Playing Santa, in the most difficult times…

Rajiv was just 22 years old when his near-dead body was put on a life-support system. Seeing him breathing artificially through a ventilator, with innumerable pipes converging on his frail lifeless body piercing him at various points, was an unbearable sight that his mother, Mrs Shashi Sharma, had to endure on a daily basis for the last one month.

It was exactly a month ago, when Rajiv had hurriedly hugged his doting mother for the last time, as he was getting late for one of his friends birthday party. The young man couldn’t make it, for he met with an accident. Mrs Sharma was informed about the accident a few hours later.

Apart from the multiple fractures and a ruptured spleen, lung contusion, he had a massive head injury. Rajiv hated to wear a helmet.

After a month of best medical care , what was left of Rajiv was what the doctors termed as the impending ‘vegetative state ‘ — his maximum part of the brain was irreversibly damaged and he was surviving on external support. “It was only a matter of time — a few hours, days or maybe a month — if we continue the full supports,” Dr Rathore , the Head of Critical Care at the Sacred Heart Hospital,  had gradually counselled her over the days about his grave prognosis.

Multiple surgeries and expensive medical procedures, and the prolonged stay in the Intensive Care Unit on ventilator, had incurred a huge bill that had nearly drained her savings. She was hoping against hope, for Rajiv was her only child and only surviving family member, after her husband’s death five years ago. She had to get him back to life at any cost!

But it was not the hefty bills that was troubling her much, but the bouts of moral pangs that she suffered, every time a critical patient was turned away, as all four ventilators in the ICU were “occupied”. Rajiv was on one of them , and knowing the prognosis of his case, it was immoral to deny a chance to somebody who could actually survive.

Unfortunately, The Sacred Heart Hospital was the only hospital in their town which had a reasonably good ICU facility with ventilators. The next hospital with good facility was 200 km away!

Moreover, if Rajiv could miraculously gain consciousness for a moment, he would certainly disapprove of the tug- of-war that was being played with life and death, with painful procedures done on his body on a daily basis.

Mrs Sharma vividly remembered the last shot of Tetanus injection that was given to him two years ago; what fuss he had made, he had even complained of discomfort for the next one month; such was his low threshold for pain!

Finally, with lot of courage, Mrs Sharma brought up the sensitive topic of Euthanasia with Dr Rathore. “Rajiv was a restless soul all his life, full of youthful energy, and nothing could tie down his enthusiasm for all matters in life. He abhorred even wearing a helmet while driving , as it made him suffocate. And now , for the last one month, he has been confined to his bed with  shackles of pipes and tubes all over his body.  His helplessness makes my heart wrench with anguish. Please let him go away with dignity, doctor. I am ready to do all legal formalities. “

Dr Rathore listened to her patiently, and said, “It would probably be the best way out for Rajiv. But the law of the land doesn’t allow ‘mercy killing‘. In a country where we are struggling to offer ‘dignity to life ‘ for our citizens , any talk over ‘dignity in death ‘ is a distant dream .”

He asked: “Mrs Sharma, have you heard about the tragic story of Ms Aruna Shanbaug? “

Mrs Sharma nodded and asked who she was?

“Aruna was a staff nurse at KEM Hospital in Mumbai, who was raped and brutally tormented by a ward boy, way back in 1973. She suffered an irreversible brain damage, left to languish in a vegetable state for the rest of her 42 years of life, till she finally passed away in 2015. She was abandoned by her relatives, but was  taken care by her kind colleagues of the hospital , who took so good care of her that she never developed one single blister or  bedsore all the years.

They even appealed to the courts, for a dignified end to their colleagues gruesome ordeal, by allowing euthanasia. But, the Supreme Court,  in 2011 , in its wisdom , denied their appeal, but not before her case  at least paved  the way for a passionate countrywide  debate on ‘mercy killing’, finally getting a law favouring passive euthanasia, which means , scaling down and aborting  of proactive medical methods for a terminally ill patient , as willed by the patient or relatives , after clearance by law . Unfortunately, that legal process itself is no less that a Byzantine maze. “

Tears rolled down Mrs Sharma’s cheeks, as she sobbed incessantly. “That’s very unfair on the part of law, to deny any person a dignified death. Dr Rathore , can you enlighten me about the present status of euthanasia in India. “

It opened up a barrage of emotions by an otherwise composed Dr Rathore: “ It is a desperate situation in India. End -of -life care  is a raging discussion amongst the Critical care specialists , who are the ones who witness the agony of the caregivers and the terminally sick patients , but the government and the legal eagles are wary to open this ‘ Pandora’s Box ‘ , which is fraught with possibilities of gross misuse . “

Critical care experts all over India want to come up with  an ethical framework  for limiting inappropriate therapeutic interventions to improve the quality of care of the dying in the intensive care unit through a professional consensus process.

End-of-life care (EOLC) is about improving the ‘quality of dying’.

“Dying can be a peaceful event or a great agony when it is inappropriately sustained by life support,” Dr Roger Bone had famously said.

“Without due care, instead of a ‘good death’ ( i.e., a peaceful end occurring in the presence of loved ones), the patient may needlessly experience an artificial and lonely end surrounded by the dehumanizing milieu of the ICU . The manner in which death is managed may affect the survivors for the rest of their lives. Also, especially in the economically fragile Indian context, prolonged futile life support can be very burdensome on the patients’ families; many of them even end up as paupers, spending all their life belongings on such terminally sick relatives. Scarce medical infrastructure should be used judiciously to salvage patients who stand a better chance to survive. “

“Hmm, can I take Rajiv home,“ asked Mrs Sharma , after a long pause .

“To discontinue treatment and taking away the patient is your right , but unfortunately, as long as he is here, we cannot legally deny him treatment.“ Dr Rathore explained his predicament.

“Can you confirm whether Rajiv will die peacefully within moments of taking him home? I can’t see my darling son struggle, Doctor, “said the mother.

Dr Rathore immediately embraced her lightly and patted on her back to console her: “That’s impossible for me to answer, I cannot be 100 per cent correct in my assessment, nobody can be. It’s the most difficult decision to take Mrs Sharma, I can understand. “

It was the Christmas Eve and the whole town was busy doused in festivities .

It being a long weekend this time, most of the people had gone out of town to tourist destinations, but the doctors and staff in the ICU were having a busy day , as usual , with some sick patients teetering on the fine line between life and death.

Mrs Sharma had seen the dedicated doctors work hard for her son for the last one month , and for  all those who got admitted  during that time, with equal diligence and compassion.

Behind the closed confines of the ICU, each patient that survived or improved, called for a silent celebration, and the unfortunate ones who could not be saved, was reason  for collective disappointment and introspection for the ICU team .

A small but neatly decorated Christmas Tree sat on the nursing counter, and paper stars and frills and twinkling lights adorned the ICU.

The festive mood had  gently grazed  Mrs Sharma, as she was smiling , for a change after so many days , and she told Dr Rathore that each of the staff in the ICU were all Santas in their  own accord , giving the precious gift of life to their sick patients.

Dr Rathore  laughed and said, “Only difference is our ICU Santas don’t slide down the chimneys , and they are on their Job throughout the year.“ One of the ward boys, fully dressed as a pot-bellied Santa, waddled into the ICU to cheer up the patients.

Dr Rathore  looked into her eyes and said: “Everybody comes across these  ‘Santa moments ‘ , Life gives many opportunities to become a Satna , it’s just that you should be conscious enough to not let the chance go. “  Dr Rathore ‘s  words sounded like a prophecy to Mrs Sharma, as it reverberated in her mind for a moment , as he walked away to see another patient.

Next morning, as Mrs Sharma was entering the hospital, she heard loud  desperate wails  of a distraught women coming from the Emergency Room .

As she rushed into the ER out of curiosity , she saw a women half crying -half pleading with the ER doctor to admit his son , who had met with an accident , lying lifeless on a stretcher besides her.

“We have done the emergency treatment. But sorry Madam , we don’t have a bed in the ICU with ventilator. Your son is serious and will require critical ICU care. “

Mrs Sharma asked the medical officer: “Doctor, how much chances do you give for his survival “, as she glanced at the young boy on the stretcher, who looked so much like Rajiv !! …..Or was it her delusion? But she didn’t have the time to inspect closely .

“The vitals of the patient  are well preserved and he was luckily brought in time, and  has no significant head injury. He has a fairly good chance of survival, provided , he gets immediate ICU care . We have arranged the ambulance to transfer him to the nearest Hospital as soon as possible. Don’t worry “

“No no, just wait doctor. Please manage this boy for some time here in the emergency, don’t send him anywhere. “

And she run upstairs to the ICU and met Dr Rathore who was walking down the corridors. “ I want  Rajiv  to be discharged from the ICU . I’ll take Rajiv home against medical advice.  I can’t bear the sight of his sufferings anymore, or anyone suffering because of him , Rajiv would never have approved of that in his life. There’s another critical child who has just come to the emergency. Please admit him into the ICU and save him. “

The ‘Santa ‘moment had finally came to her life also, in the most cruel way !

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