In Part 1, we met Kadam. He had almost given up his wife, Sheela, to cancer and did not expect her to return from her coma. Palliative care put her back on her feet. He was grateful for the free care and medicines she was getting at Cipla Centre that made this “miracle” possible. After his one of his regular visits to the centre for medicines and consultation, when Kadam was walking out, a big car swung in. Probably a new doctor, Kadam thought.
Am I doing the right thing?
Venkat, at the wheel of the car, was no doctor but a young businessman, angry and frustrated. With him were his father, his mother and their family doctor. And Venkat still was not sure if he was doing the right thing. He hesitated to step out of the car and looked pleadingly at the doctor. “Dr Singh, are you really sure? There must be something—” His mother’s hand on his shoulder silenced him.
Venkat’s father had been diagnosed with cancer of the prostate more than a year ago. The family had spared no effort and expenditure to treat him. They had even consulted a doctor in London to find a solution. Several rounds of radiation and chemotherapy had reduced his father to a shadow of his former strong, proud self. Now, he was just a frail, helpless bundle of pain.
One day Dr Singh dropped in and had a long chat with Venkat’s parents. He told them the cancer had already spread and was beyond the reach of medicine. Then came the inevitable question from the patient: “How much time do I have?”
Dr Singh had no definite answer. He did have an answer to the question that Venkat’s mother asked when they were alone. “Is there any way he can be free of pain at least for some days? Can he become less dependent on others for everything? There are a few things that we have always wanted to do together, like making some trips. Can he regain enough strength to do that?”
She was fighting tears, but managed a smile when Dr Singh answered: “Yes, You can do that. I know just the place. God willing, you will even make those trips with him.”
This is no hospital
Now, they were at the centre. Venkat was willing to spend any amount of money to make his father well again. And Dr Singh and his mother were trying to tell him a place that provided free care would make him better. This place didn’t even look like a hospital. There were no doctors moving around with stethoscopes and no nurses rushing about in their uniform. Everything looked very relaxed, very green.
“After going through your father’s case papers, it is clear that you have already tried all possible treatment options,” the doctor at Cipla Centre said. “His cancer is now at a very advanced stage. As you know, what we do here is provide palliative care.”
“No, I do not know what palliative care is,” Venkat snapped. “And how is it going to be any better than what other hospitals can give? Do you know we had even consulted a doctor in London?”
Dr Singh and Venkat’s mother shifted in their chairs uncomfortably, but the doctor remained calm. “You are right. Every other hospital must be better or at least different. We are not a hospital. We care for cancer patients to help them with their pain and symptoms, right from the time they are diagnosed. It does not matter at what stage the cancer is or whether there is a possibility of a cure or not. We try to improve the quality of life of the patient.”
Venkat thought this was getting nowhere.
The doctor continued, “Mr Venkat, imagine your father, free from pain and able to take care of his own basic needs. We try to help him achieve that. Severe pain and nausea are two most common problems. We try to take care of those problems, so that even with cancer he can live in peace, comfort and dignity.”
At that moment, Venkat’s father opened his eyes and looked at his son. The old man was too weak to talk. In the few moments that their eyes met, Venkat thought he detected some sort of mute appeal in his father’s eyes.
He accompanied his mother and the doctor on a tour of the palliative care centre. The breeze blowing across the clean, wide passages had a soothing effect on him. “This is one of our wards,” they stopped at one of the doors. Venkat looked and looked again. Not an AC, deluxe room that he would have preferred but very pleasant and colourful. Every ward opened into a garden. The tour went on–works of art by patients, photos of happy celebrations.
“And this is where your mother will be staying,” they were at the dormitory.
“What?” Venkat was shocked. Apparently, it was discussed before, but he had somehow failed to register the information. His mother was to stay in the centre too, so that she could learn how to take care of the father at home. His mother looked calm and confident. He bit back his protest.
The doctor appeared to have read his mind. “We hope to be able to send your father back home in 15 days. That is the usual duration the first time we admit any patient. Of course, even after discharge, you can come back any time. And you must come to pick up medicines at regular intervals. If necessary, our home care team will come to your place to check on your father and tell if you need to change any medicine.”
What will people say?
Venkat left the place, alone, his mind still in turmoil. What would be his father’s condition when he returned from his tour to Europe after 20 days? Was he making a mistake? Was he abandoning his father? Was he running away from his responsibility?
“I think what you have done is the best, Venkat.” It was already a week after he had admitted his father to Cipla Centre. Venkat was in England. With him was Cathy, his colleague in London. He had known Cathy for years, but he never knew that she was also a volunteer at a local hospice. It did not take long for him to share his fears and worries with her.
Cathy went on, “You know, Venkat, I have worked in India and I have also trained at that palliative care centre. They have a good team and I think your father is in caring hands. There is a lot of compassion in India. You have strong families. The centre makes good use of the family model of care. It is always a happy sight to see a patient go home, free from pain.”
“But, Cathy, you don’t understand,” Venkat protested. “That free centre may be the best. It is all right for poor people. I can’t help feeling that I should have given some more treatment to my father. I may not be a millionaire, but I have the money you know. I think I just … just abandoned him. Tomorrow if something happens, what will people say?” Venkat was close to tears.
“What do you think will happen tomorrow, Venkat? You think he would have lived forever if you were not to admit him there? Would you have been happier to force doctors to treat him even after they told you there was no hope? Do you have any idea of the pain he was suffering? Do you know how ashamed he must have been to be so helpless? Did you want him to leave in pain and shame?” Cathy stopped, realising that Venkat was shocked by her tone.
She got up, put a hand on his shoulder, and continued. “Palliative care can make his remaining days comfortable. Perhaps, if he had got palliative care along with his treatment, he would have suffered less pain. It is too late for that now. Even now, he can get his dignity back. You know how much it means to be able to wear a shirt on your own, to visit the toilet without help from another person? There is no escaping death, Venkat. We all know that. You know that too, don’t you? So, is your real worry about what people will say? Or would you rather do what is best for your father?”
Bonds that bind
Six months later, Venkat was back at the centre. He planted 75 saplings to mark his father’s 75th birthday. Walking with him from sapling to sapling were his mother and father. His father was not strong enough to bend and water each sapling. But he insisted on planting the first and the 75th saplings.
Three months before his next birthday, his father died. It happened at home. He passed away peacefully, in the company of his wife, son and Dr Singh. As Venkat held his hand, he opened his eyes one last time and Venkat thought he saw gratitude there.
Venkat returned to the centre on his father’s birth anniversary. He wanted to make a donation. There were many patients and relatives. He was only planning to stay for a few minutes, but ended up spending the day. He even enjoyed a musical programme put up by volunteers at Cipla Centre. There he met Kadam, who had brought some sweets made by his wife. “Well, actually, I made it. But she told me how to do everything,” Kadam admitted and everyone laughed with him.
Then Venkat came across a familiar face, the same young nurse who was in the ward when his father was admitted. She appeared to have been crying. Kadam told him why. “Asha is dead.” Venkat looked puzzled. “You don’t know Asha?” Kadam asked. “That little girl with big eyes, always used to be in the garden with her doll? Seven years old. She died in her sleep last night. Blood cancer.”
Venkat wondered why he was joining Kadam in consoling the nurse. He was a little embarrassed to find himself crying with two strangers over the fate of a girl he never knew.
As Venkat walked out, he took a detour to take a look at the saplings. They were thriving. Someone was watering them. Someone with a piece of cloth tied around the head and neck, which did not fully conceal a large bandage covering his right cheek. The man stopped to bow to Venkat and then continued watering. Venkat rolled up his sleeves and joined in to help.
Together, they tended to the garden, as the birds in the fruit trees above kept up a chorus. Perhaps, they were celebrating the glory of life.
This fictionalised two-part account is based on the realities at Cipla Palliative Care and Training Centre, and the fears, worries and joys of the people for whom the centre is a second home. Cipla Centre has completed 15 years of service and, so far, has cared for more than 8000 patients and their families, free of cost.