Playing God

Ramesh never knew he trained to handle emotion. Through out his childhood, he had dreamt to wear that white apron with those dangling ear buds he later on called the stethoscope. He was a determined child and so went on to study hard and work incessantly to finally gain the difficult entry into this world of agony and remedy. He had had uncles and aunts as doctors and had grown up having them as his secret mentors. His father had been a math teacher and mother a clerk in the state government. Money was there but not aplenty and so as is true for major India, he had to navigate through the very competitive audience to be able to look at the stage called success. And he thought he had, reasonably. 

Joytaram was a 65 year old farmer, ready to die. He felt he’d lived his life. Perhaps since boyhood had worked in the fields ploughing and seeding, manuring and planting. He could drive a tractor with one hand. Loved the feeling of the powerful giant wheels through the fields. His sons had shifted to cities to live an urban life who they thought, was better but Joytaram disagreed and his two daughters were happily married rurally. They took care of him and his wife Savita when they fell sick. He smoked 20 a day, since childhood and was candid in saying even if he lived now, he would. Joytaram had caught the virus, he thought while travelling to the city to his son’s place. Had neglected the fevers and sore throat as he always did. He never watched the news and so did not know of this deadly germ but through people at bidi shops. He was not very religious and so did not believe in God’s curse etc. His approach was simple and pragmatic, coinciding with what science taught us in our sophisticated air conditioned classrooms. And he had been ushered in here to the city hospital by his elder daughter. There were a few of his farm colleagues who accompanied them. 7-8 days down the admission only the daughter sat hoping for him to live it through. Ramesh was in charge of him. History had been difficult to elicit as is often true for rural folk especially men. He managed to get the above from his daughter. The test was positive and it meant serious business at his age, with his bidis down his lungs and, in the hospital, where he was first time detected both hypertensive and diabetic. He was now on a ventilator which he abhorred. Two days back when he had to gasp to speak, he was asked and his answer was simple and straight like his farming : ‘I’ve lived my life, ten years beyond, to be honest. At our place people are ready to die once they cross 50 sir. This is bonus.’ At first Ramesh thought ignorance was bliss and he probably, being a low IQed peasant, did not comprehend the seriousness of the matter. Until he once overheard his daughter talking to someone on her cell. She was crying all the while and informing the person at the other end how Joytaram had arranged for all funds to be shared, all his loans had been taken care of, conveyed his will a few months before only and this time, when he left even wished his wife Savita a good bye almost dictating her to take care of the fields and crops and their cow. There are no rural kisses, certainly not in the open. Love is understood. No exhibition. Silent tears tell all. He detested wasting money on himself. And while the whole nation and even the world was battling on saving lives versus livelihood for the youth, he had already decided for himself. Here was a life ready to call it a day when it was not yet.

Haseena’s case had been different. She wanted time from death.  She was a typical mother. Strange about women. Indian, certainly. When do they live for themselves ? First for their parents, a sister for the brother, then a daughter and daughter in law and then a mother. She too lived for her children. 3 of them and Ramesh knew all their names and ages as he video called them for her. She was a graduate in arts but could never use her education. Not that she repented it one bit. Happily married to a sensible husband, she was unsure where she contracted the infection. Perhaps in a shaadi recently attended, perhaps when she’d travelled to Mumbai, in the train; perhaps her neighbor who’d been asked to quarantine and she out of kindness, used to supply her with food and other essentials although she never touched or went near her, she swore. She had rapidly deteriorated and had to be shifted from the general ward to the ICU in just two days. Ramesh had done a detailed work up and had managed a good history from her. Nothing suggested she should be positive but the laboratory thought otherwise. He was bewildered at the number of times laboratory science betrayed his clinical judgment. Even then his teacher kept blabbering about clinical diagnoses all the time ! Vintage, Ramesh thought. Haseena’s husband Jafferbhai had been a very loving husband. He sat through her death. In stoic silence. The suddenness of tragedies not infrequently turn you into a stone. At least with three children, he could not afford to be liquid. Haseena badly wanted to live. Ramesh had exhausted all his reserves. Even experimental drugs and plasma exchange. The problem is lives and destinies don’t get exchanged even with the most sophisticated, state of the art machines.  And when Ramesh realized the futility of endeavours from their side, he held up his phone and video called her home so she heard her children, or he thought so. She expressed till she could. Then he had to read her eyes. They revealed all. On the other side was innocence. Some times these one way roads are a boon,  a blessing in disguise. They wanted to have answers from their mother but in a short while got lost in their own trivialities. He knew, especially the boys (take time to realise losses), will secretly cry for their mother, when grown up. Jafferbhai had been prognosticated. His mother, her mother in law, showed that she cared but did not. Jafferbhai had faith in Allah but sometimes it is just a good placebo. Haseena died, trying to live. Here was a life wanting itself but could not.

Mr Gajjar was influential.  By the time he came to the hospital, even the lobbies were bedded. It seemed like a whole big ICU with alarms from all four corners. The pandemic had engulfed the whole city like a Godzilla. And the virus seemed to make fun of humanity. He was an elite business man of the city. Rich and famous. Had swanking bungalows and cars he could not keep a count on. He never breathed above a certain temperature and had never travelled in a bus. Mr Gajjers don’t need entry cards or permissions. Perhaps the virus did not know of all this. Or  perhaps it didn’t care a hoot. But humans do, have to, the lesser ones. And so, much against the wishes of Ramesh and his colleagues, he was allotted the best bed in the best corner with space. Mr Gajjar had all that would go against him – a 30 year diabetic, uncontrolled, 3 stents in his heart, honeycombing in his lungs, hypertensive on cholesterol lowing drugs too. He was 80. He hoped to live till death was compulsory. He’d never lost in life, a game of chess or in business. He had been to a temple gathering from where he contracted the infection – many did but he was admitted as a preventive measure when the test did not get bribed by his power and decided to be positive. He had been in the hospital for a good 15 days now and only for the last couple of days was on invasive ventilation. No one waited for him. But they all called. Many others also called. The other rich, powerful. They wanted their calls conveyed. Ramesh never did that. He just focused on the technical part of his role. When the situation came to intubate him, although Ramesh was  reluctant, especially because of the lung fibrosis, he had to. The orders were clear. Keep Mr Gajjer alive till and after he dies. And so Mr Gajjer lived on, a dead life.  Here was a life that deserved to die.

And while Ramesh mastered at producing and enumerating evidence on each of his technical decisions and was trained for the same since his undergraduate and post graduate days, he was not ready for such disasters and the decisions that needed to be taken at such times. Cases kept coming in and the hospital was but over filled. There was no expertise to time all of them. And then it came down to the most difficult part of patient preferences. To play God. Something he feared for he had only read about it. And here he was, in charge of deciding who’d live and who be allowed to die. He shivered for in each such decision, he saw his father, his mother, his aunt, his cousin. Would he be able to live with the guilt of allowing some to die ? And then there were the unwelcome challenges like with Mr Gajjer’s intubation. And this, he though was never taught in the curriculum. But then that’s true for life in general isn’t it ? Most questions in life are out of the curriculum called experience. You would never have fully read all. And its not always MCQ. Some unlucky like Haseena get only five questions all to be answered, no options.

Joytaram died. A contended death. The ventilator he withdrew from saved ten other lives. So he lived on, in them.

Jafferbhai came to thank a month after her demise. With the three children. They ran helter skelter looking for their mother, under beds, in corners.

Mr Gajjer finally acceded to death after a month and a half. They had to be informed to take his body away. And someone, perhaps his wife, or son, requested at the other end to pull on till the weekend.  So while he died on Monday, he died again on the next Sunday. 

Ramesh added empathy to his CV.

He had learnt to play God.

 

Dr Sapan C Pandya

Consultant Clinical Immunologist and Rheumatologist

Ahmedabad