chair, bowing to the statue of Buddha down the corridor, having bits of tomato-ketchup-flavoured-pringles with tiny sips of Coke, watching sparrows on frangipani trees. But this was not his chosen way of life. He had had enough. His heart had had enough. It stopped. The time to say good-bye left his doctors and nurses in tears too.

Ninety-one days of pure love and deep suffering. The former remains while the latter is done.

May there be peace for all beings everywhere.

“What will survive of us is love.” – Philip Larkin.

Unspeakable.

Age: 82 years.

Sex: Male

Residence: Bed number 19. Intensive Care Unit.

Duration of stay: 70 days and on-going.

Last heard speaking 68 days ago.

Up and down with repeated pneumonias, rising and falling need for support with breathing and blood pressure, weeks of starting and stopping a plethora of antibiotics, kidneys pushed to their limits, sepsis coming and going, metabolic state constantly fighting off infections. This goes on and on and we, his family go up and down with him. In between spells of invasions by nasty bugs, he mouths words, some of which we can decipher and some we can’t. It’s excruciating on both sides when he gives up after a few times of trying to be understood.

“I want to speak.”

Last evening, he insisted silently, sitting up in his hospital bed. His lips firmly formed the shapes of those words. After a quick consultation with the doctor in-charge, we arranged a brief attempt to enable him to speak. We did the appropriate suctions, explained everything to him and blocked his tracheostomy manually with a thumb covered in a sterile glove, to enable the small amount of air in his lungs to leave through his vocal cords, which have not been used for nearly ten weeks.

This man who used to have a big voice, spoke four languages and sang sweet songs had been rendered wordless. In a somewhat broken, hoarse, unrecognisable semi-voice he whispered, “I am trying.”

There were tears. Lots of them. Of love and all the unspeakable stuff.

His eyes were two bright lamps in a poor man’s hut. Oh! To be understood!

Bed number 19.

I never really left. I was always there. At home with my folks. Even when I flew across oceans, a part of me remained at home. The part that refused to leave. The rest of me has been homesick since that day.

The first time I was to leave my Motherland, India, twenty-three years ago, my dad noticed I was close to tears at the airport. He said, “Chin up my dear. Remember who you are and how proud we are of you.”

Two weeks back he had a routine surgery on his neck that has left him unable to breathe adequately for now. He has received all the support he needs in a timely and gentle manner. For a while he was sedated but when he came out of it, the first thing he verbalised on seeing my mum and I was ‘I love you.’

Two days back I left him again. This time in an Intensive Care Unit bed. Bed number 19. I left his doctors, my brothers, my mother and all the extended family in-charge of him and of each other. I left a list of plans, strategies and resources. I left not knowing what happens next. I left as I breathed and meditated and pleaded with the Gods to heal him.

Once again, I see the fragility of human life. I witness people and situations in a constant state of flux, the tide of hope rising and plunging, our uneven shallow breaths and his, our collective helplessness, the tentative stepping forward and standing back, the engagement of distant Healers, the comforting holding and massaging of hands, hours of sitting in air-conditioned rooms and waiting, second-guessing other’s needs, the tender wetting of lips and applying Vaseline, the daily mid-morning updates that set the tone for the day.

Walking purposefully through hospital corridors is something I’ve done a lot of. But this time it’s me who’s walking through them, lost and vacant.

After four weeks, we hope to return home for a longish time. The very thought makes my heart sing. May Mother Nature do its magical, mysterious dance – make things worse and then, make them better again.

Oceans apart

My mother.

she was known by

her chum-chum silver key ring

tucked into her slim waist

and her swishing saris.

Those delicate fabrics

draping her like feathers.

Her face so gentle, her red bindi

was home.

Still is.

*

No other.

I saw me in her.

Years carried me away

to far-off places,

where every house

had steep staircases

inside.

Outside, the winds blew hard and

the terrible winter

could bite.

*

Why bother?

Here, jeans and polo-necks,

only they would do.

The stairs would unfurl

my sari in milliseconds,

if I dared to.

My dupattas would sweep the floor.

My bindi out of place,

found no spot to decorate.

The years I blame.

*

Not like her.

Yes. Oceans apart,

she is she, in her handwoven

white, pink and blue cotton sari

and me is me, in my blue Gap jeans.

Yet we are somewhat the same.

***

Two suitcases, three homes.

Diwali at home with Mum and Dad – after ages!

Nineteen months passed before I could travel again. The uncertainty in the air for all this time meant no one knew when they would see their close family that lived in far-off countries. The news relayed the horrendousness of the situation in India and the 6700 kilometers between them and me made me feel utterly powerless. I would have flown to India at least thrice in this time but I waited for it to become possible.

Then, it did. Si booked my tickets and I felt like I was flying already but coming up to the date of travel, the extra layer of bureaucracy turned me into a tight knot of nerves. This test, that certificate, the other QR code, the timing of this, the reference number of that, one on-line form to be filled on the way out and another on the way back and so on and so forth. I had 2 close friends on speed dial, one in India and the other, a frequent flyer in the UK.

Yet, in the run up to the date of departure, my antacid consumption seriously shot up. In my awful dreams, the faceless uniforms looked at my paper work and shook their heads from side to side. They sent me back home from the airport. They told me I would have to quarantine at the other end in a seedy hotel for 10 days. That would eat up more than half my holiday. I woke up in a bath of sweat.

My two suitcases were mostly packed with chocolates, cheeses, cheese-crackers, sheep’s wool, woolly jumpers, bamboo socks and other such goodies for my folks. I got on the plane at Heathrow and landed at New Delhi safely, utterly grateful to be united with all my loved ones back home. How much I take for granted!

I immersed myself in the everyday life back home- boiling milk, making chapattis, creating rangolis at Diwali, indiscriminately consuming sweets dripping in desi ghee, singing, praying, chatting and overeating at every meal. I set aside my concerns about pending jobs, deadlines for writing assignments, hacked e-mail accounts, consciously locked them away in a clanking steel Godrej cup-board.  

Yes, there was pollution and poverty. There was religious and political bigotry. There was the Right and the Left and the Middle, the Farmer’s protest, the choked Press and the Covid dictats. There was my mind, noticing that Saagar was not physically present in the room. His cousins were messing about, grandma was cooking his favourite chicken curry, Olivia Rodrigo was singing ‘Jealousy Jealousy’ on the Bose speaker, his uncles and aunts were drinking beer and chomping on roasted, salted cashew nuts, talking about the joys of driving on the new highways network and the high price of petrol. We were celebrating our togetherness but he was not here.

In that thought, he became present to me. His essence appeared in the room, as me, my presence, my noticing, my love and my longing. It was subtle, only perceptible at a certain frequency that in now accessible to me. This nameless, formless realm that makes itself known when I pay attention. My real home. Its doors always open.

Before I knew it was time to come home. My two suitcases filled with silk and cotton fabrics, saris ‘borrowed’ from my mother, home-made carrot halwa, cashews and almonds and proper Darjeeling tea.

I am back home from back home now. Rested and reconnected. Refreshed and reassured.

All is well. All is well.

Fresh off the boat

Twenty-two years ago, when I first landed in the UK, I arrived as a qualified anaesthetist. I didn’t think of myself as a ‘female doctor’. I did not classify myself as one from the ‘ethnic minorities’. Both of those things were incidental to the fact that there was a job to be done and I could do it well, even if it was in a completely different setting, four and a half thousand miles away from home, at Antrim Area Hospital, Antrim, Northern Ireland. I was nervous but being from an army family, I was accustomed to moving every couple of years from one state of India to another (states as different as Punjab and Bengal), making it my own, learning from a different way of life and moving on to the next. I was sure of my ability to adapt.

My belongings comprised of a family photograph in a silver frame, a suitcase, mostly filled with books and two hundred pounds in cash. From the window of the plane I could see forty shades of green, in a mesmerising patchwork across the fields and hills of Ireland. The sky was the deepest, most startling blue. My heart was up in my throat with the excitement of living and working in a country where everyone was educated (why wouldn’t they be if education was free?)  and well-mannered (why wouldn’t they be if everyone was well looked after by the Government?)

One of the secretaries from the Antrim Area Hospital, Mary, very kindly came to receive me at the airport. The drive from Aldergrove Airport to the hospital was like gliding through a picture postcard. After Delhi, I could fully appreciate the wide golden-green expanses gleaming in the sunshine with not one human being in sight. When I complemented Mary on how gorgeous her country was, she was perplexed, “Really?”

Saagar was 5 years old then. He had stayed back with his dad. My plan was to find my feet and have him join me as soon as possible. I wanted to get my post-graduate exams within one or two years and go back to work in India. In the next few months, as I settled into my job, I acquired a cheap second hand Renault 19, found a family home and an appropriate child-minder. In the tea room of the hospital, the nurses would tell me about their families and ask me about mine. When I told them that I had a 5 years old child back home, they would say, “How could you leave him there?” I didn’t know what to say to that.

I still don’t.

Catriarchy

His dad was Russian royalty. Since the age of six weeks he could tell the difference between gourmet and ordinary meals, silk and cotton stoles, real and fake woolen throws, synthetic and down duvets, the warmth emanating from humans and radiators. He could tell if he had the full attention of his staff or not. He still can. He knows how to get them to do what he wants without saying a word, be it opening the door for him or being stroked at the back of his neck.

For entertainment, for a short while the laser pen was fun but very soon he let us, his staff, know it was cheap and silly. He wants action, involving blood and gore. He’s out hunting, bringing home trophies of half-dead mice, baby sparrows and often a big gash somewhere on his body.

He knows he’s good-looking. His James Bond swagger gets exaggerated when he knows he’s being watched. He sits like a statue when he’s being talked about but his upright ears change direction like a satellite dish. If he’s in the mood he humours our affections but prefers that we stick with our duties.

I do believe that he needs to check his cat-privilege. For centuries, cats have pretended to be domesticated while all the time exploiting humans. It’s about time we, as humans did something about it. I am in the process of designing an ‘unconscious bais’ training for him while at the same time preparing myself to be royally ignored. He has a clear preference for male company. It has been communicated to me in no uncertain terms that I am ‘extra’.

Named and reared by one of the finest specimens of the human species, he is a Maharaja of the Kingdom of Two. We celebrate his majesty, Mr Milkshake, paws, claws, whiskers and all. And his surrogate mum, Saagar today and every day.

Happy Christmas. xxx

“What?”
Summer 2013

Isness of Is. Clayness of clay.

T: It came to a point when she couldn’t bear to celebrate Christmas with her family. Her brother and sister and their respective spouses could roll out one child per year effortlessly while she had been through all kinds of tests and procedures, and nothing. Absolutely nothing but heartache and multitudes of unbelievably negative pregnancy tests to show for it. Six years of nothing.

S: Yes. I suppose nobody’s got it all. Some of the missing stuff is obvious and some not. Surely, even those who appear to have it all have their painful stuff hidden away. Who said everyone has to have everything?

T: It’s hard for her to watch other people with their babies. Intolerable. I can understand.

S: Isn’t that like saying no one should walk in front of a man in a wheel-chair? They might be offended. Let’s all pretend we can’t walk. Poor man! It might be intolerable for him.

T: That’s harsh. That’s a completely different situation.

S: It is an extreme example. Yes. It’s all about comparisons though. Isn’t it? You have something that I don’t. By right I should have what you have. Everyone should have it. But everyone is different. Their life path is different. The lessons coming their way are different. Her unhappiness comes from ‘yours’ and ‘mine’, ‘desirable’ and ‘undesirable’. Kids come with their own brand of drool, cackles, dirty nappies and tantrums. Those things are there for everyone.

T: But her sister’s kid is not hers. That is fact.

S: Indeed. However, the kidness of the kid belongs to the whole world. It’s okay to be jealous – nothing wrong with it. It’s also okay to know there are other possible routes to take, other possible responses to make. She could choose to recognise jealousy as the most conditioned and expected response and embrace it. She could also be present to the pastness of the past, the kidness of the kid, the sisterness of the sister, the aliveness of her life, the heartfulness of her heart and work with that. See what happens. She might be surprised. There might be a beautiful garden behind that wall.

T: It’s hard though.

S: It’s worth a try. There are more Christmases on the way and they want to be happy.

Mum’s the problem.

Recently I have met a Professor of Psychotherapy, a Consultant Psychiatrist and a GP – all parents of children lost to mental illnesses. Here’s what one mum says:

“Whenever I have seen a therapist, they have gone straight to my childhood, my up-bringing, my parents and their parents. All my behaviours and feelings seem to be explained and understood based on their behaviours, however ‘normal’, for their times. I am encouraged to think of all the ways in which they could have directly or indirectly damaged me.

By that principle, all of my child’s behaviours and feelings should be explained and understood based on the behaviours of his parents. Half of them is me. I agree. I must be part of the problem. My profession is perceived as a bigger problem. ‘High achieving Asian’ parents are assumed to put a lot of pressure on their children. So much so, the medics looking after him didn’t even need to meet me or know the quality of our relationship to be certain that my job makes me a bigger problem than most other mums. They could squarely put the blame on me and actively keep me out of the picture. I asked too many questions. I was the biggest problem. They wrote it in their notes.

However, that does not mean that I cannot be part of the solution. NICE guidelines lay out my role beautifully but do the people on ground read any of these guidelines? In my experience, not. If half of all that is written in Policies and guidelines was implemented, families could engage meaningfully in helping their kids recover.”

Screen Shot 2019-04-23 at 23.01.58

Ref: https://www.nice.org.uk/guidance/cg185/chapter/1-Recommendations#recognising-diagnosing-and-managing-bipolar-disorder-in-children-and-young-people-2

A song and a prayer.

images-1

Once upon a time I used to sing. My friends had to beg me to stop. In 1987, a whole bunch of us, medical students traveled from Ludhiana to Delhi to participate in the Annual music festival at All India Institute of Medical Sciences, called ‘Pulse’. It was just the perfect time for us to be and sing together. We belted out song after song for the entire duration of the train ride. Some onlookers were entertained and others annoyed but we were oblivious to them all. By the end of the journey, we were hoarse. I had no regrets that on the day of the competition, I sounded nothing like myself. I had had a great time.

I grew up in a house filled with music. The radio used to be on before we woke up in the morning and we followed the charts closely every friday on ‘Binaca Geet Mala’. My parents loved Hindi film music which by default is the most popular music in India. My mother has an uncanny ability to remember lyrics that I seem to have inherited. The popularity of the music of a film determines its box-office success. Our playback singers are worshiped like Gods.

Saagar found Hindi film music b-o-r-i-n-g!!! He thought it lacked imagination and the lyrics were always about romantic love. True. Yet, he accompanied me in my singing whenever I asked him. Despite the fact he didn’t know the songs, he played the drums or Djembe along to perfection. The boy had a solid sense of rhythm. After losing Saagar, I lost my songs. Some, I just couldn’t bear to listen to. Others, I could sometimes play for myself and occasionally enjoy. But singing was undoable. My tears would come tumbling in waves if I attempted it. For more than 4 years, I mostly stuck with words, Radio 4 and the random weekly music of someone else’s choice on Desert Island Discs. For the last 2 years, Si and I would dance to some of our favourites on Saturday evenings, while pottering around in the kitchen.

A few months ago, some songs came to me. They were devotional and Sufi. Initially, they came with tears of love, sorrow and gratitude. With practice, the tears learnt to hide. My friends accompanied me – Katie on viola and Rajesh on the tabla and finally, last week I gathered the confidence to sing in public after 5 years. It was an exercise in equanimity. It didn’t matter how melodious or off-key the song was, it was an offering from the heart. It was a way of loving and honouring myself, Saagar,  friends and families present and all the lovely people they had lost to suicide. It was a new beginning.

English translation of O Paalan hare

Oh, nurturing Lord, beyond description and beyond all,
Except you, we have no one
Ease our difficulties, oh God

Except you, we have no one
You are our only supporter
You are our only protector
Except you, we have no one.

It is you who has filled the moon with moonlight
The sun’s brightness is from you
The sky is content, you have given it stars
God, if you don’t adorn this life
Then who will adorn it?

Oh, nurturing Lord, beyond description and beyond all,
Except you, we have no one.

If you listen, Lord, I shall make a plea
Give patience to the sorrowful
So that they never give in to their sorrow
Provide the powerless with protection
So that the powerless can live happily.

Provide our devotion with strength.
Provide our devotion with strength.

As you are the master of the world, please hear this plea
There is darkness in our path
Shine your divine light for us.

Oh, nurturing Lord, beyond description and beyond all,
Except you, we have no one
Ease our difficulties, oh God
Except you, we have no one.

Lyricist: Javed Akhtar
Composer: A R Rahman
Film: Lagaan

Youtube: https://www.youtube.com/watch?v=arF8gWNFyZo

Recording: http://we.tl/t-npGeikz9QP?src=dnl

Venue: St Martin in the Fields. 9th March 2019.

Big thanks to Mary Kennedy for recording the song and to David Mosse for organising the Time to Talk service.